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Ong C, Briones J, Lim ZZ, Chandran NS, Lee HY, Li BK, Yew YW, Wee HL. Cost-Effectiveness of Dupilumab and Oral Janus Kinase Inhibitors for the Treatment of Moderate-to-Severe Atopic Dermatitis in Singapore. PHARMACOECONOMICS - OPEN 2024:10.1007/s41669-024-00507-5. [PMID: 39003392 DOI: 10.1007/s41669-024-00507-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Atopic dermatitis (AD) affects both adults and children, impacting their quality of life and productivity; however, traditional systemic treatments such as cyclosporine have limitations. Emerging novel systemic interventions, including monoclonal antibodies and Janus kinase (JAK) inhibitors, have been shown to improve patient outcomes. OBJECTIVE This study evaluates the cost-effectiveness of novel systemic interventions for moderate-to-severe AD in adults compared with the best supportive care (BSC) in Singapore. METHODS The economic evaluation used a hybrid model consisting of a decision tree and Markov model. Treatment responses at 16 weeks were based on a network meta-analysis that was developed specifically for this study. Long-term response, discontinuation rates, episodes of flares and treatment-emergent adverse events were obtained from key dupilumab, abrocitinib, baricitinib and upadacitinib trials. The study had a 5-year time horizon and considered the healthcare payer's perspective. Sensitivity and scenario analyses were performed as well. RESULTS Baricitinib 4 mg and 2 mg have the lowest incremental cost-effectiveness ratios, at Singapore dollars (S$) 60,730/quality-adjusted life-year (QALY) and S$66,842/QALY, respectively. Upadacitinib 30 mg offers the highest incremental QALY gain, while baricitinib 2 mg offers the least. The cost of the intervention drugs accounted for the highest proportion of the overall expenses (68-93%) for those in the maintenance state. Other influential factors within the model included (1) the incremental utility derived from intervention response; (2) the probability of achieving Eczema Area and Severity Index 75 (EASI-75) with BSC; and (3) the relative risk of achieving EASI-75 with the interventions. In a scenario where the cost of all drugs is matched to the lowest-priced drug, the top three cost-effectiveness interventions are dupilumab, upadacitinib 30 mg and abrocitinib 200 mg, respectively. CONCLUSION The interventions are not found to be cost-effective at their existing prices when compared with BSC. Ideally, a composite score of treatment success and quality-of-life scores ought to be included, but such data were unavailable. Future research should consider conditional discontinuation data and long-term outcomes when such data become accessible.
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Affiliation(s)
- Clarence Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore.
| | - Jamaica Briones
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Zhi Zhen Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore
| | | | | | | | | | - Hwee-Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore
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Chia SY, Chee EEC, Wee LWY, Koh MJA. Phototherapy for the treatment of atopic dermatitis in Singaporean children and adolescents. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12986. [PMID: 38874329 DOI: 10.1111/phpp.12986] [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: 10/17/2023] [Revised: 05/12/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND/PURPOSE Phototherapy has emerged as a safe yet effective form of treatment of atopic dermatitis (AD). Few studies have been done to evaluate the efficacy of phototherapy in Asian children. The aim of this study was to review the phototherapy experience in a cohort of Asian pediatric patients with AD at a tertiary dermatologic center in Singapore. METHODS A retrospective study of patients 18 years and below with AD who had undergone phototherapy at KK Women's and Children's Hospital, Singapore, over a 4-year period was performed. RESULTS Sixty-two patients were identified, between ages 4 and 16 years (mean age 11 years) at the time of commencement of phototherapy. Thirty-five (60%) patients were males and 23 (40%) were females. Most patients had moderate to severe disease, with 60.3% of the patients with an initial body surface area (BSA) involvement of 31%-60% and 13.8% of the patients with an initial BSA involvement of 61%-90%. For patients who had undergone narrowband ultraviolet B (NBUVB) and combined ultraviolet A (UVA) and NBUVB phototherapy, the mean reduction of the Eczema Area and Severity Index (EASI) scores were 11.4 and 7.9, respectively. Common side effects experienced include xerosis, pruritus, erythema, and pain. Other reasons for cessation of therapy in the NBUVB group included time commitment difficulty (9.3%), hyperactivity (2.3%), and claustrophobia (2.3%). Two patients that had photochemotherapy (psoralen + UVA) [PUVA] suffered from post-UVA burns requiring cessation of treatment. More than half of the patients (56.9%) treated with phototherapy experienced treatment success with improvement in Investigator Global Assessment and EASI scores. 86.2% of the patients had good compliance to the treatment regime, 12% had poor-compliance, and 3.4% were lost to follow-up. CONCLUSION Phototherapy is a useful treatment adjunct for moderate to severe AD in Asian children.
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Affiliation(s)
- Shi Yun Chia
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Department of Dermatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Elton Ern Cher Chee
- Department of Dermatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Lynette Wei Yi Wee
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Department of Dermatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Department of Dermatology, KK Women's and Children's Hospital, Singapore, Singapore
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Faye O, Flohr C, Kabashima K, Ma L, Paller AS, Rapelanoro FR, Steinhoff M, Su JC, Takaoka R, Wollenberg A, Yew YW, Postigo JAR, Schmid-Grendelmeier P, Taïeb A. Atopic dermatitis: A global health perspective. J Eur Acad Dermatol Venereol 2024; 38:801-811. [PMID: 38151270 DOI: 10.1111/jdv.19723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/17/2023] [Indexed: 12/29/2023]
Abstract
The International Society of AD (ISAD) organized a roundtable on global aspects of AD at the WCD 2023 in Singapore. According to the Global Burden of Disease (GBD) consortium, at least 171 million individuals were affected with AD in 2019, corresponding to 2.23% of the world population, with age-standardized prevalence and incidence rates that were relatively stable from 1990 to 2019. Based on the panel experience, most AD cases are mild-to-moderate. Without parallel data on disease prevalence and severity, the GBD data are difficult to interpret in many regions. This gap is particularly important in countries with limited medical infrastructure, but indirect evidence suggests a significant burden of AD in low-and-medium resource settings, especially urban areas. The Singapore roundtable was an opportunity to compare experiences in World Bank category 1 (Madagascar and Mali), 3 (Brazil, China) and 4 (Australia, Germany, Qatar, USA, Singapore, Japan) countries. The panel concluded that current AD guidelines are not adapted for low resource settings and a more pragmatic approach, as developed by WHO for skin NTDs, would be advisable for minimal access to moisturizers and topical corticosteroids. The panel also recommended prioritizing prevention studies, regardless of the level of existing resources. For disease long-term control in World Bank category 3 and most category 4 countries, the main problem is not access to drugs for most mild-to-moderate cases, but rather poor compliance due to insufficient time at visits. Collaboration with WHO, patient advocacy groups and industry may promote global change, improve capacity training and fight current inequalities. Finally, optimizing management of AD and its comorbidities needs more action at the primary care level, because reaching specialist care is merely aspirational in most settings. Primary care empowerment with store and forward telemedicine and algorithms based on augmented intelligence is a future goal.
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Affiliation(s)
- Ousmane Faye
- Department of Dermatology, Faculty of Medicine and Odontostomatology, Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
| | - Carsten Flohr
- Paediatric & Population-Based Dermatology Research, St John's Institute of Dermatology, London, UK
- Guy & St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Singapore Research Institute of Singapore (SRIS), Kyoto, Japan
- A*STAR Skin Research Labs (A*SRL), Agency for Science, Technology, and Research (A*STAR)Biopolis, Singapore City, Singapore
| | - Lin Ma
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Martin Steinhoff
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- School of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
- Department of Dermatology, Weill Cornell Medicine, New York City, New York, USA
| | - John C Su
- Eastern Health, Monash University, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Roberto Takaoka
- International Society of Atopic Dermatitis, Davos, Switzerland
- Division of Dermatology, University of São Paulo Medical School Hospital, São Paulo, Brazil
| | - Andreas Wollenberg
- International Society of Atopic Dermatitis, Davos, Switzerland
- Division of Dermatology, University of São Paulo Medical School Hospital, São Paulo, Brazil
- University Hospital Augsburg, Augsburg, Germany
- Ludwig-Maximilian University, Munich, Germany
| | | | | | - Peter Schmid-Grendelmeier
- International Society of Atopic Dermatitis, Davos, Switzerland
- World Allergy Organization, Milwaukee, Wisconsin, USA
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - Alain Taïeb
- International Society of Atopic Dermatitis, Davos, Switzerland
- INSERM U 1312, University of Bordeaux, Bordeaux, France
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Lim JJ, Lim YYE, Ng JY, Malipeddi P, Ng YT, Teo WY, Wong QYA, Matta SA, Sio YY, Wong YR, Teh KF, Rawanan Shah SM, Reginald K, Say YH, Liu MH, Chew FT. Burgers, Fast Foods, and Increased Associated Risk for Atopic Dermatitis: A Cross-Sectional Study of Dietary Habits among Young Chinese Adults in Singapore/Malaysia. Dermatology 2023; 240:77-84. [PMID: 37666213 DOI: 10.1159/000533942] [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: 05/26/2022] [Accepted: 08/29/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND We see increasing evidence that dietary and nutrients factors play a pivotal role in allergic diseases and recent global findings suggest that dietary habits influence the pathogenesis of atopic dermatitis (AD). Frequent consumption of fast food diets is associated with AD development. Despite the rising prevalence of AD in Asia, efforts in investigating the role of dietary habits and AD in adults are still lacking. METHODS We evaluated the association between the dietary intake of 16 food types and AD manifestations using our Singapore/Malaysia Cross-sectional Genetics Epidemiology Study (SMCGES) population. Dietary habits profiles of 11,494 young Chinese adults (1,550 AD cases/2,978 non-atopic controls/6,386 atopic controls) were assessed by an investigator-administered questionnaire. AD cases were further evaluated for their chronicity (550 chronic) and severity (628 moderate-to-severe). Additionally, we derived a novel food index, Quality of Diet based on Glycaemic Index Score (QDGIS), to examine the association between dietary intake of glycaemic index (GI) and various AD phenotypes. RESULTS The majority of AD subjects are distributed in the good (37.1%) and moderate (36.2%) QDGIS classes. From the multivariable analyses for age and gender, a moderate QDGIS class was significantly associated with a lower odds of AD (adjusted odds ratio (AOR): 0.844; 95% confidence interval (CI): 0.719-0.991; p < 0.05) and moderate-to-severe AD (AOR: 0.839; 95% CI: 0.714-0.985; p < 0.05). A good QDGIS class was only significantly associated with a lower odds of chronic AD (AOR: 0.769; 95% CI: 0.606-0.976; p < 0.05). Among high GI foods, frequent consumption of burgers/fast food was strongly associated with an increased risk of chronic and moderate-to-severe AD. Among low GI foods, increased intake frequencies of fruits, vegetables, and pulses decreased the odds of AD. Finally, we identified significant associations between frequent seafood, margarine, butter, and pasta consumption with an increased odds of AD despite them having little GI values. CONCLUSION While genetic components are well-established in their risks associated with increased AD prevalence, there is still a lack of a focus epidemiology study associating dietary influence with AD. Based on the first allergic epidemiology study conducted here in Singapore and Malaysia, it laid the groundwork to guide potential dietary interventions from changing personal dietary habits.
