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Ma EZ, Hooper SR, Seegan PL, Wan J. Association of atopic dermatitis with emotional and behavioral problems in childhood. J Am Acad Dermatol 2024; 90:1249-1252. [PMID: 38320626 PMCID: PMC11096002 DOI: 10.1016/j.jaad.2024.01.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/21/2023] [Accepted: 01/30/2024] [Indexed: 02/08/2024]
Affiliation(s)
- Emily Z Ma
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Baltimore, Maryland
| | - Stephen R Hooper
- Department of Health Sciences, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Paige L Seegan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joy Wan
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
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2
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Artusa S, Mazzuca G, Piacentini G, Castagnoli R, Marseglia GL, Pietrobelli A, Pecoraro L. Paediatric Atopic Dermatitis: The Unexpected Impact on Life with a Specific Look at the Molecular Level. Int J Mol Sci 2024; 25:4778. [PMID: 38731996 PMCID: PMC11083669 DOI: 10.3390/ijms25094778] [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: 03/19/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Atopic dermatitis (AD) is a condition with a multifactorial aetiology that affects the skin. It most often begins at preschool age and involves the skin. The disease's main symptom is intense itching, which occurs especially at night and affects the child's sleep, negatively impacting the quality of life of affected children and, consequently, their families. The difficulty in resting during the night leads to many problems during the day, particularly behavioural disorders and difficulties in paying attention at school, which results in learning impairment. The unexpected symptoms of AD are caused by pathophysiological processes that include many molecular pathways and inflammatory cytokines such as IL-31, IL-1, IL-2, TNF-a, and IL-6. Drawing on a comprehensive review of the literature in PubMed/MedLine, our review offers an in-depth exploration of both the psychosocial impacts of AD and the molecular processes that contribute to this disorder.
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Affiliation(s)
- Silvia Artusa
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (S.A.); (G.M.)
| | - Giorgia Mazzuca
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (S.A.); (G.M.)
| | - Giorgio Piacentini
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (S.A.); (G.M.)
| | - Riccardo Castagnoli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Angelo Pietrobelli
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (S.A.); (G.M.)
| | - Luca Pecoraro
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (S.A.); (G.M.)
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3
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Cameron S, Donnelly A, Broderick C, Arichi T, Bartsch U, Dazzan P, Elberling J, Godfrey E, Gringras P, Heathcote LC, Joseph D, Wood TC, Pariante C, Rubia K, Flohr C. Mind and skin: Exploring the links between inflammation, sleep disturbance and neurocognitive function in patients with atopic dermatitis. Allergy 2024; 79:26-36. [PMID: 37469218 DOI: 10.1111/all.15818] [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: 03/03/2023] [Revised: 06/06/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
Atopic dermatitis (AD) is a chronic, pruritic and inflammatory, dry skin condition with many known comorbidities. These include airway disease, food allergies, atopic eye disease and autoimmune conditions. Furthermore, there is often significant sleep disturbance as well as increased psychological distress and mental health problems. Severe AD therefore often has a significant impact on the quality of life of both patients and their families. In this review we discuss recent findings on the putative links between AD, its association with itch, sleep disturbance and neuropsychiatric morbidity, including the role of inflammation in these conditions. Itch was thought to predominantly drive sleep disruption in AD. We now understand changes in sleep influence immune cell distribution and the associated inflammatory cytokines, which suggests a bidirectional relationship between AD and sleep. We also increasingly recognize inflammation as a key driver in psychological symptoms and disorders. The link between cutaneous, systemic and possible brain inflammation could at least in part be driven by the sleep deprivation and itch-driven neuronal proliferation seen in AD.
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Affiliation(s)
- Shona Cameron
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ali Donnelly
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Conor Broderick
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ullrich Bartsch
- Surrey Sleep Research Centre, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London and University of Surrey, Guildford, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jesper Elberling
- Depart of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Emma Godfrey
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Gringras
- Paediatric Sleep Department, Evelina Children's Hospital, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Desaline Joseph
- Paediatric Sleep Department, Evelina Children's Hospital, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tobias C Wood
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carmine Pariante
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London and University of Surrey, Guildford, UK
| | - Katya Rubia
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London and University of Surrey, Guildford, UK
| | - Carsten Flohr
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
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4
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Barilla S, Felix K, Jorizzo JL. Stressors in Atopic Dermatitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1447:83-90. [PMID: 38724786 DOI: 10.1007/978-3-031-54513-9_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
As with other inflammatory skin disorders, atopic dermatitis has a tendency to cause stress and also be exacerbated by it. Patients with atopic dermatitis have several disease-associated stressors, some of which include physical discomfort due to itching and altered appearance due to flare-ups. These stressors have been shown to effect patients psychosocially by altering sleep patterns, decreasing self-esteem, and interfering with interpersonal relationships. In combination with its direct effect on patients, atopic dermatitis also causes stress for parents and caregivers. Studies suggest that atopic dermatitis is strongly correlated with co-sleeping habits, which can negatively impact the health and mood of parents or caregivers. It has also been reported to interfere with the formation of a strong mother-child relationship. In order to optimize treatment for patients with atopic dermatitis, it is important to note the impact that it has on quality of life. By implementing patient counseling, sleep-targeted therapies, and the use of quality of life (QoL) indices, atopic dermatitis patients and caregivers have the potential to experience greater satisfaction with treatment.
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Affiliation(s)
- Steven Barilla
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kayla Felix
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Joseph L Jorizzo
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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5
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Tai LR, Chiang YF, Huang KC, Chen HY, Ali M, Hsia SM. Hinokitiol as a modulator of TLR4 signaling and apoptotic pathways in atopic dermatitis. Biomed Pharmacother 2024; 170:116026. [PMID: 38128179 DOI: 10.1016/j.biopha.2023.116026] [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: 10/24/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Atopic dermatitis (AD) poses a significant global health challenge, characterized by dysregulated inflammation and apoptotic processes. This study explores the therapeutic efficacy of hinokitiol, employing a comprehensive in vivo and in vitro approach. Assessment of inflammation-related markers in the animal model included observation of physical appearance, Western blotting, ELISA, and H&E staining. Additionally, the cell culture model enabled the evaluation of apoptosis and ROS levels using MTT assay, crystal violet staining, Western blot, and DCFDA assays. The results revealed hinokitiol's proficiency in ameliorating ear and skin morphology in the DNCB-induced AD model, mediated through the TLR4/MyD88 pathway. Notably, hinokitiol intervention led to a reduction in both M1 and M2 macrophage phenotypes. In vitro investigations demonstrated hinokitiol's ability to enhance cell viability and morphology under TNF-α and IFN-γ induction. Mechanistically, hinokitiol exhibited regulatory effects on apoptosis-related proteins, including Bax, Cytochrome c, Caspase-3, and PARP, thereby averting cellular damage. These findings suggest that hinokitiol is a promising natural compound with significant potential for alleviating inflammation and apoptosis in AD, indicating potential avenues for future therapeutic developments.
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Affiliation(s)
- Ling-Ray Tai
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan
| | - Yi-Fen Chiang
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan
| | - Ko-Chieh Huang
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan
| | - Hsin-Yuan Chen
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan
| | - Mohamed Ali
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, 11566 Cairo, Egypt; Deaprtment of Obstertrics and Gynecology, University of Chicago, 60637, Chicago, IL, USA
| | - Shih-Min Hsia
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan; Graduate Institute of Metabolism and Obesity Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan; School of Food Safety, Taipei Medical University, Taipei 11031, Taiwan; Nutrition Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan; TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan.
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6
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Padmanabha A, Choudhary S, Majidi C, Erickson Z. A multimodal sensing ring for quantification of scratch intensity. COMMUNICATIONS MEDICINE 2023; 3:115. [PMID: 37726377 PMCID: PMC10509275 DOI: 10.1038/s43856-023-00345-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/04/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND An objective measurement of chronic itch is necessary for improvements in patient care for numerous medical conditions. While wearables have shown promise for scratch detection, they are currently unable to estimate scratch intensity, preventing a comprehensive understanding of the effect of itch on an individual. METHODS In this work, we present a framework for the estimation of scratch intensity in addition to the detection of scratch. This is accomplished with a multimodal ring device, consisting of an accelerometer and a contact microphone, a pressure-sensitive tablet for capturing ground truth intensity values, and machine learning algorithms for regression of scratch intensity on a 0-600 milliwatts (mW) power scale that can be mapped to a 0-10 continuous scale. RESULTS We evaluate the performance of our algorithms on 20 individuals using leave one subject out cross-validation and using data from 14 additional participants, we show that our algorithms achieve clinically-relevant discrimination of scratching intensity levels. By doing so, our device enables the quantification of the substantial variations in the interpretation of the 0-10 scale frequently utilized in patient self-reported clinical assessments. CONCLUSIONS This work demonstrates that a finger-worn device can provide multidimensional, objective, real-time measures for the action of scratching.
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Affiliation(s)
- Akhil Padmanabha
- Robotics Institute, Carnegie Mellon University, Forbes Avenue, Pittsburgh, 15213, PA, USA.
| | - Sonal Choudhary
- Department of Dermatology, University of Pittsburgh Medical Center, Fifth Avenue, Pittsburgh, 15213, PA, USA
| | - Carmel Majidi
- Robotics Institute, Carnegie Mellon University, Forbes Avenue, Pittsburgh, 15213, PA, USA
- Mechanical Engineering, Carnegie Mellon University, Forbes Avenue, Pittsburgh, 15213, PA, USA
| | - Zackory Erickson
- Robotics Institute, Carnegie Mellon University, Forbes Avenue, Pittsburgh, 15213, PA, USA
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Ziyab AH, Al-Taiar A, Al-Sabah R, Shaban L, Almousa Z, AlBaloul AH, Karmaus W. Sex and obesity status modify the association between vitamin D and eczema among adolescents. Pediatr Res 2023; 94:1235-1242. [PMID: 37173405 DOI: 10.1038/s41390-023-02641-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Epidemiologic studies have reported inconsistent associations between vitamin D and eczema. This study sought to assess whether sex and obesity status could modify the association between vitamin D and eczema. METHODS A cross-sectional study enrolled 763 adolescents in Kuwait. 25-hydroxyvitamin D (25(OH)D) was measured in venous blood. Current eczema was defined according to clinical history and characteristic morphology and distribution. RESULTS In sex-stratified analysis, decreased 25(OH)D levels were associated with increased current eczema prevalence among males (adjusted odds ratio (aOR)tertile 1 vs. tertile 3: 2.14, 95% confidence intervals (CI): 1.07-4.56), but not among females (aORtertile 1 vs. tertile 3: 1.08, 95% CI: 0.71-1.66). Further stratification by obesity status showed that lower 25(OH)D levels were associated with increased current eczema prevalence among overweight/obese males (per 10-unit decrease in 25(OH)D levels: aOR: 1.70, 95% CI: 1.17-2.46). Such an association was weaker and statistically non-significant among overweight/obese females (per 10-unit decrease in 25(OH)D levels: aOR: 1.26, 95% CI: 0.93-1.70). CONCLUSIONS Sex and obesity status modified the association between vitamin D levels and eczema, with an inverse association observed among overweight/obese males, but not among overweight/obese females. These results suggest that preventive and clinical management strategies could vary by sex and obesity status. IMPACT The current study showed that sex and obesity modify the association between vitamin D and eczema among adolescents. An inverse association between vitamin D and eczema was observed among overweight/obese males, but this association was not as pronounced among overweight/obese females. Vitamin D was not associated with eczema among underweight/normal weight males and females. The identification of effect modification by sex and obesity status add to the current scientific knowledge and further highlight the complexity of the association between vitamin D and eczema. These results may promote a more individualized approach to the future prevention and clinical management of eczema.
