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Bu Y, Sun Z, Tao Y, Zhao X, Zhao Y, Liang Y, Hang X, Han L. The synergistic effect of high temperature and relative humidity on non-accidental deaths at different urbanization levels. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 940:173612. [PMID: 38823719 DOI: 10.1016/j.scitotenv.2024.173612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/11/2024] [Accepted: 05/27/2024] [Indexed: 06/03/2024]
Abstract
Numerous studies have examined the impact of temperature on mortality, yet research on the combined effect of temperature and humidity on non-accidental deaths remains limited. This study investigates the synergistic impact of high temperature and humidity on non-accidental deaths in China, assessing the influence of urban development and urbanization level. Utilizing the distributed lag nonlinear model (DLNM) of quasi-Poisson regression, we analyzed the relationship between Wet Bulb Globe Temperature (WBGT) and non-accidental deaths in 30 Chinese cities from 2010 to 2016, including Guangzhou during 2012-2016. We stratified temperature and humidity across these cities to evaluate the influence of varying humidity levels on deaths under high temperatures. Then, we graded the duration of heat and humidity in these cities to assess the impact of deaths with different durations. Additionally, the cities were categorized based on gross domestic product (GDP), and a vulnerability index was calculated to examine the impact of urban development and urbanization level on non-accidental deaths. Our findings reveal a pronounced synergistic effect of high temperature and humidity on non-accidental deaths, particularly at elevated humidity levels. The synergies of high temperature and humidity are extremely complex. Moreover, the longer the duration of high temperature and humidity, the higher the risk of non-accidental death. Furthermore, areas with higher urbanization exhibited lower relative risks (RR) associated with the synergistic effects of heat and humidity. Consequently, it is imperative to focus on damp-heat related mortality among vulnerable populations in less developed regions.
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Affiliation(s)
- Yaqin Bu
- Key Laboratory of Western China's Environmental Systems (Ministry of Education), College of Earth and Environmental Sciences, Lanzhou University, Lanzhou 730000, China; State Key Laboratory of Severe Weather (LASW), Chinese Academy of Meteorological Sciences (CAMS), China Meteorological Administration, Beijing 100081, China
| | - Zhaobin Sun
- State Key Laboratory of Severe Weather (LASW), Chinese Academy of Meteorological Sciences (CAMS), China Meteorological Administration, Beijing 100081, China.
| | - Yan Tao
- Key Laboratory of Western China's Environmental Systems (Ministry of Education), College of Earth and Environmental Sciences, Lanzhou University, Lanzhou 730000, China
| | - Xiuge Zhao
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Yuxin Zhao
- State Key Laboratory of Severe Weather (LASW), Chinese Academy of Meteorological Sciences (CAMS), China Meteorological Administration, Beijing 100081, China
| | - Yinglin Liang
- State Key Laboratory of Severe Weather (LASW), Chinese Academy of Meteorological Sciences (CAMS), China Meteorological Administration, Beijing 100081, China
| | - Xiaoyi Hang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Ling Han
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
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2
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Zain A, Yeo I, Wong L, Shek LP. Climate change from the Asia-Pacific perspective: What an allergist needs to know and do. Pediatr Allergy Immunol 2024; 35:e14216. [PMID: 39137244 DOI: 10.1111/pai.14216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/29/2024] [Accepted: 07/31/2024] [Indexed: 08/15/2024]
Abstract
Allergic diseases such as asthma, atopic dermatitis, and food allergies are a burgeoning health challenge in the Asia-Pacific region. Compounding this, the region has become increasingly susceptible to the impacts of climate change. The region has weathered extreme precipitation, intense heat waves, and dust storms over the recent decades. While the effects of environmental and genetic factors on allergic diseases are well understood, prevailing gaps in understanding the complex interactions between climate change and these factors remain. We aim to provide insights into the various pathways by which climate change influences allergic diseases in the Asia-Pacific population. We outline practical steps that allergists can take to reduce the carbon footprint of their practice on both a systemic and patient-specific level. We recommend that allergists optimize disease control to reduce the resources required for each patient's care, which contributes to reducing greenhouse gas emissions. We encourage the responsible prescription of metered dose inhalers by promoting the switch to dry powder inhalers for certain patients, at each clinician's discretion. We also recommend the utilization of virtual consultations to reduce patient travel while ensuring that evidence-based guidelines for rational allergy management are closely adhered to. Finally, eliminating unnecessary testing and medications will also reduce greenhouse gas emissions in many areas of medical care.
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Affiliation(s)
- Amanda Zain
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Centre for Sustainable Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Inez Yeo
- Centre for Sustainable Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lydia Wong
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Lynette P Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
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3
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Wang SP, Stefanovic N, Orfali RL, Aoki V, Brown SJ, Dhar S, Eichenfield LF, Flohr C, Ha A, Mora C, Murase JE, Rosenbach M, Srinivas SM, Thyssen JP, Wei ML, Irvine AD, Abuabara K. Impact of climate change on atopic dermatitis: A review by the International Eczema Council. Allergy 2024; 79:1455-1469. [PMID: 38265114 DOI: 10.1111/all.16007] [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: 10/19/2023] [Revised: 12/04/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024]
Abstract
Atopic dermatitis (AD), the most burdensome skin condition worldwide, is influenced by climatic factors and air pollution; however, the impact of increasing climatic hazards on AD remains poorly characterized. Leveraging an existing framework for 10 climatic hazards related to greenhouse gas emissions, we identified 18 studies with evidence for an impact on AD through a systematic search. Most climatic hazards had evidence for aggravation of AD the impact ranged from direct effects like particulate matter-induced AD exacerbations from wildfires to the potential for indirect effects like drought-induced food insecurity and migration. We then created maps comparing the past, present, and future projected burden of climatic hazards to global AD prevalence data. Data are lacking, especially from those regions most likely to experience more climatic hazards. We highlight gaps important for future research: understanding the synergistic impacts of climatic hazards on AD, long-term disease activity, the differential impact on vulnerable populations, and how basic mechanisms explain population-level trends.
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Affiliation(s)
- Sheng-Pei Wang
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | | | - Raquel L Orfali
- Department of Dermatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valeria Aoki
- Department of Dermatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sara J Brown
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Sandipan Dhar
- Department of Pediatric Dermatology, Institute of Child Health, Kolkata, India
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California San Diego, San Diego, California, USA
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Alex Ha
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Camilo Mora
- Department of Geography and Environment, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Jenny E Murase
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
- Department of Dermatology, Palo Alto Foundation Medical Group, Mountain View, California, USA
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sahana M Srinivas
- Department of Dermatology, Indira Gandhi Institute of Child Health, Bengaluru, India
| | - Jacob P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maria L Wei
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
- Dermatology Service, San Francisco VA Health Care System, San Francisco, California, USA
| | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
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Mailepessov D, Ong J, Nasir MZM, Aik J, Woo M, Zhao X, Tey HL, Yew YW. Association between exposure to ambient air pollution, meteorological factors and atopic dermatitis consultations in Singapore-a stratified nationwide time-series analysis. Sci Rep 2024; 14:10320. [PMID: 38710739 DOI: 10.1038/s41598-024-60712-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/26/2024] [Indexed: 05/08/2024] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease affecting approximately 20% of children globally. While studies have been conducted elsewhere, air pollution and weather variability is not well studied in the tropics. This time-series study examines the association between air pollution and meteorological factors with the incidence of outpatient visits for AD obtained from the National Skin Centre (NSC) in Singapore. The total number of 1,440,844 consultation visits from the NSC from 2009 to 2019 was analysed. Using the distributed lag non-linear model and assuming a negative binomial distribution, the short-term temporal association between outpatient visits for AD and air quality and meteorological variability on a weekly time-scale were examined, while adjusting for long-term trends, seasonality and autocorrelation. The analysis was also stratified by gender and age to assess potential effect modification. The risk of AD consultation visits was 14% lower (RR10th percentile: 0.86, 95% CI 0.78-0.96) at the 10th percentile (11.9 µg/m3) of PM2.5 and 10% higher (RR90th percentile: 1.10, 95% CI 1.01-1.19) at the 90th percentile (24.4 µg/m3) compared to the median value (16.1 µg/m3). Similar results were observed for PM10 with lower risk at the 10th percentile and higher risk at the 90th percentile (RR10th percentile: 0.86, 95% CI 0.78-0.95, RR90th percentile: 1.10, 95% CI 1.01-1.19). For rainfall for values above the median, the risk of consultation visits was higher up to 7.4 mm in the PM2.5 model (RR74th percentile: 1.07, 95% CI 1.00-1.14) and up to 9 mm in the PM10 model (RR80th percentile: 1.12, 95% CI 1.00-1.25). This study found a close association between outpatient visits for AD with ambient particulate matter concentrations and rainfall. Seasonal variations in particulate matter and rainfall may be used to alert healthcare providers on the anticipated rise in AD cases and to time preventive measures to reduce the associated health burden.
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Affiliation(s)
- Diyar Mailepessov
- Environmental Health Institute, National Environment Agency, 11 Biopolis Way #06-05/08, Helios Block, Singapore, 138667, Singapore
| | - Janet Ong
- Environmental Health Institute, National Environment Agency, 11 Biopolis Way #06-05/08, Helios Block, Singapore, 138667, Singapore
| | - Muhammad Zafir Mohamad Nasir
- Environmental Health Institute, National Environment Agency, 11 Biopolis Way #06-05/08, Helios Block, Singapore, 138667, Singapore
| | - Joel Aik
- Environmental Health Institute, National Environment Agency, 11 Biopolis Way #06-05/08, Helios Block, Singapore, 138667, Singapore.
- Pre-Hospital and Emergency Research Centre, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Maye Woo
- Environmental Quality Monitoring Department, Environmental Monitoring and Modelling Division, National Environment Agency, Singapore, 228231, Singapore
| | | | - Hong Liang Tey
- National Skin Centre, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yik Weng Yew
- National Skin Centre, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Afshari M, Kolackova M, Rosecka M, Čelakovská J, Krejsek J. Unraveling the skin; a comprehensive review of atopic dermatitis, current understanding, and approaches. Front Immunol 2024; 15:1361005. [PMID: 38500882 PMCID: PMC10944924 DOI: 10.3389/fimmu.2024.1361005] [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: 12/24/2023] [Accepted: 02/14/2024] [Indexed: 03/20/2024] Open
Abstract
Atopic dermatitis, also known as atopic eczema, is a chronic inflammatory skin disease characterized by red pruritic skin lesions, xerosis, ichthyosis, and skin pain. Among the social impacts of atopic dermatitis are difficulties and detachment in relationships and social stigmatization. Additionally, atopic dermatitis is known to cause sleep disturbance, anxiety, hyperactivity, and depression. Although the pathological process behind atopic dermatitis is not fully known, it appears to be a combination of epidermal barrier dysfunction and immune dysregulation. Skin is the largest organ of the human body which acts as a mechanical barrier to toxins and UV light and a natural barrier against water loss. Both functions face significant challenges due to atopic dermatitis. The list of factors that can potentially trigger or contribute to atopic dermatitis is extensive, ranging from genetic factors, family history, dietary choices, immune triggers, and environmental factors. Consequently, prevention, early clinical diagnosis, and effective treatment may be the only resolutions to combat this burdensome disease. Ensuring safe and targeted drug delivery to the skin layers, without reaching the systemic circulation is a promising option raised by nano-delivery systems in dermatology. In this review, we explored the current understanding and approaches of atopic dermatitis and outlined a range of the most recent therapeutics and dosage forms brought by nanotechnology. This review was conducted using PubMed, Google Scholar, and ScienceDirect databases.
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Affiliation(s)
- Moeina Afshari
- Department of Clinical Immunology and Allergy, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czechia
| | - Martina Kolackova
- Department of Clinical Immunology and Allergy, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czechia
| | - Michaela Rosecka
- Department of Clinical Immunology and Allergy, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czechia
| | - Jarmila Čelakovská
- Department of Dermatology and Venereology, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czechia
| | - Jan Krejsek
- Department of Clinical Immunology and Allergy, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czechia
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Hui-Beckman JW, Goleva E, Leung DYM, Kim BE. The impact of temperature on the skin barrier and atopic dermatitis. Ann Allergy Asthma Immunol 2023; 131:713-719. [PMID: 37595740 DOI: 10.1016/j.anai.2023.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/20/2023]
Abstract
Climate change is a global threat to public health and causes or worsens various diseases including atopic dermatitis (AD), allergic, infectious, cardiovascular diseases, physical injuries, and mental disorders. The incidence of allergy, such as AD, has increased over the past several decades, and environmental factors such as climate change have been implicated as a potential mechanism. A substantial amount of literature has been published on the impact of climate factors, including cold and hot temperatures, on the skin barrier and AD. Studies in several countries have found a greater incidence of AD in children born in the colder seasons of fall and winter. The effect of cold and warm temperatures on itch, skin flares, increased outpatient visits, skin barrier dysfunction, development of AD, and asthma exacerbations have been reported. Understanding mechanisms by which changes in temperature influence allergies is critical to the development of measures for the prevention and treatment of allergic disorders, such as AD and asthma. Low and high temperatures induce the production of proinflammatory cytokines and lipid mediators such as interleukin-1β, thymic stromal lymphopoietin, and prostaglandin E2, and cause itch and flares by activation of TRPVs such as TRPV1, TRPV3, and TRPV4. TRPV antagonists may attenuate temperature-mediated itch, skin barrier dysfunction, and exacerbation of AD.
