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Hebert AA, Flohr C, Hong HCH, Irvine AD, Pierce E, Elmaraghy H, Pillai S, Dawson Z, Chen S, Armengol C, Siegfried E, Weidinger S. Efficacy of lebrikizumab in adolescent patients with moderate-to-severe atopic dermatitis: 16-week results from three randomized phase 3 clinical trials. J DERMATOL TREAT 2024; 35:2324833. [PMID: 38735650 DOI: 10.1080/09546634.2024.2324833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/23/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Lebrikizumab, a high-affinity monoclonal antibody targeting IL-13, previously demonstrated clinical efficacy in three randomized, double-blind, placebo-controlled Phase 3 trials that included adults and adolescents with moderate-to-severe atopic dermatitis (AD): ADvocate1, ADvocate2, and ADhere. AIM This subset analysis evaluated 16-week physician- and patient-reported outcomes of lebrikizumab in the adolescent patients enrolled in these three trials. METHODS Eligible adolescents (≥12 to <18 years weighing ≥40kg) were randomized 2:1 to subcutaneous lebrikizumab (500 mg loading doses at baseline and Week 2 followed by 250 mg every 2 weeks) or placebo as monotherapy in ADvocate1&2, and in combination with topical corticosteroids (TCS) in the ADhere study. Week 16 analyses included clinical efficacy outcomes (IGA (0,1) with ≥2-point improvement, EASI 75, EASI 90), patient-reported Pruritus NRS ≥4-point improvement and Sleep-Loss Scale ≥2-point improvement. RESULTS Pooled ADvocate1&2 16-week results in lebrikizumab (N = 67) vs placebo (N = 35) were: IGA (0,1) 46.6% vs 14.3% (p < 0.01), EASI 75 62.0% vs 17.3% (p < 0.001), EASI 90 40.7% vs 11.5% (p < 0.01), Pruritus NRS 48.9% vs 13.1% (p < 0.01), and Sleep-Loss Scale 26.9% vs 6.9% (p = 0.137). Corresponding results for ADhere, (lebrikizumab + TCS, N = 32; placebo + TCS, N = 14), were consistent. CONCLUSIONS Lebrikizumab treatment demonstrated efficacy in improving the signs and symptoms of AD in adolescent patients, consistent with the ADvocate and ADhere overall population results.
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Affiliation(s)
| | - Carsten Flohr
- St John's Institute of Dermatology, King's College London, London, UK
| | - H Chih-Ho Hong
- University of British Columbia, and Probity Medical Research, Surrey, British Columbia, Canada
| | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | | | | | | | - Zach Dawson
- Eli Lilly and Company, Indianapolis, Indiana, USA
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Criado PR, Miot HA, Bueno-Filho R, Ianhez M, Criado RFJ, de Castro CCS. Update on the pathogenesis of atopic dermatitis. An Bras Dermatol 2024:S0365-0596(24)00176-4. [PMID: 39138034 DOI: 10.1016/j.abd.2024.06.001] [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: 06/05/2024] [Accepted: 06/18/2024] [Indexed: 08/15/2024] Open
Abstract
Atopic dermatitis is a chronic, recurrent, and multifactorial skin-mucosal manifestation resulting from the interaction between elements mainly associated with the skin barrier deficit, the homeostasis of the immune response, neurological aspects, and patterns of reactivity to environmental antigens, which are established in genetically predisposed individuals. In addition to the skin, atopic diathesis involves other organs such as the airways (upper and lower), eyes, digestive tract, and neuropsychiatric aspects, which inflict additional morbidity on the dermatological patient. The different phenotypes of the disease fundamentally depend on the participation of each of these factors, in different life circumstances, such as age groups, occupational exposure patterns, physical activity, pollution, genetic load, and climatic factors. A better understanding of the complexity of its pathogenesis allows not only the understanding of therapeutic targets but also how to identify preponderant elements that mediate disease activity in each circumstance, for selecting the best treatment strategies and mitigation of triggering factors. This narrative review presents an update on the pathogenesis of atopic dermatitis, especially aimed at understanding the clinical manifestations, the main disease phenotypes and the context of available therapeutic strategies.
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Affiliation(s)
- Paulo Ricardo Criado
- Centro Universitário Faculdade de Medicina do ABC, Santo André, SP, Brazil; Faculdade de Ciências Médicas de Santos (Centro Universitário Lusíada), Santos, SP, Brazil.
| | - Hélio Amante Miot
- Department of Dermatology, Faculdade de Medicina de Botucatu, Universidade do Estado de São Paulo, Botucatu, SP, Brazil
| | - Roberto Bueno-Filho
- Division of Dermatology, Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Mayra Ianhez
- Department of Dermatology, Hospital de Doenças Tropicais de Goiás, Goiânia, GO, Brazil
| | - Roberta Fachini Jardim Criado
- Centro Universitário Faculdade de Medicina do ABC, Santo André, SP, Brazil; Alergoskin Alergia e Dermatologia, UCARE Center and ADCARE, Santo André, SP, Brazil
| | - Caio César Silva de Castro
- Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil; Hospital de Dermatologia Sanitária do Paraná, Curitiba, PR, Brazil
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Paller AS, Siegfried EC, Marron SE, Clark M, Harris N, Kosa K, Qin S, Whalley D, Chao J, Bansal A, Chuang CC, Wang Z. Skin pain and sleep quality numeric rating scales for children aged 6 months to 5 years with atopic dermatitis. J Eur Acad Dermatol Venereol 2024. [PMID: 38943435 DOI: 10.1111/jdv.20199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/14/2024] [Indexed: 07/01/2024]
Affiliation(s)
- A S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - E C Siegfried
- Saint Louis University, St. Louis, Missouri, USA
- Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA
| | - S E Marron
- Aragon Psychodermatology Research Group (GAI+PD) Partnered with Aragon Health Sciences Institute (IACS), University Hospital Miguel Servet, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
| | - M Clark
- RTI Health Solutions, Ann Arbor, Michigan, USA
| | - N Harris
- RTI Health Solutions, Durham, North Carolina, USA
| | - K Kosa
- RTI Health Solutions, Durham, North Carolina, USA
| | - S Qin
- RTI Health Solutions, Durham, North Carolina, USA
| | - D Whalley
- RTI Health Solutions, Manchester, UK
| | - J Chao
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | - A Bansal
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | | | - Z Wang
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
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Bień B, Krajewski PK, Szepietowski JC. Acne influences life-changing decisions among young adults. Ital J Dermatol Venerol 2024; 159:174-181. [PMID: 38650497 DOI: 10.23736/s2784-8671.24.07754-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Acne is a chronic inflammatory disease predominantly affecting young people. This study was undertaken to assess the impact of acne in young adults on their major life-changing decisions (MLCD), paying attention to the relationships between major life-changing decisions profile (MLCDP) and Quality of Life (QoL), feeling of stigmatization and acceptance of the disease. METHODS The study was performed on 213 young people diagnosed with acne. A variety of questionnaires were employed to measure the clinical and psychological aspects of acne. RESULTS The majority of patients (N.=148, 73.3%) reported at least one MLCD that acne affected in any way (mean number 2.9±3.2, range: 0-18). The most common MLCD influenced by acne appeared to be a decision of changing eating habits (N.=132, 65.3%), followed by changing habits associated with smoking and alcohol (N.=85, 42.1%) and deciding to be more active physically (N.=61, 30.2%). The total score of MLCDP ranged from 0 to 33 points (mean 5.41±6.23 points). MLCDP total score significantly correlated with clinical acne severity (P=0.006), QoL (P<0.001), stigmatization (P<0.001) and illness acceptance (P<0.001). CONCLUSIONS Acne has an important impact on life-changing decisions in young adults. MLCDP correlates with impaired QoL, level of stigmatization and degree of illness acceptance. This should be taken into consideration in the holistic approach to acne patients.
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Affiliation(s)
- Beata Bień
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland -
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Paller AS, Flohr C, Eichenfield LF, Irvine AD, Weisman J, Soung J, Pinto Correia A, Natalie CR, Rodriguez Capriles C, Pierce E, Reifeis S, Gontijo Lima R, Armengol Tubau C, Laquer V, Weidinger S. Safety and Efficacy of Lebrikizumab in Adolescent Patients with Moderate-to-Severe Atopic Dermatitis: A 52-Week, Open-Label, Phase 3 Study. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00942-y. [PMID: 37318750 DOI: 10.1007/s13555-023-00942-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/17/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic inflammatory skin disorder with limited treatment options for adolescents with moderate-to-severe disease. Lebrikizumab, a monoclonal antibody targeting interleukin (IL)-13, demonstrated clinical benefit in previous Phase 3 trials: ADvocate1 (NCT04146363), ADvocate2 (NCT04178967), and ADhere (NCT04250337). We report 52-week safety and efficacy outcomes from ADore (NCT04250350), a Phase 3, open-label study of lebrikizumab in adolescent patients with moderate-to-severe AD. The primary endpoint was to describe the proportion of patients who discontinued from study treatment because of adverse events (AEs) through the last treatment visit. METHODS Adolescent patients (N = 206) (≥ 12 to < 18 years old, weighing ≥ 40 kg) with moderate-to-severe AD received subcutaneous lebrikizumab 500 mg loading doses at baseline and Week 2, followed by 250 mg every 2 weeks (Q2W) thereafter. Safety was monitored using reported AEs, AEs leading to treatment discontinuation, vital signs, growth assessments, and laboratory testing. Efficacy analyses included Eczema Area and Severity Index (EASI), Investigator's Global Assessment (IGA), Body Surface Area (BSA), (Children's) Dermatology Life Quality Index ((C)DLQI), and Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, and PROMIS Depression. RESULTS 172 patients completed the treatment period. Low frequencies of SAEs (n = 5, 2.4%) and AEs leading to treatment discontinuation (n = 5, 2.4%) were reported. Overall, 134 patients (65%) reported at least one treatment-emergent AE (TEAE), most being mild or moderate in severity. In total, 62.6% achieved IGA (0,1) with ≥ 2-point improvement from baseline and 81.9% achieved EASI-75 by Week 52. The EASI mean percentage improvement from baseline to Week 52 was 86.0%. Mean BSA at baseline was 45.4%, decreasing to 8.4% by Week 52. Improvements in mean change from baseline (CFB) to Week 52 were observed in DLQI (baseline 12.3; CFB - 8.9), CDLQI (baseline 10.1; CFB - 6.5), PROMIS Anxiety (baseline 51.5; CFB - 6.3), and PROMIS Depression (baseline 49.3; CFB - 3.4) scores. CONCLUSIONS Lebrikizumab 250 mg Q2W had a safety profile consistent with previous trials and significantly improved AD symptoms and quality of life, with meaningful responses at Week 16 increasing by Week 52. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT04250350.