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Affiliation(s)
- Jun Jie Lim
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore,
| | - Yi Ying Eliza Lim
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Jun Yan Ng
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Praneeth Malipeddi
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Yu Ting Ng
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Wei Yi Teo
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Qi Yi Ambrose Wong
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Sri Anusha Matta
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Yang Yie Sio
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Yi Ru Wong
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya, Malaysia
| | - Keng Foo Teh
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya, Malaysia
| | - Smyrna Moti Rawanan Shah
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya, Malaysia
| | - Kavita Reginald
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya, Malaysia
| | - Yee-How Say
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya, Malaysia
- Department of Biomedical Science, Faculty of Science, Universiti Tunku Abdul Rahman (UTAR), Kampar, Malaysia
| | - Mei Hui Liu
- Department of Food Science and Technology, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Fook Tim Chew
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
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5
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Lim JJ, Lim YYE, Ng JY, Malipeddi P, Ng YT, Teo WY, Wong QYA, Matta SA, Sio YY, Wong YR, Teh KF, Rawanan Shah SM, Reginald K, Say YH, Chew FT. An update on the prevalence, chronicity, and severity of atopic dermatitis and the associated epidemiological risk factors in the Singapore/Malaysia Chinese young adult population: A detailed description of the Singapore/Malaysia Cross-Sectional Genetics Epidemiology Study (SMCGES) cohort. World Allergy Organ J 2022; 15:100722. [DOI: 10.1016/j.waojou.2022.100722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
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Yang TH, Chen PC, Lin YC, Lee YY, Tseng YH, Chang WH, Chang LS, Lin CH, Kuo HC. Adolescents with Atopic Dermatitis Have Lower Peak Exercise Load Capacity and Exercise Volume Compared with Unaffected Peers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10285. [PMID: 36011919 PMCID: PMC9407882 DOI: 10.3390/ijerph191610285] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
Background: Sweating and increased skin temperature caused by exercise can reduce physical activity and the willingness to exercise in adolescents with atopic dermatitis. This study was conducted to investigate the exercise load capacity of adolescents with atopic dermatitis and analyzed their exercise behavior and motivation. Methods: Adolescents with and without atopic dermatitis were assigned to the atopic dermatitis group and control group (n = 27 each). Both groups completed a cardiopulmonary exercise test and questionnaires to assess their exercise capacity, weekly exercise volume, exercise motivation, and self-efficacy, respectively. Results: The ratio of measured forced vital capacity to the predicted forced vital capacity and the peak oxygen consumption of the atopic dermatitis group were significantly lower than those of the control group. The Godin Leisure-Time Exercise Questionnaire scores of the atopic dermatitis group were significantly lower than those of the control group. As for the Behavioral Regulation in Exercise Questionnaire 2, the scores for the introjected and identified regulations of the atopic dermatitis group were significantly lower than those of the control group. Regarding the Multidimensional Self-Efficacy for Exercise Scale, the scheduling efficacy and total scores of the atopic dermatitis group were significantly lower than those of the control group. Conclusions: Adolescents with atopic dermatitis had lower peak exercise capacity and lower weekly exercise volume. Furthermore, they lacked the negative feelings toward inactivity and the self-confidence to plan regular exercise independently. The results of this study suggest that adolescents with atopic dermatitis should be encouraged to engage in regular indoor exercise.
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Affiliation(s)
- Tsung-Hsun Yang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Yun-Chung Lin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Yan-Yuh Lee
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Yu-Hsuan Tseng
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Wen-Hsin Chang
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ling-Sai Chang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Chia-Hsuan Lin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Ho-Chang Kuo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
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Association of Adult Atopic Dermatitis Severity With Decreased Physical Activity: A Cross-sectional Study. Dermatitis 2022; 34:218-223. [PMID: 35951359 DOI: 10.1097/der.0000000000000921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is associated with chronic pruritus, skin pain, sleep deprivation, depression, and anxiety, which may lead to decreased physical activity (PA). OBJECTIVE The aim of the study is to elucidate the impact of disease and itch severity on PA in adult AD. METHODS This is a prospective dermatology practice-based study of 955 AD patients (ages 18-97 years). RESULTS In multivariable logistic regression models controlling for age, sex, race/ethnicity, and asthma history, patient-reported global AD severity (PtGA), Patient-Oriented Eczema Measure, Eczema Area and Severity Index (EASI), and Investigator's Global Assessment (IGA) were associated with itch impairing light PA, moderate PA, and vigorous PA, as well as higher Patient-Reported Outcomes Measurement Information System Itch Questionnaire PA T-scores. Higher objective Scoring AD (O-SCORAD) was associated with itch impairing moderate PA. In bivariable analyses, performing greater than or equal to 30 minutes of light PA greater than or equal to 1 day a week was decreased with higher PtGA, Patient-Oriented Eczema Measure, and EASI; greater than or equal to 30 minutes of moderate PA greater than or equal to 1 day a week was decreased with PtGA, EASI, O-SCORAD, and IGA; and greater than equal to 30 minutes of vigorous PA was decreased with patient-reported AD severity, EASI, O-SCORAD, and IGA. In multivariable logistic regression models, the impact of itch on PA was inversely associated with light PA, moderate PA, and vigorous PA. CONCLUSION Adult AD patients with more severe disease have decreased levels of PA secondary to itch.
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Mitchell KN, Tay YK, Heath CR, Silverberg NB. Review article: Emerging issues in pediatric skin of color, Part 2. Pediatr Dermatol 2021; 38 Suppl 2:30-36. [PMID: 34708446 DOI: 10.1111/pde.14774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dermatology for pediatric skin of color is the application of dermatology to the genetically diverse and distinctive segment of the pediatric population that includes children of non-White racial and ethnic groups with increased pigmentation including individuals of Asian, Hispanic/LatinX, African, Native American, Pacific Island descent, indigenous people among others with overlap in particular individuals, and mixtures thereof. The discipline of pediatric skin of color can be challenging with difficulty in diagnosis of common conditions due to underlying pigmentation, variations in common hair styling practices, and differences in demographics of cutaneous disease. Whereas some conditions are more common in children of color, other conditions have nuances in clinical appearance and therapeutics with regard to skin color. This article, the second of the series, focuses on inflammatory skin disease nuances, melanocytic disorders, and hypopigmented mycosis fungoides.
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Affiliation(s)
- Krystal N Mitchell
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Yong Kwang Tay
- Department of Dermatology, Changi General Hospital, Singapore, Singapore
| | - Candrice R Heath
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Nanette B Silverberg
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mt Sinai, New York, NY, USA
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9
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Reddy S, Brahmbhatt H. A Narrative Review on the Role of Acids, Steroids, and Kinase Inhibitors in the Treatment of Keratosis Pilaris. Cureus 2021; 13:e18917. [PMID: 34692268 PMCID: PMC8528166 DOI: 10.7759/cureus.18917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 01/01/2023] Open
Abstract
Keratosis pilaris is a common and benign genetic skin disorder that results in patches of rough bumps on the skin, with varying degrees of reddening and inflammation. These bumps in the skin are caused by the dead skin cells that plug the hair follicles. Keratosis pilaris often manifests in small, hard bumps on the legs and arms. A common treatment method for many acne conditions, including keratosis pilaris, is acid, which has shown promise in recent years. This review examines the use and success of multiple types of acids, steroids, and kinase inhibitors in clinical and non-clinical settings to treat and understand keratosis pilaris. In the treatment of keratosis pilaris, acid primarily works by breaking down the dead skin cells that clog the hair follicles. Some types of steroids have anti-inflammatory properties that have proven useful in minimizing the appearance of acne. Kinase inhibitors control important skin cell functions, such as cell signaling, metabolism, division, and survival, which undoubtedly affect the appearance of skin as a whole. The known impact of acid, steroids, and kinase inhibitors on keratosis pilaris is underestimated and should be given more attention by healthcare industry leaders.