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Affiliation(s)
| | - Elena Goleva
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
| | - Byung Eui Kim
- Department of Pediatrics, National Jewish Health, Denver, Colorado
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Silverberg JI, Shi VY, Alexis A, Pierce E, Cronin A, McLean RR, Roberts-Toler C, Rueda MJ, Atwater AR, Simpson E. Racial and Ethnic Differences in Sociodemographic, Clinical, and Treatment Characteristics Among Patients with Atopic Dermatitis in the United States and Canada: Real-World Data from the CorEvitas Atopic Dermatitis Registry. Dermatol Ther (Heidelb) 2023; 13:2045-2061. [PMID: 37481484 PMCID: PMC10442294 DOI: 10.1007/s13555-023-00980-6] [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: 06/01/2023] [Accepted: 07/07/2023] [Indexed: 07/24/2023] Open
Abstract
INTRODUCTION This real-world, cross-sectional study compared sociodemographic, clinical and treatment characteristics, and patient-reported outcomes (PROs) among racial/ethnic groups in patients with atopic dermatitis (AD) who are candidates for systemic therapy. METHODS This study included adults with dermatologist- or dermatology practitioner-diagnosed AD enrolled in the CorEvitas AD Registry (July 2020-July 2021). All patients initiated systemic therapy within 12 months prior to or at enrollment or had moderate-to-severe AD (vIGA-AD® ≥ 3 and Eczema Area and Severity Index [EASI] ≥ 12) at enrollment. Patients were categorized into five mutually exclusive racial/ethnic groups: non-Hispanic White, Black, Asian, Other/Multiracial, and Hispanic (any race). Patient, clinical, and treatment characteristics were captured at enrollment. Differences in means or proportions of characteristics among racial/ethnic groups were descriptively summarized using effect sizes. Adjusted prevalence ratios and mean differences were estimated (White race/ethnicity group as the reference category) with 95% confidence intervals (CI). RESULTS Among 1288 patients, 64% (n = 822) were White, 13% (n = 167) Black, 10% (n = 129) Asian, 8% (n = 97) Hispanic, and 6% (n = 73) Other/Multiracial. In adjusted analyses, statistically more severe EASI lichenification was noted among Black compared with White patients at the head and neck (mean difference, 0.21, [95% CI 0.06, 0.36]; p = 0.01), trunk (0.32, [0.17, 0.47]; p < 0.001), upper extremities (0.27, [0.09, 0.44]; p = 0.008), and lower extremities (0.39, [0.21, 0.57]; p < 0.001). Statistically more severe EASI lichenification was observed among Asian vs White patients in certain areas (mean difference, head and neck, 0.22 [0.04, 0.39], p = 0.01; trunk, 0.25 [0.07, 0.43], p < 0.001; lower extremities, 0.22 [0.01, 0.43], p < 0.001) and SCORing for AD lichenification (mean difference: 0.34 [0.15, 0.52]; p < 0.001). Significantly higher mean pruritus over the past 7 days for Black (mean difference: 0.63 [0.01, 1.26] and Hispanic patients (0.60 [0.11, 1.09]; p = 0.03) vs White patients was observed. Among AD clinical features, the prevalence of facial erythema was significantly lower among Black compared with White patients (prevalence ratio = 0.38, [0.22, 0.67]; p = 0.007). CONCLUSION Racial/ethnic differences exist in sociodemographic, clinical and treatment characteristics, disease severity, and PROs among real-world AD patients who are candidates for systemic therapy. Recognizing these variations may be of critical importance for dermatologists for the design and delivery of targeted/personalized medicine approaches.
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Affiliation(s)
- Jonathan I Silverberg
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Vivian Y Shi
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Evangeline Pierce
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA.
| | | | | | | | - Maria J Rueda
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA
| | - Amber R Atwater
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA
| | - Eric Simpson
- Oregon Health and Science University, Portland, OR, USA
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Chan J, MacNeill SJ, Stuart B, Lo YTE, Roberts A, Mitchell D, Ridd MJ. Do temperature changes cause eczema flares? An English cohort study. Clin Exp Dermatol 2023; 48:1012-1018. [PMID: 37130096 DOI: 10.1093/ced/llad147] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/20/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND It is unclear if ambient temperature changes affect eczema. It is also unclear if people with worse disease are more susceptible to weather-related flares, or specific types of emollient offer protection. OBJECTIVES To investigate the effect of short-term temperature variations on eczema symptoms in children. METHODS Data from a UK cohort of 519 children with eczema were combined with data from the Hadley Centre's Integrated Surface Database. Hot and cold weeks were defined by average regional temperature > 75th or < 25th percentile, January 2018 to February 2020. Eczema flares were defined as ≥ 3-point change in Patient-Oriented Eczema Measure (POEM). Random-effects logistic regression models were used to estimate the odds ratios of flares in hot and cold weeks (reference group: temperate weeks). RESULTS The baseline mean age was 4.9 years (SD 3.2) and the POEM score was 9.2 (SD 5.5). From the 519 participants, there were 6796 consecutively paired POEMs and 1082 flares. Seasonal variation in POEM scores was observed, suggesting symptoms worsening in winter and improving in summer. Odds ratios of flares were: 1.15 [95% confidence interval (CI) 0.96-1.39, P = 0.14] in cold weeks and 0.85 (95% CI 0.72-1.00, P = 0.05) in hot weeks. The likelihood ratio test showed no evidence of this differing by disease severity (P = 0.53) or emollient type used (P = 0.55). CONCLUSIONS Our findings are consistent with previous studies demonstrating either improvements in eczema symptoms or reduced flares in hot weather. Worse disease and different emollient types did not increase susceptibility or provide protection against temperature changes. Further work should investigate the role of sunlight, humidity, pollution and other environmental factors.
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Affiliation(s)
- Jonathan Chan
- Population Health Sciences Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stephanie J MacNeill
- Population Health Sciences Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - Beth Stuart
- Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
| | - Y T Eunice Lo
- Cabot Institute for the Environment and School of Geographical Sciences, University of Bristol, UK
- Elizabeth Blackwell Institute for Health Research, University of Bristol, UK
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Centre of Evidenced Based Dermatology, University of Nottingham, UK
| | - Dann Mitchell
- Cabot Institute for the Environment and School of Geographical Sciences, University of Bristol, UK
| | - Matthew J Ridd
- Population Health Sciences Institute, Bristol Medical School, University of Bristol, Bristol, UK
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Çetinarslan T, Kümper L, Fölster-Holst R. The immunological and structural epidermal barrier dysfunction and skin microbiome in atopic dermatitis-an update. Front Mol Biosci 2023; 10:1159404. [PMID: 37654796 PMCID: PMC10467310 DOI: 10.3389/fmolb.2023.1159404] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/04/2023] [Indexed: 09/02/2023] Open
Abstract
Atopic dermatitis (AD) is a common, chronic and relapsing inflammatory skin disease with various clinical presentations and combinations of symptoms. The pathophysiology of AD is complex and multifactorial. There are several factors involved in the etiopathogenesis of AD including structural and immunological epidermal barrier defect, imbalance of the skin microbiome, genetic background and environmental factors. Alterations in structural proteins, lipids, proteases, and their inhibitors, lead to the impairment of the stratum corneum which is associated with the increased skin penetration and transepidermal water loss. The elevated serum immunoglobulin E levels and blood eosinophilia have been shown in the majority of AD patients. Type 2 T-helper cell immune pathway with increased expression of interleukin (IL)-4, IL-5, and IL-13, has an important role in the etiopathogenesis of AD. Both T cells and keratinocytes contribute to epidermal barrier impairment in AD via a dynamic interaction of cytokines and chemokines. The skin microbiome is another factor of relevance in the etiopathogenesis of AD. It has been shown that during AD flares, Staphylococcus aureus (S. aureus) colonization increased, while Staphylococcus epidermidis (S. epidermidis) decreased. On the contrary, S. epidermidis and species of Streptococcus, Corynebacterium and Propionibacterium increased during the remision phases. However, it is not clear whether skin dysbiosis is one of the symptoms or one of the causes of AD. There are several therapeutic options, targeting these pathways which play a critical role in the etiopathogenesis of AD. Although topical steroids are the mainstay of the treatment of AD, new biological therapies including IL-4, IL-13, and IL-31 inhibitors, as well as Janus kinase inhibitors (JAKi), increasingly gain more importance with new advances in the therapy of AD. In this review, we summarize the role of immunological and structural epidermal barrier dysfunction, immune abnormalities, impairment of lipids, filaggrin mutation and skin microbiome in the etiopathogenesis of AD, as well as the therapeutic options for AD and their effects on these abnormalities in AD skin.
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Affiliation(s)
- Tubanur Çetinarslan
- Department of Dermatology and Venereology, Manisa Celal Bayar University, Manisa, Türkiye
| | - Lisa Kümper
- MEDICE Arzneimittel Pütter GmbH and Co. KG, Iserlohn, Germany
| | - Regina Fölster-Holst
- Department of Dermatology-Venereology and Allergology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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10
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Are There Ethnic Differences in Hand Eczema? A Review. J Clin Med 2023; 12:jcm12062232. [PMID: 36983235 PMCID: PMC10056516 DOI: 10.3390/jcm12062232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023] Open
Abstract
Hand eczema is a common disease with economic and social ramifications. This study undertakes a review of certain existing literature to provide insight into contributory factors which may result in the varying prevalence and severity of hand eczema among different ethnic groups, particularly to identify modifiable risk factors, as well as to ascertain knowledge gaps for future research direction. The existing literature suggests that factors including (a) genes, (b) differing skin physiology, (c) cultural practices, (d) dietary habits and associated food preparation, (e) climate, (f) predominant occupations, (g) socioeconomic factors, and (h) dissimilar laws and regulations may account for the disparity in the risk of hand eczema among different ethnicities. Given that endogenous factors cannot be avoided, but certain exogenous aspects can be modified, especially as the environment plays an important role in hand eczema flares, it is helpful from a practical perspective to focus on addressing the modifiable risk factors. These factors pertain to unique cultural practices, customs, and food preparation methods. Healthcare professionals should be well-acquainted with such factors to tailor the treatment approach for patients of different ethnicities accordingly because, with globalization, physicians face increasingly diverse patient populations such that cultural customs no longer remain limited to particular geographic regions.
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Fadadu RP, Abuabara K, Balmes JR, Hanifin JM, Wei ML. Air Pollution and Atopic Dermatitis, from Molecular Mechanisms to Population-Level Evidence: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2526. [PMID: 36767891 PMCID: PMC9916398 DOI: 10.3390/ijerph20032526] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
Atopic dermatitis (AD) has increased in prevalence to become the most common inflammatory skin condition globally, and geographic variation and migration studies suggest an important role for environmental triggers. Air pollution, especially due to industrialization and wildfires, may contribute to the development and exacerbation of AD. We provide a comprehensive, multidisciplinary review of existing molecular and epidemiologic studies on the associations of air pollutants and AD symptoms, prevalence, incidence, severity, and clinic visits. Cell and animal studies demonstrated that air pollutants contribute to AD symptoms and disease by activating the aryl hydrocarbon receptor pathway, promoting oxidative stress, initiating a proinflammatory response, and disrupting the skin barrier function. Epidemiologic studies overall report that air pollution is associated with AD among both children and adults, though the results are not consistent among cross-sectional studies. Studies on healthcare use for AD found positive correlations between medical visits for AD and air pollutants. As the air quality worsens in many areas globally, it is important to recognize how this can increase the risk for AD, to be aware of the increased demand for AD-related medical care, and to understand how to counsel patients regarding their skin health. Further research is needed to develop treatments that prevent or mitigate air pollution-related AD symptoms.