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Affiliation(s)
- Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Carsten Flohr
- St John's Institute of Dermatology, King's College London, London, UK
| | | | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Jennifer Soung
- Southern California Dermatology, Inc., Santa Ana, CA, USA
| | | | | | | | | | | | | | | | | | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
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Inomata T, Sung J, Fujio K, Nakamura M, Akasaki Y, Nagino K, Okumura Y, Iwagami M, Fujimoto K, Ebihara N, Nakamura M, Midorikawa-Inomata A, Shokirova H, Huang T, Hirosawa K, Miura M, Ohno M, Morooka Y, Iwata N, Iwasaki Y, Murakami A. Individual multidisciplinary clinical phenotypes of nasal and ocular symptoms in hay fever: Crowdsourced cross-sectional study using AllerSearch. Allergol Int 2023:S1323-8930(23)00001-1. [PMID: 36740498 DOI: 10.1016/j.alit.2023.01.001] [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: 08/28/2022] [Revised: 10/08/2022] [Accepted: 12/15/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multidisciplinary efforts to prospectively collect and analyze symptoms of hay fever are limited. We aimed to identify the characteristics of nasal and ocular symptoms of hay fever, using the AllerSearch smartphone application. METHODS This mobile health-based prospective observational study using the AllerSearch smartphone application was conducted between February 1, 2018, and May 1, 2020. Individuals who downloaded AllerSearch from Japan and provided comprehensive self-assessments (including 17 items related to quality of life [QoL]-related items) were included. The characteristics and risk factors for allergic rhinitis (AR) and allergic conjunctivitis (AC) were identified using hierarchical heat maps and multivariate logistic regression. RESULTS Of the 9041 participants with hay fever, 58.8% had AR and AC, 22.2% had AR, and 5.7% had AC. The AR-AC comorbid cohort showed worse symptoms of hay fever and QoL scores than the other cohorts. Factors (odds ratio, 95% confidence interval) associated with AR-AC included a lower age (0.98, 0.97-0.98), female sex (1.31, 1.19-1.45), liver disease (1.58, 1.26-2.35), dry eye disease (1.45, 1.30-1.63), unknown dry eye disease status (1.46, 1.31-1.62), contact lens use discontinuation during the hay fever season (1.69, 1.28-2.23), and bedroom flooring material other than hardwood, carpet, tatami, or vinyl (1.91, 1.16-3.14). CONCLUSIONS Analysis of medical big data for hay fever performed using a mobile health app helped identify risk factors and characteristics of AC, AR, and AR-AC. Phenotyping of highly variable symptoms of hay fever, such as nasal and ocular symptoms, can facilitate better-quality clinical care.
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Affiliation(s)
- Takenori Inomata
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan; AI Incubation Farm, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Jaemyoung Sung
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Kenta Fujio
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masahiro Nakamura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Precision Health, Department of Bioengineering, Graduate School of Bioengineering, The University of Tokyo, Tokyo, Japan
| | - Yasutsugu Akasaki
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ken Nagino
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuichi Okumura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Keiichi Fujimoto
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology, Urayasu Hospital, Juntendo University, Chiba, Japan
| | - Masahiro Nakamura
- Department of Otorhinolaryngology and Head and Neck Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Akie Midorikawa-Inomata
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hurramhon Shokirova
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tianxiang Huang
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kunihiko Hirosawa
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Maria Miura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mizu Ohno
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Morooka
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nanami Iwata
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuma Iwasaki
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Neri I, Galli E, Baiardini I, Picozza M, Rossi AB, Matruglio P, Moretti D, Cipriani F. Implications of Atopic Dermatitis on the Quality of Life of 6-11 Years Old Children and Caregivers (PEDI-BURDEN). J Asthma Allergy 2023; 16:383-396. [PMID: 37077900 PMCID: PMC10106808 DOI: 10.2147/jaa.s404350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/20/2023] [Indexed: 04/21/2023] Open
Abstract
Purpose Atopic dermatitis (AD) is a chronic, relapsing and remitting inflammatory skin disease characterized by intense itch. The disease burden includes physical limitations, psychosocial discomfort, and a reduced quality of life (HRQoL). This study presents the results of a parent-reported survey on the psychosocial impact of AD on Italian pre-adolescent children (6-11 years old), with a specific focus on bullying, self-isolation, absenteeism, and presenteeism. Methods An online questionnaire was sent to 3067 random recipients and 160 matched the inclusion criteria for age, self-reported AD diagnosis, localizations (according to ISAAC), and disease severity (POEM ≥8). 100 children, with comparable ages, not matching the inclusion criteria for AD, were recruited as a control group. Results Children with AD and their caregivers had a significantly lower quality of sleep (QoS) compared to the control group. The presence of AD was directly responsible for many restless nights, both in children and caregivers (58.9 and 55.4 respectively). Children with AD and their parents also experienced significantly more daytime drowsiness (43.6 and 54.6 days, respectively). Children with AD were more frequently victims of bullying at school (20.0% vs 9.0%; p≤0.05) or in other social environments (16.9% vs 3.0%; p≤0.05). AD caused 17.7 days of absenteeism and 20.1 days of presenteeism per student over the previous 12 months, accounting for 37.8 days of study impairment overall. Severe/very severe AD had a significantly greater impact on presenteeism than moderate AD (25.1 vs 17.5 days; p≤0.05). Presenteeism, which was more pronounced among bullied students, was positively correlated with absenteeism only in the AD cohort. Conclusion AD has a detrimental impact on the HRQoL of pediatric patients, causing stigmatization and social isolation. Functional distress was also reported by caregivers. Our study might inform the public and policymakers about the disease burden of AD at a young age.
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Affiliation(s)
- Iria Neri
- Dermatology Unit, IRCCS Azienda Ospedaliero Universitaria Bologna, University of Bologna, Bologna, Italy
| | - Elena Galli
- UOS Immuno-Allergologia dell’Età evolutive, Ospedale S.Pietro-Fatebenefratelli, Rome, Italy
| | - Ilaria Baiardini
- Respiratory Unit for Continuity of Care, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
- Personalized Medicine Asthma, & Allergy Clinic, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Mario Picozza
- National Association of Atopic Dermatitis (ANDeA), Prato, Italy
- Neuroimmunology Unit, Santa Lucia Foundation IRCCS, Rome, Italy
| | | | | | | | - Filippo Cipriani
- Sanofi, Milan, Italy
- Correspondence: Filippo Cipriani, Sanofi, Viale Bodio 37b, Milan, Italy, Email
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Paller AS, Yosipovitch G, Weidinger S, DiBenedetti D, Whalley D, Gadkari A, Guillemin I, Zhang H, Eckert L, Chao J, Bansal A, Chuang CC, Delevry D. Development, Psychometric Validation and Responder Definition of Worst Itch Scale in Children with Severe Atopic Dermatitis. Dermatol Ther (Heidelb) 2022; 12:2839-2850. [PMID: 36269504 DOI: 10.1007/s13555-022-00804-z] [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: 07/14/2022] [Accepted: 08/26/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Itch associated with atopic dermatitis (AD) has a profoundly negative effect on patients of all ages. Therefore, itch is a main target for AD therapeutic approaches, and treatments are perceived as beneficial when they achieve an itch reduction. In the absence of a validated scale for children aged 6-11 years that is suitable for assessing itch intensity in clinical trial settings, the Worst Itch Scale was developed. METHODS Qualitative interviews, comprising concept elicitation and cognitive debriefing, were conducted to develop and evaluate the content validity of the Worst Itch Scale. Psychometric assessments used data from the LIBERTY AD PEDS phase 3 trial of dupilumab in patients aged 6-11 years with severe AD. These included test-retest reliability, construct validity, known-groups validity and responsiveness. Thresholds for clinically meaningful change were defined using anchor- and distribution-based methods. RESULTS The Worst Itch Scale consisted of two items asking about 'worst itching' experienced 'last night' and 'today'. Worst Itch Scale scores showed large, positive correlations with existing patient-reported outcome (PRO) measures of itch, and weaker correlations with clinician-reported outcome (ClinRO) measures assessing objective signs of AD. Improvements in Worst Itch Scale scores were highly correlated with improvements in other itch PROs and moderately correlated with improvements in ClinROs. The responder definition based on the primary anchor, a 1-point improvement in the Patient Global Impression of Disease, was 2.84. Supportive anchors produced response estimates ranging from 2.43 to 4.80 points. CONCLUSIONS The Worst Itch Scale is a fit-for-purpose (e.g. well-defined, reliable, responsive and valid) scale for evaluating worst itch intensity in children aged 6-11 years with severe AD. The within-patient threshold for defining a clinically meaningful response was a ≥ 3-4-point change in the Worst Itch Scale score. TRIAL REGISTRATION NCT03345914. Video: How can we reliably assess itch intensity in children 6-11 years with severe atopic dermatitis in clinical trial settings?
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Affiliation(s)
- Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Gil Yosipovitch
- Department of Dermatology and Itch Center, University of Miami, Miami, FL, USA
| | - Stephan Weidinger
- Department of Dermatology and Allergy, Center for Inflammatory Skin Diseases, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | | | - Diane Whalley
- RTI Health Solutions, Wilmslow Road, Didsbury, Manchester, UK
| | | | | | - Haixin Zhang
- Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Rd, Tarrytown, NY, USA
| | - Laurent Eckert
- Sanofi Aventis, 1 Avenue Pierre Brossolette, 91380, Chilly-Mazarin, France
| | - Jingdong Chao
- Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Rd, Tarrytown, NY, USA
| | - Ashish Bansal
- Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Rd, Tarrytown, NY, USA
| | | | - Dimittri Delevry
- Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Rd, Tarrytown, NY, USA
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Wang X, Meng J, Wu Q, Feng J, Jing H. Clinical Efficacy of Integrated Traditional Chinese and Western Medicine in the Treatment of Eczema: A Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7202626. [PMID: 35401779 PMCID: PMC8986438 DOI: 10.1155/2022/7202626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/05/2022] [Accepted: 01/17/2022] [Indexed: 11/18/2022]
Abstract
Background Both traditional Chinese medicine (TCM) and Western medicine are widely applied in the treatment of eczema, but there are few reports on integrated TCM and Western medicine for eczema. Objective This meta-analysis carried out the evaluation on the efficacy of integrated TCM and Western medicine in the treatment of eczema. Methods PubMed, Web of Science, Embase, CNKI, and Wanfang databases were searched for all possible randomized controlled trials from 2000 to 2021. A meta-analysis of the included studies was also performed using Stata16 software. Results A total of 16 studies including 1946 patients were included. Compared with the control group, the pooled results of the 16 studies showed that effective rate in the treatment group was higher (OR = 4.50, 95% CI: 3.16-6.40, P < 0.05), and the pooled data of 15 studies revealed that the cure rate was increased in the treatment group (OR = 2.60, 95% CI: 2.13-3.18, P < 0.05). Additionally, compared with the control group, pooled data of 11 studies demonstrated that lesion area after treatment was reduced in the treatment group (SMD = -1.91; 95% CI: -2.51, -1.31; P < 0.05), and pooled data of 9 studies showed that the degree of pruritus after treatment in the treatment group was lower (SMD = -1.69; 95% CI: -2.07, -1.30; P < 0.05). Conclusion In comparison with Western medicine alone, integrated TCM and Western medicine are a more effective treatment for eczema, which can not only significantly improve the effective rate and cure rate but also reduce the lesion area and degree of pruritus.
