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Narla S, Silverberg JI. Atopic Dermatitis: A Disorder of both Adults and Children with Varying Longitudinal Course. Dermatol Clin 2024; 42:513-518. [PMID: 39278704 DOI: 10.1016/j.det.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
The longitudinal course of atopic dermatitis (AD) is heterogeneous and complex. While previously thought to be a childhood disorder, recent studies demonstrated that childhood-onset AD may take several different courses that may involve persistence into adulthood becoming a lifelong condition. Other patients only demonstrated adult-onset AD. Different factors may play a role in the timing of AD onset. Assessing the longitudinal course also involves understanding the changing temporal pattern of AD. Understanding the dynamic course of AD is important in identifying individualized treatment recommendations for patients.
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Affiliation(s)
- Shanthi Narla
- Department of Dermatology, Medical College of Wisconsin, Office A3698, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Suite 2B-430, 2150 Pennsylvania Avenue, Washington, DC 20037, USA.
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Traidl-Hoffmann C, Afghani J, Akdis CA, Akdis M, Aydin H, Bärenfaller K, Behrendt H, Bieber T, Bigliardi P, Bigliardi-Qi M, Bonefeld CM, Bösch S, Brüggen MC, Diemert S, Duchna HW, Fähndrich M, Fehr D, Fellmann M, Frei R, Garvey LH, Gharbo R, Gökkaya M, Grando K, Guillet C, Guler E, Gutermuth J, Herrmann N, Hijnen DJ, Hülpüsch C, Irvine AD, Jensen-Jarolim E, Kong HH, Koren H, Lang CCV, Lauener R, Maintz L, Mantel PY, Maverakis E, Möhrenschlager M, Müller S, Nadeau K, Neumann AU, O'Mahony L, Rabenja FR, Renz H, Rhyner C, Rietschel E, Ring J, Roduit C, Sasaki M, Schenk M, Schröder J, Simon D, Simon HU, Sokolowska M, Ständer S, Steinhoff M, Piccirillo DS, Taïeb A, Takaoka R, Tapparo M, Teixeira H, Thyssen JP, Traidl S, Uhlmann M, van de Veen W, van Hage M, Virchow C, Wollenberg A, Yasutaka M, Zink A, Schmid-Grendelmeier P. Navigating the evolving landscape of atopic dermatitis: Challenges and future opportunities: The 4th Davos declaration. Allergy 2024; 79:2605-2624. [PMID: 39099205 DOI: 10.1111/all.16247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/18/2024] [Accepted: 07/04/2024] [Indexed: 08/06/2024]
Abstract
The 4th Davos Declaration was developed during the Global Allergy Forum in Davos which aimed to elevate the care of patients with atopic dermatitis (AD) by uniting experts and stakeholders. The forum addressed the high prevalence of AD, with a strategic focus on advancing research, treatment, and management to meet the evolving challenges in the field. This multidisciplinary forum brought together top leaders from research, clinical practice, policy, and patient advocacy to discuss the critical aspects of AD, including neuroimmunology, environmental factors, comorbidities, and breakthroughs in prevention, diagnosis, and treatment. The discussions were geared towards fostering a collaborative approach to integrate these advancements into practical, patient-centric care. The forum underlined the mounting burden of AD, attributing it to significant environmental and lifestyle changes. It acknowledged the progress in understanding AD and in developing targeted therapies but recognized a gap in translating these innovations into clinical practice. Emphasis was placed on the need for enhanced awareness, education, and stakeholder engagement to address this gap effectively and to consider environmental and lifestyle factors in a comprehensive disease management strategy. The 4th Davos Declaration marks a significant milestone in the journey to improve care for people with AD. By promoting a holistic approach that combines research, education, and clinical application, the Forum sets a roadmap for stakeholders to collaborate to improve patient outcomes in AD, reflecting a commitment to adapt and respond to the dynamic challenges of AD in a changing world.
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Affiliation(s)
- Claudia Traidl-Hoffmann
- Institute of Environmental Medicine and Integrative Health, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine, Helmholtz Zentrum München, Augsburg, Germany
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
| | - Jamie Afghani
- Institute of Environmental Medicine and Integrative Health, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Cezmi A Akdis
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Zurich, Switzerland
| | - Mübecel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Zurich, Switzerland
| | | | - Katja Bärenfaller
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Zurich, Switzerland
| | - Heidrun Behrendt
- Center for Allergy and Environment (ZAUM), Technische Universität München, Germany
| | - Thomas Bieber
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
- Davos Biosciences, Davos, Switzerland
| | | | | | - Charlotte Menné Bonefeld
- Department of Immunology and Microbiology, The LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Stefanie Bösch
- Department of Dermatology, Allergy Unit, University Hospital of Zürich, Zürich, Switzerland
- Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Marie Charlotte Brüggen
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
- Department of Dermatology, Allergy Unit, University Hospital of Zürich, Zürich, Switzerland
- Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | | | - Hans-Werner Duchna
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
- Hochgebirgsklinik Davos, Davos, Switzerland
| | | | - Danielle Fehr
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
- Department of Dermatology, Allergy Unit, University Hospital of Zürich, Zürich, Switzerland
- Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | | | - Remo Frei
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Bern University Hospital, Bern, Switzerland
- Department of BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Lena H Garvey
- Department of Dermatology and Allergy, Allergy Clinic, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Raschid Gharbo
- Psychosomatic Department, Hochgebirgsklinik, Davos, Switzerland
| | - Mehmet Gökkaya
- Institute of Environmental Medicine and Integrative Health, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine, Helmholtz Zentrum München, Augsburg, Germany
| | - Karin Grando
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
- Department of Dermatology, Allergy Unit, University Hospital of Zürich, Zürich, Switzerland
- Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Carole Guillet
- Department of Dermatology, Allergy Unit, University Hospital of Zürich, Zürich, Switzerland
- Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | | | | | - Nadine Herrmann
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | - Dirk Jan Hijnen
- Diakonessenhuis Utrecht Zeist Doorn Locatie Utrecht, Erasmus MC, University Medical Center Utrecht, Utrecht, Netherlands
| | - Claudia Hülpüsch
- Institute of Environmental Medicine and Integrative Health, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine, Helmholtz Zentrum München, Augsburg, Germany
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
| | - Alan D Irvine
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Erika Jensen-Jarolim
- Center of Pathophysiology, Infectiology and Immunology, Institute of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
- The interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Heidi H Kong
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Hillel Koren
- Environmental Health, LLC, Durham, North Carolina, USA
| | - Claudia C V Lang
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
- Department of Immunology and Microbiology, The LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
- Department of Dermatology, Allergy Unit, University Hospital of Zürich, Zürich, Switzerland
| | - Roger Lauener
- Ostschweizer Kinderspital St. Gallen, St.Gallen, Switzerland
| | - Laura Maintz
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | - Pierre-Yves Mantel
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
| | - Emanuel Maverakis
- Department of Dermatology, University of California Davis, Sacramento, California, USA
| | | | - Svenja Müller
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | - Kari Nadeau
- Stanford University School of Medicine, Stanford, California, USA
| | - Avidan U Neumann
- Institute of Environmental Medicine and Integrative Health, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine, Helmholtz Zentrum München, Augsburg, Germany
| | - Liam O'Mahony
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Medicine and School of Microbiology, University College Cork, Cork, Ireland
| | | | - Harald Renz
- Institute of Laboratory Medicine, Philipps University, Marburg, Germany
| | - Claudio Rhyner
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
| | - Ernst Rietschel
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
| | - Johannes Ring
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Munich, Germany
| | - Caroline Roduit
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Bern University Hospital, Bern, Switzerland
- Ostschweizer Kinderspital St. Gallen, St.Gallen, Switzerland
| | - Mari Sasaki
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Bern University Hospital, Bern, Switzerland
| | - Mirjam Schenk
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Jens Schröder
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein (UK-SH), Kiel, Germany
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland
- Institute of Biochemistry, Brandenburg Medical School, Neuruppin, Germany
| | - Milena Sokolowska
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Zurich, Switzerland
| | - Sonja Ständer
- Center for Chronic Pruritus and Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Martin Steinhoff
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- School of Medicine, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
| | - Doris Straub Piccirillo
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
| | - Alain Taïeb
- INSERM 1312, University of Bordeaux, Bordeaux, France
| | - Roberto Takaoka
- Department of Dermatology, Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | | | - Jacob Pontoppidan Thyssen
- Department of Dermatology and Venerology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Stephan Traidl
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
- Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany
| | - Miriam Uhlmann
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
| | - Willem van de Veen
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Zurich, Switzerland
| | - Marianne van Hage
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institute and Karolinska University Hospital Stockholm, Solna, Sweden
| | - Christian Virchow
- Department of Pneumology, Intensive Care Medicine, Center for Internal Medicine, Universitätsmedizin Rostock, Rostock, Germany
| | - Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian-University, Munich, Germany
- Department of Dermatology and Allergy, University Hospital Augsburg, Augsburg, Germany
- Comprehensive Center of Inflammation Medicine, University Hospital Schleswig Holstein Campus Luebeck, Lubeck, Germany
| | - Mitamura Yasutaka
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Zurich, Switzerland
| | - Alexander Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Medicine Solna, Division of Dermatology and Venereology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Schmid-Grendelmeier
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Medicine Campus, Davos, Switzerland
- Department of Immunology and Microbiology, The LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
- Department of Dermatology, Allergy Unit, University Hospital of Zürich, Zürich, Switzerland
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Saxena SS, Tartar DM, Patki SS, Shi L. Paraneoplastic Eczematous Dermatitis With Palmoplantar Keratoderma as an Initial Manifestation of Acute Myeloid Leukemia. Am J Med 2024; 137:835-838. [PMID: 38583753 DOI: 10.1016/j.amjmed.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 04/09/2024]
Affiliation(s)
| | - Danielle M Tartar
- Department of Dermatology, University of California, Davis, Sacramento
| | - Swati Shripad Patki
- Department of Internal Medicine, University of California, Davis, Sacramento
| | - Lucy Shi
- Department of Internal Medicine, University of California, Davis, Sacramento.
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Singleton H, Hodder A, Almilaji O, Ersser SJ, Heaslip V, O'Meara S, Boyers D, Roberts A, Scott H, Van Onselen J, Doney L, Boyle RJ, Thompson AR. Educational and psychological interventions for managing atopic dermatitis (eczema). Cochrane Database Syst Rev 2024; 8:CD014932. [PMID: 39132734 PMCID: PMC11318083 DOI: 10.1002/14651858.cd014932.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
BACKGROUND Atopic dermatitis (eczema), can have a significant impact on well-being and quality of life for affected people and their families. Standard treatment is avoidance of triggers or irritants and regular application of emollients and topical steroids or calcineurin inhibitors. Thorough physical and psychological assessment is central to good-quality treatment. Overcoming barriers to provision of holistic treatment in dermatological practice is dependent on evaluation of the efficacy and economics of both psychological and educational interventions in this participant group. This review is based on a previous Cochrane review published in 2014, and now includes adults as well as children. OBJECTIVES To assess the clinical outcomes of educational and psychological interventions in children and adults with atopic dermatitis (eczema) and to summarise the availability and principal findings of relevant economic evaluations. SEARCH METHODS We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, APA PsycINFO and two trials registers up to March 2023. We checked the reference lists of included studies and related systematic reviews for further references to relevant randomised controlled trials (RCTs) and contacted experts in the field to identify additional studies. We searched NHS Economic Evaluation Database, MEDLINE and Embase for economic evaluations on 8 June 2022. SELECTION CRITERIA Randomised, cluster-randomised and cross-over RCTs that assess educational and psychological interventions for treating eczema in children and adults. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods, with GRADE to assess the certainty of the evidence for each outcome. Primary outcomes were reduction in disease severity, as measured by clinical signs, patient-reported symptoms and improvement in health-related quality-of-life (HRQoL) measures. Secondary outcomes were improvement in long-term control of symptoms, improvement in psychological well-being, improvement in standard treatment concordance and adverse events. We assessed short- (up to 16 weeks after treatment) and long-term time points (more than 16 weeks). MAIN RESULTS We included 37 trials (6170 participants). Most trials were conducted in high-income countries (34/37), in outpatient settings (25/37). We judged three trials to be low risk of bias across all domains. Fifteen trials had a high risk of bias in at least one domain, mostly due to bias in measurement of the outcome. Trials assessed interventions compared to standard care. Individual educational interventions may reduce short-term clinical signs (measured by SCORing Atopic Dermatitis (SCORAD); mean difference (MD) -5.70, 95% confidence interval (CI) -9.39 to -2.01; 1 trial, 30 participants; low-certainty evidence) but patient-reported symptoms, HRQoL, long-term eczema control and psychological well-being were not reported. Group education interventions probably reduce clinical signs (SCORAD) both in the short term (MD -9.66, 95% CI -19.04 to -0.29; 3 studies, 731 participants; moderate-certainty evidence) and the long term (MD -7.22, 95% CI -11.01 to -3.43; 3 studies, 1424 participants; moderate-certainty evidence) and probably reduce long-term patient-reported symptoms (SMD -0.47 95% CI -0.60 to -0.33; 2 studies, 908 participants; moderate-certainty evidence). They may slightly improve short-term HRQoL (SMD -0.19, 95% CI -0.36 to -0.01; 4 studies, 746 participants; low-certainty evidence), but may make little or no difference to short-term psychological well-being (Perceived Stress Scale (PSS); MD -2.47, 95% CI -5.16 to 0.22; 1 study, 80 participants; low-certainty evidence). Long-term eczema control was not reported. We don't know whether technology-mediated educational interventions could improve short-term clinical signs (SCORAD; 1 study; 29 participants; very low-certainty evidence). They may have little or no effect on short-term patient-reported symptoms (Patient Oriented Eczema Measure (POEM); MD -0.76, 95% CI -1.84 to 0.33; 2 studies; 195 participants; low-certainty evidence) and probably have little or no effect on short-term HRQoL (MD 0, 95% CI -0.03 to 0.03; 2 studies, 430 participants; moderate-certainty evidence). Technology-mediated education interventions probably slightly improve long-term eczema control (Recap of atopic eczema (RECAP); MD -1.5, 95% CI -3.13 to 0.13; 1 study, 232 participants; moderate-certainty evidence), and may improve short-term psychological well-being (MD -1.78, 95% CI -2.13 to -1.43; 1 study, 24 participants; low-certainty evidence). Habit reversal treatment may reduce short-term clinical signs (SCORAD; MD -6.57, 95% CI -13.04 to -0.1; 1 study, 33 participants; low-certainty evidence) but we are uncertain about any effects on short-term HRQoL (Children's Dermatology Life Quality Index (CDLQI); 1 study, 30 participants; very low-certainty evidence). Patient-reported symptoms, long-term eczema control and psychological well-being were not reported. We are uncertain whether arousal reduction therapy interventions could improve short-term clinical signs (Eczema Area and Severity Index (EASI); 1 study, 24 participants; very low-certainty evidence) or patient-reported symptoms (visual analogue scale (VAS); 1 study, 18 participants; very low-certainty evidence). Arousal reduction therapy may improve short-term HRQoL (Dermatitis Family Impact (DFI); MD -2.1, 95% CI -4.41 to 0.21; 1 study, 91 participants; low-certainty evidence) and psychological well-being (PSS; MD -1.2, 95% CI -3.38 to 0.98; 1 study, 91 participants; low-certainty evidence). Long-term eczema control was not reported. No studies reported standard care compared with self-help psychological interventions, psychological therapies or printed education; or adverse events. We identified two health economic studies. One found that a 12-week, technology-mediated, educational-support programme may be cost neutral. The other found that a nurse practitioner group-education intervention may have lower costs than standard care provided by a dermatologist, with comparable effectiveness. AUTHORS' CONCLUSIONS In-person, individual education, as an adjunct to conventional topical therapy, may reduce short-term eczema signs compared to standard care, but there is no information on eczema symptoms, quality of life or long-term outcomes. Group education probably reduces eczema signs and symptoms in the long term and may also improve quality of life in the short term. Favourable effects were also reported for technology-mediated education, habit reversal treatment and arousal reduction therapy. All favourable effects are of uncertain clinical significance, since they may not exceed the minimal clinically important difference (MCID) for the outcome measures used (MCID 8.7 points for SCORAD, 3.4 points for POEM). We found no trials of self-help psychological interventions, psychological therapies or printed education. Future trials should include more diverse populations, address shared priorities, evaluate long-term outcomes and ensure patients are involved in trial design.
