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Shortt G, Shortt N, Bird G, Kerse K, Lieffering N, Martin A, Eathorne A, Black B, Kim B, Rademaker M, Reiche L, Paa ST, Harding S, Armour M, Semprini A. Mānuka oil based ECMT-154 versus vehicle control for the topical treatment of eczema: study protocol for a randomised controlled trial in community pharmacies in Aotearoa New Zealand. BMC Complement Med Ther 2024; 24:61. [PMID: 38287323 PMCID: PMC10823637 DOI: 10.1186/s12906-024-04358-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 01/14/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Eczema is a chronic, relapsing skin condition commonly managed by emollients and topical corticosteroids. Prevalence of use and demand for effective botanical therapies for eczema is high worldwide, however, clinical evidence of benefit is limited for many currently available botanical treatment options. Robustly-designed and adequately powered randomised controlled trials (RCTs) are essential to determine evidence of clinical benefit. This protocol describes an RCT that aims to investigate whether a mānuka oil based emollient cream, containing 2% ECMT-154, is a safe and effective topical treatment for moderate to severe eczema. METHODS This multicentre, single-blind, parallel-group, randomised controlled trial aims to recruit 118 participants from community pharmacies in Aotearoa New Zealand. Participants will be randomised 1:1 to receive topical cream with 2% ECMT-154 or vehicle control, and will apply assigned treatment twice daily to affected areas for six weeks. The primary outcome is improvement in subjective symptoms, assessed by change in POEM score. Secondary outcomes include change in objective symptoms assessed by SCORAD (part B), PO-SCORAD, DLQI, and treatment acceptability assessed by TSQM II and NRS. DISCUSSION Recruitment through community pharmacies commenced in January 2022 and follow up will be completed by mid-2023. This study aims to collect acceptability and efficacy data of mānuka oil based ECMT-154 for the treatment of eczema. If efficacy is demonstrated, this topical may provide an option for a novel emollient treatment. The community-based design of the trial is anticipated to provide a generalisable result. ETHICS AND DISSEMINATION Ethics approval was obtained from Central Health and Disability Ethics Committee (reference: 2021 EXP 11490). Findings of the study will be disseminated to study participants, published in peer-reviewed journal and presented at scientific conferences. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001096842. Registered on August 18, 2021 ( https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382412&isReview=true ). PROTOCOL VERSION 2.1 (Dated 18/05/2022).
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Affiliation(s)
- Gabrielle Shortt
- Medical Research Institute of New Zealand, Wellington, Aotearoa, New Zealand.
- Victoria University of Wellington, Wellington, Aotearoa, New Zealand.
| | - Nicholas Shortt
- Medical Research Institute of New Zealand, Wellington, Aotearoa, New Zealand
- Victoria University of Wellington, Wellington, Aotearoa, New Zealand
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Georgina Bird
- Medical Research Institute of New Zealand, Wellington, Aotearoa, New Zealand
| | - Kyley Kerse
- Medical Research Institute of New Zealand, Wellington, Aotearoa, New Zealand
| | - Nico Lieffering
- Medical Research Institute of New Zealand, Wellington, Aotearoa, New Zealand
| | - Alexander Martin
- Medical Research Institute of New Zealand, Wellington, Aotearoa, New Zealand
- Victoria University of Wellington, Wellington, Aotearoa, New Zealand
| | - Allie Eathorne
- Medical Research Institute of New Zealand, Wellington, Aotearoa, New Zealand
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Bianca Black
- Medical Research Institute of New Zealand, Wellington, Aotearoa, New Zealand
| | - Bob Kim
- Anderson's Exchange Pharmacy, Dunedin, Aotearoa, New Zealand
| | - Marius Rademaker
- Waikato Clinical Campus, University of Auckland, Hamilton, Aotearoa, New Zealand
- New Zealand Dermatology Research Trust, Palmerston North, Aotearoa, New Zealand
| | - Louise Reiche
- New Zealand Dermatological Society Inc, Palmerston North, Aotearoa, New Zealand
- New Zealand Dermatology Research Trust, Palmerston North, Aotearoa, New Zealand
| | - Selwyn Te Paa
- Medical Research Institute of New Zealand, Wellington, Aotearoa, New Zealand
- University of Otago, Wellington, Aotearoa, New Zealand
| | - Suki Harding
- Manuka Bioscience Ltd, Auckland, Aotearoa, New Zealand
| | - Mike Armour
- Medical Research Institute of New Zealand, Wellington, Aotearoa, New Zealand
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Alex Semprini
- Medical Research Institute of New Zealand, Wellington, Aotearoa, New Zealand
- Victoria University of Wellington, Wellington, Aotearoa, New Zealand
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
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Gochnauer H, Valdes-Rodriguez R, Cardwell L, Anolik RB. The Psychosocial Impact of Atopic Dermatitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1447:69-81. [PMID: 38724785 DOI: 10.1007/978-3-031-54513-9_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Atopic dermatitis is a chronic skin condition that has significant psychosocial and quality-of-life impact. The condition causes physical discomfort, emotional distress, embarrassment, social stigma, and daily activity limitation. In an effort to assess these aspects of disease burden, quality-of-life measurement tools were developed. Through use of these tools, we have expanded our knowledge of the psychosocial and quality-of-life burden of this condition. A variety of quality of assessment tools exist, yet there is no consensus on which tool is best suited to assess the quality-of-life impact of atopic dermatitis. Research studies assessing quality-of-life in atopic dermatitis patients utilize a variety of quality-of-life measurement tools; this complicates comparisons across research studies. Though comparison across studies is difficult, the data echoes tremendous overall burden of disease, especially pertaining to psychosocial status and life quality.
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Affiliation(s)
- Heather Gochnauer
- Department of Dermatology, Temple University Lewis Katz School of Medicine and Section of Dermatology, Reading Health System, Philadelphia, PA, USA
| | - Rodrigo Valdes-Rodriguez
- Department of Dermatology, Temple University Lewis Katz School of Medicine and Section of Dermatology, Reading Health System, Philadelphia, PA, USA
| | - Leah Cardwell
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rachel B Anolik
- Department of Dermatology, Temple University Lewis Katz School of Medicine and Section of Dermatology, Reading Health System, Philadelphia, PA, USA
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Adamson AS. The Economic Impact of Atopic Dermatitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1447:91-104. [PMID: 38724787 DOI: 10.1007/978-3-031-54513-9_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disorder that affects over 30 million people in the United States. Given the large and growing prevalence of AD, the associated economic burden is significant. It has been estimated that AD costs over $5 billion dollars annually. These costs include both direct and indirect costs. Direct costs include prescription medicines, visits to health-care providers, hospitalizations, and transportation. Indirect costs include missed days or lost productivity at work or school, career modification, and reduced quality of life. Understanding and measuring these costs can be accomplished through rigorous economic evaluation, which is the organized process of considering inputs and outcomes of various activities. Economic evaluation has been used to contextualize the burden of AD in society. It has also been used to inform patients, providers, and other stakeholders on how to deliver the most evidence-based, efficient way possible. Understanding the economic impact of atopic dermatitis is an important aspect of delivering high-quality care.
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Affiliation(s)
- Adewole S Adamson
- University of North Carolina Hospitals, Department of Dermatology, Chapel Hill, NC, USA
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Penton H, Jayade S, Selveindran S, Heisen M, Piketty C, Ulianov L, Jabbar-Lopez ZK, Silverberg JI, Puelles J. Assessing Response in Atopic Dermatitis: A Systematic Review of the Psychometric Performance of Measures Used in HTAs and Clinical Trials. Dermatol Ther (Heidelb) 2023; 13:2549-2571. [PMID: 37747670 PMCID: PMC10613159 DOI: 10.1007/s13555-023-01038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION Assessing treatment response is key to determining treatment value in atopic dermatitis (AD). Currently, response is assessed using various clinician- or patient-reported measures and response criteria. This variation creates a mismatch of evidence across trials, hindering the ability of clinicians, regulators, and payers to compare the efficacy of treatments. This review identifies which measures and criteria are used to determine response in clinical trials and health technology assessments (HTAs). Moreover, it systematically reviews the psychometric performance of those measures and criteria to understand which perform best in capturing patient-relevant symptoms and treatment benefits. METHODS A scoping review of clinical trials and HTAs in AD identified the following measures for inclusion: the Eczema Area and Severity Index (EASI), the Investigator's Global Assessment (IGA), the Dermatology Life Quality Index (DLQI) and the Peak Pruritus Numerical Rating Scale (PP-NRS). A systematic search was performed in MEDLINE and Embase to identify studies testing the psychometric performance of these measures in adults or adolescents with AD. RESULTS A lack of consistency in the assessment of response was observed across clinical trials and HTAs. Important gaps in psychometric evidence were identified. No content validations of the EASI and IGA in AD were found, while some quantitative studies suggested that these measures fail to capture itch, a core symptom. The PP-NRS and DLQI performed well. No studies compared the performance of different response criteria. CONCLUSION Content validation of the PP-NRS confirmed the importance of itch as a core symptom and treatment priority in AD; however, itch is not well covered in the EASI or IGA. Including the PP-NRS in clinical trials and HTAs will better capture patient-relevant benefit and response. Although various response criteria were used, no studies compared the performance of different criteria to inform which were most appropriate to compare treatments in clinical trials and HTAs.
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Affiliation(s)
| | | | | | | | | | | | | | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Oh J, Oh HJ, Han KD, Gee HY, Lee JH. Increased Risk of Renal Malignancy in Patients with Moderate to Severe Atopic Dermatitis. Cancers (Basel) 2023; 15:5007. [PMID: 37894374 PMCID: PMC10605056 DOI: 10.3390/cancers15205007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/28/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Evidence for an association between atopic dermatitis (AD) and cancer is still insufficient. In particular, the association between the risk of renal malignancy and the severity of AD has not been thoroughly investigated. OBJECTIVE To investigate the risk of renal malignancy and determine the association between AD severity and cancer risk using data from the Korean National Health Insurance Service (KNHIS) database. METHODS We performed a population-based cohort study using the National Health Claims database from the NHIS in Korea. RESULTS We found a statistically significant association between AD and overall malignancy (for mild AD, hazard ratio (HR): 1.061, 95% confidence interval (CI): 1.006-1.118; for moderate to severe AD, HR: 1.061, 95% CI: 1.014-1.11) compared with the no AD group. The moderate to severe AD group showed a significantly increased risk for renal malignancy (adjusted HR: 1.533, 95% CI: 1.209-1.944) compared with the no AD group. LIMITATIONS Patient inclusion is solely based on diagnostic codes. We had no data about drug use, genetic factors, or other medical history that could affect the cancer risk. CONCLUSION In our large population-based cohort study, moderate to severe AD was associated with increased risk of renal malignancy. Regular check-ups for renal malignancy are recommended in this population.
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Affiliation(s)
- Jongwook Oh
- Department of Pharmacology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Medicine, Physician-Scientist Program, Yonsei University Graduate School of Medicine, Seoul 03722, Republic of Korea
| | - Hyun Ju Oh
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea
| | - Heon Yung Gee
- Department of Pharmacology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Ferreira BR, Misery L. Psychopathology Associated with Chronic Pruritus: A Systematic Review. Acta Derm Venereol 2023; 103:adv8488. [PMID: 37606153 PMCID: PMC10461306 DOI: 10.2340/actadv.v103.8488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/20/2023] [Indexed: 08/23/2023] Open
Abstract
There are no previous studies of the psychopathology associated with different aetiologies of chronic pruritus. A systematic review was performed of cohort and case-control studies comparing healthy controls with patients with chronic pruritus related to primary dermatoses, systemic diseases, psychogenic pruritus, idiopathic pruritus, prurigo nodularis and/or lichen simplex chronicus. The review was registered in PROSPERO and performed according to the PRISMA statement, which allowed the inclusion of 26 studies. The quality of eligible studies was assessed using the modified Newcastle-Ottawa Scale. Most of the studies concern primary dermatoses and systemic diseases. Sleep disorders are a common comorbidity interrelated with pruritus, anxiety and depressive symptoms, in primary dermatoses. Sleep disorders are linked with pruritus and depressive symptoms in end-stage renal disease and hepatobiliary disease. Depressive and anxiety symptoms are associated with psychogenic pruritus. Psychogenic pruritus, lichen simplex chronicus and some primary dermatoses are linked with personality characteristics. Further studies are required to explore in depth the psychopathology linked with psychogenic pruritus and prurigo nodularis, as well as psychopathology linked with other primary dermatoses and systemic disorders associated with chronic pruritus, and to better differentiate psychogenic pruritus from psychopathological characteristics linked with other aetiologies of chronic pruritus, in order to improve the management of patients with chronic pruritus.