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Affiliation(s)
- Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, Safat, Kuwait.
| | - Abdullah Al-Taiar
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, USA.
| | - Reem Al-Sabah
- Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, Safat, Kuwait
| | - Lemia Shaban
- Department of Food Science and Nutrition, College of Life Sciences, Kuwait University, Safat, Kuwait
| | - Zainab Almousa
- Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, Safat, Kuwait
| | - Anwar H AlBaloul
- Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, Safat, Kuwait
| | - Wilfried Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
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Siegfried EC, Cork MJ, Katoh N, Zhang H, Chuang CC, Thomas RB, Rossi AB, Cyr SL, Zhang A. Dupilumab Provides Clinically Meaningful Responses in Children Aged 6-11 Years with Severe Atopic Dermatitis: Post Hoc Analysis Results from a Phase III Trial. Am J Clin Dermatol 2023; 24:787-798. [PMID: 37300760 PMCID: PMC10460374 DOI: 10.1007/s40257-023-00791-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Children with severe atopic dermatitis (AD) have a multidimensional disease burden. OBJECTIVE Here we assess the clinically meaningful improvements in AD signs, symptoms, and quality of life (QoL) in children aged 6-11 years with severe AD treated with dupilumab compared with placebo. METHODS R668-AD-1652 LIBERTY AD PEDS was a randomized, double-blinded, placebo-controlled, parallel-group, phase III clinical trial of dupilumab with concomitant topical corticosteroids (TCS) in children aged 6-11 years with severe AD. This post hoc analysis focuses on 304 patients receiving either dupilumab or placebo with TCS and assessed the percentage of patients considered responsive to dupilumab treatment at week 16. RESULTS At week 16, almost all patients receiving dupilumab + TCS (95%) demonstrated clinically meaningful improvements in AD signs, symptoms, or QoL compared with placebo + TCS (61%, p < 0.0001). Significant improvements were seen as early as week 2 and sustained through the end of the study in the full analysis set (FAS) and the subgroup of patients with an Investigator's Global Assessment score greater than 1 at week 16. LIMITATIONS Limitations include the post hoc nature of the analysis and that some outcomes were not prespecified; the small number of patients in some subgroups potentially limits generalizability of findings. CONCLUSION Treatment with dupilumab provides significant and sustained improvements within 2 weeks in AD signs, symptoms, and QoL in almost all children with severe AD, including those who did not achieve clear or almost clear skin by week 16. TRIAL REGISTRATION NCT03345914. Video Abstract: Does dupilumab provide clinically meaningful responses in children 6 to 11 years old with severe atopic dermatitis? (MP4 99484 kb).
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Affiliation(s)
- Elaine C Siegfried
- Saint Louis University, St. Louis, MO, USA
- Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Michael J Cork
- Sheffield Dermatology Research, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield Children's Hospital, Sheffield, UK
- Sheffield Children's Hospital Clinical Research Facility, Sheffield, UK
| | - Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Haixin Zhang
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | | | - Sonya L Cyr
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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Bratu D, Boda D, Caruntu C. Genomic, Epigenomic, Transcriptomic, Proteomic and Metabolomic Approaches in Atopic Dermatitis. Curr Issues Mol Biol 2023; 45:5215-5231. [PMID: 37367080 DOI: 10.3390/cimb45060331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/03/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease with a high prevalence in the developed countries. It is associated with atopic and non-atopic diseases, and its close correlation with atopic comorbidities has been genetically demonstrated. One of the main roles of genetic studies is to comprehend the defects of the cutaneous barrier due to filaggrin deficit and epidermal spongiosis. Recently, epigenetic studies started to analyze the influence of the environmental factors on gene expression. The epigenome is considered to be a superior second code that controls the genome, which includes alterations of the chromatin. The epigenetic changes do not alter the genetic code, however, changes in the chromatin structure could activate or inhibit the transcription process of certain genes and consequently, the translation process of the new mRNA into a polypeptide chain. In-depth analysis of the transcriptomic, metabolomic and proteomic studies allow to unravel detailed mechanisms that cause AD. The extracellular space and lipid metabolism are associated with AD that is independent of the filaggrin expression. On the other hand, around 45 proteins are considered as the principal components in the atopic skin. Moreover, genetic studies based on the disrupted cutaneous barrier can lead to the development of new treatments targeting the cutaneous barrier or cutaneous inflammation. Unfortunately, at present, there are no target therapies that focus on the epigenetic process of AD. However, in the future, miR-143 could be an important objective for new therapies, as it targets the miR-335:SOX axis, thereby restoring the miR-335 expression, and repairing the cutaneous barrier defects.
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Affiliation(s)
- Dalia Bratu
- Department of Dermatology, 'Colentina' Clinical Hospital, 020125 Bucharest, Romania
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Daniel Boda
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology, 'Ponderas' Academic Hospital, 014142 Bucharest, Romania
- Department of Dermatology, "Prof. N.C. Paulescu" National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
| | - Constantin Caruntu
- Department of Dermatology, "Prof. N.C. Paulescu" National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
- Department of Physiology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Guo M, Su J, Zheng S, Chen B. Objective Sleep in Atopic Dermatitis: A Meta-Analysis. Dermatitis 2023; 34:145-150. [PMID: 36917527 DOI: 10.1089/derm.2022.29005.mgu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: The evidence regarding objective sleep especially for the sleep architecture in atopic dermatitis (AD) was limited and not well summarized. Objective: To determine the objective sleep in AD patients as well as its confounders. Methods: We searched PubMed/Medline, Embase, and PsycInfo up to May 2021. Case-control studies or cohort studies that recruited AD patients and healthy controls and reported objective sleep parameters assessed by polysomnography or actigraphy were included. Results: A total of 7 studies with 173 AD patients and 122 controls were analyzed. Specifically, AD patients have significantly decreased total sleep time (TST, -13.797 minutes) and sleep efficiency (SE, -5.589%) accompanied by prolonged wake time after sleep onset (WASO, 29.972 minutes) and rapid eye movement sleep latency (31.894 minutes, all P < 0.05). Furthermore, subgroup analyses showed more WASO in severe AD subgroup compared with nonsevere AD subgroup (51.323 minutes vs 20.966 minutes, P = 0.032), less SE in male-majority subgroup compared with female-majority subgroup (-9.443% vs -4.997%, P = 0.018), and less TST in adult subgroup compared with child subgroup (-41.045 vs -4.016 minutes, P = 0.037). Conclusion: Objective sleep was worse in AD patients, especially among patients with severe AD, males, and adults. AD appears to more predispose difficulty in sleep maintenance rather than falling asleep.
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Affiliation(s)
| | - Jing Su
- From the Department of Nursing
| | | | - Baixin Chen
- Department of Sleep Medicine, Shantou University Mental Health Center
- Sleep Medicine Center, Shantou University Medical College, Shantou, China
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11
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Ureña-Paniego C, Montero-Vílchez T, Sanabria-de-la-Torre R, Soto-Moreno A, Molina-Leyva A, Arias-Santiago S. Improvement of Sexual Function and Sleep Quality in Patients with Atopic Dermatitis Treated with Dupilumab: A Single-Centre Prospective Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1918. [PMID: 36767285 PMCID: PMC9914896 DOI: 10.3390/ijerph20031918] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease presenting as xerosis, eczema and intense pruritus. These symptoms negatively impact patients' quality of life. However, the effect of AD on sexual function and sleep quality and how treatment with dupilumab could modify them have not been explored in depth. The aim of this study is to assess the effects of dupilumab on sexual and sleep quality in patients with AD. For that purpose, an observational prospective study was designed. Patients were evaluated at baseline and after 16 weeks of dupilumab treatment. Disease severity was assessed by Eczema Area and Severity (EASI) and SCORing Atopic Dermatitis index (SCORAD). Sexual function was evaluated using validated questionnaires, for men via the International Index of Erectile Dysfunction 5 (IIEF-5) and for women via the Female Sexual Function Index (FSFI). Sleep impairment was recorded through Pittsburgh Sleep Quality Index (PSQI). Thirty-two patients, with a mean age of 30.53 ± 14.48 years old, were included. Regarding sex, 59.8% (20) were female. Most patients had a severe disease reflected in a mean basal EASI of 23.24 ± 6.74 and a SCORAD of 54.07 ± 13.89. Clinical scores improved after dupilumab treatment. At baseline, 47.37% women presented sexual dysfunction and 66.67% men had erectile dysfunction. FSFI improved from 23.51 to 27.93 points (p = 0.008) after dupilumab. Desire, arousal, satisfaction and pain were the components with great improvement. Women with a great improvement in FSFI showed greater clinical results and increased quality of life. At first, 96.9% (31/32) of participants presented with poor sleep quality. After treatment with dupilumab, sleep quality was enhanced and PSQI scores decreased from 12.8 points at baseline to 7.73 points (p < 0.001). In conclusion, dupilumab is associated with reduced sexual dysfunction, mainly in women, and sleep quality.
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Affiliation(s)
- Clara Ureña-Paniego
- Department of Dermatology, Virgen de las Nieves University Hospital, 18012 Granada, Spain
| | - Trinidad Montero-Vílchez
- Department of Dermatology, Virgen de las Nieves University Hospital, 18012 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | | | - Alberto Soto-Moreno
- Department of Dermatology, Virgen de las Nieves University Hospital, 18012 Granada, Spain
| | - Alejandro Molina-Leyva
- Department of Dermatology, Virgen de las Nieves University Hospital, 18012 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Salvador Arias-Santiago
- Department of Dermatology, Virgen de las Nieves University Hospital, 18012 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Cell Production and Tissue Engineering Unit, Virgen de las Nieves University Hospital, Andalusian Network, 18014 Granada, Spain
- Department of Dermatology, Faculty of Medicine, University of Granada, 18071 Granada, Spain
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12
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Lenehan SM, Fogarty L, O’Connor C, Mathieson S, Boylan GB. The Architecture of Early Childhood Sleep Over the First Two Years. Matern Child Health J 2023; 27:226-250. [PMID: 36586054 PMCID: PMC9925493 DOI: 10.1007/s10995-022-03545-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The architecture and function of sleep during infancy and early childhood has not been fully described in the scientific literature. The impact of early sleep disruption on cognitive and physical development is also under-studied. The aim of this review was to investigate early childhood sleep development over the first two years and its association with neurodevelopment. METHODS This review was conducted according to the 2009 PRISMA guidelines. Four databases (OVID Medline, Pubmed, CINAHL, and Web of Science) were searched according to predefined search terms. RESULTS Ninety-three studies with approximately 90,000 subjects from demographically diverse backgrounds were included in this review. Sleep is the predominant state at birth. There is an increase in NREM and a decrease in REM sleep during the first two years. Changes in sleep architecture occur in tandem with development. There are more studies exploring sleep and early infancy compared to mid and late infancy and early childhood. DISCUSSION Sleep is critical for memory, learning, and socio-emotional development. Future longitudinal studies in infants and young children should focus on sleep architecture at each month of life to establish the emergence of key characteristics, especially from 7-24 months of age, during periods of rapid neurodevelopmental progress.
