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Esposito M, Amicucci G, Salfi F, Pellegrini C, De Berardinis A, Chiricozzi A, Peris K, Tempesta D, Ferrara M, Fargnoli MC. Exploring the interplay of atopic dermatitis severity with sleep and mental health: a case-control study in adult patients. Postgrad Med 2024; 136:533-540. [PMID: 38864389 DOI: 10.1080/00325481.2024.2366162] [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: 01/17/2024] [Accepted: 06/06/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVES Atopic dermatitis (AD) is a chronic inflammatory skin disease often associated with non-atopic comorbidities. Recently, a severity-dependent relationship between AD and sleep/mental health diseases has been proposed. However, few studies investigated these comorbidities and their association with AD severity through validated questionnaires. This study aimed to use a set of validated instruments to assess the impact of AD on sleep and psychological disorders and estimate the association of itch and AD severity with sleep disorders and psychological symptoms, distinguishing between clinical-oriented and patient-oriented measures. METHODS We conducted a case-control study, recruiting 57 adult AD patients (mean age ± std. dev. 34.28 years ± 13.07; 27 males) matched for age and sex with 57 healthy adults (34.39 years ± 13.09; 27 males). To investigate the differences in sleep quality, insomnia, depression, and anxiety between the two groups, we performed independent sample t-Tests. Moreover, we conducted univariate linear regression analyses to examine the relationship between itch and objective/subjective severity of AD and sleep quality, insomnia, and psychological symptoms. RESULTS AD patients reported lower sleep quality (p = 0.002), more severe insomnia (p = 0.006) and depression (p = 0.013), and higher stress levels than healthy adults (p = 0.049). Itch intensity was linked to sleep disturbances and psychological symptoms (R2range = 0.13-0.19, prange = 0.02-<0.001). Objective and subjective AD severity were similarly associated with worse sleep quality (R2 = 0.26, p < 0.001; R2 = 0.24, p < 0.001; respectively), anxiety (R2 = 0.15, p = 0.04; R2 = 0.17, p = 0.001; respectively), and self-perceived stress (R2 = 0.10, p = 0.02; R2 = 0.07, p = 0.049; respectively). However, subjective AD severity was more strongly associated with insomnia (R2 = 0.31, p < 0.001) and depression (R2 = 0.20, p < 0.001) than clinical-oriented AD severity (R2 = 0.19, p < 0.001; R2 = 0.05, p = 0.098; respectively). CONCLUSIONS The study demonstrated poor sleep quality and high levels of insomnia, depression, and stress in AD patients, with an aggravated psychological status for adults with more severe skin disease. We suggest implementing a multidisciplinary approach to AD management/treatment that considers objective and subjective measures of disease severity.
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Affiliation(s)
- Maria Esposito
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- UOSD General and Oncologic Dermatology, San Salvatore Hospital, L'Aquila, Italy
| | - Giulia Amicucci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Federico Salfi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Cristina Pellegrini
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea De Berardinis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea Chiricozzi
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Tempesta
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Ferrara
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- UOSD General and Oncologic Dermatology, San Salvatore Hospital, L'Aquila, Italy
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Wang SH, Liang RL, Yang H, Cai XC, Wang J, Sun XY, Chen JL, Wang CX, Jiang WC, Li X. Electroacupuncture for relieving itching in atopic eczema: study protocol for a multicenter, randomized, sham-controlled trial. Front Med (Lausanne) 2023; 10:1320230. [PMID: 38173936 PMCID: PMC10761491 DOI: 10.3389/fmed.2023.1320230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Background Atopic eczema (AE) is a common atopic inflammatory skin disease affecting 2.1-4.9% of the population in different countries. Pruritus, one of the most burdensome symptoms, is often underestimated for the problems it can cause, creating a vicious loop of itching, scratching, and lichenification. Therefore, further research into practical and safe treatments that relieve itchy symptoms and enhance skin protection is key to overcoming AE. Acupuncture, with or without electrical stimulation, is one of the most commonly used therapeutic measures to treat AE. This trial aimed to objectively evaluate the efficacy and safety of the electroacupuncture (EA) antipruritic technique in AE pruritus and obtain high-level clinical evidence for the popularization and application of EA for AE. Methods and analysis This multicenter, single-blinded, randomized controlled trial is planned to transpire from April 15, 2023, to June 30, 2025. We will recruit 132 participants with AE (44 per group). Participants will be assigned randomly to three equal-sized groups: EA, sham electroacupuncture, and sham acupuncture. Treatment will be administered three times a week during the 2-week intervention phase. The primary outcome measure is the Visual Analog Scale, with a numeric rating scale to evaluate pruritus. Secondary outcome measures include the Eczema Area and Severity Index and Dermatology Life Quality Index. Other outcome measures include physical examination, serum IgE, and safety evaluation. The number, nature, and severity of adverse events will be carefully recorded. Trial registration ClinicalTrials.gov, 22Y11922200. Registered 3 September 2022, https://register.clinicaltrials.gov.