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10
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Ng SWL, Teo N, Lee NKL, Lim KBL. Septic Arthritis in Paediatric Patients: A 10-year Experience at a Single Institution. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/20101058211035222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background We evaluated the clinical presentation and microbiological profile of a cohort of paediatric patients with septic arthritis at a tertiary institution in Singapore. Methods After obtaining institutional board approval, records of all patients below 18 years presenting with septic arthritis between 2010 and 2019 were reviewed. Patient demographic and medical data were analysed. Results Of 24 patients with 26 infected joints with a mean age of 7.1 years, 50.0% had pre-existing atopic dermatitis. The most common site infected was the hip ( n = 11, 42.3%). The most common pathogen isolated from tissue cultures was methicillin-sensitive-Staphylococcus aureus (MSSA) ( n = 9, 37.5%). Twenty-three (95.8%) of the patients underwent surgical drainage. Conclusions The skin of patients with atopic dermatitis has been shown to be more frequently colonised with Staphylococcus aureus compared to healthy individuals. The prevalence of atopic dermatitis in our cohort was higher compared to the reported national average of 20.8%. MSSA was the most commonly reported pathogen, and the hip joint most commonly affected. Less than half of the cohort had positive tissue or blood cultures. In paediatric patients with known atopic dermatitis who present with a fever, a painful joint and limited range of motion, septic arthritis should be considered and early drainage and antibiotics instituted.
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Affiliation(s)
- Stacy Wei Ling Ng
- Singhealth Orthopaedic Residency, Department of Orthopedic Surgery, KK Women’s and Children’s Hospital, Singapore
| | - Nicole Teo
- Division of Surgery, KK Women’s and Children’s Hospital, Singapore
| | | | - Kevin Boon Leong Lim
- Division of Surgery, KK Women’s and Children’s Hospital, Singapore
- Department of Orthopaedic Surgery, KK Women’s and Children’s Hospital, Singapore
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Risk factor analysis of allergic rhinitis in 6-8 year-old children in Taipei. PLoS One 2021; 16:e0249572. [PMID: 33798255 PMCID: PMC8018651 DOI: 10.1371/journal.pone.0249572] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/20/2021] [Indexed: 01/12/2023] Open
Abstract
The incidence of allergic rhinitis (AR) has increased rapidly in Taiwan during the past 30 years; however, potential risk factors of AR have yet to be examined. The purpose of this study is to explore the prevalence, personal and environmental risk factors of rhinitis. A cross-sectional survey was conducted in 26418 first graders (6–8 years old) in Taipei with a response rate of 94.6% (24999/26418). Modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires were completed by their parents or main caregivers. Logistic regression was used to examine possible personal and environmental (in early life and current) factors related to rhinitis. The prevalence of rhinitis in the past 12 months was 42.8% in 6–8 years old children. Multivariate logistic regression analysis for both males and females revealed that male gender, antibiotic use in first year of life, bronchiolitis before the age of two years, diagnosed asthma, and diagnosed eczema, having a cat the first year of life were associated with an increased risk of rhinitis. Having older siblings, on the other hand, may reduce the risk of rhinitis. Based on the present study, we may recommend less use of antibiotics the first year of life and not having a cat in the home in the child’s first year of life as preventive measures to reduce the risk of rhinitis. From the subgroup analysis, we can take preventive measures for the different risk factors of rhinitis and the severity of rhinitis in each subgroup.
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12
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Practical Recommendations for the Topical Treatment of Atopic Dermatitis in South and East Asia. Dermatol Ther (Heidelb) 2020; 11:275-291. [PMID: 33313998 PMCID: PMC7859143 DOI: 10.1007/s13555-020-00467-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction There is some evidence to suggest that the prevalence of atopic dermatitis (AD) in Asia is rising. We have therefore developed an algorithm for the topical treatment of AD throughout South and East Asia for use by primary care physicians, pediatricians and dermatologists. Methods Nine AD experts from South and East Asia and one from Europe developed the algorithm based upon treatment guidelines, relevant literature and local treatment practices. The algorithm outlines current best practice for the use of emollients, topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI), with the intention of simplifying the treatment regimen of mild-to-moderate AD in South and East Asia. Results Patients with AD should bathe and cleanse affected skin to remove crusts and scales daily. Emollients should also be applied daily as a maintenance treatment. When selecting appropriate topical anti-inflammatory treatment for AD flares, several factors should be taken into consideration, including the patient’s age, attitude to treatment options and site of AD lesions. Given the concerns regarding the risk of skin atrophy with use of TCS, a TCI should be used to treat AD lesions in sensitive skin areas: pimecrolimus is recommended for mild-to-moderate AD in these locations, while tacrolimus should be considered for moderate and severe cases. Either pimecrolimus or tacrolimus is recommended for flares in other, non-sensitive body locations. A proactive or intermittent maintenance treatment strategy involving regular emollient use and twice-weekly application of a TCI to previously affected areas is encouraged to reduce the risk of flares. Conclusions The algorithm proposed here is intended to simplify the topical treatment of mild-to-moderate AD in daily practice in South and East Asian countries.
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13
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Efficacy of health education on treatment of children with atopic dermatitis: a meta-analysis of randomized controlled trials. Arch Dermatol Res 2020; 312:685-695. [DOI: 10.1007/s00403-020-02060-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 12/24/2019] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
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14
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Lee MP, Saffari SE, Loh W, Goh SH, Goh A, Chiang WC, Chong KW. A 5-year retrospective review of children with peanut allergy in the largest paediatric hospital in Singapore. Asia Pac Allergy 2020; 10:e6. [PMID: 32099828 PMCID: PMC7016321 DOI: 10.5415/apallergy.2020.10.e6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/23/2020] [Indexed: 11/04/2022] Open
Abstract
Background The prevalence of peanut allergy (PA) among children has increased significantly over the past decade. Even though the prevalence of PA in Singapore is considered low, peanut is the top trigger for food-induced anaphylaxis in Singaporean children. Objective To describe the demographic characteristics and clinical features of children with PA. Methods This is a 5-year retrospective review of children diagnosed with PA based on clinical history coupled with a positive skin prick test to peanut or positive oral food challenge results. Results There were 269 patients (53.9% males) with a clinical diagnosis of PA. The median age at first allergic presentation for the PA group was 24 months old, with interquartile range of 13-39 months. The most common form of peanut introduced was roasted peanut. The rate of peanut anaphylaxis was 7.1%. Concomitant tree nut sensitization was found in 32.3% of this cohort, predominantly to cashew nut. Majority of them have a personal history of atopy - 75.8% with eczema, 63.6% with allergic rhinitis, and 19.7% with asthma. Conclusion This is the first large review of peanut-allergic children in Singapore. Prospective population-based studies are needed to establish the true prevalence and risk factors associated with the development of this potentially life-threatening condition.
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Affiliation(s)
- May Ping Lee
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Seyed Ehsan Saffari
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Medical School, Singapore
| | - Wenyin Loh
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Si Hui Goh
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Anne Goh
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Wen Chin Chiang
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Kok Wee Chong
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
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15
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Xu X, van Galen LS, Koh MJA, Bajpai R, Thng S, Yew YW, Ho VPY, Alagappan U, Järbrink KSA, Car J. Factors influencing quality of life in children with atopic dermatitis and their caregivers: a cross-sectional study. Sci Rep 2019; 9:15990. [PMID: 31690745 PMCID: PMC6831568 DOI: 10.1038/s41598-019-51129-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/15/2019] [Indexed: 11/09/2022] Open
Abstract
Better understanding of atopic dermatitis' effect on quality of life could enhance current management and therapeutic strategies. Studies investigating factors related to the health-related quality of life (HRQOL) of children with atopic dermatitis and their caregivers are limited. This cross-sectional study included 559 children (<16 years) with atopic dermatitis and their caregivers. Disease severity was associated with infants' HRQOL (moderate: IRR: 1.42, 95% CI 1.20-1.67; severe: IRR: 1.72, 95% CI 1.32-2.24). Age and disease severity were associated with children's HRQOL (age: IRR: 0.99, 95% CI 0.98-1.00; moderate: IRR: 1.08, 95% CI 1.02-1.14). Quality of life subdomains itching/scratching, emotional distress and sleep disturbance were most reported and increased with higher disease severity. Both caregivers' mental and physical health were negatively affected by children's HRQOL (physical: IRR: 0.99, 95% CI 0.99-1.00; mental: IRR: 0.98, 95% CI 0.97-0.99). Sociodemographic characteristics (gender, ethnicity, educational attainment of carers, number of children) did not demonstrate significance in children's HRQOL model. In conclusion, current atopic dermatitis diagnostics and treatment have to be extended to the factors influencing both children' as their caregivers' quality of life and adapting management accordingly. Itching/scratching, emotional distress and sleep disturbance deserve attention. Sociodemographic characteristics in children's HRQOL models also merit attention in further research.