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Affiliation(s)
| | - Leanna Fogarty
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Cathal O’Connor
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Sean Mathieson
- INFANT Research Centre, University College Cork, Cork, Ireland
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13
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Neri I, Galli E, Baiardini I, Picozza M, Rossi AB, Matruglio P, Moretti D, Cipriani F. Implications of Atopic Dermatitis on the Quality of Life of 6-11 Years Old Children and Caregivers (PEDI-BURDEN). J Asthma Allergy 2023; 16:383-396. [PMID: 37077900 PMCID: PMC10106808 DOI: 10.2147/jaa.s404350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/20/2023] [Indexed: 04/21/2023] Open
Abstract
Purpose Atopic dermatitis (AD) is a chronic, relapsing and remitting inflammatory skin disease characterized by intense itch. The disease burden includes physical limitations, psychosocial discomfort, and a reduced quality of life (HRQoL). This study presents the results of a parent-reported survey on the psychosocial impact of AD on Italian pre-adolescent children (6-11 years old), with a specific focus on bullying, self-isolation, absenteeism, and presenteeism. Methods An online questionnaire was sent to 3067 random recipients and 160 matched the inclusion criteria for age, self-reported AD diagnosis, localizations (according to ISAAC), and disease severity (POEM ≥8). 100 children, with comparable ages, not matching the inclusion criteria for AD, were recruited as a control group. Results Children with AD and their caregivers had a significantly lower quality of sleep (QoS) compared to the control group. The presence of AD was directly responsible for many restless nights, both in children and caregivers (58.9 and 55.4 respectively). Children with AD and their parents also experienced significantly more daytime drowsiness (43.6 and 54.6 days, respectively). Children with AD were more frequently victims of bullying at school (20.0% vs 9.0%; p≤0.05) or in other social environments (16.9% vs 3.0%; p≤0.05). AD caused 17.7 days of absenteeism and 20.1 days of presenteeism per student over the previous 12 months, accounting for 37.8 days of study impairment overall. Severe/very severe AD had a significantly greater impact on presenteeism than moderate AD (25.1 vs 17.5 days; p≤0.05). Presenteeism, which was more pronounced among bullied students, was positively correlated with absenteeism only in the AD cohort. Conclusion AD has a detrimental impact on the HRQoL of pediatric patients, causing stigmatization and social isolation. Functional distress was also reported by caregivers. Our study might inform the public and policymakers about the disease burden of AD at a young age.
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Affiliation(s)
- Iria Neri
- Dermatology Unit, IRCCS Azienda Ospedaliero Universitaria Bologna, University of Bologna, Bologna, Italy
| | - Elena Galli
- UOS Immuno-Allergologia dell’Età evolutive, Ospedale S.Pietro-Fatebenefratelli, Rome, Italy
| | - Ilaria Baiardini
- Respiratory Unit for Continuity of Care, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
- Personalized Medicine Asthma, & Allergy Clinic, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Mario Picozza
- National Association of Atopic Dermatitis (ANDeA), Prato, Italy
- Neuroimmunology Unit, Santa Lucia Foundation IRCCS, Rome, Italy
| | | | | | | | - Filippo Cipriani
- Sanofi, Milan, Italy
- Correspondence: Filippo Cipriani, Sanofi, Viale Bodio 37b, Milan, Italy, Email
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14
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Bergmans RS, Smith J. Associations of mental health and chronic physical illness during childhood with major depression in later life. Aging Ment Health 2022; 26:1813-1820. [PMID: 34353181 PMCID: PMC8818054 DOI: 10.1080/13607863.2021.1958143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study examined whether childhood chronic physical illness burden was associated with major depression in later life (>50 years) and whether this relationship was mediated by childhood mental health status. METHOD Data came from the 2016 United States Health and Retirement Study (n = 18,483). Logistic regression tested associations of childhood chronic physical illness burden with childhood mental health status and major depression in later life. Path analysis quantified mediation of the association between chronic physical illness burden and major depression by childhood mental health status. RESULTS One standard deviation increase in childhood chronic physical illness burden was associated with 1.34 (95% CI = 1.25, 1.43) times higher odds of major depression in later life. Childhood mental health status explained 53.4% (95% CI: 37.3%, 69.6%) of this association. In follow-up analyses of categorical diagnoses, having difficulty seeing, ear problems or infections, a respiratory disorder, asthma, an allergic condition, epilepsy or seizures, migraines or severe headaches, heart trouble, stomach problems, or a disability lasting ≥6 months was associated with major depression in later life with mediation by childhood mental health status. CONCLUSION Findings of this study indicate that children with a higher chronic physical illness burden are more likely to have major depression in later life and poor mental health during childhood mediates this relationship. Further research is needed to determine whether increased screening and treatment of psychiatric symptoms in pediatrics can decrease the burden of major depression across the life course.
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Affiliation(s)
- Rachel S. Bergmans
- University of Michigan, Institute for Social Research, Ann Arbor, MI 48106
| | - Jacqui Smith
- University of Michigan, Institute for Social Research, Ann Arbor, MI 48106
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15
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Muller D, Paine SJ, Signal TL. The role of sleep in health and health inequities in early childhood in Aotearoa New Zealand. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2109689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Diane Muller
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University Wellington, Wellington, New Zealand
| | - Sarah-Jane Paine
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tracey Leigh Signal
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University Wellington, Wellington, New Zealand
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16
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O'Connor C, Irvine AD, Murray D, Murphy M, O'B Hourihane J, Boylan G. Study protocol: assessing SleeP IN infants with early-onset atopic Dermatitis by Longitudinal Evaluation (The SPINDLE study). BMC Pediatr 2022; 22:352. [PMID: 35717147 PMCID: PMC9206384 DOI: 10.1186/s12887-022-03382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is the most common chronic inflammatory skin condition in childhood. Most (50-60%) children with AD report sleep disturbance, which is secondary to itch, dry skin, inflammation, and abnormal circadian rhythm. Sleep is essential for brain development, learning, and growth. Sleep disruption in early life is associated with cognitive and psychological dysfunction in later life. The aim of this study is to describe in detail the sleep architecture of infants with early-onset atopic dermatitis (AD), compared to controls, by using EEG polysomnography, sleep actigraphy, and parental reporting. METHODS This observational study will recruit six- to eight-month old infants with moderate to severe AD and age-matched control infants who do not have AD. At six-eight months diurnal sleep electroencephalography and polysomnography will be performed in our research center. Nocturnal sleep actigraphy will be performed at home for five consecutive nights at six-eight months and 12 months. Between six and 12 months, monthly questionnaires will capture data on quantitative sleep and parental sleep. Skin barrier and immune profiles will be captured at six-eight and 12 months. AD will be assessed using standardized severity assessment tools and treated according to protocol. A neurodevelopmental assessment will be performed at 18 months to assess cognition and behaviour. An estimated sample size of 50 participants in each group is required to power the primary outcome of disturbed macrostructure of sleep and secondary outcomes of disturbed microstructure of sleep, and disturbed parental sleep, assuming an attrition rate of 60%. Potential confounding factors which will be controlled for in the data analysis will include parental educational level, parental depression, feeding practice, and number of siblings. DISCUSSION This study will provide a rich analysis of sleep in infants with AD in the first year of life using detailed electroencephalography, novel actigraphy techniques, and longitudinal parent-reported data. It may provide guidance on the optimal treatment of AD to prevent or reduce sleep disruption. TRIAL REGISTRATION clinicaltrials.gov NCT05031754 , retrospectively registered on September 2nd, 2021.
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Affiliation(s)
- Cathal O'Connor
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland. .,Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland. .,INFANT research centre, University College Cork, Cork, Ireland.
| | - Alan D Irvine
- INFANT research centre, University College Cork, Cork, Ireland.,Department of Dermatology, Children's Health Ireland at Crumlin, Dublin, Ireland.,Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Murray
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland.,INFANT research centre, University College Cork, Cork, Ireland
| | - Michelle Murphy
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - Jonathan O'B Hourihane
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland.,INFANT research centre, University College Cork, Cork, Ireland
| | - Geraldine Boylan
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland.,INFANT research centre, University College Cork, Cork, Ireland
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17
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Sherrey J, Biggs S, Dorrian J, Martin J, Gold M, Kennedy D, Lushington K. Allergic disease, sleep problems and psychological distress in children recruited from the general community. Ann Allergy Asthma Immunol 2022; 129:366-372. [PMID: 35598883 DOI: 10.1016/j.anai.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is unclear which allergic disease is most strongly related to which sleep problem and whether sleep problems may mediate the association between allergic disease and psychological distress. There is also a need for more community-based studies using non-referred samples. OBJECTIVE To examine the association between individual allergic diseases and sleep problems and test whether the association between allergic disease and psychological distress is mediated through sleep problems. METHODS Parents of 1449 Australian children aged 6-10y recruited from the general community completed measures of sleep problems (Pediatric Sleep Survey Instrument), psychological distress (Strengths and Difficulties Questionnaire), and frequency of allergic disease. RESULTS Sleep and psychological distress scores were in the normal range. After controlling for co-existing allergic diseases: allergic rhinitis was associated with sleep routine problems, morning tiredness, night arousals, sleep disordered breathing and restless sleep; asthma with sleep routine problems, sleep disordered breathing and restless sleep; and eczema with restless sleep. Path analyses revealed that sleep problems mediated the association between asthma and allergic rhinitis but not eczema with psychological distress. CONCLUSION In this non-referred community sample, the frequency of sleep problems and psychological distress was lower than that typically reported in children referred to specialized centres. However, allergic rhinitis was associated with a broad range of sleep problems and to a lesser extent in children with asthma and least in children with eczema. Path analysis revealed that the association between allergic disease and psychological distress was mediated through sleep problems highlighting the importance of assessing sleep health in children with allergic disease.
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Affiliation(s)
- Jade Sherrey
- University of South Australia, Justice and Society Unit, Adelaide, Australia
| | - Sarah Biggs
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Jillian Dorrian
- University of South Australia, Justice and Society Unit, Adelaide, Australia
| | | | | | | | - Kurt Lushington
- University of South Australia, Justice and Society Unit, Adelaide, Australia.
