1
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Caron AGM, Bloem M, El Khattabi H, de Waal AC, van Huizen AM, Denswil NP, Gerbens LAA, Spuls PI. The wide variety of methotrexate dosing regimens for the treatment of atopic dermatitis: a systematic review. J DERMATOL TREAT 2024; 35:2292962. [PMID: 38124505 DOI: 10.1080/09546634.2023.2292962] [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: 09/13/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
Background:Methotrexate is an off-label therapy for atopic dermatitis. A lack of consensus on dosing regimens poses a risk of underdosing and ineffective treatment or overdosing and increased risk of side effects. This systematic review summarizes the available evidence on dosing regimens.Materials and methods:A literature search was conducted, screening all randomized controlled trials (RCTs) and guidelines published up to 6 July 2023, in the MEDLINE, Embase, and Cochrane Library databases.Results:Five RCTs and 21 guidelines were included. RCTs compared methotrexate with other treatments rather than different methotrexate dosing regimens. The start and maintenance doses in RCTs varied between 7.5-15 mg/week and 14.5-25 mg/week, respectively. Despite varied dosing, all RCTs demonstrated efficacy in improving atopic dermatitis signs and symptoms. Guidelines exhibited substantial heterogeneity but predominantly proposed starting doses of 5-15 mg/week for adults and 10-15 mg/m2/week for children. Maintenance doses suggested were 7.5-25 mg/week for adults and 0.2-0.7 mg/kg/week for children. One guideline suggested a test dose and nearly half advised folic acid supplementation.Conclusion:This systematic review highlights the lack of methotrexate dosing guidelines for atopic dermatitis. It identifies commonly recommended and utilized dosing regimens, serving as a valuable resource for clinicians prescribing methotrexate off-label and providing input for an upcoming consensus study.
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Affiliation(s)
- Anouk G M Caron
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands
| | - Manja Bloem
- Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Hajar El Khattabi
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Ayla C de Waal
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Astrid M van Huizen
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands
| | - Nerissa P Denswil
- Medical Library, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Louise A A Gerbens
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands
| | - Phyllis I Spuls
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands
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2
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Soung J, Ständer S, Gutermuth J, Pau-Charles I, Dawson Z, Yang FE, Sun L, Pierce E, Elmaraghy H, Stein-Gold L. Lebrikizumab monotherapy impacts on quality of life scores through improved itch and sleep interference in two Phase 3 trials. J DERMATOL TREAT 2024; 35:2329240. [PMID: 38679419 DOI: 10.1080/09546634.2024.2329240] [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: 12/04/2023] [Accepted: 03/05/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Lebrikizumab improved itch, interference of itch on sleep, and quality of life (QoL) in patients with moderate-to-severe atopic dermatitis (AD), in two Phase 3 trials at 16 weeks compared to placebo. OBJECTIVES We assess improvements in itch and sleep interference due to itch and their impact on QoL measurements after treatment. METHODS Data were analyzed from ADvocate1 (NCT04146363) and ADvocate2 (NCT04178967) in patients with moderate-to-severe AD. QoL was evaluated using Dermatology Life Quality Index (DLQI) at Week 16 in patients (>16 years of age) who were itch responders/non-responders (defined as ≥4-point improvement in Pruritus Numeric Rating Scale) or Sleep-Loss Scale responders/non-responders (defined as ≥2-point improvement in itch interference on sleep). RESULTS In ADvocate1 and ADvocate2, significantly greater proportions of itch responders had a clinically meaningful improvement in measures related to QoL (DLQI scores (0/1), ≤5 DLQI total score and ≥4-point DLQI improvement) compared to itch non-responders. In both studies, a significantly greater proportion of Sleep-Loss Scale responders, reported a DLQI score of (0/1), DLQI total score of ≤5 and DLQI improvement of ≥4 points compared to Sleep-Loss Scale non-responders. CONCLUSIONS Improvement in itch and sleep interference due to itch is associated with improvement in the QoL of patients after treatment with lebrikizumab for moderate-to-severe AD. ClinicalTrials.gov registration NCT04146363 (ADvocate1) and NCT04178967 (ADvocate2).