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Affiliation(s)
- Bárbara R Ferreira
- University Brest, Laboratoire interactions épithéliums-neurones (LIEN), Brest, France.
| | - Laurent Misery
- University Brest, Laboratoire interactions épithéliums-neurones (LIEN), Brest, France
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Son SW, Lee JH, Ahn J, Chang SE, Choi EH, Han TY, Jang YH, Kim HO, Kim MB, Kim YC, Ko HC, Ko JY, Lee SE, Lee YW, Lew BL, Na CH, Park CO, Park CW, Park KY, Park K, Park YL, Roh JY, Seo YJ, Shin MK, Lee S, Cho SH. Assessment of Disease Severity and Quality of Life in Patients with Atopic Dermatitis from South Korea. Ann Dermatol 2022; 34:419-430. [PMID: 36478424 PMCID: PMC9763909 DOI: 10.5021/ad.21.239] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/22/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Data illustrating the impact of atopic dermatitis (AD) on lives of adults with AD in South Korea are limited. OBJECTIVE To assess the AD disease severity and its impact on quality of life (QoL) in patients with AD from South Korea. METHODS Patients with AD utilizing the specialist dermatology services of major hospitals in South Korea were assessed for disease severity using Eczema Area and Severity Index (EASI) score, for QoL using Dermatology Life Quality Index (DLQI) (for QoL), and for comorbidities and treatment experience via retrospective review of 12-month medical records. Clinical and sociodemographic characteristics were also measured. RESULTS Of the 1,163 patients, 695 (59.8%) were men (mean age [years]±standard deviation: 31.6±12.1). Overall, 52.9% (n=615) patients had moderate-to-severe disease (EASI>7). The QoL of 72.3% (n=840) patients was affected moderately-to-severely (DLQI score: 6~30). Systemic immunosuppressants were used ≥1 over past 12 months in 51.9% (n=603) patients, and the most commonly used were cyclosporines (45.7%, n=531) and systemic corticosteroids (40.5%, n=471). Approximately, 10.8% (n=126) patients consulted or received treatment for AD-related eye problem. Of these, 40% (n=50) patients reported poor, very poor, or completely blind status; approximately, 16.7% patients (n=192) reported having depression or anxiety; and 35.5% (n=410) reported suicidal ideation or suicidal attempt. CONCLUSION A large proportion of patients had moderate-to-severe AD, a compromised QoL, and ocular or mental health comorbidities, indicating a high disease burden despite systemic treatment. These findings highlight the importance of a holistic approach for the evaluation and treatment of patients with AD.
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Affiliation(s)
- Sang Wook Son
- Department of Dermatology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jiyoung Ahn
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology and Research Institute of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eung Ho Choi
- Department of Dermatology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Tae Young Han
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Yong Hyun Jang
- Department of Dermatology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hye One Kim
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Moon-Bum Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Korea
| | - You Chan Kim
- Department of Dermatology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Chang Ko
- Department of Dermatology, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Eun Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yang Won Lee
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Bark-Lynn Lew
- Department of Dermatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Chan Ho Na
- Department of Dermatology, Chosun University Hospital, College of Medicine, Chosun University, Gwangju, Korea
| | - Chang Ook Park
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chun Wook Park
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kun Park
- Department of Dermatology, Wonkwang University Hospital, Iksan, Korea
| | - Young Lip Park
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Joo Young Roh
- Department of Dermatology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Young-Joon Seo
- Department of Dermatology, Chungnam National University Hospital, Daejeon, Korea
| | - Min Kyung Shin
- Department of Dermatology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sujin Lee
- Medical Affairs, Sanofi-Aventis Korea Co., Ltd., Seoul, Korea
| | - Sang Hyun Cho
- Department of Dermatology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kelbore AG, Enbiale W, Mosam A, van Wyk JM. Mapping research evidence on quality of life in children with atopic dermatitis in sub-Saharan Africa: a scoping review protocol. Syst Rev 2022; 11:254. [PMID: 36424634 PMCID: PMC9685884 DOI: 10.1186/s13643-022-02133-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic, debilitating disease affecting children worldwide. Several studies have shown the disease to be a significant problem which leads to a diminished quality of life (QoL) for the affected children, but systematic evaluation of such studies in Africa is yet to be reported. Therefore, this scoping review aims to map research evidence on children with AD and their QoL in sub-Saharan Africa (SSA). METHODS The scoping review will follow the Arksey and O'Mally methodological framework. The electronic databases to be searched will include PubMed, EBSCOhost (Academic Search Complete, CINAHL, PsycINFO, and Health Sources), and Scopus and Google Scholar, for published literature between 2010 and 2021. The search strategy for the databases will include keywords, Medical Subject Headings terms, and Boolean operators. The reference list of the included sources of evidence and the WHO website will also be consulted for evidence relating to QoL of children with AD in SSA. Two independent reviewers will undertake abstract and full-text article screening with the guidance of eligibility criteria. This review will include studies conducted in SSA, and publications focusing on QoL and associated factors of AD in children. Data will be extracted from the included studies and analyzed qualitatively; NVIVO software V.11 will be used, and the emerging themes reported narratively. The mixed-method appraisal tool (MMAT) will be employed for quality appraisal of included studies. DISCUSSION We look forward to the findings of several studies that describe the QoL and associated factors among children with AD and that report on the use of different diagnostic criteria, severity scaling and QoL measuring scale tools used to ascertain the presence of AD, scale the severity of AD, and the impact of AD on QoL among children. This will help to improve clinical practice and the QoL of children with AD in SSA. The study findings will be disseminated through publication in a peer-reviewed journal, peer presentations, and presentations at relevant conferences. CONCLUSION This study will add new knowledge on the QoL in children with AD in the SSA context. The study has the potential to inform research and clinical practice to impact the QoL of children with AD in SSA.
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Affiliation(s)
- Abraham Getachew Kelbore
- Department of Dermatology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia. .,Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Wendemagegn Enbiale
- Department of Dermatology, College of Health Sciences and Medicine, Bahir Dar University, Bahir Dar, Ethiopia.,Department of Dermatology, Amsterdam Institute for Infection and Immunity (AII), Academic Medical Centre, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Anisa Mosam
- Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Jacqueline M van Wyk
- Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Huang J, Choo YJ, Smith HE, Apfelbacher C. Quality of life in atopic dermatitis in Asian countries: a systematic review. Arch Dermatol Res 2022; 314:445-462. [PMID: 34086064 PMCID: PMC9162971 DOI: 10.1007/s00403-021-02246-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin condition which impacts psychological wellbeing and social relationships. There have been studies of AD's impact on quality of life (QoL) in Western countries, but these findings cannot be directly extrapolated to Asian populations with genetic, environmental and cultural differences. Therefore, we aimed to systematically review the literature pertaining to QoL impairment in AD in East and Southeast Asia to characterize the impact of AD on patients and their families, and to identify the factors affecting the degree of QoL impairment. A search of English language papers was conducted on MEDLINE, EMBASE, PSYCInfo, Global Health and Web of Science. Observational studies measuring QoL using single or multi-item instruments in people with self-reported or physician diagnosed atopic dermatitis were included. 27 studies from 29 articles were included and synthesized. There is data documenting QoL impairment in AD sufferers and their families, across a wide range of Asian countries, healthcare settings and ages. Aspects of QoL impacted to a greater extent included symptoms of itch, feelings of embarrassment, and sleep disturbance. Severity of disease affects the degree of impairment of QoL, but there is no apparent link between QoL impairment and patient demographic factors, or other medical factors such as age at diagnosis or duration of illness. Our findings also highlighted the need for clinicians to actively explore the impact of patient's symptoms, especially in an Asian context where healthcare communications are traditionally doctor-centric.
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Affiliation(s)
- Jinghui Huang
- Department of Family Medicine and Primary Care, Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Yue Jia Choo
- Department of Family Medicine and Primary Care, Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Helen Elizabeth Smith
- Department of Family Medicine and Primary Care, Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Christian Apfelbacher
- Department of Family Medicine and Primary Care, Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore.
- Institute of Social Medicine and Health Systems Research, Otto Von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
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General and Skin-Specific Health-Related Quality of Life in Patients With Atopic Dermatitis Before and During the COVID-19 Pandemic. Dermatitis 2022; 33:S92-S103. [PMID: 35674639 DOI: 10.1097/der.0000000000000908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Few studies have investigated health-related quality of life (HRQoL) in patients with atopic dermatitis (AD) during the COVID-19 pandemic. OBJECTIVES The objectives of this study were to compare HRQoL in adult AD patients before and during the pandemic and to assess measurement performance of 4 HRQoL measures. METHODS Between 2018 and 2021, a multicenter, cross-sectional survey was conducted, involving 218 adult AD patients. Health-related quality of life outcomes included the EQ-5D-5L, Skindex-16, Dermatology Life Quality Index (DLQI), and DLQI-Relevant (DLQI-R). Severity was measured using objective SCORing Atopic Dermatitis, Eczema Area and Severity Index, and Investigator Global Assessment. RESULTS The mean ± SD EQ-5D-5L utility, Skindex-16, DLQI, and DLQI-R scores were 0.82 ± 0.22, 56.84 ± 27.46, 13.44 ± 8.46, and 13.76 ± 8.60, respectively. The patients reported more problems during the pandemic (P < 0.05) regarding pain/discomfort (odds ratio [OR], 1.78), worrying (OR, 1.89), concerns about persistence/reoccurrence of disease (OR, 1.88), and social relationships (OR, 1.69). The HRQoL outcomes showed strong correlations with each other (range of rs, |0.69| to |0.99|). The Skindex-16, DLQI, and DLQI-R were able to discriminate between severity groups with large (η2 = 0.20-0.23), whereas the EQ-5D-5L with moderate effect sizes (η2 = 0.08-0.11). CONCLUSIONS Atopic dermatitis patients experienced significantly more problems in some areas of HRQoL during the pandemic. The EQ-5D-5L, Skindex-16, DLQI, and DLQI-R demonstrated good convergent and known-group validity and can be suitable instruments for HRQoL assessment in clinical and research settings.
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11
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Chatrath S, Lei D, Yousaf M, Chavda R, Gabriel S, Silverberg JI. Longitudinal course and predictors of depressive symptoms in atopic dermatitis. J Am Acad Dermatol 2022; 87:582-591. [PMID: 35551964 DOI: 10.1016/j.jaad.2022.04.061] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/27/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is associated with eczematous lesions, pruritus, pain, and sleep disturbance, which may negatively impact mental health over time. OBJECTIVE Determine the predictors and longitudinal course of depressive symptoms in adults with AD. METHODS A prospective, dermatology practice-based study was performed (n=695). AD signs, symptoms and severity and Patient Health Questionnaire (PHQ)-9 were assessed. RESULTS At baseline, 454 (65.32%) had minimal, 139 (20.00%) mild, 57 (8.20%) moderate, 27 (3.88%) moderately severe, and 8 (2.59%) had severe depression. Most had fluctuating levels of depressive symptoms. Feeling bad, thoughts of self-harm, difficulty concentrating, and slow movement were most persistent. Predictors of persistent depression included older age, non-white race, male sex, public or no insurance, more severe itch, skin pain, facial erythema, nipple eczema, sleep disturbance, and presence of pityriasis alba. LIMITATIONS Single center study. CONCLUSION Depressive symptoms are closely related to and fluctuate with AD severity over time. Improved control of AD signs and symptoms, particularly itch, may secondarily improve mental health.