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Affiliation(s)
- Heidi Singleton
- Bournemouth University, Department of Nursing Science, Bournemouth, UK
| | - Andrew Hodder
- Department of Dermatology, University Hospitals Dorset, Christchurch, UK
- Yell Health Centre, NHS Scotland, Shetland, UK
| | - Orouba Almilaji
- Department of Health Service Research and Policy, LSHTM, London, UK
| | - Steven J Ersser
- Bournemouth University, Department of Nursing Science, Bournemouth, UK
| | - Vanessa Heaslip
- Department of Nursing and Midwifery , University of Salford, Salford, UK
| | | | - Dwayne Boyers
- Health Economics Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | - Helen Scott
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Julie Van Onselen
- Dermatology Education Partnership, Oxford, UK
- National Eczema Society, London, UK
| | - Liz Doney
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Robert J Boyle
- National Heart & Lung Institute, Section of Inflammation and Repair, Imperial College London, London, UK
| | - Andrew R Thompson
- South Wales Clinical Psychology Training Programme, Cardiff and Vale University Health Board & Cardiff University, Cardiff, UK
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Chiang BM, Ye M, Chattopadhyay A, Halezeroglu Y, Van Blarigan EL, Abuabara K. Sodium Intake and Atopic Dermatitis. JAMA Dermatol 2024; 160:725-731. [PMID: 38837130 PMCID: PMC11154362 DOI: 10.1001/jamadermatol.2024.1544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/12/2024] [Indexed: 06/06/2024]
Abstract
Importance The association of diet with atopic dermatitis (AD) remains poorly understood and could help explain heterogeneity in disease course. Objective To determine the extent to which a higher level of dietary sodium intake, estimated using urine sodium as a biomarker, is associated with AD in a large, population-based cohort. Design, Setting, and Participants This cross-sectional study of adult participants (aged 37-73 years) from the UK Biobank examined 24-hour urine sodium excretion, which was estimated using a single spot urine sample collected between March 31, 2006, and October 1, 2010, and calculations from the sex-specific International Cooperative Study on Salt, Other Factors, and Blood Pressure equation, incorporating body mass index; age; and urine concentrations of potassium, sodium, and creatinine. The data were analyzed between February 23, 2022, and March 20, 2024. Exposure The primary exposure was 24-hour urinary sodium excretion. Main Outcome and Measure The primary outcome was AD or active AD based on diagnostic and prescription codes from linked electronic medical records. Multivariable logistic regression models adjusted for age, sex, race and ethnicity, Townsend Deprivation Index, and education were used to measure the association. Results The analytic sample comprised 215 832 participants (mean [SD] age, 56.52 [8.06] years; 54.3% female). Mean (SD) estimated 24-hour urine sodium excretion was 3.01 (0.82) g per day, and 10 839 participants (5.0%) had a diagnosis of AD. Multivariable logistic regression revealed that a 1-g increase in estimated 24-hour urine sodium excretion was associated with increased odds of AD (adjusted odds ratio [AOR], 1.11; 95% CI, 1.07-1.14), increased odds of active AD (AOR, 1.16; 95% CI, 1.05-1.28), and increased odds of increasing severity of AD (AOR, 1.11; 95% CI, 1.07-1.15). In a validation cohort of 13 014 participants from the National Health and Nutrition Examination Survey, a 1 g per day higher dietary sodium intake estimated using dietary recall questionnaires was associated with a higher risk of current AD (AOR, 1.22; 95% CI, 1.01-1.47). Conclusions and Relevance These findings suggest that restriction of dietary sodium intake may be a cost-effective and low-risk intervention for AD.
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Affiliation(s)
- Brenda M. Chiang
- Department of Dermatology, University of California, San Francisco
| | - Morgan Ye
- Department of Dermatology, University of California, San Francisco
| | | | | | - Erin L. Van Blarigan
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Urology, University of California, San Francisco
| | - Katrina Abuabara
- Department of Dermatology, University of California, San Francisco
- Division of Epidemiology and Biostatistics, University of California, Berkeley
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6
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Zhao J, Zhang Z, Chen H, Dou X, Zhao Z, Liu L, Wang Y, Li H. Associations of demographics, aggravating factors, comorbidities, and treatments with atopic dermatitis severity in China: A national cross-sectional study. Chin Med J (Engl) 2024:00029330-990000000-00982. [PMID: 38431766 DOI: 10.1097/cm9.0000000000003042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disorder impacting populations worldwide, although its clinical characteristics and patient demographics remain uncharacterized in China. The aim of this study was to investigate the demographics, comorbidities, aggravating factors, and treatments in AD patients across different age groups in China. METHODS This cross-sectional study included Chinese AD patients from 205 hospitals spanning 30 provinces. Patients completed dermatologist-led surveys of general medical history, comorbidities, AD-related aggravating factors, and medications. Two-level mixed-ordered logistic regression was used to evaluate aggravating factors. RESULTS Overall, 16,838 respondents were included in the final analysis (age 30.9 ± 24.1 years). The proportion of severe AD was the highest in patients with AD onset at ≥60 years (26.73%). Allergic rhinitis and hypertension were the most common atopic and metabolism-related non-atopic comorbidities, respectively. AD severity was significantly associated with chronic urticaria, food allergies, and diabetes. Aggravating factors including foods, seasonal changes, and psychological factors were also linked to AD severity. The cross-sectional survey implied that severe AD may be related to the undertreatment of effective systemic or topical interventions. CONCLUSION To enhance the management of AD, it is crucial to consider both aggravating factors and the increased utilization of systemic immunotherapy. REGISTRATION ClinicalTrials.gov Identifier: NCT05316805, CORNERSTONE.
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Affiliation(s)
- Jiahui Zhao
- Department of Dermatology, Peking University First Hospital, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, National Clinical Research Center for Skin and Immune Disease, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing 100034, China
| | - Zhixin Zhang
- Department of Dermatology, Peking University First Hospital, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, National Clinical Research Center for Skin and Immune Disease, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing 100034, China
| | - Hongguang Chen
- NHC Key Laboratory of Mental Health, Peking University Sixth Hospital, Beijing 100191, China
| | - Xia Dou
- Department of Dermatology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China
| | - Zuotao Zhao
- Department of Dermatology, Peking University First Hospital, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, National Clinical Research Center for Skin and Immune Disease, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing 100034, China
| | - Lingling Liu
- Department of Dermatology, Peking University First Hospital, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, National Clinical Research Center for Skin and Immune Disease, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing 100034, China
| | - Yang Wang
- Department of Dermatology, Peking University First Hospital, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, National Clinical Research Center for Skin and Immune Disease, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing 100034, China
| | - Hang Li
- Department of Dermatology, Peking University First Hospital, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, National Clinical Research Center for Skin and Immune Disease, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing 100034, China
- Center for Clinical Big Data of National Clinical Medical Research Center for Skin and Immune Disease, National Institute of Health Data Science, Beijing 100191, China
- Peking University-Yunnan Baiyao International Medical Research Center, Beijing 100871, China
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Coelho PS, Apalhão M, Victorino G, Cardoso C, Camilo J, Silva JM. The burden of atopic dermatitis in Portuguese patients: an observational study. Sci Rep 2024; 14:5181. [PMID: 38431751 PMCID: PMC10908846 DOI: 10.1038/s41598-024-55965-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/29/2024] [Indexed: 03/05/2024] Open
Abstract
Atopic dermatitis (AD) is a common inflammatory skin condition that significantly affects patients' lives and imposes both economic and non-economic burdens. The precise societal and individual consequences of AD remain incompletely understood. This study aimed to characterize AD in Portuguese patients and assess its personal, familial, and societal implications, including health status and quality of life. The research, conducted from June 2019 to January 2020, involved 204 confirmed AD patients in Portugal, who completed a 70-question questionnaire. Results show that, on average, patients experienced a two-year delay in diagnosis, with two-thirds having allergic comorbidities. Late-onset AD (after age 20) was found to be correlated with worsening symptoms post-diagnosis. Globally, patients reported substantial effects on health, quality of life, and mental well-being. Effects include significant levels of anxiety, frustration and sleep disorders. Severe AD correlated with more suffering and reduced perceived health, indicating a link between disease severity and quality of life. Remarkably, despite questionable effectiveness, 92% of severe AD patients were prescribed antihistamines, while only 19% received biological treatments. In Portugal, delayed AD diagnosis hinders timely treatment, and despite its profound impact and high comorbidity rates, AD patients tend to remain undertreated. Recognizing the personal and societal repercussions is crucial for enhancing care, contributing to improving QoL, social functioning and global well-being.
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Affiliation(s)
- Pedro S Coelho
- NOVA Information Management School (NOVA IMS), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Miguel Apalhão
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
- Dermatology Research Unit, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
| | - Guilherme Victorino
- NOVA Information Management School (NOVA IMS), Universidade NOVA de Lisboa, Lisbon, Portugal.
| | | | - Joana Camilo
- ADERMAP-Atopic Dermatitis Association, Lisbon, Portugal
| | - João Maia Silva
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
- Dermatology Center, Hospital CUF Descobertas, Lisbon, Portugal
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8
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Wan J, Wang S, Shin DB, Syed MN, Abuabara K, Lemeshow AR, Gelfand JM. Incident Asthma, Asthma Exacerbations, and Asthma-Related Hospitalizations in Patients With Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:421-430.e1. [PMID: 37972919 PMCID: PMC10922794 DOI: 10.1016/j.jaip.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/04/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is thought to induce asthma via the "atopic march," but the effects of AD on incident asthma and asthma severity have not been fully characterized. OBJECTIVE To determine risk of asthma, asthma exacerbations, and asthma-related hospitalizations among patients fwith AD. METHODS A cohort study was conducted using electronic health records data from UK general practices from 1994 to 2015. Children (<18 years old) and adults (≥18 years) with AD were matched on age, practice, and index date to patients without AD. AD severity was categorized using treatments and dermatologist referrals. Outcomes were incident asthma among all patients and asthma exacerbation or hospitalization among patients with asthma. RESULTS On comparing 409,341 children with AD (93.2% mild, 5.5% moderate, 1.3% severe) with 1,809,029 unaffected children, those with AD were found to be associated with a 2-fold greater risk of asthma compared with those without AD (hazard ratio, 1.96; 95% CI, 1.93-1.98). On comparing 625,083 adults with AD (65.7% mild, 31.4% moderate, and 2.9% severe) with 2,678,888 unaffected adults, AD was found to be associated with a 38% higher risk of asthma (hazard ratio, 1.38; 95% CI, 1.36-1.40). Asthmatic patients with AD also had a 21% to 63% greater risk of asthma exacerbations and a 20% to 64% greater risk of asthma-related hospitalizations compared with asthmatic patients without AD. Risk of asthma, asthma exacerbation, or asthma-related hospitalization increased with AD severity in a dose-dependent manner in both the pediatric and adult cohorts. CONCLUSIONS AD, especially in children and when more severe, is associated with greater risk of asthma as well as greater risk of asthma exacerbations and hospitalizations among asthmatic patients.
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Affiliation(s)
- Joy Wan
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Sonia Wang
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Daniel B Shin
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Maha N Syed
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, Calif
| | | | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa.
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9
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Harries L, Traidl S, Klespe KC, Werfel T. [Eczema and its treatment in older adults]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:678-686. [PMID: 37638989 DOI: 10.1007/s00105-023-05206-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/29/2023]
Abstract
Eczema encompass a wide range of dermatoses that can affect elderly patients in particular. Common differential diagnoses in elderly patients include asteatotic eczema, late-onset atopic dermatitis, allergic contact dermatitis, early phases of mycosis fungoides, eczematous and pruriginous variants of premonitory bullous pemphigoid, as well as eczematized scabies and post-scabietic eczema. Given the partly overlapping clinical presentations, accurate diagnosis plays a crucial role in the management of these conditions. Therapeutic options depend on the underlying disease and necessitate an individualized approach. This review presents relevant types of eczema in older adults together with diagnostic and therapeutic approaches. In addition to confirming the diagnosis and selecting the appropriate treatment, aspects relevant to the care of older patients should be incorporated into the tailored therapeutic approach.
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Affiliation(s)
- Leonard Harries
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Stephan Traidl
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Kai-Christian Klespe
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Thomas Werfel
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Maintz L, Schmitz MT, Herrmann N, Müller S, Havenith R, Brauer J, Rhyner C, Dreher A, Bersuch E, Fehr D, Hammel G, Reiger M, Luschkova D, Neumann A, Lang CCV, Renner ED, Schmid-Grendelmeier P, Traidl-Hoffmann C, Akdis CA, Lauener R, Brüggen MC, Schmid M, Bieber T. Atopic dermatitis: Correlation of distinct risk factors with age of onset in adulthood compared to childhood. Allergy 2023; 78:2181-2201. [PMID: 36946297 DOI: 10.1111/all.15721] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/11/2023] [Accepted: 02/05/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) has long been regarded as a primarily pediatric disease. However, there is growing evidence for a high rate of adult-onset AD. We aimed to characterize factors associated with adult-onset versus childhood-onset AD and controls. METHODS We analyzed cross-sectional data of the CK-CARE-ProRaD cohorts Bonn, Augsburg, Davos, Zürich of 736 adult patients stratified by age of AD onset (childhood-onset <18 years: 76.4% (subsets: 0 to 2; ≥2 to 6; ≥7 to 11; ≥12 to 18); adult-onset ≥18 years: 23.6% (subsets: ≥18 to 40; ≥41 to 60; ≥61) and 167 controls (91 atopic, 76 non-atopic)). RESULTS We identified active smoking to be associated with adult-onset AD versus controls (adjusted Odds Ratio (aOR) = 5.54 [95% Confidence Interval: 1.06-29.01] vs. controlsnon-atopic , aOR = 4.03 [1.20-13.45] vs. controlsatopic ). Conjunctivitis showed a negative association versus controlsatopic (aOR = 0.36 [0.14-0.91]). Food allergy (aOR = 2.93 [1.44-5.96]), maternal food allergy (aOR = 9.43 [1.10-80.95]), palmar hyperlinearity (aOR = 2.11 [1.05-4.25]), and academic background (aOR = 2.14 [1.00-4.54]) increased the odds of childhood-onset AD versus controlsatopic . Shared AD-associated factors were maternal AD (4-34x), increased IgE (2-20x), atopic stigmata (2-3x) with varying effect sizes depending on AD onset and control group. Patients with adult-compared to childhood-onset had doubled odds of allergic rhinitis (aOR = 2.15 [1.12-4.13]), but reduced odds to feature multiple (3-4) atopic comorbidities (aOR = 0.34 [0.14-0.84]). Adult-onset AD, particularly onset ≥61 years, grouped mainly in clusters with low contributions of personal and familial atopy and high frequencies of physical inactivity, childhood-onset AD, particularly infant-onset, mainly in "high-atopic"-clusters. CONCLUSIONS The identified associated factors suggest partly varying endo- and exogeneous mechanisms underlying adult-onset versus childhood-onset AD. Our findings might contribute to better assessment of the individual risk to develop AD throughout life and encourage prevention by non-smoking and physical activity as modifiable lifestyle factors.
