The global, regional, and national burden of atopic dermatitis in 195 countries and territories: An ecological study from the Global Burden of Disease Study 2017

Demonstrating the potential of bioactive glass-infused electrospun PVB fibrous patches in atopic dermatitis moisturizing therapy

Atopic dermatitis (AD) is a prevalent chronic inflammatory skin disorder characterized by pruritic and eczematous lesions. Current treatment modalities often focus on symptomatic relief through topical moisturizers to restore impaired skin barrier function. Bioactive glasses, such as 45S5 and 59S compositions, have gained attention for their potential therapeutic applications in dermatological conditions due to their biocompatibility, bioactivity, and ability to promote wound healing. In this study, we explore the feasibility and efficacy of utilizing electrospun polyvinyl butyral (PVB) fibrous patches infused with bioactive glass particles as a novel approach for moisturizing therapy in AD. The electrospun PVB fibrous patches were fabricated through a simple and scalable electrospinning technique, incorporating bioactive glass particles. Physicochemical properties, including morphology, mechanical strength, and bioactive properties, were characterized using scanning electron microscopy (SEM), tensile testing, and in- vitro bioactivity. Additionally, the protein absorption kinetics of the fibrous patches were evaluated. Furthermore, in-vitro hemocompatibility, cell viability studies and live/dead assay were conducted to assess the biocompatibility of the bioactive glass-infused PVB fibrous patches. Our findings demonstrate that the incorporation of bioactive glass particles into electrospun PVB fibrous patches confers enhanced mechanical properties and sustained release of bioactive ions, providing a promising platform for prolonged moisturizing therapy.

Worldwide prevalence of atopic dermatitis in children between 2000 and 2021: A systematic analysis

BACKGROUND

Atopic dermatitis (AD) is a prevalent allergic disease that significantly impacts pediatric health.

OBJECTIVE

To comprehensively describe the global, regional, and national AD prevalence trends among children aged 0 to 14 years between 2000 and 2021.

METHODS

Data from the Global Burden of Disease Study 2021 were used to analyze AD prevalence and case numbers. The annual average percentage change was calculated to assess prevalence trends.

RESULTS

In 2021, global pediatric AD cases reached 72.4 million (95% uncertainty interval: 68.5-76.5), a 6.2% increase from 2000. Despite the rise in cases, the prevalence rate decreased on average by 0.15% (95% CI: 0.14%-0.16%). Regional prevalence varied widely, with the highest rates in Central Asia, high-income Asia Pacific, and Western Europe and the lowest in Sub-Saharan Africa. Nationally, the AD prevalence rates ranged from 1.50% in Rwanda to 10.67% in Mongolia. Between 2000 and 2021, 108 countries or territories showed a significant increase in AD prevalence, with the most notable rises in Russia, Ghana, and Latvia. In contrast, 48 countries, including the United States, Syria, and Japan, experienced a marked decrease in AD prevalence. Age and sex (male and female) patterns showed the highest prevalence in children aged 5 to 9 years, with girls having higher rates than boys across all age groups.

CONCLUSION

This study reveals complex global patterns in pediatric AD prevalence, underscoring the necessity of regionally tailored public health strategies and further research into the diverse causes of AD to enhance prevention and management efforts.

Relationships between parenting and illness factors and child behaviour difficulties in children with asthma and/or eczema

Chronic health conditions such as asthma and eczema are common and are associated with significant psychosocial sequelae for children and their families. A number of parenting variables have been implicated in child health outcomes; however, there are gaps in understanding of the relationships between parenting and child adjustment in the context of chronic illness. This study examined the role that modifiable parenting factors including parenting style, self-efficacy, and adjustment play in explaining general and illness-related child behaviour and emotional problems. Parents (N = 107) of children diagnosed with asthma only (n = 22), eczema only (n = 59), or both conditions (n = 26) completed a range of parenting and child adjustment measures. The majority of the modifiable parenting factors (parents' self-efficacy with managing their child's internalising, asthma-related, and eczema-related behaviours; parent adjustment; and use of ineffective parenting strategies) made significant contributions to explaining variance child behaviour. Parenting variables consistently explained greater proportions of variance in general and illness-related child behaviour difficulties compared to demographic and illness factors and represent important intervention targets.

Global Antimicrobial Susceptibility Patterns of Staphylococcus aureus in Atopic Dermatitis: A Systematic Review and Meta-Analysis

Importance

Individuals with atopic dermatitis are frequently colonized and infected with Staphylococcus aureus. Empirical antibiotic therapy for individuals with atopic dermatitis is common, but data about the antimicrobial susceptibility profiles of S aureus strains isolated from these individuals are scarce for those living in particular geographic areas.

Objective

To determine the antimicrobial susceptibility of S aureus from individuals with atopic dermatitis and analyze differences according to the income level of the country of origin and the data collection period.

Data Sources

A meta-analysis of the literature was performed from the inception of the included databases (MEDLINE, Embase, Web of Science, Scopus, and Cochrane) to June 20, 2023, using predetermined Medical Subject Headings.

Study Selection

Studies were included if they reported antibiotic susceptibility profiles of 1 or more S aureus cutaneous isolates from individuals with atopic dermatitis. Articles written in English, Spanish, French, or German were included.

Data Extraction and Synthesis

Working in pairs, 6 of the authors conducted the data extraction. The guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were followed.

Main Outcomes and Measures

The outcome of interest was antimicrobial susceptibility.

Results

A total of 61 studies reported 4091 S aureus isolates from individuals with atopic dermatitis. For 4 of the 11 commonly used antibiotics (36.4%), antimicrobial susceptibility was 85% or less, including for methicillin (binomial proportion, 0.85 [95% CI, 0.76-0.91]), erythromycin (binomial proportion, 0.73 [95% CI, 0.61-0.83]), fusidic acid (binomial proportion, 0.80 [95% CI, 0.62-0.91]), and clindamycin (binomial proportion, 0.79 [95% CI, 0.65-0.89]). Most studies (46; 75.4%) were conducted in high-income countries. Antimicrobial susceptibility to erythromycin, methicillin, and trimethoprim and sulfamethoxazole was significantly lower in lower middle-income countries and upper middle-income countries. Regarding the temporal trends, 33 studies (54.1%) reported data collected from 1998 to 2010. Antimicrobial susceptibility patterns have not changed over time.

Conclusions and Relevance

In this systematic review and meta-analysis, antimicrobial susceptibility of S aureus to β-lactams, erythromycin, clindamycin, and fusidic acid may be suboptimal for empirical use in individuals with atopic dermatitis. Significant differences in antimicrobial susceptibility patterns were found in high-income countries and in lower middle-income countries and upper middle-income countries for some antibiotics.

Chemical and Biological Changes Under Force Degradation and Acceleration Condition of the Combination of Ha-Rak Remedy, Piper betle, and Garcinia mangostana Extracts for Atopic Dermatitis

Herbal medicine could be an option for atopic dermatitis (AD) treatment for those suffering from global public health. HMB is a new combination of three herb extracts, consisting of the Ha-Rak (HR) remedy extract, Piper betle (PB) extract, and Garcinia mangostana (GM) extract in equal proportions, using Thai traditional medicine theory, that uses a combination of medications that can improve therapeutic efficacy and reduce side effects and toxicity. HMB extract has anti-inflammatory and antiallergic properties, is a component for AD treatment, and tends to develop topical products. Drug registration requires stability data. Results from drug stability testing affect not only the efficacy of the drug but also its safety. The aim of this study was to investigate stability through forced degradation and an accelerated study of extracts. Chemical content analysis and in vitro biological activities such as anti-inflammatory and antiallergic activities determined the effects of all examined samples. Anti-inflammatory and antiallergic effects were assessed by inhibiting nitric oxide synthesis in RAW 264.7 cells and β-hexosaminidase release in RBL-2H3 cells, respectively. High-performance liquid chromatography (HPLC) assessed content indicators. Moisture and temperature hydrolysis had no significant differences in the chemical or biological properties of the HMB. However, the HMB demonstrated sensitivity to alkaline hydrolysis, showed low anti-inflammatory activity, and decreased hydroxychavicol, eugenol, and α-mangostin contents. The contents of the three compounds also decrease with acid hydrolysis. For the accelerated study, anti-inflammatory and antiallergic effects and hydroxychavicol amount were not significantly different after 180 days at 40°C and 75% RH. Therefore, the contents of eugenol and α-mangostin were changed. Eugenol in HMB decreased significantly from the 15th day until the 180th day of storage. In addition, α-mangostin amounts in HMB decreased slightly on 180th day. Fortunately, reducing the two chemicals did not affect anti-inflammatory or antiallergic effects. For stability, combination extract should be stored in a closed container in the refrigerator at a low temperature and protected from light, high temperature, oxygen, and pH. Further HMB development should avoid pH or oxidation processes or components.