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Affiliation(s)
- Si-han Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Rui-long Liang
- Department of Acupuncture, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Han Yang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-ce Cai
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Jiao Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-ying Sun
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Jia-le Chen
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Chun-xiao Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Wen-cheng Jiang
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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3
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Matthewman J, Mansfield KE, Hayes JF, Adesanya EI, Smith CH, Roberts A, Langan SM, Henderson AD. Anxiety and Depression in People with Eczema or Psoriasis: A Comparison of Associations in UK Biobank and Linked Primary Care Data. Clin Epidemiol 2023; 15:891-899. [PMID: 37575973 PMCID: PMC10421744 DOI: 10.2147/clep.s417176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/03/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Previous research has shown associations between eczema and psoriasis and anxiety and depression. We investigated whether associations are consistent across different settings of ascertainment for depression and anxiety, including interview and survey responses from UK Biobank (a large longitudinal cohort recruiting individuals aged 40-69 years between 2006-2010), and linked primary care data, with the aim of drawing more reliable conclusions through triangulation. Methods In cross-sectional studies, we estimated associations between eczema or psoriasis and anxiety or depression, defining anxiety or depression as 1) self-reported previous diagnosis at UK Biobank recruitment interview; 2) PHQ-9/GAD-7 score indicating depression or anxiety from a UK Biobank mental health follow-up survey in 2016; and 3) diagnosis in linked primary care electronic health record data. Results We analysed 230,047 people with linked Biobank and primary care data. We found poor agreement between the data sources for eczema, psoriasis, anxiety, and depression. Eg, 9474 had a previous eczema diagnosis in primary care data, 4069 self-reported previous eczema diagnosis at the UK biobank interview, and 1536 had eczema in both data sources (for depression 40,455; 13,320; and 9588 respectively). Having eczema or psoriasis (recorded in primary care or baseline interview) was associated with higher odds of anxiety and depression. Eg, the adjusted odds ratio for depression comparing those with eczema to those without was greater than 1 when defining the outcome from 1) the recruitment interview (1.36, 95% confidence interval 1.27-1.45); 2) the follow-up survey (1.24, 1.09-1.39), and 3) primary care records (1.56, 1.50-1.62). Discussion Our findings support increased prevalence of mental illness in people with psoriasis and eczema across multiple data sources, which should be considered in planning of mental health services. However, we found poor agreement in disease ascertainment between settings, with implications for data interpretation in electronic health records.
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Affiliation(s)
- Julian Matthewman
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathryn E Mansfield
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph F Hayes
- Division of Psychiatry, University College London, London, UK
| | - Elizabeth I Adesanya
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine H Smith
- St John’s Institute of Dermatology, Kings College London, London, UK
| | - Amanda Roberts
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sinéad M Langan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Alasdair D Henderson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Salfi F, Amicucci G, Ferrara M, Tempesta D, De Berardinis A, Chiricozzi A, Peris K, Fargnoli MC, Esposito M. The role of insomnia in the vulnerability to depressive and anxiety symptoms in atopic dermatitis adult patients. Arch Dermatol Res 2023; 315:1577-1582. [PMID: 36749389 PMCID: PMC10338550 DOI: 10.1007/s00403-023-02538-0] [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: 07/21/2022] [Revised: 10/26/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
Atopic dermatitis (AD) is a common inflammatory chronic skin disease typically associated with atopic comorbidities and other non-atopic conditions such as sleep disturbances, and mood/anxiety disorders. A growing literature proposed a crucial role of sleep disturbances in the development of mental health problems in AD. We tested this assumption by mediation model analyses in adult AD patients.A total of 57 patients (mean age ± std. dev., 34.28 ± 13.07 years; 27 males; range 18-67 years) diagnosed with AD participated in a cross-sectional study. We evaluated self-perceived severity of AD, insomnia, depression, and anxiety symptoms using validated questionnaires: the Patient-Oriented Eczema Measure (POEM), the Insomnia Severity Index (ISI), the Beck Depression Inventory-second edition (BDI-II), and the Generalized Anxiety Disorder-7 scale (GAD-7), respectively. Two mediation models were performed, testing the mediation effect of insomnia symptoms on the relationship between AD severity and depression (model 1) and anxiety (model 2). AD symptoms, as expressed by POEM, were positively associated with insomnia, depression, and anxiety severity. Insomnia fully mediated the effect of AD severity on depression and anxiety. Specifically, insomnia accounted for 81.64% of the relationship between atopic eczema severity and depression, and for 81.84% of the effect of AD severity on anxiety symptoms. The present study proposed a critical role of insomnia in predisposing adult AD patients to experience depression and anxiety. Early interventions focused on treating sleep disturbances could indirectly be beneficial on mental health of patients with AD, counteracting the onset and exacerbation of anxiety and depression disorders.