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Affiliation(s)
- Xiaomeng Xu
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Louise Sandra van Galen
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Section of Acute Medicine, Department of Internal Medicine, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ram Bajpai
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Yik Weng Yew
- National Skin Centre, Singapore, Singapore.,Skin Research Institute of Singapore, Singapore, Singapore
| | | | - Uma Alagappan
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Krister Sven Ake Järbrink
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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16
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Olsson M, Bajpai R, Wee L, Yew Y, Koh M, Thng S, Car J, Järbrink K. The cost of childhood atopic dermatitis in a multi‐ethnic Asian population: a cost‐of‐illness study. Br J Dermatol 2019; 182:1245-1252. [DOI: 10.1111/bjd.18442] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2019] [Indexed: 11/27/2022]
Affiliation(s)
- M. Olsson
- Centre for Population Health Sciences (CePHaS) Lee Kong Chian School of Medicine Nanyang Technological University Clinical Sciences Building, 11 Mandalay Road Singapore 308232 Singapore
- Queensland University of Technology Kelvin Grove Queensland Australia
| | - R. Bajpai
- Centre for Population Health Sciences (CePHaS) Lee Kong Chian School of Medicine Nanyang Technological University Clinical Sciences Building, 11 Mandalay Road Singapore 308232 Singapore
- Research Institute for Primary Care and Health Sciences Keele University Staffordshire ST55BG U.K
| | - L.W.Y. Wee
- Dermatology Service KK Women's and Children's Hospital Singapore
| | - Y.W. Yew
- National Skin Centre 1 Mandalay Road Singapore 308205
| | - M.J.A. Koh
- Dermatology Service KK Women's and Children's Hospital Singapore
| | - S. Thng
- National Skin Centre 1 Mandalay Road Singapore 308205
- Skin Research Institute of Singapore Singapore
| | - J. Car
- Centre for Population Health Sciences (CePHaS) Lee Kong Chian School of Medicine Nanyang Technological University Clinical Sciences Building, 11 Mandalay Road Singapore 308232 Singapore
- Global eHealth Unit Department of Primary Care and Public Health School of Public Health Imperial College London 3rd floor Reynolds Building, St Dunstan's Road London W6 8RP U.K
| | - K. Järbrink
- Centre for Population Health Sciences (CePHaS) Lee Kong Chian School of Medicine Nanyang Technological University Clinical Sciences Building, 11 Mandalay Road Singapore 308232 Singapore
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17
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Kim J. Low-intensity tower climbing resistance exercise reduces experimentally induced atopic dermatitis in mice. J Exerc Rehabil 2019; 15:518-525. [PMID: 31523671 PMCID: PMC6732538 DOI: 10.12965/jer.1938276.138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/19/2019] [Indexed: 11/23/2022] Open
Abstract
In general, exercise can help improve overall health and prevent diseases. However, individuals with atopic dermatitis (AD) often lose the desire for physical exercise owing to itching caused by sweating. In the present study, we have evaluated the effect of low-intensity tower climbing resistance exercise (TCRE) on Dermatophagoides farinae extract (DFE; house dust mite extract)- and 2,4-dinitrochlorobenzene-induced AD-like skin lesions in a BALB/c model. Histopathological examination showed reduced thickness of the epidermis/dermis and dermal infiltration of inflammatory cells in the ears. TCRE downregulated serum Ig levels and suppressed mRNA expression of pro-inflammatory cytokines in the ear tissue, and reduced the size and weight of draining lymph nodes (dLNs) and nondraining lymph nodes (ndLNs), along with expression of pro-inflammatory cytokines in CD4+ T cells from dLNs and ndLNs. Taken together, we showed that low-intensity TCRE reduced AD symptoms. These results will help improve treatment of AD, and will be of interest to dermatologists as well as to patients with AD.
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Affiliation(s)
- Jooyoung Kim
- Department of Anatomy, School of Medicine, Kyungpook National University, Daegu, Korea
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18
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Tsai TF, Rajagopalan M, Chu CY, Encarnacion L, Gerber RA, Santos-Estrella P, Llamado LJQ, Tallman AM. Burden of atopic dermatitis in Asia. J Dermatol 2019; 46:825-834. [PMID: 31436343 DOI: 10.1111/1346-8138.15048] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/22/2019] [Indexed: 11/28/2022]
Abstract
Atopic dermatitis is a chronic, inflammatory skin disease characterized by intense pruritus and eczematous lesions. It is considered one of the most common chronic conditions, with an estimated global prevalence of nearly 230 million. As in the rest of the world, prevalence of atopic dermatitis has been increasing in Asian countries over the last few decades. This increased prevalence in Asian countries has been attributed to factors such as rapid urbanization, increasingly Westernized lifestyles, and improved standards of living and education. As a result, it is important to understand the increasing burden of disease in Asian countries and the differences between the countries in terms of epidemiology, diagnostic criteria, management, quality of life and economic burden.
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Affiliation(s)
- Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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van Galen LS, Xu X, Koh MJA, Thng S, Car J. Eczema apps conformance with clinical guidelines: a systematic assessment of functions, tools and content. Br J Dermatol 2019; 182:444-453. [PMID: 31179535 DOI: 10.1111/bjd.18152] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Eczema is a prevalent complex skin condition requiring active disease monitoring and personalized education. No studies have assessed the quality of apps that aim to support eczema self-management. OBJECTIVES To evaluate the quality and comprehensiveness of English, Chinese and Spanish self-management eczema smartphone apps for patients and/or their caregivers. METHODS A systematic assessment of eczema apps from July 2018 to November 2018. The assessment criteria were based on conformance with international eczema guidelines. The following domains were assessed: consistency and comprehensiveness of eczema-specific educational information; quality and comprehensiveness of eczema-specific tracking functions; compliance with health information best practice principles. RESULTS In total, 98 apps were assessed: 82 (84%) provided educational information; 38 (39%) tracking functions; and 13 (13%) both. We found that 34% (28/82) of apps provided misleading information, particularly regarding aspects of treatment and disease progression of eczema. Only 15% (12/82) provided international guideline supported information on pharmacological therapies and 16% (13/82) on nonpharmacological therapies. Among 38 apps with a tracking function, 82% (31/38) measured specific symptoms, disease severity or current skin condition and 89% (34/38) helped users to record medication usage including application of topicals. Environmental or dietary allergens were recorded by 34% (13/38). None of the included apps complied with all criteria for educational information, tracking functions or health information principles. CONCLUSIONS Eczema apps have not yet reached their potential. The large variance in quality of eczema apps highlights the need for quality assurance mechanisms for health apps and guidance for clinicians that would enable them to make personalized recommendations for patients and caregivers. What's already known about this topic? There is limited information about the quality of eczema self-management smartphone apps on the global market. What does this study add? This systematic assessment evaluated all English, Chinese and Spanish language apps that support eczema self-management. The majority did not conform with information in guidelines and insufficiently support evidence-based self-management. The large variance in the quality of eczema apps highlights the need for mechanisms to ensure app quality and to guide personalized app selection for patients, caregivers and doctors.
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Affiliation(s)
- L S van Galen
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore.,Section of Acute Medicine, Department of Internal Medicine, Amsterdam UMC location VUmc, the Netherlands
| | - X Xu
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore
| | - M J A Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore
| | - S Thng
- National Skin Centre, 1 Mandalay Road, 308205, Singapore
| | - J Car
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore.,Global Digital Health Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, 3rd floor Reynolds Building, St Dunstan's Road, London, W6 8RP, U.K
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20
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Bonamonte D, Filoni A, Vestita M, Romita P, Foti C, Angelini G. The Role of the Environmental Risk Factors in the Pathogenesis and Clinical Outcome of Atopic Dermatitis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2450605. [PMID: 31119157 PMCID: PMC6500695 DOI: 10.1155/2019/2450605] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/10/2019] [Indexed: 12/17/2022]
Abstract
Atopic dermatitis (AD) prevalence is rising worldwide. Literature data suggest the incidence of AD in developing countries is gradually getting close to that of developed ones, in which AD affects 20% of the paediatric population. Such an increment, associated with significant variations in prevalence among the various countries, underlines the importance of environmental factors in the disease onset. Among these, great importance is given to hygiene, intestinal microbiota, exposure to bacterial endotoxins, outdoor living with contact to animals, atmospheric pollution, weather, and diet. Genetic (alteration of the skin barrier function) as well as immunologic factors concur with the environmental ones. Only the systematical study of all these elements can best elucidate AD epidemiology.
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Affiliation(s)
- Domenico Bonamonte
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, 11 Piazza Giulio Cesare, Bari 70124, Italy
| | - Angela Filoni
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, 11 Piazza Giulio Cesare, Bari 70124, Italy
- San Gallicano Dermatologic Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Michelangelo Vestita
- Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, 11 Piazza Giulio Cesare, Bari 70124, Italy
| | - Paolo Romita
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, 11 Piazza Giulio Cesare, Bari 70124, Italy
| | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, 11 Piazza Giulio Cesare, Bari 70124, Italy
| | - Gianni Angelini
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, 11 Piazza Giulio Cesare, Bari 70124, Italy
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21
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Matta SA, Blanchet-Rethore S, Sio YY, Suri BK, Andiappan AK, Anantharaman R, Piketty C, Bourdes V, Chew FT. Different phenotypes and factors associated with atopic dermatitis in the young adult Singaporean Chinese population: A cross-sectional study. World Allergy Organ J 2019; 12:100008. [PMID: 30937133 PMCID: PMC6439406 DOI: 10.1016/j.waojou.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 11/07/2018] [Accepted: 11/28/2018] [Indexed: 10/28/2022] Open
Abstract
Background Atopic dermatitis (AD) is a chronic allergic disease typically accompanied by atopy and thus, a tendency to develop allergic diseases such as allergic rhinitis, asthma or food allergies. Currently, individuals with AD are classified into those presenting with AD alone and those presenting with AD along with other allergic diseases (AD+). It is important to identify the various endophenotypes of AD using anthropometric, environmental, socio-economic, and disease history data in order to improve disease management. To characterize the phenotypic differences among Singaporean Chinese individuals with AD alone and AD+, and identify the socioeconomic, lifestyle, and environmental factors associated with these different presentations. Methods Based on data collected via a standardized/validated questionnaire, 4604 participants (mean age: 22.1 years) were classified into three groups: 1) AD alone group; 2) AD with other allergic diseases group (AD+); and 3) Control group. Results Participants were less sensitized to common inhalant allergens in the AD alone group versus the Control group (67% vs. 72%, respectively; p < 0.05).High Body Mass Index (i.e., BMI > 23) was associated with the disease and the difference was more pronounced in the AD alone group compared to the AD+ group (Odds Ratio: 1.38; 95% Confidence Interval: 1.4-1.67; p < 0.001). No major differences in habits were observed between the AD alone and AD+ groups. Conclusions The two presentations of AD may have different underlying pathogenesis and associated risk factors.