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18
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Allergy-related outcomes and sleep-related disorders in adults: a cross-sectional study based on NHANES 2005-2006. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:27. [PMID: 35317862 PMCID: PMC8941730 DOI: 10.1186/s13223-022-00669-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/10/2022] [Indexed: 11/23/2022]
Abstract
Background Epidemiological evidence between the sleep disorders and allergy-related outcomes is limited. Objectives The purpose of the present study was to estimate the relationship between sleep disorders and allergy-related outcomes in adults. Methods We built logistic regression models to examine the associations between sleep disorders and allergy-related outcomes in adult participants using the 2005–2006 NHANES database. Allergy-related outcomes included sIgE levels, asthma, hay fever, sneezing, wheezing, and eczema. Sleep disorders included sleep latency, sleep length, sleep problems, OSA symptoms, and daytime sleepiness. A t-test was used for between-group comparisons. Results Participants with OSA symptoms had 2.72 × higher odds of experiencing hay fever and 1.54 × higher odds of having eczema compared to Non-OSA symptoms participants. Participants with insufficient sleep (≤ 6 h/night) had 1.27 × higher odds of developing allergic sensitisation compared to participants with adequate sleep (7–8 h/night). Sneezing was positively associated with sleep problems (OR: 1.706; 95% CI 1.386, 2.099), OSA symptoms (OR: 1.297; 95% CI 1.049, 1.605), and daytime sleepiness (OR: 1.569; 95% CI 1.205, 2.04). Conclusion Our findings suggest a positive association between allergy-related outcomes and sleep disorders. In particular, OSA symptoms, daytime sleepiness, and sleep problems are strongly associated with allergic conditions. Graphical Abstract ![]()
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19
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Topical Melatonin Exerts Immunomodulatory Effect and Improves Dermatitis Severity in a Mouse Model of Atopic Dermatitis. Int J Mol Sci 2022; 23:ijms23031373. [PMID: 35163297 PMCID: PMC8835891 DOI: 10.3390/ijms23031373] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 02/05/2023] Open
Abstract
Oral melatonin supplement has been shown to improve dermatitis severity in children with AD, but the mechanism of the effect is unclear, and it is uncertain whether melatonin has a direct immunomodulatory effect on the dermatitis. Topical melatonin treatment was applied to DNCB-stimulated Balb/c mice, and gross and pathological skin findings, serum IgE, and cytokine levels in superficial lymph nodes were analyzed. Secretion of chemokines and cell proliferative response after melatonin treatment in human keratinocyte HaCaT cells were also studied. We found that in DNCB-stimulated Balb/c mice, topical melatonin treatment improved gross dermatitis severity, reduced epidermal hyperplasia and lymphocyte infiltration in the skin, and decreased IP-10, CCL27, IL-4, and IL-17 levels in superficial skin-draining lymph nodes. Melatonin also reduced cytokine-induced secretion of AD-related chemokines IP-10 and MCP-1 and decreased IL-4-induced cell proliferation in HaCaT cells. Melatonin seems to have an immunomodulatory effect on AD, with IP-10 as a possible target, and topical melatonin treatment is a potentially useful treatment for patients with AD.
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20
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Murota H, Koike Y, Morisaki H, Matsumoto M, Takenaka M. Exacerbating factors and disease burden in patients with atopic dermatitis. Allergol Int 2022; 71:25-30. [PMID: 34764038 DOI: 10.1016/j.alit.2021.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Indexed: 11/01/2022] Open
Abstract
The number of patients with atopic dermatitis is on the rise worldwide, and Japan is no exception. According to recent estimates of the percentage of patients with atopic dermatitis in Japan by age, the majority of patients are between 20 and 44 years old. Because the peak age of onset of atopic dermatitis is during infancy, many patients may experience prolonged symptoms from infancy to adulthood. A prolonged clinical course also increases the burden of atopic dermatitis on affected patients. Decreased productivity due to work disruptions, reduced daily activity, higher direct medical costs, fatigue, and daytime sleepiness due to sleep disturbances are typical burdens on patients with atopic dermatitis. In order to reduce these burdens, it is necessary to shorten its clinical course and achieve long-term control without relying on medications, possibly by using avoidance or coping measures of aggravating factors. Typical aggravating factors of atopic dermatitis include irritant dermatitis, food allergy in children, sweating, and psychological stress in adults. Food allergy places a heavy burden on the quality of life of affected patients and their families. The effectiveness of educational interventions for sweating and psychological stress is unclear. We must also evaluate the economic burden and cost-effectiveness of interventions on the patient as aggravating factors to be addressed.
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21
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Erdem Y, Altunay İK, Özkur E, Şekerlisoy G, Karabay EA, Özdemir FT, Çerman AA. The Association between Melatonin Levels and Sleep Quality in Patients with Pruritus: A Potential Biomarker on a Candidate Future Treatment. Indian J Dermatol 2021; 66:609-615. [PMID: 35283519 PMCID: PMC8906312 DOI: 10.4103/ijd.ijd_31_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Melatonin is a hormone that regulates the sleep–wake cycle and has immunomodulatory and anti-inflammatory roles. Aims: The aim of this study is to assess melatonin levels and investigate the association with pruritus severity, sleep quality, and depressive symptoms in dermatoses with nocturnal pruritus. Methods: The study was a prospective study with 82 participants, including 41 patients and 41 healthy volunteers. The visual analog scale (VAS), Pittsburg Sleep Quality Index (PSQI), and Beck Depression Inventory (BDI) were recorded for each patient. To assess the melatonin levels, urinary 6-sulfatoxymelatonin levels in the first urine in the morning were measured. Results: Melatonin concentrations were significantly lower (P = 0.007), while the BDI (P = 0.001) and PSQI (P = 0.001) scores were significantly higher in the patients with pruritus than in the healthy control subjects. There was an inverse correlation between melatonin levels and PSQI scores (r = −0.355, P = 0.023), and a positive correlation was detected between BDI scores and PSQI scores (r = 0.631, P = 0.001) in the pruritus group. Conclusion: Melatonin levels were found to decrease in relation to sleep quality in nocturnal pruritus patients. Low melatonin levels in these patients may be associated with sleep disorders and pruritus.
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Affiliation(s)
- Yasemin Erdem
- Department of Dermatology, Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, istanbul, Turkey
| | - İlknur Kıvanç Altunay
- Department of Dermatology, Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, istanbul, Turkey
| | - Ezgi Özkur
- Department of Dermatology, Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, istanbul, Turkey
| | - Gül Şekerlisoy
- Department of Dermatology, Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, istanbul, Turkey
| | - Ezgi Aktaş Karabay
- Department of Dermatology and Venereology, Bahçeşehir University Faculty of Medicine, istanbul, Turkey
| | - Filiz Türe Özdemir
- Department of Immunology, Marmara University Faculty of Medicine, istanbul, Turkey
| | - Aslı Aksu Çerman
- Department of Dermatology, Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, istanbul, Turkey
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22
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Dreno B, Amici JM, Demessant-Flavigny AL, Wright C, Taieb C, Desai SR, Alexis A. The Impact of Acne, Atopic Dermatitis, Skin Toxicities and Scars on Quality of Life and the Importance of a Holistic Treatment Approach. Clin Cosmet Investig Dermatol 2021; 14:623-632. [PMID: 34163201 PMCID: PMC8213955 DOI: 10.2147/ccid.s315846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/15/2021] [Indexed: 01/15/2023]
Abstract
Skin conditions such as acne, atopic dermatitis, skin toxicity from oncology treatment, and scars are among the most common health conditions and negatively impact quality of life (QoL). Yet the physician perception of this impact often varies greatly from the patient perception. This is important because patient illness perception is closely linked with seeking help and treatment adherence behaviors. The objective of this review is to better understand the impact of these four highly prevalent skin conditions on QoL including their health-related economic factors to improve treatment outcomes. The literature search included literature published on QoL with acne, atopic dermatitis, scars (from any cause) and skin toxicities on PubMed between 2015 and 2020. We found that patients with skin conditions have a much higher frequency of altered QoL and psychological distress than those without. Also, skin conditions negatively impact self-image and can cause feelings of isolation, loneliness, lower self-esteem, and lower body satisfaction. Additionally, physical discomfort adds to the psychological distress. These physical and psychological impacts are an enormous financial burden on patients, their families and society. We found evidence that holistic treatment including treating the skin condition itself, providing wider peer and psychological support as well as shared decision-making, therapeutic patient education and dermatologist involvement improves outcomes. Holistic history-taking, checklists, or the use of more formal QoL scoring tools can be incorporated into routine consultations to better assess patient well-being and provide clinicians with important information for adapting treatment to individual patient requirements. In conclusion, this review highlights the overall impact of skin conditions (including psychological and QoL impacts) and the importance of providing holistic care to optimize treatment outcomes. A comprehensive QoL screening tool would be useful to help provide patient-centered treatment.
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Affiliation(s)
- Brigitte Dreno
- Dermatology Department, CHU Nantes, CIC 1413, CRCINA, Nantes University, Nantes, Pays de la Loire, France
| | - Jean Michel Amici
- Dermatology Department, Bordeaux University Hospital, Bordeaux, Nouvelle-Aquitaine, France
| | | | - Charlotte Wright
- Speak the Speech Consulting, Asnières-sur-Seine, Ile-de-France, France
| | - Charles Taieb
- Patients Priority Department, European Market Maintenance Assessment, Fontenay Sousbois, Ile-de-France, France
| | - Seemal R Desai
- Department of Dermatology, The University of Texas Southwestern Medical Center & Innovative Dermatology, Dallas, TX, USA
| | - Andrew Alexis
- Skin of Color Center, Mount Sinai St. Luke’s and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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23
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Fishbein AB, Cheng BT, Tilley CC, Begolka WS, Carle AC, Forrest CB, Zee PC, Paller AS, Griffith JW. Sleep Disturbance in School-Aged Children with Atopic Dermatitis: Prevalence and Severity in a Cross-Sectional Sample. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3120-3129.e3. [PMID: 33991704 DOI: 10.1016/j.jaip.2021.04.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) causes sleep disturbance but the epidemiology is not known. OBJECTIVE To estimate the US prevalence of sleep disturbance and its impact on psychological and neurocognitive function. METHODS We conducted a cross-sectional survey of 180 parent-child dyads with AD using stratified sampling based on disease severity (Patient Oriented Eczema Measure: mild [n = 30), moderate (n = 75) or severe (n = 75]), age, and race (White or Black or African American or other). Symptoms of sleep and psychologic health were assessed using the Patient-Reported Outcome Measurement Information System. To estimate the prevalence of sleep disturbance, we calculated weights using poststratification adjustment making marginal frequencies of AD severity, race, and age similar to marginal frequencies in the 2007 National Survey of Children's Health. Unweighted regression models examined associations with sleep disturbance. RESULTS In children age 5 to 17 years with AD, we estimated that sleep disturbance occurred in 66.9% (95% confidence interval, 53.3% to 80.5%; 3,116,305 children). The odds of severe sleep disturbance (worse than 95% of US children) were highest in moderate to severe versus mild AD (2.03 [1.00-4.10]; P = .0495; compared with 8.68 [1.82-41.49]; P = .0068). Predictors of parent proxy-reported sleep disturbance were itch intensity (adjusted β [95% confidence interval] 1.33 [0.62-2.04]) and low income (<$50,000: 6.64 [2.05-11.23]; and $50,000 to less than 100,000: 4.75 [0.35-9.14]). Controlling for disease severity, itch intensity, and significant sociodemographics-parent-proxy, reported sleep disturbance was associated with increased severity of sleep-related impairment, depression, fatigue, and anxiety, in addition to worse inattention and impulsivity. In fully adjusted models, children who self-reported sleep disturbance (T-score ≥60) had increased odds of sleep-related impairment (1.20 [1.11-1.29]), depression (1.13 [1.03, 1.24]), fatigue (1.28 [1.06-1.54]), and anxiety (1.16 [1.02-1.31]). CONCLUSIONS Sleep disturbance is a common symptom of AD. It affects about 3 million US children and is associated with neuropsychiatric impairment, including depression, anxiety, and inattention. Clinicians should screen for these symptoms in school-aged children, particularly those with moderate to severe AD.