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Affiliation(s)
- Federico Salfi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giulia Amicucci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Michele Ferrara
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Daniela Tempesta
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea De Berardinis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- UOSD General and Oncologic Dermatology, San Salvatore Hospital, L'Aquila, Italy
| | - Andrea Chiricozzi
- UOC di DermatologiaDipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ketty Peris
- UOC di DermatologiaDipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
- UOSD General and Oncologic Dermatology, San Salvatore Hospital, L'Aquila, Italy.
| | - Maria Esposito
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- UOSD General and Oncologic Dermatology, San Salvatore Hospital, L'Aquila, Italy
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Health Promotion Model-Based Skin Health Program to Improve Skin Health Behaviors, Quality of Life, and Self-Efficacy and Reduce Eczema Symptoms in Hairdresser Apprentices. JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION 2023. [DOI: 10.1097/jdn.0000000000000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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6
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Standen L, Garip G. The influence of self-management, anxiety and depression on chronic eczema-related quality of life. SKIN HEALTH AND DISEASE 2022; 2:e106. [PMID: 36479268 PMCID: PMC9720206 DOI: 10.1002/ski2.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 06/17/2023]
Abstract
Chronic eczema, a persistent inflammatory skin condition, affects 1 in 12 adults in the United Kingdom and negatively influences quality of life. Self-management can potentially influence chronic conditions, such as eczema, reducing symptoms and positively influencing quality of life; however, there is a lack of public education for eczema. Anxiety and depression negatively influence quality of life, and frequently present alongside eczema. Psychological interventions for anxiety and depression have shown to be effective for eczema-related quality of life. This study aimed at examining the relationship between self-management, anxiety, and depression, on quality of life in individuals with chronic eczema. The main hypothesis proposed that anxiety and depression reduce the influence of eczema self-management on quality of life, potentially as individuals might be less likely to support their eczema treatment when experiencing symptoms of anxiety and depression. A cross-sectional design and opportunistic sampling were used to analyse the data from 77 participants who responded to four self-report scales to assess self-management understanding, anxiety, depression and quality of life in participants with chronic eczema. Data were analysed by a hierarchical multiple linear regression to assess the variance contributed by each variable added to the model. Results from this sample shows a trend whereby self-management of eczema contributes less variance to quality of life alongside comorbid anxiety and depression; this suggests that self-management has reduced influence on eczema-related quality of life when anxiety and depression are present. Furthermore, low self-management, high anxiety, and high depression significantly negatively influence quality of life. The three variables combined accounted for 41.1% of variance in quality of life scores, suggesting anxiety, depression and self-management influence quality of life in the sample. Self-management, anxiety, and depression significantly influence eczema-related quality of life, and participants who reported comorbid anxiety and depression were more likely to report lower levels of self-management in this sample.
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Affiliation(s)
- Laura Standen
- College of Health, Psychology & Social CareUniversity of DerbyDerbyUK
| | - Gulcan Garip
- College of Health, Psychology & Social CareUniversity of DerbyDerbyUK
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7
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Muacevic A, Adler JR, Choday S, Kampa P, Ravi N, Sherpa ML, Agrawal H, Alfonso M. A Molecular Basis Approach of Eczema and Its Link to Depression and Related Neuropsychiatric Outcomes: A Review. Cureus 2022; 14:e32639. [PMID: 36660532 PMCID: PMC9845527 DOI: 10.7759/cureus.32639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
"What about my eczema do I love the most? The hurt? A scratch? The humiliation of the public? Oh, there are so many options available!" Studies have shown an association between atopic eczema (AE), a common inflammatory skin condition, and an increased risk of mental health problems. Despite this, experts are still examining the causes of the links between common mental diseases (such as depression and anxiety) and skin conditions. We collected studies that were published in the past 10 years. We searched the following databases: PubMed, PubMed Central, Science Direct, and Google Scholar. Further relevant research was assessed by examining the bibliographies of eligible studies and related ones. Two reviewers looked at the titles and abstracts of the studies to see if they were eligible, and then they read the full texts. We went through eczema and depression relationships, their etiopathogenesis, molecular basis, immune response, the role of genetic factors, and possible interactions between neurons and the immune system. Another possible contributing factor could be a change in cutaneous microbiota in eczema patients. Part of the initial connection could be explained by psychological stress, which further leads to depression in eczema patients. Healthcare professionals treating eczema patients must be aware of the comorbidity of mental problems and the potential that people with poor mental health may need social or emotional support. Patients with eczema, especially youngsters, can benefit from routine health checks since they can help identify neuropsychiatric issues like depression early and lessen the burden of both physical sickness and poor mental health. Given that AE is a condition that appears to be related to depression and anxiety, more research with larger samples is needed to determine a potential role for targeted mental health screening in people with AE, as well as the possibility of mental health modification through improved AE control (e.g., using new biologic agents).