Systems Biology Methods via Genome-Wide RNA Sequences to Investigate Pathogenic Mechanisms for Identifying Biomarkers and Constructing a DNN-Based Drug-Target Interaction Model to Predict Potential Molecular Drugs for Treating Atopic Dermatitis

This study aimed to construct genome-wide genetic and epigenetic networks (GWGENs) of atopic dermatitis (AD) and healthy controls through systems biology methods based on genome-wide microarray data. Subsequently, the core GWGENs of AD and healthy controls were extracted from their real GWGENs by the principal network projection (PNP) method for Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway annotation. Then, we identified the abnormal signaling pathways by comparing the core signaling pathways of AD and healthy controls to investigate the pathogenesis of AD. Then, IL-1β, GATA3, Akt, and NF-κB were selected as biomarkers for their important roles in the abnormal regulation of downstream genes, leading to cellular dysfunctions in AD patients. Next, a deep neural network (DNN)-based drug-target interaction (DTI) model was pre-trained on DTI databases to predict molecular drugs that interact with these biomarkers. Finally, we screened the candidate molecular drugs based on drug toxicity, sensitivity, and regulatory ability as drug design specifications to select potential molecular drugs for these biomarkers to treat AD, including metformin, allantoin, and U-0126, which have shown potential for therapeutic treatment by regulating abnormal immune responses and restoring the pathogenic signaling pathways of AD.

Trends in atopic dermatitis prevalence among the Chinese population (1990-2021) with projections for 2022-2030

BACKGROUND

Atopic dermatitis (AD) has the highest disease burden among all skin diseases. However, reports on AD prevalence trends in China are limited. This study aimed to investigate the time trends of AD prevalence in China from 1990 to 2021 and to explore the age and sex differences.

METHODS

Data were obtained from the Global Burden of Disease Study, 2021. We analyzed the annual percentage change in the crude prevalence rate and age-standardized prevalence rate (ASPR) of AD from 1990 to 2021 using the Joinpoint model. We predicted the future prevalence of AD from 2022 to 2030 using the Bayesian age-period-cohort model.

RESULTS

The total ASPR decreased slightly from 1990 (1357.93 per 100,000) to 2021 (1347.11 per 100,000). The ASPR of females (1457.64 per 100,000) was higher than that of males (1247.04 per 100,000) in 2021. The prevalence rate of AD was highest in the under 5 years old age group (3455.56 per 100,000) and the 5-9 years old age group (3360.31 per 100,000). By 2030, the predicted ASPR of AD will be 1394.36 (per 100,000) in males and 1603.69 in females (per 100,000). The predicted prevalence rate in the under 5 years old (3996.14 per 100,000 in males and 3990.68 per 100,000 in females) and 5-9 years old (3714.61 per 100,000 in males and 3963.96 per 100,000 in females) age groups will be higher than those in other age groups.

CONCLUSION

Despite a slight decrease from 1990 to 2021, there has been an increasing trend since 2015 in the total AD burden. Given the increasing burden of AD on Chinese children and females, healthcare practitioners should enhance community education, improve disease management abilities of patients and caregivers, and reduce the burden and healthcare costs of AD.

Proxy endpoints - bridging clinical trials and real world data

OBJECTIVE

Disease severity scores, or endpoints, are routinely measured during Randomized Controlled Trials (RCTs) to closely monitor the effect of treatment. In real-world clinical practice, although a larger set of patients is observed, the specific RCT endpoints are often not captured, which makes it hard to utilize real-world data (RWD) to evaluate drug efficacy in larger populations.

METHODS

To overcome this challenge, we developed an ensemble technique which learns proxy models of disease endpoints in RWD. Using a multi-stage learning framework applied to RCT data, we first identify features considered significant drivers of disease available within RWD. To create endpoint proxy models, we use Explainable Boosting Machines (EBMs) which allow for both end-user interpretability and modeling of non-linear relationships.

RESULTS

We demonstrate our approach on two diseases, rheumatoid arthritis (RA) and atopic dermatitis (AD). As we show, our combined feature selection and prediction method achieves good results for both disease areas, improving upon prior methods proposed for predictive disease severity scoring.

CONCLUSION

Having disease severity over time for a patient is important to further disease understanding and management. Our results open the door to more use cases in the space of RA and AD such as treatment effect estimates or prognostic scoring on RWD. Our framework may be extended beyond RA and AD to other diseases where the severity score is not well measured in electronic health records.

The clinical, mechanistic, and social impacts of air pollution on atopic dermatitis

Atopic dermatitis (AD) is a complex disease characterized by dry, pruritic skin and significant atopic and psychological sequelae. Although AD has always been viewed as multifactorial, early research was dominated by overlapping genetic determinist views of either innate barrier defects leading to inflammation or innate inflammation eroding skin barrier function. Since 1970, however, the incidence of AD in the United States has increased at a pace that far exceeds genetic drift, thus suggesting a modern, environmental etiology. Another implicated factor is Staphylococcus aureus; however, a highly contagious microorganism is unlikely to be the primary etiology of a noncommunicable disease. Recently, the roles of the skin and gut microbiomes have received greater attention as potentially targetable drivers of AD. Here too, however, dysbiosis on a population scale would require induction by an environmental factor. In this review, we describe the evidence supporting the environmental hypothesis of AD etiology and detail the molecular mechanisms of each of the AD-relevant toxins. We also outline how a pollution-focused paradigm demands earnest engagement with environmental injustice if the field is to meaningfully address racial and geographic disparities. Identifying specific toxins and their mechanisms can also inform in-home and national mitigation strategies.

Quality of Care and Management of Atopic Dermatitis Across Different Levels of Healthcare-A Survey-Based Patient Experience

Atopic dermatitis (AD) is a chronic and fluctuating disease. Optimal management of AD and related comorbidities requires seamless coordination across multiple layers of the healthcare system. The objective of this survey was to explore patients' experiences with current management of AD. Out of 251 responders to this anonymous survey, 76% reported to have moderate or severe AD. Sixty-nine percent with moderate and 45% with severe AD were followed up at primary care level only. Use of advanced systemic treatment options was rare, and the majority experienced itch (97%), dry skin, rash, negative impact on self-esteem and comorbidities despite ongoing treatment. Only 36% received a treatment plan, more often in secondary (78.3%) than primary care (25.0%). Forty-three percent did not know who was responsible for their follow-up and 54% felt no one was responsible. Treatment options were commonly not known or understood. The survey results demonstrate undertreatment, lack of a holistic approach for management of AD. A national pathway including clear referral criteria and timelines can streamline management of AD across multiple levels of the healthcare system.

Oral and topical administration of a geranyl acetophenone attenuates DNCB-induced atopic dermatitis-like skin lesions in BALB/c mice

Atopic dermatitis (AD) is a chronic, allergic inflammatory skin disorder that lacks a definite cure. Using a mouse DNCB-induced AD-like skin lesions model, this study evaluated the potential therapeutic utility of tHGA as an oral and topical treatment for AD. Male BALB/c mice were sensitised and challenged with 1% and 0.5% DNCB on their shaved dorsal skin. Mice in the treatment group were administered tHGA (20, 40, and 80 mg/kg) orally three times per week for 2 weeks, or tHGA (0.2%, 1%, and 5%) topically once daily for 12 days. On day 34, the mice were euthanized, and blood and dorsal skin samples were obtained for analysis. All doses of orally and topically administered tHGA significantly improved scratching, epidermal thickness, blood eosinophilia and mast cell infiltration. There was a minor discrepancy between the two routes of administration, with orally treated tHGA showing significant reductions in Scoring of Atopic Dermatitis (SCORAD), tissue eosinophil infiltration, serum IgE and skin IL-4 levels with treatment of 40 and 80 mg/kg tHGA, whereas topically applied tHGA showed significant reductions in all dosages. These findings suggest that tHGA exhibited therapeutic potential for AD as both oral and topical treatment ameliorates AD-like symptoms in the murine model.