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Affiliation(s)
- Sheena Chatrath
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Donald Lei
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Muhammad Yousaf
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Rajeev Chavda
- Galderma SA
- Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - Sylvie Gabriel
- Galderma SA
- Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC USA
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Kaundinya T, Rakita U, Guraya A, Abboud DM, Croce E, Thyssen JP, Alexis A, Silverberg JI. Differences in Psychometric Properties of Clinician- and Patient-Reported Outcome Measures for Atopic Dermatitis by Race and Skin Tone: A Systematic Review. J Invest Dermatol 2022; 142:364-381. [PMID: 34352262 PMCID: PMC8792149 DOI: 10.1016/j.jid.2021.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 02/03/2023]
Abstract
The psychometric validity and reliability of widely used atopic dermatitis (AD) outcome measures across different races and ethnicities are unclear. We describe the rates of reporting race, ethnicity, and skin tone in studies testing the psychometric properties of AD outcome measures and compare the psychometric analyses across race, ethnicity, and skin tone. We systematically reviewed MEDLINE and EMBASE for studies reporting psychometric properties of clinician-reported or patient-reported outcome measures in AD (International Prospective Register of Systematic Reviews: CRD42021239614). Overall, 16,100 nonduplicate articles were screened; 165 met inclusion criteria. Race and/or ethnicity were reported in 55 (33.3%) studies; of those, race was assessed by self-report in 10 studies (6.1%) or was unspecified in 45 (27.3%). A total of 16 studies (9.7%) evaluated psychometric property differences by race, and only five (4.4%) of those did not recognize it as a limitation. Properties assessed across race, ethnicity, or skin tone were differential item functioning, convergent validity feasibility, inter-rater reliability, intrarater reliability, test‒retest reliability, and known-groups validity. Multiple instruments demonstrated performance differences across ethnoracial groups. This review highlights the paucity of race/ethnicity consideration for psychometric property testing in AD outcome measurement instruments. More AD outcomes instruments should be validated in diverse populations.
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Affiliation(s)
- Trisha Kaundinya
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Uros Rakita
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Armaan Guraya
- Chicago College of Osteopathic Medicine, Midwestern University, Chicago, Illinois, USA
| | | | - Emily Croce
- School of Nursing, The University of Texas at Austin, Austin, Texas, USA; Pediatric and Adolescent Dermatology, Dell Children's Medical Group, Austin, Texas, USA
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrew Alexis
- Dermatology, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Jonathan I Silverberg
- Department of Dermatology, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA.
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13
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Hon KL, Chu S, Leung AKC. Quality of Life for Children with Allergic Skin Diseases. Curr Pediatr Rev 2022; 18:191-196. [PMID: 34488587 DOI: 10.2174/1573396317666210901124211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 04/06/2021] [Accepted: 04/27/2021] [Indexed: 11/22/2022]
Abstract
Allergic skin diseases are highly prevalent among children. Patients with allergic skin diseases experience sociopsychological and quality-of-life (QoL) burdens in excess of those in the general population. Children and their caregivers are especially vulnerable to the burden of many of the common allergic skin diseases. In the past few decades, researchers have developed a number of disease-specific scores and indices for the measurement of QoL for childhood skin diseases. Most of the research in this area has focused on atopic eczema and urticaria and less so on allergic contact dermatitis. We provide an overview of QoL and its assessment for these dermatologic conditions.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shenzhen, Hong Kong.,Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Samantha Chu
- Faculty of Medicine, The Chinese University of Hong Kong, Shenzhen, Hong Kong
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada
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14
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Chahine B, Cherfane M, Sakr F, Safwan J, Dabbous M, Akel M, Rahal M. Community pharmacists' perceptions and role in the management of common dermatological problems in Lebanon: a cross-sectional study. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:573-579. [PMID: 34454404 DOI: 10.1093/ijpp/riab056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/01/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To explore the types and frequency of dermatologic disorders routinely encountered by community pharmacists in Lebanon, identify their educational preparedness and confidence, reasons for referrals to dermatologists and their attitude toward the potential pharmacist role in the treatment of dermatologic disorders. METHODS A cross-sectional descriptive study was conducted between June and October 2017. It involved the use of a self-administered questionnaire, distributed to a randomly selected sample of 500 community pharmacists from all Lebanese districts. KEY FINDINGS A total of 456 pharmacists completed the questionnaire. Sixty-four per cent of participants had received a dermatology course at university and 38.7% had undertaken some form of postgraduate education in dermatology. Pharmacists believed that the most commonly encountered disorders were sunburn (22.6%) and acne (15.6%) during spring/summer and skin dryness (18.8%) followed by head lice (13.1%) during autumn/winter. Additionally, more than half of respondents reported that skin-related advice requests were 6-15% of the total advice offered to patients. Sixty-four per cent were confident or extremely confident in advising patients with dermatological complaints. Pharmacists ranked 'unsure of diagnosis' as the most common reason for patient referral to dermatologists. Pharmacists who received postgraduate dermatology training had higher self-reported confidence in tackling skin diseases and their treatments (P < 0.05). CONCLUSIONS Our study revealed that community pharmacists in Lebanon commonly encounter a limited number of dermatologic disorders and the majority believed that they can confidently advise and manage patients. Nonetheless, they admitted a gap in their dermatology education at both undergraduate and postgraduate levels.
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Affiliation(s)
- Bahia Chahine
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Michelle Cherfane
- School of Pharmacy, Lebanese International University, Beirut, Lebanon.,Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon.,College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Jihan Safwan
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Marwan Akel
- School of Pharmacy, Lebanese International University, Beirut, Lebanon.,Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon
| | - Mohamad Rahal
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
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Nagata A, Kazi T, Akter Z, Nody FA, Khan MS, Shahriar ASM, Islam MS, Nakagawa T, Inui S. The Influence of Atopic Dermatitis on Health-Related Quality of Life in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111593. [PMID: 34770105 PMCID: PMC8583474 DOI: 10.3390/ijerph182111593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022]
Abstract
Atopic dermatitis (AD) is the foremost non-fatal skin-related disease that affects all age groups. Despite the growing prevalence of AD in low- and middle-income countries, its physiological consequences remain overlooked in countries like Bangladesh. Therefore, we aim to assess and characterize the influence of AD on the health-related quality of life (HRQoL) in Bangladeshi patients. A cross-sectional study comprising 184 eligible adults (83 men and 101 women; mean age, 33.46 ± 15.44 years) was conducted at the dermatology outpatient department of Shaheed Suhrawardy Medical College Hospital (a tertiary hospital in Dhaka, Bangladesh). AD was determined using the UK Working Party criteria. A structured questionnaire, Eczema Area and Severity Index (EASI), and Dermatology Life Quality Index (DLQI) were administered to obtain information on patient characteristics, AD severity, and HRQoL. The mean DLQI score for the entire sample was 11.29 ± 5.27 (range, 1–26), and 51.60% reported the disease greatly affected their lives. Bivariate analysis revealed significant differences in self-rated health measures of DLQI scores in terms of self-reported AD severity, overall health, and the EASI. In multivariable regression models adjusted for patient characteristics, the self-perceived severe AD group reported significantly higher DLQI scores (coefficient = 2.72; 95% confidence interval (CI) = 0.38–5.05; p = 0.022) than the mild group. Concurrently, we observed a substantial increase in the DLQI scores among patients with moderate and severe EASI scores (coefficient = 1.96, 95% CI = 0.08–3.92, p < 0.05 and coefficient = 4.35, 95% CI = 1.98–6.72, p < 0.001, respectively) than in those with mild EASI scores, suggesting that HRQoL was markedly influenced by greater AD severity. These findings highlight the need for a more patient-centric approach to the management of AD in order to alleviate patient suffering and, thereby, improve HRQoL.
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Affiliation(s)
- Abir Nagata
- Department of Regenerative Dermatology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan; (T.K.); (T.N.); (S.I.)
- Correspondence: ; Tel.: +81-06-6879-3960
| | - Taheruzzaman Kazi
- Department of Regenerative Dermatology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan; (T.K.); (T.N.); (S.I.)
| | - Zubaida Akter
- Department of Dermatology and Venereology, Shaheed Suhrawardy Medical College Hospital, Dhaka 1207, Bangladesh;
| | - Fariha Afrin Nody
- Ibrahim Cardiac Hospital and Research Institute, Dhaka 1000, Bangladesh;
| | - Mohammad Shahriar Khan
- International Platform for Dryland Research and Education, Tottori University, Tottori 680-0001, Japan;
| | | | - Md Sayeedul Islam
- Department of Biological Sciences, Graduate School of Science, Osaka University, Toyonaka 560-0043, Japan;
| | - Takatoshi Nakagawa
- Department of Regenerative Dermatology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan; (T.K.); (T.N.); (S.I.)
| | - Shigeki Inui
- Department of Regenerative Dermatology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan; (T.K.); (T.N.); (S.I.)
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Simpson EL, de Bruin-Weller M, Bansal A, Chen Z, Nelson L, Whalley D, Prescilla R, Guillemin I, Delevry D. Definition of Clinically Meaningful Within-Patient Changes in POEM and CDLQI in Children 6 to 11 Years of Age with Severe Atopic Dermatitis. Dermatol Ther (Heidelb) 2021; 11:1415-1422. [PMID: 34046851 PMCID: PMC8322340 DOI: 10.1007/s13555-021-00543-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The Patient-Oriented Eczema Measure (POEM) assesses patient-reported severity of atopic dermatitis (AD) symptoms, whereas the Children's Dermatology Life Quality Index (CDLQI) measures how AD affects health-related quality of life (HRQoL) in children. Although the POEM and CDLQI have established thresholds for clinically meaningful within-patient change in adolescents (aged 12-17 years), there are no defined within-patient responder thresholds for clinically meaningful change in children aged 6-11 years. METHODS Data from the LIBERTY AD PEDS phase 3 randomized, double-blind, placebo-controlled trial of dupilumab in children aged 6-11 years with severe AD were used to define the threshold for within-patient meaningful change in POEM and CDLQI scores. Anchor-based methods were applied to estimate mean change in POEM and CDLQI scores from baseline to week 16, with anchors of a 1-point improvement in the Patient Global Impression of Disease (PGID) scale and an improvement in score of ''A little better'' on the Patient Global Impression of Change (PGIC) scale. The distribution-based methods, a one-half standard deviation (SD) at baseline and a standard error mean (SEM) were also used. RESULTS The mean POEM change scores associated with the anchors were a change of - 8.40 with the PGID anchor and - 6.30 with the PGIC anchor. Distribution-based estimates for POEM were one-half SD at baseline of 2.76, with a SEM of 3.32. Mean CDLQI change scores corresponding to the PGID and PGIC anchors were - 7.30 and - 6.80, respectively, while distribution-based estimates for CDLQI were a one-half SD at baseline of 3.69, with a SEM of 3.52. CONCLUSIONS In children with severe AD, an appropriate minimum threshold of clinically meaningful within-patient change was estimated as 6 points for both the POEM and CDLQI scores. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03345914. What is the clinically meaningful within-person change in Patient-Oriented Eczema Measure and Children's Dermatology Life Quality Index scores in children 6 to 11 years old with severe atopic dermatitis? (MP4 289443 KB).
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Affiliation(s)
- Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA.
| | | | | | - Zhen Chen
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY, USA
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Zyriax BC, Augustin M, Abeck F, Mohr N, Kirsten N, Langenbruch A. Adherence to Guideline-Oriented Preventive Measures in Patients with Atopic Dermatitis in Germany. Dermatology 2021; 238:307-312. [PMID: 34175853 DOI: 10.1159/000517019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease that is often associated with comorbidities and quality of life losses. The implementation of evidence-based preventive measures strengthens patient participation and offers the potential to improve quality of care for AD. OBJECTIVES To assess adherence to guideline-oriented preventive measures in adult patients with AD in dermatological routine care in Germany. METHODS The self-responsible application of preventive measures, clinical features, pruritus, disease severity, and duration of disease as well as skin disease-related quality of life were assessed in two independent cross-sectional studies in 2010 and 2017-2019. RESULTS Between 2017 and 2019, 706 patients (55.8% female, mean age 41 years) were recruited in a comparable way to the survey in 2010 with 1,678 patients (60.5% female, mean age 38 years). Regular skin care was applied by 99.5% (2010: 94.9%), 90.9% avoided skin irritants (2010: 84.6%), and 80.2% (2010: 61.6%) did not smoke at home. Relaxation techniques were applied by 44.4% (2010: 29.9%). Advice on self-help measures was taken by 36.4% (2010: 27.1%) and 29.2% (2010: 15.4%) attended AD patient education courses. All six preventive measures categorized as obligatory were performed by 13.9% of the patients (2010: 6.7%). Predictors for the number of obligatory preventive measures applied were a high level of education, a longer disease duration, and a lower quality of life. CONCLUSIONS Although the self-reported use of evidence-based preventive measures in the 2017-2019 study appears to be more frequent than in 2010, important measures are still insufficiently established. Hence, more implementation, including education, is needed to increase the use of guideline-oriented preventive measures.