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Wollenberg A, Kinberger M, Arents B, Aszodi N, Avila Valle G, Barbarot S, Bieber T, Brough HA, Calzavara Pinton P, Christen-Zäch S, Deleuran M, Dittmann M, Dressler C, Fink-Wagner AH, Fosse N, Gáspár K, Gerbens L, Gieler U, Girolomoni G, Gregoriou S, Mortz CG, Nast A, Nygaard U, Redding M, Rehbinder EM, Ring J, Rossi M, Serra-Baldrich E, Simon D, Szalai ZZ, Szepietowski JC, Torrelo A, Werfel T, Flohr C. European guideline (EuroGuiDerm) on atopic eczema - part II: non-systemic treatments and treatment recommendations for special AE patient populations. J Eur Acad Dermatol Venereol 2022; 36:1904-1926. [PMID: 36056736 DOI: 10.1111/jdv.18429] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/03/2022] [Indexed: 12/01/2022]
Abstract
The evidence- and consensus-based guideline on atopic eczema was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. Four consensus conferences were held between December 2020 and July 2021. Twenty-nine experts (including clinicians and patient representatives) from 12 European countries participated. This second part of the guideline includes recommendations and detailed information on basic therapy with emollients and moisturizers, topical anti-inflammatory treatment, antimicrobial and antipruritic treatment and UV phototherapy. Furthermore, this part of the guideline covers techniques for avoiding provocation factors, as well as dietary interventions, immunotherapy, complementary medicine and educational interventions for patients with atopic eczema and deals with occupational and psychodermatological aspects of the disease. It also contains guidance on treatment for paediatric and adolescent patients and pregnant or breastfeeding women, as well as considerations for patients who want to have a child. A chapter on the patient perspective is also provided. The first part of the guideline, published separately, contains recommendations and guidance on systemic treatment with conventional immunosuppressive drugs, biologics and janus kinase (JAK) inhibitors, as well as information on the scope and purpose of the guideline, and a section on guideline methodology.
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Affiliation(s)
- A Wollenberg
- Department of Dermatology and Allergy, LMU Munich, Munich, Germany.,Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, Brussels, Belgium
| | - M Kinberger
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - B Arents
- European Federation of Allergy and Airways Diseases Patients' Associations (EFA), Brussels, Belgium
| | - N Aszodi
- Department of Dermatology and Allergy, LMU Munich, Munich, Germany
| | - G Avila Valle
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - S Barbarot
- Department of Dermatology, CHU Nantes, UMR 1280 PhAN, INRAE, Nantes Université, Nantes, France
| | - T Bieber
- Department of Dermatology and Allergy, University Hospital of Bonn, Bonn, Germany
| | - H A Brough
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, and Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | | | | | - M Deleuran
- Aarhus University Hospital, Aarhus, Denmark
| | - M Dittmann
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - C Dressler
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - A H Fink-Wagner
- Global Allergy and Airways diseases Patient Platform GAAPP, Vienna, Austria
| | - N Fosse
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - K Gáspár
- Department of Dermatology of the University of Debrecen, Debrecen, Hungary
| | - L Gerbens
- Department of Dermatology, Amsterdam UMC (University Medical Centers), Amsterdam, The Netherlands
| | - U Gieler
- Department Dermatology, University of Giessen, Giessen, Germany
| | - G Girolomoni
- Dermatology and Venereology Section, Department of Medicine, University of Verona, Verona, Italy
| | - S Gregoriou
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - C G Mortz
- Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - A Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - U Nygaard
- Department of Dermato-Venerology, Aarhus University Hospital, Aarhus, Denmark
| | - M Redding
- Eczema Outreach Support (UK), Linlithgow, UK
| | - E M Rehbinder
- Dermatology Department, Oslo University Hospital, Oslo, Norway
| | - J Ring
- Department Dermatology Allergology Biederstein, Technical University Munich, Munich, Germany
| | - M Rossi
- Dermatology Unit, Spedali Civili Hospital Brescia, Brescia, Italy
| | | | - D Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Z Z Szalai
- Pediatric Dermatology Unit, Heim Pál National Children's Institute Budapest, Budapest, Hungary
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - A Torrelo
- Hospital Infantil Niño Jesús, Madrid, Spain
| | - T Werfel
- Hannover Medical School, Hanover, Germany
| | - C Flohr
- St John's Institute of Dermatology, King's College London, London, UK.,Guy's & St Thomas' NHS Foundation Trust, London, UK
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Wren GH, Humby T, Thompson AR, Davies W. Mood symptoms, neurodevelopmental traits, and their contributory factors in X-linked ichthyosis, ichthyosis vulgaris and psoriasis. Clin Exp Dermatol 2022; 47:1097-1108. [PMID: 35104372 PMCID: PMC9314151 DOI: 10.1111/ced.15116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
Abstract
Background High rates of adverse mood/neurodevelopmental traits are seen in multiple dermatological conditions, and can significantly affect patient quality of life. Understanding the sex‐specific nature, magnitude, impact and basis of such traits in lesser‐studied conditions like ichthyosis, is important for developing effective interventions. Aim To quantify and compare relevant psychological traits in men with X‐linked ichthyosis (XLI, n = 54) or in XLI carrier women (n = 83) and in patients with ichthyosis vulgaris (IV, men n = 23, women n = 59) or psoriasis (men n = 30, women n = 122), and to identify factors self‐reported to contribute most towards depressive, anxious and irritable phenotypes. Methods Participants recruited via relevant charities or social media completed an online survey of established questionnaires. Data were analysed by sex and skin condition, and compared with general population data. Results Compared with the