Race science without racists: how bigoted paradigms persist in allergy research

In the wake of the murder of George Floyd and the massacre in Buffalo, the editorial boards of the prominent scientific publication companies formally apologized for their journals' historical role in advancing race science and promised to improve their standards. However, flowery commentaries cannot undo the consistent pattern of endorsing biologic differences between ethnic groups, even when discussing diseases or traits that are not considered politically charged. In this report, an exemplar is made of a recent publication claiming to identify phenotypes of atopic dermatitis that are distinct between European Americans, Asians, and African Americans. The insufficiency of the evidence and logic underlying these claims are discussed. Although devoid of malice, numerous publications continue to demonstrate how claims of biological differences between races is mainstreamed in modern scientific publications. Overall, the goal of this work is to challenge the scientific community, particularly the publication companies, to evaluate how assumptions of innate biologic disadvantage have clouded assessments of racial disparities in disease beyond the topics that are more stereotypical of race science.

Hydrogel-Based Treatment of House Dust Mite-Induced Atopic Dermatitis through Triple Cleaning of Mites, Bacteria, and ROS-Related Inflammation

Atopic dermatitis (AD) is a chronic and recurrent inflammatory disease caused by abnormalities in skin immunoregulation. House dust mite can directly damage the skin barrier and thus sensitize the skin, which is one of the main allergens inducing AD in humans and widely exists in daily life. Meanwhile, the accompanying bacterial infections and exposure to additional allergens exacerbate the condition by generating excessive reactive oxygen species (ROS). Herein, we have developed the CPDP hydrogel with injectable and self-healing ability to combat pathogenic microorganisms and inflammatory environments for AD therapy. In vitro experiments have affirmed the efficacy of the CPDP hydrogel in combating mites, killing bacteria, and scavenging ROS. In a mouse model closely mimicking HDM-induced AD, the CPDP hydrogel has shown superior therapeutic effects, including reducing epidermal thickness and mast cell count, increasing collagen deposition, as well as down-regulating pro-inflammatory factors.

Association of Countries' Atopic Dermatitis Burden and Sociodemographic Index with Topical Calcineurin Inhibitor Utilization

Background: There is limited knowledge on international trends in topical calcineurin inhibitor (TCI) utilization. Objective: To describe international TCI utilization trends from 2012 to 2019 and evaluate the relationship of country-level economic status, geographic location, and atopic dermatitis (AD) disease burden with drug utilization. Methods: We used IQVIA MIDAS® pharmaceutical quarterly sales data to attain country-level purchasing of TCIs in grams from 2012 to 2019. A multivariable linear regression estimated the association between countries' sociodemographic index (SDI), AD disability-adjusted life year (DALY) rates, and geographic location with TCI utilization. Results: A total of 68 countries were included in our analysis. From 2012 to 2019, overall TCI utilization increased by 66% but remained 11.2 times higher in high-sociodemographic compared with low-middle/low-sociodemographic countries. SDI and geographic location were associated with greater TCI utilization in multivariable analyses, whereas AD DALY rates were not. High-SDI countries used 21,476 grams (95% confidence interval [CI]: 11,915 to 31,036) and high-middle SDI countries used 9,403 grams (95% CI: -393 to 19,200) more TCIs per 100,000 people compared with low-middle/low-SDI countries, respectively. Northern hemisphere countries used 8,588 grams more TCIs per 100,000 people (95% CI: 612 to 16,564). Conclusions: We demonstrated greater TCI utilization among high-SDI compared with lower SDI countries.

Deciphering epigenetic regulations in the inflammatory pathways of atopic dermatitis

Atopic dermatitis, commonly referred to as atopic eczema, is a persistent inflammatory skin disorder that predominantly manifests in children but may endure into adulthood. Its clinical management poses challenges due to the absence of a definitive cure, and its prevalence varies across ethnicities, genders, and geographic locations. The epigenetic landscape of AD includes changes in DNA methylation, changes in histone acetylation and methylation, and regulation by non-coding RNAs. These changes affect inflammatory and immune mechanisms, and research has identified AD-specific variations in DNA methylation, particularly in the affected epidermis. Histone modifications, including acetylation, have been associated with the disruption of skin barrier function in AD, suggesting the potential therapeutic benefit of histone deacetylase inhibitors such as belinostat. Furthermore, non-coding RNAs, particularly microRNAs and long non-coding RNAs (lncRNAs), have been implicated in modulating various cellular processes central to AD pathogenesis. Therapeutic implications in AD include the potential use of DNA methylation inhibitors and histone deacetylase inhibitors to correct aberrant methylation patterns and modulate gene expression related to immune responses and skin barrier functions. Additionally, the emerging role of lncRNAs suggests the possibility of using small interfering RNAs or antisense oligonucleotides to inhibit lncRNAs and adjust their regulatory impact on gene expression. In conclusion, the importance of epigenetic elements in AD is becoming increasingly clear as studies highlight the contribution of DNA methylation, histone modifications and, control by non-coding RNAs to the onset and progression of the disease. Understanding these epigenetic changes provides valuable insights for developing targeted therapeutic strategies.

Strategic Approaches to Reducing the Burden of Atopic Dermatitis in the Middle East and Africa Region

OBJECTIVES

Atopic dermatitis (AD) creates a significant burden on patients and society. This study proposes a set of health policy interventions that can reduce the burden of AD in the Middle East and Africa.

METHODS

We conducted a scoping review to find relevant actions that have been implemented or recommended to decrease AD burden globally. An expert panel was conducted to discuss the review findings, then experts were surveyed to suggest the most efficient actions. Finally, survey results and recommendations were formulated into key actions to reduce the burden in the Middle East and Africa region.

RESULTS

Recommended actions were related to 5 domains; capacity building, guidelines, research, public awareness, and patient support and education. Several actions related to each domain can help reduce the burden. One of the most advocated recommendations was investing in patient education through trained healthcare professionals. Understanding the disease and learning how to control it is a key cornerstone to treatment optimization and reducing the burden. Multidisciplinary care, publishing defined therapeutic guidelines, and investing in research were the most recommended actions based on the experts' discussion and survey results.

CONCLUSIONS

Although the burden of AD is the highest among dermatological diseases, a well-grounded action plan has the potential to reduce the disease burden. Decision makers may develop a national AD action plan by selecting the most relevant items of this study based on their potential impact, feasibility, timeliness, and affordability.

A Review of Atomic-Force Microscopy in Skin Barrier Function Assessment

Skin barrier function (SBF) disorders are a class of pathologies that affect a significant portion of the world population. These disorders cause skin lesions with intense itch, impacting patients' physical and psychological well-being as well as their social functioning. It is in the interest of patients that their disorder be monitored closely while under treatment to evaluate the effectiveness of the ongoing therapy and any potential adverse reactions. Symptom-based assessment techniques are widely used by clinicians; however, they carry some limitations. Techniques to assess skin barrier impairment are critical for understanding the nature of the disease and for helping personalize treatment. This review recalls the anatomy of the skin barrier and describes an atomic-force microscopy approach to quantitatively monitor its disorders and their response to treatment. We review a panel of studies that show that this technique is highly relevant for SBF disorder research, and we aim to motivate its adoption into clinical settings.