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Affiliation(s)
- Raj P. Fadadu
- Department of Dermatology, University of California, San Francisco, CA 94115, USA
- Dermatology Service, San Francisco VA Health Care System, San Francisco, CA 94121, USA
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Katrina Abuabara
- Department of Dermatology, University of California, San Francisco, CA 94115, USA
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - John R. Balmes
- School of Public Health, University of California, Berkeley, CA 94720, USA
- Division of Occupational and Environmental Medicine, University of California, San Francisco, CA 94143, USA
| | - Jon M. Hanifin
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Maria L. Wei
- Department of Dermatology, University of California, San Francisco, CA 94115, USA
- Dermatology Service, San Francisco VA Health Care System, San Francisco, CA 94121, USA
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12
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Feng L, Zhang Q, Ruth N, Wu Y, Saliou C, Yu M. Compromised skin barrier induced by prolonged face mask usage during the COVID-19 pandemic and its remedy with proper moisturization. Skin Res Technol 2023; 29:e13214. [PMID: 36428277 PMCID: PMC9838772 DOI: 10.1111/srt.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/26/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prolonged face mask usage, a daily practice for the public due to the COVID-19 pandemic, creates high levels of humidity underneath the mask, which may cause unexpected skin concerns. OBJECTIVE To investigate the impact of repeated mask usage on the face by comparing skin properties inside and outside of the mask-covered areas. METHODS A double-blinded, randomized, split-face clinical study was conducted with 21 healthy female participants who wore face masks at least 6 h every day for 1 week, with one side of their face treated with a moisturizer three times daily. On day 8, after 5 h of wearing the mask, skin properties (sebum, hydration, and trans-epidermal water loss [TEWL]) were evaluated at 15, 60, and 120 min post-mask removal, followed by barrier disruption and recovery assessment. RESULTS Mask usage weakened stratum corneum (SC) on facial skin compared to uncovered areas, including reduced SC hydration (p < 0.02 at 15 min) and increased TEWL in response to tape stripping challenge (p < 0.03 after stripping). In addition, sebum production also increased after mask removal (p < 0.01 at 15 min). Notably, a daily moisturizer mitigated these effects by increasing SC hydration (p < 0.001) and improving SC resilience against barrier disruption. CONCLUSION Daily prolonged usage of a facial mask, essential due to the COVID-19 situation, generated a high-humidity microenvironment and led to compromised SC, which was revealed by a barrier challenge technique. Moreover, proper facial moisturization may help to maintain skin homeostasis and prevent the barrier impairment caused by repeated mask usage.
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Affiliation(s)
- Li Feng
- Estée Lauder Companies, Melville, New York, USA
| | | | - Nora Ruth
- Estée Lauder Companies, Melville, New York, USA
| | - Yan Wu
- Department of Dermatology, Peking University First Hospital, Beijing, China
| | | | - Mei Yu
- Estée Lauder Companies, Melville, New York, USA
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13
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Huang Y, Song H, Wang Z, Cheng Y, Liu Y, Hao S, Li N, Wang Y, Wang Y, Zhang X, Sun B, Li Y, Yao X. Heat and outpatient visits of skin diseases – A multisite analysis in China, 2014–2018. Heliyon 2022; 8:e11203. [PMID: 36339999 PMCID: PMC9626933 DOI: 10.1016/j.heliyon.2022.e11203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/05/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background Many studies have shown that various kinds of diseases were associated with the variation of ambient temperature. However, there’s only a scrap of evidence paying attention to the link between temperature and skin diseases, and no relevant national research was performed in China. Objective This study aimed to quantify the effect of heat on skin diseases and identify the vulnerable populations and areas in China. Methods Daily meteorological data, air pollutant data and outpatient data were collected from in 18 sites of China during 2014–2018. A time-series study with distributed lag nonlinear model and multivariate meta-analysis was applied to analyze the site-specific and pooled associations between daily mean temperature and daily outpatient visits of skin diseases by using the data of warm season (from June to September). Stratified analysis by age, sex and climate zones and subtypes of skin diseases were also conducted. Results We found a positive linear relationship between the ambient temperature and risk of skin diseases, with a 1.25% (95%CI: 0.34%, 2.16%) increase of risk of outpatient visits for each 1 °C increase in daily mean temperature during the warm season. In general, groups aged 18–44 years, males and people living in temperate climate regions were more susceptible to high temperature. Immune dysfunction including dermatitis and eczema were heat-sensitive skin diseases. Conclusions Our findings suggested that people should take notice of heat-related skin diseases and also provided some references about related health burden for strategy-makers. Targeted measures for vulnerable populations need to be taken to reduce disease burden, including monitoring and early warning systems, and sun-protection measures.
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14
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Navarrete-Rodríguez EM, Del-Río-Navarro BE, Reyes Noriega N, Berber A, Mérida Palacio V, García-Almaráz R, Ellwood P. Have the prevalence of eczema symptoms increased in the Mexican pediatric population? Prevalence and associated factors according to Global Asthma Network Phase I. World Allergy Organ J 2022; 15:100710. [PMID: 36267354 PMCID: PMC9578987 DOI: 10.1016/j.waojou.2022.100710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 10/31/2022] Open
Abstract
Background In children, atopic dermatitis or eczema is the most common inflammatory disease of the skin. According to the International Study of Asthma and Allergies in Childhood (ISAAC) Phase IIIB in Mexico, 5.8% of children and 4.9% of adolescents had eczema symptoms. In 2012, Global Asthma Network (GAN) was established to update the prevalence of eczema and estimate potential factors contributing to its development. Objective To estimate the prevalence and associated factors for atopic eczema symptoms and diagnosis in children and adolescents according to GAN Phase I and compare the results with ISAAC Phase IIIB in Mexico. Methods A cross-sectional, multicenter survey was conducted in 15 Mexican centers during the period of 2015-2017 using the GAN Phase I questionnaires in children (6-7-year-olds) and adolescents (13-14-year-olds). The prevalences obtained from the GAN Phase I study, were compared with ISAAC Phase IIIB results; a Spearman's correlation analysis was conducted between temperature, relative humidity, and altitude and eczema symptoms, and a logistic regression was performed to predict current eczema symptoms by age group. Results A total of 35 777 children and 41 399 adolescents were included. Since ISAAC Phase IIIB, the prevalence of itchy rash in the past 12 months significantly increased in the children's group [6.6% (95% CI 5.7-7.4) vs 7.8 (95% CI 7.5-8.1), p = 0.000] and adolescents' group [5.8% (95% CI 5.0-6.7) vs 6.7% (95% CI 6.5-7.0), p = 0.000].In the adolescents' group, the prevalence of nocturnal awakenings caused by rash symptoms on more than one night per week had a negative correlation between altitude (Spearman's Rho = -0.558, p value = 0.031), and a positive correlation with the average annual temperature (Spearman's Rho = 0.604, p value = 0.017) and annual relative humidity (Spearman's Rho = 0.742, p value = 0.002). The most significant associations in children were the presence of sneezing or runny or blocked nose in the past 12 months [(OR 3.13, 95% CI 2.60-3.77), p = 0.000], the use of paracetamol in the first year of life ([OR 1.52, 95% CI 1.15-2.01), p = 0.003] and the use of antibiotics in the first year of life [(OR 1.30, 95% CI 1.08-1.55) p = 0.004]. Moreover, altitude at 100-1000 m above sea level was associated with current eczema symptoms in adolescents (p = 0.001). Conclusions There has been a significant increase in eczema symptoms in both age groups since ISAAC Phase IIIB study. Additionally, eczema symptoms were associated with temperature, relative humidity, asthma, hay fever symptoms, the use of paracetamol and antibiotics.
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Affiliation(s)
| | - Blanca Estela Del-Río-Navarro
- Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico,Corresponding author. Hospital Infantil de México Federico Gómez, Dr. Márquez No. 162, Col. Doctores, Deleg. Cuauhtémoc, 06720, México, D.F., Mexico.
| | - Nayely Reyes Noriega
- Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Arturo Berber
- Asesor Externo del Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | | | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, 1023, New Zealand
| | - GAN Phase I Study groupRamos-GarcíaBeatriz Del CarmenMDfEscalante-DomínguezAlberto JoséMDgLinares-ZapiénFrancisco JavierMDhGardea-MorenoHéctor LeonardoMDiOchoa-LópezGeorginaMDjHernández-MondragónLuis OctavioMDkLozano-SáenzJosé SantosMDlSacre-HazouriJosé AntonioMDmJuan-PinedaMa de los ÁngelesMDnSánchez-CoronelMaría GuadalupeMDoRodríguez-PérezNoelMDpAmbriz-MorenoMaría de JesúsMDpDel-Río-ChivardiJaime MarianoqSaucedo-RamírezOmar JosueMDqInstituto Mexicano del Seguro Social San Luis Potosí, San Luis Potosí, MexicoHospital General Tijuana, Baja California, MexicoCentro de Investigación, Diagnóstico y Tratamiento de Asma y Alergias, Toluca, Estado de México, MexicoHospital Ángeles Chihuahua, Chihuahua, MexicoHospital Ángeles Ciudad Juárez, Chihuahua, MexicoCRIT Michoacán, Morelia, Michoacán, MexicoHospital Ángeles Xalapa, Veracruz, MexicoUniversidad Veracruzana, Córdoba, Veracruz, MexicoPrivate Practice, Puerto Vallarta, Jalisco, MexicoBenemérita Universidad Autónoma de Aguascalientes, Aguascalientes, MexicoHospital General de Matamoros, Tamaulipas, MexicoServicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
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15
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Uibel D, Sharma R, Piontkowski D, Sheffield PE, Clougherty JE. Association of ambient extreme heat with pediatric morbidity: a scoping review. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:1683-1698. [PMID: 35751701 PMCID: PMC10019589 DOI: 10.1007/s00484-022-02310-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 06/01/2023]
Abstract
Global climate change is leading to higher ambient temperatures and more frequent heatwaves. To date, impacts of ambient extreme heat on childhood morbidity have been understudied, although-given children's physiologic susceptibility, with smaller body surface-to-mass ratios, and many years of increasing temperatures ahead-there is an urgent need for better information to inform public health policies and clinical approaches. In this review, we aim to (1) identify pediatric morbidity outcomes previously associated with extreme heat, (2) to identify predisposing co-morbidities which may make children more susceptible to heat-related outcomes, and (3) to map the current body of available literature. A scoping review of the current full-text literature was conducted using the Arksey and O'Malley framework Int J Soc Res Methodol 8:19-32, (2015). Search terms for (1) pediatric population, (2) heat exposures, (3) ambient conditions, and (4) adverse outcomes were combined into a comprehensive PubMed and Medline literature search. Of the 1753 publications identified, a total of 20 relevant studies were ultimately selected based on selection criteria of relevance to US urban populations. Most identified studies supported positive associations between high extreme temperature exposures and heat-related illness, dehydration/electrolyte imbalance, general symptoms, diarrhea and digestion disorders, infectious diseases/infections, asthma/wheeze, and injury. Most studies found no association with renal disease, cardiovascular diseases, or diabetes mellitus. Results were mixed for other respiratory diseases and mental health/psychological disorders. Very few of the identified studies examined susceptibility to pre-existing conditions; Cystic Fibrosis was the only co-morbidity for which we found significant evidence. Further research is needed to understand the nuances of associations between extreme heat and specific outcomes-particularly how associations may vary by child age, sex, race/ ethnicity, community characteristics, and other pre-existing conditions.
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Affiliation(s)
- Danielle Uibel
- Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Rachit Sharma
- Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Danielle Piontkowski
- Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Perry E Sheffield
- Departments of Environmental Medicine and Public Health and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jane E Clougherty
- Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
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16
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Rutter KJ, Farrar MD, Marjanovic EJ, Rhodes LE. Clinicophotobiological Characterization of Photoaggravated Atopic Dermatitis. JAMA Dermatol 2022; 158:1022-1030. [PMID: 35895040 PMCID: PMC9330275 DOI: 10.1001/jamadermatol.2022.2823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Photoaggravated atopic dermatitis (PAD) is estimated to affect 1.4% to 16% of patients with AD but remains poorly characterized with limited published data. Objective To provide detailed clinical and photobiological characterization of PAD. Design, Setting, and Participants This case series study used cross-sectional data collected from 120 consecutive patients diagnosed with PAD from January 2015 to October 2019 at a tertiary center referral unit for photobiology. Main Outcomes and Measures Routinely collected standardized clinical and photobiological data were analyzed using descriptive statistics, and regression analysis explored associations between demographic and clinical data. Results Of 869 patients who underwent photoinvestigation, 120 (14%) were diagnosed with PAD (69 female [58%]; median age, 45 [IQR, 31-61] years; range, 5-83 years; skin phototypes [SPTs] I-VI). Of these patients, 104 (87%) were adults. All patients had a history of AD, and most (62 of 104 [60%]) presented with sunlight-provoked or photodistributed eczema; median age at photosensitivity onset was 37 years (range, 1-72 years). Past-year Dermatology Life Quality Index score was greater than 10 for 80 of 103 adults (78%), and 82 of 119 (69%) had vitamin D (25-hydroxyvitamin D) level insufficiency or deficiency (<20 ng/mL; to convert ng/mL to nmol/L, multiply by 2.496). Broadband UV radiation provocation test results were positive for 112 patients (93%). In 28 patients (23%) with abnormal monochromator phototest findings, sensitivity occurred to UV-A, UV-B, and/or visible light, and UV-A of 350 ± 10 nm was the most prevalent wavelength. Photopatch test reactions were positive for 18 patients (15%). Patients with SPTs V to VI (31 [26%]) vs SPTs I to IV (89 [74%]) were younger at photosensitivity onset (median age, 24 years [IQR, 15-37 years] vs 40 years [IQR, 25-55 years]; P = .003), were more likely to be female (23 [74%] vs 46 [52%]; P = .03), and had a lower vitamin D status and a higher frequency of abnormal monochromator phototest findings. Conclusions and Relevance In this case series study, PAD affected patients with different ages and SPTs and was associated with substantially impaired quality of life. The findings suggest that confirming PAD through phototesting may provide better personalized care for patients through identification of provoking wavelengths, relevant photocontact allergies, and appropriate photoprotection advice.