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Affiliation(s)
- Laura Maintz
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Marie-Therese Schmitz
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Nadine Herrmann
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Svenja Müller
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Regina Havenith
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Juliette Brauer
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Claudio Rhyner
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF), Davos, Switzerland
- DavosBioSciences, Davos, Switzerland
| | - Anita Dreher
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- DavosBioSciences, Davos, Switzerland
| | - Eugen Bersuch
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Danielle Fehr
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Gertrud Hammel
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine Helmholtz Zentrum München, German Research Center for Environmental Health, Augsburg, Germany
| | - Matthias Reiger
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine Helmholtz Zentrum München, German Research Center for Environmental Health, Augsburg, Germany
| | - Daria Luschkova
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine Helmholtz Zentrum München, German Research Center for Environmental Health, Augsburg, Germany
| | - Avidan Neumann
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine Helmholtz Zentrum München, German Research Center for Environmental Health, Augsburg, Germany
| | - Claudia C V Lang
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Ellen D Renner
- Translational Immunology of Environmental Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Pediatrics, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Peter Schmid-Grendelmeier
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Claudia Traidl-Hoffmann
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine Helmholtz Zentrum München, German Research Center for Environmental Health, Augsburg, Germany
| | - Cezmi A Akdis
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF), Davos, Switzerland
| | - Roger Lauener
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Marie-Charlotte Brüggen
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Hochgebirgsklinik Davos, Davos, Switzerland
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- DavosBioSciences, Davos, Switzerland
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Cowdell F, Lax S, Van Onselen J, Pendleton R. Can co-created knowledge mobilisation interventions alter and enhance mindlines to improve childhood eczema care? A UK-based Social Impact Framework evaluation. BMJ Open 2023; 13:e065557. [PMID: 37076153 PMCID: PMC10124191 DOI: 10.1136/bmjopen-2022-065557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE To evaluate the impact of using knowledge mobilisation interventions to alter and enhance mindlines and improve childhood eczema care. DESIGN The eczema mindlines study involved three stages: (1) mapping and confirming eczema mindlines, (2) intervention development and delivery and (3) analysis of intervention impact. The focus of this paper is on stage 3. Data analysis was guided by the Social Impact Framework to address the questions: (1) what is the impact of this study on individuals and groups? (2) what changes in behaviour and practice have occurred due to their involvement? (3) what mechanisms have enabled these impacts or changes to occur? and (4) what are the recommendations and questions arising from this research? SETTINGS A deprived inner-city neighbourhood in central England and national/international settings. PARTICIPANTS Patients, practitioners and wider community members exposed to the interventions locally, nationally and internationally. RESULTS Data revealed tangible multi-level, relational and intellectual impacts. Mechanisms supporting impact included: simplicity and consistency of messages adapted to audience, flexibility, opportunism and perseverance, personal interconnectivity and acknowledgement of emotion. Co-created knowledge mobilisation strategies to alter and enhance mindlines mediated through knowledge brokering were effective in producing tangible changes in eczema care practice and self-management and in 'mainstreaming' childhood eczema in positive way across communities. These changes cannot be directly attributed to the knowledge mobilisation interventions, however, the evidence points to the significant contribution made. CONCLUSION Co-created knowledge mobilisation interventions offer a valuable method of altering and enhancing eczema mindlines across lay-practitioner-wider society boundaries. The Social Impact Framework provides comprehensive method of understanding and documenting the complex web of impact occurring as a result of knowledge mobilisation. This approach is transferable to managing other long-term conditions.
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Affiliation(s)
- Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Stephanie Lax
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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12
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Weinmann T, Forster F, Hell K, Gerlich J, Wengenroth L, Schlotz W, Vogelberg C, von Mutius E, Nowak D, Radon K. Work-related stress and atopic dermatitis: Results from the study on occupational allergy risks. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2023; 20:109-119. [PMID: 36441057 DOI: 10.1080/15459624.2022.2151604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Chronic stress at work is ubiquitous in modern societies. However, its influence on atopic dermatitis (AD) has hardly been investigated. This study aimed to elucidate the association between work-related stress and AD via a longitudinal study. The analysis comprised data from three phases (2002-2003, 2007-2009, 2017-2018) of the prospective Study on Occupational Allergy Risks (SOLAR), including 1,240 young adults aged 16 to 18 years at baseline (61% female) who were originally recruited for the International Study of Asthma and Allergies in Childhood Phase II in 1995-1996. AD was assessed at all three phases based on self-reports of a physician's diagnosis and symptoms. Work-related stress was measured at all three periods using the work discontent and work overload scales from the Trier Inventory for the Assessment of Chronic Stress with adaptions to school and university. Generalized estimating equations were used to analyze the association between stress and AD, treating work discontent and work overload first as continuous and then as categorical exposure variables. We observed 50 AD cases (4%) at SOLAR I, 48 (4%) at SOLAR II, and 42 (3%) at SOLAR III. A one-point increase in the work discontent score was associated with an odds ratio (OR) for AD of 1.05 (95% confidence interval [CI], 1.00-1.10). The respective increase in the work overload score led to an OR of 1.03 (95% CI, 0.99-1.06). In the categorical analysis, there was no clear indication of elevated odds of AD in the highest vs. lowest exposure group (4th vs. 1st quartile: OR, 1.53; 95% CI, 0.92-2.53 for work discontent; OR, 1.38, 95% CI, 0.83-2.27 for work overload). Altogether, we observed limited to no evidence for an association between work-related stress and AD. Our study's ability to detect stronger evidence may have been compromised by shortcomings such as nondifferential misclassification of the outcome or insufficient statistical precision due to small numbers of AD cases. Another explanation could be that AD predominantly becomes evident in childhood, not in adulthood.
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Affiliation(s)
- Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Felix Forster
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Katharina Hell
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jessica Gerlich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Laura Wengenroth
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Wolff Schlotz
- Max Planck Institute of Empirical Aesthetics, Frankfurt am Main, Germany
| | - Christian Vogelberg
- Paediatric Department, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Erika von Mutius
- Dr. v. Haunersches Kinderspital, University Hospital, LMU Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
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Margolis DJ, Duke JL, Mitra N, Berna RA, Hoffstad OJ, Wasserman JR, Dinou A, Damianos G, Kotsopoulou I, Tairis N, Ferriola DA, Mosbruger TL, Hayeck TJ, Yan AC, Monos DS. A combination of HLA-DP α and β chain polymorphisms paired with a SNP in the DPB1 3' UTR region, denoting expression levels, are associated with atopic dermatitis. Front Genet 2023; 14:1004138. [PMID: 36911412 PMCID: PMC9995861 DOI: 10.3389/fgene.2023.1004138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/13/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction: Components of the immune response have previously been associated with the pathophysiology of atopic dermatitis (AD), specifically the Human Leukocyte Antigen (HLA) Class II region via genome-wide association studies, however the exact elements have not been identified. Methods: This study examines the genetic variation of HLA Class II genes using next generation sequencing (NGS) and evaluates the resultant amino acids, with particular attention on binding site residues, for associations with AD. The Genetics of AD cohort was used to evaluate HLA Class II allelic variation on 464 subjects with AD and 384 controls. Results: Statistically significant associations with HLA-DP α and β alleles and specific amino acids were found, some conferring susceptibility to AD and others with a protective effect. Evaluation of polymorphic residues in DP binding pockets revealed the critical role of P1 and P6 (P1: α31M + (β84G or β84V) [protection]; α31Q + β84D [susceptibility] and P6: α11A + β11G [protection]) and were replicated with a national cohort of children consisting of 424 AD subjects. Independently, AD susceptibility-associated residues were associated with the G polymorphism of SNP rs9277534 in the 3' UTR of the HLA-DPB1 gene, denoting higher expression of these HLA-DP alleles, while protection-associated residues were associated with the A polymorphism, denoting lower expression. Discussion: These findings lay the foundation for evaluating non-self-antigens suspected to be associated with AD as they potentially interact with particular HLA Class II subcomponents, forming a complex involved in the pathophysiology of AD. It is possible that a combination of structural HLA-DP components and levels of expression of these components contribute to AD pathophysiology.
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Affiliation(s)
- David J. Margolis
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jamie L. Duke
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Ronald A. Berna
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Ole J. Hoffstad
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jenna R. Wasserman
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Amalia Dinou
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Georgios Damianos
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Ioanna Kotsopoulou
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Nikolaos Tairis
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Deborah A. Ferriola
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Timothy L. Mosbruger
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Tristan J. Hayeck
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pathology and Laboratory Medicine, Perelman Schools of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Albert C. Yan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Section of Dermatology, Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Dimitri S. Monos
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pathology and Laboratory Medicine, Perelman Schools of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Maintz L, Welchowski T, Herrmann N, Brauer J, Traidl-Hoffmann C, Havenith R, Müller S, Rhyner C, Dreher A, Schmid M, Bieber T. IL-13, periostin and dipeptidyl-peptidase-4 reveal endotype-phenotype associations in atopic dermatitis. Allergy 2023; 78:1554-1569. [PMID: 36647778 DOI: 10.1111/all.15647] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/28/2022] [Accepted: 12/10/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND The heterogeneous (endo)phenotypes of atopic dermatitis (AD) require precision medicine. Currently, systemic therapy is recommended to patients with an Eczema Area and Severity Index (EASI)≥16. Previous studies have demonstrated an improved treatment response to the anti-interleukin (IL)-13 antibody tralokinumab in AD subgroups with elevated levels of the IL-13-related biomarkers dipeptidyl-peptidase (DPP)-4 and periostin. METHODS Herein, 373 AD patients aged≥12 years were stratified by IL-13high , periostinhigh and DPP-4high endotypes using cross-sectional data from the ProRaD cohort Bonn. "High" was defined as >80th quantile of 47 non-atopic controls. We analyzed endotype-phenotype associations using machine-learning gradient boosting compared to logistic regression. RESULTS AD severity and eosinophils correlated with IL-13 and periostin levels. Correlations of IL-13 with EASI were stronger in patients with increased (rs=0.482) than with normal (rs=0.342) periostin levels. We identified eosinophilia>6% and an EASI range of 5.5-17 dependent on the biomarker combination to be associated with increasing probabilities of biomarkerhigh endotypes. Also patients with mild-to-low-moderate severity (EASI<16) featured increased biomarkers (IL-13high : 41%, periostinhigh : 48.4%, DPP-4high : 22.3%). Herthoge sign (adjusted Odds Ratio (aOR)=1.89, 95% Confidence Interval (CI) [1.14-3.14]) and maternal allergic rhinitis (aOR=2.79-4.47) increased the probability of an IL-13high -endotype, "dirty neck" (aOR=2.83 [1.32-6.07]), orbital darkening (aOR=2.43 [1.08-5.50]), keratosis pilaris (aOR=2.21 [1.1-4.42]) and perleche (aOR=3.44 [1.72-6.86]) of a DPP-4high -endotype. CONCLUSIONS A substantial proportion of patients with EASI<16 featured high biomarker levels suggesting systemic impact of skin inflammation already below the current cut-off for systemic therapy. Our findings facilitate the identification of patients with distinct endotypes potentially linked to response to IL-13-targeted therapy.
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Affiliation(s)
- Laura Maintz
- Department of Dermatology and Allergy, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), Herman-Burchard-Str. 1, 7265, Davos, Switzerland
| | - Thomas Welchowski
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), Herman-Burchard-Str. 1, 7265, Davos, Switzerland
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Nadine Herrmann
- Department of Dermatology and Allergy, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), Herman-Burchard-Str. 1, 7265, Davos, Switzerland
| | - Juliette Brauer
- Department of Dermatology and Allergy, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), Herman-Burchard-Str. 1, 7265, Davos, Switzerland
| | - Claudia Traidl-Hoffmann
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), Herman-Burchard-Str. 1, 7265, Davos, Switzerland
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Stenglinstraße 2, Augsburg, Germany
- Institute of Environmental Medicine, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, Augsburg, Germany
| | - Regina Havenith
- Department of Dermatology and Allergy, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), Herman-Burchard-Str. 1, 7265, Davos, Switzerland
| | - Svenja Müller
- Department of Dermatology and Allergy, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), Herman-Burchard-Str. 1, 7265, Davos, Switzerland
| | - Claudio Rhyner
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), Herman-Burchard-Str. 1, 7265, Davos, Switzerland
- Davos Biosciences, Herman-Burchard-Str. 1, 7265, Davos, Switzerland
| | - Anita Dreher
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), Herman-Burchard-Str. 1, 7265, Davos, Switzerland
- Davos Biosciences, Herman-Burchard-Str. 1, 7265, Davos, Switzerland
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), Herman-Burchard-Str. 1, 7265, Davos, Switzerland
- Davos Biosciences, Herman-Burchard-Str. 1, 7265, Davos, Switzerland
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Abuabara K, Langan SM. Atopic dermatitis across the life course. Br J Dermatol 2022; 188:709-717. [PMID: 36715326 DOI: 10.1093/bjd/ljac072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/13/2022] [Accepted: 10/22/2022] [Indexed: 01/22/2023]
Abstract
Atopic dermatitis, the most common chronic inflammatory skin disease, can occur at any age, and patterns of disease activity vary over time. Both prevalence and incidence are highest in infancy and early childhood, followed by a second peak in older adulthood. Birth cohort studies from European countries following children through adolescence have identified subgroups of patients with early-onset persistent disease, early-onset resolving disease, and later-onset disease. Parental history of atopy and genetic factors are among the most consistent predictors of more persistent disease. Studies have begun to examine whether molecular markers differ by age group, although longitudinal data are lacking. Breastfeeding, probiotics and skin-directed therapies such as emollients have been investigated as potential preventive measures, but randomized trials have not found consistent long-term benefit. Future research should focus on patterns of disease activity beyond early adulthood and the role of treatments on long-term disease activity.