Investigation of the Impact of Atopic Dermatitis (AD) on Stress, Depression, Anxiety, and Suicidal Ideation: A Systematic Review and Meta-Analysis

Skin inflammation, known as atopic dermatitis (AD), is often accompanied by various psychological disorders. The objective of this meta-analysis was to assess the impact of AD on stress, depression, anxiety, and suicidal ideation. A comprehensive search was conducted using nine databases. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS). ORs were generated to analyze the results. Thirty-one articles met the requirements for inclusion, with 25 deemed of good quality and six of fair quality. A positive association was observed between AD and stress (OR = 1.546; 95% CI: 1.445-1.653; p = 0.000), depression (OR = 1.140; 95% CI: 1.127-1.153; p = 0.000), anxiety (OR = 1.080; 95% CI: 1.063-1.097; p = 0.000), and suicidal ideation (OR = 1.158; 95% CI: 1.144-1.172; p = 0.000). Interestingly, a significant publication bias was found in the outcomes related to depression and anxiety. This analysis suggests that AD significantly impacts the psychological well-being of patients. Stress, depression, anxiety, and suicidal ideation are among the mental health issues commonly associated with AD. Therefore, clinicians should consider mental health evaluations for patients with AD.

Modelling atopic dermatitis in healthy human skin for the characterization of topical compounds

Suitable human models for the development and characterization of topical compounds for inflammatory skin diseases such as atopic dermatitis are not readily available to date. We describe here the development of a translational model involving healthy human skin mimicking major aspects of AD and its application for the characterization of topical Janus kinase inhibitors. Full thickness human abdominal skin obtained from plastic surgery stimulated in vitro with IL4 and IL13 shows molecular features of AD. This is evidenced by STAT6 phosphorylation assessed by immunohistochemistry and analysis of skin lysates. Broad transcriptome changes assessed by AmpliSeq followed by gene set variation analysis showed a consistent upregulation of gene signatures characterizing AD in this model. Topical application of experimental formulations of compounds targeting the JAK pathway to full thickness skin normalizes the molecular features of AD induced by IL4 and IL13 stimulation. The inhibitory effects of topical JAK inhibitors on molecular features of AD are supported by pharmacokinetic analysis. The model described here is suited for the characterization of topical compounds for AD and has the potential to be extended to other inflammatory skin diseases and pathophysiological pathways.

The use of essential oils in atopic dermatitis: a review

Atopic dermatitis (AD) has become a common childhood disease that affects a large number of children worldwide and has become a chronic skin disease that causes huge economical and psychological damage to the whole family. Despite the use of steroids, immunosuppressants, and various topical preparation, the prognosis is still poor. Hence, this review aimed to explore the potential of using essential oils (EO) as an active ingredient in managing AD. The review was completed by using Pubmed, Scopus, and Medline to search for relevant articles that study the pathophysiology of AD, the properties of EO, the use of EO in managing AD, and the suitable advanced formulation to incorporate EO. From the review conducted, it was concluded that EO have huge potential in managing AD and can be used as complimentary therapeutic agents in AD treatment. Scientists and industries should venture into commercializing more topical products with EO to help manage AD more effectively.

Pharmacokinetic Profile of Brepocitinib with Topical Administration in Atopic Dermatitis and Psoriasis Populations: Strategy to Inform Clinical Trial Design in Adult and Pediatric Populations

INTRODUCTION

Topical brepocitinib, a tyrosine kinase (TYK)2/Janus kinase (JAK)1 inhibitor, is in development for psoriasis (PsO) and atopic dermatitis (AD). Quantitative analyses of prior clinical trial data were used to inform future clinical trial designs.

METHODS

Two phase 2b studies in patients with AD and PsO were used to characterize the amount of topical brepocitinib and the resultant systemic trough concentration (CTrough) using a linear mixed-effects regression (LMER). This model was used to predict brepocitinib systemic CTrough for higher treated body surface areas (BSAs) in adults and children. Information from non-clinical and clinical trials with oral brepocitinib was leveraged to set safety thresholds. This combined approach was used to inform future dose-strength selection and treated BSA limits.

RESULTS

Data from 256 patients were analyzed. Patient type, dose strength, and frequency had significant impacts on the dose-exposure relationship. Systemic concentration in patients with PsO was predicted to be 45% lower than in patients with AD from the same dose. When topically applied to the same percentage BSA, brepocitinib systemic exposures are expected to be comparable between adults and children. The systemic steady-state exposure after 3% once daily and twice daily (2 mg/cm2) cream applied to less than 50% BSA in patients with AD and PsO, respectively, maintains at least a threefold margin to non-clinical safety findings and clinical hematologic markers.

CONCLUSION

The relationship between the amount of active drug applied and brepocitinib systemic CTrough, described by LMER, may inform the development strategy for dose optimization in the brepocitinib topical program.

Early intervention and disease modification in atopic dermatitis-the current state of the field and barriers to progress

Atopic dermatitis (AD) is a highly prevalent chronic inflammatory skin disease representing a major source of global disability burden. Disease-modifying therapies are showing promise in chronic inflammatory disorders such as rheumatoid arthritis and Crohn's disease with method and timing of initial treatment impacting long-term disease outcomes. Whether disease-modifying therapies, specifically those used as an early interventional approach, impacts disease course and comorbidity development in AD is not well-understood. We reviewed the progress in disease modification strategies, emphasizing early intervention approaches in common (or proto-typical) inflammatory diseases. Although more common in other fields, disease modification approaches are becoming increasingly investigated in dermatology, though studies in AD are lacking. Despite significant limitations in ongoing and completed studies, early data are promising and suggest that both the choice and timing of early intervention approach can affect long-term disease course and comorbidity development. To best improve AD patient outcomes, more research is needed to further explore the impact of early disease-modifying therapies. Future studies should focus on identifying the most effective approaches and extend the early results to a more inclusive set of comorbidities and longer-term outcomes.

The burden of dermatitis from 1990-2019 in the Middle East and North Africa region

BACKGROUND

There are several types of dermatitis, each capable of causing enduring changes that extend beyond physical discomfort. In severe cases, dermatitis can significantly affect mental health, social interactions, and the overall quality of life. This study reports the burden of dermatitis in the Middle East and North Africa (MENA) region from 1990 to 2019, according to sex, age category, and socio-demographic index (SDI).

METHODS

Publicly available data regarding the point prevalence, incidence, and years lived with disability (YLDs) were collected from the Global Burden of Disease 2019 study for both the MENA region and its constituent countries. The point prevalence, incidence, and YLDs of dermatitis were represented as counts and age-standardised rates with 95% uncertainty intervals (UIs).

RESULTS

In 2019, the age-standardised point prevalence of dermatitis was 2744.6 (2517.8-3003.1) per 100,000 population, which was 2.3% lower than in 1990. The YLD rate was 92.3 (55.6-143.4) per 100,000 population, which was 3.1% lower than in 1990. The largest point prevalence rates were observed among those aged 70-74, for both sexes. The 2019 MENA/Global DALY ratio was not above one in any age group for either sex. During the period 1990 to 2019, there was no clear correlation between the burden of dermatitis and the SDI level.

CONCLUSION

The dermatitis burden in the MENA region remained relatively stable from 1990 to 2019. Future prevention efforts should focus on improving healthcare access, health education, and workplace safety regulations.

Pharmacoequity in Allergy-Immunology: Disparities in Access to Medications for Allergic Diseases and Proposed Solutions in the United States and Globally

Pharmacoequity is the principle that individuals should have access to high-quality medications regardless of race and ethnicity, socioeconomic status, or availability of resources. In this review, we summarize access to therapeutics for allergic diseases in the United States and other selected countries. We focus on domains of health care access (health insurance coverage, medication availability, and specialist access) as well as system-level factors and clinician- and patient-level factors such as interpersonal racism and cultural beliefs, and how they can affect timely access to appropriate therapy for allergic diseases. Finally, we propose how pharmacoequity in allergy-immunology can be achieved by highlighting solutions to factors limiting access to medications for allergic diseases, and identify potential future research directions.

Global epidemiology of atopic dermatitis: a comprehensive systematic analysis and modelling study

BACKGROUND

Atopic dermatitis (AD) is the leading cause of the global burden from skin disease; no study has provided global and country-specific epidemiological estimates of AD.