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Affiliation(s)
- Sri Anusha Matta
- Department of Biological Science, National University of Singapore, Singapore
| | | | - Yang Yie Sio
- Department of Biological Science, National University of Singapore, Singapore
| | - Bani Kaur Suri
- Department of Biological Science, National University of Singapore, Singapore
| | - Anand Kumar Andiappan
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (ASTAR), Singapore
| | - Ramani Anantharaman
- Department of Biological Science, National University of Singapore, Singapore
| | | | - Valerie Bourdes
- Nestlé Skin Health-Galderma R&D, Sophia Antipolis, Biot, France
| | - Fook Tim Chew
- Department of Biological Science, National University of Singapore, Singapore
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22
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Cheong JYV, Hie SL, Koh EW, de Souza NNA, Koh MJA. Impact of pharmacists' counseling on caregiver's knowledge in the management of pediatric atopic dermatitis. Pediatr Dermatol 2019; 36:105-109. [PMID: 30408232 DOI: 10.1111/pde.13708] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a common skin condition in childhood. AD management can be complex, and caregivers may have inadequate information on the disease, aggravating factors, and management. Comprehensive therapeutic education has been closely associated with increased compliance and is recommended for all patients. There are, as yet, no studies on the impact of a pharmacist-led eczema counseling service. OBJECTIVES The primary objective was to assess the impact of a pharmacist-led eczema counseling service on improving caregivers' knowledge. The secondary objective was to evaluate caregivers' satisfaction of the service and their confidence in handling the patient's condition after counseling. METHODS This was a prospective, questionnaire-based observational study. After obtaining informed consent, caregivers were required to complete questionnaire A, containing items on demographics and knowledge assessment. Caregivers then underwent a counseling session by a dermatology-trained pharmacist. After counseling, caregivers were required to complete questionnaire B containing items on satisfaction and confidence level. A follow-up phone call was conducted after initial counseling session, during which knowledge-based questionnaire C would be completed. RESULTS Data from 32 participants were included in the analysis. There was a significant improvement in caregivers' knowledge score after receiving counseling, with mean precounseling score of 8.38 ± 3.92 and mean postcounseling score of 13.88 ± 3.65 (P < 0.001). Majority was satisfied with the service and was confident in handling their child's condition. CONCLUSION Pharmacist-led eczema counseling has a positive impact on caregiver's knowledge and can lead to improved compliance. The service was well received, although more time could be spent during the counseling.
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Affiliation(s)
| | - Szu Liang Hie
- Department of Pharmacy, KK Women's and Children's Hospital, Singapore
| | - En Wei Koh
- Department of Pharmacy, KK Women's and Children's Hospital, Singapore
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23
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Wang JF, Orlow SJ. Keratosis Pilaris and its Subtypes: Associations, New Molecular and Pharmacologic Etiologies, and Therapeutic Options. Am J Clin Dermatol 2018; 19:733-757. [PMID: 30043128 DOI: 10.1007/s40257-018-0368-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Keratosis pilaris is a common skin disorder comprising less common variants and rare subtypes, including keratosis pilaris rubra, erythromelanosis follicularis faciei et colli, and the spectrum of keratosis pilaris atrophicans. Data, and critical analysis of existing data, are lacking, so the etiologies, pathogeneses, disease associations, and treatments of these clinical entities are poorly understood. The present article aims to fill this knowledge gap by reviewing literature in the PubMed, EMBASE, and CINAHL databases and providing a comprehensive, analytical summary of the clinical characteristics and pathophysiology of keratosis pilaris and its subtypes through the lens of disease associations, genetics, and pharmacologic etiologies. Histopathologic, genomic, and epidemiologic evidence points to keratosis pilaris as a primary disorder of the pilosebaceous unit as a result of inherited mutations or acquired disruptions in various biomolecular pathways. Recent data highlight aberrant Ras signaling as an important contributor to the pathophysiology of keratosis pilaris and its subtypes. We also evaluate data on treatments for keratosis pilaris and its subtypes, including topical, systemic, and energy-based therapies. The effectiveness of various types of lasers in treating keratosis pilaris and its subtypes deserves wider recognition.
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Affiliation(s)
- Jason F Wang
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, 11th Floor, New York, NY, 10016, USA
| | - Seth J Orlow
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, 11th Floor, New York, NY, 10016, USA.
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24
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Zhuo F, Abourehab MA, Hussain Z. Hyaluronic acid decorated tacrolimus-loaded nanoparticles: Efficient approach to maximize dermal targeting and anti-dermatitis efficacy. Carbohydr Polym 2018; 197:478-489. [DOI: 10.1016/j.carbpol.2018.06.023] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/13/2018] [Accepted: 06/05/2018] [Indexed: 01/08/2023]
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25
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Steinke S, Beikert F, Langenbruch A, Fölster-Holst R, Ring J, Schmitt J, Werfel T, Hintzen S, Franzke N, Augustin M. Measurement of healthcare quality in atopic dermatitis - development and application of a set of quality indicators. J Eur Acad Dermatol Venereol 2018; 32:2237-2243. [DOI: 10.1111/jdv.15074] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/04/2018] [Indexed: 01/14/2023]
Affiliation(s)
- S. Steinke
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
- Department of Dermatology; University Hospital Münster; Münster Germany
| | - F.C. Beikert
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
- Practice Dres. Büttner/Meewes/Faubel; Neumünster Germany
| | - A. Langenbruch
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - R. Fölster-Holst
- Department of Dermatology; University Medical Center Schleswig-Holstein; Kiel Germany
| | - J. Ring
- Department of Dermatology and Allergy; Technical University Munich; Munich Germany
| | - J. Schmitt
- Center for Evidence-based Healthcare; University Hospital Carl Gustav Carus; Dresden Germany
| | - T. Werfel
- Division of Immunodermatology and Allergy Research; Clinic for Dermatology; Allergology and Venerology; Hannover Medical School; Hannover Germany
| | - S. Hintzen
- Department of Dermatology; Bundeswehrkrankenhaus Berlin; Berlin Germany
| | - N. Franzke
- Hautarztpraxis Braunschweig; Braunschweig Germany
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
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Lee HH, Patel KR, Singam V, Rastogi S, Silverberg JI. A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis. J Am Acad Dermatol 2018; 80:1526-1532.e7. [PMID: 29864464 DOI: 10.1016/j.jaad.2018.05.1241] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/16/2018] [Accepted: 05/28/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies found conflicting results about whether atopic dermatitis (AD) begins in adulthood. OBJECTIVE To determine rates, predictors, and phenotypic differences of adult-onset AD. METHODS A systematic review was performed with all published observational studies in Medline, Embase, GREAT (Global Resource of EczemA Trials), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library, and Scopus that analyzed the age of AD onset beyond 10 years of age. At least two reviewers performed study title, abstract review, and data extraction. Pooled meta-analysis of the proportion of adult-onset AD was performed by using random-effects weighting (I2 = 99.3%). RESULTS Overall, 25 studies met inclusion criteria. Seventeen studies reported age of AD onset as after 16 years of age and had sufficient data for meta-analysis. The pooled proportion (95% confidence interval) of adult-onset AD was 26.1% (16.5%-37.2%). Similar results were found in sensitivity analyses by AD diagnostic method, study region, and sex. Phenotypic differences were observed across studies for adult-onset and child-onset AD, including higher rates of foot dermatitis and personal history of atopy but lower rates of flexural lesions and other signs and symptoms. LIMITATIONS Characteristics of adult-onset versus child-onset AD were not commonly reported. CONCLUSION AD is not only a disease of childhood; 1 in 4 adults with AD report adult-onset disease, which has distinct clinical characteristics as compared to child-onset AD.
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Affiliation(s)
- Harrison H Lee
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kevin R Patel
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Vivek Singam
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Supriya Rastogi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois.
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Banihani SA, Abu-Alia KF, Khabour OF, Alzoubi KH. Association between Resistin Gene Polymorphisms and Atopic Dermatitis. Biomolecules 2018; 8:biom8020017. [PMID: 29584687 PMCID: PMC6023010 DOI: 10.3390/biom8020017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 03/22/2018] [Accepted: 03/23/2018] [Indexed: 11/22/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic, relapsing, and inflammatory skin disorder. It is characterized by an inappropriate skin barrier function, allergen sensitization, and recurrent skin infections. Resistin is an adipokine expressed mainly in macrophages and monocytes; it has a role in the inflammatory process and is associated with multiple inflammatory human diseases; however, only few studies linked resistin to atopic dermatitis. This study tested the association between G>A (rs3745367) and C>T (rs3219177) single nucleotide polymorphisms (SNPs) of the RETN gene with atopic dermatitis. In addition, it explored the relationship between serum resistin protein and atopic dermatitis. To achieve objectives of this study, 162 atopic dermatitis patients and 161 healthy participants were recruited in the study. A significant association was detected between rs3745367 and atopic dermatitis with age and gender specificity (p < 0.05), while no significant association between rs3219177 and atopic dermatitis was found (p > 0.05). For the serum resistin levels, a significant decrease was indicated in atopic dermatitis patients compared to healthy subjects (p < 0.05). In conclusion, rs3745367 may play a gender and age-specific role in atopic dermatitis. In addition, the significant decrease in the resistin protein level confirmed this association.
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Affiliation(s)
- Saleem A Banihani
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Khawla F Abu-Alia
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Omar F Khabour
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan.