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Affiliation(s)
- Jennifer Soung
- Southern California Dermatology, Inc, Santa Ana, CA, USA
| | - Sonja Ständer
- University Hospital Westphalian Wilhems University, Munster, Germany
| | - Jan Gutermuth
- Department of Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Jette, Belgium
| | | | - Zach Dawson
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Luna Sun
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Linda Stein-Gold
- Clinic for Dermatology, Henry Ford Health System, Detroit, MI, USA
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3
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Krontoft ASB, Lomborg K, Skov L. The development and initial evaluation of conversation cards for optimizing consultations for patients with atopic dermatitis. J DERMATOL TREAT 2024; 35:2376268. [PMID: 38981618 DOI: 10.1080/09546634.2024.2376268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
Purpose: Patients with atopic dermatitis (AD) require both skills and support to effectively manage life with the disease. Here, we developed an agenda-setting tool for consultations with patients with AD to establish a collaborative agenda that enhances patient involvement and prioritizes on self-management support. Materials and methods: Using the design thinking process, we included 64 end-users (patients and healthcare professionals (HCPs)) across the different phases of design thinking. We identified seven overall categories that patients find important to discuss during consultations, which informed the development of a tool for co-creating a consultation agenda (conversation cards, CCs). Results: Through iterative user testing of the CCs, patients perceived the cards as both inspiring and an invitation from HCPs to openly discuss their needs during consultations. Healthcare professionals have found the CCs easy to use, despite the disruption to the typical consultation process. Conclusion: In summary, the CCs provide a first-of-its-kind agenda-setting tool for patients with AD. They offer a simple and practical method to establishing a shared agenda that focuses on the patients' needs and are applicable within real-world clinical settings.
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Affiliation(s)
- Anna Sophie Belling Krontoft
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev-Gentofte Hospital, Hellerup, Denmark
| | - Kirsten Lomborg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
- Department of Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev-Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
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4
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Potestio L, Patruno C, Napolitano M. Comment on 'Dupilumab for atopic dermatitis in metastatic cancer'. Australas J Dermatol 2024. [PMID: 39007411 DOI: 10.1111/ajd.14351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/07/2024] [Indexed: 07/16/2024]
Affiliation(s)
- Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Maddalena Napolitano
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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5
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Mao Q, Wang X, Cai H, Yang J, Zhang Y, Min W, Qian Q, Zeng Y. Research Progress on the Correlation of Atopic Dermatitis with Gut Microbiota. Clin Cosmet Investig Dermatol 2024; 17:1613-1619. [PMID: 39006130 PMCID: PMC11244069 DOI: 10.2147/ccid.s442551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 06/02/2024] [Indexed: 07/16/2024]
Abstract
Atopic dermatitis (AD) is a common skin disease, the pathogenesis of which has not been fully elucidated. The gut microbiota is the largest micro-ecosystem in the human body that affects the immune system and skin barrier function. Recent studies have shown that in addition to the environmental factors, skin barrier, genetic factors and immune response, gut microbiota disturbance may also cause AD. This review described the correlation of AD with gut microbiota and existing research status of AD treatment via targeting gut microbiota.