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Affiliation(s)
- Katrina Abuabara
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco School of Medicine (UCSF), San Francisco, CA, USA
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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16
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Kelleher MM, Phillips R, Brown SJ, Cro S, Cornelius V, Carlsen KCL, Skjerven HO, Rehbinder EM, Lowe AJ, Dissanayake E, Shimojo N, Yonezawa K, Ohya Y, Yamamoto-Hanada K, Morita K, Axon E, Cork M, Cooke A, Van Vogt E, Schmitt J, Weidinger S, McClanahan D, Simpson E, Duley L, Askie LM, Williams HC, Boyle RJ. Skin care interventions in infants for preventing eczema and food allergy. Cochrane Database Syst Rev 2022; 11:CD013534. [PMID: 36373988 PMCID: PMC9661877 DOI: 10.1002/14651858.cd013534.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Eczema and food allergy are common health conditions that usually begin in early childhood and often occur in the same people. They can be associated with an impaired skin barrier in early infancy. It is unclear whether trying to prevent or reverse an impaired skin barrier soon after birth is effective for preventing eczema or food allergy. OBJECTIVES Primary objective To assess the effects of skin care interventions such as emollients for primary prevention of eczema and food allergy in infants. Secondary objective To identify features of study populations such as age, hereditary risk, and adherence to interventions that are associated with the greatest treatment benefit or harm for both eczema and food allergy. SEARCH METHODS We performed an updated search of the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, and Embase in September 2021. We searched two trials registers in July 2021. We checked the reference lists of included studies and relevant systematic reviews, and scanned conference proceedings to identify further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA: We included RCTs of skin care interventions that could potentially enhance skin barrier function, reduce dryness, or reduce subclinical inflammation in healthy term (> 37 weeks) infants (≤ 12 months) without pre-existing eczema, food allergy, or other skin condition. Eligible comparisons were standard care in the locality or no treatment. Types of skin care interventions could include moisturisers/emollients; bathing products; advice regarding reducing soap exposure and bathing frequency; and use of water softeners. No minimum follow-up was required. DATA COLLECTION AND ANALYSIS This is a prospective individual participant data (IPD) meta-analysis. We used standard Cochrane methodological procedures, and primary analyses used the IPD dataset. Primary outcomes were cumulative incidence of eczema and cumulative incidence of immunoglobulin (Ig)E-mediated food allergy by one to three years, both measured at the closest available time point to two years. Secondary outcomes included adverse events during the intervention period; eczema severity (clinician-assessed); parent report of eczema severity; time to onset of eczema; parent report of immediate food allergy; and allergic sensitisation to food or inhalant allergen. MAIN RESULTS We identified 33 RCTs comprising 25,827 participants. Of these, 17 studies randomising 5823 participants reported information on one or more outcomes specified in this review. We included 11 studies, randomising 5217 participants, in one or more meta-analyses (range 2 to 9 studies per individual meta-analysis), with 10 of these studies providing IPD; the remaining 6 studies were included in the narrative results only. Most studies were conducted at children's hospitals. Twenty-five studies, including all those contributing data to meta-analyses, randomised newborns up to age three weeks to receive a skin care intervention or standard infant skin care. Eight of the 11 studies contributing to meta-analyses recruited infants at high risk of developing eczema or food allergy, although the definition of high risk varied between studies. Durations of intervention and follow-up ranged from 24 hours to three years. All interventions were compared against no skin care intervention or local standard care. Of the 17 studies that reported information on our prespecified outcomes, 13 assessed emollients. We assessed most of the evidence in the review as low certainty and had some concerns about risk of bias. A rating of some concerns was most often due to lack of blinding of outcome assessors or significant missing data, which could have impacted outcome measurement but was judged unlikely to have done so. We assessed the evidence for the primary food allergy outcome as high risk of bias due to the inclusion of only one trial, where findings varied based on different assumptions about missing data. Skin care interventions during infancy probably do not change the risk of eczema by one to three years of age (risk ratio (RR) 1.03, 95% confidence interval (CI) 0.81 to 1.31; risk difference 5 more cases per 1000 infants, 95% CI 28 less to 47 more; moderate-certainty evidence; 3075 participants, 7 trials) or time to onset of eczema (hazard ratio 0.86, 95% CI 0.65 to 1.14; moderate-certainty evidence; 3349 participants, 9 trials). Skin care interventions during infancy may increase the risk of IgE-mediated food allergy by one to three years of age (RR 2.53, 95% CI 0.99 to 6.49; low-certainty evidence; 976 participants, 1 trial) but may not change risk of allergic sensitisation to a food allergen by age one to three years (RR 1.05, 95% CI 0.64 to 1.71; low-certainty evidence; 1794 participants, 3 trials). Skin care interventions during infancy may slightly increase risk of parent report of immediate reaction to a common food allergen at two years (RR 1.27, 95% CI 1.00 to 1.61; low-certainty evidence; 1171 participants, 1 trial); however, this was only seen for cow's milk, and may be unreliable due to over-reporting of milk allergy in infants. Skin care interventions during infancy probably increase risk of skin infection over the intervention period (RR 1.33, 95% CI 1.01 to 1.75; risk difference 17 more cases per 1000 infants, 95% CI one more to 38 more; moderate-certainty evidence; 2728 participants, 6 trials) and may increase the risk of infant slippage over the intervention period (RR 1.42, 95% CI 0.67 to 2.99; low-certainty evidence; 2538 participants, 4 trials) and stinging/allergic reactions to moisturisers (RR 2.24, 95% 0.67 to 7.43; low-certainty evidence; 343 participants, 4 trials), although CIs for slippages and stinging/allergic reactions were wide and include the possibility of no effect or reduced risk. Preplanned subgroup analyses showed that the effects of interventions were not influenced by age, duration of intervention, hereditary risk, filaggrin (FLG) mutation, chromosome 11 intergenic variant rs2212434, or classification of intervention type for risk of developing eczema. We could not evaluate these effects on risk of food allergy. Evidence was insufficient to show whether adherence to interventions influenced the relationship between skin care interventions and eczema or food allergy development. AUTHORS' CONCLUSIONS Based on low- to moderate-certainty evidence, skin care interventions such as emollients during the first year of life in healthy infants are probably not effective for preventing eczema; may increase risk of food allergy; and probably increase risk of skin infection. Further study is needed to understand whether different approaches to infant skin care might prevent eczema or food allergy.
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Affiliation(s)
- Maeve M Kelleher
- National Heart & Lung Institute, Section of Inflammation and Repair, Imperial College London, London, UK
| | - Rachel Phillips
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Sara J Brown
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - Suzie Cro
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | | | - Karin C Lødrup Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Håvard O Skjerven
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Eva M Rehbinder
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Eishika Dissanayake
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Naoki Shimojo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Kaori Yonezawa
- Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | | | - Kumiko Morita
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Emma Axon
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Michael Cork
- Sheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Alison Cooke
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Eleanor Van Vogt
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technischen Universität (TU) Dresden, Dresden, Germany
| | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Scheswig-Holstein, Kiel, Germany
| | - Danielle McClanahan
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Eric Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Lisa M Askie
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Robert J Boyle
- National Heart & Lung Institute, Section of Inflammation and Repair, Imperial College London, London, UK
- Cochrane Skin, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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17
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Volke A, Toompere K, Laisaar KT, Oona M, Tisler A, Johannson A, Kallavus K, Lang K, Kiisk E, Uusküla A. 12-month prevalence of atopic dermatitis in resource-rich countries: a systematic review and meta-analysis. Sci Rep 2022; 12:15125. [PMID: 36068263 PMCID: PMC9448775 DOI: 10.1038/s41598-022-19508-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
There is a lack of robust prevalence estimates of atopic dermatitis (AD) globally and trends over time due to wide variation of populations and age groups studied, different study methodologies and case definitions used. We sought to characterize 12-month AD prevalence across the life span and change over time in resource-rich countries focusing on population-based studies and using a standardized AD case definition. This systematic review was conducted according to PRISMA guidelines. Medline (Ovid), Embase, WOS core collection, Cinahl, and Popline were searched for studies published since inception through August 15, 2016. Studies were synthesized using random effects meta-analysis. Sources of heterogeneity were investigated using subgroup analyses and meta-regression. From 12,530 records identified, 45 studies met the inclusion criteria. Meta-analysis with random effects revealed the 12-month period prevalence of 9.2% (95% confidence interval 8.4-10.1%). The prevalence was significantly higher among 0-5-year-old children (16.2%; 95% confidence interval 14.2-18.7%) than in older age groups. Studies using a random sampling strategy yielded lower prevalence estimates than studies relying on other sampling methods. There was no clear time trend in AD prevalence over the period of 1992-2013.
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Affiliation(s)
- Annika Volke
- Department of Dermatology, Institute of Clinical Medicine, University of Tartu, Raja 31, 50417, Tartu, Estonia.
- Dermatology Clinic, Tartu University Hospital, Tartu, Estonia.
| | - Karolin Toompere
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Kaja-Triin Laisaar
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Marje Oona
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Anna Tisler
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Annika Johannson
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
- Diagnostic Service, Pärnu Hospital, Pärnu, Estonia
| | - Kadi Kallavus
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Katrin Lang
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Ele Kiisk
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Anneli Uusküla
- Dermatology Clinic, Tartu University Hospital, Tartu, Estonia
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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18
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Maintz L, Bieber T, Simpson HD, Demessant-Flavigny AL. From Skin Barrier Dysfunction to Systemic Impact of Atopic Dermatitis: Implications for a Precision Approach in Dermocosmetics and Medicine. J Pers Med 2022; 12:jpm12060893. [PMID: 35743678 PMCID: PMC9225544 DOI: 10.3390/jpm12060893] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
: Atopic dermatitis (AD) affects up to 20% of children and is considered the starting point of the atopic march with the development of food allergy, asthma, and allergic rhinitis. The heterogeneous phenotype reflects distinct and/or overlapping pathogenetic mechanisms with varying degrees of epidermal barrier disruption, activation of different T cell subsets and dysbiosis of the skin microbiome. Here, we review current evidence suggesting a systemic impact of the cutaneous inflammation in AD together with a higher risk of asthma and other comorbidities, especially in severe and persistent AD. Thus, early therapy of AD to restore the impaired skin barrier, modified microbiome, and target type 2 inflammation, depending on the (endo)phenotype, in a tailored approach is crucial. We discuss what we can learn from the comorbidities and the implications for preventive and therapeutic interventions from precision dermocosmetics to precision medicine. The stratification of AD patients into biomarker-based endotypes for a precision medicine approach offers opportunities for better long-term control of AD with the potential to reduce the systemic impact of a chronic skin inflammation and even prevent or modify the course, not only of AD, but possibly also the comorbidities, depending on the patient’s age and disease stage.
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Affiliation(s)
- Laura Maintz
- Department of Dermatology and Allergy, University Hospital Bonn, 53127 Bonn, Germany;
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), 7265 Davos, Switzerland
- Correspondence: ; Tel.: +49-228-287-16898
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital Bonn, 53127 Bonn, Germany;
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), 7265 Davos, Switzerland
- Davos Biosciences, Herman-Burchard-Str. 9, CH-7265 Davos Wolfgang, Switzerland
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19
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Ziyab AH, Mukherjee N, Zhang H, Arshad SH, Karmaus W. Sex-specific developmental trajectories of eczema from infancy to age 26 years: A birth cohort study. Clin Exp Allergy 2022; 52:416-425. [PMID: 34854146 PMCID: PMC8866217 DOI: 10.1111/cea.14068] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/08/2021] [Accepted: 11/29/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Eczema is a common inflammatory skin disease with varying developmental trajectories/patterns that are influenced by different risk factors. The aim of this study was to investigate eczema development from infancy to early adulthood by identifying distinct developmental trajectories that describe disease patterns over time and evaluate the role of prenatal and early-life risk factors. METHODS The Isle of Wight Birth Cohort (n = 1456) was prospectively assessed at birth, 1, 2, 4, 10, 18 and 26 years. In all assessments, eczema was defined as chronic or chronically relapsing itchy dermatitis lasting >6 weeks with characteristic morphology and distribution in the past 12 months. Developmental trajectories of eczema between 1 or 2 and 26 years were identified separately for males and females by applying semiparametric mixture models. Associations were assessed by applying a modified Poisson regression to estimate adjusted risk ratios (aRR) and 95% confidence intervals (CI). RESULTS In both males and females, the following eczema developmental trajectories were identified: unaffected/transient (males: 77.7% vs. females: 73.0%), mid-onset late-resolving (males: 7.8% vs. females: 4.4%), late-onset (males: 5.2% vs. females: 9.5%) and early-onset persistent (males: 9.3% vs. females: 5.4%). In females, an additional trajectory was identified as follows: early-onset early-resolving (7.7%). Among males, filaggrin gene (FLG) variants (aRR = 2.45, 95% CI: 1.34-4.46) and paternal eczema (2.66, 1.39-5.08) were associated with the early-onset persistent trajectory. Among females, maternal eczema (2.84, 1.42-5.70) and high birthweight (2.25, 1.08-4.69) were associated with the early-onset persistent trajectory. CONCLUSIONS Four and five trajectories represented eczema development among males and females, respectively, with different predisposing risk factors. Our results indicate that males and females may experience a different course of eczema.
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Affiliation(s)
- Ali H. Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Nandini Mukherjee
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - S. Hasan Arshad
- David Hide Asthma and Allergy Research Centre, St Mary’s Hospital, Isle of Wight, UK
- Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, UK
| | - Wilfried Karmaus
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
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20
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Bosma AL, Ascott A, Iskandar R, Farquhar K, Matthewman J, Langendam MW, Mulick A, Abuabara K, Williams HC, Spuls PI, Langan SM, Middelkamp-Hup MA. Classifying atopic dermatitis: a systematic review of phenotypes and associated characteristics. J Eur Acad Dermatol Venereol 2022; 36:807-819. [PMID: 35170821 PMCID: PMC9307020 DOI: 10.1111/jdv.18008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/10/2021] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Abstract
Atopic dermatitis is a heterogeneous disease, accompanied by a wide variation in disease presentation and the potential to identify many phenotypes that may be relevant for prognosis and treatment. We aimed to systematically review previously reported phenotypes of atopic dermatitis and any characteristics associated with them. Ovid EMBASE, Ovid MEDLINE and Web of Science were searched from inception till the 12th of February 2021 for studies attempting to classify atopic dermatitis. Primary outcomes are atopic dermatitis phenotypes and characteristics associated with them in subsequent analyses. A secondary outcome is the methodological approach used to derive them. In total, 8,511 records were found. By focusing only on certain clinical phenotypes, 186 studies were eligible for inclusion. The majority of studies were hospital-based (59%, 109/186) and cross-sectional (76%, 141/186). The number of included patients ranged from seven to 526,808. Data-driven approaches to identify phenotypes were only used in a minority of studies (7%, 13/186). Ninety-one studies (49%) investigated a phenotype based on disease severity. A phenotype based on disease trajectory, morphology and eczema herpeticum was investigated in 56 (30%), 22 (12%) and 11 (6%) studies, respectively. Thirty-six studies (19%) investigated morphological characteristics in other phenotypes. Investigated associated characteristics differed between studies. In conclusion, we present an overview of phenotype definitions used in literature for severity, trajectory, morphology and eczema herpeticum, including associated characteristics. There is a lack of uniform and consistent use of atopic dermatitis phenotypes across studies.
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Affiliation(s)
- A L Bosma
- Department of Dermatology, UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
| | - A Ascott
- Department of Dermatology, University Hospitals Sussex NHS Foundation Trust, Worthing, United Kingdom
| | - R Iskandar
- Faculty of Epidemiology and Population Health, School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - J Matthewman
- Department of Non-communicable disease epidemiology, School of Hygiene and Tropical Medicine, London, United Kingdom
| | - M W Langendam
- Department of Epidemiology and Data Science, UMC, location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - A Mulick
- Faculty of Epidemiology and Population Health, School of Hygiene and Tropical Medicine, London, United Kingdom
| | - K Abuabara
- Department of Dermatology, University of California San Francisco, United States
| | - H C Williams
- Centre of Evidence-Based Dermatology, University of Nottingham, United Kingdom
| | - P I Spuls
- Department of Dermatology, UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
| | - S M Langan
- Department of Dermatology, UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands.,Faculty of Epidemiology and Population Health, School of Hygiene and Tropical Medicine, London, United Kingdom
| | - M A Middelkamp-Hup
- Department of Dermatology, UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
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21
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Johansson EK, Bergström A, Kull I, Melén E, Jonsson M, Lundin S, Wahlgren CF, Ballardini N. Prevalence and characteristics of atopic dermatitis among young adult females and males - report from the Swedish population-based study BAMSE. J Eur Acad Dermatol Venereol 2022; 36:698-704. [PMID: 35032357 PMCID: PMC9303811 DOI: 10.1111/jdv.17929] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 11/13/2021] [Accepted: 12/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is limited knowledge regarding prevalence and characteristics of Atopic Dermatitis (AD) among young adults in the general population. OBJECTIVES To study AD among young adults in a Swedish population-based birth cohort, with a particular focus on prevalence, sex differences including risk for AD at different ages, disease course and characteristics of AD at 24 years. METHODS The BAMSE cohort includes 4,089 individuals who have been followed regularly from birth to age 24 years regarding AD and atopic diseases. For this study 3,055 individuals who answered questions regarding AD at the 24-year follow-up were included. All were invited to a clinical examination including skin examination, evaluation by Williams criteria and collection of blood for analysis of specific IgE and 2,264 individuals chose to participate. RESULTS At 24 years the 12-month prevalence of AD was 17.8% and more females than males had AD (20.5% versus 14.8%), p<0.0001. The point-prevalence of ongoing AD at clinical examination was 8.0%. AD severity as assessed by Patient-Oriented Eczema Measure (POEM) did not differ between sexes. The proportion of adult onset of AD was 16.9% (92 of 543), females 17.3% versus males 16.4%. More females than males with AD at 24 years reported disturbed sleep due to itch (26.1% versus 15.5%, p<0.003). IgE-sensitization was less common among females with AD than males with AD (61.3% versus 79.6%, p<0.0001). In addition, male sex (female sex being the reference) was associated with increased odds for AD the first year of life (OR 1.31, 95% CI; 1.10-1.56), and decreased odds of AD in adolescence and young adulthood (OR 0.66, 95% CI; 0.55-0.80). CONCLUSIONS AD is a common disease among young adults and even though more females than males have AD at 24 years, adult onset of AD seems to be equally prevalent among both sexes in young adulthood.