general population, there was a higher rate of lifetime prevalence of mood disorder diagnoses across all groups and of neurodevelopmental disorder diagnoses in the XLI groups. The groups exhibited similarly significant elevations in recent mood symptoms (Cohen d statistic 0.95–1.28, P < 0.001) and neurodevelopmental traits (d = 0.31–0.91, P < 0.05) compared with general population controls, and self‐reported moderate effects on quality of life and stigmatization. There were strong positive associations between neurodevelopmental traits and recent mood symptoms (r > 0.47, P < 0.01), and between feelings of stigmatization and quality of life, particularly in men. Numerous factors were identified as contributing significantly to mood symptoms in a condition or sex‐specific, or condition or sex‐independent, manner. Conclusion We found that individuals with XLI, IV or psoriasis show higher levels of mood disorder diagnoses and symptoms than matched general population controls, and that the prevalence and severity of these is similar across conditions. We also identified a number of factors potentially conferring either general or condition‐specific risk of adverse mood symptoms in the three skin conditions, which could be targeted clinically and/or through education programmes. In clinical practice, recognizing mood/neurodevelopmental problems in ichthyosis and psoriasis, and addressing the predisposing factors identified by this study should benefit the mental health of affected individuals.
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Affiliation(s)
| | - Trevor Humby
- School of Psychology, Cardiff University, Cardiff, UK
| | - Andrew R Thompson
- School of Psychology, Cardiff University, Cardiff, UK.,South Wales Clinical Psychology Doctoral Programme, Cardiff, Vale University Health Board, Cardiff, UK
| | - William Davies
- School of Psychology, Cardiff University, Cardiff, UK.,Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK.,MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
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10
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Tamschick R, Navarini A, Strobel W, Müller S. Insomnia and other sleep disorders in dermatology patients: A questionnaire-based study with 634 patients. Clin Dermatol 2021; 39:996-1004. [PMID: 34920837 DOI: 10.1016/j.clindermatol.2021.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Insufficient sleep duration and quality are associated with various adverse health outcomes. Whereas sleep disorders have been studied in a few skin conditions, data in a more comprehensive dermatology population are lacking. We sought to describe the prevalence, causes, and consequences of sleep disorders in dermatology patients. In this cross-sectional, single-center study, dermatology patients completed a questionnaire addressing skin-related and non-skin-related health, sleep behavior, causes, and consequences of sleep disorders. According to the Regensburg Insomnia Scale, 27.92% of the 634 participants had insomnia (177 of 634 patients). Of these 177 patients, 115 (64.97%) were subjectively sleep disturbed, with skin-related causes accounting for 55.65% (64 of 115 patients), non-skin-related accounting for 33.04% (38 of 115 patients), and combined accounting for 11.30% (13 of 115 patients). Itch was the leading cause of skin-related sleep disorders (64.49%, 50 of 77 patients), followed by skin-related pain (55.84%, 43 of 77 patients) and skin-related fearful thoughts (54.55%, 42 of 77 patients). Sleep disorders reduced daytime performance in 68.70% (79 of 115 patients) and sleep quality of relatives in 20.87% (24 of 115 patients). The prevalence of insomnia among different diagnostic categories ranged from 20.31% to 50.00%. The most common strategy to improve sleep was taking sleep medication (57.39%, 66 of 115 patients). We conclude that sleep disorders are highly prevalent in dermatology patients, often leading to reduced daytime performance, impaired sleep among the patients' relatives, and increased use of substances.
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Affiliation(s)
- Rianna Tamschick
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland.
| | - Alexander Navarini
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | - Werner Strobel
- Sleep Unit, Respiratory Medicine, Department of Internal Medicine, University Hospital of Basel, Basel, Switzerland
| | - Simon Müller
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
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11
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Ayasse MT, Ahmed A, Espinosa ML, Walker CJ, Yousaf M, Thyssen JP, Silverberg JI. What are the highest yielding search strategy terms for systematic reviews in atopic dermatitis? A systematic review. Arch Dermatol Res 2021; 313:737-750. [PMID: 33221950 DOI: 10.1007/s00403-020-02165-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 12/30/2022]
Abstract
The impact of search strategies on systematic reviews (SR) of atopic dermatitis (AD) is unknown. The purpose of this review was to evaluate search strategies used in SR of AD and their impact on the frequency of manuscripts identified. MEDLINE and EMBASE were searched for SR related to AD. Simulations were performed by running combinations of search terms in MEDLINE and EMBASE. Overall, 250 SR met inclusion criteria, of which 225 specified search strategies. SR using 5-6 terms (20.0% to 12.1%) or ≥ 7 (40.0% to 18.8%) terms decreased, whereas SR using 3-4 terms numerically increased (18.8% to 30.2%) and 1-2 terms remained similar (37.5% to 38.9%) from 1999-2009 to 2015-2019. The most commonly searched terms were "atopic dermatitis" (n = 166), followed by "eczema" (n = 156), "dermatitis atopic'" (n = 81), "atopic eczema" (n = 74), "neurodermatitis" (n = 59), "Besniers prurigo" (n = 29), "infantile eczema" (n = 27), and "childhood eczema" (n = 19). Simulations revealed that "eczema" and "atopic dermatitis" yielded the most hits. The number of search terms that maximized hits in MEDLINE and EMBASE was 5 and 4, respectively. Search strategies for AD were heterogeneous, with high proportions of search strategies providing few search hits. Future studies should use standardized and optimized search terms.