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Affiliation(s)
- Anna B Fishbein
- Division of Allergy-Immunology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Brian T Cheng
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Caroline C Tilley
- Division of Allergy-Immunology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | - Adam C Carle
- Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Psychology, University of Cincinnati College of Arts and Sciences, Cincinnati, Ohio
| | - Christopher B Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Phillis C Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - James W Griffith
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Pedersen CJ, Uddin MJ, Saha SK, Darmstadt GL. Prevalence and psychosocial impact of atopic dermatitis in Bangladeshi children and families. PLoS One 2021; 16:e0249824. [PMID: 33861780 PMCID: PMC8051797 DOI: 10.1371/journal.pone.0249824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Skin conditions are the fourth leading cause of nonfatal disease globally, with atopic dermatitis (AD) a major and rising contributor. Though atopic dermatitis (AD) is rising in prevalence, little is known about its psychosocial effects on children and families in low- and middle-income countries (LMICs). METHODS We conducted a community-based, cross-sectional survey of 2242 under-5 children in rural Bangladesh using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire to measure AD prevalence and severity, the Patient-Oriented Eczema Measure (POEM) to measure severity, and the Infants' Dermatitis Quality of Life index (IDQoL) and Dermatitis Family Index (DFI) to measure quality of life. FINDINGS Overall AD prevalence in under-five children was 11.9% [95% confidence interval (CI) 10.6-13.3%]. Prevalence was highest in children age 30-35 months [16.2% (95% CI 11.4-21.0)]. IDQoL was significantly higher in males (2.67) vs. females (1.95, p = 0.015), the lowest (3.06) vs. highest (1.63) wealth quintile (p<0.001), and among mothers with < primary (2.41) vs. > secondary (1.43) education (p = 0.039). POEM severity was correlated with IDQoL (r = 0.77, p<0.001) and DFI (r = 0.56, p<0.001). Severe disease as rated by caretakers was correlated with POEM (r = 0.73, p<0.001), IDQoL (r = 0.82, p<0.001) and DFI (r = 0.57, p<0.001). CONCLUSIONS Severe AD significantly affects quality of life for children and families in Bangladesh. As access to healthcare expands in LMICs, identification and treatment of both the medical and psychosocial morbidities associated with the disease are needed.
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Affiliation(s)
- Courtney J. Pedersen
- Stanford University School of Medicine, Stanford, California, United States of America
| | | | | | - Gary L. Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
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Chun KS, Kang YJ, Lee JY, Nguyen M, Lee B, Lee R, Jo HH, Allen E, Chen H, Kim J, Yu L, Ni X, Lee K, Jeong H, Lee J, Park Y, Chung HU, Li AW, Lio PA, Yang AF, Fishbein AB, Paller AS, Rogers JA, Xu S. A skin-conformable wireless sensor to objectively quantify symptoms of pruritus. SCIENCE ADVANCES 2021; 7:7/18/eabf9405. [PMID: 33931455 PMCID: PMC8087407 DOI: 10.1126/sciadv.abf9405] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/15/2021] [Indexed: 05/27/2023]
Abstract
Itch is a common clinical symptom and major driver of disease-related morbidity across a wide range of medical conditions. A substantial unmet need is for objective, accurate measurements of itch. In this article, we present a noninvasive technology to objectively quantify scratching behavior via a soft, flexible, and wireless sensor that captures the acousto-mechanic signatures of scratching from the dorsum of the hand. A machine learning algorithm validated on data collected from healthy subjects (n = 10) indicates excellent performance relative to smartwatch-based approaches. Clinical validation in a cohort of predominately pediatric patients (n = 11) with moderate to severe atopic dermatitis included 46 sleep-nights totaling 378.4 hours. The data indicate an accuracy of 99.0% (84.3% sensitivity, 99.3% specificity) against visual observation. This work suggests broad capabilities relevant to applications ranging from assessing the efficacy of drugs for conditions that cause itch to monitoring disease severity and treatment response.
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Affiliation(s)
- Keum San Chun
- Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX 78712, USA
| | - Youn J Kang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Jong Yoon Lee
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Sibel Health, Niles, IL 60714, USA
| | - Morgan Nguyen
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Brad Lee
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | | | - Emily Allen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Hope Chen
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | | | - Lian Yu
- Electrical and Computer Engineering, University of Illinois at Champaign-Urbana, Champaign, IL 61801, USA
| | - Xiaoyue Ni
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA
| | - KunHyuck Lee
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Hyoyoung Jeong
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | | | - Yoonseok Park
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Ha Uk Chung
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Sibel Health, Niles, IL 60714, USA
| | - Alvin W Li
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Peter A Lio
- Chicago Eczema Center, Chicago, IL 60654, USA
| | - Albert F Yang
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Anna B Fishbein
- Department of Pediatrics (Allergy and Immunology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL 60611, USA
| | - Amy S Paller
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Pediatrics (Dermatology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL 60611, USA
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA.
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA.
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Pediatrics (Allergy and Immunology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL 60611, USA
- Department of Pediatrics (Dermatology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL 60611, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
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Mahadevan N, Christakis Y, Di J, Bruno J, Zhang Y, Dorsey ER, Pigeon WR, Beck LA, Thomas K, Liu Y, Wicker M, Brooks C, Kabiri NS, Bhangu J, Northcott C, Patel S. Development of digital measures for nighttime scratch and sleep using wrist-worn wearable devices. NPJ Digit Med 2021; 4:42. [PMID: 33658610 PMCID: PMC7930047 DOI: 10.1038/s41746-021-00402-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/15/2021] [Indexed: 11/17/2022] Open
Abstract
Patients with atopic dermatitis experience increased nocturnal pruritus which leads to scratching and sleep disturbances that significantly contribute to poor quality of life. Objective measurements of nighttime scratching and sleep quantity can help assess the efficacy of an intervention. Wearable sensors can provide novel, objective measures of nighttime scratching and sleep; however, many current approaches were not designed for passive, unsupervised monitoring during daily life. In this work, we present the development and analytical validation of a method that sequentially processes epochs of sample-level accelerometer data from a wrist-worn device to provide continuous digital measures of nighttime scratching and sleep quantity. This approach uses heuristic and machine learning algorithms in a hierarchical paradigm by first determining when the patient intends to sleep, then detecting sleep–wake states along with scratching episodes, and lastly deriving objective measures of both sleep and scratch. Leveraging reference data collected in a sleep laboratory (NCT ID: NCT03490877), results show that sensor-derived measures of total sleep opportunity (TSO; time when patient intends to sleep) and total sleep time (TST) correlate well with reference polysomnography data (TSO: r = 0.72, p < 0.001; TST: r = 0.76, p < 0.001; N = 32). Log transformed sensor derived measures of total scratching duration achieve strong agreement with reference annotated video recordings (r = 0.82, p < 0.001; N = 25). These results support the use of wearable sensors for objective, continuous measurement of nighttime scratching and sleep during daily life.
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Affiliation(s)
| | | | | | | | | | - E Ray Dorsey
- University of Rochester Medical Center, Rochester, NY, USA
| | - Wilfred R Pigeon
- University of Rochester Medical Center, Rochester, NY, USA.,Department of Veterans Affairs, Canandaigua, NY, USA
| | - Lisa A Beck
- University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin Thomas
- Boston University School of Medicine, Boston, MA, USA
| | - Yaqi Liu
- Boston University School of Medicine, Boston, MA, USA
| | | | - Chris Brooks
- Boston University School of Medicine, Boston, MA, USA
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Chronic Systemic Inflammatory Skin Disease as a Risk Factor for Cardiovascular Disease. Curr Probl Cardiol 2021; 46:100799. [PMID: 33607473 DOI: 10.1016/j.cpcardiol.2021.100799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/10/2021] [Indexed: 11/24/2022]
Abstract
Chronic systemic skin disease and cardiovascular disease are multisystem disorders which have been associated with each other for centuries. Recent research has strengthened this association, particularly in systemic inflammatory disease. Here we explore the current literature on psoriasis, hidradenitis suppurativa, lupus erythematosus, acanthosis nigricans, atopic dermatitis, and bullous pemphigoid. Psoriasis is a chronic inflammatory disorder that has been labeled as a risk-modifier for hyperlipidemia and coronary artery disease by the American College of Cardiology ACC lipid guidelines. Cardiovascular disease is also found at a significantly higher rate in patients with hidradenitis suppurativa and lupus erythematosus. Some associations have even been noted between cardiovascular disease and acanthosis nigricans, atopic dermatitis, and bullous pemphigoid. While many of these associations have been attributed to a shared underlying disease process such as chronic systemic inflammation and shared underlying risk factors, these dermatologic manifestations can help to identify patients at higher risk for cardiovascular disease.
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Misery L. Fardeau de la dermatite atopique chez l’enfant et l’adolescent. Ann Dermatol Venereol 2020; 147:11S31-11S36. [DOI: 10.1016/s0151-9638(20)31086-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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29
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Treister AD, Stefek H, Grimaldi D, Rupani N, Zee P, Yob J, Sheldon S, Fishbein AB. Sleep and Limb Movement Characteristics of Children With Atopic Dermatitis Coincidentally Undergoing Clinical Polysomnography. J Clin Sleep Med 2020; 15:1107-1113. [PMID: 31482832 DOI: 10.5664/jcsm.7800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Atopic dermatitis (AD) is a prevalent, chronic, itchy skin condition. Children undergoing polysomnography (PSG) may coincidentally have AD. Many children with AD have sleep disturbances. Our study aimed to characterize limb movements in children with AD and their effect on sleep. METHODS A retrospective chart review was conducted for children who underwent comprehensive attended PSG and had AD. PSG sleep parameters were compared to published normative data. A subset of patients with markedly elevated total limb movements was further compared to a matched group of patients with a diagnosis of periodic limb movement disorder (PLMD) and no history of AD. RESULTS There were 34 children with AD 6.36 ± 3.21 years (mean ± standard deviation), 50% female and with mild to moderate AD. There was increased wake after sleep onset (WASO = 46.0 ± 37.8 minutes), sleep onset latency (46.5 ± 53.0 minutes) and total limb movement index (13.9 ± 7.5 events/h) compared to normative values. Although our cohort was mostly mild AD, 7 of the 34 children with AD (20%) had a total limb movement index during sleep > 15 events/h. Increased total limb movements in PLMD versus patients with AD was most notable during stage N2 sleep (38 ± 17 versus 22 ± 7, P = .01, respectively). CONCLUSIONS We found altered PSG parameters in children with AD, suggesting that clinicians should consider the diagnosis when affected children undergo PSG. Although our AD cohort was mild, we still determined a need to consider AD when diagnosing PLMD given the presence of elevated total limb movements in children with AD. CITATION Treister AD, Stefek H, Grimaldi D, Rupani N, Zee P, Yob J, Sheldon S, Fishbein AB. Sleep and limb movement characteristics of children with atopic dermatitis coincidentally undergoing clinical polysomnography. J Clin Sleep Med. 2019;15(8):1107-1113.
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Affiliation(s)
- Alison D Treister
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Allergy, Division of Pediatric Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Heather Stefek
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Allergy, Division of Pediatric Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Daniela Grimaldi
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center for Circadian and Sleep Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Neil Rupani
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Allergy, Division of Pediatric Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Phyllis Zee
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center for Circadian and Sleep Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jeremy Yob
- Department of Pediatrics, Division of Pulmonology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois; Co-first author, contributed equally
| | - Stephen Sheldon
- Department of Pediatrics, Division of Pulmonology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois; Co-first author, contributed equally
| | - Anna B Fishbein
- Department of Allergy, Division of Pediatric Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
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30
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Abstract
Atopic dermatitis (AD) was once thought to be a benign childhood disease that remitted with increasing age. However, recent studies have transformed the understanding of AD, particularly in adult patients. AD is common in adults and can lead to substantial disability by negatively affecting sleep, mental health, and quality of life. There seem to be different genetic, immunologic, and epidemiologic risk factors for AD in adults than in children. This article examines the pathophysiology, epidemiology, heterogeneous clinical presentation, burden, diagnosis, and treatment of adult AD.