OBJECTIVES

To quantify global, regional and country-specific estimates of the epidemiology of AD.

METHODS

A comprehensive search for epidemiological studies in AD was conducted in four electronic databases (PubMed, Embase, Web of Science and China National Knowledge Infrastructure). A Bayesian hierarchical linear mixed model was constructed to calculate epidemiological estimates of AD considering the heterogeneity of regions, countries, type of diagnoses and age strata.

RESULTS

In total, 344 studies met the inclusion criteria. Incidence varied substantially with the location and age of the surveyed participants. The global prevalence of AD and the population affected by AD were estimated to be 2.6% [95% uncertainty interval (UI) 1.9-3.5] and 204.05 million people, respectively. Around 101.27 million adults and 102.78 million children worldwide have AD, corresponding to prevalence rates of 2.0% (95% UI 1.4-2.6) and 4.0% (95% UI 2.8-5.3), respectively. Females were more likely to suffer from AD than males: the global prevalence of AD in females was 2.8% (95% UI 2.0-3.7%) and affected 108.29 million people, while in males the corresponding estimates were 2.4% (95% UI 1.7-3.3%) and 95.76 million people.

CONCLUSIONS

Epidemiological AD data are lacking in 41.5% of countries worldwide. The epidemiology of AD varies substantially with age and sex and is distributed unequally across geographical regions.

Gestational hypertension and risk of atopic diseases in offspring, a national-wide cohort study

INTRODUCTION

Gestational hypertension can lead to complications, such as preeclampsia. Preeclampsia is one of leading causes of perinatal morbidity and mortality. Abnormal placentation, immune dysregulation, and maternal inflammatory response are possible etiologies. The burden of atopic diseases is increasing worldwide. Prenatal exposure might play a role in the pathogenesis of these two diseases. The aim of this study was to evaluate the association between gestational hypertension and atopic diseases from a nationwide perspective.

MATERIAL AND METHODS

The primary data were retrieved from Taiwan's National Health Insurance Research Database. The Maternal and Child Health Database was used to generate links between mothers and children. From 2004 to 2019, mothers with a diagnosis of gestational hypertension were identified as cases. The control groups were matched to the cases by maternal age, neonatal gender, date of birth, at a control-to-case ratio of 4:1. Each child was reviewed to confirm the diagnosis of atopic disease. Covariates including both maternal and neonatal factors were also collected.

RESULTS

A total of 1,935,874 primiparas were enrolled in this study. After excluding 16,851 mothers with a history of hypertension, a total of 1,919,023 offspring were included in the study for the period 2004-2019. Gestational hypertension was associated with asthma (HR, 1.12, 95% CI, 1.02-1.23) and atopic dermatitis (HR, 1.10, 95% CI, 1.00-1.21) in offspring after controlling for cofactors. Nevertheless, gestational hypertension did not play an independent factor for allergic rhinitis (HR, 1.02, 95% CI, 0.95-1.10) or urticaria (HR, 1.02, 95% CI, 0.91-1.15).

CONCLUSION

Maternal gestational hypertension increases the cumulative risk for asthma and atopic dermatitis in offspring.

Novel Vehicles For Drug Delivery in Atopic Dermatitis: A Narrative Review

INTRODUCTION

Atopic dermatitis (AD) causes dry and itchy skin and inflammation that severely impairs the quality of life of affected children and adults. While topical glucocorticosteroid application is typically the first-line treatment of choice, steroid treatment is associated with side effects and, increasingly, patient concerns about prolonged use. Novel drugs and drug delivery vehicles are required for patients with AD.

OBJECTIVES

To summarize the current literature on novel topical agents for atopic dermatitis and novel delivery vehicles.

METHODS

A literature search was conducted, and a narrative review was compiled to summarize recent evidence.

RESULTS

Novel topical drugs approved or in late-phase clinical trials for the treatment of AD include the Janus kinase inhibitor ruxolitinib, the phosphodiesterase-4 inhibitors crisaborole, and roflumilast, and the aryl hydrocarbon receptor activator tapinarof. While current topical drugs for AD are delivered via creams, ointments, gels, and related vehicles, novel delivery approaches such as electrospun patches, sprays, liposomes, nanoparticles, and lasers are being developed to enhance transdermal delivery, reduce side effects, and increase treatment adherence.

CONCLUSIONS

Topical application of creams or ointments is currently the predominant vehicle for the delivery of atopic dermatitis drugs. In vitro studies on novel vehicles show promising results to overcome the issues associated with topical delivery. Still, these findings have to be corroborated by controlled studies with human patients in the future.

Challenges of current treatment and exploring the future prospects of nanoformulations for treatment of atopic dermatitis

Atopic dermatitis (AD) is a predominant and deteriorating chronic inflammation of the skin, categorized by a burning sensation and eczematous lesions in diverse portions of the body. The treatment of AD is exclusively focused to limit the itching, reduce inflammation, and repair the breached barrier of the skin. Several therapeutic agents for the treatment and management of AD have been reported and are in use in clinics. However, the topical treatment of AD has been an unswerving challenge for the medical fraternity owing to the impaired skin barrier function in this chronic skin condition. To surmount the problems of conventional drug delivery systems, numerous nanotechnology-based formulations are emerging as alternative new modalities for AD. Latter enhances the bioavailability and delivery to the target disease site, improves drug permeation and therapeutic efficacy with reduced systemic and off-target side effects, and thus improves patient health and promotes compliance. This review aims to describe the various pathophysiological events involved in the occurrence of AD, current challenges in treatment, evidence of molecular markers of AD and its management, combinatorial treatment options, and the intervention of nanotechnology-based formulations for AD therapeutics.

Atopic Dermatitis in Children Under 5: Prevalence Trends in Central, Eastern, and Western Europe

BACKGROUND

Atopic dermatitis is a major public health issue worldwide, but data on trends in prevalence in children in European countries are sparse. The aim of this study was to assess the trends in the prevalence of atopic dermatitis in children under 5 in the Central, Eastern, and Western European sub-regions from 1990 to 2019.

METHODS

In this study, a descriptive, observational epidemiological method was applied. In addition, an ecological study design was used. Joinpoint regression analysis was used to assess trends.

RESULTS

A total of 118 million (54 million males and 64 million females) prevalent cases of atopic dermatitis in children under 5 were reported in European countries in 1990-2019. More than half of all cases of atopic dermatitis in children under 5 in Europe were recorded in the Western European sub-region. The highest prevalence rates of atopic dermatitis in children under 5 were observed in the Eastern European sub-region, with the highest rates in both males and females recorded in Estonia (equally at about 15,000 per 100,000), followed by the Russian Federation (equally at about 12,000 per 100,000). Moreover, the lowest prevalence rates were reported in the Eastern European sub-region (equally at about 5000 per 100,000 in Romania and Latvia). A sex disparity in the prevalence and trends of atopic dermatitis in children under 5 was observed. A significantly increased trend in atopic dermatitis prevalence in children under 5 was recorded in the Eastern European sub-region from 1990 to 2019 (by +0.3% per year in males and by +0.1% per year in females). Conversely, in the Western and Central European sub-regions, trends in the prevalence of atopic dermatitis in children under 5 slightly decreased (about -0.1% per year). The Pearson coefficient showed a significant negative correlation between the prevalence of atopic dermatitis in children under 5 and the Human Development Index in most countries in the Eastern European sub-region, while a significant positive correlation was reported between the prevalence and HDI in high-income countries in the Western European sub-region.

CONCLUSIONS

High prevalence rates and mostly stable trends during the last three decades make atopic dermatitis still a major health issue in children under 5 in European countries.

Burden of Disease and Unmet Needs in the Diagnosis and Management of Atopic Dermatitis in the Arabic Population of the Middle East

Atopic dermatitis (AD) affects diverse ethnic groups with significant disparities in prevalence, disease progression, clinical outcomes, and access to care. There are limited data on AD in the Arabic population of the Middle East, yet there is a substantial economic and psychosocial burden of AD in this region with a large unmet need with regards to disease management that is critical to address. There is a trend of increasing prevalence of AD in the Arab Middle East; however, due to the large environmental, socioeconomic, and sociocultural heterogeneity of this region, prevalence varies greatly across and within countries. Similarly, clinical differences in disease presentations exist across the region, although data are limited. In this review, we will present clinical phenotypes of AD common in different regions of the Arab Middle East, and data on prevalence, genetic variations, and challenges of treatment. Further studies exploring molecular biomarkers, genetic polymorphisms, immune factors, and the microbiome of patients in the region will help to elucidate the mechanism behind ethnic differences in AD in this population as well as to understand susceptibilities and treatment response.