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Affiliation(s)
- E K Johansson
- Dermatology and Venereology Unit, Department of Medicine, Solna, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Dermatology, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - A Bergström
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, County Council, Stockholm, Sweden
| | - I Kull
- Sachs' Children and Youth Hospital, Södersjukhuset, SE-118 83, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Erik Melén
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, SE-118 83, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - M Jonsson
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, County Council, Stockholm, Sweden
| | - S Lundin
- Sachs' Children and Youth Hospital, Södersjukhuset, SE-118 83, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - C-F Wahlgren
- Dermatology and Venereology Unit, Department of Medicine, Solna, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Dermatology, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - N Ballardini
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Dermatology and Sexual Health, Södersjukhuset, SE-118 83, Stockholm, Sweden
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22
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Hon KL, Chu S, Leung AKC, Wong A. Atopic Dermatitis: Conventional and Integrative Medicine. Curr Pediatr Rev 2022; 18:84-96. [PMID: 34279204 DOI: 10.2174/1573396317666210716152325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/24/2021] [Accepted: 02/25/2021] [Indexed: 11/22/2022]
Abstract
Although Western medicine and ideas about atopic dermatitis (AD) have become popular in many Asian countries, local beliefs about the disease and its treatment often prevail. The multi- racial background of these countries as well as the influence of the diverse religions (such as Taoism and Ramadan) in these regions often lead to diverse belief systems about the causes of AD (such as the Chi concept, also known as the balance of yin and yang) and the types of treatment (e.g. herbal remedies, topical versus concoctions, and decoctions). In addition, many of the cultural practices are preserved among the Southeast Asian minorities residing in the United Kingdom and North America. Eastern treatments typically take a holistic approach to AD and emphasize the psychosomatic component of the disorder. This overview provides a summary of the difference between conventional, complementary, alternative, and integrative medicine in terms of epidemiology, aetiology, therapy, and prognosis in children with AD. There are a number of similarities in genetic and environmental factors in epidemiology and aetiology; however, differences exist in terms of the concept of management. Complementary and alternative medicine, traditional Chinese medicine, and integrative medicine usage are not only prevalent among the Asian population but are also becoming more popular and accepted in Western societies.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shenzhou, Hong Kong.,Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Samantha Chu
- Faculty of Medicine, The Chinese University of Hong Kong, Shenzhou, Hong Kong
| | - Alexander K C Leung
- Department of Paediatrics, The University of Calgary, and The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alex Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
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23
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Dvornyk V, Ponomarenko I, Belyaeva T, Reshetnikov E, Churnosov M. Filaggrin gene polymorphisms are associated with atopic dermatitis in women but not in men in the Caucasian population of Central Russia. PLoS One 2021; 16:e0261026. [PMID: 34882715 PMCID: PMC8659355 DOI: 10.1371/journal.pone.0261026] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background and purpose This study aimed to analyze the gender-specific association of the filaggrin (FLG) gene polymorphisms with atopic dermatitis (AD) in Caucasians from the central region of Russia. Methods The study sample consisted of 906 female (including 474 patients with AD and 432 controls) and 406 male (such as 226 patients with AD and 180 controls) participants. Genotyping of ten polymorphisms of the FLG gene was done. The logistic regression was used to analyze the associations. A total of 125 SNPs (seven AD-associated SNPs and 118 proxy SNPs, r2≥0.8) FLG gene were used for the in silico functional annotation analysis in the females. Results Significant associations were identified between seven SNPs of the FLG gene (rs12130219, rs61816761, rs558269137, rs12144049, rs3126085, rs471144, rs6661961) and AD in females: rs12144049 was associated independent individually (for allele C OR = 1.71, 95%Сl 1.19–2.46, рperm = 0.004 and OR = 1.76, 95%Сl 1.18–2.63, рperm = 0.006 according to the additive and dominant genetic models, respectively) and seven SNPs of the FLG gene within 14 haplotypes. Haplotype GGT [rs61816761-rs3126085-rs12144049] showed the strongest association (OR = 0.55, рperm = 0.001). No association between the analyzed SNPs and AD was determined in the male group. The subsequent bioinformatic analysis predicted the SNPs of the FLG gene that possessed epigenetic and non-synonymous effects, were involved in the control of gene expression and alternative splicing of genes that contribute to AD pathophysiology. Conclusion Polymorphisms of the FLG gene are associated with AD in females but not in males in the Caucasian population of Central Russia.
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Affiliation(s)
- Volodymyr Dvornyk
- Department of Life Sciences, College of Science and General Studies, Alfaisal University, Riyadh, Saudi Arabia
| | - Irina Ponomarenko
- Department of Medical Biological Disciplines, Belgorod State University, Belgorod, Russia
| | - Tatyana Belyaeva
- Department of Medical Biological Disciplines, Belgorod State University, Belgorod, Russia
| | - Evgeny Reshetnikov
- Department of Medical Biological Disciplines, Belgorod State University, Belgorod, Russia
- * E-mail:
| | - Mikhail Churnosov
- Department of Medical Biological Disciplines, Belgorod State University, Belgorod, Russia
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24
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Singleton H, Hodder A, Boyers D, Doney L, Almilaji O, Heaslip V, Thompson AR, Boyle RJ, Axon E, Van Onselen J, O'Meara S, Roberts A, Ersser SJ. Psychological and educational interventions for managing eczema. Hippokratia 2021. [DOI: 10.1002/14651858.cd014932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Heidi Singleton
- Department of Nursing Science; Bournemouth University; Bournemouth UK
| | - Andrew Hodder
- Department of Dermatology; Royal Cornwall Hospitals NHS Trust; Truro UK
- Department of Dermatology; University Hospitals Dorset; Christchurch UK
| | - Dwayne Boyers
- Health Economics Research Unit; University of Aberdeen; Aberdeen UK
| | - Liz Doney
- Cochrane Skin, Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | - Orouba Almilaji
- Department of Medical Science and Public Health; Bournemouth University; Bournemouth UK
| | - Vanessa Heaslip
- Department of Nursing Science; Bournemouth University; Bournemouth UK
| | - Andrew R Thompson
- South Wales Clinical Psychology Training Programme; Cardiff and Vale University Health Board & Cardiff University; Cardiff UK
| | - Robert J Boyle
- Cochrane Skin, Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
- National Heart & Lung Institute, Section of Inflammation and Repair; Imperial College London; London UK
| | - Emma Axon
- Cochrane Skin, Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | | | | | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema; Nottingham UK
| | - Steven J Ersser
- Department of Nursing Science; Bournemouth University; Bournemouth UK
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25
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Maintz L, Welchowski T, Herrmann N, Brauer J, Kläschen AS, Fimmers R, Schmid M, Bieber T, Schmid-Grendelmeier P, Traidl-Hoffmann C, Akdis C, Lauener R, Brüggen MC, Rhyner C, Bersuch E, Renner E, Reiger M, Dreher A, Hammel G, Luschkova D, Lang C. Machine Learning-Based Deep Phenotyping of Atopic Dermatitis: Severity-Associated Factors in Adolescent and Adult Patients. JAMA Dermatol 2021; 157:1414-1424. [PMID: 34757407 DOI: 10.1001/jamadermatol.2021.3668] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Atopic dermatitis (AD) is the most common chronic inflammatory skin disease and is driven by a complex pathophysiology underlying highly heterogeneous phenotypes. Current advances in precision medicine emphasize the need for stratification. Objective To perform deep phenotyping and identification of severity-associated factors in adolescent and adult patients with AD. Design, Setting, and Participants Cross-sectional data from the baseline visit of a prospective longitudinal study investigating the phenotype among inpatients and outpatients with AD from the Department of Dermatology and Allergy of the University Hospital Bonn enrolled between November 2016 and February 2020. Main Outcomes and Measures Patients were stratified by severity groups using the Eczema Area and Severity Index (EASI). The associations of 130 factors with AD severity were analyzed applying a machine learning-gradient boosting approach with cross-validation-based tuning as well as multinomial logistic regression. Results A total of 367 patients (157 male [42.8%]; mean [SD] age, 39 [17] years; 94% adults) were analyzed. Among the participants, 177 (48.2%) had mild disease (EASI ≤7), 120 (32.7%) had moderate disease (EASI >7 and ≤ 21), and 70 (19.1%) had severe disease (EASI >21). Atopic stigmata (cheilitis: odds ratio [OR], 8.10; 95% CI, 3.35-10.59; white dermographism: OR, 4.42; 95% CI, 1.68-11.64; Hertoghe sign: OR, 2.75; 95% CI, 1.27-5.93; nipple eczema: OR, 4.97; 95% CI, 1.56-15.78) was associated with increased probability of severe AD, while female sex was associated with reduced probability (OR, 0.30; 95% CI, 0.13-0.66). The probability of severe AD was associated with total serum immunoglobulin E levels greater than 1708 IU/mL and eosinophil values greater than 6.8%. Patients aged 12 to 21 years or older than 52 years had an elevated probability of severe AD; patients aged 22 to 51 years had an elevated probability of mild AD. Age at AD onset older than 12 years was associated with increased probability of severe AD up to a peak at 30 years; age at onset older than 33 years was associated with moderate to severe AD; and childhood onset was associated with mild AD (peak, 7 years). Lifestyle factors associated with severe AD were physical activity less than once per week and (former) smoking. Alopecia areata was associated with moderate (OR, 5.23; 95% CI, 1.53-17.88) and severe (OR, 4.67; 95% CI, 1.01-21.56) AD. Predictive performance of machine learning-gradient boosting vs multinomial logistic regression differed only slightly (mean multiclass area under the curve value: 0.71 [95% CI, 0.69-0.72] vs 0.68 [0.66-0.70], respectively). Conclusions and Relevance The associations found in this cross-sectional study among patients with AD might contribute to a deeper disease understanding, closer monitoring of predisposed patients, and personalized prevention and therapy.
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Affiliation(s)
- Laura Maintz
- Department of Dermatology and Allergy, University Hospital Bonn, Venusberg-Campus 1, Germany.,Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | - Thomas Welchowski
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland.,Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg-Campus 1, Germany
| | - Nadine Herrmann
- Department of Dermatology and Allergy, University Hospital Bonn, Venusberg-Campus 1, Germany.,Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | - Juliette Brauer
- Department of Dermatology and Allergy, University Hospital Bonn, Venusberg-Campus 1, Germany.,Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | - Anna Sophie Kläschen
- Department of Dermatology and Allergy, University Hospital Bonn, Venusberg-Campus 1, Germany.,Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | - Rolf Fimmers
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg-Campus 1, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg-Campus 1, Germany
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital Bonn, Venusberg-Campus 1, Germany.,Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | | | - Peter Schmid-Grendelmeier
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland.,Allergy Unit, Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
| | - Claudia Traidl-Hoffmann
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland.,Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.,Institute of Environmental Medicine, Helmholtz Zentrum Muenchen, Augsburg, Germany
| | - Cezmi Akdis
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland.,Swiss Institute of Allergy and Asthma Research (SIAF), Davos, Switzerland
| | - Roger Lauener
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland.,Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Marie-Charlotte Brüggen
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland.,Allergy Unit, Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zurich, Zürich, Switzerland
| | - Claudio Rhyner
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | - Eugen Bersuch
- Allergy Unit, Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
| | - Ellen Renner
- Translational Immunology in Environmental Medicine, School of Medicine, Technical University of Munich, Munich, Germany.,Hochgebirgsklinik Davos, Davos, Switzerland
| | - Matthias Reiger
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland.,Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.,Institute of Environmental Medicine, Helmholtz Zentrum Muenchen, Augsburg, Germany
| | - Anita Dreher
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | - Gertrud Hammel
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland.,Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.,Institute of Environmental Medicine, Helmholtz Zentrum Muenchen, Augsburg, Germany
| | - Daria Luschkova
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland.,Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.,Institute of Environmental Medicine, Helmholtz Zentrum Muenchen, Augsburg, Germany
| | - Claudia Lang
- Allergy Unit, Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
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26
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Immunological Targets of Biologic Drugs in Allergic Skin Diseases in Children. Biomedicines 2021; 9:biomedicines9111615. [PMID: 34829844 PMCID: PMC8616006 DOI: 10.3390/biomedicines9111615] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/25/2022] Open
Abstract
Atopic dermatitis and urticaria are two invalidating skin disorders that are very common in children. Recent advances in the understanding of their specific intracellular molecular pathways have permitted the development of precise biological molecules, targeting inflammatory mediators and arresting the pathogenetic pathways of skin diseases. Many biologics with promising results have been studied, although few are currently approved in children. In this review, we aim to provide the latest evidence about the use, indications, efficacy and safety of biologic therapies to treat atopic dermatitis and chronic urticaria in children and adolescents.
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27
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Nomura T, Kabashima K. Advances in Atopic Dermatitis in 2019-2020: Endotypes from skin barrier, ethnicity, properties of antigen, cytokine profiles, microbiome, and engagement of immune cells. J Allergy Clin Immunol 2021; 148:1451-1462. [PMID: 34756922 DOI: 10.1016/j.jaci.2021.10.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022]
Abstract
Key research advances in atopic dermatitis (AD) suggest the complexity of its endotypes. A comprehensive serum biomarker panel revealed at least four types of AD. Some represent classic TH2-dominant AD with filaggrin mutations commonly reported in Europeans, a simultaneously activated multipolar axes of cytokines often reported in Asians, and an intrinsic type characterized by TH2-inferiority. Innate lymphoid cells, including NK cells, NKT cells, and fibroblasts, play a role in AD development and heterogeneity. Here, we discuss the endotypes of AD from the perspective of antigen types (hapten vs. protein antigens), barrier function, and a novel set of immune cells. Endotypic stratification of AD may lead to the development of customized therapeutic strategies in the future.
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Affiliation(s)
- Takashi Nomura
- Department of Dermatology, Faculty of Medicine, Kyoto University 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kenji Kabashima
- Department of Dermatology, Faculty of Medicine, Kyoto University 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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28
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Chan LN, Magyari A, Ye M, Al-Alusi NA, Langan SM, Margolis D, McCulloch CE, Abuabara K. The epidemiology of atopic dermatitis in older adults: A population-based study in the United Kingdom. PLoS One 2021; 16:e0258219. [PMID: 34614025 PMCID: PMC8494374 DOI: 10.1371/journal.pone.0258219] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/21/2021] [Indexed: 01/06/2023] Open
Abstract
Background Atopic dermatitis is known to be common among children, but there are few studies examining the epidemiology across the life course. In particular, there is a paucity of data on atopic dermatitis among older adults. Objective To evaluate participant characteristics, patterns of disease activity and severity, and calendar trends in older adult atopic dermatitis in comparison to other age groups in a large population-based cohort. Methods This was a cohort study of 9,154,936 individuals aged 0–99 years registered in The Health Improvement Network, a database comprised of electronic health records from general practices in the United Kingdom between 1994 and 2013. Atopic dermatitis was defined by a previously validated algorithm using a combination of at least one recorded atopic dermatitis diagnostic code in primary care and two atopic dermatitis therapies recorded on separate days. Cross-sectional analyses of disease prevalence were conducted at each age. Logistic mixed effect regression models were used to identify predictors of prevalent disease over time among children (0–17 years), adults (18–74 years), and older adults (75–99 years). Results Physician-diagnosed atopic dermatitis was identified in 894,454 individuals with the following proportions in each age group: 18.3% of children, 7.7% of adults, and 11.6% of older adults. Additionally, atopic dermatitis prevalence increased across the 2-decade period (beta from linear regression test for trend in the change in proportion per year = 0.005, p = 0.044). In older adults, atopic dermatitis was 27% less common among females (adjusted OR 0.73, 95% CI 0.70–0.76) and was more likely to be active (59.7%, 95% CI 59.5–59.9%) and of higher severity (mean annual percentage with moderate and severe disease: 31.8% and 3.0%, respectively) than in other age groups. Conclusion In a large population-based cohort, the prevalence of physician-diagnosed atopic dermatitis has increased throughout adulthood and was most common among males age 75 years and above. Compared to children ages 0–17 and adults ages 18–74, older adult atopic dermatitis was more active and severe. Because the prevalence of atopic dermatitis among older adults has increased over time, additional characterization of disease triggers and mechanisms and targeted treatment recommendations are needed for this population.