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Affiliation(s)
- Xingxing Wang
- Department of Dermatology, Xi'an Hospital of Traditional Chinese Medicine, Xi'an, Shaanxi 710021, China
| | - Jian Meng
- Department of Second Surgery, Gushi County Hospital of Traditional Chinese Medicine, Xinyang, Henan 465200, China
| | - Qing Wu
- Department of Dermatology, Xi'an Hospital of Traditional Chinese Medicine, Xi'an, Shaanxi 710021, China
| | - Jingjing Feng
- Department of Dermatology, Xi'an Hospital of Traditional Chinese Medicine, Xi'an, Shaanxi 710021, China
| | - Huiling Jing
- Department of Dermatology, Xi'an Hospital of Traditional Chinese Medicine, Xi'an, Shaanxi 710021, China
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10
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Skin Disease in Children: Effects on Quality of Life, Stigmatization, Bullying, and Suicide Risk in Pediatric Acne, Atopic Dermatitis, and Psoriasis Patients. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8111057. [PMID: 34828770 PMCID: PMC8619705 DOI: 10.3390/children8111057] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/23/2022]
Abstract
Acne, atopic dermatitis (AD), and psoriasis are all chronic dermatologic conditions that greatly impact the lives of pediatric patients and their caregivers. The visible nature of these diseases negatively affects the self-image of children early in life as well as their relationships with their families and peers. Physicians recognize the importance of addressing both the physical and mental symptoms of their patients but are currently not equipped with clear guidelines to manage long-term psychosocial comorbidities in pediatric dermatologic patients. A PubMed and Google Scholar search of key words was conducted to explore self-image in pediatric patients with acne, AD, and psoriasis. Chronic skin diseases put pediatric patients at risk for strained family relationships, poor self-image, psychiatric comorbidities, stigmatization, and eventual suicidal behavior. A limitation of this study is a lack of a validated measure of quality of life in the pediatric population that fulfills enough criteria to evaluate long term quality of life in children and adults. Possible management options, including connecting patients with the same diagnosis and allocating resources to parents and teachers to better understand these chronic skin conditions, may provide pediatric patients with the support they need to develop resilience in the face of these challenges.
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11
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Stingeni L, Belloni Fortina A, Baiardini I, Hansel K, Moretti D, Cipriani F. Atopic Dermatitis and Patient Perspectives: Insights of Bullying at School and Career Discrimination at Work. J Asthma Allergy 2021; 14:919-928. [PMID: 34321892 PMCID: PMC8312319 DOI: 10.2147/jaa.s317009] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by recurrent eczematous lesions and intense pruritus. AD patients are known to face a considerable disease burden, including physical and emotional limitations. There is still limited knowledge about daily implications in education and occupation. We describe disease social stigmatization by measuring bullying and self-isolation in students and professional discrimination in workers. Overall loss of productivity, either at school and at the workplace, was quantified as the sum of absenteeism (number of days AD sick leave) and presenteeism (number of days with decreased focus and functionality). Methods An on-line web survey was sent to 3235 random recipients and 401 met the inclusion criteria (self-reporting AD and ≥12 yo). The survey domains included daily limitations, QoL, feelings and relationships, together with specific questions about bullying, discrimination and loss of productivity. Results AD negatively affected QoL in 51.6% of respondents, whereas 68.8% considered AD as a real limit to daily routine. More in detail, 39.3% of students were victims of bullying and 33.9% of workers felt discriminated because of AD. On average, absenteeism in students was for 17.1 days/year (presenteeism: 19.5 days/year), whereas in workers, the estimate was 10.9 days/year (presenteeism: 13.1 days/year). Absenteeism and presenteeism were more pronounced in bullied/discriminated subjects. Conclusion AD multidimensional implications deeply affect and undermine personal and professional fulfillments. Our results contribute to a better understanding of what living with AD means.
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Affiliation(s)
- Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Anna Belloni Fortina
- Unit of Dermatology, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Ilaria Baiardini
- Respiratory Unit for Continuity of Care, IRCCS, Ospedale Policlinico San Martino, Genova, Italy.,Personalized Medicine Asthma, & Allergy Clinic, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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12
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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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13
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Gieler U, Gieler T, Peters EMJ, Linder D. Haut und Psychosomatik – Psychodermatologie heute. J Dtsch Dermatol Ges 2020; 18:1280-1300. [PMID: 33251743 DOI: 10.1111/ddg.14328_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Uwe Gieler
- Universitäts-Hautklinik, Universitätsklinikum Gießen
| | - Tanja Gieler
- Kinder- und Jugendpsychosomatik, Universitäts-Kinderklinik, Universitätsklinikum Gießen
| | - Eva Milena Johanne Peters
- Psychoneuroimmunologie Labor, Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Gießen, Gießen in Kooperation mit der Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin - Charité, Berlin
| | - Dennis Linder
- Universitäts-Hautklinik, Universität Padua, Italien, Institut für Medizinische Psychologie und Psychotherapie, Medizinische Universität Graz, Österreich
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14
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Wollenberg A, Christen‐Zäch S, Taieb A, Paul C, Thyssen J, Bruin‐Weller M, Vestergaard C, Seneschal J, Werfel T, Cork M, Kunz B, Fölster‐Holst R, Trzeciak M, Darsow U, Szalai Z, Deleuran M, Kobyletzki L, Barbarot S, Heratizadeh A, Gieler U, Hijnen D, Weidinger S, De Raeve L, Svensson Å, Simon D, Stalder J, Ring J. ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. J Eur Acad Dermatol Venereol 2020; 34:2717-2744. [DOI: 10.1111/jdv.16892] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/10/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023]
Affiliation(s)
- A. Wollenberg
- Department of Dermatology and Allergy Ludwig‐Maximilian‐University Munich Germany
| | - S. Christen‐Zäch
- Pediatric Dermatology Unit Departments of Dermatology and Pediatrics Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - A. Taieb
- University of Bordeaux Bordeaux France
| | - C. Paul
- Department of Dermatology and Allergy Toulouse University and CHU Toulouse France
| | - J.P. Thyssen
- Department of Dermatology and Allergy Herlev‐Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
| | - M. Bruin‐Weller
- National Expertise Center for Atopic Dermatitis Department of Dermatology and Allergology University Medical Center Utrecht The Netherlands
| | - C. Vestergaard
- Department of Dermatology Aarhus University Hospital Aarhus Denmark
| | - J. Seneschal
- Department of Dermatology National Reference Center for Rare Skin Diseases Bordeaux University Hospitals Bordeaux France
| | - T. Werfel
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - M.J. Cork
- Sheffield Dermatology Research IICDUniversity of Sheffield UK
| | - B. Kunz
- Dermatologikum Hamburg Hamburg Germany
| | - R. Fölster‐Holst
- Department of Dermatology and Allergy University Hospital Schleswig‐Holstein Kiel Germany
| | - M. Trzeciak
- Department of Dermatology, Venereology and Allergology Medical University of Gdansk Gdansk Poland
| | - U. Darsow
- Department of Dermatology and Allergy Biederstein Technische Universität München Munich Germany
- ZAUM – Center of Allergy & Environment Munich Germany
| | - Z. Szalai
- Department of Dermatology Heim Pál National Children’s Institute Budapest Hungary
| | - M. Deleuran
- Department of Dermatology Aarhus University Hospital Aarhus Denmark
| | - L. Kobyletzki
- School of Medical Sciences Lund University Malmö Sweden
- School of Medical Sciences Örebro University Örebro Sweden
| | - S. Barbarot
- Department of Dermatology CHU Nantes UMR 1280 PhAN INRA, F‐44000 Nantes Université Nantes France
| | - A. Heratizadeh
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - U. Gieler
- Department of Dermatology University of Gießen and Marburg GmbH Gießen Germany
| | - D.J. Hijnen
- Department of Dermatology Erasmus MC University Medical Center Rotterdam The Netherlands
| | - S. Weidinger
- Department of Dermatology and Allergy University Hospital Schleswig‐Holstein Kiel Germany
| | - L. De Raeve
- Department of Dermatology Universitair Ziekenhuis Brussel (UZB)Free University of Brussels (VUB) Brussels Belgium
| | - Å. Svensson
- Department of Dermatology Skane University Hospital Malmö Sweden
| | - D. Simon
- Department of Dermatology, Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - J.F. Stalder
- Department of Dermatology CHU Nantes UMR 1280 PhAN INRAE, F‐44000 Nantes Université Nantes France
| | - J. Ring
- Department of Dermatology and Allergy Biederstein Technische Universität München Munich Germany
- Christiane‐Kühne Center for Allergy Research and Education (CK‐Care) Davos Switzerland
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15
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Gieler U, Gieler T, Peters EMJ, Linder D. Skin and Psychosomatics - Psychodermatology today. J Dtsch Dermatol Ges 2020; 18:1280-1298. [PMID: 33251751 PMCID: PMC7756276 DOI: 10.1111/ddg.14328] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023]
Abstract
Modern psychodermatology relies on the bio-psycho-social disease model in psychosomatics, according to which biological, psychological and social factors (on various levels, from molecules to the biosphere) play a major role in the disease pathogenesis through complex, non-linear interactions over the entire disease course. It is nowadays experimentally proven that "emotions get into the skin". Recent research shows close anatomical, physiological and functional connections between skin and nervous system, already known to be ontogenetically related. These connections are reflected in many skin diseases where psychological and somatic etiological factors are closely intertwined. A holistic approach by the physician should do justice to this interdependence; biological, psychological and social factors should be adequately taken into account when taking anamnesis, making a diagnosis and choosing a therapy. The "visibility" of the skin organ bestows dermatology a special position among the various other clinical subjects, and renders a holistic, psychosomatic approach to the patient that is particularly important. The life course belongs also to modern psychodermatological approaches. Based on the modern psychodermatology concept, other corresponding sub-areas such as psychogastroenterology, psychocardiology etc. have emerged. After the theoretical part of this article, some selected skin diseases are discussed in more detail from the psychosomatic point of view.