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Affiliation(s)
- Birgit-Christiane Zyriax
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Finn Abeck
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Nicole Mohr
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Natalia Kirsten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anna Langenbruch
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Lundin S, Jonsson M, Wahlgren CF, Johansson E, Bergstrom A, Kull I. Young adults' perceptions of living with atopic dermatitis in relation to the concept of self-management: a qualitative study. BMJ Open 2021; 11:e044777. [PMID: 34162639 PMCID: PMC8231057 DOI: 10.1136/bmjopen-2020-044777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Learning to take control of one's health is an important part of the transition from adolescence to adulthood. This study aimed to explore young adults' perceptions of living with atopic dermatitis (AD) in relation to the concept of self-management. DESIGN A qualitative study with an inductive approach was performed through semistructured interviews (n=15). The interviews were recorded, transcribed verbatim and analysed with systematic text condensation. PARTICIPANTS Young adults (mean age 23,4 years) with persistent AD in a longitudinal population-based birth cohort. To capture experience of living with persistent AD (preschool/school-age onset) of different severity (mild to severe/very severe), a purposive selection was performed. In total, 15 young adults were included. Persistent AD (preschool/school-age onset) was defined as dry skin in combination with itchy rash of typical localisation in the 12 months preceding the 16-year and the 24-year follow-ups. Severity was self-assessed using the Patient Oriented Eczema Measure. RESULTS Despite having experience of AD since childhood, the respondents expressed uncertainty about treatment and how it affected their bodies. Their uncertainties and feelings affected how they used topical corticosteroids. The respondents emphasised that they perceived availability of healthcare and knowledge about treatment of AD among healthcare providers to be limited. The participants did not state any experiences of support to self-management from healthcare, which affect young adults' possibilities to take full control of their AD care. CONCLUSIONS Young adults with preschool/school-age onset of AD are unsure how to treat and manage the disease. One explanation may be insufficient transition process.
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Affiliation(s)
- Susanne Lundin
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Marina Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Councíl, Stockholm, Sweden
| | - Carl-Fredrik Wahlgren
- Department of Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Emma Johansson
- Department of Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska Universitetssjukhuset i Solna, Stockholm, Sweden
| | - Anna Bergstrom
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Inger Kull
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Rocholl M, Ludewig M, Brakemeier C, John SM, Wilke A. Illness perceptions of adults with eczematous skin diseases: a systematic mixed studies review. Syst Rev 2021; 10:141. [PMID: 33962662 PMCID: PMC8106167 DOI: 10.1186/s13643-021-01687-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eczematous skin diseases, e.g., atopic dermatitis or contact dermatitis, are associated with a high disease burden, a significant impact on quality of life and a higher risk for anxiety and depression. Therefore, coping strategies are of interest. In order to understand coping processes, it is necessary to examine the patients' perspectives on their illness. The aim of this systematic mixed studies review is to investigate the illness perceptions of patients with eczematous skin diseases to get a better understanding of their coping processes. METHODS We performed a systematic literature search in PubMed, The Cochrane Library, PsycInfo, PSYNDEX, CINAHL, Web of Science, and Scopus until February 20, 2019. Both qualitative and quantitative studies were included in the review. Two independent reviewers conducted data extraction and carried out a narrative synthesis. We assessed study quality with the Mixed Methods Appraisal Tool. RESULTS Three qualitative and four quantitative studies were included in the systematic review. We found different methodological approaches for investigating illness perceptions: guided interviews, focus group interviews as well as standardized questionnaires, e.g., the Brief Illness Perception Questionnaire. All studies report suspected causes of the skin disease, such as endogenous and exogenous causes (namely, psychological or occupational factors). We found long timeline beliefs as well as various perceived and experienced social, economic, and psychological consequences. Our analysis reveals complex emotional representations in patients with eczematous skin diseases, in particular impairment of emotional well-being, and feelings of shame or helplessness. Qualitative and quantitative data were predominantly complementary and convergent. CONCLUSION Patients with eczematous skin diseases have complex illness representations regarding their disease. These representations interrelate with the coping behavior of patients. Therefore, medical professionals should consider them for counseling and treatment. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2018 CRD42018109217 .
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Affiliation(s)
- Marc Rocholl
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
| | - Michaela Ludewig
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
| | - Carola Brakemeier
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
| | - Swen Malte John
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
| | - Annika Wilke
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrueck, Am Finkenhuegel 7a, 49076 Osnabrueck, Germany
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Vittrup I, Andersen YMF, Droitcourt C, Skov L, Egeberg A, Fenton MC, Mina-Osorio P, Boklage S, Thyssen JP. Association between hospital-diagnosed atopic dermatitis and psychiatric disorders and medication use in childhood. Br J Dermatol 2021; 185:91-100. [PMID: 33454962 DOI: 10.1111/bjd.19817] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND While adult atopic dermatitis (AD) is associated with anxiety and depression, and paediatric AD is linked to attention deficit hyperactivity disorder (ADHD), the relationship between AD in childhood and other psychiatric disorders is largely unknown. OBJECTIVES To determine the relationship between AD and diagnosis and treatment of psychiatric disorders in children. METHODS All Danish children born between 1 January 1995 and 31 December 2012 with a hospital diagnosis of AD (n = 14 283) were matched 1 : 10 with children without a hospital diagnosis of AD. Endpoints were psychotropic medication use, hospital diagnoses of depression, anxiety, ADHD, or self-harming behaviour, accidental/suicidal death, and consultation with a psychiatrist or psychologist. RESULTS Significant associations were observed between hospital-diagnosed AD and antidepressant [adjusted hazard ratio (aHR) 1·19, 95% confidence interval (CI) 1·04-1·36], anxiolytic (aHR 1·72, 95% CI 1·57-1·90), and centrally acting sympathomimetic (aHR 1·29, 95% CI 1·18-1·42) medication use. Consultation with a psychiatrist (aHR 1·33, 95% CI 1·16-1·52) or psychologist (aHR 1·25, 95% CI 1·11-1·41) was also associated with AD. No association with a hospital diagnosis of depression (aHR 0·58, 95% CI 0·21-1·56), anxiety (aHR 1·47, 95% CI 0·98-2·22) or self-harming behaviour (aHR 0·88, 95% CI 0·27-2·88) was observed, but a diagnosis of ADHD (aHR 1·91, 95% CI 1·56-2·32) was significantly associated with AD. The absolute risks were generally low. CONCLUSIONS The increased risk of treatment, but not of a hospital diagnosis of psychiatric disorders in children with hospital-diagnosed AD, suggests that psychiatric issues in children with AD could be of a transient, reversible or mild-moderate nature.
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Affiliation(s)
- I Vittrup
- Department of Dermatology and Allergy, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Y M F Andersen
- Department of Dermatology and Allergy, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - C Droitcourt
- Department of Dermatology and Allergy, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Department of Dermatology, CHU Rennes, F35000, Rennes, France.,University of Rennes, EA 7449 REPERES 'Pharmacoepidemiology and Health Services Research', F35000, Rennes, France
| | - L Skov
- Department of Dermatology and Allergy, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - A Egeberg
- Department of Dermatology and Allergy, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - M C Fenton
- Formerly Sanofi Genzyme, Cambridge, MA, USA
| | - P Mina-Osorio
- Formerly Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - S Boklage
- Formerly Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - J P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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21
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Narasimha Rao P, Vellala M, Potharaju AR, Udaya Kiran K. Cosmetic camouflage of visible skin lesions enhances life quality indices in leprosy as in vitiligo patients: an effective stigma reduction strategy. LEPROSY REV 2020. [DOI: 10.47276/lr.91.4.343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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22
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Ferreira FC, Sathler CSCDO, Hida IY, Leite SC, Kusabara AA, de Castro ACV, Ribeiro MZML, Nahas TR. Upper eyelid blepharoplasty using plasma exeresis: Evaluation of outcomes, satisfaction, and symptoms after procedure. J Cosmet Dermatol 2020; 20:2758-2764. [PMID: 33252188 DOI: 10.1111/jocd.13868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/03/2020] [Accepted: 11/17/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Facial care treatments have grown a remarkable demand for effective and minimally invasive techniques with fast recovery time. Plasma technology is a nonsurgical alternative technique for skin rejuvenation. AIMS We assessed patient satisfaction and symptoms after upper eyelid blepharoplasty with plasma technology. PATIENTS/METHODS Observational study including 16 patients submitted to upper eyelid blepharoplasty using plasma technology to treat dermatochalasis. Patient satisfaction, symptoms, and quality of life were assessed using 2 questionnaires at follow-up days 7 and 30. Also, the answers were correlated with age, Fitzpatrick skin type, and quantity of eyelid skin treated with plasma. RESULTS All 16 patients were treated and completed the survey. Fourteen (87.5%) were female, and the mean age was 50.5 years. Physical appearance was the most relevant factor impacting on quality of life at first week postoperative. Regarding satisfaction with results, most patients stated higher level of satisfaction at day 7 follow-up analysis (P = .038). Less impact on quality of life and higher satisfaction was associated with eyelid-treated area (P = .044 and P = .036) and Fitzpatrick skin type (P = .043) at 7 and 30 days after procedure, respectively. Eyelid edema and itching were the symptoms most reported at 7 and 30 days, respectively. CONCLUSIONS Upper blepharoplasty with plasma is a minimally invasive treatment with low impact on quality of life. However, overall patient satisfaction is questionable when considering less willing of undergoing procedure again and decreased expectation with results over postoperative period. Symptoms are reported mainly at the first week after procedure.
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Affiliation(s)
- Flávio Calice Ferreira
- Oculoplastic Surgery Service, Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Ilana Yamakami Hida
- Oculoplastic Surgery Service, Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Suzana Crispin Leite
- Oculoplastic Surgery Service, Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Ana Clara Vieira de Castro
- Oculoplastic Surgery Service, Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Tatiana Rizkallah Nahas
- Oculoplastic Surgery Service, Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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23
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Carvalho D, Aguiar P, Ferrinho P. Skindex-29 cutoffs in an atopic dermatitis sample. Int J Dermatol 2020; 60:e45-e47. [PMID: 33040360 DOI: 10.1111/ijd.15237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/29/2020] [Accepted: 09/14/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Daniela Carvalho
- Public Health Research Center, NOVA University of Lisbon, Lisboa, Portugal
| | - Pedro Aguiar
- Public Health Research Center, NOVA University of Lisbon, Lisboa, Portugal
| | - Paulo Ferrinho
- GHTM, Instituto de Higiene e Medicina Tropical of the Universidade Nova de Lisboa, Lisboa, Portugal
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24
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Johansson EK, Ivert LU, Bradley B, Lundqvist M, Bradley M. Weight gain in patients with severe atopic dermatitis treated with dupilumab: a cohort study. BMC DERMATOLOGY 2020; 20:8. [PMID: 32962676 PMCID: PMC7510313 DOI: 10.1186/s12895-020-00103-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Dupilumab, targeting the interleukin-4α receptor and inhibiting the action of interleukin-4 and interleukin-13, was recently approved for treatment of moderate to severe atopic dermatitis. There is limited data on long-term effects and safety among patients with severe atopic dermatitis treated with dupilumab. Weight gain was observed among patients treated with dupilumab in our clinic. The aim was to describe weight change in a cohort study of patients with severe atopic dermatitis treated with dupilumab from baseline to follow-up after 12 months, and to analyze if weight change was associated with effect of treatment, reported appetite, and/or disturbed night sleep due to itching. METHODS All patients with atopic dermatitis receiving systemic treatment at the Unit of Dermatology, Karolinska University Hospital, have been registered and monitored consecutively since January 2017. This cohort constituted all patients who started treatment on dupilumab or methotrexate between 10 January 2017 and 30 June 2019 with at least 6 months of follow-up within the study period. The following variables were monitored at start of and during treatment: Eczema Severity Score Index, Patient-Oriented Eczema Measure, visual analogue scale for pruritus 10 cm, Montgomery-Åsberg Depression Rating Scale, Dermatology Life Quality Index, and weight. Data analyses were performed using two-sample Wilcoxon-Mann-Whitney rank-sum test, or the Wilcoxon matched-pairs sign-rank test with a p-value < 0.05 considered as statistically significant. RESULTS Patients treated with dupilumab (n = 12) gained weight (mean 6.1 kg, range [0.1-18.0], p = 0.002) after 1 year on treatment. The majority of patients showed a good response to treatment with dupilumab (n = 11); at follow-up at 6, 9, or 12 months, they reached EASI-90 (n = 6), EASI-75 (n = 4), or EASI-50 (n = 1). There was no significant association between weight gain and treatment response, reported appetite, or disturbed night-sleep due to itch. Patients treated with methotrexate showed no significant weight change (n = 8). CONCLUSIONS To our knowledge, this is the first report on a possible association between weight gain and dupilumab treatment; the extent of the association is yet to be seen, as is the mechanism behind this finding.