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Affiliation(s)
- Kirsty J Rutter
- Centre for Dermatology Research, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, England.,Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, Manchester, England
| | - Mark D Farrar
- Centre for Dermatology Research, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, England.,Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, Manchester, England
| | - Elizabeth J Marjanovic
- Centre for Dermatology Research, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, England.,Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, Manchester, England
| | - Lesley E Rhodes
- Centre for Dermatology Research, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, England.,Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, Manchester, England
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17
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Chao L, Lu M, Gao W, An Z, Li J, Liu Y, Wu W, Song J. Ambient temperature exposure and risk of outpatient visits for dermatologic diseases in Xinxiang, China: a time-series analysis. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:1487-1493. [PMID: 35522347 DOI: 10.1007/s00484-022-02297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 06/14/2023]
Abstract
The effect of ambient temperature on dermatologic diseases has received widespread attention. Previous studies have shown that ambient temperature might affect specific dermatologic diseases, but results were inconsistent. This study aims to assess the short-term effect of ambient temperature on outpatient visits due to dermatologic diseases (DMs) in Xinxiang, China. Daily DMs outpatient visits, mean temperature, mean relative humidity, and air pollution data of Xinxiang were retrieved from January 1, 2015, to December 31, 2018. A distributed lag nonlinear model (DLNM) was applied to analyze the effect of ambient temperature on DMs outpatients. We controlled several potential confounding factors such as the long-term trend, public holiday, day of the week, humidity, and air pollutants (NO2, PM2.5). Finally, two more stratification analysis was conducted by age and gender. A total of 164,270 outpatients of DMs were enrolled during our study, and the daily mean visits were 113. The estimated effect of temperature on DMs was nonlinear. Heat temperature would exacerbate outpatients of dermatologic diseases. With a reference median temperature (17 °C), the effect of temperature on DMs was most pronounced at lag0-14; exposure to heat (32 °C, 99th) was associated with 1.565 (95% CI: 1.266-1.934) increased risk of outpatients for DMs. Stratification analysis showed that citizens of young ages were susceptive to heat; both genders had a similar relationship between temperature and DMs risk. This study highlights that ambient temperature was associated with DMs outpatients; heat temperature might aggravate DMs risk. The health hazards of heat temperature required more attention, and more effective prevention measurements should be designed and implemented to curb global warming.
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Affiliation(s)
- Ling Chao
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Mengxue Lu
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Wenshan Gao
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Zhen An
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Juan Li
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Yue Liu
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China
| | - Weidong Wu
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Jie Song
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China.
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18
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Jazdarehee A, Lee J, Lewis R, Mukovozov I. Potential Mechanisms of the Sparing of Atopic Dermatitis in the Diaper Region: A Scoping Review. J Cutan Med Surg 2022; 26:398-403. [PMID: 35317630 PMCID: PMC9361425 DOI: 10.1177/12034754221088533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Atopic dermatitis (AD) is a chronic, inflammatory skin condition commonly
affecting infants with notable sparing of the diaper region. Though
sources anecdotally attribute this sparing to the physical barrier
formed by the diaper and the subsequent retention of moisture, urine,
sweat and feces, no studies have formally investigated the factors
contributing to this sparing phenomenon. We performed a scoping
literature review to investigate the factors involved in sparing of AD
in the diaper region, namely humidity, scratching, urine, sweat,
feces, and microbiome composition. A total of 130 papers met the
inclusion criteria, and extracted data were analyzed in an iterative
manner. Increased local humidity facilitates protective changes at the
cellular level and offsets transepidermal water loss. Exposure to urea
from both sweat and urine may contribute to improved moisturization of
the skin through its natural humectant properties and ability to
modulate gene expression. Introduction of flora in feces contributes
to the generation of protective immune responses and outcompetes
growth of pathogens such as Staphylococcus aureus.
Finally, diapers physically prevent scratching, which directly
interrupts the itch-scratch cycle classically implicated in AD. Our
study reviews factors that may contribute to the sparing of AD in the
diaper region in infants. A limitation to our findings is that the
studies reviewed here explore the impacts of these factors on AD
broadly, and not explicitly in the diaper region. Additional studies
investigating this may further our understanding of AD pathogenesis
and contribute to the development of effective therapeutics.
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Affiliation(s)
- Aria Jazdarehee
- 8166 Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason Lee
- 8166 Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard Lewis
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Kamloops Dermatology, Kamloops, BC, Canada
| | - Ilya Mukovozov
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
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19
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Chao L, Sun Y, An Z, Li J, Wu W, Liu Y, Song J. Effects of ambient temperature on outpatient visits for dermatitis in Xinxiang, China: a time-series analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:15999-16005. [PMID: 34642884 DOI: 10.1007/s11356-021-16710-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/21/2021] [Indexed: 06/13/2023]
Abstract
Previous studies have reported regional variations in the relationship between ambient temperature and dermatitis, which therefore remain inconclusive. This study aimed to understand the short-term effects of ambient temperature in outpatients with dermatitis in Xinxiang. Routine data of dermatitis outpatient visits between January 1, 2015, and December 31, 2018 were acquired from the First Affiliated Hospital of Xinxiang Medical University. A distributed lag nonlinear model (DLNM) in combination with a generalized additive model (GAM) was applied to investigate the acute impact of ambient temperature on dermatitis outpatients. Two stratified analyses based on age and sex were conducted to explore their potential modification effects. A total of 18,064 dermatitis outpatient records were retrieved during the study period. The relationship between ambient temperature and dermatitis outpatients was found to be nonlinear; exposure-response curves were approximately "J" shaped. The risk of dermatitis outpatient increased with a corresponding elevation in temperature from 11.5 to 27.5°C. However, the significance was lost when the temperature exceeded the given range. Stratified analysis demonstrated higher sensitivity to temperature in females than in males, and the young groups (<15 years) might be sensitive to heat temperature. This study provides first-hand epidemiological evidence demonstrating a higher risk of dermatitis outpatient visits associated with moderately higher temperatures. The outcomes of this study create awareness among citizens to take the necessary precautions to prevent the adverse effects of moderate heat temperature during early summer and autumn seasons.
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Affiliation(s)
- Ling Chao
- Henan International Collaborative Laboratory for Air Pollution Health Effects and Intervention, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, China
| | - Yajun Sun
- Zhuhai Center for Chronic Disease Control, The Third People's Hospital of Zhuhai, Zhuhai, 519000, China
| | - Zhen An
- Henan International Collaborative Laboratory for Air Pollution Health Effects and Intervention, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, China
| | - Juan Li
- Henan International Collaborative Laboratory for Air Pollution Health Effects and Intervention, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, China
| | - Weidong Wu
- Henan International Collaborative Laboratory for Air Pollution Health Effects and Intervention, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, China
| | - Yue Liu
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China.
| | - Jie Song
- Henan International Collaborative Laboratory for Air Pollution Health Effects and Intervention, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, China.
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20
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Wang J, Zhang Y, Li B, Zhao Z, Huang C, Zhang X, Deng Q, Lu C, Qian H, Yang X, Sun Y, Sundell J, Norbäck D. Eczema, facial erythema, and seborrheic dermatitis symptoms among young adults in China in relation to ambient air pollution, climate, and home environment. INDOOR AIR 2022; 32:e12918. [PMID: 34337784 DOI: 10.1111/ina.12918] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 07/12/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
A questionnaire survey on dermal symptoms and home environment was performed in eight Chinese cities (40 279 participants). Data on city level temperature, precipitation, PM10 , NO2, and gross domestic product (GDP) per capita were collected. In total, 2.2% had eczema, 2.4% facial erythema (FE) and 2.6% seborrheic dermatitis symptoms (SD). Higher temperature was associated with eczema (OR = 1.09). Higher GDP per capita was related to less SD. Higher PM10 was related to SD. Suburban living was protective for eczema (OR = 0.77) (vs. urban). Living in old buildings (built before 1991) was related to eczema (OR = 1.42). Living near heavily trafficked roads was related to FE (OR = 1.33) and SD (OR = 1.35). Having new furniture was related to all symptoms (OR = 1.26-1.47). Burning mosquito coils (OR = 1.37-1.57) and incense (OR = 1.33-1.37) were associated with eczema, FE, or SD. Presence of cockroaches and rats/mice was associated with FE or SD (OR = 1.31-1.40). Using air conditioner, daily cleaning and frequently exposing bedding to sunshine were protective (OR = 0.60-0.83). In conclusion, higher temperature, higher PM10 , urban living, living near heavily trafficked roads, old buildings, new furniture, burning mosquito coils and incense, and presence of cockroaches/rats/mice increased the risk of eczema, FE, or SD. Higher GDP, air conditioner, daily cleaning, and exposing bedding to sunshine were protective.
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Affiliation(s)
- Juan Wang
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Yinping Zhang
- School of Architecture, Tsinghua University, Beijing, China
| | - Baizhan Li
- Key Laboratory of Three Gorges Reservoir Region's Eco-Environment, Chongqing University, Chongqing, China
| | - Zhuohui Zhao
- Department of Environmental Health, Fudan University, Shanghai, China
| | - Chen Huang
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Xin Zhang
- Institute of Environmental Science, Shanxi University, Taiyuan, China
| | - Qihong Deng
- Xiangya School of Public Health, Central South University, Changsha, China
- School of Energy Science and Engineering, Central South University, Changsha, China
| | - Chan Lu
- Xiangya School of Public Health, Central South University, Changsha, China
- School of Energy Science and Engineering, Central South University, Changsha, China
| | - Hua Qian
- School of Energy Environment, Southeast University, Nanjing, China
| | - Xu Yang
- College of Life Sciences, Central China Normal University, Wuhan, China
| | - Yuexia Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Jan Sundell
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Dan Norbäck
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
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21
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Mick A, Tizek L, Schielein M, Zink A. Can crowdsourced data help to optimize atopic dermatitis treatment? Comparing web search data and environmental data in Germany. J Eur Acad Dermatol Venereol 2021; 36:557-565. [PMID: 34921466 DOI: 10.1111/jdv.17875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is one of the most common chronic skin diseases worldwide, showing various manifestations and having a severe impact on quality of life. As previous studies demonstrated, internet search analysis can help identify public interest in diseases and possible influencing factors on search behavior. OBJECTIVE To identify AD-related topics of interest in Germany using internet search volume. METHODS Google Ads Keyword Planner was used to identify AD-related search terms including their search volume in Germany on a national level as well as in 16 selected cities from January 2016 to December 2019. Identified keywords were qualitatively analyzed, and temporal trends as well as the influence of seasonal and environmental factors on search volume were assessed. RESULTS Overall, 1222 AD-related search terms with a search volume of 8 842 360 searches were identified. An increase from 2016 to 2019 and seasonal peaks from January to April of each year were observed. Nationwide, the search volume correlated with mean monthly temperature and sun duration. With increasing temperature and sun duration, a significant decrease in search queries was observed. The most populated cities showed the lowest number of searches per 100 000 inhabitants (Berlin, Hamburg, and Munich). In the eight categories formed (comorbidities, general, influential factors, localization, stage of life, symptoms/severity, therapy/information, and questions on AD), the highest proportion of search queries were assigned to the category "therapy/information" in most cities. In this category, a focus on the topics of "alternative medicine" and "home remedies" could be observed. CONCLUSION The overall high and increasing search volume indicates a high interest in AD-related topics, especially regarding treatment and disease education. Information provided by internet search volume analyses can optimize AD therapy and patient-centered care by providing insight into patient needs and predicting potential climatic trigger factors.