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Affiliation(s)
- Leslie N Chan
- School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Alexa Magyari
- University of California Berkeley, Berkeley, California, United States of America
| | - Morgan Ye
- Department of Dermatology, University of California San Francisco, San Francisco, California, United States of America
| | - Noor A Al-Alusi
- School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Sinead M Langan
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England, United Kingdom
| | - David Margolis
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, California, United States of America
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29
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Abuabara K, Ye M, Margolis DJ, McCulloch CE, Mulick AR, Silverwood RJ, Sullivan A, Williams HC, Langan SM. Patterns of Atopic Eczema Disease Activity From Birth Through Midlife in 2 British Birth Cohorts. JAMA Dermatol 2021; 157:1191-1199. [PMID: 34468687 DOI: 10.1001/jamadermatol.2021.2489] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Atopic eczema is characterized by a heterogenous waxing and waning course, with variable age of onset and persistence of symptoms. Distinct patterns of disease activity such as early-onset/resolving and persistent disease have been identified throughout childhood; little is known about patterns into adulthood. Objective This study aimed to identify subtypes of atopic eczema based on patterns of disease activity through mid-adulthood, to examine whether early life risk factors and participant characteristics are associated with these subtypes, and to determine whether subtypes are associated with other atopic diseases and general health in mid-adulthood. Design, Setting, and Participants This study evaluated members of 2 population-based birth cohorts, the 1958 National Childhood Development Study (NCDS) and the 1970 British Cohort Study (BCS70). Participant data were collected over the period between 1958 and 2016. Data were analyzed over the period between 2018 and 2020. Main Outcomes and Measures Subtypes of atopic eczema were identified based on self-reported atopic eczema period prevalence at multiple occasions. These subtypes were the outcome in models of early life characteristics and an exposure variable in models of midlife health. Results Latent class analysis identified 4 subtypes of atopic eczema with distinct patterns of disease activity among 15 939 individuals from the NCDS (51.4% male, 75.4% White) and 14 966 individuals from the BCS70 (51.6% male, 78.8% White): rare/no (88% to 91%), decreasing (4%), increasing (2% to 6%), and persistently high (2% to 3%) probability of reporting prevalent atopic eczema with age. Sex at birth and early life factors, including social class, region of residence, tobacco smoke exposure, and breastfeeding, predicted differences between the 3 atopic eczema subtypes and the infrequent/no atopic eczema group, but only female sex differentiated the high and decreasing probability subtypes (odds ratio [OR], 1.99; 95% CI, 1.66-2.38). Individuals in the high subtype were most likely to experience asthma and rhinitis, and those in the increasing subtype were at higher risk of poor self-reported general (OR, 1.29; 95% CI, 1.09-1.53) and mental (OR 1.45; 95% CI, 1.23-1.72) health in midlife. Conclusions and Relevance The findings of this cohort study suggest that extending the window of observation beyond childhood may reveal clear subtypes of atopic eczema based on patterns of disease activity. A newly identified subtype with increasing probability of activity in adulthood warrants additional attention given observed associations with poor self-reported health in midlife.
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Affiliation(s)
- Katrina Abuabara
- Program for Clinical Research, Department of Dermatology, University of California School of Medicine, San Francisco
| | - Morgan Ye
- Program for Clinical Research, Department of Dermatology, University of California School of Medicine, San Francisco
| | - David J Margolis
- Center for Epidemiology and Biostatistics, Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California School of Medicine, San Francisco
| | - Amy R Mulick
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Richard J Silverwood
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, United Kingdom
| | - Alice Sullivan
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, United Kingdom
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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30
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Traidl S, Roesner L, Zeitvogel J, Werfel T. Eczema herpeticum in atopic dermatitis. Allergy 2021; 76:3017-3027. [PMID: 33844308 DOI: 10.1111/all.14853] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023]
Abstract
Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases leading to pruritic skin lesions. A subset of AD patients exhibits a disseminated severe HSV infection called eczema herpeticum (EH) that can cause life-threatening complications. This review gives an overview of the clinical picture, and characteristics of the patients as well as the diagnosis and therapy of EH. A special focus lies on the pathophysiological hallmarks identified so far that predispose for EH. This aspect covers genetic aberrations, immunological changes, and environmental influences displaying a complex multifactorial situation, which is not completely understood. Type 2 skewing of virus-specific T cells in ADEH+ patients has been implicated in immune profile abnormalities, along with impaired functions of dendritic cells and natural killer cells. Furthermore, aberrations in interferon pathway-related genes such as IFNG and IFNGR1 have been identified to increase the risk of EH. IL-4, IL-25, and thymic stromal lymphopoietin (TSLP) are overexpressed in EH, whereas antimicrobial peptides like human β-defensins and LL-37 are reduced. Concerning the epidermal barrier, single nucleotide polymorphisms (SNPs) in skin barrier proteins such as filaggrin were identified in ADEH+ patients. A dysbalance of the skin microbiome also contributes to EH due to an increase of Staphylococcus aureus, which provides a supporting role to the viral infection via secreted toxins such as α-toxin. The risk of EH is reduced in AD patients treated with dupilumab. Further research is needed to identify and specifically target risk factors for EH in AD patients.
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Affiliation(s)
- Stephan Traidl
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
- Cluster of Excellence RESIST (EXC 2155) Hannover Medical School Hannover Germany
| | - Lennart Roesner
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
- Cluster of Excellence RESIST (EXC 2155) Hannover Medical School Hannover Germany
| | - Jana Zeitvogel
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
- Cluster of Excellence RESIST (EXC 2155) Hannover Medical School Hannover Germany
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
- Cluster of Excellence RESIST (EXC 2155) Hannover Medical School Hannover Germany
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31
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Alenius H, Sinkko H, Moitinho-Silva L, Rodriguez E, Broderick C, Alexander H, Reiger M, Hjort Hjelmsø M, Fyhrquist N, Olah P, Bryce P, Smith C, Koning F, Eyerich K, Greco D, van den Bogaard EH, Neumann AU, Traidl-Hoffmann C, Homey B, Flohr C, Bønnelykke K, Stokholm J, Weidinger S. The power and potential of BIOMAP to elucidate host-microbiome interplay in skin inflammatory diseases. Exp Dermatol 2021; 30:1517-1531. [PMID: 34387406 DOI: 10.1111/exd.14446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/02/2021] [Accepted: 08/02/2021] [Indexed: 11/27/2022]
Abstract
The two most common chronic inflammatory skin diseases are atopic dermatitis (AD) and psoriasis. The underpinnings of the remarkable degree of clinical heterogeneity of AD and psoriasis are poorly understood and, as a consequence, disease onset and progression are unpredictable and the optimal type and time-point for intervention are as yet unknown. The BIOMAP project is the first IMI (Innovative Medicines Initiative) project dedicated to investigating the causes and mechanisms of AD and psoriasis and to identify potential biomarkers responsible for the variation in disease outcome. The consortium includes 7 large pharmaceutical companies and 25 non-industry partners including academia. Since there is mounting evidence supporting an important role for microbial exposures and our microbiota as factors mediating immune polarization and AD and psoriasis pathogenesis, an entire work package is dedicated to the investigation of skin and gut microbiome linked to AD or psoriasis. The large collaborative BIOMAP project will enable the integration of patient cohorts, data and knowledge in unprecedented proportions. The project has a unique opportunity with a potential to bridge and fill the gaps between current problems and solutions. This review highlights the power and potential of BIOMAP project in the investigation of microbe-host interplay in AD and psoriasis.
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Affiliation(s)
- Harri Alenius
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77, Stockholm, Sweden.,Human Microbiome Research Program (HUMI), Faculty of Medicine, University of Helsinki, Finland
| | - Hanna Sinkko
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77, Stockholm, Sweden.,Human Microbiome Research Program (HUMI), Faculty of Medicine, University of Helsinki, Finland
| | - Lucas Moitinho-Silva
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.,Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Elke Rodriguez
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Conor Broderick
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Helen Alexander
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Matthias Reiger
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.,Institute of Environmental Medicine, Helmholtz Zentrum München, Augsburg, Germany.,Chair of Environmental Medicine, Technical University Munich, Munich, Germany
| | - Mathis Hjort Hjelmsø
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Fyhrquist
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77, Stockholm, Sweden
| | - Peter Olah
- Department of Dermatology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Department of Dermatology, Venereology and Oncodermatology, Medical Faculty, University of Pécs, Hungary
| | - Paul Bryce
- Type 2 Inflammation & Fibrosis Cluster, Immunology & Inflammation Therapeutic Area, Sanofi US, Cambridge, MA, United States of America
| | - Catherine Smith
- St John's Institute of Dermatology, Kings College London, and Guys and St Thomas' NHS Foundation Trust, 9th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
| | - Frits Koning
- Department of Immunology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Kilian Eyerich
- Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Dario Greco
- Institute of Biotechnology, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ellen H van den Bogaard
- Department of Dermatology, Radboud university medical center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Avidan U Neumann
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.,Institute of Environmental Medicine, Helmholtz Zentrum München, Augsburg, Germany
| | - Claudia Traidl-Hoffmann
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.,Institute of Environmental Medicine, Helmholtz Zentrum München, Augsburg, Germany.,Chair of Environmental Medicine, Technical University Munich, Munich, Germany.,CK CARE, Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.,ZIEL - Institute for Food & Health, Technical University of Munich, Freising-Weihenstephan, Germany
| | - Bernhard Homey
- Department of Dermatology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Food Science, University of Copenhagen, Frederiksberg, Denmark
| | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Margolis DJ, Mitra N, Duke JL, Berna R, Margolis JD, Hoffstad O, Kim BS, Yan AC, Zaenglein AL, Chiesa Fuxench Z, Dinou A, Wasserman J, Tairis N, Mosbruger TL, Ferriola D, Damianos G, Kotsopoulou I, Monos DS. Human leukocyte antigen class-I variation is associated with atopic dermatitis: A case-control study. Hum Immunol 2021; 82:593-599. [PMID: 33875297 PMCID: PMC8238855 DOI: 10.1016/j.humimm.2021.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/23/2021] [Accepted: 04/04/2021] [Indexed: 12/21/2022]
Abstract
Atopic dermatitis (AD) is a common immune-medicated skin disease. Previous studies have explored the relationship between Human Leukocyte Antigen (HLA) allelic variation and AD with conflicting results. The aim was to examine HLA Class I genetic variation, specifically peptide binding groove variation, and associations with AD. A case-control study was designed to evaluate HLA class I allelic variation and binding pocket polymorphisms, using next generation sequencing on 464 subjects with AD and 388 without AD. Logistic regression was used to evaluate associations with AD by estimating odds ratios (95% confidence intervals). Significant associations were noted with susceptibility to AD (B*53:01) and protection from AD (A*01:01, A*02:01, B*07:02 and C*07:02). Evaluation of polymorphic residues in Class I binding pockets revealed six amino acid residues conferring protection against AD: A9F (HLA-A, position 9, phenylalanine) [pocket B/C], A97I [pocket C/E], A152V [pocket E], A156R [pocket D/E], B163E [pocket A] and C116S [pocket F]. These findings demonstrate that specific HLA class I components are associated with susceptibility or protection from AD. Individual amino acid residues are relevant to protection from AD and set the foundation for evaluating potential HLA Class I molecules in complex with peptides/antigens that may initiate or interfere with T-cell responses.
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Affiliation(s)
- D J Margolis
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, Philadelphia, PA, United States; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - N Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, Philadelphia, PA, United States
| | - J L Duke
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - R Berna
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - J D Margolis
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, Philadelphia, PA, United States
| | - O Hoffstad
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, Philadelphia, PA, United States
| | - B S Kim
- Division of Dermatology, Department of Medicine, Center for the Study of Itch, Washington University School of Medicine, St. Louis, MO, United States
| | - A C Yan
- Division of Dermatology, Department of Medicine, Center for the Study of Itch, Washington University School of Medicine, St. Louis, MO, United States
| | - A L Zaenglein
- Departments of Dermatology and Pediatrics, Pennsylvania State University/Hershey Medical Center, Hershey, PA, United States
| | - Z Chiesa Fuxench
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - A Dinou
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - J Wasserman
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - N Tairis
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - T L Mosbruger
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - D Ferriola
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Georgios Damianos
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Ioanna Kotsopoulou
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - D S Monos
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pathology and Laboratory Medicine, Perelman Schools of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
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Traidl S, Werfel T, Traidl-Hoffmann C. Atopic Eczema: Pathophysiological Findings as the Beginning of a New Era of Therapeutic Options. Handb Exp Pharmacol 2021; 268:101-115. [PMID: 34236520 DOI: 10.1007/164_2021_492] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Atopic eczema (AE) is a chronic inflammatory disease hallmarked by intense pruritus and eczematous lesions. It depicts one of the most common skin diseases affecting a major part of children and several percentages of adults.Both pathogenesis and pathophysiology are based on complex orchestrated interactions of skin barrier defects, immunological changes, the environment, and an abundance of other contributing factors. Frequently, AE displays the starting point for other allergic diseases such as allergic asthma and rhinoconjunctivitis. Additionally, the risk of developing food allergy is increased. Furthermore, the disease is accompanied by a susceptibility to bacterial, fungal, and viral infections. The development of new therapies received great impetus by an ample research of the pathophysiological mechanisms, leading to a new era in the treatment of severe atopic eczema due to targeted treatments, e.g. the IL-4R alpha specific monoclonal antibody dupilumab.This article provides an overview of the causative and pathophysiological characteristics, the clinical and diagnostic aspects as well as current and future therapeutical possibilities focusing allergic aspects contributing to the course of the disease.
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Affiliation(s)
- Stephan Traidl
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany. .,Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany.
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.,Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany
| | - Claudia Traidl-Hoffmann
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München-German Research Center for Environmental Health, Augsburg, Germany.,Outpatient Clinic for Environmental Medicine, University Clinic Augsburg, Augsburg, Germany.,Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
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34
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[Dysbalance between the immune system and skin microbiome in chronic inflammatory dermatoses]. Hautarzt 2021; 72:570-577. [PMID: 34136940 DOI: 10.1007/s00105-021-04832-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The skin is an organ frequently affected by chronic diseases. Inflammatory, immune-mediated dermatoses such as atopic dermatitis and psoriasis show a high prevalence as well as a significant impact on the quality of life of those affected. In a large proportion of cases, atopic dermatitis is associated with a marked change in microbial colonization of both clinically healthy and affected skin. In psoriasis, changes to this effect have been described, but clinical relevance remains elusive. AIM In recent years, increasing knowledge has been gained in microbiome research with resulting clinical relevance. The present article deals with the disturbed balance of the immune system and the skin microbiome in chronic inflammatory dermatoses on the basis of atopic dermatitis and psoriasis vulgaris. MATERIALS AND METHODS A literature search was performed in PubMed and Medline databases (entries until 09 April 2021). RESULTS Staphylococcus aureus is known to play a central pathophysiological role in atopic dermatitis. This is revisited in light of new insights regarding biodiversity and immunoregulatory processes. In psoriasis, a more heterogeneous body of data emerges regarding the microbiome and its contribution to disease development. DISCUSSION While topical applications to directly influence the microbiome are already being tested in atopic dermatitis, further knowledge regarding the pathophysiological significance of the microbiota is still needed in psoriasis.
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35
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Bocheva GS, Slominski RM, Slominski AT. Immunological Aspects of Skin Aging in Atopic Dermatitis. Int J Mol Sci 2021; 22:ijms22115729. [PMID: 34072076 PMCID: PMC8198400 DOI: 10.3390/ijms22115729] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 12/13/2022] Open
Abstract
The cutaneous immune response is important for the regulation of skin aging well as for the development of immune-mediated skin diseases. Aging of the human skin undergoes immunosenescence with immunological alterations and can be affected by environmental stressors and internal factors, thus leading to various epidermal barrier abnormalities. The dysfunctional epidermal barrier, immune dysregulation, and skin dysbiosis in the advanced age, together with the genetic factors, facilitate the late onset of atopic dermatitis (AD) in the elderly, whose cases have recently been on the rise. Controversial to the healthy aged skin, where overproduction of many cytokines is found, the levels of Th2/Th22 related cytokines inversely correlated with age in the skin of older AD patients. As opposed to an endogenously aged skin, the expression of the terminal differentiation markers significantly increases with age in AD. Despite the atenuated barrier disturbances in older AD patients, the aged skin carries an impairment associated with the aging process, which reflects the persistence of AD. The chronicity of AD in older patients might not directly affect skin aging but does not allow spontaneous remission. Thus, adult- and elderly subtypes of AD are considered as a lifelong disease.