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Affiliation(s)
- Uwe Gieler
- Department of DermatologyUniversity Hospital Gießen
| | - Tanja Gieler
- Psychosomatic Medicine for Children and AdolescentsDepartment of PediatricsUniversity Hospital Gießen
| | - Eva Milena Johanne Peters
- Laboratory for PsychoneuroimmunologyDepartment of Psychosomatic Medicine and PsychotherapyUniversity Hospital Gießen in cooperation with the Department of Psychosomatic Medicine and PsychotherapyUniversity Hospital – CharitéBerlin
| | - Dennis Linder
- Department of DermatologyUniversity of PaduaItalyInstitute for Medical Psychology and PsychotherapyMedical University GrazAustria
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16
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Sawangjit R, Dilokthornsakul P, Lloyd-Lavery A, Lai NM, Dellavalle R, Chaiyakunapruk N. Systemic treatments for eczema: a network meta-analysis. Cochrane Database Syst Rev 2020; 9:CD013206. [PMID: 32927498 PMCID: PMC8128359 DOI: 10.1002/14651858.cd013206.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Eczema is a common and chronic, relapsing, inflammatory skin disorder. It seriously impacts quality of life and economic outcomes, especially for those with moderate to severe eczema. Various treatments allow sustained control of the disease; however, their relative benefit remains unclear due to the limited number of trials directly comparing treatments. OBJECTIVES To assess the comparative efficacy and safety of different types of systemic immunosuppressive treatments for moderate to severe eczema using NMA and to generate rankings of available systemic immunosuppressive treatments for eczema according to their efficacy and safety. SEARCH METHODS We searched the following databases up to August 2019: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, and Embase. SELECTION CRITERIA All randomised controlled trials (RCTs) of systemic immunosuppressive agents for moderate to severe atopic eczema when compared against placebo or any other eligible eczema treatment. DATA COLLECTION AND ANALYSIS We synthesised data using pair-wise analysis and NMA to compare treatments and rank them according to their effectiveness. Effectiveness was assessed primarily by determining the proportion of participants who achieved at least 75% improvement in the Eczema Area and Severity Index (EASI75) and improvement in the Patient-Oriented Eczema Measure (POEM). Safety was evaluated primarily by considering the proportion of participants with serious adverse events (SAEs) and infection. We deemed short-term follow-up as ≤ 16 weeks and long-term follow-up as > 16 weeks. We assessed the certainty of the body of evidence from the NMA for these primary outcomes using six domains of CiNEMA grading. MAIN RESULTS We included a total of 74 studies, with 8177 randomised participants. Approximately 55% of participants were male, with average age of 32 years (range 2 to 84 years), although age and gender were unreported for 419 and 902 participants, respectively. Most of the included trials were placebo controlled (65%), 34% were head-to-head studies (15% assessed the effects of different doses of the same drug), and 1% were multi-armed studies with both an active comparator and a placebo. All trials included participants with moderate to severe eczema, but 62% of studies did not separate data by severity; 38% of studies assessed only severe eczema. The total duration of included trials ranged from 2 weeks to 60 months, whereas treatment duration varied from a single dose (CIM331, KPL-716) to 60 months (methotrexate (MTX)). Seventy studies were available for quantitative synthesis; this review assessed 29 immunosuppressive agents from three classes of interventions. These included (1) conventional treatments, with ciclosporin assessed most commonly; (2) small molecule treatments, including phosphodiesterase (PDE)-4 inhibitors, tyrosine kinase inhibitors, and Janus kinase (JAK) inhibitors; and (3) biological treatments, including anti-CD31 receptors, anti-interleukin (IL)-22, anti-IL-31, anti-IL-13, anti-IL-12/23p40, anti-OX40, anti-TSLP, anti-CRTH2, and anti-immunoglobulin E (IgE) monoclonal antibodies, but most commonly dupilumab. Most trials (73) assessed outcomes at a short-term duration ranging from 2 to 16 weeks, whereas 33 trials assessed long-term outcomes, with duration ranging from 5 to 60 months. All participants were from a hospital setting. Fifty-two studies declared a source of funding, and of these, pharmaceutical companies funded 88%. We rated 37 studies as high risk; 21, unclear risk, and 16, low risk of bias, with studies most commonly at high risk of attrition bias. Network meta-analysis suggests that dupilumab ranks first for effectiveness when compared with other biological treatments. Dupilumab is more effective than placebo in achieving EASI75 (risk ratio (RR) 3.04, 95% confidence interval (CI) 2.51 to 3.69) and improvement in POEM score (mean difference 7.30, 95% CI 6.61 to 8.00) at short-term follow-up (high-certainty evidence). Very low-certainty evidence means we are uncertain of the effects of dupilumab when compared with placebo, in terms of the proportion of participants who achieve EASI75 (RR 2.59, 95% CI 1.87 to 3.60) at longer-term follow-up. Low-certainty evidence indicates that tralokinumab may be more effective than placebo in achieving short-term EASI75 (RR 2.54, 95% CI 1.21 to 5.34), but there was no evidence for tralokinumab to allow us to assess short-term follow-up of POEM or long-term follow-up of EASI75. We are uncertain of the effect of ustekinumab compared with placebo in achieving EASI75 (long-term follow-up: RR 1.17, 95% CI 0.40 to 3.45; short-term follow-up: RR 0.91, 95% CI 0.28 to 2.97; both very low certainty). We found no evidence on ustekinumab for the POEM outcome. We are uncertain whether other immunosuppressive agents that targeted our key outcomes influence the achievement of short-term EASI75 compared with placebo due to low- or very low-certainty evidence. Dupilumab and ustekinumab were the only immunosuppressive agents evaluated for longer-term EASI75. Dupilumab was the only agent evaluated for improvement in POEM during short-term follow-up. Low- to moderate-certainty evidence indicates a lower proportion of participants with SAEs after treatment with QAW039 and dupilumab compared to placebo during short-term follow-up, but low- to very low-certainty evidence suggests no difference in SAEs during short-term follow-up of other immunosuppressive agents compared to placebo. Evidence for effects of immunosuppressive agents on risk of any infection during short-term follow-up and SAEs during long-term follow-up compared with placebo was of low or very low certainty but did not indicate a difference. We did not identify differences in other adverse events (AEs), but dupilumab is associated with specific AEs, including eye inflammation and eosinophilia. AUTHORS' CONCLUSIONS Our findings indicate that dupilumab is the most effective biological treatment for eczema. Compared to placebo, dupilumab reduces eczema signs and symptoms in the short term for people with moderate to severe atopic eczema. Short-term safety outcomes from clinical trials did not reveal new safety concerns with dupilumab. Overall, evidence for the efficacy of most other immunosuppressive treatments for moderate to severe atopic eczema is of low or very low certainty. Given the lack of data comparing conventional with newer biological treatments for the primary outcomes, there remains high uncertainty for ranking the efficacy and safety of conventional treatments such as ciclosporin and biological treatments such as dupilumab. Most studies were placebo-controlled and assessed only short-term efficacy of immunosuppressive agents. Further adequately powered head-to-head RCTs should evaluate comparative long-term efficacy and safety of available treatments for moderate to severe eczema.
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Affiliation(s)
- Ratree Sawangjit
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mahasarakham University, Mahasarakham, Thailand
| | - Piyameth Dilokthornsakul
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Antonia Lloyd-Lavery
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nai Ming Lai
- School of Medicine, Taylor's University, Subang Jaya, Malaysia
| | | | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
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17
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Maurice‐Stam H, Nijhof SL, Monninkhof AS, Heymans HSA, Grootenhuis MA. Review about the impact of growing up with a chronic disease showed delays achieving psychosocial milestones. Acta Paediatr 2019; 108:2157-2169. [PMID: 31250466 DOI: 10.1111/apa.14918] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 01/02/2023]
Abstract
AIM This review aimed to provide a comprehensive overview of the psychosocial developmental trajectory of various diseases during childhood and adolescence. METHODS Studies of Dutch young adults aged 18-35 years, who had grown up with a chronic disease, were included if the Course of Life Questionnaire had been used to assess psychosocial developmental milestones in three domains: social, autonomy and psychosexual. Differences between the disease groups and the general population were presented as Cohen's d and odds ratios. RESULTS We included 17 studies comprising 1899 young adults, who had grown up with 18 different paediatric diseases. Psychosocial development was delayed in all three questionnaire domains. Remarkable findings with regard to specific milestones were as follows: less participation in sports clubs in the social domain, less likely to have had paid jobs in the autonomy domain and later sexual intimacy in the psychosexual domain. End-stage renal disease, galactosaemia (males), childhood cancer and orthotopic liver transplants were the most affected disease groups. CONCLUSION Children and adolescents with chronic diseases risked delays in psychosocial development. This should be addressed by healthcare providers, along with the physical aspects of diseases, and they should focus on the optimal psychosocial development of the patient.
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Affiliation(s)
- Heleen Maurice‐Stam
- Psychosocial Department Emma Children's Hospital Amsterdam University Medical Centers University of Amsterdam Amsterdam The Netherlands
| | - Sanne L. Nijhof
- Division of Paediatrics Wilhelmina Children's Hospital University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Anneke S. Monninkhof
- Division of Paediatrics Wilhelmina Children's Hospital University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Hugo S. A. Heymans
- Department of Paediatrics Emma Children's Hospital Amsterdam University Medical Centers University of Amsterdam Amsterdam The Netherlands
| | - Martha A. Grootenhuis
- Psychosocial Department Emma Children's Hospital Amsterdam University Medical Centers University of Amsterdam Amsterdam The Netherlands
- Princess Máxima Center for Paediatric Oncology Utrecht The Netherlands
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18
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Abstract
PURPOSE OF REVIEW The effects of skin disease on stigmatization are important but understudied in the pediatric population. Given the highly visible nature of dermatologic conditions, stigmatization is a common problem that requires significant attention in patients with skin diseases. In this review, we examine the recent literature addressing stigmatization of patients suffering from common dermatologic diseases with the goal to increase clinician awareness of these issues and identify new avenues for future research. RECENT FINDINGS A number of studies have examined the impact of skin disease on psychosocial well being and quality of life. Although some skin diseases are often overlooked medically and considered to be primarily cosmetic issues, the long-term consequences of skin diseases on psychosocial health, especially in pediatric patients, can be profound. SUMMARY The precipitating factors for stigma vary widely depending on age, sex, and culture. In order to effectively reduce the impact of pediatric skin diseases on psychosocial health, physicians should be able to identify specific characteristics that may increase risks for stigmatization in chidlren. Carefully monitoring psychosocial development in pediatric patients with dermatological conditions in addition to proactively guiding patients and families to appropriate resources can benefit the child's development and overall long-term well being.
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Affiliation(s)
- Julie H Wu
- Baylor College of Medicine, Houston, Texas
| | - Bernard A Cohen
- Department of Pediatrics.,Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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19
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van der Pal SM, Maurice-Stam H, Grootenhuis MA, van Wassenaer-Leemhuis AG, Verrips GHW. Psychosocial developmental trajectory of a cohort of young adults born very preterm and/or with a very low birth weight in the Netherlands. J Patient Rep Outcomes 2019; 3:17. [PMID: 30847606 PMCID: PMC6405782 DOI: 10.1186/s41687-019-0106-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background The achievement of age-specific developmental milestones in youth is of great importance to the adjustment in adult life. Young adults who were born preterm, might go through a different developmental trajectory and transition into adulthood than their peers. This study aimed to compare the psychosocial developmental trajectory of young adults who were born preterm with peers from the general population. Young adults from the POPS (Project On Preterm and Small for gestational age infants) cohort study, born in 1983 in the Netherlands, completed online the Course of Life Questionnaire (CoLQ - achievement of psychosocial developmental milestones) at 28 years of age. Analysis of variance by group, age and gender was performed to test differences on the CoLQ scale scores between the POPS-group and 211 peers (25–30 years) from the general population (Ref-group). Differences on item level, representing the achievement of individual milestones, were analyzed with logistic regression analyses by group, age and gender. Results The POPS-group (n = 300, 32,3% biased response) scored significantly lower than the Ref-group on the scales Psychosexual Development (effect size − 0.26, p < 0.01), Antisocial Behavior (ES − 0.44, p < 0.001) and Substance Use & Gambling (ES − 0.35, p < .001). A further exploration on item-level revealed, among others, that the POPS-group had their first boyfriend/girlfriend at later age, were more often single, misbehaved less at school and smoked, drank and gambled less than the Ref-group. On the scales Autonomy Development and Social Development no differences were found between the POPS-group and the Ref-group. Conclusions A relatively less vulnerable respondent group of young adults born preterm showed some psychosocial developmental trajectory delays and might benefit from support at teenage age. Because of the non-response bias, we hypothesize that the total group of young adults born preterm will show more severe psychosocial developmental problems.