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Affiliation(s)
- Qiuyu Mao
- Department of Dermatology, Minhang Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xinyi Wang
- Department of Dermatology, Minhang Hospital, Fudan University, Shanghai, People's Republic of China
| | - Haibin Cai
- Department of Dermatology, Minhang Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jingyi Yang
- Department of Dermatology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Yiwen Zhang
- Department of Dermatology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Wei Min
- Department of Dermatology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Qihong Qian
- Department of Dermatology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Yibin Zeng
- Department of Dermatology, Minhang Hospital, Fudan University, Shanghai, People's Republic of China
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6
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Salle R, Del Giudice P, Skayem C, Hua C, Chosidow O. Secondary Bacterial Infections in Patients with Atopic Dermatitis or Other Common Dermatoses. Am J Clin Dermatol 2024; 25:623-637. [PMID: 38578398 DOI: 10.1007/s40257-024-00856-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/06/2024]
Abstract
Secondary bacterial infections of common dermatoses such as atopic dermatitis, ectoparasitosis, and varicella zoster virus infections are frequent, with Staphylococcus aureus and Streptococcus pyogenes being the bacteria most involved. There are also Gram-negative infections secondary to common dermatoses such as foot dyshidrotic eczema and tinea pedis. Factors favoring secondary bacterial infections in atopic dermatitis, ectoparasitosis, and varicella zoster virus infections mainly include an epidermal barrier alteration as well as itch. Mite-bacteria interaction is also involved in scabies and some environmental factors can promote Gram-negative bacterial infections of the feet. Furthermore, the bacterial ecology of these superinfections may depend on the geographical origin of the patients, especially in ectoparasitosis. Bacterial superinfections can also have different clinical aspects depending on the underlying dermatoses. Subsequently, the choice of class, course, and duration of antibiotic treatment depends on the severity of the infection and the suspected bacteria, primarily targeting S. aureus. Prevention of these secondary bacterial infections depends first and foremost on the management of the underlying skin disorder. At the same time, educating the patient on maintaining good skin hygiene and reporting changes in the primary lesions is crucial. In the case of recurrent secondary infections, decolonization of S. aureus is deemed necessary, particularly in atopic dermatitis.
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Affiliation(s)
- Romain Salle
- Service de Dermatologie Générale et Oncologique, UVSQ, EA4340-BECCOH, AP-HP, Hôpital Ambroise-Paré, Université Paris-Saclay, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.
| | - Pascal Del Giudice
- Unité D'Infectiologie et Dermatologie, Centre Hospitalier Intercommunal de Fréjus-Saint-Raphaël, Fréjus, France
| | - Charbel Skayem
- Service de Dermatologie Générale et Oncologique, UVSQ, EA4340-BECCOH, AP-HP, Hôpital Ambroise-Paré, Université Paris-Saclay, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Camille Hua
- AP-HP, Service de Dermatologie, Hôpital Henri Mondor, Créteil, France
| | - Olivier Chosidow
- Consultation Dermatoses Faciales, Service d'ORL, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
- UPEC Créteil, Créteil, France
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7
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Vitek M, Matjaž MG. Clinical application of hempseed or flaxseed oil-based lyotropic liquid crystals: Evaluation of their impact on skin barrier function. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2024; 74:301-313. [PMID: 38815204 DOI: 10.2478/acph-2024-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 06/01/2024]
Abstract
The principal function of skin is to form an effective barrier between the human body and its environment. Impaired barrier function represents a precondition for the development of skin diseases such as atopic dermatitis (AD), which is the most common inflammatory skin disease characterized by skin barrier dysfunction. AD significantly affects patients' quality of life, thus, there is a growing interest in the development of novel delivery systems that would improve therapeutic outcomes. Herein, eight novel lyotropic liquid crystals (LCCs) were investigated for the first time in a double-blind, interventional, before-after, single-group trial with healthy adult subjects and a twice-daily application regimen. LCCs consisted of constituents with skin regenerative properties and exhibited lamellar micro-structure, especially suitable for dermal application. The short- and long-term effects of LCCs on TEWL, SC hydration, erythema index, melanin index, and tolerability were determined and compared with baseline. LCCs with the highest oil content and lecithin/Tween 80 mixture stood out by providing a remarkable 2-fold reduction in TEWL values and showing the most distinctive decrease in skin erythema levels in both the short- and long-term exposure. Therefore, they exhibit great potential for clinical use as novel delivery systems for AD treatment, capable of repairing skin barrier function.