Link between obesity and atopic dermatitis: Does obesity predispose to atopic dermatitis, or vice versa?

Two serious health conditions, obesity and atopic dermatitis (AD), share some pathological features such as insulin resistance, leptin resistance and inflammation, and a growing body of evidence suggests a link between obesity and AD. Obesity predisposes an individual to and/or worsens AD, whereas AD increases the risk of obesity. Obesity and AD's interactions are mediated by cytokines, chemokines and immune cells. Obese individuals with AD are more resistant to anti-inflammatory therapy, while weight loss can alleviate AD. In this review, we summarize the evidence linking AD and obesity. We also discuss the pathogenic role of obesity in AD, and vice versa. Because of the connection between these two conditions, mitigation of one could possibly prevent the development of or alleviate the other condition. Effective management of AD and weight loss can enhance the wellness of individuals with both of these conditions. However, proper clinical studies are warranted to validate this speculation.

National situation, trends, and predictions of disease burden of atopic dermatitis in Chinese children and adolescents

Background

Atopic dermatitis (AD) is an important global health problem affecting children and adolescents and detailed national information of disease burden in China is lacking. We aimed to evaluate the national disease burden of AD in Chinese children and adolescent, to provide the temporal trends over the past 30 years and to predict the burden for the next 10 years.

Methods

The data of AD in China, including incidence, prevalence, and DALY, and population data were obtained from the Global Burden of Disease Study 2019 (GBD study 2019), which were estimated using the DisMod-MR 2.1. We analyzed the three measures by age and sex; the age groups were <5 years, 5-9 years, 10-14 years, and 15-19 years. The joinpoint regression analyses was conducted to assess the temporal trends from 1990 to 2019. The Bayesian age-period cohort (BAPC) model was used to predict measures from 2020 to 2030.

Results

In 2019, the highest incidence case and rate were observed in <5 years group; for prevalence and disability adjusted life year (DALY), the groups of <5 years and 5-9 years showed similar higher levels and the groups of 10-14 years and 15-19 years had similar relatively lower levels. Overall, the male-to-female ratios were >1 in <5 years group and <1 in 10-14 and 15-19 age groups. The trend analyses found an overall trend of decrease in cases of the three measures; in recent about 3 years, slight increase trends were shown in cases and rates of the three measures in <5 years group. The prediction analyses found a slight decreasing trend for cases of these measures and a slight increasing trend for rates of these measures in the <5 years group in the next 10 years; the 5-9 years group was predicted to increase slightly in rates of the three measures.

Conclusion

In conclusion, the groups of <5 years and 5-9 years are two important populations that need targeted measures to reduce disease burden of AD in China. Regarding sex disparity, we should pay more attention to males in <5 years group and to females in 10-19 years group.

Hydrogel dressing integrating FAK inhibition and ROS scavenging for mechano-chemical treatment of atopic dermatitis

Atopic dermatitis (AD) is a chronic skin disease caused by skin immune dyshomeostasis and accompanied by severe pruritus. Although oxidative stress and mechanical scratching can aggravate AD inflammation, treatment targeting scratching is often overlooked, and the efficiency of mechano-chemically synergistic therapy remains unclear. Here, we find that enhanced phosphorylation of focal adhesion kinase (FAK) is associated with scratch-exacerbated AD. We then develop a multifunctional hydrogel dressing that integrates oxidative stress modulation with FAK inhibition to synergistically treat AD. We show that the adhesive, self-healing and antimicrobial hydrogel is suitable for the unique scratching and bacterial environment of AD skin. We demonstrate that it can scavenge intracellular reactive oxygen species and reduce mechanically induced intercellular junction deficiency and inflammation. Furthermore, in mouse AD models with controlled scratching, we find that the hydrogel alleviates AD symptoms, rebuilds the skin barrier, and inhibits inflammation. These results suggest that the hydrogel integrating reactive oxygen species scavenging and FAK inhibition could serve as a promising skin dressing for synergistic AD treatment.

Efficacy and safety of dupilumab in pediatric patients with moderate to severe atopic dermatitis: a real-world study

Dupilumab is the first human monoclonal antibody that treats atopic dermatitis (AD) by blocking interleukin 4 (IL-4) and interleukin 13 (IL-13), which can suppress the Th2 inflammatory reaction. Effective treatments for pediatric AD patients are limited; therefore, we aimed to assess the efficacy and safety of dupilumab in pediatric AD patients. Fifteen pediatric patients diagnosed with moderate to severe AD and treated with dupilumab were enrolled in this study. SPSS was used to analyze data and obtain the average values of Eczema Area and Severity Index (EASI), SCORing AD (SCORAD), and Children's Dermatology Life Quality Index (CDLQI). GRAPHPAD was used to analyze and plot the statistics. The average EASI values were 19.23 ± 3.03 and 1.69 ± 0.54 at baseline and at following up for 6 months after standardized treatment protocol, respectively. The average SCORAD values were 43.27 ± 4.63 and 6.13 ± 1.41 at baseline and at following up for 6 months after standardized treatment protocol, respectively. The average CDLQI value at baseline was 13.53 ± 2.88 and following up for 6 months after standardized treatment protocol was 1.60 ± 0.63. The most frequent adverse event was conjunctivitis. No serious adverse events occurred during the treatment period. Dupilumab could reduce symptoms and improve pruritus in pediatric AD patients, and the frequent adverse events were reversible. It has a definite therapeutic effect on AD; nevertheless, further studies should be conducted to obtain information on its the long-term efficacy and safety.

Rates of malignancies among patients with moderate to severe atopic dermatitis: a retrospective cohort study

OBJECTIVES

Patients with atopic dermatitis (AD), also known as eczema, may be at an increased risk for malignancies compared with patients without AD; however, incidence rates (IRs) of malignancies in patients with moderate to severe AD are largely unknown. The objective of this study was to evaluate and compare IRs of malignancies in adults with moderate to severe AD (aged ≥18 years).

DESIGN

Retrospective cohort study using data from a Kaiser Permanente Northern California (KPNC) cohort. AD severity classification was adjudicated with medical chart review. Covariates and stratification variables included age, sex and smoking status.

SETTING

Data were obtained from the KPNC healthcare delivery system in northern California, USA. Cases of AD were defined by outpatient dermatologist-rendered codes and prescriptions of topical therapy or phototherapy (moderate) or systemic treatment (severe).

PARTICIPANTS

KPNC health plan members with moderate or severe AD (2007-2018).

PRIMARY AND SECONDARY OUTCOME MEASURES

Malignancy IRs and 95% CIs per 1000 person-years were calculated.

RESULTS

7050 KPNC health plan members with moderate and severe AD met eligibility criteria for inclusion. IRs (95% CI) were highest for non-melanoma skin cancer (NMSC) in patients with moderate and severe AD (4.6 (95% CI 3.9 to 5.5) and 5.9 (95% CI 3.8 to 9.2), respectively) and breast cancer (2.2 (95% CI 1.6 to 3.0) and 0.5 (95% CI 0.1 to 3.9), respectively). Except for breast cancer, which was only evaluated in women, malignancies were higher (with non-overlapping CIs) in patients with moderate and moderate to severe AD in men versus women for basal cell carcinoma and NMSC and in former versus never smokers for NMSC and squamous cell carcinoma.

CONCLUSIONS

This study estimated IRs of malignancies in patients with moderate and severe AD and provides valuable information for dermatology clinicians and ongoing clinical trials in these populations.