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Affiliation(s)
- Emma Kristin Johansson
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, SE-171 77, Stockholm, Sweden. .,Dermatological and Venereal Clinic, Södersjukhuset, SE-118 83, Stockholm, Sweden.
| | - Lina Ulrika Ivert
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Dermatology, Karolinska University Hospital Solna, SE-171 76, Stockholm, Sweden
| | - Baltzar Bradley
- Department of Dermatology, Karolinska University Hospital Solna, SE-171 76, Stockholm, Sweden
| | - Maria Lundqvist
- Department of Dermatology, Karolinska University Hospital Solna, SE-171 76, Stockholm, Sweden
| | - Maria Bradley
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Dermatology, Karolinska University Hospital Solna, SE-171 76, Stockholm, Sweden
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25
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Knobler R, Arenberger P, Arun A, Assaf C, Bagot M, Berlin G, Bohbot A, Calzavara-Pinton P, Child F, Cho A, French LE, Gennery AR, Gniadecki R, Gollnick HPM, Guenova E, Jaksch P, Jantschitsch C, Klemke C, Ludvigsson J, Papadavid E, Scarisbrick J, Schwarz T, Stadler R, Wolf P, Zic J, Zouboulis C, Zuckermann A, Greinix H. European dermatology forum: Updated guidelines on the use of extracorporeal photopheresis 2020 - Part 2. J Eur Acad Dermatol Venereol 2020; 35:27-49. [PMID: 32964529 PMCID: PMC7821314 DOI: 10.1111/jdv.16889] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/06/2020] [Indexed: 12/22/2022]
Abstract
Background Following the first investigational study on the use of extracorporeal photopheresis for the treatment of cutaneous T‐cell lymphoma published in 1983, this technology has received continued use and further recognition for additional earlier as well as refractory forms. After the publication of the first guidelines for this technology in the JEADV in 2014, this technology has maintained additional promise in the treatment of other severe and refractory conditions in a multidisciplinary setting. It has confirmed recognition in well‐known documented conditions such as graft‐vs.‐host disease after allogeneic bone marrow transplantation, systemic sclerosis, solid organ transplant rejection including lung, heart and liver and to a lesser extent inflammatory bowel disease. Materials and methods In order to further provide recognized expert practical guidelines for the use of this technology for all indications, the European Dermatology Forum (EDF) again proceeded to address these questions in the hands of the recognized experts within and outside the field of dermatology. This was done using the recognized and approved guidelines of EDF for this task. All authors had the opportunity to review each contribution as it was added. Results and conclusion These updated 2020 guidelines provide at present the most comprehensive available expert recommendations for the use of extracorporeal photopheresis based on the available published literature and expert consensus opinion. The guidelines were divided into two parts: PART I covers Cutaneous T‐cell lymphoma, chronic graft‐vs.‐host disease and acute graft‐vs.‐host disease, while PART II will cover scleroderma, solid organ transplantation, Crohn’s disease, use of ECP in paediatric patients, atopic dermatitis, type 1 diabetes, pemphigus, epidermolysis bullosa acquisita and erosive oral lichen planus.
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Affiliation(s)
- R Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - P Arenberger
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - A Arun
- FRCPath, The Rotherham NHA Foundation Trust, Rotherham, United Kingdom
| | - C Assaf
- Department of Dermatology and Venerology, Helios Klinikum Krefeld, Krefeld, Germany
| | - M Bagot
- Hospital Saint Louis, Université de Paris, Paris, France
| | - G Berlin
- Department of Clinical Immunology and Transfusion Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - A Bohbot
- Onco-Hematology Department, Hautepierre Hospital, Strasbourg, France
| | | | - F Child
- FRCP, St John's Institution of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - A Cho
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - L E French
- Department of Dermatology, University Hospital, München, Germany
| | - A R Gennery
- Translational and Clinical Research Institute Newcastle University Great North Children's Hospital Newcastle upon Tyne, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - R Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, Canada
| | - H P M Gollnick
- Department Dermatology & Venereology Otto-von-Guericke University, Magdeburg, Germany
| | - E Guenova
- Faculty of Biology and Medicine, University of Lausanne and Department of Dermatology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - P Jaksch
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - C Jantschitsch
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Klemke
- Hautklinik Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - J Ludvigsson
- Crown Princess Victoria Children's Hospital and Division of Pediatrics, Department of Biomedical and Clinical Sciences, University Hospital, Linköping University, Linköping, Sweden
| | - E Papadavid
- National and Kapodistrian University of Athens, Athens, Greece
| | - J Scarisbrick
- University Hospital Birmingham, Birmingham, United Kingdom
| | - T Schwarz
- Department of Dermatology, University Clinics Schleswig-Holstein, Kiel, Germany
| | - R Stadler
- University Clinic for Dermatology Johannes Wesling Medical Centre, UKRUB, University of Bochum, Minden, Germany
| | - P Wolf
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - J Zic
- Vanderbilt University Medical Center Department of Dermatology, Nashville, Tennessee, USA
| | - C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - A Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - H Greinix
- LKH-Univ. Klinikum Graz, Division of Haematology, Medical University of Graz, Graz, Austria
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26
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Elmets CA, Korman NJ, Prater EF, Wong EB, Rupani RN, Kivelevitch D, Armstrong AW, Connor C, Cordoro KM, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Siegel M, Stoff B, Strober B, Wu JJ, Hariharan V, Menter A. Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol 2020; 84:432-470. [PMID: 32738429 DOI: 10.1016/j.jaad.2020.07.087] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 01/23/2023]
Abstract
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the United States population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.
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Affiliation(s)
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas
| | - Reena N Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | - Matthew Kiselica
- Patient Advocate, National Psoriasis Foundation, Portland, Oregon
| | | | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jason Lichten
- Patient Advocate, National Psoriasis Foundation, Portland, Oregon
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Nehal N Mehta
- The National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | - Michael Siegel
- Pediatric Dermatology Research Alliance, Indianapolis, Indiana
| | | | - Bruce Strober
- Central Connecticut Dermatology Research, Cromwell, Connecticut; Yale University, New Haven, Connecticut
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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27
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Patient-Reported Outcome Measures in Atopic Dermatitis and Chronic Hand Eczema in Adults. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 12:445-459. [PMID: 31270775 PMCID: PMC6697713 DOI: 10.1007/s40271-019-00373-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patient-reported outcome measures (PROMs) provide an important complement to physician-assessed clinical outcome measures in dermatologic diseases such as atopic dermatitis (AD) and chronic hand eczema (CHE). AD and CHE are chronic and relapsing inflammatory skin conditions that often co-occur. While both diseases result in various signs and symptoms that are burdensome and can negatively affect patients’ lives, there may be distinct differences in the signs, symptoms, burden, and health-related quality of life (HRQOL) impact of these diseases. The objective of this study was to identify and evaluate PROMs used in studies of AD and CHE. The aim was to explore the assessment of key symptoms and impacts, and identify any gaps in the measures in use. A structured review of the PubMed database was conducted to identify PROMs used or developed for use in AD or CHE. The Dermatology Life Quality Index (DLQI), the Pruritus/Itch Numeric Rating Scale (NRS), the Patient-Oriented Eczema Measure (POEM), and the Quality of Life in Hand Eczema Questionnaire (QOLHEQ) were identified and reviewed in detail. With these measures, the AD and CHE symptoms and impacts most commonly evaluated in the literature include dermatology-related HRQOL in the domains of symptoms and feelings, daily activities, leisure, work and school, personal relationships, and adverse effects; pruritus; sleep disturbance; AD-specific symptoms (dryness, itching, flaking, cracking, bleeding, and weeping/oozing); and CHE-specific symptoms (pain, itch, fissuring, redness, bleeding, and dryness). A review of regulatory labels of drugs approved for AD by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) found that, among the four measures reviewed, the Pruritus NRS was included in the FDA and EMA labels for dupilumab, the DLQI was included in the EMA labels for dupilumab and tacrolimus, and the POEM was included in the EMA label for dupilumab. Key symptoms of AD (e.g. itching, flaking, cracking) and CHE (e.g. pain, itching, fissuring) are increasingly being assessed with PROMs; however, primary endpoints in clinical trials are often based on clinician-reported outcome measures. As therapeutic strategies in dermatology are targeted at specific dermatologic symptoms and diseases affecting specific sites (e.g. CHE), future research should explore patients’ experiences with these symptoms and sites and the changes with treatment that are most meaningful to them.
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28
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Birdi G, Cooke R, Knibb RC. Impact of atopic dermatitis on quality of life in adults: a systematic review and meta-analysis. Int J Dermatol 2020; 59:e75-e91. [PMID: 31930494 DOI: 10.1111/ijd.14763] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 11/26/2019] [Accepted: 12/06/2019] [Indexed: 11/28/2022]
Abstract
Atopic dermatitis (AD) can affect quality of life (QoL) of adult patients in whom the condition can be severe and persistent. There are currently no systematic reviews of the impact of AD on adults. This paper provides the first systematic literature review and meta-analysis of the impact of AD on QoL in adults. A systematic search was conducted using MEDLINE, Scopus, and Web of Science for articles published until October 2018. Inclusion criteria were a clinical diagnosis of AD, adult patients, and QoL as an outcome measure. Interventions were excluded. A total of 32 studies were included. While QoL was assessed using Dermatology Life Quality Index (DLQI) in 25 studies, there was heterogeneity in the tools used to measure disease severity across studies. Meta-analysis of the seven studies that used the SCORAD to measure disease severity showed severity to be significantly related to poorer QoL. The remaining 18 studies also showed increased disease severity significantly related to poorer QoL. When compared to healthy controls, AD patients demonstrated significantly lower QoL, but findings were mixed in studies that compared QoL in AD to other skin conditions. The findings highlight the significant impact that AD has on QoL in adults and the need for validated and relevant QoL measures to be implemented in clinical assessments for AD. Areas that require further research include an exploration of gender differences in QoL and the use of longitudinal study designs to explore factors that may cause differences in QoL ratings.
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Affiliation(s)
- Gurkiran Birdi
- Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Richard Cooke
- Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Rebecca C Knibb
- Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK
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29
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Gabes M, Tischer C, Apfelbacher C. Measurement properties of quality-of-life outcome measures for children and adults with eczema: An updated systematic review. Pediatr Allergy Immunol 2020; 31:66-77. [PMID: 31505076 DOI: 10.1111/pai.13120] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/05/2019] [Accepted: 08/22/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of this updated systematic review was to systematically assess the measurement properties of previously discussed and new quality-of-life patient-reported outcome measures (PROMs) in children and adults with eczema using the new COSMIN guideline. METHODS A systematic literature search was conducted in PubMed and EMBASE. Eligible studies reported on measurement properties of quality-of-life PROMs for children and adults with eczema. The methodological quality of selected already known PROMs and new evidence identified through the literature search was assessed with the COSMIN Risk of Bias checklist. The adequacy of included PROMs was judged with updated quality criteria, and the quality of evidence of the summarized results was graded. Finally, PROMs were placed in a recommendation category (A-C). RESULTS In total, 133 measurement properties of nine different PROMs were assessed. No PROM could be placed in category A due to a lack of validation studies. Only the DLQI fulfilled the criteria for category C and therefore should not be recommended for use. All other PROMs were placed in category B, that is, they still have the opportunity to be recommended, but need further validation. CONCLUSIONS Currently, no PROM for quality of life can be recommended for use in children and adults with eczema. Further validation is needed. The DLQI cannot be recommended for future use.