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Affiliation(s)
- Marissa T Ayasse
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Suite 2B-425, Washington, DC, 20037, USA
| | - Adnan Ahmed
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Maria L Espinosa
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Christina J Walker
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Muhammad Yousaf
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Suite 2B-425, Washington, DC, 20037, USA.
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12
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Rocholl M, Ludewig M, Brakemeier C, John SM, Wilke A. Illness perceptions of adults with eczematous skin diseases: a systematic mixed studies review. Syst Rev 2021; 10:141. [PMID: 33962662 PMCID: PMC8106167 DOI: 10.1186/s13643-021-01687-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eczematous skin diseases, e.g., atopic dermatitis or contact dermatitis, are associated with a high disease burden, a significant impact on quality of life and a higher risk for anxiety and depression. Therefore, coping strategies are of interest. In order to understand coping processes, it is necessary to examine the patients' perspectives on their illness. The aim of this systematic mixed studies review is to investigate the illness perceptions of patients with eczematous skin diseases to get a better understanding of their coping processes. METHODS We performed a systematic literature search in PubMed, The Cochrane Library, PsycInfo, PSYNDEX, CINAHL, Web of Science, and Scopus until February 20, 2019. Both qualitative and quantitative studies were included in the review. Two independent reviewers conducted data extraction and carried out a narrative synthesis. We assessed study quality with the Mixed Methods Appraisal Tool. RESULTS Three qualitative and four quantitative studies were included in the systematic review. We found different methodological approaches for investigating illness perceptions: guided interviews, focus group interviews as well as standardized questionnaires, e.g., the Brief Illness Perception Questionnaire. All studies report suspected causes of the skin disease, such as endogenous and exogenous causes (namely, psychological or occupational factors). We found long timeline beliefs as well as various perceived and experienced social, economic, and psychological consequences. Our analysis reveals complex emotional representations in patients with eczematous skin diseases, in particular impairment of emotional well-being, and feelings of shame or helplessness. Qualitative and quantitative data were predominantly complementary and convergent. CONCLUSION Patients with eczematous skin diseases have complex illness representations regarding their disease. These representations interrelate with the coping behavior of patients. Therefore, medical professionals should consider them for counseling and treatment. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2018 CRD42018109217 .
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Affiliation(s)
- Marc Rocholl
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
| | - Michaela Ludewig
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
| | - Carola Brakemeier
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
| | - Swen Malte John
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
| | - Annika Wilke
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
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13
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Adesanya EI, Schonmann Y, Hayes JF, Mathur R, Mulick AR, Rayner L, Smeeth L, Smith CH, Langan SM, Mansfield KE. Risk factors for mental illness in adults with atopic eczema or psoriasis: protocol for a systematic review. BMJ Open 2020; 10:e038324. [PMID: 33372068 PMCID: PMC7772326 DOI: 10.1136/bmjopen-2020-038324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Evidence indicates that people with the common inflammatory skin diseases atopic eczema or psoriasis are at increased risk of mental illness. However, the reasons for the relationship between skin disease and common mental disorders (ie, depression and anxiety) or severe mental illnesses (ie, schizophrenia, bipolar disorder and other psychoses) are unclear. Therefore, we aim to synthesise the available evidence regarding the risk factors for mental illness in adults with atopic eczema or psoriasis. METHODS AND ANALYSIS We will conduct a systematic review of randomised controlled trials, cohort, case-control and cross-sectional studies. We will search the following databases from inception to March 2020: Medline, Embase, Global Health, Scopus, the Cochrane Library, Web of Science, Base, PsycInfo, the Global Resource of Eczema Trials, and the grey literature databases Open Grey, PsycExtra and the New York Academy of Medicine Grey Literature Report. We will also search the bibliographies of eligible studies and relevant systematic reviews to identify additional relevant studies. Citation searching of large summary papers will be used to further identify relevant publications. Two reviewers will initially review study titles and abstracts for eligibility, followed by full text screening. We will extract data using a standardised data extraction form. We will assess the risk of bias of included studies using the Quality in Prognosis Studies tool. We will synthesise data narratively, and if studies are sufficiently homogenous, we will consider a meta-analysis. We will assess the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation framework. ETHICS AND DISSEMINATION Ethical approval is not required for a systematic review. Results of the review will be published in a peer-reviewed journal and disseminated through conferences. PROSPERO REGISTRATION NUMBER CRD42020163941.