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Pandey M, Choudhury H, Gunasegaran TAP, Nathan SS, Md S, Gorain B, Tripathy M, Hussain Z. Hyaluronic acid-modified betamethasone encapsulated polymeric nanoparticles: fabrication, characterisation, in vitro release kinetics, and dermal targeting. Drug Deliv Transl Res 2018; 9:520-533. [DOI: 10.1007/s13346-018-0480-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Botteman MF, Bhanegaonkar AJ, Horodniceanu EG, Ji X, Lee BW, Shek LP, Van Bever HP, Detzel P. Economic value of using partially hydrolysed infant formula for risk reduction of atopic dermatitis in high-risk, not exclusively breastfed infants in Singapore. Singapore Med J 2017; 59:439-448. [PMID: 29214323 DOI: 10.11622/smedj.2017113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Previous trials have demonstrated reductions in atopic dermatitis (AD) incidence when healthy, high-risk, non-exclusively breastfed infants were fed until four months of age with 100% whey-based partially hydrolysed formula (PHF-W) versus standard cow's milk formula (CMF). We assessed the cost-effectiveness of this intervention in Singapore. METHODS Modelling techniques were used to simulate, from birth to Month 30, the incidence and clinical/economic burden of AD in high-risk, non-exclusively breastfed infants fed with PHF-W or CMF for up to four months. Epidemiologic and clinical data were from a local comparative trial. Expert opinion informed AD treatment patterns and outcomes. Outcomes included reduction in AD risk, time spent with AD, days without AD flare, quality-adjusted life years (QALYs) and direct/indirect costs. Multivariate probabilistic sensitivity analysis was used to assess model parameter uncertainty. RESULTS Over 30 months, with the use of PHF-W instead of CMF, the proportion of children who developed AD and the time spent with AD decreased by 16.0% (28.3% vs. 44.3%) and 6.4 months, respectively, while time without AD flare and QALYs increased by 14.9 days and 0.021 QALYs per patient, respectively. Estimated AD-related discounted costs per child for PHF-W and CMF were SGD 771 and SGD 1,309, respectively (net savings: SGD 538). PHF-W was less expensive and more effective than CMF for 73%, and cost less than SGD 50,000 per QALY for 87% of all multivariate simulations. CONCLUSION Early short-term nutritional intervention with PHF-W instead of CMF may reduce AD incidence and costs for healthy, high-risk, non-exclusively breastfed infants in Singapore.
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Affiliation(s)
| | | | | | - Xiang Ji
- Pharmerit International, Bethesda, Maryland, USA
| | - Bee Wah Lee
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Lynette P Shek
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Hugo Ps Van Bever
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
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Cheok S, Yee F, Song Ma JY, Leow R, Ho MSL, Yew YW, Tay YK, Rebello SA, Luo N, Koh MJA. Prevalence and descriptive epidemiology of atopic dermatitis and its impact on quality of life in Singapore. Br J Dermatol 2017; 178:276-277. [PMID: 28415136 DOI: 10.1111/bjd.15587] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Cheok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - F Yee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - J Y Song Ma
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - R Leow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Y W Yew
- National Skin Center, Singapore
| | - Y K Tay
- Dermatology Department, Changi General Hospital, Singapore
| | - S A Rebello
- Saw Swee Hock School of Public Health, Singapore
| | - N Luo
- Saw Swee Hock School of Public Health, Singapore
| | - M J A Koh
- Dermatology Service, KK Women's & Children's Hospital, Singapore
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Hussain Z, Thu HE, Shuid AN, Kesharwani P, Khan S, Hussain F. Phytotherapeutic potential of natural herbal medicines for the treatment of mild-to-severe atopic dermatitis: A review of human clinical studies. Biomed Pharmacother 2017; 93:596-608. [DOI: 10.1016/j.biopha.2017.06.087] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 06/18/2017] [Accepted: 06/23/2017] [Indexed: 02/07/2023] Open
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Ng MSY, Tan S, Chan NHQ, Foong AYW, Koh MJA. Effect of atopic dermatitis on quality of life and its psychosocial impact in Asian adolescents. Australas J Dermatol 2017; 59:e114-e117. [DOI: 10.1111/ajd.12632] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 01/07/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Michelle SY Ng
- Dermatology Service; KK Women's and Children's Hospital; Singapore City Singapore
| | - Shiyun Tan
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore City Singapore
| | - Nicole HQ Chan
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore City Singapore
| | - Alice YW Foong
- Dermatology Service; KK Women's and Children's Hospital; Singapore City Singapore
| | - Mark JA Koh
- Dermatology Service; KK Women's and Children's Hospital; Singapore City Singapore
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Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disorder with significant morbidity and quality-of-life impairment. The epidemiology of AD is complex and challenging to study. The 1-year US prevalence of AD was 12.98% in children in 2007-2008 and 7.2%-10.2% in adults in 2010-2012. There is considerable statewide and countrywide variation of AD prevalence and severity. The prevalence of childhood AD dramatically increased over the past few decades but may be leveling off in developed nations. AD is associated with increased direct and indirect costs to payers and patients, thereby contributing toward a considerable public health burden.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 North Street Clair Street, Suite 1600, Chicago, IL 60611, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Kim YJ, Yun SJ, Lee JB, Kim SJ, Won YH, Lee SC. Four Years Prospective Study of Natural History of Atopic Dermatitis Aged 7~8 Years at an Individual Level: A Community-Based Survey by Dermatologists' Skin Examination in Childhood. Ann Dermatol 2016; 28:684-689. [PMID: 27904266 PMCID: PMC5125948 DOI: 10.5021/ad.2016.28.6.684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/11/2016] [Accepted: 02/29/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The age-dependent change in atopic dermatitis (AD) at an individual level has mostly performed in a hospital-setting. OBJECTIVE We evaluated the age-dependent change of AD symptoms at an individual level in a community-setting. METHODS For the diagnostic accuracy, all participants of schoolchildren were received skin examination by dermatologists (twice a year for the same group), instead of questionnaire-based surveys. For this study, sequential check-ups of 273 elementary school children, aged 7~8 years, were performed for 4 years up to the age of 10~11 years. RESULTS Among the 47 AD children, who had been diagnosed as having AD at the first-year check-up, spontaneous remission was detected in nine children during the follow-up periods (remission rate of 19.1%). As a consequence, the one-year AD prevalence was decreased by 5.9% in the elementary schoolchildren over four years. Unexpectedly, late onset (after 8 years of age) AD was observed in 21.7% of AD children. There was no statistically significant relationship between spontaneous remission and host factors including sex and family history of atopic diseases. CONCLUSION We observed that 19.1% of AD children in the age group of 7~11 years showed spontaneous remission based on skin examination by dermatologists. There might be an increase in the prevalence of late onset AD in Korea.
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Affiliation(s)
- Young Jee Kim
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Jee-Bum Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Jin Kim
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Young Ho Won
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung-Chul Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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Drug nanocarrier, the future of atopic diseases: Advanced drug delivery systems and smart management of disease. Colloids Surf B Biointerfaces 2016; 147:475-491. [DOI: 10.1016/j.colsurfb.2016.08.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 12/14/2022]
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Molecular Mechanisms of Cutaneous Inflammatory Disorder: Atopic Dermatitis. Int J Mol Sci 2016; 17:ijms17081234. [PMID: 27483258 PMCID: PMC5000632 DOI: 10.3390/ijms17081234] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 02/06/2023] Open
Abstract
Atopic dermatitis (AD) is a multifactorial inflammatory skin disease resulting from interactions between genetic susceptibility and environmental factors. The pathogenesis of AD is poorly understood, and the treatment of recalcitrant AD is still challenging. There is accumulating evidence for new gene polymorphisms related to the epidermal barrier function and innate and adaptive immunity in patients with AD. Newly-found T cells and dendritic cell subsets, cytokines, chemokines and signaling pathways have extended our understanding of the molecular pathomechanism underlying AD. Genetic changes caused by environmental factors have been shown to contribute to the pathogenesis of AD. We herein present a review of the genetics, epigenetics, barrier dysfunction and immunological abnormalities in AD with a focus on updated molecular biology.
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Kantor R, Silverberg JI. Environmental risk factors and their role in the management of atopic dermatitis. Expert Rev Clin Immunol 2016; 13:15-26. [PMID: 27417220 DOI: 10.1080/1744666x.2016.1212660] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors. Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on AD. Expert commentary: The increased global prevalence of AD cannot be attributed to genetics alone, suggesting that evolving environmental exposures may trigger and/or flare disease in predisposed individuals. There is a complex interplay between different environmental factors, including individual use of personal care products and exposure to climate, pollution, food and other exogenous factors. Understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions. Moreover, patients require counseling on optimal regimens for minimization of exposure to irritants and pruritogens and other harmful exposures.
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Affiliation(s)
- Robert Kantor
- a Department of Dermatology , Northwestern University , Chicago , IL , USA
| | - Jonathan I Silverberg
- b Departments of Dermatology, Preventive Medicine and Medical Social Sciences , Northwestern University , Chicago , IL , USA
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Chng KR, Tay ASL, Li C, Ng AHQ, Wang J, Suri BK, Matta SA, McGovern N, Janela B, Wong XFCC, Sio YY, Au BV, Wilm A, De Sessions PF, Lim TC, Tang MBY, Ginhoux F, Connolly JE, Lane EB, Chew FT, Common JEA, Nagarajan N. Whole metagenome profiling reveals skin microbiome-dependent susceptibility to atopic dermatitis flare. Nat Microbiol 2016; 1:16106. [PMID: 27562258 DOI: 10.1038/nmicrobiol.2016.106] [Citation(s) in RCA: 236] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 06/01/2016] [Indexed: 12/19/2022]
Abstract
Whole metagenome analysis has the potential to reveal functional triggers of skin diseases, but issues of cost, robustness and sampling efficacy have limited its application. Here, we have established an alternative, clinically practical and robust metagenomic analysis protocol and applied it to 80 skin microbiome samples epidemiologically stratified for atopic dermatitis (AD). We have identified distinct non-flare, baseline skin microbiome signatures enriched for Streptococcus and Gemella but depleted for Dermacoccus in AD-prone versus normal healthy skin. Bacterial challenge assays using keratinocytes and monocyte-derived dendritic cells established distinct IL-1-mediated, innate and Th1-mediated adaptive immune responses with Staphylococcus aureus and Staphylococcus epidermidis. Bacterial differences were complemented by perturbations in the eukaryotic community and functional shifts in the microbiome-wide gene repertoire, which could exacerbate a dry and alkaline phenotype primed for pathogen growth and inflammation in AD-susceptible skin. These findings provide insights into how the skin microbial community, skin surface microenvironment and immune system cross-modulate each other, escalating the destructive feedback cycle between them that leads to AD flare.