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Affiliation(s)
- Michaela Gabes
- Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Christina Tischer
- Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Christian Apfelbacher
- Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.,Institute of Social Medicine and Health Economics, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
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30
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Quality of Life and Disease Impact of Atopic Dermatitis and Psoriasis on Children and Their Families. CHILDREN-BASEL 2019; 6:children6120133. [PMID: 31810362 PMCID: PMC6955769 DOI: 10.3390/children6120133] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/08/2019] [Accepted: 11/25/2019] [Indexed: 12/11/2022]
Abstract
Atopic dermatitis (AD) and psoriasis are common chronic skin diseases affecting children. These disorders negatively impact the quality of life (QoL) of patients in health-related aspects such as physical, psychosocial, and mental functioning. This health impact is more accurately represented when accounting for the numerous comorbidities associated with each disorder, and the impact the disorders have on patients’ families. A number of QoL tools have been developed and can be routinely implemented in the evaluation of QoL in pediatric patients and their caregivers. Ways to improve QoL include a multidisciplinary approach to care, education, and psychological support.
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Ražnatović Đurović M, Janković J, Tomić Spirić V, Relić M, Sojević Timotijević Z, Ćirković A, Đurić S, Janković S. Does age influence the quality of life in children with atopic dermatitis? PLoS One 2019; 14:e0224618. [PMID: 31725802 PMCID: PMC6855426 DOI: 10.1371/journal.pone.0224618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/17/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is one of the most common childhood skin diseases that can affect the quality of life (QoL) of children. The QoL of Montenegrin children with AD has not been sufficiently explored. The aim of this study was to assess their QoL with special emphasize on age differences. METHODS This cross-sectional study included children with AD seen at the Clinic of Dermatology and Venereology, Clinical Center of Montenegro (CCM) in Podgorica between August 2017 and July 2018. The QoL was assessed with the Infants' Dermatitis Quality of Life Index (IDQOL) and the Children's Dermatology Life Quality Index (CDLQI). Disease severity was measured by the Three Item Severity (TIS) score. RESULTS A total of 386 children with AD aged from newborn to 16 years took part in this study. The mean total score of the QoL was 14.7 in infants (0-4 years old), 19.4 in younger children (5-9 years old), and 16.6 in older children (10-16 years old). Age was in negative correlation with the CDLQI score, leisure domain of the CDLQI and CDLQI sleep, and in positive correlation with the IDQOL child mood. TIS score was in positive correlation with both the IDQOL and CDLQI score. CONCLUSIONS The QoL measured by CDLQI was more impaired in younger children, whilst IDQOL child mood was more impaired in older infants. The most impaired QoL was seen in children in the age group 5-9 years. Regardless of disease severity, treatment and counseling of children suffering from AD should be tailored specifically to their age.
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Affiliation(s)
- Milena Ražnatović Đurović
- Clinic of Dermatology and Venereology, Clinical Center of Montenegro, Faculty of Medicine University of Montenegro, Podgorica, Montenegro
| | - Janko Janković
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- * E-mail:
| | - Vesna Tomić Spirić
- Department of Internal Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Allergology and Immunology, Clinical Center of Serbia, Belgrade, Serbia
| | - Milijana Relić
- Department of Dermatology, Faculty of Medicine, University of Priština, Kosovska Mitrovica, Serbia
| | | | - Anđa Ćirković
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slađana Đurić
- Department for Preventive Medicine, Faculty of Medicine, University of Priština, Kosovska Mitrovica, Serbia
| | - Slavenka Janković
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Pain Is a Common and Burdensome Symptom of Atopic Dermatitis in United States Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2699-2706.e7. [DOI: 10.1016/j.jaip.2019.05.055] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/25/2019] [Accepted: 05/29/2019] [Indexed: 01/29/2023]
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Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, Ong PY, Chiesa Fuxench ZC, Simpson EL. Validation and Interpretation of Short Form 12 and Comparison with Dermatology Life Quality Index in Atopic Dermatitis in Adults. J Invest Dermatol 2019; 139:2090-2097.e3. [DOI: 10.1016/j.jid.2019.03.1152] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/07/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023]
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Barton CA, Dharmage SC, Lodge CJ, Abramson MJ, Erbas B, Lowe A. Asthma, atopy and serious psychological distress: prevalence and risk factors among young people in the Melbourne atopy cohort study. J Asthma 2019; 57:1323-1331. [PMID: 31380704 DOI: 10.1080/02770903.2019.1645850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: While atopic conditions are associated with increased risk of mental health problems, the evidence that a range of allergic conditions are associated with psychological distress in young people is less clear.Methods: We recruited a longitudinal birth cohort study of 620 children with a family history of allergic disease. At the 18-year follow up, atopic sensitization was determined by skin prick testing. Surveys were used to determine psychological distress (Kessler 6), quality of life (SF12), respiratory symptoms and management, presence of current eczema and hay fever. Regression models were used to identify predictors of psychological distress and quality of life, while controlling for potential confounders.Results: Prevalence of serious psychological distress was quite low (n = 22, 5.3%), and there were no associations between psychological distress and current atopic sensitization, symptoms of hay fever, eczema or asthma. Smoking status and lower level of maternal education were associated with lower physical quality of life (SF12 PCS subscale). Psychological distress total score, lower maternal education, smoking, female sex, and current eczema were associated with worse mental quality of life (SF12 MCS subscale).Conclusion: We found relatively low levels of psychological distress in this cohort of young adults, despite a high prevalence of allergic diseases. Positive social factors may serve to buffer psychological distress amongst the cohort accounting for the low prevalence of serious psychological distress observed.
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Affiliation(s)
- Christopher A Barton
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Adrian Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
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Newton L, DeLozier AM, Griffiths PC, Hill JN, Hudgens S, Symonds T, Gable JC, Paik J, Wyrwich KW, Eichenfield LF, Abetz-Webb L, Silverberg JI. Exploring content and psychometric validity of newly developed assessment tools for itch and skin pain in atopic dermatitis. J Patient Rep Outcomes 2019; 3:42. [PMID: 31312940 PMCID: PMC6635522 DOI: 10.1186/s41687-019-0128-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 06/19/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a common skin disorder characterized by chronic inflammation, altered skin barrier function, and inflammatory cell skin infiltration that decreases health-related quality of life (HRQoL). The study objective was to understand the patient perspective of AD burden and determine suitable patient-reported outcome (PRO) measures. METHODS This mixed methods study involved the collection of qualitative and quantitative information from adults (≥ 18 years old) and adolescents (12 - 17 years old) with clinician-confirmed AD regarding their experiences of AD symptoms and its impact on HRQoL. The first part of the study included three stages: in-person concept elicitation (CE) interviews, a 2-week daily electronic diary (eDiary) study, and in-person cognitive debriefing (CD) interviews. An Itch numeric rating scale (NRS) (v1.0) and a Skin Pain NRS (v1.0) evaluation during CD interviews required participants to think about their 'worst' itch and 'worst' skin pain in the past 24 h. Other PRO measures allowed for psychometric testing. The second part of the study involved telephone-depth interviews (TDIs) and qualitative feedback from participants who had not participated in the CD interviews. Qualitative data were thematically analyzed. Psychometric evaluation of NRS measures was performed using eDiary data. RESULTS In the CE interviews, itch and/or itching and skin pain were the most prevalent symptoms consistently discussed by participants. Both NRS measures demonstrated strong psychometric reliability and were applicable across ages with suitable concurrent validity. During the CD interviews, some participants focused their answers on their 'average' itch/itching in the past 24 h, rather than their 'worst' itch. Some participants answered the Skin Pain NRS thinking about general pain or other types of pain, rather than skin pain specifically. Consequently, modifications to both measures addressed these issues and re-tested as paper-and-pen versions in subsequent TDIs. Itch NRS (v2.0) modifications helped participants focus on their worst itching. Most participants preferred Skin Pain NRS v2.0b, which included skin pain descriptors. CONCLUSIONS Itching and skin pain are the most important and relevant AD symptoms. The Itch NRS (v2.0) and Skin Pain NRS (v2.0b) appear to be appropriate endpoints for the assessment of itching and skin pain severity for clinical trials with adults and adolescents with AD.
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Affiliation(s)
- Louise Newton
- Clinical Outcomes Solutions, Unit 68, Basepoint, Shearway Rd, Shearway Business Park, Folkestone, Kent, CT19 4RH UK
| | - Amy M. DeLozier
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285 USA
| | - Philip C. Griffiths
- Clinical Outcomes Solutions, Unit 68, Basepoint, Shearway Rd, Shearway Business Park, Folkestone, Kent, CT19 4RH UK
| | - Jennifer N. Hill
- Clinical Outcomes Solutions, 53 W Jackson Blvd, Ste 1315, Chicago, IL 6064 USA
| | - Stacie Hudgens
- Clinical Outcomes Solutions, 1790 E River Rd, Ste 205, Tucson, AZ 85718 USA
| | - Tara Symonds
- Clinical Outcomes Solutions, Unit 68, Basepoint, Shearway Rd, Shearway Business Park, Folkestone, Kent, CT19 4RH UK
| | - Jonathon C. Gable
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285 USA
- Clinical Outcomes Solutions, 53 W Jackson Blvd, Ste 1315, Chicago, IL 6064 USA
| | - Jim Paik
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285 USA
| | | | - Lawrence F. Eichenfield
- Professor of Dermatology and Pediatrics Chief Pediatric and Adolescent Dermatology Vice Chair Department of Pediatrics, University of California San Diego and Rady Children’s Hospital, 8010 Frost St, San Diego, CA 92123 USA
| | - Linda Abetz-Webb
- Patient-Centred Outcomes Assessments Ltd, 1 Springbank, Bollington, Macclesfield, Cheshire, SK10 5LQ UK
| | - Jonathan I. Silverberg
- Dermatology Medical Social Sciences, Preventive Medicine, Northwestern University, NMH/Arkes Family Pavilion, Ste 1600, 676 N Saint Clair, Chicago, IL 60611 USA
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Huang D, Chen K, Zhang FR, Yang S, Guo Q, Xu JH, Li H, Tan GZ, Yang BQ, Lu QJ, Zheng J, Li LF, Gu H. Efficacy and safety of Run Zao Zhi Yang capsule on chronic eczema: a multiple-center, randomized, double-blind, placebo-controlled clinical study. J DERMATOL TREAT 2019; 30:677-684. [PMID: 31218889 DOI: 10.1080/09546634.2019.1571267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Run Zao Zhi Yang capsule (RZZYC) has been widely applied for eczema treatment as a traditional Chinese medicine, while its efficacy has not been scientifically investigated. Objective: We conducted this multiple-centers, randomized, double-blind, placebo-controlled study to investigate the effectiveness and safety of RZZYC on the treatment of patients with mild to moderate chronic eczema. Methods: 240 patients were randomly assigned into the experimental group and the placebo group. The primary efficacy indicator was the Eczama Area and Severity Index (EASI) score at week 4. The patient with an EASI score that decreases more than 95% from baseline (EASI 95) was judged as cured. The cured patients were followed up for another 8 weeks. The differences on EASI, Visual Analogue Score (VAS), and Dermatology Life Quality Index (DLQI) score were compared. Results: The proportions of EASI 95 and EASI 60 in the experimental group were significantly higher than those of the control group at week4 (p = .002 and p < .001, respectively), the VAS score decreased more significantly in the experimental group at week 4. After 8 weeks follow-up, no difference on recurrence rate and adverse event rate between the two groups was observed. Conclusion: RZZYC provides a good effect on the treatment of mild-to-moderate chronic eczema with a low recurrence and tolerable adverse events, and is a potential treatment that may be implemented in clinical practice.