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Affiliation(s)
| | - Heleen Maurice-Stam
- Psychosocial Department, Emma Children's Hospital, University Medical Center, Amsterdam, Netherlands
| | - Martha A Grootenhuis
- Psychosocial Department, Emma Children's Hospital, University Medical Center, Amsterdam, Netherlands.,Princess Máxima Center for paediatric oncology, Utrecht, Netherlands
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20
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Yew YW, Zheng Q, Kok WL, Ho MSL, Teoh J, Wong YKY, Shi L, Chan ESY. Topical treatments for eczema: a network meta-analysis. Hippokratia 2018. [DOI: 10.1002/14651858.cd013205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Yik Weng Yew
- Department of Dermatology; National Skin Centre; Singapore Singapore
| | - Qishi Zheng
- Department of Epidemiology; Singapore Clinical Research Institute; Singapore Singapore
| | - Wai Leong Kok
- Department of Dermatology; National Skin Centre; Singapore Singapore
| | | | - Jeremy Teoh
- Department of Medicine; National University of Singapore; Singapore Singapore
| | | | - Luming Shi
- Department of Epidemiology; Singapore Clinical Research Institute; Singapore Singapore
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21
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Sawangjit R, Dilokthornsakul P, Lloyd-Lavery A, Chua S, Lai NM, Dellavalle R, Chaiyakunapruk N. Systemic treatments for eczema: a network meta-analysis. Hippokratia 2018. [DOI: 10.1002/14651858.cd013206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ratree Sawangjit
- Faculty of Pharmacy, Mahasarakham University; Department of Clinical Pharmacy; 41/20 Kham Riang Kantharawichai Mahasarakham Thailand 44150
| | - Piyameth Dilokthornsakul
- Naresuan University; Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences; 99 Tha Pho Muang Phitsanulok Thailand 65000
| | - Antonia Lloyd-Lavery
- Oxford University Hospitals NHS Foundation Trust; Department of Dermatology; Churchill Hospital Roosevelt Drive Oxford UK OX3 7LE
| | - Sean Chua
- urong East St21 Blk288A #03-358 Singapore Singapore 601288
| | - Nai Ming Lai
- Taylor's University; School of Medicine; Subang Jaya Malaysia
| | - Robert Dellavalle
- University of Colorado School of Medicine; Denver VA Medical Center 1055 Clermont St. #165 Denver Colorado USA 80220
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22
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Yang EJ, Sekhon S, Sanchez IM, Beck KM, Bhutani T. Recent Developments in Atopic Dermatitis. Pediatrics 2018; 142:peds.2018-1102. [PMID: 30266868 DOI: 10.1542/peds.2018-1102] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 11/24/2022] Open
Abstract
Atopic dermatitis (AD) is a bothersome and common skin disease affecting ∼10.7% of children in the United States. This skin condition significantly decreases quality of life in not only patients, but in their families as well. Pediatricians are often the first physicians to diagnose and manage these patients and thus are relied on by families to answer questions about this disease. AD is complex, multifactorial, and has historically had limited therapeutic options, but the landscape of this disease is now rapidly changing. Pathways contributing to the pathogenesis of this disease are continually being discovered, and new therapies for AD are being developed at an unprecedented rate. With this article, we will review the current guidelines regarding the management of AD, outline updates in the current understanding of its pathophysiology, and highlight novel developments available for the treatment of this burdensome disease.
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Affiliation(s)
- Eric J Yang
- Department of Dermatology, University of California, San Francisco, San Francisco, California; .,Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and
| | - Sahil Sekhon
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Isabelle M Sanchez
- Department of Dermatology, University of California, San Francisco, San Francisco, California.,College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Kristen M Beck
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, San Francisco, California
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23
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Bronckers IMGJ, van Geel MJ, van de Kerkhof PCM, de Jong EMGJ, Seyger MMB. A cross-sectional study in young adults with psoriasis: potential determining factors in quality of life, life course and work productivity. J DERMATOL TREAT 2018; 30:208-215. [PMID: 30102075 DOI: 10.1080/09546634.2018.1506077] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Psoriasis can have a substantial impact on health-related quality of life (HRQoL), life course, and work productivity. Young adulthood is a critical, sensitive period of development that includes major life changing decisions. The impact of psoriasis on this vulnerable population is yet unknown. OBJECTIVES To assess QoL, life course, and work productivity in young adults with psoriasis and identify characteristics influencing these patient-reported outcomes (PRO). METHODS An explorative, cross-sectional study was performed in psoriasis patients aged 18-30 years. Individuals completed a set of questionnaires regarding their health status (DLQI, SF-36, EQ-5D), achievement of developmental milestones (COLQ), and work productivity (WPAI-PSO, PRODISQ). RESULTS Seventy-five patients (22 males, 53 females; median age [IQR], 21.0 [8.0]). Median PASI and BSA, respectively, were 4.4 [4.9] and 4.5 [8.4]. Young adults experienced feelings of embarrassment, impairments in physical health and work productivity, and difficulties in social development. Patients with more severe psoriasis, longer disease duration, higher body mass index (BMI), female patients and patients closer to their thirties tended to be more affected. CONCLUSION In the young adult psoriasis population, substantial QoL impairments were found. Female patients, patients with high BMI, or long disease duration in particular tended to experience more difficulties. These exploratory findings indicate the need for further studies in young adults to detect potential clinical predictors for severe HRQoL impairments.
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Affiliation(s)
- Inge M G J Bronckers
- a Department of Dermatology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Maartje J van Geel
- a Department of Dermatology , Radboud University Medical Center , Nijmegen , The Netherlands
| | | | - Elke M G J de Jong
- a Department of Dermatology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Marieke M B Seyger
- a Department of Dermatology , Radboud University Medical Center , Nijmegen , The Netherlands
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24
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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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25
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Fortson EA, Li B, Bhayana M. Introduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1027:1-10. [PMID: 29063426 DOI: 10.1007/978-3-319-64804-0_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Atopic dermatitis (AD) is a chronic relapsing condition that is characterized by itching and redness of the skin. Our modern usage of atopic dermatitis dates back to 1933, when Wise and Sulzberger first coined the term to signify the disease's close association with other respiratory atopy, such as bronchial asthma and allergic rhinitis. A recent systematic review of 69 cross-sectional and cohort studies has confirmed that AD is now a worldwide phenomenon with lifetime AD prevalences of well over 20% in many affluent country settings. Although there is no obvious consistent overall global trend in the prevalence of AD, studies have shown that climate, urbanization, lifestyle, and socioeconomic class influence the prevalence of atopic dermatitis. Despite the pervasiveness of the disease, an understanding of atopic dermatitis has been hampered by a number of factors. Data suggests that extrinsic environmental factors work in concert with intrinsic immune mechanism and genetic factors to drive disease progression. With such a complex etiology, management of atopic dermatitis currently at best achieves symptomatic control rather than cure. This approach poses a significant burden on healthcare resources, as well as patients' quality of life. Current management methods of AD often involves a combination of non-pharmacologic modalities and prescription medications. Though they can be effective when employed, there are significant barriers to treatment for patients including time, costs, and medication side effects. Our aim, throughout this text, is to explore the complexities of AD, providing the healthcare provider with tips and tricks to improve patient care and satisfaction and the most current trends and treatment approaches on the horizon.
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Affiliation(s)
- Erica A Fortson
- Department of Dermatology, Wake Forest University School of Medicine, Winston Salem, NC, USA.
| | - Becky Li
- Department of Dermatology, Howard University School of Medicine, Washington, DC, USA
| | - Mahima Bhayana
- Department of Dermatology, Howard University School of Medicine, Washington, DC, USA
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26
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Vivar KL, Kruse L. The impact of pediatric skin disease on self-esteem. Int J Womens Dermatol 2017; 4:27-31. [PMID: 29872673 DOI: 10.1016/j.ijwd.2017.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 10/31/2017] [Accepted: 11/04/2017] [Indexed: 12/13/2022] Open
Abstract
Background Pediatric skin disorders can affect children's self-esteem, relationships with caregivers and peers, and performance in school and activities. Objective This review describes common pediatric congenital and acquired dermatologic disorders and the impact that these disorders can have on children's self-esteem. Methods A review of current, English-language literature was conducted with use of the PubMed database. Search terms included atopic dermatitis, acne, infantile hemangiomas, port wine stains, congenital melanocytic nevi, hidradenitis suppurativa, and self-esteem. Results During infancy and toddlerhood, skin disorders such as infantile hemangiomas primarily affect the attachment between child and caregiver. School-aged children with port wine stains and atopic dermatitis report increased bullying, teasing, and social isolation. Acne and hidradenitis typically affect older children and teens and these conditions are associated with increased risks of depression and suicidal ideation. Effective management of these conditions has been shown to increase patients' self-esteem. Conclusion Pediatric dermatologic disorders impact self-esteem throughout childhood. In addition to the surgical and medical management of these disorders, clinicians can also take an active role in the assessment and improvement of the psychosocial impact of these skin disorders.
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Affiliation(s)
- K L Vivar
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL
| | - L Kruse
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL.,Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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27
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Yang CY, Kourosh AS. Inflammatory skin disorders and self-esteem. Int J Womens Dermatol 2017; 4:23-26. [PMID: 29872672 DOI: 10.1016/j.ijwd.2017.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/25/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- C Y Yang
- Massachusetts General Hospital, Boston, MA
- Boston University School of Medicine, Boston, MA
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28
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Abstract
Atopic dermatitis is associated with significant patient burden, with impacts from symptoms and visible physical manifestations of the disease. Consequences include detrimental effects on quality of life (QoL), sleep, self-esteem, interpersonal relationships, participation in leisure and sports, and attendance or performance at school or work. Patients also spend a significant amount of time on treatments and care. Worsening severity of disease appears to be associated with a higher risk of impaired QoL, and pharmacologic and educational interventions that improve disease severity appear to, for the most part, simultaneously improve QoL.