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Affiliation(s)
- Jonathan I Silverberg
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, USA.
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31
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Quality of Life and Disease Impact of Atopic Dermatitis and Psoriasis on Children and Their Families. CHILDREN-BASEL 2019; 6:children6120133. [PMID: 31810362 PMCID: PMC6955769 DOI: 10.3390/children6120133] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/08/2019] [Accepted: 11/25/2019] [Indexed: 12/11/2022]
Abstract
Atopic dermatitis (AD) and psoriasis are common chronic skin diseases affecting children. These disorders negatively impact the quality of life (QoL) of patients in health-related aspects such as physical, psychosocial, and mental functioning. This health impact is more accurately represented when accounting for the numerous comorbidities associated with each disorder, and the impact the disorders have on patients’ families. A number of QoL tools have been developed and can be routinely implemented in the evaluation of QoL in pediatric patients and their caregivers. Ways to improve QoL include a multidisciplinary approach to care, education, and psychological support.
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32
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Nakhjirgan P, Mahmoodi M, Kashani H, Firooz A, Nabizadeh R, Kermani M, Yunesian M. Air pollution and exacerbation of skin itching and sleep disturbance in Iranian atopic dermatitis patients. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2019; 17:811-816. [PMID: 32030154 PMCID: PMC6985420 DOI: 10.1007/s40201-019-00397-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND For about three decades now, the number of people suffering from atopy including atopic dermatitis (AD) has been increasing in developed countries. Genetic background and environmental factors including air pollution play an effective role in its incidence. This study examined the association between air pollutants and exacerbation of AD symptoms including sleep disturbance and itching in AD patients of Tehran. METHODS In this panel study, 31 patients with AD who admitted to Razi Hospital, dermatology hospital in Tehran, entered the research. Daily information including questions on disease symptoms (sleep disturbance, itching) and duration of outdoor stay (in hours) were collected using a questionnaire. The mean 24-h concentrations of PM2.5 and PM10 pollutants were obtained from the Air Quality Control Company. The relationship between the concentrations of the pollutants and exacerbation of the disease symptoms was investigated using the GEE (Generalized Estimating Equations) model. RESULTS There was a significant relationship between the concentrations of air pollutants and exacerbation of sleep disturbance and itching on the same day, before, and after adjusting the effects of the confounding variables, so that the estimated odds ratios (95% confidence interval) between PM10 and PM2.5 and exacerbation of itching were 1.06 (1.02-1.10) and 1.17 (1.07-1.28), respectively. CONCLUSIONS There was a significant statistical relationship between the concentration of particulate matter (PM2.5 and PM10) and exacerbation of sleep disturbance and itching. PM2.5 showed a stronger relationship with the exacerbation of symptoms compared to PM10.
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Affiliation(s)
- Pegah Nakhjirgan
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Poursina Street, Keshavarz Boulevard, Tehran, 1417613151 Iran
| | - Masoumeh Mahmoodi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Poursina Street, Keshavarz Boulevard, Tehran, 1417613151 Iran
| | - Homa Kashani
- Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, No. 1547, North Kargar Ave., Tehran, 1417993359 Iran
| | - Alireza Firooz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Nabizadeh
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Poursina Street, Keshavarz Boulevard, Tehran, 1417613151 Iran
| | - Majid Kermani
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Masud Yunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Poursina Street, Keshavarz Boulevard, Tehran, 1417613151 Iran
- Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
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Ražnatović Đurović M, Janković J, Tomić Spirić V, Relić M, Sojević Timotijević Z, Ćirković A, Đurić S, Janković S. Does age influence the quality of life in children with atopic dermatitis? PLoS One 2019; 14:e0224618. [PMID: 31725802 PMCID: PMC6855426 DOI: 10.1371/journal.pone.0224618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/17/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is one of the most common childhood skin diseases that can affect the quality of life (QoL) of children. The QoL of Montenegrin children with AD has not been sufficiently explored. The aim of this study was to assess their QoL with special emphasize on age differences. METHODS This cross-sectional study included children with AD seen at the Clinic of Dermatology and Venereology, Clinical Center of Montenegro (CCM) in Podgorica between August 2017 and July 2018. The QoL was assessed with the Infants' Dermatitis Quality of Life Index (IDQOL) and the Children's Dermatology Life Quality Index (CDLQI). Disease severity was measured by the Three Item Severity (TIS) score. RESULTS A total of 386 children with AD aged from newborn to 16 years took part in this study. The mean total score of the QoL was 14.7 in infants (0-4 years old), 19.4 in younger children (5-9 years old), and 16.6 in older children (10-16 years old). Age was in negative correlation with the CDLQI score, leisure domain of the CDLQI and CDLQI sleep, and in positive correlation with the IDQOL child mood. TIS score was in positive correlation with both the IDQOL and CDLQI score. CONCLUSIONS The QoL measured by CDLQI was more impaired in younger children, whilst IDQOL child mood was more impaired in older infants. The most impaired QoL was seen in children in the age group 5-9 years. Regardless of disease severity, treatment and counseling of children suffering from AD should be tailored specifically to their age.
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Affiliation(s)
- Milena Ražnatović Đurović
- Clinic of Dermatology and Venereology, Clinical Center of Montenegro, Faculty of Medicine University of Montenegro, Podgorica, Montenegro
| | - Janko Janković
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- * E-mail:
| | - Vesna Tomić Spirić
- Department of Internal Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Allergology and Immunology, Clinical Center of Serbia, Belgrade, Serbia
| | - Milijana Relić
- Department of Dermatology, Faculty of Medicine, University of Priština, Kosovska Mitrovica, Serbia
| | | | - Anđa Ćirković
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slađana Đurić
- Department for Preventive Medicine, Faculty of Medicine, University of Priština, Kosovska Mitrovica, Serbia
| | - Slavenka Janković
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Lara-Corrales I, Bergman JN, Landells I, Ramien ML, Lansang P. Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section I: Overview of Pediatric Atopic Dermatitis. J Cutan Med Surg 2019; 23:3S-11S. [DOI: 10.1177/1203475419882049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pediatric atopic dermatitis (AD) is one of the most common dermatoses encountered by health-care providers treating children. Diagnosis of AD is clinical, with no universally accepted biomarkers or assessment tools. Patient-reported outcomes and subjective assessments of quality of life in both the patient and family are important considerations when treating pediatric AD. Here, we provide an overview of pediatric AD epidemiology, its clinical presentation, burden, diagnosis, and assessment, with a focus on implications for patient counseling in order to optimize care.
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Affiliation(s)
- Irene Lara-Corrales
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada
| | - James N. Bergman
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Ian Landells
- Departments of Medicine and Pediatrics, Division of Dermatology, Memorial University, St. John’s, NL, Canada
- Nexus Clinical Research, St. John’s, NL, Canada
| | - Michele L. Ramien
- Department of Medicine, Division of Dermatology, University of Calgary, AB, Canada
- Division of Community Pediatrics, Department of Pediatrics, Alberta Children’s Hospital, Calgary, AB, Canada
| | - Perla Lansang
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada
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Mental health impairment among children with atopic dermatitis: A United States population-based cross-sectional study of the 2013-2017 National Health Interview Survey. J Am Acad Dermatol 2019; 82:1368-1375. [PMID: 31626880 DOI: 10.1016/j.jaad.2019.10.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/11/2019] [Accepted: 10/10/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is associated with mental health disorders, but its impact on global mental health symptoms is less clear. OBJECTIVE To determine the association between pediatric AD and mental health impairment. METHODS In a cross-sectional study using 2013-2017 United States National Health Interview Survey data, children with and without AD were assessed for mental disorder with impairment (MDI) using a validated behavioral screening questionnaire. Mental health services utilization was also reported. RESULTS The prevalence of any MDI was 26.7% (95% confidence interval [CI], 25.1-28.3) among children with AD and 17.7% (95% CI, 17.2-18.2) among those without AD, with severe MDI being present in 10.9% (95% CI 9.9-12.1) and 6.2% (95% CI 5.9-6.5), respectively. Adjusted for sociodemographic factors, AD was associated with higher odds of MDI (odds ratio, 1.52; 95% CI, 1.39-1.67), including impairments in conduct, emotions, peer relationships, and attention. Among children with AD, 19.9% (95% CI, 16.6-23.8) and 53.5% (95% CI, 48.5-58.5) of those with mild or severe MDI, respectively, had seen a mental health professional in the last year. LIMITATIONS Misclassification bias may arise from self-reported data. CONCLUSION AD is associated with clinically significant mental health symptoms, but many affected children may not seek or receive care for their symptoms.
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36
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Maksimovic N, Zaric M, Reljic V, Nikolic M, Gazibara T. Factors associated with improvement of quality of life among parents of children with atopic dermatitis: 1-year prospective cohort study. J Eur Acad Dermatol Venereol 2019; 34:325-332. [PMID: 31494995 DOI: 10.1111/jdv.15939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/23/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Previous studies exploring the impact of atopic dermatitis (AD) in children focused on factors associated with parental quality of life at one point in time. OBJECTIVE To examine factors associated with change of quality of life among parents of children affected with AD. METHODS The study cohort comprised 98 parent-children pairs treated for AD at the Clinic of Dermatovenereology; however, 18 parents (18.4%) were lost to follow-up after 1 year. Children were assessed with SCORing Atopic Dermatitis Index (SCORAD) and Children Dermatology Life Quality Index (CDLQI) or the Infants' Dermatitis Quality of Life Index (IDQOL), depending on their age. Parents filled in socio-demographic questionnaire and Dermatitis Family Impact Questionnaire (DFI). After 1 year, both children and parents were reassessed using the same AD-related battery of questionnaires. RESULTS After follow-up, a significant improvement in the average total DFI score was observed, especially for domains of fatigue/exhaustion, emotional distress and impact of helping in child treatment. Lower baseline SCORAD, greater improvement of SCORAD over follow-up, better CDLQI/IDQOL at baseline, greater improvement in CDLQI/IDQOL over follow-up, not having asthma and having older child with AD were associated with better parental quality of life after 1 year of follow-up. Parental higher education level, shorter AD duration, better baseline SCORAD and greater improvement in CDLQI/IDQOL over follow-up were associated with greater improvement in parental life quality over 1 year of follow-up. CONCLUSION Contributors to parental quality of life after 1 year included clinical features of AD and child's comorbidity (asthma), but also the perception of child's quality of life and its improvement.