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Affiliation(s)
- Dan Huang
- a Hospital for Skin Disease (Institute of Dermatology), Chinese Academy of Medical Sciences , Nanjing , China
| | - Kun Chen
- a Hospital for Skin Disease (Institute of Dermatology), Chinese Academy of Medical Sciences , Nanjing , China
| | - Fu-Ren Zhang
- b Shandong Province Hospital for Skin Disease , Jinan , China
| | - Sen Yang
- c The First Affiliated Hospital of Anhui Medical University , Chongqing , China
| | - Qing Guo
- d Sun Yat-sen Memorial Hospital Affiliated with Sun Yat-sen University , Guangzhou , China
| | - Jin-Hua Xu
- e Huashan Hospital Affiliated with Fudan University , Shanghai , China
| | - Hui Li
- f The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Guo-Zhen Tan
- d Sun Yat-sen Memorial Hospital Affiliated with Sun Yat-sen University , Guangzhou , China
| | - Bao-Qi Yang
- b Shandong Province Hospital for Skin Disease , Jinan , China
| | - Qian-Jin Lu
- g The Second Xiangya Hospital, Central South University , Changsha , China
| | - Jie Zheng
- h Ruijin Hospital Affiliated with Shanghai Jiaotong University Medical College , Shanghai , China
| | - Lin-Feng Li
- i Beijing Friendship Hospital, Capital Medical University , Beijing , China
| | - Heng Gu
- a Hospital for Skin Disease (Institute of Dermatology), Chinese Academy of Medical Sciences , Nanjing , China
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Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, Ong PY, Chiesa Fuxench Z, Simpson EL. Atopic Dermatitis in US Adults: From Population to Health Care Utilization. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1524-1532.e2. [DOI: 10.1016/j.jaip.2019.01.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 12/26/2018] [Accepted: 01/02/2019] [Indexed: 11/28/2022]
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Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, Ong PY, Fuxench ZC, Simpson EL. Health Utility Scores of Atopic Dermatitis in US Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1246-1252.e1. [DOI: 10.1016/j.jaip.2018.11.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 01/08/2023]
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Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, Ong PY, Chiesa Fuxench ZC, Simpson EL. Symptoms and diagnosis of anxiety and depression in atopic dermatitis in U.S. adults. Br J Dermatol 2019; 181:554-565. [PMID: 30838645 PMCID: PMC6850653 DOI: 10.1111/bjd.17683] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 12/23/2022]
Abstract
Background The relationship between atopic dermatitis (AD), anxiety and depression in the U.S. adult population is not well established. Objectives To determine the relationship of AD and its severity with symptoms and diagnosis of anxiety and depression in U.S. adults. Methods A cross‐sectional, population‐based study of 2893 adults was performed. AD was determined using modified U.K. Diagnostic Criteria. Results Adults with AD vs. those without AD had higher mean Hospital Anxiety and Depression Scale anxiety (HADS‐A) (7·7 vs. 5·6) and depression (HADS‐D) (6·0 vs. 4·3) scores and higher prevalences of abnormal (≥ 11) HADS‐A (28·6% vs. 15·5%) and HADS‐D (13·5% vs. 9·0%) scores. In multivariable linear and logistic regression models controlling for sociodemographics, AD was associated with significantly higher mean HADS‐A and HADS‐D scores (7·7 and 6·0) and higher odds of abnormal HADS‐A [odds ratio (OR) 2·19, 95% confidence interval (CI) 1·65–2·91] and HADS‐D scores (OR 1·50, 95% CI 1·04–2·17) (P ≤ 0·03 for all). Mean and abnormal HADS‐A and HADS‐D scores were increased in moderate and severe/very severe self‐reported global AD severity, Patient‐Oriented Eczema Measure (POEM), Patient‐Oriented Scoring AD (PO‐SCORAD), PO‐SCORAD itch and sleep (P < 0·0001 for all). All respondents with severe PO‐SCORAD, POEM and PO‐SCORAD itch had borderline or abnormal HADS‐A and HADS‐D scores. Adults with AD vs. those without AD had higher prevalence of self‐reported healthcare‐diagnosed anxiety or depression in the past year (40·0% vs. 17·5%). Many adults with AD who had borderline and/or abnormal HADS‐A or HADS‐D scores reported no diagnosis of anxiety or depression. Conclusions AD is associated with significantly increased anxiety and depression, which may go undiagnosed. What's already known about this topic? Previous studies found higher rates of anxiety and depression in clinical cohorts of patients with atopic dermatitis.
What does this study add? This study found dramatically higher rates of anxiety and depression among adults with atopic dermatitis in the U.S. population, which was primarily driven by atopic dermatitis severity. Anxiety and depression often go undiagnosed in adults with atopic dermatitis.
Linked Comment: https://doi.org/10.1111/bjd.18252. https://doi.org/10.1111/bjd.18278 available online https://www.bjdonline.com/article/Chronic-urticaria-and-osteoporosis-a-longitudinal-community-based-cohort-study-of-11944-patients/
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Affiliation(s)
- J I Silverberg
- Feinberg School of Medicine, Northwestern University, Chicago, IL, U.S.A
| | - J M Gelfand
- School of Medicine, University of Pennsylvania Perelman, Philadelphia, PA, U.S.A
| | - D J Margolis
- School of Medicine, University of Pennsylvania Perelman, Philadelphia, PA, U.S.A
| | - M Boguniewicz
- National Jewish Health, Denver, CO, U.S.A.,School of Medicine, University of Colorado, Denver, CO, U.S.A
| | - L Fonacier
- NYU Winthrop Hospital, Mineola, NY, U.S.A
| | - M H Grayson
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, U.S.A
| | - P Y Ong
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, U.S.A
| | - Z C Chiesa Fuxench
- School of Medicine, University of Pennsylvania Perelman, Philadelphia, PA, U.S.A
| | - E L Simpson
- Oregon Health & Science University, Portland, OR, U.S.A
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Tezepelumab, an anti-thymic stromal lymphopoietin monoclonal antibody, in the treatment of moderate to severe atopic dermatitis: A randomized phase 2a clinical trial. J Am Acad Dermatol 2018; 80:1013-1021. [PMID: 30550828 DOI: 10.1016/j.jaad.2018.11.059] [Citation(s) in RCA: 200] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Tezepelumab (AMG 157/MEDI9929), a first-in-class monoclonal antibody, targets thymic stromal lymphopoietin, a cytokine that is implicated in the pathogenesis of atopic dermatitis (AD). OBJECTIVE We sought to evaluate the efficacy and safety of tezepelumab in adults with moderate to severe AD. METHODS In this phase 2a study (NCT02525094), 113 patients were randomized 1:1 to subcutaneous tezepelumab 280 mg or placebo every 2 weeks, plus class 3 topical corticosteroids (TCS). The primary endpoint was the week 12 response rate for a ≥50% reduction in the Eczema Area and Severity Index (EASI50). Secondary endpoints including EASI75, Investigator's Global Assessment, SCORAD 50, SCORAD 75, pruritus numeric rating and 5-D itch scales, and exploratory endpoints (including EASI90) were assessed at weeks 12, and 16 (post hoc). RESULTS A numerically greater percentage of tezepelumab plus TCS-treated patients achieved EASI50 (64.7%) versus placebo plus TCS (48.2%; P = .091). Numerical improvements over placebo were demonstrated for week 12 secondary and exploratory endpoints, with further improvements at week 16. Treatment-emergent adverse events were similar between treatment groups. LIMITATIONS Greater than expected response rates in placebo-treated patients were possibly attributable to TCS. CONCLUSION Although not statistically significant, numerical improvements over placebo for all week 12 endpoints were demonstrated, with greater week 16 responses.
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Patel KR, Singam V, Vakharia PP, Chopra R, Sacotte R, Patel N, Immaneni S, Kantor R, Hsu DY, Silverberg JI. Measurement properties of three assessments of burden used in atopic dermatitis in adults. Br J Dermatol 2018; 180:1083-1089. [PMID: 30246360 DOI: 10.1111/bjd.17243] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Standardized quality-of-life (QoL) assessments can provide important and clinically relevant information. There is currently a lack of standardization in QoL assessments used in atopic dermatitis (AD). OBJECTIVES To determine the content validity, construct validity, internal consistency, differential reporting, responsiveness, floor or ceiling effects and feasibility of the Dermatology Life Quality Index (DLQI), Itchy Quality of Life (ItchyQoL) and 5-dimensions (5-D) itch scales for assessing burden of AD in adults and to compare their performance. METHODS Self-administered questionnaires and skin examination were performed in 340 adults with AD in a dermatology practice setting. RESULTS DLQI, ItchyQoL and 5-D all had good content validity. DLQI, mean ItchyQoL and 5-D itch all had strong correlations with frequency of AD symptoms (Patient-Oriented Eczema Measure) and intensity of itch (numerical rating scale for itch), and moderate correlations with AD severity (Eczema Area and Severity Index and Scoring Atopic Dermatitis) (Spearman correlations, P < 0·001 for all). DLQI and 5-D itch showed good internal consistency (Cronbach's alpha = 0·89 and 0·84), although ItchyQoL appeared to have several redundant items (alpha = 0·96). Uniform and nonuniform differential item functioning by age, sex and/or race/ethnicity was found for multiple items in DLQI, ItchyQoL and 5-D itch. DLQI, ItchyQoL and 5-D itch scores all demonstrated responsiveness, although ItchyQoL demonstrated the greatest responsiveness. There were no floor or ceiling effects for total scores. The median times for completion of DLQI, ItchyQoL and 5-D itch were 2 min. CONCLUSIONS The DLQI, ItchyQoL and 5-D itch scales all showed good content and construct validity, and responsiveness in the assessment of AD in adults, and were feasible for use in clinical trials and practice.
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Affiliation(s)
- K R Patel
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - V Singam
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - P P Vakharia
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - R Chopra
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - R Sacotte
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - N Patel
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - S Immaneni
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - R Kantor
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - D Y Hsu
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - J I Silverberg
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A.,Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A.,Department of Preventive Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A.,Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, U.S.A
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Argyropoulou M, Kanni T, Kyprianou M, Melachroinopoulos N, Giamarellos‐Bourboulis E. Cost‐savings of adalimumab in hidradenitis suppurativa: a retrospective analysis of a real‐world cohort. Br J Dermatol 2018; 180:1161-1168. [DOI: 10.1111/bjd.17151] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2018] [Indexed: 12/17/2022]
Affiliation(s)
- M. Argyropoulou
- 4th Department of Internal Medicine National and Kapodistrian University of Athens Athens Greece
| | - T. Kanni
- 4th Department of Internal Medicine National and Kapodistrian University of Athens Athens Greece
| | - M. Kyprianou
- 4th Department of Internal Medicine National and Kapodistrian University of Athens Athens Greece
| | - N. Melachroinopoulos
- 4th Department of Internal Medicine National and Kapodistrian University of Athens Athens Greece
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Bao Q, Chen L, Lu Z, Ma Y, Guo L, Zhang S, Huang X, Xu S, Ruan L. Association between eczema and risk of depression: A systematic review and meta-analysis of 188,495 participants. J Affect Disord 2018; 238:458-464. [PMID: 29929155 DOI: 10.1016/j.jad.2018.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 03/30/2018] [Accepted: 05/11/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Several studies were conducted to investigate the association between eczema and risk of depression. This was important because the care of patients with eczema might be inadequate if their psychological problems were not also recognized and treated. However, these studies had some inherent limitations such as small sample sizes or lack of controlling for potential confounders. Further, little was known about psychological co-morbidity of eczema from a global perspective. METHODS We conducted a systematic literature search in PubMed (1966 through January 26th 2017), Cochrane Library (the Cochrane central register of controlled trials, up to January 26th 2017), Scopus (up to December 31st 2016) and Embase (1980 through January 26th 2017) supplemented by manual searches of bibliographies and conference proceedings. The relative risk (RR) with 95% confidence interval (CI) was estimated. RESULTS Ten studies with a total of 188,495 patients were included. Overall, the random effects model summarizing all comparisons suggested a positive association between eczema and risk of depression, the pooled RR was 2.02 (95% confidence interval 1.76 to 2.31, I² = 33.7%). Similar results were observed in subgroup analysis by region. LIMITATIONS Methodological limitations such as selection biases, sample sizes, severity of other diseases, treatment strategy, age and other factors might have influenced the results. CONCLUSIONS Our study showed that patients with eczema were associated with an increased risk of depression. These findings implicated that clinical doctors should continue to be more aware of the association between eczema and the risk of depression.
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Affiliation(s)
- Qinyi Bao
- Department of Mental Health, Ningbo First Hospital, 59 Liuting Road, Ningbo 315010, China; Ningbo University School of Medicine, 818 Fenghua Road, Ningbo 315211, China
| | - Lina Chen
- Department of Respiratory Medicine, Ningbo First Hospital, 59 Liuting Road, Ningbo 315010, China
| | - Zhiyu Lu
- Ningbo University School of Medicine, 818 Fenghua Road, Ningbo 315211, China
| | - Yongyan Ma
- Department of Mental Health, Ningbo First Hospital, 59 Liuting Road, Ningbo 315010, China
| | - Lili Guo
- Department of Mental Health, Ningbo First Hospital, 59 Liuting Road, Ningbo 315010, China
| | - Shuaishuai Zhang
- Department of Mental Health, Ningbo First Hospital, 59 Liuting Road, Ningbo 315010, China
| | - Xiaoping Huang
- Department of Respiratory Medicine, Ningbo First Hospital, 59 Liuting Road, Ningbo 315010, China
| | - Suling Xu
- Department of Dermatology, Affiliated Hospital of Medical College, Ningbo University, Ningbo 315020, China.
| | - Liemin Ruan
- Department of Mental Health, Ningbo First Hospital, 59 Liuting Road, Ningbo 315010, China.