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Affiliation(s)
- A Mick
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - L Tizek
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - M Schielein
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - A Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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22
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Wang F, Shi C, Dong J, Nie H. Association between ambient temperature and atopic dermatitis in Lanzhou, China: a time series analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:67487-67495. [PMID: 34254239 DOI: 10.1007/s11356-021-15198-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Abstract
Many studies have explored the association between temperature and atopic dermatitis (AD); however, the results are inconsistent. We used a quasi-Poisson function fitted to a distributed lag nonlinear model (DLNM) to evaluate the association between daily average temperature and AD outpatient visits from January 1, 2013, to December 31, 2019, in Lanzhou, China. We found that the exposure-response association curve was inversely "s-shaped," low-temperature effects occurred at a lag of 11 days and then lasted for 10 days, and high-temperature effects occurred on the current day and then significantly decreased. Both low and high ambient temperatures can increase the risk of outpatient visits. Compared with median temperature (12.89°C), the cumulative relative risk (RR) of extreme high temperature and moderate-high temperature were 1.847 (95% confidence interval [CI]: 1.613, 2.114) and 1.447 (95% CI: 1.298, 1.614), respectively, at lag0-7 days, and the cumulative RRs of extremely low temperature and moderate-low temperature were 1.004 (95% CI: 0.904, 1.115) and 1.056 (95% CI: 0.925, 1.205), respectively, at lag0-21 days. Females were more sensitive to high temperatures than males, and high or low temperatures had significant effects on children ≤14 years of age. Graphical abstract.
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Affiliation(s)
- Fei Wang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Chunrui Shi
- Department of Dermatology, The First Hospital of Lanzhou University, Lanzhou, 730000, China.
| | - Jiyuan Dong
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Hui Nie
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
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23
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Manjelievskaia J, Boytsov N, Brouillette MA, Onyekwere U, Pierce E, Goldblum O, Bonafede M. The direct and indirect costs of adult atopic dermatitis. J Manag Care Spec Pharm 2021; 27:1416-1425. [PMID: 34595952 PMCID: PMC10391209 DOI: 10.18553/jmcp.2021.27.10.1416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Atopic dermatitis is considered a childhood illness, and the direct and indirect health care burden of atopic dermatitis in adults is not fully understood. OBJECTIVE: To measure the direct and indirect costs of atopic dermatitis among adults in 2018. METHODS: This retrospective cohort study compared commercial and Medicare-insured adults with atopic dermatitis in 2018 with directly matched (1:3) adults without atopic dermatitis. Atopic dermatitis prevalence was reported. Health care utilization, direct health care costs, and work loss data were compared between cohorts. This analysis was repeated for adults with atopic dermatitis in 2016 and 2017. RESULTS: 31,164 adults with atopic dermatitis in 2018 were identified and directly matched (1:3) to controls. Adults with atopic dermatitis had greater utilization of outpatient services, outpatient pharmacy services, and short-term disability benefits than controls. Unadjusted annual health care costs in 2018 were $4,979 higher for adults with atopic dermatitis ($14,603) than for the matched controls ($9,624), driven by outpatient services and pharmacy. Findings were supported by analyses of adults from 2016 and 2017 and multivariable analyses. One limitation of this study was that patients with mild cases of atopic dermatitis may not seek medical treatment and may be underrepresented in the study cohort. CONCLUSIONS: The direct health care and indirect (short-term disability) health care costs of atopic dermatitis present a significant health care burden among the adult population. DISCLOSURES: This study was funded by Eli Lilly and Company. Employees of Eli Lilly were involved in the planning, execution, and interpretation of the study. Pierce is employed by Eli Lilly and Company. Boytsov and Goldblum were employed by Eli Lilly and Company Health at the time this research was conducted. Manjelievskaia and Brouillette are employed by IBM Watson Health, which received funding from Eli Lilly and Company to conduct this study. Bonafede and Onyekwere were employed at IBM Watson Health at the time this research was conducted.
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24
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Fieten KB, John SM, Nowak D. Secondary and Tertiary Prevention: Medical Rehabilitation. Handb Exp Pharmacol 2021; 268:449-470. [PMID: 34196810 DOI: 10.1007/164_2021_511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Allergies are a major public health burden, and targeted measures are required in terms of prevention and treatment. The most common allergic conditions encompass atopic dermatitis (AD), food allergy (FA), allergic asthma (AA), and allergic rhino-conjunctivitis (AR). Primary prevention aims at preventing the onset of allergic disease, before the disease process begins. Secondary prevention aims at preventing progression and exacerbation of allergic disease whereas tertiary prevention aims at reducing disease burden in patients with established disease, by allergen immunotherapy (AIT) or medical rehabilitation. Rehabilitation programs are used for treatment of AA and AD and usually consist of extensive patient assessment, optimization of treatment management, patient education, and behavioral interventions, ideally involving a multidisciplinary treatment team and sometimes provided in a specific climate, usually alpine or maritime. Similarly, prevention of occupational skin diseases requires interdisciplinary approaches on the level of secondary and tertiary preventive intervention; if this is provided, then prevention programs have proven highly (cost-) effective. Unfortunately, the recently published Minimal Standards of Prevention of these dermatoses, underlining especially the importance of meticulous allergological diagnosis and subsequent multidisciplinary patient education, are so far being adhered to only in very few European countries.
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Affiliation(s)
- Karin B Fieten
- Swiss Institute of Allergy and Asthma Research (SIAF), Davos, Switzerland.
| | | | - Dennis Nowak
- Munich Center of Health Sciences, Munich, Germany
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25
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Hu Y, Jiang F, Tan J, Liu S, Li S, Wu M, Yan C, Yu G, Hu Y, Yin Y, Tong S. Environmental Exposure and Childhood Atopic Dermatitis in Shanghai: A Season-Stratified Time-Series Analysis. Dermatology 2021; 238:101-108. [PMID: 34082421 DOI: 10.1159/000514685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Childhood atopic dermatitis (AD) is an inflammatory skin disease which sometimes predisposes to allergies. Environmental factors (low humidity, irritants, etc.) are prominent causative triggers of AD. OBJECTIVES This study aims to explore the effects of both meteorological factors and air pollutants on childhood AD, and the modification effects by season in Shanghai, China. METHODS Quasi-Poisson generalized linear regression model, combined with a distributed lag nonlinear model was used to examine the nonlinear and lagged effects of environmental factors on childhood AD from 2009 to 2017 in Shanghai. We also performed a season-stratified analysis to determine the modification effects of environmental exposure by season on childhood AD. RESULTS There were 1,043,240 outpatient visits for childhood AD in total, at 3 major pediatric hospitals. Low temperature and relative humidity (RH), and high daily temperature difference (DTD) and air pollutants (i.e., NO2) increased the relative risks (RRs) of outpatient visits for childhood AD in the whole year. In the cold season, an increased risk of outpatient visits for childhood AD was associated with low RH (RR 2.26, 95% CI 1.69-3.02) and high NO2 (1.11, 95% CI 1.06-1.17). In the warm season, outpatient visits for childhood AD were associated with low temperature (3.49, 95% CI 3.22-3.77), low RH (1.89, 95% CI 1.74-2.06), high DTD (1.41, 95% CI 1.31-1.53), and high NO2 (1.05, 95% CI 1.03-1.06). CONCLUSIONS This study suggests that environmental exposure may be a key trigger for outpatient visits for childhood AD with apparent seasonal effects. Tailored preventive strategies to avoid environmental triggers of childhood AD should be developed.
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Affiliation(s)
- Yabin Hu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institution, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianguo Tan
- Shanghai Key Laboratory of Meteorology and Health (Shanghai Meteorological Service), Shanghai, China
| | - Shijian Liu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shenghui Li
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Meiqin Wu
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chonghuai Yan
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangjun Yu
- Center for Biomedical Informatics, Shanghai Children's Hospital, Shanghai, China
| | - Yi Hu
- Center for Biomedical Informatics, Shanghai Children's Hospital, Shanghai, China
| | - Yong Yin
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shilu Tong
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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26
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Gu HJ, Peng L, Jiang WC, Tan YM, Zhou GJ, Kan HD, Chen RJ, Zou Y. Impact of solar ultraviolet radiation on daily outpatient visits of atopic dermatitis in Shanghai, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:18081-18088. [PMID: 33405118 DOI: 10.1007/s11356-020-11907-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
The potential roles of solar ultraviolet radiation (UVR) as an environmental risk factor in inducing atopic dermatitis (AD) have not been well quantified. To determine the short-term associations between UVR and AD outpatient visits, we obtained daily outpatient visits of AD in Shanghai Skin Disease Hospital from 2013 to 2018. Data of hourly ground UVR were collected. We applied overdispersed generalized additive model to explore its associations. We found that daily exposure to UVR-A rather than UVR-B was positively associated with AD outpatient visits. The visits increased on the present day (lag 0 days) and decreased appreciably with longer lags and became insignificant at lag 4 days. For 10 w/m2 increase in daytime mean and noontime mean exposure to overall UVR and UVR-A from lag 0 to 6 days, the cumulative relative risk of AD was 1.12/1.13 and 1.08/1.08, respectively. Stronger effects of UVR exposure on AD occurred in patients aged 0-7 and > 45 years and in the cold seasons. This study contributed to the few epidemiological evidences that acute exposure to solar UVR may elevate the risks of AD.
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Affiliation(s)
- Hui-Jing Gu
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Jingan District, Shanghai, 200443, China
| | - Li Peng
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Bureau, 166 Puxi Road, Xuhui District, Shanghai, 200030, China
| | - Wen-Cai Jiang
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Jingan District, Shanghai, 200443, China
- NMPA Key Laboratory for Monitoring and Evaluation of Cosmetics, Zhangheng Road, Pudong New District, Shanghai, 201203, China
| | - Yi-Mei Tan
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Jingan District, Shanghai, 200443, China
- NMPA Key Laboratory for Monitoring and Evaluation of Cosmetics, Zhangheng Road, Pudong New District, Shanghai, 201203, China
| | - Guo-Jiang Zhou
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Jingan District, Shanghai, 200443, China
- Xiangya School of Public Health, Central South University, 238 Shang Ma Yuan Ling Lane, Changsha, 410078, China
| | - Hai-Dong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, P.O. Box 249, 130 Dong-An Road, Shanghai, 200032, China
| | - Ren-Jie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, P.O. Box 249, 130 Dong-An Road, Shanghai, 200032, China
| | - Ying Zou
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Jingan District, Shanghai, 200443, China.
- NMPA Key Laboratory for Monitoring and Evaluation of Cosmetics, Zhangheng Road, Pudong New District, Shanghai, 201203, China.
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27
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Eiken A, Laugesen CP, Isberg A, Thomsen SF, Ali Z, Chiriac A, Dutei AM, Deaconescu I, Manole I, Valk TJ, Andersen AD, Zibert JR. Smartphone data offer insights into disease activity and triggers in atopic dermatitis: a fully decentralized remote longitudinal pilot study. J Eur Acad Dermatol Venereol 2021; 35:e609-e612. [PMID: 33655625 DOI: 10.1111/jdv.17205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/13/2021] [Accepted: 02/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- A Eiken
- Studies&Me A/S, Copenhagen, Denmark
| | | | - A Isberg
- Studies&Me A/S, Copenhagen, Denmark
| | - S F Thomsen
- Department of Dermatology and Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Z Ali
- Department of Dermatology and Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | | | | | | | - I Manole
- Studies&Me A/S, Copenhagen, Denmark.,Colentina Clinical Hospital, Bucharest, Romania
| | - T J Valk
- Studies&Me A/S, Copenhagen, Denmark
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28
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Suaini NHA, Tan CPT, Loo EXL, Tham EH. Global differences in atopic dermatitis. Pediatr Allergy Immunol 2021; 32:23-33. [PMID: 32841425 DOI: 10.1111/pai.13335] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/28/2020] [Accepted: 08/12/2020] [Indexed: 12/21/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disorder, with a highly variable prevalence worldwide. Recent evidence, however, has shown an increase in prevalence in the Asia Pacific region. Nevertheless, most of the published literature has focused mainly on Western populations, and only few clinical trials have included subgroups of other ethnic populations. Reasons for the observed ethnic and geographical differences in AD are not well established. This calls into question the need for a better understanding of AD pathogenesis and inter-ethnic differences in clinical and immuno-phenotypes. These differences may reflect inherent variability in disease mechanisms between populations, which in turn may impact upon treatment responses such as biologics that are currently tailored mainly to a specific immuno-phenotype (T-helper type 2 dominant). In this article, we reviewed existing literature on the prevalence of AD globally, highlighting differences, if any, in the clinical and immuno-phenotypes of AD between different ethnicities. We discussed genetic and environmental factors that affect AD in different populations and therapeutic considerations. Our review highlights AD as a disease with ethnic-dependent clinical and immunological heterogeneity and calls for greater inclusion of ethnic diversity in future research in order to develop targeted treatments.