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Affiliation(s)
- Elizabeth I Adesanya
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Yochai Schonmann
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel
| | - Joseph F Hayes
- Division of Psychiatry, University College London, London, UK
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Amy R Mulick
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Lauren Rayner
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine H Smith
- St John's Institute of Dermatology, Guys and St Thomas' Foundation Trust and King's College London, London, UK
| | - Sinéad M Langan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Health Data Research UK, London, UK
| | - Kathryn E Mansfield
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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14
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Shen M, Xiao Y, Su J, Zhao S, Li J, Tao J, Kang X, Wu B, Shan S, Wang X, Chen X. Prevalence and patient-reported outcomes of noncommunicable skin diseases among college students in China. JAAD Int 2020; 1:23-30. [PMID: 34409315 PMCID: PMC8361873 DOI: 10.1016/j.jdin.2020.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2020] [Indexed: 01/22/2023] Open
Abstract
Background The prevalence and health-related quality of life of skin disease have been understudied in adolescents. Objective To investigate the prevalence and relevant patient-reported outcomes of noncommunicable skin diseases in college students. Methods First-year college students from 5 universities in China were investigated in the cross-sectional study. Skin diseases were diagnosed by dermatologists in the field survey. Itch and pain, symptoms of depression and anxiety, and sleep quality were measured by validated tools. Results A total of 28,364 students consented to participate and completed the survey. The prevalence of acne, eczema, chronic urticaria, psoriasis, and vitiligo was 10.3%, 5.8%, 2.6%, 0.16%, and 0.23%, respectively. Eczema and chronic urticaria were associated with lower health utility estimates. Most diseases, but not psoriasis and vitiligo, were associated with the symptoms of depression and sleep disturbance. Itch intensity predicted other patient-reported outcome scores better in healthy controls than in individuals with skin diseases. Sex difference in the associations of skin diseases with patient-reported outcomes was not identified. Limitations Cross-sectional study design and limited generalizability to the nonstudent population. Conclusion Skin diseases are associated with moderately impaired emotional well-being, sleep quality, and quality of life, partly attributable to cutaneous symptoms.
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Affiliation(s)
- Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
- Correspondence to: Yi Xiao, MD, Xiangya Hospital, 87 Xiangya Road, Changsha, Hunan, China 410008.
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Juan Tao
- Department of Dermatology, Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojing Kang
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumchi, China
| | - Bin Wu
- Department of Dermatology, The Affiliated People's Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Shijun Shan
- Department of Dermatology, Xiang'an Hospital, Xiamen University, Xiamen, China
| | - Xiaohui Wang
- Department of Dermatology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
- Xiang Chen, MD, Xiangya Hospital, 87 Xiangya Road, Changsha, Hunan, China 410008.
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15
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Schonmann Y, Mansfield KE, Hayes JF, Abuabara K, Roberts A, Smeeth L, Langan SM. Atopic Eczema in Adulthood and Risk of Depression and Anxiety: A Population-Based Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:248-257.e16. [PMID: 31479767 PMCID: PMC6947493 DOI: 10.1016/j.jaip.2019.08.030] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Atopic eczema is a common and debilitating condition associated with depression and anxiety, but the nature of this association remains unclear. OBJECTIVE To explore the temporal relationship between atopic eczema and new depression/anxiety. METHODS This matched cohort study used routinely collected data from the UK Clinical Practice Research Datalink, linked to hospital admissions data. We identified adults with atopic eczema (1998-2016) using a validated algorithm, and up to 5 individuals without atopic eczema matched on date of diagnosis, age, sex, and general practice. We estimated the hazard ratio (HR) for new depression/anxiety using stratified Cox regression to account for age, sex, calendar period, Index of Multiple Deprivation, glucocorticoid treatment, obesity, smoking, and harmful alcohol use. RESULTS We identified 526,808 adults with atopic eczema who were matched to 2,569,030 without. Atopic eczema was associated with increased incidence of new depression (HR, 1.14; 99% CI, 1.12-1.16) and anxiety (HR, 1.17; 99% CI, 1.14-1.19). We observed a stronger effect of atopic eczema on depression with increasing atopic eczema severity (HR [99% CI] compared with no atopic eczema: mild, 1.10 [1.08-1.13]; moderate, 1.19 [1.15-1.23]; and severe, 1.26 [1.17-1.37]). A dose-response association, however, was less apparent for new anxiety diagnosis (HR [99% CI] compared with no atopic eczema: mild, 1.14 [1.11-1.18]; moderate, 1.21 [1.17-1.26]; and severe, 1.15; [1.05-1.25]). CONCLUSIONS Adults with atopic eczema are more likely to develop new depression and anxiety. For depression, we observed a dose-response relationship with atopic eczema severity.