Abrocitinib for the Treatment of Moderate-to-Severe Atopic Dermatitis

BACKGROUND

Atopic dermatitis (AD) is ranked as the third most prevalent skin condition with a worldwide prevalence of 2.4%. Atopic dermatitis is a common form of eczema. It develops in infancy or childhood and continues into adulthood with symptoms ranging from mild to severe. Pruritis and inflammation are the hallmark symptoms of AD.

MECHANISM OF ACTION, PHARMACODYNAMICS, AND PHARMACOKINETICS

Abrocitinib is a JAK1 selective inhibitor; inhibition results in a decreased interleukin (IL) 4 activation and decreased pruritis in a patient with AD. Abrocitinib is hepatically metabolized by multiple cytochrome P450 enzymes, and dose modification may be required when administered with concurrent medications.

CLINICAL TRIALS

At least 6 JAK1 Atopic Dermatitis Efficacy and Safety (JADE) trials were conducted evaluating Investigator's Global Assessment and Eczema Area and Severity Index score for efficacy. All JADE trials showed abrocitinib 100 mg and 200 mg doses efficacious when compared with placebo. Common adverse reactions were related to gastrointestinal disturbances, headache, and acne. Serious adverse reactions to assess risk for include serious infections, malignancy, major adverse cardiovascular events, and venous thromboembolisms.

THERAPEUTIC ADVANCE

Abrocitinib provides a valuable treatment option for patients with moderate-to-severe AD unresponsive to other therapies for those candidates without a high risk for significant adverse reaction associated with its use.

Global, regional and national burden of alopecia areata and its associated diseases, 1990-2019: A systematic analysis of the Global Burden of Disease Study 2019

BACKGROUND

No study to date has concomitantly reported the global burden of alopecia areata (AA) and its associated diseases.

METHODS

The crude and age-standardized rates of prevalence (ASPR), incidence (ASIR) and years lived with disability (YLDs) of AA were extracted from the global burden of disease, injuries and risk factors study (GBD) database between 1990 and 2019 for 204 countries and territories. We stratified the analysis by global region, nation, sex, age and sociodemographic index (SDI) to dissect the epidemiology of AA and its associated diseases.

RESULTS

Alopecia areata was responsible for 0.024% of the total DALYs. Age-standardized DALYs rate of AA was 7.51 [4.73-11.14] per 100,000. Overall ASPR, ASIR and age-standardized YLDs rates were stable from 1990 to 2019 globally. All three rates were about two times higher in females compared to males and had a bimodal distribution with peaks at age 30-34 years and 60-64 years. AA burden was positively correlated with SDI (r = .375, p < .001) and was most prevalent in high-income countries, especially North America. Countries with a high AA incidence were more likely to have high incidences of autoimmune diseases and low incidences of ischaemic heart disease and ischaemic stroke.

CONCLUSIONS

The burden of AA was prominent in females, young adults, high sociodemographic countries and North Americans. The study corroborates sex- and region-specific implications and public health measures for AA and its associated burdens. These epidemiological data on AA burden can guide future research efforts, prevention strategies and allocation of resources.

Staphylococcus Infection: Relapsing Atopic Dermatitis and Microbial Restoration

Atopic Dermatitis (AD) skin is susceptible to Staphylococcus aureus (SA) infection, potentially exposing it to a plethora of toxins and virulent determinants, including Panton-Valentine leukocidin (PVL) (α-hemolysin (Hla) and phenol-soluble modulins (PSMs)), and superantigens. Depending on the degree of infection (superficial or invasive), clinical treatments may encompass permanganate (aq) and bleach solutions coupled with intravenous/oral antibiotics such as amoxicillin, vancomycin, doxycycline, clindamycin, daptomycin, telavancin, linezolid, or tigecycline. However, when the skin is significantly traumatized (sheathing of epidermal sections), an SA infection can rapidly ensue, impairing the immune system, and inducing local and systemic AD presentations in susceptible areas. Furthermore, when AD presents systemically, desensitization can be long (years) and intertwined with periods of relapse. In such circumstances, the identification of triggers (stress or infection) and severity of the flare need careful monitoring (preferably in real-time) so that tailored treatments targeting the underlying pathological mechanisms (SA toxins, elevated immunoglobulins, impaired healing) can be modified, permitting rapid resolution of symptoms.

Exposure to isocyanates predicts atopic dermatitis prevalence and disrupts therapeutic pathways in commensal bacteria

Atopic dermatitis (AD) is a chronic inflammatory skin condition increasing in industrial nations at a pace that suggests environmental drivers. We hypothesize that the dysbiosis associated with AD may signal microbial adaptations to modern pollutants. Having previously modeled the benefits of health-associated Roseomonas mucosa, we now show that R. mucosa fixes nitrogen in the production of protective glycerolipids and their ceramide by-products. Screening EPA databases against the clinical visit rates identified diisocyanates as the strongest predictor of AD. Diisocyanates disrupted the production of beneficial lipids and therapeutic modeling for isolates of R. mucosa as well as commensal Staphylococcus. Last, while topical R. mucosa failed to meet commercial end points in a placebo-controlled trial, the subgroup who completed the full protocol demonstrated sustained, clinically modest, but statistically significant clinical improvements that differed by study site diisocyanate levels. Therefore, diisocyanates show temporospatial and epidemiological association with AD while also inducing eczematous dysbiosis.

Electrospun fibers as carriers for topical drug delivery and release in skin bandages and patches for atopic dermatitis treatment

The skin is a complex layer system and the most important barrier between the environment and the organism. In this review, we describe some widespread skin problems, with a focus on eczema, which are affecting more and more people all over the world. Most of treatment methods for atopic dermatitis (AD) are focused on increasing skin moisture and protecting from bacterial infection and external irritation. Topical and transdermal treatments have specific requirements for drug delivery. Breathability, flexibility, good mechanical properties, biocompatibility, and efficacy are important for the patches used for skin. Up to today, electrospun fibers are mostly used for wound dressing. Their properties, however, meet the requirements for skin patches for the treatment of AD. Active agents can be incorporated into fibers by blending, coaxial or side-by-side electrospinning, and also by physical absorption post-processing. Drug release from the electrospun membranes is affected by drug and polymer properties and the technique used to combine them into the patch. We describe in detail the in vitro release mechanisms, parameters affecting the drug transport, and their kinetics, including theoretical approaches. In addition, we present the current research on skin patch design. This review summarizes the current extensive know-how on electrospun fibers as skin drug delivery systems, while underlining the advantages in their prospective use as patches for atopic dermatitis. This article is categorized under: Implantable Materials and Surgical Technologies > Nanomaterials and Implants Implantable Materials and Surgical Technologies > Nanotechnology in Tissue Repair and Replacement Therapeutic Approaches and Drug Discovery > Emerging Technologies.

Eczema among adolescents in Kuwait: Prevalence, severity, sleep disturbance, antihistamine use, and risk factors

Background

Eczema (atopic dermatitis) is a common inflammatory skin disease that is more prevalent in children and adolescents than adults. In Kuwait, there is a lack of empirical knowledge on eczema epidemiology among adolescents. Therefore, this study aimed to estimate the prevalence of eczema symptoms and severity, assess the frequency of eczema-related nocturnal sleep disturbance and its relation to antihistamine use, and determine factors that are associated with eczema prevalence and eczema-related nocturnal sleep disturbance.

Methods

A school-based cross-sectional study enrolled adolescents (n = 3864) aged 11-14 years across Kuwait. Information on eczema symptoms and clinical history, use of antihistamines, parental history of eczema, mode of delivery, and childhood life-style factors and exposures were reported by parents. Current eczema was defined as chronic or chronically relapsing itchy dermatitis with characteristic morphology and distribution in the past 12 months. Among subjects reporting current itchy rash, frequency of nocturnal sleep disturbance due to itchy rash in the past 12 months was reported as: never, <1 night per week, and ≥1 nights per week. Associations were assessed by applying a modified Poisson regression to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI).