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Affiliation(s)
- Noor H A Suaini
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Population Allergy, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Cheryl P T Tan
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Evelyn X L Loo
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System (NUHS), Singapore, Singapore
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29
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The Role of Environmental Exposures in Atopic Dermatitis. Curr Allergy Asthma Rep 2020; 20:74. [PMID: 33047271 DOI: 10.1007/s11882-020-00971-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Although genetic factors clearly play a role in the development of atopic dermatitis (AD), the recent dramatic increase in the prevalence of AD in low- and middle-income countries is not consistent with only a role of genetic factors. These findings strongly suggest that environmental factors may play an important role in the pathogenesis of AD. RECENT FINDINGS We reviewed the role of gene-environment studies; in utero exposures including tobacco smoke, alcohol, maternal stress, various digestive supplements, and gestational diabetes; early-life exposures including diet, gut microbiota, antibiotics, and breastfeeding; climate including temperature, ultraviolet radiation exposure, and air pollution; and household products, indoor allergens, water hardness, pH, and skin microbiota and their effects on AD. Environmental factors definitely play a role in the pathogenesis of AD. However, identifying definitive factors continues to be difficult in the setting of conflicting evidence and the complex interactions between genotypes and the environment resulting in a multitude of AD phenotypes. All of the different environmental interactions discussed highlight the importance of intervening on multiple levels in a patient's environment to improve or even prevent AD symptoms. Further, the importance of modifying environmental factors early on in a person's life is demonstrated. When possible, all of these environmental factors should be considered in treating a patient with AD and the appropriate modifications should be made at population and individual levels.
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30
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Jacob L, López-Sánchez GF, Koyanagi A, Veronese N, Vioque-López J, Oh H, Shin JI, Schnitzler A, Ilie CP, Stefanescu S, Gillvray C, Machado MO, Piguet V, Carvalho A, Smith L. Chronic skin disease and levels of physical activity in 17 777 Spanish adults: a cross-sectional study. Clin Exp Dermatol 2020; 46:516-524. [PMID: 32909628 DOI: 10.1111/ced.14443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/21/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND To date there is limited literature on the prevalence of chronic skin conditions and its association with levels of physical activity (PA) in Spain. AIM To determine the prevalence of chronic skin disease and to compare levels of PA between people with and without chronic skin disease in a large representative sample of Spanish adults aged 15-69 years. METHODS Data from the Spanish National Health Survey 2017 were analysed. Chronic skin disease was assessed using a yes/no question. PA was measured using the short form of the International Physical Activity Questionnaire. Total PA metabolic equivalent of task min/week were calculated, and PA was included in the analyses as a continuous and a five-category variable. RESULTS This cross-sectional study included 17 777 adult participants (52.0% women; mean ± SD age 45.8 ± 14.1 years), of whom 940 (5.3%) had chronic skin disease. After adjusting for several potential confounders, there was a negative association between chronic skin disease and PA (OR = 0.87, 95% CI 0.76-1.00, P = 0.05), which was significant for men (OR = 0.76, 95% CI 0.62-0.93, P = 0.01) but not for women (OR = 0.97, 95% CI 0.81-1.16, P = 0.72). CONCLUSIONS In this large representative sample of Spanish adults, the prevalence of chronic skin disease was low. Levels of PA were lower in men with than in men without chronic skin conditions, but this association was not seen in women.
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Affiliation(s)
- L Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France.,Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | | | - A Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,ICREA, Barcelona, Spain
| | - N Veronese
- National Research Council Neuroscience Institute Padua, Padua, Italy
| | - J Vioque-López
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain.,Nutritional Epidemiology Unit, Universidad Miguel Hernández, ISABIAL-UMH, Alicante, Spain
| | - H Oh
- University of Southern California, Suzanne Dworak Peck School of Social Work, Los Angeles, CA, USA
| | - J I Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - A Schnitzler
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, AP-HP, Garches, France.,EA4047, UFR des Sciences de la Santé Université Versailles Saint Quentin en Yvelines,, Montigny-le-Bretonneux, France
| | - C P Ilie
- Queen Elizabeth Hospital Foundation Trust, King's Lynn, UK
| | - S Stefanescu
- Queen Elizabeth Hospital Foundation Trust, King's Lynn, UK
| | - C Gillvray
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M O Machado
- Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, ON, Canada
| | - V Piguet
- Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, ON, Canada
| | - A Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - L Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
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Lee HC, Goh CL. 'Occupational dermatoses from Personal Protective Equipment during the COVID-19 pandemic in the tropics - A Review'. J Eur Acad Dermatol Venereol 2020; 35:589-596. [PMID: 32894602 DOI: 10.1111/jdv.16925] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/07/2020] [Accepted: 08/21/2020] [Indexed: 12/18/2022]
Abstract
The COVID-19 pandemic has enveloped the world and there has been a high incidence of occupational dermatoses related to Personal Protective Equipment (PPE) amongst healthcare workers (HCWs) during this period. Prevention and management of these conditions will not only improve staff morale and quality of life, but will also minimize the risk of breaching PPE protocol due to such symptoms. The tropical climate in Singapore predisposes HCWs to more skin damage and pruritus due to intense heat, high humidity and sun exposure. The effects of friction, occlusion, hyperhidrosis and overheating on the skin in the tropics should not be neglected. Preventive measures can be taken based on our recommendations, and the working environment can be made more conducive for frontline HCWs. We review the literature and discuss various preventive and management strategies for these occupational skin diseases for our frontline HCWs, especially those working in less controlled working environments beyond the hospital in Singapore. Shorter shifts and frequent breaks from PPE are recommended. Duration of continuous PPE-usage should not exceed 6 h, with breaks in non-contaminated areas every 2-3 h to hydrate and mitigate the risk of skin reactions. Other strategies, such as teledermatology, should be considered so that consultations can remain accessible, while ensuring the safety and well-being of our clinical staff.
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Affiliation(s)
- H C Lee
- Dermatology Department, KK Women's and Children's Hospital, Singapore
| | - C L Goh
- National Skin Centre, Singapore
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Hu Y, Xu Z, Jiang F, Li S, Liu S, Wu M, Yan C, Tan J, Yu G, Hu Y, Yin Y, Tong S. Relative impact of meteorological factors and air pollutants on childhood allergic diseases in Shanghai, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 706:135975. [PMID: 31841850 DOI: 10.1016/j.scitotenv.2019.135975] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/05/2019] [Accepted: 12/05/2019] [Indexed: 05/03/2023]
Abstract
BACKGROUND Non-optimal weather conditions and air pollution pose a significant threat to children's health. However, the relative impact of different environmental exposures on childhood allergic diseases remains unclear. OBJECTIVES This study aimed to quantify the relative impact of meteorological factors and air pollutants on childhood allergic diseases in Shanghai, China. METHODS Data on clinical visits due to childhood asthma, allergic rhinitis (AR) and atopic dermatitis (AD) from 2007 to 2017 in Shanghai were collected from Shanghai Children's Medical Center and Xinhua Hospital. The meteorological data (i.e. daily mean temperature, temperature difference, air pressure, air pressure difference, precipitation, relative humidity, sunshine and wind speed) for the same period were obtained from the Shanghai Meteorological Center. Air pollution data (PM10, PM2.5, NO2, SO2 and O3) were provided by the Shanghai Environmental Protection Agency. Quasi-Poisson regression with distributed lag non-linear models and Poisson regression combined with generalized linear models were used to assess the relative impact of meteorological factors and air pollutants on childhood allergic diseases. RESULTS There were a total of 2,410,392 cases of childhood allergic diseases, including 975,771 asthma, 646,975 AR and 787,646 AD. Most of environmental factors were significantly associated with childhood allergic diseases. Daily mean temperature (standard β: -0.076 (95% confidence interval (CI): -0.086, -0.067)) and air pressure (standard β: 0.075 (95% CI: 0.068, 0.082)) seemed to play more important roles than other environmental factors in the occurrence of these allergic diseases. The numbers of these allergic diseases attributable to an interquartile range (IQR) change in meteorological factors also appeared to be greater than those attributable to an IQR change in air pollutants. CONCLUSIONS Both climatic variation and air pollution were associated with childhood allergic diseases, but the former appeared to play a more important role in the occurrence of these diseases. These findings may have significant implications for the development of tailored strategies to prevent these rapidly-increasing diseases worldwide.
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Affiliation(s)
- Yabin Hu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhiwei Xu
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institution, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shenghui Li
- School of Public Health, Shanghai Jiaotong University, Shanghai, China
| | - Shijian Liu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Meiqin Wu
- Shanghai Key Laboratory of Environmental and Child Health, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chonghuai Yan
- Shanghai Key Laboratory of Environmental and Child Health, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | | - Guangjun Yu
- Shanghai Children's Hospital, Shanghai, China
| | - Yi Hu
- Shanghai Children's Hospital, Shanghai, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Shilu Tong
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China.
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Park JS, Park EK, Kim HK, Choi GS. Prevalence and Risk Factors of Occupational Skin Disease in Korean Workers from the 2014 Korean Working Conditions Survey. Yonsei Med J 2020; 61:64-72. [PMID: 31887801 PMCID: PMC6938776 DOI: 10.3349/ymj.2020.61.1.64] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Occupational skin disease (OSD) is a commonly known occupational disease. However, epidemiological data about this condition in Korea are limited. We aimed to estimate the prevalence and risk factors of OSD using nationally representative data. MATERIALS AND METHODS We used data from the large-scale, cross-sectional, nationwide 4th Korean Working Conditions Survey conducted in 2014. OSD was defined as skin diseases caused or aggravated by working environments as indicated in a self-reported questionnaire. Factors affecting the occurrences of OSD were investigated using logistic regression analysis. RESULTS The prevalence rates of OSD were 1.35% in all workers and 62.2% in workers with skin diseases. The workers with OSD were older, had lower educational levels, and had longer working times per week than those without OSD (p<0.001). Furthermore, OSDs occurred more frequently in self-employed workers (p=0.002), those with small-sized businesses (p=0.008), those with longer working durations (p<0.001), and manual and service workers (p<0.001). Although the workers with OSD had greater exposure to various hazardous factors, logistic multivariate analysis showed that high temperatures and skin contact with chemical products were significantly correlated (odds ratios: 2.096 and 2.326, respectively). High prevalence rates of OSD were observed in membership organizations/repair/other personal services (3.2%), agriculture/forestry/fishing (2.7%), manufacturing (2.0%), and construction (1.6%) industries. Additionally, depression/anxiety problems were significantly more prevalent in workers with OSD than in those without (p<0.001). CONCLUSION This is the first study to present large-scale epidemiological data on OSD prevalence in Korean workers. Our results highlight modifiable factors contributing to the development of OSDs.
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Affiliation(s)
- Jong Sun Park
- Occupational Safety and Health Research Institute , Korea Occupational Safety and Health Agency, Ulsan, Korea
| | - Eun Kee Park
- Department of Medical Humanities and Social Medicine, Kosin University College of Medicine, Busan, Korea
| | - Hee Kyoo Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Gil Soon Choi
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
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Irvine A, Mina‐Osorio P. Disease trajectories in childhood atopic dermatitis: an update and practitioner's guide. Br J Dermatol 2019; 181:895-906. [PMID: 30758843 PMCID: PMC6899789 DOI: 10.1111/bjd.17766] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a heterogeneous disease with a multifactorial aetiology and complex pathophysiology. This heterogeneity translates into different trajectories of disease progression with respect to severity, persistence and risk of development of atopic comorbidities. Determining which possible disease trajectories or comorbidities any individual child might develop is challenging in clinical practice. Tools that help identify paediatric patients at higher risk of disease progression would greatly aid clinicians. METHODS We reviewed recent cohort studies to synthesize and simplify the epidemiological data to try to identify shared clinically relevant characteristics that may help physicians estimate the risk of disease progression in paediatric patients with AD. RESULTS Despite the variability in data collection and methods of analysis and their limitations, there are common patterns of early-childhood AD that may aid in the estimation of risk for disease progression. Factors associated with risk of AD progression include younger age of onset, family history of atopy, greater AD severity, filaggrin mutations, urban environment and polysensitization and/or allergic multimorbidity. Based on these factors, we provide a practitioner's guide for identifying, counselling and/or referring infants and children with AD at potentially higher risk of developing persistent AD and atopic comorbidities. We also present clinical scenarios to illustrate how these data relate to real-life situations. CONCLUSIONS Useful insights are provided for physicians and patients to inform them better about the risk of AD progression and to help guide care pathways for the paediatric population with AD. What's already known about this topic? The complex pathophysiology of atopic dermatitis (AD) translates into a heterogeneous clinical presentation and trajectories of disease progression. Although the consensus is that most paediatric patients with AD will eventually 'outgrow' the disease or follow the longitudinal trajectory known as the 'atopic march', a significant proportion will develop persistent AD and/or other atopic conditions. No known factors conclusively predict the risk of progression or development of comorbidities. What does this study add? Recent analyses of data from large cohorts of paediatric patients with AD have suggested the existence of potentially discrete clusters of patients who present with relatively common AD phenotypes. These studies have shed some light onto the factors associated with risk of progression, which we review in this article. A practitioner's guide with clinical scenarios is provided to help identify patients at high risk of progression to determine whether a patient should be monitored and/or would require specialist referral.