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Affiliation(s)
- Cathryn Sibbald
- Division of Dermatology, University of Toronto, 2075 Bayview Avenue M1-700, Toronto, Ontario M4N 3M5, Canada; Division of Dermatology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue M1-700, Toronto, Ontario M4N 3M5, Canada
| | - Aaron M Drucker
- Department of Dermatology, Warren Alpert Medical School, Brown University, Box G-D, Providence, RI 02912, USA.
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29
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Chernyshov P, Tomas-Aragones L, Manolache L, Marron S, Salek M, Poot F, Oranje A, Finlay A. Quality of life measurement in atopic dermatitis. Position paper of the European Academy of Dermatology and Venereology (EADV) Task Force on quality of life. J Eur Acad Dermatol Venereol 2017; 31:576-593. [DOI: 10.1111/jdv.14058] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/31/2016] [Indexed: 12/17/2022]
Affiliation(s)
- P.V. Chernyshov
- Department of Dermatology and Venereology; National Medical University; Kiev Ukraine
| | - L. Tomas-Aragones
- Aragon Health Sciences Institute; University of Zaragoza; Zaragoza Spain
| | | | - S.E. Marron
- Department of Dermatology; Aragon Health Sciences Institute (IACS); Alcañiz Hospital; Alcañiz Spain
| | - M.S. Salek
- University of Hertfordshire; Hatfield UK
| | - F. Poot
- Department of Dermatology; ULB-Erasme Hospital; Brussels Belgium
| | - A.P. Oranje
- Dermicis Skin Hospital, Alkmaar, and (Kinder)huid; Rotterdam The Netherlands
| | - A.Y. Finlay
- Division of Infection and Immunity; Department of Dermatology and Wound Healing; School of Medicine; Cardiff University; Cardiff UK
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30
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Drucker AM, Wang AR, Li WQ, Sevetson E, Block JK, Qureshi AA. The Burden of Atopic Dermatitis: Summary of a Report for the National Eczema Association. J Invest Dermatol 2017; 137:26-30. [DOI: 10.1016/j.jid.2016.07.012] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/23/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
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31
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Shin J, Choi Y, Park EC, Lee KH, Hwang SY, Oh SH, Lee SG. Psychiatry outpatient visits by atopic dermatitis patients varying in the complexity of their prescriptions: A nationwide cohort study conducted from 2005 to 2013. Medicine (Baltimore) 2016; 95:e5411. [PMID: 27930517 PMCID: PMC5265989 DOI: 10.1097/md.0000000000005411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The uncomfortable symptoms of atopic dermatitis (AD) often trigger psychological stress.We investigated the association between AD severity and outpatient visits to psychiatrists using Korean National Health Insurance claims data from 2004 to 2013.This was a retrospective cohort analysis; we estimated hazard ratios (HRs).Of the 266,182 subjects, 18,290 (6.9%) had a history of visiting a psychiatrist, and 25,419 (9.5%) were diagnosed with AD. Compared with the subjects without AD, subjects with AD had a higher HR for visiting a psychiatrist (3.70, 95% confidence interval [CI]:48 3.43-3.98), and this significantly increased as the complexity of the AD medications increased. Subjects who received topical treatments plus a systematic steroid (HR: 4.88, 95% CI: 4.51-5.27) and those who received topical treatments plus a systematic steroid plus a systematic calcineurin inhibitor (HR: 9.56, 95% CI: 4.29-21.28) had higher HRs compared with those without AD.Severe AD patients exhibited greater psychological stress than those without AD or with mild AD symptoms. Moreover, medication diversity may represent an efficient and low-cost method by which to identify a vulnerable population.
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Affiliation(s)
- Jaeyong Shin
- Department of Preventive Medicine
- Institute of Health Services Research, College of Medicine
- Department of Public Health, Graduate School
| | - Young Choi
- Institute of Health Services Research, College of Medicine
- Department of Public Health, Graduate School
| | - Eun-Cheol Park
- Department of Preventive Medicine
- Institute of Health Services Research, College of Medicine
- Department of Public Health, Graduate School
| | - Kwang Hoon Lee
- Department of Dermatology, Severance hospital, College of medicine
| | - Seo Young Hwang
- Department of Dermatology, Severance hospital, College of medicine
| | - Sang Ho Oh
- Department of Dermatology, Severance hospital, College of medicine
| | - Sang Gyu Lee
- Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
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32
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Chernyshov PV. Stigmatization and self-perception in children with atopic dermatitis. Clin Cosmet Investig Dermatol 2016; 9:159-66. [PMID: 27499642 PMCID: PMC4959581 DOI: 10.2147/ccid.s91263] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Atopic dermatitis (AD) is one of the most common skin diseases. Prevalence of AD is highest in childhood. Because of chronicity and often visible lesions, AD may lead to stigmatization and problems with self-perception. However, problems of self-perception and stigmatization in AD children are poorly studied. Literature data on general tendencies of children’s development, clinical course, and epidemiologic tendencies of AD in different age groups make it possible to highlight three main periods in the formation of self-perception and stigmatization. The first period is from early infancy till 3 years of age. The child’s problems in this period depend on parental exhaustion, emotional distress, and security of the mother–child attachment. The child’s AD may form a kind of vicious circle in which severe AD causes parental distress and exhaustion that in turn lead to exacerbation of AD and psychological problems in children. The second period is from 3 till 10 years of age. During this period, development of AD children may be influenced by teasing, bullying, and avoiding by their peers. However, the majority of children in this age group are very optimistic. The third period is from 10 years till adulthood. Problems related to low self-esteem are characteristic during this period. It is important to identify children with AD and their parents who need psychological help and provide them with needs-based consultation and care. Appropriate treatment, medical consultations, and educational programs may help to reduce emotional problems in AD children and their parents.
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Affiliation(s)
- Pavel V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
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33
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Houtzager BA, Möller EL, Maurice-Stam H, Last BF, Grootenhuis MA. Parental perceptions of child vulnerability in a community-based sample: Association with chronic illness and health-related quality of life. J Child Health Care 2015; 19:454-65. [PMID: 24842887 DOI: 10.1177/1367493514530954] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The study aimed to assess the prevalence of parental perceptions of a child's vulnerability (PPCV) in a Dutch community-based sample and its relationship with children's health and health-related quality of life (HRQoL). Parents completed the Child Vulnerability Scale and a socio-demographic questionnaire. The Pediatric Quality of Life Inventory 4.0 was administered to measure HRQoL. The prevalence of PPCV was assessed in relation to socio-demographic and health-related characteristics. In a three-step multiple hierarchical regression model, the mediational role of PPCV in the association between chronic illness and HRQoL was investigated. Participants were 520 Dutch children aged 5-18 years from nine Dutch schools. In all, 69 (13.3%) had a chronic illness; 1.9% was perceived vulnerable, 3.0% in groups 5-7 and 1.7% in groups 8-12 and 13-18. Younger age of the child, presence of a chronic illness and low HRQoL were associated with PPCV. PPCV partially mediated the negative association between chronic illness and HRQoL. In conclusion, PPCV is associated with adjustment to chronic illness. More research is needed regarding the mechanisms through which PPCV affects HRQoL and to examine whether PPCV can be targeted in parenting interventions.
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Affiliation(s)
- Bregje A Houtzager
- Deventer Hospital, The Netherlands; Emma Children's Hospital, Academic Medical Centre Amsterdam, The Netherlands
| | | | - Heleen Maurice-Stam
- Emma Children's Hospital, Academic Medical Centre Amsterdam, The Netherlands
| | - Bob F Last
- Emma Children's Hospital, Academic Medical Centre Amsterdam, The Netherlands; Free University Amsterdam, The Netherlands
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Cury Martins J, Martins C, Aoki V, Gois AFT, Ishii HA, da Silva EMK. Topical tacrolimus for atopic dermatitis. Cochrane Database Syst Rev 2015; 2015:CD009864. [PMID: 26132597 PMCID: PMC6461158 DOI: 10.1002/14651858.cd009864.pub2] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) (or atopic eczema) is a chronic inflammatory skin condition that affects children and adults and has an important impact on quality of life. Topical corticosteroids (TCS) are the first-line therapy for this condition; however, they can be associated with significant adverse effects when used chronically. Tacrolimus ointment (in its 2 manufactured strengths of 0.1% and 0.03%) might be an alternative treatment. Tacrolimus, together with pimecrolimus, are drugs called topical calcineurin inhibitors (TCIs). OBJECTIVES To assess the efficacy and safety of topical tacrolimus for moderate and severe atopic dermatitis compared with other active treatments. SEARCH METHODS We searched the following databases up to 3 June 2015: the Cochrane Skin Group Specialised Register, CENTRAL in the Cochrane Library (Issue 5, 2015), MEDLINE (from 1946), EMBASE (from 1974), LILACS (from 1982), and the Global Resource of Eczema Trials (GREAT database). We searched six trials registers and checked the bibliographies of included studies for further references to relevant trials. We contacted specialists in the field for unpublished data.A separate search for adverse effects of topical tacrolimus was undertaken in MEDLINE and EMBASE on 30 July 2013. We also scrutinised the U.S. Food and Drug Administration (FDA) websites for adverse effects information. SELECTION CRITERIA All randomised controlled trials (RCTs) of participants with moderate to severe atopic dermatitis (both children and adults) using topical tacrolimus at any dose, course duration, and follow-up time compared with other active treatments. DATA COLLECTION AND ANALYSIS Two authors independently screened and examined the full text of selected studies for compliance with eligibility criteria, risk of bias, and data extraction. Our three prespecified primary outcomes were physician's assessment, participant's self-assessment of improvement, and adverse effects. Our secondary outcomes included assessment of improvement of the disease by validated or objective measures, such as SCORAD (SCORing Atopic Dermatitis), the EASI (Eczema Area and Severity Index), and BSA (Body Surface Area) scores. MAIN RESULTS We included 20 studies, with 5885 participants. The variability of drug doses, outcomes, and follow-up periods made it difficult to carry out meta-analyses.A single trial showed that tacrolimus 0.1% was better than low-potency TCS by the physician's assessment (risk ratio (RR) 3.09, 95% confidence interval (CI) 2.14 to 4.45, 1 study, n = 371, moderate-quality evidence). It was also marginally better than low-potency TCS on face and neck areas and moderate-potency TCS on the trunk and extremities by the physician's assessment (RR 1.32, 95% CI 1.17 to 1.49, 1 study, n = 972, moderate level of evidence) and for some of the secondary outcomes. Compared with pimecrolimus 1%, people treated with tacrolimus were almost twice as likely to improve by the physician's assessment (RR 1.80, 95% CI 1.34 to 2.42, 2 studies, n = 506, moderate quality of evidence). Compared with the lower concentration of 0.03%, the tacrolimus 0.1% formulation reduced the risk of not having an improvement by 18% as evaluated by the physician's assessment (RR 0.82, 95% CI 0.72 to 0.92, 6 studies, n = 1640, high-quality evidence). Tacrolimus 0.1% compared with moderate-to-potent TCS showed no difference by the physician's assessment, and 2 secondary outcomes (1 study, 377 participants) and a marginal benefit favouring tacrolimus 0.1% was found by the participant's assessment (RR 1.21, 95% CI 1.13 to 1.29, 1 study, n = 974, low quality of evidence) and SCORAD.Based on data from 2 trials, tacrolimus 0.03% was superior to mild TCS for the physician's assessment (RR 2.58, 95% CI 1.96 to 3.38, 2 studies, n = 790, moderate-quality evidence) and the participant's self-assessment (RR 1.64, 95% CI 1.41 to 1.90, 1 study, n = 416, moderate quality of evidence). One trial showed moderate benefit of tacrolimus 0.03% compared with pimecrolimus 1% on the physician's assessment (RR 1.42, 95% CI 1.02 to 1.98, 1 study, n = 139, low-quality evidence), but the effects were equivocal when evaluating BSA. In the comparison of tacrolimus 0.03% with moderate-to-potent corticosteroids, no difference was found in most of the outcomes measured (including physician's and participant's assessment and also for the secondary outcomes), but in two studies, a marginal benefit favouring the corticosteroid group was found for the EASI and BSA scores.Burning was more frequent in those using calcineurin inhibitors than those using corticosteroid tacrolimus 0.03% (RR 2.48, 95% CI 1.96 to 3.14, 5 studies, 1883 participants, high-quality evidence), but no difference was found for skin infections. Symptoms observed were mild and transient. The comparison between the two calcineurin inhibitors (pimecrolimus and tacrolimus) showed the same overall incidence of adverse events, but with a small difference in the frequency of local effects.Serious adverse events were rare; occurred in both the tacrolimus and corticosteroid groups; and in most cases, were considered to be unrelated to the treatment. No cases of lymphoma were noted in the included studies nor in the non-comparative studies. Cases were only noted in spontaneous reports, cohorts, and case-control studies. Systemic absorption was rarely detectable, only in low levels, and this decreased with time. Exception is made for diseases with severe barrier defects, such as Netherton's syndrome, lamellar ichthyosis, and a few others, with case reports of a higher absorption. We evaluated clinical trials; case reports; and in vivo, in vitro, and animal studies; and didn't find any evidence that topical tacrolimus could cause skin atrophy. AUTHORS' CONCLUSIONS Tacrolimus 0.1% was better than low-potency corticosteroids, pimecrolimus 1%, and tacrolimus 0.03%. Results were equivocal when comparing both dose formulations to moderate-to-potent corticosteroids. Tacrolimus 0.03% was superior to mild corticosteroids and pimecrolimus. Both tacrolimus formulations seemed to be safe, and no evidence was found to support the possible increased risk of malignancies or skin atrophy with their use. The reliability and strength of the evidence was limited by the lack of data; thus, findings of this review should be interpreted with caution. We did not evaluate costs.