Results

The prevalence estimate of current (past 12 months) itchy rash was 20.5% (735/3593) and current eczema was 10.2% (388/3791), with 19.5% (736/3775) reporting history of ever doctor-diagnosed eczema. Among subjects with current itchy rash, nocturnal sleep disturbance due to itchy rash affected 21.7% (157/724) of participants for <1 night per week and affected 12.7% (92/724) of participants for ≥1 nights per week. Antihistamine use at least once per month increased as the frequency of nocturnal sleep disturbance due to itchy rash increased (P_trend <0.001). Factors that demonstrated association with current eczema prevalence included underweight body mass index (aPR = 1.71, 95% CI: 1.16-2.53), Cesarean section delivery (1.29, 1.01-1.65), and maternal (1.72, 1.35-2.19) and paternal (1.83, 1.44-2.32) history of eczema. Frequent (≥1 nights per week) nocturnal sleep disturbance was associated with Cesarean section delivery (1.98, 1.37-2.85), exposure to household tobacco smoke (1.70, 1.18-2.47), and dog-keeping (1.93, 1.06-3.52).

Conclusions

Eczema symptoms are common among adolescents in Kuwait, with similar epidemiological patterns as those observed in western countries. A large proportion of affected adolescents reported nocturnal sleep disturbance due to itchy rash. Modifiable risk factors were associated increased prevalence of eczema and night awakenings.

Acne Vulgaris, Atopic Dermatitis and Rosacea: The Role of the Skin Microbiota-A Review

The skin harbors a huge number of different microorganisms such as bacteria, fungi and viruses, and it acts as a protective shield to prevent the invasion of pathogens and to maintain the health of the commensal microbiota. Several studies, in fact, have shown the importance of the skin microbiota for healthy skin. However, this balance can be altered by intrinsic and extrinsic factors, leading to the development of skin disease, such as acne vulgaris (AV), atopic dermatitis (AD) and rosacea(RS). Although these diseases are widespread and affect both adolescents and adults, the scientific correlation between these disorders and the skin microbiota and physiological parameters (TEWL, hydration and lipid composition) is still unclear. This review aims to investigate the current literature regarding the correlation between the skin microbiota and its imbalance underlying microbiological aspects, how the skin microbiota changes over the course of the disease and the current possible treatments. The following reported studies show a general imbalance of the bacterial flora. For this reason, more in-depth studies are necessary to explore the different subspecies and strains involved in all three diseases.

12-month prevalence of atopic dermatitis in resource-rich countries: a systematic review and meta-analysis

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.

Urea-Based Patches with Controlled Release for Potential Atopic Dermatitis Treatment

Skin diseases such as atopic dermatitis (AD) are widespread and affect people all over the world. Current treatments for dry and itchy skin are mostly focused on pharmaceutical solutions, while supportive therapies such as ointments bring immediate relief. Electrospun membranes are commonly used as a drug delivery system, as they have a high surface to volume area, resulting in high loading capacity. Within this study we present the manufacturing strategies of skin patches using polymer membranes with active substances for treating various skin problems. Here, we manufactured the skin patches using electrospun poly(vinyl butyral-co-vinyl alcohol-co-vinyl acetate) (PVB) fibers blended and electrosprayed with urea. The highest cumulative release of urea was obtained from the PVB patches manufactured via blend electrospinning with 5% of the urea incorporated in the fiber. The maximum concentration of released urea was acquired after 30 min, which was followed up by 6 h of constant release level. The simultaneous electrospinning and electrospraying limited the urea deposition and resulted in the lowest urea incorporation followed by the low release level. The urea-based patches, manufactured via blend electrospinning, exhibited a great potential as overnight treatment for various skin problems and their development can bring new trends to the textile-based therapies for AD.

Regional Differences in the Prevalence of Atopic Dermatitis among Schoolchildren in Japan and Its Associated Factors from 2006 to 2018

The trends in the prevalence of atopic dermatitis for each prefecture over recent years have not been investigated in Japan, and no studies investigating the factors associated with the prevalence using nationwide data have been conducted. We investigated the trends in the prevalence of atopic dermatitis among schoolchildren for each prefecture in Japan from 2006 to 2018 and identified the factors associated with regional differences in prevalence. The data on the atopic dermatitis prevalence in schoolchildren aged 6–17 years were collected as part of the School Health Statistics Research. The demographic, socioeconomic, medical, and environmental characteristics of the prefectures were examined for possible associations with the prevalence. The age-standardized prevalence rates of atopic dermatitis were calculated separately for boys and girls and by prefecture and year. We examined the associations between the age-standardized prevalence rates and prefectural characteristics using an ecological study. The age-standardized prevalence rates of atopic dermatitis tended to be stable for Japan as a whole, whereas the trend in the age-standardized prevalence rates differed across prefectures. In the regression analysis, the year was negatively associated and the number of medical clinics per 100,000 persons was positively associated with the age-standardized prevalence in girls. The taxable income per capita was positively associated with the age-standardized prevalence both in boys and in girls.

Potential of Tamanu (Calophyllum inophyllum) Oil for Atopic Dermatitis Treatment

Tamanu oil, derived from the nut of Calophyllum inophyllum L., has been traditionally used to treat various skin-related ailments. In recent years, this oil is increasingly gaining popularity as researchers continue to search for novel natural alternative therapies for various skin diseases. There have been a number of in vitro and in vivo studies investigating various skin-active properties of tamanu oil, and it has been proven to have potent anti-inflammatory, antioxidant, antimicrobial, analgesic, and even wound-healing abilities. These properties make tamanu oil an especially interesting candidate for the treatment of atopic dermatitis (AD). This multifaceted disease is marked by the disruption of the skin barrier function, chronic inflammation, and skin microbiome dysbiosis with limited treatment options, which is free from adverse events and inexpensive, making it desperate for a new treatment option. In this review, we examine previous in vitro and in vivo studies on AD-relevant pharmacological properties of tamanu oil in order to evaluate the potential of tamanu oil as a novel treatment option for AD.

The humanistic and economic burden of atopic dermatitis among adults and adolescents in Saudi Arabia

Aims: Atopic dermatitis (AD) is a chronic skin disease that creates a significant burden to patients and society. There is scarcity in local data about the burden of AD in the Kingdom of Saudi Arabia (KSA). We aimed to fill in this gap and quantify the humanistic and economic burden of AD among adults and adolescents in KSA.Materials and methods: A literature search and local expert interviews were conducted to assess the disease burden. Prevalence values were estimated through the literature. International data about health-related quality of life lost owing to AD was adjusted to age and prevalence in KSA. Direct and indirect costs were calculated using a bottom-up approach. Resource utilization data were collected from local dermatologists through online interviews, and indirect costs were based on absenteeism and presenteeism estimates. Validation meetings were conducted with local experts to adjust the final estimates.Results: The age-standardized health loss per patient due to AD is 0.187 quality-adjusted life-years (QALYs) annually, aggregating to 64 thousand lost QALYs in KSA. The annual average direct cost for a patient with AD was 2924 Saudi Riyal (SAR; 780 USD), totaling 373 million SAR in KSA (99.5 million USD). This value represents 0.2% of the annual health expenditure in KSA. The total productivity loss due to AD was 1.36 billion SAR (363.7 million USD). Overall, the economic burden of AD consumes up to 0.059% of the national gross domestic product.Limitations: Local quality of life and productivity lost data were not available for KSA, so global averages were used, assuming these numbers also apply to KSA.Conclusion: Indirect costs represent a large proportion of AD burden in KSA. The disease has a substantial effect on patient quality of life and social well-being. Alleviating the burden might result in significant savings in resources to society.

Advances in atopic dermatitis

Atopic dermatitis (AD) is a common inflammatory skin disease characterised by itch and is responsible for significant reduction in quality of life. While AD primarily arises in those under the age of 2 years, it is frequently persistent into adulthood. Recognition of AD is important for the general physician, especially to distinguish causes of acute flares that may present in any medical setting, such as eczema herpeticum and associated allergic reactions. While, to date, treatments have largely focused on broad spectrum immunomodulation with corticosteroids or systemic therapies (such as ciclosporin and methotrexate), increased knowledge in the pathophysiology of the disease has recently led to the expansion of treatment options available for those suffering with AD, and the new drugs on the horizon promise a previously unimagined potential for effective and safe treatment.