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Affiliation(s)
- A.D. Irvine
- Paediatric DermatologyOur Lady's Children's HospitalCrumlin, Dublin12Ireland
- National Children's Research CentreOur Lady's Children's HospitalCrumlin, Dublin12Ireland
- Clinical MedicineTrinity College DublinDublinIreland
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Wei J, Jaleel T, MacLeod AS, Ji JS. Inverted U-shaped relationship between vitamin D and ever-reported eczema in US adults. Allergy 2019; 74:964-975. [PMID: 30589434 DOI: 10.1111/all.13708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 11/12/2018] [Accepted: 11/26/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Eczema is a skin condition which affects up to 10% to 20% of people worldwide. Previous literature finds that low vitamin D levels may be a risk factor for eczema, but the association is not clear. METHODS We used the cross-sectional data from U.S. National Health and Nutrition Examination Survey 2005-2006. Adults were defined as 20 years and older. The association between eczema and serum 25-hydroxyvitamin D [25(OH)D] was estimated using multivariate logistic regression models adjusted for patient demographics, lifestyle variables, stress, and medical comorbidities. Restricted cubic spline analyses were performed to explore nonlinear relationship. We also stratified by race. RESULTS A total of 3921 adults were included in the analysis. The prevalence of ever-report of eczema was 7.94% in US adults. Reports of eczema were higher in people with higher socioeconomic status, depressive symptoms, previous history of asthma and hay fever, female, sampled in summer, and nonHispanic white. The logistic regression found higher odds ratio of eczema in vitamin D deficiency group (<50 nmol/L) compared to sufficiency group (>75 nmol/L) (OR = 1.81, 95% CI: 1.09-3.01, P = 0.02). The spline analysis found an inverted U-shaped relationship between eczema and serum 25(OH)D level. Eczema risk reached the highest at around 45 nmol/L, with decreasing risk in both directions away from this value. This relationship was absent in nonHispanic black population. CONCLUSION Vitamin D is associated with reports of eczema in nonHispanic white population, but not in the nonHispanic black population in the United States.
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Affiliation(s)
- Jia Wei
- Environmental Research Center Duke Kunshan University Kunshan China
| | - Tarannum Jaleel
- Department of Dermatology Duke University Medical Center Durham North Carolina
| | - Amanda S. MacLeod
- Department of Dermatology Duke University Medical Center Durham North Carolina
| | - John S. Ji
- Environmental Research Center Duke Kunshan University Kunshan China
- Nicholas School of the Environment Duke University Durham North Carolina
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36
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Jeter J, Bowen C. Atopic Dermatitis and Implications for Military Service. Mil Med 2019; 184:e177-e182. [DOI: 10.1093/milmed/usy427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/08/2018] [Accepted: 12/18/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jonathan Jeter
- San Antonio Uniformed Services Education Consortium, 1100 Wilford Hall Loop, Lackland AFB, TX
| | - Casey Bowen
- Offut AFB. 55th Medical Group, Department of Dermatology, 2501 Capehart Rd, Offut AFB, NE
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Leshem YA, Bissonnette R, Paul C, Silverberg JI, Irvine AD, Paller AS, Cork MJ, Guttman-Yassky E. Optimization of placebo use in clinical trials with systemic treatments for atopic dermatitis: an International Eczema Council survey-based position statement. J Eur Acad Dermatol Venereol 2019; 33:807-815. [PMID: 30859656 PMCID: PMC6594032 DOI: 10.1111/jdv.15480] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/04/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND As novel systemic therapeutics for patients with atopic dermatitis (AD) are developed, ethical and methodological concerns regarding placebo-controlled-trials (PCT) have surfaced. OBJECTIVE To guide the design and implementation of PCT in AD, focusing on trials with systemic medications. METHODS A subgroup of the International Eczema Council (IEC) developed a consensus e-survey, which was disseminated to IEC members. RESULTS The response rate was 43/82 (52%). Consensus was reached on 24/27 statements and on 3/11 options from multiple-selection statements, including: performing monotherapy studies in proof-of-concept phases; avoiding concomitant topical corticosteroids or calcineurin inhibitors until a predefined timepoint as rescue (borderline consensus); selection of sites and assessors with recognized expertise in AD clinical trials; clear definition and identification of baseline disease severity; minimizing time and proportion of patients on placebo; using daily emollients with several options provided; instigating open-label extension studies for enrolment after a predefined timepoint; and including outcomes which set a higher bar for disease clearance. CONCLUSION Conducting PCT in AD requires balancing several, sometimes opposing principles, including ethics, methodology, regulatory requirements and real-world needs. This paper can provide a framework for conducting PCT with systemic medications for patients with AD.
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Affiliation(s)
- Y A Leshem
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach-Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - C Paul
- Paul Sabatier University, Toulouse, France
| | - J I Silverberg
- Department of Dermatology, Department of Preventive Medicine, and Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A D Irvine
- Pediatric Dermatology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.,National Children's Research Centre, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.,Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - A S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - M J Cork
- Sheffield Dermatology Research Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
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38
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Ibekwe PU, Ukonu BA. Impact of Weather Conditions on Atopic Dermatitis Prevalence in Abuja, Nigeria. J Natl Med Assoc 2018; 111:88-93. [PMID: 30129480 DOI: 10.1016/j.jnma.2018.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/07/2018] [Accepted: 06/16/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Climatic conditions may trigger subclinical disease in predisposed individuals and also exacerbate eczematous symptoms resulting in persistence or increased frequency of atopic dermatitis (AD) flares. The aim of this study is to assess the impact of tropical weather conditions on the frequency at which atopic dermatitis patients present at the dermatology clinic of a tertiary hospital in Abuja, Nigeria; and, to find out which component of these conditions exerts the most significant effects. METHODS Medical records of all new patients seen at the clinic within July 2015 and June 2017 was obtained. Data for monthly temperature, humidity, precipitation, cloud cover and UV index of Abuja during this period was obtained from worldweatheronline. Univariate analyses and multiple regressions were used to assess the associations between monthly prevalence of AD and the above-mentioned meteorological variables. RESULTS Patients had a 1.6 times odds (95% CI: 1.03-2.56, p = 0.038) of presenting with AD in the dry season as compared to wet season. Dry season was associated with higher temperatures and UV index and lower precipitation, humidity and cloud cover, p<0.001. Multivariate logistic regression modelling adjusting for precipitation, humidity, cloud cover and age group demonstrated that precipitation (OR = 1.01, 95% CI: 1.00-1.02, p = 0.002), humidity (OR = 1.03, 95% CI:1.01-1.05, p = 0.015) and cloud cover (OR = 0.92, 95% CI: 0.88-1.02, p = 0.002) exert the most significant effects. Also infants had 4.4 times odds of AD than adults (95% CI: 2.04-9.69, p<0.001). CONCLUSION Exposure to tropical season meteorological variables can influence the presentation of AD.
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Affiliation(s)
- P U Ibekwe
- Consultant Dermatologist, Dermatology Unit, Department of Internal Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.
| | - B A Ukonu
- Consultant Dermatologist, Dermatology Unit, Department of Internal Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
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Nguyen GH, Andersen LK, Davis MDP. Climate change and atopic dermatitis: is there a link? Int J Dermatol 2018; 58:279-282. [PMID: 29873062 DOI: 10.1111/ijd.14016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 02/12/2018] [Accepted: 04/03/2018] [Indexed: 11/29/2022]
Abstract
Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease with a growing health concern, because of its high prevalence and associated low quality of life. The etiology of AD is multifactorial with interaction between various factors such as genetic predisposition, immune, and importantly, environmental factors. Since climate change is associated with a profound shift in environmental factors, we suggest that AD is being influenced by climate change. This review highlights the effects of ultraviolet light, temperature, humidity, pollens, air pollutants, and their interaction between them contributing to the epidemiology and pathophysiology of AD.
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Affiliation(s)
- Giang Huong Nguyen
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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40
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Belugina IN, Yagovdik NZ, Belugina OS, Belugin SN. Outdoor environment, ozone, radionuclide-associated aerosols and incidences of infantile eczema in Minsk, Belarus. J Eur Acad Dermatol Venereol 2018; 32:1977-1985. [PMID: 29730889 DOI: 10.1111/jdv.15063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/27/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The early occurrence of atopic dermatitis in infants may be influenced by urban air pollution. OBJECTIVE The aim of this study was to determine the relationship between incidences of infantile eczema in children under 2 years of age and urban outdoor environmental factors. METHODS A 11-year population-based study was conducted in retrospective design. The age/gender-adjusted incidence rates of infantile eczema were determined using the data of outpatient visits. We analysed 1965 cases with atopic dermatitis including infantile eczema in relation to the annual means of outdoor monitoring data from 2005 through 2015 in Minsk. Logistic regression and principal component analysis were performed to determine association between the annual means of air pollutants, meteorological variables and incidences of infantile eczema. RESULTS Higher mean annual carbon monoxide, ammonia, formaldehyde, lead, particulate matter and ground-level ozone were associated with high incidence rates of infantile eczema both in boys and girls. Higher nitrogen dioxide was associated with high incidence rates of infantile eczema in girls 1-2 years of age and boys 0-2 years of age. There were identified by principal component analysis five combinations of pollutants and meteorological factors. High incidence rates of infantile eczema were associated with the combinations contained higher levels of air pollutants and ultraviolet index, or lower β-activity of the radionuclide-associated aerosols. The higher phenol and formaldehyde levels the higher incidence rates of infantile eczema were observed among boys 0-1 years of age and girls 1-2 years of age. The higher total column ozone with lower lead level was associated with low incidence rates of infantile eczema among boys and girls 1-2 years of age. CONCLUSION Urban outdoor air pollutants and their combination with meteorological conditions may impact onset of infantile eczema in both genders.
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Affiliation(s)
- I N Belugina
- Department of Venereology and Dermatology, Belarusian State Medical University, Minsk, Belarus
| | - N Z Yagovdik
- Department of Venereology and Dermatology, Belarusian State Medical University, Minsk, Belarus
| | - O S Belugina
- Department of Psychiatry, Belarusian State Medical University, Minsk, Belarus
| | - S N Belugin
- Department of Radiation and Environmental Medicine, Belarusian State Medical University, Minsk, Belarus
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41
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Kaufman BP, Guttman-Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups-Variations in epidemiology, genetics, clinical presentation and treatment. Exp Dermatol 2018; 27:340-357. [DOI: 10.1111/exd.13514] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Bridget P. Kaufman
- Department of Dermatology; Mount Sinai St. Luke's and Mount Sinai West; New York NY USA
| | - Emma Guttman-Yassky
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Andrew F. Alexis
- Department of Dermatology; Mount Sinai St. Luke's and Mount Sinai West; New York NY USA
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42
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Kim YM, Kim J, Lee JY, Kim M, Kim H, Jung K, Eo S, Ahn M, Ahn K. Impact of solar ultraviolet radiation on atopic dermatitis symptoms in young children: A longitudinal study. Pediatr Allergy Immunol 2017. [PMID: 28631848 DOI: 10.1111/pai.12746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are controversial data about the effects of sun exposure on atopic dermatitis (AD). We evaluated the association between solar ultraviolet radiation (UVR) exposure and AD symptoms in children. METHODS Eighty-two children under 6 years (48 boys and 34 girls) with AD living in Seoul, Korea, were enrolled and followed for 12 months between September 2013 and August 2014. Daily symptoms were recorded to describe the degree of itching, sleep disturbance, erythema, dryness, oozing, and edema. We assessed solar UVR by measuring radiation heat flux over the 290-400 nm wavelength range using thermopiles. A generalized linear mixed model and a generalized additive mixed model were used to evaluate the effects of UVR exposure on AD symptoms after adjusting for age, sex, outdoor temperature, outdoor humidity, and ambient air pollution. RESULTS Symptom records of 12 915 person-days were analyzed. UVR showed a significantly positive relationship with AD symptoms. Over the study period, an increase in UVR by 10 W/cm2 was associated with a 1.46% increase in AD symptoms (95% CI: 0.85-2.07) on the exposure day. An increase in the 6-day average level of UVR of the previous 5 days and the current day by 10 W/cm2 was associated with a 3.58% (95% CI: 2.60-4.56) increase in AD symptoms. UVR exposure significantly increased AD symptoms in autumn, but decreased them in winter. CONCLUSIONS Atopic dermatitis symptoms in children are likely to be affected by exposure to solar UVR with a cumulative effect, and this effect is different according to season.