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Affiliation(s)
- Kern Rei Chng
- Genome Institute of Singapore, Singapore 138672, Singapore
| | | | - Chenhao Li
- Genome Institute of Singapore, Singapore 138672, Singapore
| | | | - Jingjing Wang
- Institute of Molecular and Cell Biology, Singapore 138673, Singapore.,Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, China.,Institute of Biomedical Studies, Baylor University, Waco, Texas 76798, USA
| | - Bani Kaur Suri
- Department of Biological Sciences, National University of Singapore, Singapore 117543
| | - Sri Anusha Matta
- Department of Biological Sciences, National University of Singapore, Singapore 117543
| | - Naomi McGovern
- Singapore Immunology Network, Singapore 138648, Singapore
| | | | | | - Yang Yie Sio
- Department of Biological Sciences, National University of Singapore, Singapore 117543
| | - Bijin Veonice Au
- Institute of Molecular and Cell Biology, Singapore 138673, Singapore
| | - Andreas Wilm
- Genome Institute of Singapore, Singapore 138672, Singapore
| | | | - Thiam Chye Lim
- Division of Plastic, Reconstructive &Aesthetic Surgery, National University Health System, Singapore 119074, Singapore
| | | | | | - John E Connolly
- Institute of Molecular and Cell Biology, Singapore 138673, Singapore.,Institute of Biomedical Studies, Baylor University, Waco, Texas 76798, USA.,Department of Microbiology and Immunology, National University of Singapore, Singapore 117545, Singapore
| | | | - Fook Tim Chew
- Department of Biological Sciences, National University of Singapore, Singapore 117543
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Silverberg JI, Song J, Pinto D, Yu SH, Gilbert AL, Dunlop DD, Chang RW. Atopic Dermatitis Is Associated with Less Physical Activity in US Adults. J Invest Dermatol 2016; 136:1714-1716. [PMID: 27189827 DOI: 10.1016/j.jid.2016.04.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Jonathan I Silverberg
- Departments of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Jing Song
- Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel Pinto
- Department of Rehabilitation and Physical Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sherry H Yu
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Abigail L Gilbert
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dorothy D Dunlop
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rowland W Chang
- Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Rehabilitation and Physical Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Kim G, Bae JH. Vitamin D and atopic dermatitis: A systematic review and meta-analysis. Nutrition 2016; 32:913-20. [PMID: 27061361 DOI: 10.1016/j.nut.2016.01.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/26/2016] [Accepted: 01/29/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Despite the evidence supporting the use of vitamin D supplements for managing atopic dermatitis (AD), no meta-analysis providing definite conclusions in this field has been reported. The purpose of the present study was to conduct a systematic review and meta-analysis of all controlled studies of vitamin D for treating AD to elucidate the efficacy of vitamin D for alleviating the symptoms of AD. METHODS Literature searches were conducted using Ovid-MEDLINE, EMBASE, Web of Science, Cochrane Library, and Korean and Chinese databases. Search terms used were "vitamin D", "atopic dermatitis", "randomized", "controlled trial", and "clinical trial". Random effects models were used to calculate the mean difference, with 95% confidence intervals to analyze the effects of vitamin D supplementation for severity of AD. RESULTS Initial searches yielded 266 citations. Of these original results, nine met specific selection criteria. Four of the randomized controlled trials compared the efficacy of vitamin D with a placebo on severity of AD and were included in the meta-analysis. The vitamin D supplementation interventions showed a higher mean difference in severity of AD symptoms (mean difference = -5.81, 95% CI: -9.03 to -2.59, P = 0.0004, I(2) = 50%). CONCLUSIONS Vitamin D has a potentially significant role for improving the symptoms of AD. The results from this study suggest that vitamin D supplementation may help ameliorate the severity of AD, and can be considered as a safe and tolerable therapy. However, larger-scale studies over a longer duration of treatment are needed to confirm this conclusion.
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Affiliation(s)
- Gaeun Kim
- Department of Nursing, Keimyung University, Daegu, South Korea
| | - Ji-Hyun Bae
- Department of Food Science and Nutrition, Keimyung University, Daegu, South Korea.
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Lee XHM, Ong LX, Cheong JYV, Sultana R, Rao R, Lim HH, Ding XM, Loh WY, Punan M, Chiang WC. A stepwise approach in the management of chronic spontaneous urticaria in children. Asia Pac Allergy 2016; 6:16-28. [PMID: 26844216 PMCID: PMC4731476 DOI: 10.5415/apallergy.2016.6.1.16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/19/2016] [Indexed: 12/03/2022] Open
Abstract
Background There is limited literature in the management of chronic urticaria in children. Treatment algorithms are generally extrapolated from adult studies. Objective Utility of a weight and age-based algorithm for antihistamines in management of chronic spontaneous urticaria (CSU) in childhood. To document associated factors that predict for step of control of CSU and time taken to attain control of symptoms in children. Methods A workgroup comprising of allergists, nurses, and pharmacists convened to develop a stepwise treatment algorithm in management of children with CSU. Sequential patients presenting to the paediatric allergy service with CSU were included in this observational, prospective study. Results Ninety-eight patients were recruited from September 2012 to September 2013. Majority were male, Chinese with median age 4 years 7 months. A third of patients with CSU had a family history of acute urticaria. Ten point two percent had previously resolved CSU, 25.5% had associated angioedema, and 53.1% had a history of atopy. A total of 96.9% of patients achieved control of symptoms, of which 91.8% achieved control with cetirizine. Fifty percent of all the patients were controlled on step 2 or higher. Forty-seven point eight percent of those on step 2 or higher were between 2 to 6 years of age compared to 32.6% and 19.6% who were 6 years and older and lesser than 2 years of age respectively. Eighty percent of those with previously resolved CSU required an increase to step 2 and above to achieve chronic urticaria control. Conclusion We propose a weight- and age-based titration algorithm for different antihistamines for CSU in children using a stepwise approach to achieve control. This algorithm may improve the management and safety profile for paediatric CSU patients and allow for review in a more systematic manner for physicians dealing with CSU in children.
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Affiliation(s)
- Xin Hui Magdeline Lee
- Pharmacy Department, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
| | - Lin Xin Ong
- Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
| | - Jing Yi Vanessa Cheong
- Pharmacy Department, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
| | - Rehena Sultana
- Duke-NUS Graduate Medical School Singapore, Singapore 169857, Singapore
| | - Rajeshwar Rao
- Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
| | - Hwee Hoon Lim
- Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
| | - Xiao Mei Ding
- Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
| | - Wen Yin Loh
- Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
| | - Monika Punan
- Pharmacy Department, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
| | - Wen Chin Chiang
- Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
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Wei CC, Lin CL, Shen TC, Li TC, Chen AC. Atopic Dermatitis and Association of Risk for Henoch-Schönlein Purpura (IgA Vasculitis) and Renal Involvement Among Children: Results From a Population-Based Cohort Study in Taiwan. Medicine (Baltimore) 2016; 95:e2586. [PMID: 26817917 PMCID: PMC4998291 DOI: 10.1097/md.0000000000002586] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Elevation of Th2 cytokine-driven inflammatory mediators has been reported in acute stage of Henoch-Schönlein purpura (HSP). However, the temporal interaction between Th2-mediated allergic diseases and HSP with renal involvement remains unknown. Herein, we conducted a population-based cohort analysis to investigate the risk of HSP and renal involvement in children with atopic dermatitis (AD) as 1 of the first steps in the atopic march.From 2000 to 2007, 95,208 children with newly diagnosed AD and 190,416 randomly selected non-AD controls were included in the study. By the end of 2008, incidences of HSP in both cohorts and the AD cohort to non-AD cohort hazard ratios (HRs) and confidence intervals (CIs) were measured. Comparison of renal involvement in HSP between children with and without AD was analyzed.The incidence of HSP during the study period was 1.75-fold greater (95% CI: 1.27-2.42) in the AD cohort than in the non-AD cohort (14.2 vs 8.11 per 100,000 person-years). The AD to non-AD HR of HSP was greater for girls (1.92, 95% CI: 1.18-3.13), children older than 6 years (2.54, 95% CI: 1.15-5.59), and those living in less urbanized area (2.74, 95% CI: 1.10-6.82). Concurrent allergic rhinitis or asthma did not increase the HR of HSP further. The HR for HSP in AD children increased from 0.67 (95% CI: 0.41-1.11) for those with ≤2 AD-related visits to 9.77 (95% CI: 6.44-14.8) for those with >4 visits (P < 0.0001, by the trend test). The risk of developing HSP in the AD cohort was highest within first year after AD diagnosis (HR: 3.99; 95% CI: 1.61-9.89). AD cohort with HSP had higher occurrence rate of renal involvement, particular hematuria, than non-AD cohort with HSP.AD children had a greater risk of developing HSP and HSP with renal involvement. Further research is needed to clarify the role of allergy in the pathogenesis of HSP and renal involvement.