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Affiliation(s)
- N Maksimovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - M Zaric
- Parexel International, Belgrade, Serbia
| | - V Reljic
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - M Nikolic
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - T Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Zijlstra WT, Os‐Medendorp H, Fieten KB, Sinnema G, Bruijnzeel‐Koomen CAFM, Zuithoff NPA, L'Hoir MP, Pasmans SGMA. Effects of shared medical appointments compared to individual appointments in children with atopic dermatitis: A pragmatic randomized controlled trial. Clin Exp Allergy 2019; 49:1095-1106. [DOI: 10.1111/cea.13416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Wieneke T. Zijlstra
- Department of Dermatology and Allergology University Medical Centre Utrecht Utrecht The Netherlands
- Department of Pediatrics OLVG Amsterdam Amsterdam The Netherlands
| | - Harmieke Os‐Medendorp
- Department of Dermatology and Allergology University Medical Centre Utrecht Utrecht The Netherlands
| | - Karin B. Fieten
- Department of Dermatology and Allergology University Medical Centre Utrecht Utrecht The Netherlands
| | - Gerben Sinnema
- Department of Pediatric Psychology and Social Work, Wilhelmina Children's Hospital University Medical Center Utrecht Utrecht The Netherlands
| | | | - Nicolaas P. A. Zuithoff
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht The Netherlands
| | - Monique P. L'Hoir
- Human Nutrition Wageningen University & Research (WUR) Wageningen The Netherlands
| | - Suzanne G. M. A. Pasmans
- Department of Dermatology and Allergology University Medical Centre Utrecht Utrecht The Netherlands
- Department of Pediatric Dermatology, Sophia Children's Hospital Erasmus University Medical Centre Rotterdam The Netherlands
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Altered hypothalamus-pituitary-adrenal axis function: A relevant factor in the comorbidity of atopic eczema and attention deficit/hyperactivity disorder? Psychoneuroendocrinology 2019; 105:178-186. [PMID: 30583940 DOI: 10.1016/j.psyneuen.2018.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 12/20/2022]
Abstract
Epidemiological data show a significant association between childhood atopic eczema (AE) and an increased risk to develop attention deficit/hyperactivity disorder (ADHD). However, the underlying mechanisms of the comorbidity of AE and ADHD are mostly unknown. We investigated whether alterations of hypothalamus-pituitary-adrenal (HPA) axis function represent a shared feature of AE and ADHD potentiating AE-ADHD comorbidity. Children aged 6-12 years with AE, ADHD, or comorbid AE + ADHD and healthy control (HC) children were examined cross-sectionally (N = 145). To evaluate HPA axis function, salivary cortisol in response to psychosocial stress (Trier Social Stress Test for Children, TSST-C), after awakening (cortisol awakening response, CAR), and throughout the day (short diurnal profile) and hair cortisol capturing long-term HPA axis activity were assessed. Quantile regression analyses showed an attenuated cortisol response (% maximum change) to the TSST-C in children with ADHD compared to HC. A diminished cortisol response to acute stress was also observed in the comorbid AE + ADHD group, in which the reduction was numerically even more pronounced. Contrary to our previous findings, no alteration of the cortisol response to the TSST-C was observed in children with AE. However, in children with AE, increased ADHD-like behavior (i.e., inattention, impulsivity, and overall ADHD symptom severity) was associated with a reduced HPA axis response to acute stress. No such associations were observed in children without AE. Groups did not differ in CAR, short diurnal profile, and hair cortisol. These findings underscore the potential relevance of HPA axis function in the pathophysiology of AE and ADHD with emphasis on stress reactivity. Additional studies are required to further explore the separate and joint role of the HPA axis in the pathophysiology of AE and ADHD.
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"We're doing the best job we can": maternal experiences of facilitators and barriers to preschoolers sleeping well in Aotearoa/New Zealand. Sleep Health 2019; 5:248-256. [PMID: 31208708 DOI: 10.1016/j.sleh.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/02/2019] [Accepted: 01/10/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This study considered sleep from a social determinants of health and socioecological perspective. It aimed to explore facilitators and barriers to 4-year-old children sleeping well, as experienced by Māori and non-Māori mothers, with low and high socioeconomic position (SEP), in Aotearoa/New Zealand. DESIGN Experiential qualitative research involving face-to-face, semistructured individual interviews. PARTICIPANTS Fifteen Māori (low SEP = 7; high SEP = 8) and 16 non-Māori (low SEP = 7; high SEP = 9) mothers of preschoolers. MEASUREMENTS Interviews were guided by questions about how preschoolers slept and what mothers thought made a difference to their child's sleep. Data were analyzed inductively using thematic analysis. RESULTS Four themes were identified: "health, activity, and diet"; "sleep-promoting physical environments"; "consistency"; and "doing it our way." Children being healthy and active, sleep-conducive bedroom spaces, consistent routines, and supportive social environments assisted preschoolers to sleep well. However, broader contextual factors beyond mothers' control influenced the degree of autonomy they had over implementing sleep-supporting strategies that worked for their families. External influences included access to financial resources; parental work patterns; early childhood education service practices; access to quality housing; and affordable, culturally responsive, and respectful professional sleep advice. CONCLUSION Efforts aimed at facilitating healthy sleep among preschoolers and effective preschooler sleep interventions must go beyond simply recommending individual-focused sleep-promoting tips to include actions on the social determinants of sleep and the sociopolitical drivers that influence these.
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Ramirez FD, Chen S, Langan SM, Prather AA, McCulloch CE, Kidd SA, Cabana MD, Chren MM, Abuabara K. Association of Atopic Dermatitis With Sleep Quality in Children. JAMA Pediatr 2019; 173:e190025. [PMID: 30830151 PMCID: PMC6503516 DOI: 10.1001/jamapediatrics.2019.0025] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pruritus, a hallmark of atopic dermatitis (AD), is thought to disrupt sleep, yet little is known about how variations in disease activity and severity of this common childhood condition may be associated with sleep patterns over time. Objective To determine whether children with active AD have impaired sleep duration and quality at multiple time points throughout childhood and whether disease severity affects sleep outcomes. Design, Setting, and Participants This longitudinal cohort study used data of children enrolled in the Avon Longitudinal Study of Parents and Children, a population-based birth cohort in Avon, United Kingdom. Participants were children (N = 13 988) alive at 1 year and followed up with repeated measures of self-reported AD and sleep through 16 years of age. This study was based on data collected from 1990 to 2008. Data analysis was performed from September 2017 to September 2018. Main Outcomes and Measures Standardized measure of sleep duration and composite measure of sleep quality, including nighttime awakenings, early morning awakenings, difficulty falling asleep, and nightmares, were repeated at multiple time points between 2 and 16 years of age. Results The study sample comprised 13 988 children (7220 male [51.6%]) followed up for a median (interquartile range [IQR]) duration of 11 (5-14) years. Of this total, 4938 children (35.3%) met the definition of having atopic dermatitis between 2 and 16 years of age. Total sleep duration was similar between children with active AD and without AD at all ages, and the average estimated difference across childhood was a clinically negligible difference of 2 minutes less per day for children with AD (95% CI, -4 to 0 minutes). In contrast, children with active AD were more likely to report worse sleep quality at all time points, with a nearly 50% higher odds of experiencing more sleep-quality disturbances (adjusted odds ratio [aOR], 1.48; 95% CI, 1.33 to 1.66). Children with more severe active disease (quite bad or very bad AD: aOR, 1.68; 95% CI, 1.42 to 1.98) and with comorbid asthma or allergic rhinitis (aOR, 1.79; 95% CI, 1.54 to 2.09) had worse sleep quality. However, even children with mild AD (OR, 1.40; 95% CI, 1.27 to 1.54) or inactive AD (OR, 1.41; 95% CI, 1.28 to 1.55) had statistically significantly increased odds of impaired sleep quality. Conclusions and Relevance Atopic dermatitis appeared to be associated with impaired sleep quality throughout childhood; thus, it is suggested that clinicians should consider sleep quality among all children with AD, especially those with comorbid asthma or allergic rhinitis and severe disease, and that interventions to improve sleep quality are needed.
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Affiliation(s)
- Faustine D Ramirez
- Department of Dermatology Program for Clinical Research, University of California, San Francisco, San Francisco
| | - Shelley Chen
- Department of Dermatology Program for Clinical Research, University of California, San Francisco, San Francisco
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aric A Prather
- Department of Psychiatry, University of California, San Francisco, San Francisco
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco
| | - Sharon A Kidd
- Department of Dermatology Program for Clinical Research, University of California, San Francisco, San Francisco
| | - Michael D Cabana
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco.,Department of Pediatrics, University of California, San Francisco, San Francisco.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katrina Abuabara
- Department of Dermatology Program for Clinical Research, University of California, San Francisco, San Francisco
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L Kruse L, Cices A, Fishbein AB, Paller AS. Neurocognitive function in moderate-severe pediatric atopic dermatitis: A case-control study. Pediatr Dermatol 2019; 36:110-114. [PMID: 30506922 DOI: 10.1111/pde.13710] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES Epidemiological studies have shown an increased prevalence of attention deficit hyperactivity disorder (ADHD) in children with atopic dermatitis (AD), but many of the features of ADHD may occur as a result of the poor sleep and itch distraction associated with AD. METHODS A case-control study was performed in children aged 6-17 years with moderate/severe AD compared with age-/sex-matched healthy controls. Participants were screened for ADHD using Vanderbilt assessments. RESULTS Seventeen patients with AD and 18 controls completed the study. Two children with AD (11.7%) and one control (5.56%) met screening criteria for ADHD via parent-completed Vanderbilt assessments; AD patients were not significantly more likely to screen positive for ADHD (P = 0.47), or comorbid behavior disorders (P = 0.23). However, AD patients were more likely than controls to exhibit ADHD-associated behaviors, most significantly inattention. CONCLUSIONS Our AD cohort did not have a significantly increased prevalence of ADHD. Certain neurocognitive symptoms are increased in children with moderate-to-severe AD compared to controls.
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Affiliation(s)
- Lacey L Kruse
- Division of Dermatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ahuva Cices
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anna B Fishbein
- Division of Pediatric Allergy & Immunology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Amy S Paller
- Division of Dermatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Taghavi Ardakani A, Farrehi M, Sharif MR, Ostadmohammadi V, Mirhosseini N, Kheirkhah D, Moosavi SGA, Behnejad M, Reiter RJ, Asemi Z. The effects of melatonin administration on disease severity and sleep quality in children with atopic dermatitis: A randomized, double-blinded, placebo-controlled trial. Pediatr Allergy Immunol 2018; 29:834-840. [PMID: 30160043 DOI: 10.1111/pai.12978] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/07/2018] [Accepted: 08/16/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of this clinical trial was to determine the effects of melatonin administration on disease severity and sleep quality in children diagnosed with atopic dermatitis (AD). METHODS This randomized, double-blinded, placebo-controlled trial was conducted by recruiting 70 patients, aged 6-12 years, who had been diagnosed with AD. Study participants were randomly allocated into two intervention groups to receive either 6 mg/d melatonin supplements or placebo (n = 35 each group) for 6 weeks. Severity of disease was assessed using the scoring atopic dermatitis (SCORAD) and objective SCORAD indices. Sleep quality was evaluated by completing the Children's Sleep Habits Questionnaire (CSHQ). RESULTS Following 6 weeks of intervention, melatonin supplementation significantly improved SCORAD index (β -3.55; 95% CI, -6.11, -0.98; P = 0.007), objective SCORAD index (β -3.23; 95% CI, -5.08, -1.38; P = 0.001), serum total IgE levels (β -153.94 ku/L; 95% CI, -260.39, -47.49; P = 0.005), and CSHQ scores (β -2.55; 95% CI, -4.34, -0.75; P = 0.006). However, melatonin had no significant impact on pruritus scores, high-sensitivity C-reactive protein (hs-CRP), sleep-onset latency, total sleep time, weight, and BMI compared with placebo. CONCLUSIONS Overall, melatonin supplementation had beneficial effects on disease severity, serum total IgE levels, and CSHQ among children diagnosed with AD.