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Chernyshov PV, Boffa MJ, Corso R, Pustišek N, Marinovic B, Manolache L, Salavastru CM, Tiplica GS, Kakourou T, Alexopoulos A, Nasi L, Wojciechowska-Zdrojowy M, Seniuta J, Szepietowski JC, Erkens A, Fölster-Holst R, Sampogna F, Chernyshov AV, Jemec GB, Esmann S, Mazereeuw-Hautier J, Merlos M, Tomas-Aragones L, Marron SE. Creation and pilot test results of the dermatology-specific proxy instrument: the Infants and Toddlers Dermatology Quality of Life. J Eur Acad Dermatol Venereol 2018; 32:2288-2294. [DOI: 10.1111/jdv.15229] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022]
Affiliation(s)
- P. V. Chernyshov
- Department of Dermatology and Venereology; National Medical University; Kiev Ukraine
| | - M. J. Boffa
- Department of Dermatology; Sir Paul Boffa Hospital; Harper Lane Floriana Malta
| | - R. Corso
- Department of Dermatology; Sir Paul Boffa Hospital; Harper Lane Floriana Malta
| | - N. Pustišek
- Medical School; Children's Hospital Zagreb; University of Zagreb; Zagreb Croatia
| | - B. Marinovic
- University Department of Dermatology and Venereology; Clinical Hospital Center Zagreb and School of Medicine of University in Zagreb; Zagreb Croatia
| | | | - C. M. Salavastru
- Department of Paediatric Dermatology; Colentina Clinical Hospital; ‘Carol Davila’ University of Medicine and Pharmacy; Bucharest Romania
| | - G. S. Tiplica
- Department of Dermatology II; Colentina Clinical Hospital; ‘Carol Davila’ University of Medicine and Pharmacy; Bucharest Romania
| | - T. Kakourou
- First Pediatric Department; Athens University; Aghia Sophia Children's Hospital; Athens Greece
| | - A. Alexopoulos
- First Pediatric Department; Athens University; Aghia Sophia Children's Hospital; Athens Greece
| | - L. Nasi
- First Pediatric Department; Athens University; Aghia Sophia Children's Hospital; Athens Greece
| | | | - J. Seniuta
- Department of Dermatology, Venereology and Allergology; Wrocław Medical University; Wrocław Poland
| | - J. C. Szepietowski
- Department of Dermatology, Venereology and Allergology; Wrocław Medical University; Wrocław Poland
| | - A. Erkens
- Dermatology, Venereology and Allergology; University of Schleswig-Holstein; Kiel Germany
| | - R. Fölster-Holst
- Dermatology, Venereology and Allergology; University of Schleswig-Holstein; Kiel Germany
| | - F. Sampogna
- Clinical Epidemiology Unit; Istituto Dermopatico dell'Immacolata (IDI)-IRCCS FLMM; Rome Italy
| | - A. V. Chernyshov
- Department of Cellular Radiobiology; State Institution “National Research Center for Radiation Medicine of National Academy of Medical Sciences of Ukraine”; Kiev Ukraine
| | - G. B. Jemec
- Department of Dermatology; Zealand University Hospital; Roskilde Denmark
| | - S. Esmann
- Department of Dermatology; Zealand University Hospital; Roskilde Denmark
| | - J. Mazereeuw-Hautier
- Department of Dermatology; Reference Centre for Rare Skin Disease; Toulouse University Hospital; Toulouse France
| | - M. Merlos
- Department of Dermatology; Reference Centre for Rare Skin Disease; Toulouse University Hospital; Toulouse France
| | - L. Tomas-Aragones
- Department of Psychology; University of Zaragoza; Aragon Health Sciences Institute (IACS); Zaragoza Spain
| | - S. E. Marron
- Department of Dermatology; Royo Villanova Hospital; Aragon Health Sciences Institute (IACS); Zaragoza Spain
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Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, Simpson EL, Ong PY, Chiesa Fuxench ZC. Patient burden and quality of life in atopic dermatitis in US adults: A population-based cross-sectional study. Ann Allergy Asthma Immunol 2018; 121:340-347. [PMID: 30025911 DOI: 10.1016/j.anai.2018.07.006] [Citation(s) in RCA: 339] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/01/2018] [Accepted: 07/04/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The patient burden and quality of life (QOL) impact of atopic dermatitis (AD) in the United States population is not well established. OBJECTIVE To elucidate the patient burden of AD in the US population. METHODS A cross-sectional, population-based study of 602 adults was performed. Atopic dermatitis was determined using modified UK Diagnostic Criteria for AD. Its severity was assessed using self-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Patient-Oriented Scoring AD (PO-SCORAD), PO-SCORAD-itch, and sleep. Quality of life was assessed using short-form (SF-)12 mental and physical health scores and Dermatology Life Quality Index (DLQI). RESULTS Adults with AD reported higher proportions of having only fair/poor overall health (25.8% vs. 15.8%), being somewhat/very dissatisfied with life (16.7% vs 11.4%), lower weighted mean (standard deviation [SD]) SF-12 mental (45.9 [9.9] vs 50.9 [9.2]) and physical health subscores (53.0 [2.5] vs 53.5 [2.3]) and higher DLQI (4.9 [6.5] vs 1.1 [2.8]). In multivariable regression models adjusting for sociodemographics and multiple comorbid health disorders, significant stepwise decreases by AD severity (self-reported, POEM, PO-SCORAD) of overall health, life satisfaction, SF-12 mental health, and increases of DLQI scores were seen. The SF-12 physical health scores were only associated with moderate AD. Concurrently, severe PO-SCORAD, POEM, or PO-SCORAD-itch was associated with very low mean SF-12 mental health (34.7) and high DLQI scores (24.7). Atopic dermatitis commonly limited lifestyle (51.3%), led to avoidance of social interaction (39.1%), and impacted activities (43.3%). The most burdensome AD symptoms were itch (54.4%), excessive dryness/scaling (19.6%), and red/inflamed skin (7.2%). CONCLUSION These data support the heavy burden that AD places on patients, particularly those with moderate and severe AD.
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Affiliation(s)
| | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - David J Margolis
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mark Boguniewicz
- National Jewish Health and University of Colorado School of Medicine, Denver, Colorado
| | | | - Mitchell H Grayson
- Nationwide Children's Hospital-The Ohio State University College of Medicine, Columbus, Ohio
| | | | - Peck Y Ong
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California
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46
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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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47
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Owen JL, Vakharia PP, Silverberg JI. The Role and Diagnosis of Allergic Contact Dermatitis in Patients with Atopic Dermatitis. Am J Clin Dermatol 2018; 19:293-302. [PMID: 29305764 DOI: 10.1007/s40257-017-0340-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Patients with atopic dermatitis (AD) have increased penetration of allergens, immune dysregulation (including shared cytokine pathways), and frequent use of emollients and topical medications, all of which may predispose toward developing allergic contact dermatitis (ACD). Recent systematic reviews have suggested that ACD is a significant clinical problem in both children and adults with AD. While this remains controversial, ACD remains an important comorbidity and potential exacerbant of AD in clinical practice. Common relevant allergens, include lanolin, neomycin, formaldehyde, sesquiterpene lactone mix, compositae mix, and fragrances that are commonly found in AD patients' personal care products. We herein review the clinical scenarios where patch testing is indicated in AD. In addition, we review the contraindications, preferred patch-testing series, pitfalls, and challenges determining the relevance of positive patch-test reactions in AD patients.
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Affiliation(s)
- Joshua L Owen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Paras P Vakharia
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St, Suite 1600, Chicago, IL, 60611, USA.
- Northwestern Medicine Multidisciplinary Eczema Center, Chicago, USA.
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48
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Vakharia PP, Cella D, Silverberg JI. Patient-reported outcomes and quality of life measures in atopic dermatitis. Clin Dermatol 2018; 36:616-630. [PMID: 30217274 DOI: 10.1016/j.clindermatol.2018.05.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Atopic dermatitis (AD) is a complex and heterogeneous disorder with a profound symptom burden and harmful impact on multiple domains of quality of life (QOL). Many different patient-reported outcome (PRO) measures exist to assess clinical manifestations and QOL impairment in AD, but none comprehensively assess all aspects of the disease. This review addresses the PRO and QOL measures currently used in AD and their properties, strengths, weaknesses, and feasibility for assessing AD in randomized controlled trials and clinical practice. Currently, the patient-oriented eczema measure (POEM) has emerged as a preferred PRO for AD clinical manifestations, though no single instrument has developed as a preferred QOL measure. Validated PRO and QOL measures should be incorporated in all clinical trials of AD and in clinical practice where feasible.
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Affiliation(s)
- Paras P Vakharia
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois, USA.
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49
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Halling-Overgaard AS, Hamann C, Holm R, Linneberg A, Silverberg J, Egeberg A, Thyssen J. Atopic dermatitis and alcohol use - a meta-analysis and systematic review. J Eur Acad Dermatol Venereol 2018; 32:1238-1245. [DOI: 10.1111/jdv.14814] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/10/2018] [Indexed: 12/24/2022]
Affiliation(s)
- A.-S. Halling-Overgaard
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS); Herlev and Gentofte Hospital; Hellerup Denmark
| | - C.R. Hamann
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS); Herlev and Gentofte Hospital; Hellerup Denmark
| | - R.P. Holm
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - A. Linneberg
- Research Centre for Prevention and Health; the Capital Region of Denmark; Copenhagen Denmark
- Department of Clinical Experimental Research; Rigshospitalet Denmark
- Department of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - J.I. Silverberg
- Departments of Dermatology, Preventive Medicine, and Medical Social Sciences; Feinberg School of Medicine at Northwestern University; Chicago IL USA
| | - A. Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS); Herlev and Gentofte Hospital; Hellerup Denmark
| | - J.P. Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS); Herlev and Gentofte Hospital; Hellerup Denmark
- National Allergy Research Centre, Herlev and Gentofte Hospital; Hellerup Denmark
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50
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Liang Y, Tian J, Shen CP, Xu F, Wang H, Li P, Guo YP, Wei FL, Ma L. Therapeutic patient education in children with moderate to severe atopic dermatitis: A multicenter randomized controlled trial in China. Pediatr Dermatol 2018; 35:70-75. [PMID: 29243849 DOI: 10.1111/pde.13362] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Therapeutic patient education is a continuous, systematic, patient-centered learning process to help patients and their families acquire and maintain the skills they need to manage their lives with a chronic disease. It has been proven effective in increasing treatment adherence and improving quality of life for patients with atopic dermatitis (AD) in Western countries. We introduce the first multicenter, randomized controlled clinical trial of therapeutic patient education in Chinese children with AD. OBJECTIVES To evaluate the effects of therapeutic patient education on the severity of AD, quality of life, and understanding and successful use of emollients in Chinese children with eczema. METHODS We recruited 580 children, ages 2-14 years, with moderate to severe AD from six hospitals in China. Participants were randomized (1:1) to an intervention (n = 293) or control (n = 249) group. In addition to the severity of AD, data on quality of life and a questionnaire on family and patient knowledge of emollients were evaluated at the 6-month follow-up. RESULTS On study completion, we found that the intervention group showed a significantly greater reduction in mean SCORing Atopic Dermatitis (P < .001) and Infant's Dermatology Life Quality Index (P = .030) scores than the control group. In addition, knowledge about the use of emollients improved significantly in the intervention group. There was no significant difference between groups in Children's Dermatology Life Quality Index scores. CONCLUSIONS The first randomized controlled trial of a therapeutic patient education program in China had positive long-term effects on decreasing eczema severity and improvement of quality of life in children 2-4 years of age with AD, as well as in promoting greater understanding of the use of emollients.
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Affiliation(s)
- Yuan Liang
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Jing Tian
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Chun Ping Shen
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Feng Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Hua Wang
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Li
- Department of Dermatology, Shenzhen Children's Hospital, Shenzhen, China
| | - Yan Ping Guo
- Department of Dermatology, Harbin Children's Hospital, Harbin, China
| | - Feng Lei Wei
- Department of Dermatology, Dalian Children's Hospital of Dalian Medical University, Dalian, China
| | - Lin Ma
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
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