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Affiliation(s)
- Yochai Schonmann
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Clalit Health Services, Department of Family Medicine, Rabin Medical Center, Petah Tikva, Israel; Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Kathryn E Mansfield
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Joseph F Hayes
- Division of Psychiatry, University College London, London, United Kingdom; Camden and Islington National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, Calif
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, United Kingdom
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sinéad M Langan
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; St John's Institute of Dermatology, Guy's & St Thomas' Hospital National Health Service (NHS) Foundation Trust and King's College London, London, United Kingdom; Health Data Research UK, London, United Kingdom
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16
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Frantz T, Wright EG, Balogh EA, Cline A, Adler-Neal AL, Feldman SR. Topical and Oral Therapies for Childhood Atopic Dermatitis and Plaque Psoriasis. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E125. [PMID: 31694234 PMCID: PMC6915686 DOI: 10.3390/children6110125] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/24/2019] [Accepted: 11/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment of atopic dermatitis and psoriasis in children is difficult due to lack of standardized treatment guidelines and few FDA-approved treatment options. Treatments approved for adults may be used off-label in pediatric patients. OBJECTIVE This review evaluates the topical and oral treatment options available, including off-label uses, and provides a basic therapeutic guideline for pediatric atopic dermatitis and psoriasis. METHODS A PubMed review of topical and systemic treatments for pediatric psoriasis and atopic dermatitis with information regarding age, efficacy, dosing, contra-indications, adverse events, and off-label treatments. RESULTS The search identified seven topical and five systemic treatments that are routinely employed to treat pediatric atopic dermatitis and psoriasis. LIMITATIONS Standardized guidelines regarding treatment choice, dosing, and long-term safety are scarce. Reviews may be subject to ascertainment bias. CONCLUSIONS Current treatment guidelines are based on clinical experience and expert advice with few treatments officially approved for atopic dermatitis and psoriasis in children.
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Affiliation(s)
- Travis Frantz
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Ellen G Wright
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Esther A Balogh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Abigail Cline
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Adrienne L Adler-Neal
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
- Department of Dermatology, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
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17
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Ballardini N, Kramer MS, Oken E, Henderson AJ, Bogdanovich N, Dahhou M, Patel R, Thompson J, Vilchuck K, Yang S, Martin RM, Flohr C. Associations of atopic dermatitis and asthma with child behaviour: Results from the PROBIT cohort. Clin Exp Allergy 2019; 49:1235-1244. [PMID: 31081565 DOI: 10.1111/cea.13417] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/02/2019] [Accepted: 04/14/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Conflicting findings from studies evaluating associations of allergic disease with child behaviour require longitudinal studies to resolve. OBJECTIVE To estimate the magnitude of associations of atopic dermatitis (AD) in infancy, and symptoms of asthma and AD at 6.5 years, with child behaviour at 6.5 years. METHODS Secondary cohort analysis of the Promotion of Breastfeeding Intervention Trial (PROBIT). PROBIT enrolled 17 046 infants at birth and followed them up at 6.5 years (n = 13 889). Study paediatricians collected data on infantile AD at repeated follow-up examinations during the first year of life. At 6.5 years, paediatricians performed skin prick tests and parents reported asthma and AD symptoms during the prior year. In addition, parents and teachers completed the Strength and Difficulties Questionnaire, which includes scales on hyperactivity/inattention, emotional problems, conduct problems, peer problems and prosocial behaviours. RESULTS Physician-diagnosed AD in the first year of life was not associated with increased risk for behavioural problems at 6.5 years. Emotional problems at 6.5 years were more common among children with AD symptoms (OR: 2.24, 95% CI: 1.62-3.12) and asthma symptoms (OR: 1.45; 95% CI: 1.07-1.96) during the past year at 6.5 years and ORs for children with symptoms of more severe AD and asthma were also higher. AD in the past year was also associated with probable hyperactivity/inattention disorder at 6.5 years (OR: 2.05; 95% CI: 1.09-3.84). Other subscales of the SDQ were not related to asthma or AD symptoms during the past year. CONCLUSIONS AND CLINICAL RELEVANCE Children with AD symptoms were at higher risk for concomitant hyperactivity/inattention and emotional disorder, and children with asthma symptoms were at higher risk of having concomitant emotional problems. However, AD during infancy did not predict childhood behaviours.
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Affiliation(s)
- Natalia Ballardini
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,St John's Institute of Dermatology, King's College London, London, UK
| | - Michael S Kramer
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Alexander John Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Natalia Bogdanovich
- National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Mourad Dahhou
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rita Patel
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jennifer Thompson
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Konstantin Vilchuck
- National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Seungmi Yang
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Richard M Martin
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust, National Institute for Health Research, Bristol Biomedical Research Centre, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Carsten Flohr
- St John's Institute of Dermatology, Guy's and St Thomas' Hospital, NHS Foundation Trust and King's College London, London, UK
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