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Affiliation(s)
- Abbas Taghavi Ardakani
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Department of Pediatrics, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Maryam Farrehi
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Department of Pediatrics, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Reza Sharif
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Department of Pediatrics, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Vahidreza Ostadmohammadi
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Davood Kheirkhah
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Department of Pediatrics, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Gholam Abbas Moosavi
- Department of Statistics and Public Health, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Milad Behnejad
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Russel J Reiter
- Department of Cellular and Structural Biology, UT Health Science Center, San Antonio, TX, USA
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
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Garthus-Niegel S, Horsch A, Bickle Graz M, Martini J, von Soest T, Weidner K, Eberhard-Gran M. The prospective relationship between postpartum PTSD and child sleep: A 2-year follow-up study. J Affect Disord 2018; 241:71-79. [PMID: 30098473 DOI: 10.1016/j.jad.2018.07.067] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/11/2018] [Accepted: 07/22/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The main aim of this study was to examine the prospective impact of maternal postpartum PTSD on several standardized child sleep variables two years postpartum in a large, population-based cohort of mothers. Moreover, we investigated the influence of numerous potential confounding maternal and child factors. Finally, we tested potential reverse temporal associations between child sleep eight weeks postpartum and maternal PTSD symptoms two years postpartum. METHODS This study is part of the population-based Akershus Birth Cohort, a prospective cohort study at Akershus University Hospital, Norway. Data from the hospital's birth record, from questionnaires at 17 weeks gestation, eight weeks and two years postpartum were used. At two years postpartum, 39% of the original participants could be retained, resulting in a study population of n = 1480. All child sleep variables significantly correlated with postpartum PTSD symptoms were entered into multiple linear regression analyses, adjusting for confounding factors. RESULTS Postpartum PTSD symptoms were related to all child sleep variables, except daytime sleep duration. When all significant confounding factors were included into multivariate regression analyses, postpartum PTSD symptoms remained a significant predictor for number and duration of night wakings (β = 0.10 and β = 0.08, respectively), duration of settling time (β = 0.10), and maternal rating of their child's sleep problems (β = 0.12, all p<.01. Child sleep at eight weeks postpartum was not significantly related to maternal sleep two years postpartum when controlling for postpartum PTSD at eight weeks. LIMITATIONS Child outcomes were based on maternal reporting and might be influenced by maternal mental health. CONCLUSIONS Our results showed for the first time that maternal postpartum PTSD symptoms were prospectively associated with less favorable child sleep, thus increasing the risk of developmental or behavioral problems through an indirect, but treatable pathway. Early detection and treatment of maternal postpartum PTSD may prevent or improve sleep problems and long-term child development.
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Affiliation(s)
- Susan Garthus-Niegel
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine,Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany; Department of Child Health, Norwegian Institute of Public Health, P.O. box 222 Skøyen, 0213 Oslo, Norway.
| | - Antje Horsch
- Department Woman-Mother-Child, Faculty of Biology and Medicine, Lausanne University Hospital, Rue du Bugnon 21, CH-1011 Lausanne, Switzerland; Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, Lausanne University and Lausanne University Hospital, Rue du Bugnon 21, CH-1011 Lausanne, Switzerland
| | - Myriam Bickle Graz
- Department Woman-Mother-Child, Faculty of Biology and Medicine, Lausanne University Hospital, Rue du Bugnon 21, CH-1011 Lausanne, Switzerland
| | - Julia Martini
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Tilmann von Soest
- Department of Psychology, University of Oslo, P.O. box 1094, Blindern, 0317 Oslo, Norway
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine,Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Malin Eberhard-Gran
- Department of Child Health, Norwegian Institute of Public Health, P.O. box 222 Skøyen, 0213 Oslo, Norway; HØKH, Research Centre, Akershus University Hospital, P.O. box 1000, 1478 Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, P.O. box 1171, Blindern, 0318 Oslo, Norway
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A Randomized Controlled Trial of an Eczema Care Plan. Acad Pediatr 2018; 18:789-796. [PMID: 29505898 DOI: 10.1016/j.acap.2018.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/19/2018] [Accepted: 02/24/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To test whether an eczema care plan (ECP) would improve provider documentation and management, decrease eczema severity, and increase patient quality of life (QOL) in the pediatric primary care setting. METHODS We conducted a randomized controlled trial from June 2015 to September 2016 at a large hospital-based pediatric primary care clinic. Participants included children from 1 month to 16 years of age with a diagnosis of eczema. The intervention group received the ECP and the control group received usual care. Both groups completed a validated eczema severity scale (Patient-Oriented Eczema Measure [POEM]) and a QOL scale (Infant's Dermatitis Quality of Life Index [IDQOL]) or Children's Dermatology Life Quality Index [CDLQI]) before the visit and again ~1 month later. RESULTS A total of 211 caregivers completed both the pre- and postintervention surveys (100 control group and 111 intervention group [94% completion]). Intervention group providers were more likely to recommend a comprehensive "step-up" plan (88%) vs 28%; P < .001, bleach baths (45%) vs 9%; P < .001, and wet wraps (50%) vs 7%; P < .001. They were also more likely to document providing a written plan to families (80%) vs 2%; P < .001. In the intervention and control groups, eczema severity and QOL improved between the pre- and postintervention periods. However, there was not a significant difference between the groups on either measure: POEM difference -0.8, 95% confidence interval (CI) -3.2 to 1.7; IDQOL difference -0.1, 95% CI -1.8 to 1.6; CDLQI difference 0.8, 95% CI -0.9 to 2.6. CONCLUSIONS Intervention group providers documented more comprehensive eczema care than control group providers. Although patients improved on all measures in the postintervention period, the ECP did not augment that improvement.
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Sleep disorders and atopic dermatitis: A 2-way street? J Allergy Clin Immunol 2018; 142:1033-1040. [PMID: 30144472 DOI: 10.1016/j.jaci.2018.08.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022]
Abstract
Sleep disturbance is very common in patients with atopic dermatitis (AD) and is a major factor leading to impaired quality of life. Sleep disturbance is often viewed as one of the symptoms of AD and one of the measures of disease severity. In this review we describe a variety of sleep disorders associated with AD and a wide range of effect that sleep disorders have on patients with AD. We also discuss our current understanding of the mechanism of sleep disturbance in patients with AD. The relationship between sleep disorders and AD might be bidirectional and could form a vicious cycle. Therefore we suggest viewing sleep disorders as a comorbidity of AD for which regular screening and bidirectional management strategies are indicated, with equal focus on maintaining disease control and implementing specific strategies to improve sleep.
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Abstract
Atopic dermatitis is a chronic, pruritic inflammatory disease that often disrupts sleep in severely affected children, but there are limited studies to guide clinical management of these sleep problems. Disease control is crucial in improving sleep, but additional sleep aids may sometimes be helpful in decreasing scratching during the night. This review discusses the benefits and limitations of potential therapeutic agents available to manage sleep disturbances in children with atopic dermatitis.
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Affiliation(s)
- Devika Patel
- Department of Dermatology, Palo Alto Medical Foundation, Dublin, CA, USA
| | | | - Tor Shwayder
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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Lee JH, Choi CS, Bae IH, Choi JK, Park YH, Park M. A novel, topical, nonsteroidal, TRPV1 antagonist, PAC-14028 cream improves skin barrier function and exerts anti-inflammatory action through modulating epidermal differentiation markers and suppressing Th2 cytokines in atopic dermatitis. J Dermatol Sci 2018; 91:S0923-1811(18)30204-4. [PMID: 29752146 DOI: 10.1016/j.jdermsci.2018.04.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/21/2018] [Accepted: 04/25/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although it is established that epidermal barrier disturbance and immune dysfunction resulting in IgE sensitization are critical factors in the development of cutaneous inflammation, the pathogenesis and targeted therapy of atopic dermatitis (AD)-specific pathways have still been unknown. OBJECTIVE Taking into account the fact that Th2 cytokines in AD have both unique and overlapping functions including increased epidermal thickening, inflammation, and decreased expressing of the barrier proteins keratinocyte differentiation, we sought to clarify our hypothesis that TRPV1 antagonist plays a critical role in skin barrier function and can be a therapeutic target for AD. METHODS AD-like dermatitis was induced in hairless mice by repeated oxazolone (Ox) challenges to hairless mice. The functional studies concerning skin barrier function, anti-inflammatory action, and molecular mechanism by TRPV1 antagonism were conducted by histopathological assays, ELISA, qPCR, western blotting, and skin blood flow measurement. RESULTS Topically administered TRPV1 antagonist, PAC-14028 (Asivatrep: C21H22F5N3O3S), improved AD-like dermatitis and skin barrier functions, and restored the expression of epidermal differentiation markers. In addition, the PAC-14028 cream significantly inhibited cutaneous inflammation by decreasing the expression of serum IgE, and the epidermal expression of IL-4, and IL-13 in Ox-AD mice. These results may provide a novel insight into the molecular mechanism of PAC-14028 cream involved in anti-inflammatory effects and skin barrier functions by suppressing the multiple signaling pathways including IL-4/-13-mediated activation of JAK/STAT, TRPV1, and neuropeptides. CONCLUSION PAC-14028 cream can be a potential therapeutic tool for the treatment of chronic inflammation and disrupted barrier function in patients with AD.
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Affiliation(s)
- Ji-Hae Lee
- Vital Beautie Research Institute, Amorepacific Corporation R&D Center, Yongin, Republic of Korea
| | - Chang Soon Choi
- Vital Beautie Research Institute, Amorepacific Corporation R&D Center, Yongin, Republic of Korea
| | - Il-Hong Bae
- Vital Beautie Research Institute, Amorepacific Corporation R&D Center, Yongin, Republic of Korea
| | - Jin Kyu Choi
- Medical Beauty QA Team, Aestura Corporation, Anseong, Republic of Korea
| | - Young-Ho Park
- Vital Beautie Research Institute, Amorepacific Corporation R&D Center, Yongin, Republic of Korea
| | - Miyoung Park
- Vital Beautie Research Institute, Amorepacific Corporation R&D Center, Yongin, Republic of Korea.
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Affiliation(s)
- Andrea R Waldman
- Pediatric and Adolescent Dermatology, University of California, San Diego, and Rady Children's Hospital, San Diego, CA
| | - Jusleen Ahluwalia
- Pediatric and Adolescent Dermatology, University of California, San Diego, and Rady Children's Hospital, San Diego, CA
| | - Jeremy Udkoff
- Pediatric and Adolescent Dermatology, University of California, San Diego, and Rady Children's Hospital, San Diego, CA
| | - Jenna F Borok
- Pediatric and Adolescent Dermatology, University of California, San Diego, and Rady Children's Hospital, San Diego, CA
| | - Lawrence F Eichenfield
- Pediatric and Adolescent Dermatology, University of California, San Diego, and Rady Children's Hospital, San Diego, CA
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Abstract
Atopic dermatitis is a heterogeneous, chronic, and inflammatory skin disease that is associated with a profound symptom burden. Recent studies have demonstrated associations between atopic dermatitis and a number of multi-organ and systemic disorders. The origin of these comorbid conditions is likely multifactorial, with combined effects of skin-barrier disruption, immune dysregulation, intense symptoms, and iatrogenic complications. Some of these comorbid conditions appear to be related to the underlying severity of atopic dermatitis and inadequate disease control. This review will summarize recent developments in the understanding of the comorbid health disorders associated with atopic dermatitis, particularly infections, sleep disturbances, and cardiovascular disease.
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Affiliation(s)
- Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Arkes building, 676 N Saint Clair St, Suite 1600, Chicago, IL, 60611, USA
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