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Affiliation(s)
- Jade Cury Martins
- Universidade Federal de São PauloDepartment of DermatologyWagih Assad Abdalla 172São PauloSão PauloBrazil05651‐020
| | - Ciro Martins
- Belecara Premium Multispecialty CenterDepartment of Dermatology1427 Clarkview RoadSuite 300BBaltimoreMarylandUSA21210
| | - Valeria Aoki
- University of Sao Paulo Medical School Hospital das ClinicasDepartment of DermatologyAv. Dr. Eneas de Carvalho Aguir255‐sala 3016‐ICHCSão PauloBrazil05403‐002
| | - Aecio FT Gois
- Escola Paulista de Medicina, Universidade Federal de São PauloBrazilian Cochrane CentreRua Pedro de Toledo, 598São PauloSão PauloBrazil04039‐001
| | - Henrique A Ishii
- The University of Nottinghamc/o Cochrane Skin GroupA103, King's Meadow CampusLenton LaneNottinghamUKNG7 2NR
| | - Edina MK da Silva
- Universidade Federal de São PauloEmergency Medicine and Evidence Based MedicineRua Borges Lagoa 564 cj 64Vl. ClementinoSão PauloSão PauloBrazil04038‐000
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Silverberg JI, Greenland P. Eczema and cardiovascular risk factors in 2 US adult population studies. J Allergy Clin Immunol 2015; 135:721-8.e6. [PMID: 25579484 DOI: 10.1016/j.jaci.2014.11.023] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 10/24/2014] [Accepted: 11/11/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Eczema is associated with high rates of sleep disturbance and quality-of-life impairment. These factors might have a negative impact on psychosocial development and behavior and could increase cardiovascular risk. OBJECTIVE We sought to determine whether adults with eczema have increased cardiovascular risk factors. METHODS We analyzed data for 27,157 and 34,525 adults aged 18 to 85 years from the 2010 and 2012 National Health Interview Survey. RESULTS Adults with eczema had higher odds of ever smoking 100 cigarettes in their lifetime (survey logistic regression; adjusted odds ratio [aOR], 1.32; 95% CI, 1.18-1.47) and current smoking history (aOR, 1.28; 95% CI, 1.12-1.45), with significantly younger age of onset (survey linear regression; adjusted β, -0.58; 95% CI, -0.95 to -0.21). Eczema was also associated with greater odds of ever drinking 12 or more alcoholic beverages annually (aOR, 1.16; 95% CI, 1.03-1.31), including current intake of moderate (aOR, 1.33; 95% CI, 1.09-1.62) and heavier (aOR, 1.58; 95% CI, 1.23-2.03) amounts. Adults with a history of eczema had lower odds of daily vigorous activity (aOR, 0.79; 95% CI, 0.63-0.99) and lower frequency of vigorous activity in the past week (adjusted β, -0.46; 95% CI, -0.72 to -0.21) than did adults without a history of eczema. Those with eczema had a higher body mass index than did those without eczema (adjusted β, 0.86; 95% CI, 0.37-1.36), particularly a body mass index of 35 or more (aOR, 1.54; 95% CI, 1.16-2.05), and higher odds of hypertension (aOR, 1.48; 95% CI, 1.18-1.85), hypertension on 2 visits (aOR, 1.56; 1.22-1.99), and lifetime prediabetes (aOR, 1.71; 95% CI, 1.19-2.45). Finally, there were significant interactions between eczema and sleep disturbances such that eczema associated with fatigue, daytime sleepiness, or insomnia was associated with even higher odds of obesity, hypertension, hypertension on 2 visits, prediabetes, diabetes, and high cholesterol than eczema alone. CONCLUSIONS We found that eczema in adults is a marker for cardiovascular risk, emphasizing the importance of behavioral modification and perhaps more aggressive interventions to better manage eczema.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, Preventive Medicine, and Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, Ill.
| | - Philip Greenland
- Department of Preventive Medicine and Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Ill
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Abstract
Atopic dermatitis is a common inflammatory skin condition characterized by relapsing eczematous lesions in a typical distribution. It can be frustrating for pediatric patients, parents, and health care providers alike. The pediatrician will treat the majority of children with atopic dermatitis as many patients will not have access to a pediatric medical subspecialist, such as a pediatric dermatologist or pediatric allergist. This report provides up-to-date information regarding the disease and its impact, pathogenesis, treatment options, and potential complications. The goal of this report is to assist pediatricians with accurate and useful information that will improve the care of patients with atopic dermatitis.
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Ang SB, Teng CWC, Monika TP, Wee HL. Impact of Atopic Dermatitis on Health-Related Quality of Life among Infants and Children in Singapore: A Pilot Cross-Sectional Study. PROCEEDINGS OF SINGAPORE HEALTHCARE 2014. [DOI: 10.1177/201010581402300203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Atopic dermatitis (AD) is a chronic relapsing skin disease that affects about 20.8% of children between seven to 16 years old in Singapore. Impairment in quality of life for one with AD is greater than childhood chronic disease like epilepsy or asthma. This study aims to describe the areas of health-related quality of life affected by AD in a cross-sectional survey of infants and children in Singapore. Methods: Thirty-four children aged 0 to 16 years old with atopic eczema were recruited. Quality of life was measured using Infant's Dermatitis Quality of Life Index in children aged four years and below and Children's Dermatitis Life Quality Index was used in children between five to 16 years old. Results: Children with severe disease experience significant impact on quality of life compared to those with mild/moderate disease. Itching and sleep disturbance are the two items in the top three domains for both the younger and older children. Impairment in participation in family activities was significant in boys compared with girls. Social impact on girls is greater compared to boys with a trend towards significance. Conclusion: This study shows that quality of life in patients with AD is affected. There appears to be gender and racial differences in some of the domains affected. Future studies should investigate the differences seen and the need for better holistic management of AD, taking into consideration the various needs of the different patient groups.
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Affiliation(s)
- Seng Bin Ang
- Family Medicine Service, KK Women's & Children's Hospital, Singapore
- Duke-NUS Graudate Medical School, Singapore
| | | | | | - Hwee-Lin Wee
- Department of Pharmacy, National University of Singapore, Singapore
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Suicidal ideation, mental health problems, and social function in adolescents with eczema: a population-based study. J Invest Dermatol 2014; 134:1847-1854. [PMID: 24496238 DOI: 10.1038/jid.2014.70] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 01/08/2014] [Accepted: 01/10/2014] [Indexed: 11/08/2022]
Abstract
There are few studies on psychosocial problems in adolescents with eczema. We performed a cross-sectional, questionnaire-based study to explore the relationship of suicidal ideation, mental health problems, and social functioning with eczema. A total of 4,744 adolescents (18-19 years) were invited for the study, of whom 3,775 (80%) participated. The overall prevalence of current eczema was 9.7%. Among those with current eczema, 15.5% reported suicidal ideation compared with 9.1% among those without eczema, significantly associated in a multivariate model (odds ratio 1.87, 95% confidence interval 1.31-2.68). In a subgroup analyses, the prevalence of suicidal ideation in those with both eczema and itch was 23.8%, and was significantly associated, compared with those without eczema (3.57, 2.46-5.67). Eczema was associated with mental health problems assessed by the Strength and Difficulties Questionnaire (1.72, 1.21-2.45) and the Hopkins Symptom Checklist 10 (1.63, 1.23-2.16). Five questions assessed social function: feeling attached to family and friends; thriving at school; experiencing bullying; and romantic relationships. Boys with current eczema were less likely to have had romantic relationships (1.93, 1.21-3.08). Eczema in late adolescence is associated with suicidal ideation and mental health problems but rarely with social problems. Our findings point to the importance of addressing mental health issues in adolescents with eczema.
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Abstract
BACKGROUND AND OBJECTIVES Inflammatory bowel disease (IBD) is a chronic, debilitating disorder occurring in young patients in the most productive period of their lives. Little is known about the effect on the developmental trajectory of adolescents growing up with IBD. The purpose of this study was to assess the psychosocial developmental trajectory ("course of life") and sociodemographic outcomes in adolescents with IBD compared with peers from the general population. METHODS A total of 62 adolescents (response rate 74%, boys 51.6%, mean age 18.6 years) completed the course of life questionnaire. RESULTS Patients with IBD achieved fewer milestones on the domains of autonomy and social and psychosexual development compared with their healthy peers. They went less frequently on holidays without adults, had fewer jobs during secondary school, were less frequently going out to a bar/disco during secondary school, and were older when falling in love for the first time. After secondary school, patients with IBD were more often unemployed. CONCLUSIONS Negative consequences in terms of psychosocial development are prevalent in adolescents with IBD. Physicians should be attentive to these consequences and provide additional support if necessary. During transition to adult clinic, these topics are of major importance and should be an integral component of the comprehensive care of chronically ill adolescents and young adults.