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Affiliation(s)
- Georgeta St. Bocheva
- Department of Pharmacology and Toxicology, Medical University of Sofia, 1431 Sofia, Bulgaria
- Correspondence: (G.S.B.); (A.T.S.)
| | - Radomir M. Slominski
- Division of Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Andrzej T. Slominski
- Department of Dermatology, Comprehensive Cancer Center, Cancer Chemoprevention Program, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Veteran Administration Medical Center, Birmingham, AL 35294, USA
- Correspondence: (G.S.B.); (A.T.S.)
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36
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Biologics for Treatment of Atopic Dermatitis: Current Status and Future Prospect. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:1053-1065. [PMID: 33685604 DOI: 10.1016/j.jaip.2020.11.034] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/16/2022]
Abstract
Atopic dermatitis (AD) is a common inflammatory skin disease characterized by intense pruritus and recurrent eczematous lesions that significantly impair quality of life. It is a heterogeneous disease affecting both children and adults. The treatment of moderate-to-severe forms of AD is challenging, as topical corticosteroids are often insufficient to achieve disease control or inappropriate and off-label use of immunosuppressants may have significant undesirable side effects. The development of targeted biologic therapies specifically for AD is thus highly desirable. Dupilumab is the only biologic therapy that is Food and Drug Administration approved for the treatment of moderate-to-severe AD in patients 6 years and older, with consistent long-term efficacy and safety trial data. In this article, we review the mechanisms, safety, and efficacy of dupilumab from recent clinical trials, and we review the current data, mechanism of action, clinical efficacy, and limitations of new biologics currently in phase 2 and 3 clinical trials (lebrikizumab, tralokinumab, nemolizumab, tezepelumab, and ISB 830).
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37
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Toron F, Neary MP, Smith TW, Gruben D, Romero W, Cha A, Patel K, Vasileva SZ, Ameen M. Clinical and Economic Burden of Mild-to-Moderate Atopic Dermatitis in the UK: A Propensity-Score-Matched Case-Control Study. Dermatol Ther (Heidelb) 2021; 11:907-928. [PMID: 33846907 PMCID: PMC8163940 DOI: 10.1007/s13555-021-00519-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/24/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction The burden of mild-to-moderate atopic dermatitis (AD) in the United Kingdom (UK) is not well understood. Long-lasting AD flares may lead to systemic inflammation resulting in reversible progression from mild to more severe AD. This study aimed to assess the clinical and economic burden of mild-to-moderate AD in the UK. Methods AD patients were identified in the Health Improvement Network (THIN) from 2013 to 2017 and propensity score matched to non-AD controls by demographics. Patients were identified based on continuous disease activity using validated algorithms and sufficient patient status to fully validate data integrity for the entire period. Mild-to-moderate AD patients were identified by using treatment as a surrogate. Demographics, clinical characteristics and healthcare resource use (HCRU) were obtained from THIN. Literature reviews were conducted to obtain additional outcomes. A cost-of-illness model was developed to extrapolate the burden in 2017 to the UK population and in subsequent years (2018–2022). Results In 2017, the prevalence of mild-to-moderate AD in THIN was 1.28%. These patients reported higher comorbidity rates and significantly higher (p < 0.0001) HCRU, encompassing mean general practitioner visits (5.57 versus 3.59), AD-related prescriptions (5.85 versus 0.68) and total referrals (0.97 versus 0.82) versus matched non-AD controls. The model projected total HCRU and drug excess costs of €462.99M over the 5 years. The excess cost decreased to €417.35M after excluding patients on very potent topical corticosteroids, who most likely had at least moderate disease. The excess costs increased to €1.21B and €7.06B when considering comorbidity burden and productivity losses, respectively. Conclusion Mild-to-moderate AD patients had higher comorbidity burden, HCRU and cost compared with matched non-AD controls. Overall, UK country-based economic burden was high given partly the high prevalence of this disease. Moreover, productivity burden and comorbidities had considerable impact on the economic burden, which further suggests the importance of optimal disease management. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00519-7.
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Affiliation(s)
- Farah Toron
- Health Economics and Outcomes Research, Real World Solutions, IQVIA, 210 Pentonville Road, London, N1 9JY, UK
| | - Maureen P Neary
- Inflammation & Immunology, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Timothy W Smith
- Inflammation & Immunology, Pfizer Inc, New York, New York, USA
| | - David Gruben
- Global Biometrics and Data Management (Statistics), Pfizer Inc, Groton, Connecticut, USA
| | | | - Amy Cha
- Inflammation & Immunology, Pfizer Inc, New York, New York, USA
| | - Keyur Patel
- Health Economics and Outcomes Research, Real World Solutions, IQVIA, 210 Pentonville Road, London, N1 9JY, UK
| | - Simona Z Vasileva
- Health Economics and Outcomes Research, Real World Solutions, IQVIA, 210 Pentonville Road, London, N1 9JY, UK.
| | - Mahreen Ameen
- Royal Free London National Health Services Foundation Trust, London, UK
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38
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Capucci S, Hahn-Pedersen J, Vilsbøll A, Kragh N. Impact of Atopic Dermatitis and Chronic Hand Eczema on Quality of Life Compared With Other Chronic Diseases. Dermatitis 2021; 31:178-184. [PMID: 32404625 DOI: 10.1097/der.0000000000000598] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
: The aim of this study was to conduct 3 literature reviews to examine the impact of atopic dermatitis (AD) and chronic hand eczema (CHE) on health-related quality of life (HRQoL) compared with other chronic conditions by comparing reported utility scores of 4 commonly used generic HRQoL instruments. A systematic search was performed using PubMed, ScienceDirect, MEDLINE, EMBASE, Health Technology Assessment database, and ScHARRHUD. Inclusion criteria included, but were not limited to, patients of any age, studies from any location, publications reporting utility data based on EuroQoL 5 dimensions, the EuroQoL 5-dimension Visual Analog Scale, the Short-Form Health Survey, and the Short-Form 6 Dimensions in the English language. Inclusion criteria were met by 16 articles for AD, 25 articles for chronic conditions, and 9 articles for CHE. The findings of this review highlight that the disutility and loss in HRQoL of patients with AD and CHE are similar to or higher than other chronic conditions, such as cancer or hepatitis.
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Affiliation(s)
- Silvia Capucci
- From the SDA Bocconi School of Management, Bocconi University, Milan, Italy
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39
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de Lusignan S, Alexander H, Broderick C, Dennis J, McGovern A, Feeney C, Flohr C. The epidemiology of eczema in children and adults in England: A population-based study using primary care data. Clin Exp Allergy 2021; 51:471-482. [PMID: 33179341 PMCID: PMC7984097 DOI: 10.1111/cea.13784] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/12/2020] [Accepted: 11/04/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Whilst eczema is a common inflammatory skin condition, we lack contemporary estimates of disease incidence and prevalence across the lifespan. OBJECTIVE To estimate the incidence and prevalence of eczema in children and adults in England and variation by sociodemographic factors (sex, socio-economic status, ethnicity, and geography). METHODS We used the Royal College of General Practitioners Research and Surveillance Centre primary care research database of 3.85 million children and adults registered with participating general practitioner practices between 2009 and 2018 inclusive. Eczema incidence was defined as the first-ever diagnosis of eczema recorded in the primary care record, and eczema prevalence was defined as fulfilment of criteria for active eczema (two eczema records appearing in the primary care record within any one-year period). RESULTS Eczema incidence was highest in infants younger than 1 year (15.0 per 100 person-years), lowest in adults aged 40-49 (0.35 p/100 person-years), and increased from middle age to a second smaller peak in people 80 years or older (0.79 p/100 person-years). Eczema prevalence was highest in children aged 2 (16.5%) and lowest in adults aged 30-39 (2.8%). Eczema incidence was higher in male infants (<2) and male adults older than 70; for all other ages, incidence was higher in females. Eczema was more common in Asian and black ethnic groups than in people of white ethnicity. Higher socio-economic status was associated with a greater incidence of eczema in infants younger than 2, but the reverse was seen for all other age groups. Both incidence and prevalence of eczema were greater in urban settings and in North-West England. CONCLUSIONS AND CLINICAL RELEVANCE Eczema has a bimodal distribution across the lifespan. We observed differences in incidence and prevalence of eczema by ethnicity, geography, sex, and socio-economic status, which varied in magnitude throughout life.
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Affiliation(s)
- Simon de Lusignan
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
- Royal College of General Practitioners Research and Surveillance CentreLondonUK
| | - Helen Alexander
- Unit for Population‐Based Dermatology Research, St John's Institute of Dermatology, Guy's & Thomas' NHS Foundation Trust and King's College LondonLondonUK
| | - Conor Broderick
- Unit for Population‐Based Dermatology Research, St John's Institute of Dermatology, Guy's & Thomas' NHS Foundation Trust and King's College LondonLondonUK
| | | | | | | | - Carsten Flohr
- Unit for Population‐Based Dermatology Research, St John's Institute of Dermatology, Guy's & Thomas' NHS Foundation Trust and King's College LondonLondonUK
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Kelleher MM, Cro S, Cornelius V, Lodrup Carlsen KC, Skjerven HO, Rehbinder EM, Lowe AJ, Dissanayake E, Shimojo N, Yonezawa K, Ohya Y, Yamamoto-Hanada K, Morita K, Axon E, Surber C, Cork M, Cooke A, Tran L, Van Vogt E, Schmitt J, Weidinger S, McClanahan D, Simpson E, Duley L, Askie LM, Chalmers JR, Williams HC, Boyle RJ. Skin care interventions in infants for preventing eczema and food allergy. Cochrane Database Syst Rev 2021; 2:CD013534. [PMID: 33545739 PMCID: PMC8094581 DOI: 10.1002/14651858.cd013534.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Eczema and food allergy are common health conditions that usually begin in early childhood and often occur together in the same people. They can be associated with an impaired skin barrier in early infancy. It is unclear whether trying to prevent or reverse an impaired skin barrier soon after birth is effective in preventing eczema or food allergy. OBJECTIVES Primary objective To assess effects of skin care interventions, such as emollients, for primary prevention of eczema and food allergy in infants Secondary objective To identify features of study populations such as age, hereditary risk, and adherence to interventions that are associated with the greatest treatment benefit or harm for both eczema and food allergy. SEARCH METHODS We searched the following databases up to July 2020: Cochrane Skin Specialised Register, CENTRAL, MEDLINE, and Embase. We searched two trials registers and checked reference lists of included studies and relevant systematic reviews for further references to relevant randomised controlled trials (RCTs). We contacted field experts to identify planned trials and to seek information about unpublished or incomplete trials. SELECTION CRITERIA RCTs of skin care interventions that could potentially enhance skin barrier function, reduce dryness, or reduce subclinical inflammation in healthy term (> 37 weeks) infants (0 to 12 months) without pre-existing diagnosis of eczema, food allergy, or other skin condition were included. Comparison was standard care in the locality or no treatment. Types of skin care interventions included moisturisers/emollients; bathing products; advice regarding reducing soap exposure and bathing frequency; and use of water softeners. No minimum follow-up was required. DATA COLLECTION AND ANALYSIS This is a prospective individual participant data (IPD) meta-analysis. We used standard Cochrane methodological procedures, and primary analyses used the IPD dataset. Primary outcomes were cumulative incidence of eczema and cumulative incidence of immunoglobulin (Ig)E-mediated food allergy by one to three years, both measured by the closest available time point to two years. Secondary outcomes included adverse events during the intervention period; eczema severity (clinician-assessed); parent report of eczema severity; time to onset of eczema; parent report of immediate food allergy; and allergic sensitisation to food or inhalant allergen. MAIN RESULTS This review identified 33 RCTs, comprising 25,827 participants. A total of 17 studies, randomising 5823 participants, reported information on one or more outcomes specified in this review. Eleven studies randomising 5217 participants, with 10 of these studies providing IPD, were included in one or more meta-analysis (range 2 to 9 studies per individual meta-analysis). Most studies were conducted at children's hospitals. All interventions were compared against no skin care intervention or local standard care. Of the 17 studies that reported our outcomes, 13 assessed emollients. Twenty-five studies, including all those contributing data to meta-analyses, randomised newborns up to age three weeks to receive a skin care intervention or standard infant skin care. Eight of the 11 studies contributing to meta-analyses recruited infants at high risk of developing eczema or food allergy, although definition of high risk varied between studies. Durations of intervention and follow-up ranged from 24 hours to two years. We assessed most of this review's evidence as low certainty or had some concerns of risk of bias. A rating of some concerns was most often due to lack of blinding of outcome assessors or significant missing data, which could have impacted outcome measurement but was judged unlikely to have done so. Evidence for the primary food allergy outcome was rated as high risk of bias due to inclusion of only one trial where findings varied when different assumptions were made about missing data. Skin care interventions during infancy probably do not change risk of eczema by one to two years of age (risk ratio (RR) 1.03, 95% confidence interval (CI) 0.81 to 1.31; moderate-certainty evidence; 3075 participants, 7 trials) nor time to onset of eczema (hazard ratio 0.86, 95% CI 0.65 to 1.14; moderate-certainty evidence; 3349 participants, 9 trials). It is unclear whether skin care interventions during infancy change risk of IgE-mediated food allergy by one to two years of age (RR 2.53, 95% CI 0.99 to 6.47; 996 participants, 1 trial) or allergic sensitisation to a food allergen at age one to two years (RR 0.86, 95% CI 0.28 to 2.69; 1055 participants, 2 trials) due to very low-certainty evidence for these outcomes. Skin care interventions during infancy may slightly increase risk of parent report of immediate reaction to a common food allergen at two years (RR 1.27, 95% CI 1.00 to 1.61; low-certainty evidence; 1171 participants, 1 trial). However, this was only seen for cow's milk, and may be unreliable due to significant over-reporting of cow's milk allergy in infants. Skin care interventions during infancy probably increase risk of skin infection over the intervention period (RR 1.34, 95% CI 1.02 to 1.77; moderate-certainty evidence; 2728 participants, 6 trials) and may increase risk of infant slippage over the intervention period (RR 1.42, 95% CI 0.67 to 2.99; low-certainty evidence; 2538 participants, 4 trials) or stinging/allergic reactions to moisturisers (RR 2.24, 95% 0.67 to 7.43; low-certainty evidence; 343 participants, 4 trials), although confidence intervals for slippages and stinging/allergic reactions are wide and include the possibility of no effect or reduced risk. Preplanned subgroup analyses show that effects of interventions were not influenced by age, duration of intervention, hereditary risk, FLG mutation, or classification of intervention type for risk of developing eczema. We could not evaluate these effects on risk of food allergy. Evidence was insufficient to show whether adherence to interventions influenced the relationship between skin care interventions and risk of developing eczema or food allergy. AUTHORS' CONCLUSIONS Skin care interventions such as emollients during the first year of life in healthy infants are probably not effective for preventing eczema, and probably increase risk of skin infection. Effects of skin care interventions on risk of food allergy are uncertain. Further work is needed to understand whether different approaches to infant skin care might promote or prevent eczema and to evaluate effects on food allergy based on robust outcome assessments.