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Affiliation(s)
- Young-Min Kim
- The Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,The Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Jihyun Kim
- The Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,The Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Ji Young Lee
- The Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minji Kim
- The Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunmi Kim
- The Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Kwon Jung
- The Seoul Research Institute of Public Health and Environment, Gwacheon, Korea
| | - Soomi Eo
- The Seoul Research Institute of Public Health and Environment, Gwacheon, Korea
| | - Mijin Ahn
- The Seoul Research Institute of Public Health and Environment, Gwacheon, Korea
| | - Kangmo Ahn
- The Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,The Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
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43
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Wang X, Shi XD, Li LF, Zhou P, Shen YW. Classification and possible bacterial infection in outpatients with eczema and dermatitis in China: A cross-sectional and multicenter study. Medicine (Baltimore) 2017; 96:e7955. [PMID: 28858126 PMCID: PMC5585520 DOI: 10.1097/md.0000000000007955] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Little is known about the classification and bacterial infection in outpatients with eczema and dermatitis in China.To investigate the prevalence of eczema and dermatitis in outpatients of dermatology clinics in China, examine classification and proportion of common types of dermatitis and the possible bacterial infection, and analyze the possible related factors.Outpatients with eczema or dermatitis from 39 tertiary hospitals of 15 provinces in mainland China from July 1 to September 30, 2014, were enrolled in this cross-sectional and multicenter study. Among 9393 enrolled outpatients, 636 patients (6.7%) were excluded because of incomplete information.The leading subtypes of dermatitis were unclassified eczema (35.5%), atopic dermatitis (13.4%), irritant dermatitis (9.2%), and widespread eczema (8.7%). Total bacterial infection rate was 52.3%, with widespread eczema, stasis dermatitis, and atopic dermatitis being the leading three (65.7%, 61.8%, and 61.4%, respectively). Clinically very likely bacterial infection has a significant positive correlation with disease duration, history of allergic disease, history of flexion dermatitis, and severe itching.Atopic dermatitis has become a common subtype of dermatitis in China. Secondary bacterial infection is common in all patients with dermatitis, and more attentions should be paid on this issue in other type of dermatitis apart from atopic dermatitis.
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Affiliation(s)
- Xin Wang
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University
| | - Xiao-Dong Shi
- Market Research Department, China Telecom Corporation Limited, Beijing Research Institute, Beijing, China
| | - Lin-Feng Li
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University
| | - Ping Zhou
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University
| | - Yi-Wei Shen
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University
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Fuertes E, Flohr C, Silverberg JI, Standl M, Strachan DP. Global Associations between UVR Exposure and Current Eczema Prevalence in Children from ISAAC Phase Three. J Invest Dermatol 2017; 137:1248-1256. [DOI: 10.1016/j.jid.2017.02.966] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/30/2017] [Accepted: 02/12/2017] [Indexed: 11/16/2022]
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Kim YM, Kim J, Han Y, Jeon BH, Cheong HK, Ahn K. Short-term effects of weather and air pollution on atopic dermatitis symptoms in children: A panel study in Korea. PLoS One 2017; 12:e0175229. [PMID: 28384276 PMCID: PMC5383262 DOI: 10.1371/journal.pone.0175229] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 03/22/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The effects of weather and air pollution on the severity and persistence of atopic dermatitis (AD) are important issues that have not been investigated in detail. The objective of our study was to determine the short-term effects of meteorological variables and air pollution on AD symptoms in children. METHODS We enrolled 177 AD patients with 5 years or younger from the Seoul Metropolitan Area, Korea, and followed for 17 months between August 2013 and December 2014. Symptoms records of 35,158 person-days, including itching, sleep disturbance, erythema, dry skin, oozing, and edema, were obtained. We estimated the effect of meteorological variables including daily mean temperature, relative humidity (RH), diurnal temperature range (DTR), rainfall and air pollutants including particulate matter with an aerodynamic diameter ≤10 μm (PM10), nitrogen dioxide (NO2), and tropospheric ozone (O3) on AD symptoms using a generalized linear mixed model with adjustment for related confounding factors. RESULTS A 5°C increase in outdoor temperature and a 5% increase in outdoor RH was associated with 12.8% (95% confidence intervals (CI): 10.5, 15.2) and 3.3% (95% CI: 1.7, 4.7) decrease in AD symptoms, respectively, on the same day. An increase of rainfall by 5 mm increased AD symptoms by 7.3% (95% CI: 3.6, 11.1) for the days with <40 mm rainfall. The risk of AD symptoms increased by 284.9% (95% CI: 67.6, 784.2) according to a 5°C increase in DTR when it was >14°C. An increase in PM10, NO2, and O3 by 10 units increased the risk of AD symptoms on the same day by 3.2% (95% CI: 1.5, 4.9), 5.0% (95% CI: 1.4, 8.8), and 6.1% (95% CI: 3.2, 9.0), respectively. CONCLUSION Exposure to meteorological variables and air pollutants are associated with AD symptoms in young children.
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Affiliation(s)
- Young-Min Kim
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jihyun Kim
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youngshin Han
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Byoung-Hak Jeon
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Hae-Kwan Cheong
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Kangmo Ahn
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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46
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Wang WH, Li LF, Lu XY, Wang J. Environmental exogenous factors and facial dermatitis: A case control study. DERMATOL SIN 2017. [DOI: 10.1016/j.dsi.2016.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Wang X, Li LF, Zhao DY, Shen YW. Prevalence and Clinical Features of Atopic Dermatitis in China. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2568301. [PMID: 27957490 PMCID: PMC5124451 DOI: 10.1155/2016/2568301] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/25/2016] [Accepted: 10/13/2016] [Indexed: 12/22/2022]
Abstract
Background. The epidemiology of atopic dermatitis (AD) in Chinese outpatients is yet to be clarified. Objectives. To investigate population-based prevalence and clinical features of AD in Chinese outpatients. Methods. A multicenter cross-sectional study was conducted in outpatients with eczema or dermatitis from 39 tertiary hospitals in 15 provinces. Results. This study included 682 patients diagnosed with AD, with the mean age of 28.8 ± 20.1 years and the median course of 5.3 ± 6.9 years. AD patients had more severe itching (30.4% versus 13.8%, p < 0.001) and clinically suspected bacterial infection (21.7% versus 16.1%, p < 0.001) than those of other types of dermatitis. Older patients were more susceptible to have a history of flexion dermatitis (p < 0.001), bacterial infection (p = 0.005), and severe itching (p < 0.001). Outpatients with clinically suspected bacterial infection had 3.53-fold increased risk of AD than those without it (p < 0.001). The morbidity rate of AD in the (20-25°N) region is 2.86 times higher than that in the (40-45°N) region [OR (95% CI): 0.352 (0.241-0.514), p < 0.001]. Conclusions. AD is characterized by unique clinical/demographic features. Bacterial infection and latitude region may have an impact on the incidence of AD in China.
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Affiliation(s)
- Xin Wang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Lin-Feng Li
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Da-yu Zhao
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Yi-wei Shen
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
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Li Q, Yang Y, Chen R, Kan H, Song W, Tan J, Xu F, Xu J. Ambient Air Pollution, Meteorological Factors and Outpatient Visits for Eczema in Shanghai, China: A Time-Series Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111106. [PMID: 27834842 PMCID: PMC5129316 DOI: 10.3390/ijerph13111106] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 10/16/2016] [Accepted: 10/31/2016] [Indexed: 12/21/2022]
Abstract
Environmental irritants are important risk factors for skin diseases, but little is known about the influence of environmental factors on eczema incidence. In this time-series study, our objective was to examine the associations of environmental factors with outpatient visits for eczema. Daily outpatient visits between 2007 and 2011 (1826 days) were collected from Huashan Hospital in Shanghai, China. We used an overdispersed generalized additive model to investigate the short-term association between environmental factors and outpatient visits for eczema. Daily outpatient visits for eczema were significantly associated with air pollution and meteorological factors. For example, a 10 μg/m³ increase of 7-day (lag 06) average concentrations of PM10 (particulate matter no greater than 10 microns), SO₂, NO₂ was associated with 0.81% (95% confidence intervals (CI) 0.39%, 1.22%), 2.22% (95% CI: 1.27%, 3.16%) and 2.31% (95% CI: 1.17%, 3.45%) increase in outpatient visits for eczema, respectively. A 10 °C elevation of temperature on lag 0 day were associated with 8.44% (95% CI: 4.66%, 12.22%) increase in eczema visits, whereas 10 unit decrease of 7-day average relative humidity were associated with 10.86% (95% CI: 8.83%, 12.89%) increase in eczema visits. This study provided clear evidence of ambient air pollution, high temperature and low relative humidity on increasing the incidence of eczema in Shanghai, China.
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Affiliation(s)
- Qiao Li
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai 200040, China.
| | - Yingying Yang
- Department of Women's and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China.
| | - Renjie Chen
- Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, School of Public Health, Fudan University, Shanghai 200040, China.
| | - Haidong Kan
- Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, School of Public Health, Fudan University, Shanghai 200040, China.
| | - Weimin Song
- Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, School of Public Health, Fudan University, Shanghai 200040, China.
| | - Jianguo Tan
- Shanghai Key Laboratory of Meteorological and Health, Shanghai 200135, China.
| | - Feng Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai 200040, China.
| | - Jinhua Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai 200040, China.
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Kallawicha K, Chuang YC, Lung SCC, Han BC, Ting YF, Chao HJ. Exposure to ambient bioaerosols is associated with allergic skin diseases in Greater Taipei residents. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2016; 216:845-850. [PMID: 27389548 DOI: 10.1016/j.envpol.2016.06.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/24/2016] [Accepted: 06/25/2016] [Indexed: 06/06/2023]
Abstract
Allergic skin diseases may result from various types of chemical and biological allergens. This study investigated the association between ambient bioaerosol exposure and allergic skin diseases by using the exposure data obtained from land use regression models and interpolated data. Data on daily average outpatient visits for atopic dermatitis (ICD-9-CM 691.8) and contact dermatitis and other eczema (ICD-9-CM 692.9) between November 2011 and August 2012 were obtained from the National Health Insurance Research Database. A generalized estimating equation was used to analyze the associations between the skin diseases and ambient bioaerosol levels. The results indicated that during the study period, contact dermatitis and other eczema were more prevalent than atopic dermatitis in the study area. Most cases were observed in districts of Taipei City and 3 major districts of New Taipei City, namely Xinzhuang, Banqiao, and Xindian. In univariate analysis, most bioaerosols were positively associated with both skin diseases. After adjustment for air pollution and sociodemographic factors, exposure to total fungal spores was significantly associated with atopic dermatitis in males (relative risk [RR] = 1.12; 95% confidence interval [CI] = 1.05-1.19). Contact dermatitis and other eczema had significant relationships with Cladosporium in males (RR = 1.07; 95% CI = 1.02-1.14) and with Aspergillus/Penicillium in females (RR = 1.04; 95% CI = 1.02-1.07). Meteorological parameters, namely wind speed, temperature, and rainfall, were also significantly associated with skin diseases. Our findings reveal that exposure to ambient bioaerosols is a significant and independent risk factor for allergic skin diseases.
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Affiliation(s)
- Kraiwuth Kallawicha
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Ying-Chih Chuang
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | | | - Bor-Cheng Han
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Yi-Fang Ting
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Hsing Jasmine Chao
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
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Kathuria P, Silverberg JI. Association of pollution and climate with atopic eczema in US children. Pediatr Allergy Immunol 2016; 27:478-85. [PMID: 26842875 DOI: 10.1111/pai.12543] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND We sought to determine the relationship between childhood eczema, climate, and environmental pollutants. METHODS We analyzed data from the 2007-2008 National Survey of Children's Health including a representative sample of 91,642 children age 0-17 years and the 2006-2007 Environmental Protection Agency measurements of carbon monoxide (CO), nitrate (NO3 ), nitrogen dioxide (NO2 ), organic carbon (OC), sulfate (SO3 ), sulfur dioxide (SO2 ), particulate matter ≤2.5 μm (PM-2.5) and <10 μm (PM-10), and tropospheric ozone levels, and the National Climate Data Center measurements of relative humidity (%), issued UV index, outdoor air temperature, and precipitation levels. RESULTS In multivariate survey logistic regression models controlling for age, sex, race/ethnicity, household income, US birthplace, and history of moving to a new location, eczema was associated with higher mean annual NO2 (p = 0.008), SO2 (p = 0.006), SO3 (p = 0.0002), arsenic (p = 0.0007), nickel (p = 0.0002), lead (p = 0.03), vanadium (p < 0.0001), and zinc (p = 0.003), but lower NO3 (p = 0.002), OC (p = 0.03), PM-2.5 (p = 0.006), cadmium (p < 0.0001), copper (p = 0.004), and potassium (p < 0.0001). In contrast, moderate-severe eczema was associated with higher NO3 (p = 0.03), OC (p = 0.008) and PM-2.5 (p = 0.01), copper (p = 0.04), lead (p = 0.008), and zinc (p = 0.01), but lower CO (p = 0.03). Principal component analysis was used and identified 4 combinations of pollutants and climate factors occurring in the USA, of which 1 was associated with higher prevalence and two were associated with lower prevalences of eczema (p < 0.05). CONCLUSIONS Pollutants in conjunction with climate factors may differentially impact eczema prevalence and severity, some with apparent harmful effects.
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Affiliation(s)
- P Kathuria
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J I Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, USA
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