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Gelmetti C, Boralevi F, Seité S, Grimalt R, Humbert P, Luger T, Stalder JF, Taïeb A, Tennstedt D, Garcia Diaz R, Rougier A. Quality of life of parents living with a child suffering from atopic dermatitis before and after a 3-month treatment with an emollient. Pediatr Dermatol 2012; 29:714-8. [PMID: 23106672 DOI: 10.1111/j.1525-1470.2012.01817.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Atopic dermatitis (AD) can be extremely disabling and may cause psychological problems for affected children and their families. Moisturizers and emollients are important in the baseline daily skin care of patients with AD. To assess the effect of a 3-month, twice-daily treatment with an emollient on the quality of life (QoL) of parents with a child with mild to moderate AD (SCORing Atopic Dermatitis [SCORAD] ≤ 30, a multicenter open trial was performed by eight dermatologists on 191 volunteers. Evaluation by the dermatologist of the child's clinical condition (SCORAD) and of the efficacy and overall safety of the treatment was associated with a QoL questionnaire completed by one parent of the atopic child. A self-assessment of the global QoL and of the efficacy and overall safety was also performed. During the study, mean SCORAD dropped from 28 to 12 (p < 0.001), with good improvement in skin dryness and pruritus criteria. At the same time, the self-assessment of the global parent QoL scores dropped from 4.4 to 2.1 (p < 0.001) with 60%, 48% and 79% favorable parent opinions regarding wellbeing or improvement of the health condition, quality of sleep, and efficacy of the emollient, respectively. This trial revealed the efficacy of the product in improving parent QoL (85% of parents noted improvement in QoL), and its global safety was considered to be very good or good, with 80% favorable opinions in parents' declarative judgements and dermatologists' assessments. The emollient evaluated improves the course of AD and can improve the QoL of patients and their families.
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Affiliation(s)
- Carlo Gelmetti
- Scienze Dermatologiche, Università degli Studi di Milano, Fondazione IRCSS Ospedale Maggiore Policlinico, Milan, Italy.
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Cury Martins J, Martins C, Aoki V, Leonardi-Bee J, Gois AFT, Ishii HA, da Silva EMK. Topical tacrolimus for atopic dermatitis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ricci G, Bellini F, Dondi A, Patrizi A, Pession A. Atopic dermatitis in adolescence. Dermatol Reports 2012; 4:e1. [PMID: 25386309 PMCID: PMC4212666 DOI: 10.4081/dr.2012.e1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 10/24/2011] [Accepted: 10/24/2011] [Indexed: 11/23/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disorder that typically occurs during childhood especially in the first year of life, with a variable frequency from 10% to 30%. Recent studies have shown that in Europe among 10-20% of children with AD suffer from this disorder also in adolescence. AD is a chronic inflammatory skin disease with a typical onset in the first years of life and with a 10-30% prevalence among young children. AD prevalence in adolescence has been estimated around 5-15% in European countries. AD persists from childhood through adolescence in around 40% of cases and some risk factors have been identified: female sex, sensitization to inhalant and food allergens, allergic asthma and/or rhinoconjunctivitis, the practice of certain jobs. During adolescence, AD mainly appears on the face and neck, often associated with overinfection by Malassezia, and on the palms and soles. AD persistence during adolescence is correlated with psychological diseases such as anxiety; moreover, adolescents affected by AD might have problems in the relationship with their peers. Stress and the psychological problems represent a serious burden for adolescents with AD and cause a significant worsening of the patients' quality of life (QoL). The pharmacological treatment is similar to other age groups. Educational and psychological approaches should be considered in the most severe cases.
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Affiliation(s)
- Giampaolo Ricci
- Pediatric Unit, Department of Gynecologic, Obstetric and Pediatric Sciences
| | - Federica Bellini
- Pediatric Unit, Department of Gynecologic, Obstetric and Pediatric Sciences
| | - Arianna Dondi
- Pediatric Unit, Department of Gynecologic, Obstetric and Pediatric Sciences
- Dermatology Unit, Department of Internal Medicine, Aging and Nephrological Diseases, University of Bologna, Italy
| | - Annalisa Patrizi
- Dermatology Unit, Department of Internal Medicine, Aging and Nephrological Diseases, University of Bologna, Italy
| | - Andrea Pession
- Pediatric Unit, Department of Gynecologic, Obstetric and Pediatric Sciences
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Monti F, Agostini F, Gobbi F, Neri E, Schianchi S, Arcangeli F. Quality of life measures in Italian children with atopic dermatitis and their families. Ital J Pediatr 2011; 37:59. [PMID: 22192570 PMCID: PMC3287107 DOI: 10.1186/1824-7288-37-59] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 12/22/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The impact of atopic dermatitis (AD) on children's quality of life (QoL) in US and European countries is relatively well known, though rarely evaluated in the Italian population. Moreover, the association between child age and QoL has not been enough investigated, even though few studies detected a worse QoL in youngest AD children. The aim of the study was to evaluate the QoL in an Italian sample of atopic children and their families, also exploring a possible association with child age. METHODS 60 AD children aged between 1-12 years and their mothers completed specific QoL questionnaires (IDQoL/CDLQI, DFI) and a clinician completed a measure of AD severity (SCORAD). RESULTS AD severity (Objective SCORAD) significantly correlated with QoL measures. Severe AD children showed higher IDQoL/CDLQI and DFI scores compared to mild and moderate AD groups (P = 0.006 and P < 0.0005, respectively), but only DFI scores differed in these last two conditions (P = 0.014). DFI scores negatively correlated with children's age (P = 0.046), but did not differ when considering child age ranges. Multiple linear regression analyses revealed a significant association between Objective SCORAD and QoL measures. CONCLUSIONS A strong association between severe AD and poor QoL, both in children and mothers, was found in the Italian sample, in line with the international literature. Family's QoL scores were sensitively related to AD severity, more than the child's QoL, emphasising that the disease has a deep impact on the family. A significant association between age and QoL was only partially found and needs further investigation.
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Affiliation(s)
- Fiorella Monti
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, Bologna, Italy
| | - Francesca Agostini
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, Bologna, Italy
| | | | - Erica Neri
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, Bologna, Italy
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Lee SH. Platform Technologies for Research on the G Protein Coupled Receptor: Applications to Drug Discovery Research. Biomol Ther (Seoul) 2011. [DOI: 10.4062/biomolther.2011.19.1.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Nam KW, Noh JK, Kim SK, Lee SJ, Kim KH, Oh KB, Shin JH, Mar WC. Essential Oil of Thujopsis dolobrata Suppresses Atopic Dermatitis-Like Skin Lesions in NC/Nga Mice. Biomol Ther (Seoul) 2011. [DOI: 10.4062/biomolther.2011.19.1.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kelsay K, Klinnert M, Bender B. Addressing Psychosocial Aspects of Atopic Dermatitis. Immunol Allergy Clin North Am 2010; 30:385-96. [DOI: 10.1016/j.iac.2010.05.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ong PY, Boguniewicz M. Investigational and Unproven Therapies in Atopic Dermatitis. Immunol Allergy Clin North Am 2010; 30:425-39. [DOI: 10.1016/j.iac.2010.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Walling HW, Swick BL. Update on the management of chronic eczema: new approaches and emerging treatment options. Clin Cosmet Investig Dermatol 2010; 3:99-117. [PMID: 21437065 PMCID: PMC3047944 DOI: 10.2147/ccid.s6496] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Indexed: 01/24/2023]
Abstract
Atopic dermatitis (AD) is a common disease with worldwide prevalence, affecting up to 20% of children and 3% of adults. Recent evidence regarding pathogenesis has implicated epidermal barrier defects deriving from filagrin mutations with resulting secondary inflammation. In this report, the authors comprehensively review the literature on atopic dermatitis therapy, including topical and systemic options. Most cases of AD will benefit from emollients to enhance the barrier function of skin. Topical corticosteroids are first-line therapy for most cases of AD. Topical calcineurin inhibitors (tacrolimus ointment, pimecrolimus cream) are considered second line therapy. Several novel barrier-enhancing prescription creams are also available. Moderate to severe cases inadequately controlled with topical therapy may require phototherapy or systemic therapy. The most commonly employed phototherapy modalites are narrow-band UVB, broadband UVB, and UVA1. Traditional systemic therapies include short-term corticosteroids, cyclosporine (considered to be the gold standard), methotrexate, azathioprine, mycophenolate mofetil, and most recently leflunamide. Biologic therapies include recombinant monoclonal antibodies acting on the immunoglobulin E / interleukin-5 pathway (omalizumab, mepolizumab), acting as tumor necrosis factor-α inhibitors (infliximab, etanercept, adalimumab), and acting as T-cell (alefacept) and B-cell (rituxumab) inhibitors, as well as interferon γ and intravenous immunoglobulin. Efficacy, safety, and tolerability are reviewed for each medication.
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Kimball AB, Gieler U, Linder D, Sampogna F, Warren RB, Augustin M. Psoriasis: is the impairment to a patient's life cumulative? J Eur Acad Dermatol Venereol 2010; 24:989-1004. [PMID: 20477920 DOI: 10.1111/j.1468-3083.2010.03705.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Psoriasis is associated with significant physical and psychological burden affecting all facets of a patient's life--relationships, social activities, work and emotional wellbeing. The cumulative effect of this disability may be self-perpetuating social disconnection and failure to achieve a 'full life potential' in some patients. Health-related quality of life studies have quantified the burden of psoriasis providing predominantly cross-sectional data and point-in-time images of patients' lives rather than assessing the possible cumulative disability over a patient's lifetime. However, social and economic outcomes indicate there are likely negative impacts that accumulate over time. To capture the cumulative effect of psoriasis and its associated co-morbidities and stigma over a patient's life course, we propose the concept of 'Cumulative Life Course Impairment' (CLCI). CLCI results from an interaction between (A) the burden of stigmatization, and physical and psychological co-morbidities and (B) coping strategies and external factors. Several key aspects of the CLCI concept are supported by data similar to that used in health-related quality of life assessments. Future research should focus on (i) establishing key components of CLCI and determining the mechanisms of impairment through longitudinal or retrospective case-control studies, and (ii) assessing factors that put patients at increased risk of developing CLCI. In the future, this concept may lead to a better understanding of the overall impact of psoriasis, help identify more vulnerable patients, and facilitate more appropriate treatment decisions or earlier referrals. To our knowledge, this is a first attempt to apply and develop concepts from 'Life Course Epidemiology' to psoriasis research.
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Affiliation(s)
- A B Kimball
- Department of Dermatology, Harvard Medical School, Boston, MA, USA
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