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Affiliation(s)
- Maeve M Kelleher
- National Heart & Lung Institute, Section of Inflammation and Repair, Imperial College London, London, UK
| | - Suzie Cro
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | | | - Karin C Lodrup Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Håvard O Skjerven
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Eva M Rehbinder
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Eishika Dissanayake
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Naoki Shimojo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Kaori Yonezawa
- Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | | | - Kumiko Morita
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Emma Axon
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Christian Surber
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Michael Cork
- Sheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Alison Cooke
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Lien Tran
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Eleanor Van Vogt
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technischen Universität (TU) Dresden, Dresden, Germany
| | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Scheswig-Holstein, Kiel, Germany
| | - Danielle McClanahan
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Eric Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Lisa M Askie
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Robert J Boyle
- National Heart & Lung Institute, Section of Inflammation and Repair, Imperial College London, London, UK
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Laughter MR, Maymone MBC, Mashayekhi S, Arents BWM, Karimkhani C, Langan SM, Dellavalle RP, Flohr C. The global burden of atopic dermatitis: lessons from the Global Burden of Disease Study 1990-2017. Br J Dermatol 2021; 184:304-309. [PMID: 33006135 DOI: 10.1111/bjd.19580] [Citation(s) in RCA: 206] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Global Burden of Disease (GBD) Study provides an annually updated resource to study disease-related morbidity and mortality worldwide. OBJECTIVES Here we present the burden estimates for atopic dermatitis (AD), including data from inception of the GBD project in 1990 until 2017. METHODS Data on the burden of AD were obtained from the GBD Study. RESULTS Atopic dermatitis (AD) ranks 15th among all nonfatal diseases and has the highest disease burden among skin diseases as measured by disability-adjusted life-years (DALYs). Overall, the global DALY rate for AD in 1990 was 121 [95% uncertainty interval (UI) 65·4-201] and remained similar in 2017 at 123 (95% UI 66·8-205). The three countries with the highest DALY rates of AD were Sweden (327, 95% UI 178-547), the UK (284, 95% UI 155-478) and Iceland (277, 95% UI 149-465), whereas Uzbekistan (85·1, 95% UI 45·2-144), Armenia (85·1, 95% UI 45·8-143) and Tajikistan (85·1, 95% UI 46·1-143) ranked lowest. CONCLUSIONS The global prevalence rate of AD has remained stable from 1990 to 2017. However, the distribution of AD by age groups shows a bimodal curve with the highest peak in early childhood, decreasing in prevalence among young adults, and a second peak in middle-aged and older populations. We also found a moderate positive correlation between a country's gross domestic product and disease burden. GBD data confirm the substantial worldwide burden of AD, which has remained stable since 1990 but shows significant geographical variation. Lifestyle factors, partially linked to affluence, are likely important disease drivers. However, the GBD methodology needs to be developed further to incorporate environmental risk factors, such as ultraviolet exposure, to understand better the geographical and age-related variations in disease burden.
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Affiliation(s)
- M R Laughter
- Department of Dermatology, University of Colorado School of Medicine, Denver, CO, USA
| | - M B C Maymone
- Department of Dermatology, University of Colorado School of Medicine, Denver, CO, USA
| | - S Mashayekhi
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - B W M Arents
- Dutch Association for People with Atopic Dermatitis (VMCE), Nijkerk, the Netherlands
| | - C Karimkhani
- Department of Dermatology, University of Colorado School of Medicine, Denver, CO, USA
| | - S M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - R P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Denver, CO, USA
| | - C Flohr
- Dutch Association for People with Atopic Dermatitis (VMCE), Nijkerk, the Netherlands
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Silverberg JI, Barbarot S, Gadkari A, Simpson EL, Weidinger S, Mina-Osorio P, Rossi AB, Brignoli L, Saba G, Guillemin I, Fenton MC, Auziere S, Eckert L. Atopic dermatitis in the pediatric population: A cross-sectional, international epidemiologic study. Ann Allergy Asthma Immunol 2021; 126:417-428.e2. [PMID: 33421555 DOI: 10.1016/j.anai.2020.12.020] [Citation(s) in RCA: 186] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/14/2020] [Accepted: 12/28/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Little is known on the current global prevalence of atopic dermatitis (AD) in the pediatric population. OBJECTIVE To estimate the real-world global prevalence of AD in the pediatric population and by disease severity. METHODS This international, cross-sectional, web-based survey of children and adolescents (6 months to <18 years old) was conducted in the following 18 countries: North America (Canada, United States), Latin America (Argentina, Brazil, Columbia, Mexico), Europe (France, Germany, Italy, Spain, United Kingdom), Middle East and Eurasia (Israel, Saudi Arabia, Turkey, United Arab Emirates, Russia), and East Asia (Japan, Taiwan). Prevalence was determined using the following 2 definitions: (1) diagnosed as having AD according to the International Study of Asthma and Allergies in Childhood (ISAAC) criteria and self- or parent-report of ever being told by a physician that they or their child child had AD (eczema); and (2) reported AD based on the ISAAC criteria only. Severity was assessed using the Patient Global Assessment (PtGA) and Patient-Oriented Eczema Measure (POEM). RESULTS Among 65,661 responders, the 12-month diagnosed AD prevalence (ISAAC plus self-reported diagnosis) ranged from 2.7% to 20.1% across countries; reported AD (ISAAC only) was 13.5% to 41.9%. Severe AD evaluated with both PtGA and POEM was generally less than 15%; more subjects rated AD as mild on PtGA than suggested by POEM. No trends in prevalence were observed based on age or sex; prevalence was generally lower in rural residential settings than urban or suburban. CONCLUSION This global survey in 18 countries revealed that AD affects a substantial proportion of the pediatric population. Although prevalence and severity varied across age groups and countries, less than 15% had severe AD.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sebastien Barbarot
- Department of Dermatology, Centre Hospitalier Universitaire de Nantes, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - Abhijit Gadkari
- Health Economics and Outcomes Research, Regeneron, Tarrytown, NY, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Stephan Weidinger
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Ana B Rossi
- Medical Affairs, Sanofi Genzyme, Cambridge, MA, USA
| | | | | | | | | | | | - Laurent Eckert
- Real World Evidence, Sanofi Genzyme, Cambridge, MA, USA.
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Arnedo-Pena A, Puig-Barberà J, Artero-Civera A, Romeu-Garcia MA, Meseguer-Ferrer N, Fenollosa-Amposta C, Vizcaino-Batllés A, Silvestre-Silvester E, Pac-Sa MR, Segura-Navas L, Dubón MA, Fabregat-Puerto J, Bellido-Blasco JB. Atopic dermatitis incidence and risk factors in young adults in Castellon (Spain): A prospective cohort study. Allergol Immunopathol (Madr) 2020; 48:694-700. [PMID: 32402624 DOI: 10.1016/j.aller.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 01/29/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION There are few atopic dermatitis (AD) incidence cohort studies in young adults, the etiology of this disease remains obscure, and AD risk factors in adults are not well understood. The objective of this study was to estimate AD ten-year incidence and prevalence in a cohort of adolescent aged 14-16 at inception in Castellon province in Valencia Region, Spain and describe related risk factors. MATERIAL AND METHODS From 2002 to 2012, a population-based prospective cohort study was carried out. Questionnaires from the International Study of Asthma and Allergies in Childhood (ISAAC) were used with an additional questionnaire for related factors completed by participants and their parents, respectively, in 2002. In 2012 the same questionnaires were completed by the participants' through a telephone interview, and incidence and prevalence of AD were estimated. Directed acyclic graphs, Poisson regression and inverse probability weighted regression adjustment were used. RESULTS The participation rate was 79.5% (1435/1805) with AD lifetime prevalence of 34.9% and AD incidence of 13.5 per 1000 person years. Females presented higher prevalence and incidence than males. After adjustment significant risk factors were being female, history of asthma or allergic rhinitis, family history of AD, history of respiratory infections, history of bronchitis, history of pneumonia, history of sinusitis, and birthplace outside Castellon province. The highest AD population attributable risks were female, 30.3%, and history of respiratory infections 15.3%. Differences with AD childhood risk factors were found. CONCLUSIONS AD incidence in our cohort was high and several risks factors were related to AD.
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Affiliation(s)
- A Arnedo-Pena
- Epidemiology Division, Public Health Center, Castelló de la Plana, Spain; Department Health Sciences, Public University Navarra, Pamplona, Spain; CIBER Salud Pública Epidemiología (CIBERESP), Barcelona, Spain.
| | | | | | - M A Romeu-Garcia
- Epidemiology Division, Public Health Center, Castelló de la Plana, Spain
| | - N Meseguer-Ferrer
- Epidemiology Division, Public Health Center, Castelló de la Plana, Spain
| | | | | | | | - M R Pac-Sa
- International Health, Sanidad Exterior, Castelló de la Plana, Spain
| | | | - M A Dubón
- Public Health Center, Castelló de la Plana, Spain
| | | | - J B Bellido-Blasco
- Epidemiology Division, Public Health Center, Castelló de la Plana, Spain; CIBER Salud Pública Epidemiología (CIBERESP), Barcelona, Spain; Department Health Sciences, Universitat Jaume I, Castelló de la Plana, Spain
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44
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Wong A, Frøslev T, Forbes H, Kjærsgaard A, Mulick A, Mansfield K, Silverwood R, Sørensen H, Smeeth L, Schmidt S, Langan S. Partner bereavement and risk of psoriasis and atopic eczema: cohort studies in the U.K. and Denmark. Br J Dermatol 2020; 183:321-331. [PMID: 31782133 PMCID: PMC7496681 DOI: 10.1111/bjd.18740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Stress is commonly cited as a risk factor for psoriasis and atopic eczema, but such evidence is limited. OBJECTIVES To investigate the association between partner bereavement (an extreme life stressor) and psoriasis or atopic eczema. METHODS We conducted cohort studies using data from the U.K. Clinical Practice Research Datalink (1997-2017) and Danish nationwide registries (1997-2016). The exposed cohort was partners who experienced partner bereavement. The comparison cohort was up to 10 nonbereaved partners, matched to each bereaved partner by age, sex, county of residence (Denmark) and general practice (U.K.). Outcomes were the first recorded diagnosis of psoriasis or atopic eczema. We estimated hazard ratios (HRs) and confidence intervals (CIs) using a stratified Cox proportional hazards model in both settings, which were then pooled in a meta-analysis. RESULTS The pooled adjusted HR for the association between bereavement and psoriasis was 1·01 (95% CI 0·98-1·04) across the entire follow-up. Similar results were found in other shorter follow-up periods. Pooled adjusted HRs for the association between bereavement and atopic eczema were 0·97 (95% CI 0·84-1·12) across the entire follow-up, 1·09 (95% CI 0·86-1·38) within 0-30 days, 1·18 (95% CI 1·04-1·35) within 0-90 days, 1·14 (95% CI 1·06-1·22) within 0-365 days and 1·07 (95% CI 1·02-1·12) within 0-1095 days. CONCLUSIONS We found a modest increase in the risk of atopic eczema within 3 years following bereavement, which peaked in the first 3 months. Acute stress may play a role in triggering onset of new atopic eczema or relapse of atopic eczema previously in remission. We observed no evidence for increased long-term risk of psoriasis and atopic eczema following bereavement.
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Affiliation(s)
- A.Y.S. Wong
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
| | - T. Frøslev
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - H.J. Forbes
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
- Health Data Research U.K.LondonU.K
| | - A. Kjærsgaard
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - A. Mulick
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
| | - K. Mansfield
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
| | - R.J. Silverwood
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
- Centre for Longitudinal StudiesDepartment of Social ScienceUniversity College LondonLondonU.K
| | - H.T. Sørensen
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - L. Smeeth
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
- Health Data Research U.K.LondonU.K
| | - S.A.J. Schmidt
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
- Department of DermatologyAarhus University HospitalAarhusDenmark
| | - S.M. Langan
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
- Health Data Research U.K.LondonU.K
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Abstract
Atopic dermatitis is a common inflammatory skin disorder characterised by recurrent eczematous lesions and intense itch. The disorder affects people of all ages and ethnicities, has a substantial psychosocial impact on patients and relatives, and is the leading cause of the global burden from skin disease. Atopic dermatitis is associated with increased risk of multiple comorbidities, including food allergy, asthma, allergic rhinitis, and mental health disorders. The pathophysiology is complex and involves a strong genetic predisposition, epidermal dysfunction, and T-cell driven inflammation. Although type-2 mechanisms are dominant, there is increasing evidence that the disorder involves multiple immune pathways. Currently, there is no cure, but increasing numbers of innovative and targeted therapies hold promise for achieving disease control, including in patients with recalcitrant disease. We summarise and discuss advances in our understanding of the disease and their implications for prevention, management, and future research.
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Affiliation(s)
- Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK; Health Data Research UK, London, UK.
| | - Alan D Irvine
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland; Dermatology, Children's Health Ireland, Crumlin, Ireland; National Children's Research Centre, Dublin, Ireland
| | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
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46
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Abstract
Atopic dermatitis (AD) is a common frequent chronic inflammatory skin disease which begins frequently in infancy. The clinical expression of AD is a recurrent eczema on a dry skin. AD is a multifactorial disease characterized by two linked abnormalities: a skin barrier defect and a cellular inflammation, with type-2 main components. However, the pathophysiology of AD is not as simple as this description looks like. In this review, we will present a synthesis of current knowledge on natural history of AD and the involved factors, in order to clarify AD care. The evolution of AD is associated with many atopic comorbidities, following the "atopic march" scheme: IgE-mediated food allergy, allergic asthma and rhinitis occurring classically after AD. In fact, this is rarely the case, but the atopic march seems to be associated with AD severity. AD has also many neuropsychological complications which are essential to be detected. Other factors could influence the natural history of AD: genetic mutations on different genes (proteins of skin barrier, innate and adaptive immunity pathways), skin dysbiosis with colonization by Staphylococcus aureus, sensitization against environmental proteins. AD treatment is based on the restauration of the skin barrier using emollients and on anti-inflammatory drugs (notably topical corticosteroids) during the inflammatory flares. It is not recommended to treat the skin colonization by S. aureus, excepted in case of skin infection. The probiotics have no efficiency as curative treatment of AD, but could have an interest for the primary prevention, especially in at-risk populations. © 2019 Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- C Braun
- Centre international de recherche en infectiologie (CIRI) (International Center for Infectiology Research), INSERM U1111, CNRS UMR 5308, 21 avenue Tony-Garnier, 69007 Lyon, France; Hospices civils de Lyon, service de pneumologie et allergologie pédiatriques, hôpital Femme-Mère-Enfant, Bron, France.
| | - A Nosbaum
- Centre international de recherche en infectiologie (CIRI) (International Center for Infectiology Research), INSERM U1111, CNRS UMR 5308, 21 avenue Tony-Garnier, 69007 Lyon, France; Hospices civils de Lyon, service d'allergologie et immunologie clinique, centre hospitalier Lyon-Sud, Pierre-Bénite, France
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47
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Progression of acute-to-chronic atopic dermatitis is associated with quantitative rather than qualitative changes in cytokine responses. J Allergy Clin Immunol 2019; 145:1406-1415. [PMID: 31891686 PMCID: PMC7214216 DOI: 10.1016/j.jaci.2019.11.047] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/12/2019] [Accepted: 11/25/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although multiple studies have assessed molecular changes in chronic atopic dermatitis (AD) lesions, little is known about the transition from acute to chronic disease stages, and the factors and mechanisms that shape chronic inflammatory activity. OBJECTIVES We sought to assess the global transcriptome changes that characterize the progression from acute to chronic stages of AD. METHODS We analyzed transcriptome changes in paired nonlesional skin, acute and chronic AD lesions from 11 patients and 38 healthy controls by RNA-sequencing, and conducted in vivo and histological assays to evaluate findings. RESULTS Our data demonstrate that approximately 74% of the genes dysregulated in acute lesions remain or are further dysregulated in chronic lesions, whereas only 34% of the genes dysregulated in chronic lesions are altered already in the acute stage. Nonlesional AD skin exhibited enrichment of TNF, TH1, TH2, and TH17 response genes. Acute lesions showed marked dendritic-cell signatures and a prominent enrichment of TH1, TH2, and TH17 responses, along with increased IL-36 and thymic stromal lymphopoietin expression, which were further heightened in chronic lesions. In addition, genes involved in skin barrier repair, keratinocyte proliferation, wound healing, and negative regulation of T-cell activation showed a significant dysregulation in the chronic versus acute comparison. Furthermore, our data show progressive changes in vasculature and maturation of dendritic-cell subsets with chronicity, with FOXK1 acting as immune regulator. CONCLUSIONS Our results show that the changes accompanying the transition from nonlesional to acute to chronic inflammation in AD are quantitative rather than qualitative, with chronic AD having heightened TH2, TH1, TH17, and IL36 responses and skin barrier repair mechanisms. These findings provide novel insights and highlight underappreciated pathways in AD pathogenesis that may be amenable to therapeutic targeting.
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