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Affiliation(s)
- Chang-Ching Wei
- From the Children's Hospital (C-CW, A-CC), Management Office for Health Data (C-LL), and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (T-CS), China Medical University Hospital, Taichung, Taiwan; and School of Medicine (C-CW, T-CS, A-CC) and Department of Public Health (C-LL, T-CL), China Medical University, Taichung, Taiwan
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Silverberg JI. Association between adult atopic dermatitis, cardiovascular disease, and increased heart attacks in three population-based studies. Allergy 2015; 70:1300-8. [PMID: 26148129 DOI: 10.1111/all.12685] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Adults with eczema are more likely to smoke cigarettes, consume alcohol, and have sedentary lifestyle. We sought to determine whether adult eczema is associated with increased cardiovascular and cerebrovascular disease. METHODS Data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) (n = 4970) and 2010 (n = 27 157) and 2012 (n = 34 525) National Health Interview Survey (NHIS). History of coronary artery disease (CAD), angina, heart attack, stroke, and peripheral vascular disease (PVD) were determined. RESULTS In NHANES, flexural eczema in the past year was associated with significantly higher odds of CAD (P ≤ 0.04), heart attack (P ≤ 0.01), and congestive heart failure (P ≤ 0.02), but not with stroke (P ≥ 0.37), in survey-weighted multivariate logistic regression models that controlled for socio-demographics, comorbid asthma, and hay fever. Similarly, in NHIS 2010 and 2012, 1-year history of eczema was associated with significantly higher odds of CAD (P ≤ 0.02), angina (P ≤ 0.02), heart attack (P ≤ 0.047), other heart disease (P < 0.0001), stroke (P ≤ 0.02), and PVD (<0.0001) in multivariate models. CONCLUSIONS Adults with atopic dermatitis may have increased cardiovascular disease, heart attack, and stroke.
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Affiliation(s)
- 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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Lee JH, Han KD, Kim KM, Park YG, Lee JY, Park YM. Prevalence of Atopic Dermatitis in Korean Children Based on Data From the 2008-2011 Korean National Health and Nutrition Examination Survey. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2015; 8:79-83. [PMID: 26540505 PMCID: PMC4695412 DOI: 10.4168/aair.2016.8.1.79] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 04/20/2015] [Accepted: 05/21/2015] [Indexed: 11/20/2022]
Abstract
Population-based studies of atopic dermatitis (AD) in Korean children are lacking. Thus, the purpose of this study was to determine the prevalence, geographic distribution, and risk factors of AD in the Korean pediatric population. We examined AD prevalence using data from the 2008-2011 Korea National Health and Nutrition Examination Survey (KNHANES), which was a cross-sectional survey of 8,947 children up to age 18 throughout the country. Overall, 13.50% of children reported a diagnosis of AD. The age-standardized prevalence ranged from 9.13% to 17.67% between cities and provinces, with the highest prevalence-observed in many of the larger cities at low latitudes, as well as Jeju-do. After adjusting for confounders, high economic status was found to be a significant factor for predicting increased prevalence of AD, with an odds ratio of 1.35 (95% confidence interval of 1.02-1.79, P=0.0034). Urban living (odds ratio 1.24, 95% confidence interval of 1.00-1.53, P=0.0526) was also associated with a higher prevalence of AD. In this first large scale, nationwide study in Korean children, we found that the overall prevalence of AD depends on age, household income, and geographic distribution.
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Affiliation(s)
- Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Min Kim
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Young Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Min Park
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Shadi TZ, Talal AZ. A review of four common medicinal plants used to treat eczema. ACTA ACUST UNITED AC 2015. [DOI: 10.5897/jmpr2015.5831] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Lee BW, Detzel PR. Treatment of Childhood Atopic Dermatitis and Economic Burden of Illness in Asia Pacific Countries. ANNALS OF NUTRITION AND METABOLISM 2015; 66 Suppl 1:18-24. [DOI: 10.1159/000370221] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin condition in children. In Asia, the prevalence of AD is increasing, which is largely attributed to environmental and socioeconomic factors including family income, parental education, lifestyle and metropolitan living. Current clinical guidelines recommend a stepped approach in the management of eczema in children, with treatment steps tailored to the severity of the eczema. To address the skin barrier dysfunction, skin hydration and the application of emollients is essential. There is evidence supporting the use of bleach baths as an antimicrobial therapy against Staphylococcus aureus. In patients in whom topical treatment fails, wet wrap therapy may be considered as a treatment option before considering systemic therapies. In the second part of this article, the economic burden of AD is addressed. AD not only negatively impacts the child's quality of life but also that of the whole family and is associated with a burden on health-care costs and society. AD in an infant will lead to frequent additional visits to the pediatrician, to additional and partially expensive treatment costs and, in rare cases, to hospitalization. It is thus of utmost importance to define efficient strategies to not only treat AD but also to decrease the risk of developing the disease.
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Botteman M, Detzel P. Cost-effectiveness of partially hydrolyzed whey protein formula in the primary prevention of atopic dermatitis in high-risk urban infants in Southeast Asia. ANNALS OF NUTRITION AND METABOLISM 2015; 66 Suppl 1:26-32. [PMID: 25925338 DOI: 10.1159/000370222] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is one of the most common skin conditions among infants. Proteins found in cow's milk formula (CMF) have been found to be attributable to heightened AD risk, particularly in infants with familial AD heredity. Previous studies have suggested that intervention with partially hydrolyzed formula in nonexclusively breastfed infants can have a protective effect against AD development. OBJECTIVE The aim of the present study was to compare the estimates of the economic impact of reducing the AD incidence by feeding a partially hydrolyzed whey-based formula (PHF-W) instead of a standard CMF to high-risk nonexclusively breastfed urban infants for the first 17 weeks of life in the Philippines, Malaysia, and Singapore. METHODS In each country, a mathematical model simulated AD incidence and burden from birth to 6 years of age of using PHF-W versus CMF in the target population using data from the German Infant Nutritional Intervention study. The models integrated literature, current cost and market data, and expert clinician opinion. Modeled outcomes included AD risk reduction, time spent after AD diagnosis, AD symptom-free days, quality-adjusted life years (QALYs), and costs (direct and indirect). Outcomes were discounted at 3% per year. Costs were expressed in USD. RESULTS Feeding high-risk infants PHF-W instead of CMF resulted in an estimated absolute 14% (95% CI 1-24) AD risk reduction, a 0.69-year (95% CI 0.25-1.13) reduction in the time spent after AD diagnosis per child, reductions of 16-38 AD days, and gains in 0.02-0.04 QALYs, depending on the country. The per-child AD-related 6-year cost-saving estimates of feeding high-risk infants with PHF-W versus CMF were USD 739 in Singapore, USD 372 in Malaysia, and USD 237 in the Philippines.
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Silverberg JI, Greenland P. Eczema and cardiovascular risk factors in 2 US adult population studies. J Allergy Clin Immunol 2015; 135:721-8.e6. [PMID: 25579484 DOI: 10.1016/j.jaci.2014.11.023] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 10/24/2014] [Accepted: 11/11/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Eczema is associated with high rates of sleep disturbance and quality-of-life impairment. These factors might have a negative impact on psychosocial development and behavior and could increase cardiovascular risk. OBJECTIVE We sought to determine whether adults with eczema have increased cardiovascular risk factors. METHODS We analyzed data for 27,157 and 34,525 adults aged 18 to 85 years from the 2010 and 2012 National Health Interview Survey. RESULTS Adults with eczema had higher odds of ever smoking 100 cigarettes in their lifetime (survey logistic regression; adjusted odds ratio [aOR], 1.32; 95% CI, 1.18-1.47) and current smoking history (aOR, 1.28; 95% CI, 1.12-1.45), with significantly younger age of onset (survey linear regression; adjusted β, -0.58; 95% CI, -0.95 to -0.21). Eczema was also associated with greater odds of ever drinking 12 or more alcoholic beverages annually (aOR, 1.16; 95% CI, 1.03-1.31), including current intake of moderate (aOR, 1.33; 95% CI, 1.09-1.62) and heavier (aOR, 1.58; 95% CI, 1.23-2.03) amounts. Adults with a history of eczema had lower odds of daily vigorous activity (aOR, 0.79; 95% CI, 0.63-0.99) and lower frequency of vigorous activity in the past week (adjusted β, -0.46; 95% CI, -0.72 to -0.21) than did adults without a history of eczema. Those with eczema had a higher body mass index than did those without eczema (adjusted β, 0.86; 95% CI, 0.37-1.36), particularly a body mass index of 35 or more (aOR, 1.54; 95% CI, 1.16-2.05), and higher odds of hypertension (aOR, 1.48; 95% CI, 1.18-1.85), hypertension on 2 visits (aOR, 1.56; 1.22-1.99), and lifetime prediabetes (aOR, 1.71; 95% CI, 1.19-2.45). Finally, there were significant interactions between eczema and sleep disturbances such that eczema associated with fatigue, daytime sleepiness, or insomnia was associated with even higher odds of obesity, hypertension, hypertension on 2 visits, prediabetes, diabetes, and high cholesterol than eczema alone. CONCLUSIONS We found that eczema in adults is a marker for cardiovascular risk, emphasizing the importance of behavioral modification and perhaps more aggressive interventions to better manage eczema.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, Preventive Medicine, and Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, Ill.
| | - Philip Greenland
- Department of Preventive Medicine and Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Ill
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Abstract
Atopic dermatitis (AD) or eczema is a chronic inflammatory skin disorder with significant morbidity and quality of life impairment. Elucidating the epidemiology of AD is important for understanding disease risk factors and facilitates development of interventions for disease prevention. This contribution aims to summarize recent developments in the epidemiology of AD, including the US prevalence, regional differences, and secular trends of disease prevalence, genetic and environmental determinants, distribution, and determinants of disease severity and health care use for AD.
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