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Affiliation(s)
- Mercedes Vitek
- 1University of Ljubljana Faculty of Pharmacy, Department of Pharmaceutical Technology, 1000 Ljubljana Slovenia
| | - Mirjam Gosenca Matjaž
- 1University of Ljubljana Faculty of Pharmacy, Department of Pharmaceutical Technology, 1000 Ljubljana Slovenia
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8
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Domínguez-Santana CM, Viedma-Martínez M, Ríos-Sánchez E. [Translated article] Tralokinumab in Atopic Dermatitis: Real-Life Data from a Spanish Tertiary Referral Center. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T618-T624. [PMID: 38648932 DOI: 10.1016/j.ad.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/03/2023] [Indexed: 04/25/2024] Open
Affiliation(s)
- C M Domínguez-Santana
- Departamento de Farmacia Hospitalaria, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España
| | - M Viedma-Martínez
- Departamento de Dermatología, Hospital Universitario Puerta del Mar, Cádiz, España.
| | - E Ríos-Sánchez
- Departamento de Farmacia Hospitalaria, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España
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9
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Domínguez-Santana CM, Viedma-Martínez M, Ríos-Sánchez E. Tralokinumab in Atopic Dermatitis: Real-Life Data from a Spanish Tertiary Referral Center. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:618-624. [PMID: 38311227 DOI: 10.1016/j.ad.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/20/2023] [Accepted: 12/03/2023] [Indexed: 02/10/2024] Open
Affiliation(s)
- C M Domínguez-Santana
- Departamento de Farmacia Hospitalaria, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España
| | - M Viedma-Martínez
- Departamento de Dermatología, Hospital Universitario Puerta del Mar, Cádiz, España.
| | - E Ríos-Sánchez
- Departamento de Farmacia Hospitalaria, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España
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10
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Liu H. Effect of Skin Barrier on Atopic Dermatitis. Dermatitis 2024. [PMID: 38738291 DOI: 10.1089/derm.2024.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
The skin acts as the body's primary physical and immune barrier, maintaining the skin microbiome and providing a physical, chemical, and immune barrier. A disrupted skin barrier plays a critical role in the onset and advancement of inflammatory skin conditions such as atopic dermatitis (AD) and contact dermatitis. This narrative review outlines the relationship between AD and skin barrier function in preparation for the search for possible markers for the treatment of AD.
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Affiliation(s)
- Hanye Liu
- From the Beihua University, Jilin, China
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11
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Carmanius PL, Lundin S, Ödling M, Kimland E, Ballardini N, Melén E, Bergström A, Dahlén E. Drug utilization among young adults with atopic dermatitis: Influence of sex, socio-economic status and disease severity. J Eur Acad Dermatol Venereol 2024. [PMID: 38709168 DOI: 10.1111/jdv.20076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/21/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Atopic dermatitis (AD) affects individuals of all ages, and the first-line treatment are emollients and topical corticosteroids. There is insufficient knowledge about factors possibly affecting the drug utilization of young adults with AD. OBJECTIVES To describe the drug utilization of young adults with AD in relation to sex, socio-economic status and disease severity. METHODS A cross-sectional study based on the 24-year follow-up from the population-based BAMSE (Children, Allergy, Milieu, Stockholm, Epidemiology Survey) birth cohort linked with dispensing data from the National Drug Register (n = 2912). Self-reported AD and socio-economic status were defined from questionnaire data and disease severity was determined through the clinical examination and Patient-Oriented Eczema Measure questionnaire. RESULTS The prevalence of AD in young adults was 17.7% (n = 516) and 45.5% of them were dispensed at least one drug for the treatment of AD during the study period (January 2016 to June 2019). Topical corticosteroids (TCS) were the most common drugs (32.9%) followed by emollients (21.7%). A larger proportion of men were dispensed TCS than women (39.0% vs. 29.1%: p-value = 0.020). A larger proportion of young adults with moderate-to-severe AD were dispensed TCS than those with mild AD (52.6% vs. 35.3%: p-value = 0.026). No one was dispensed the recommended amount of emollients and less than five individuals were dispensed the recommended amount of TCS for mild disease. Male sex (adj.OR 1.54, 95% CI 1.06-2.34) and moderate-to-severe AD (adj.OR 2.62, 95% CI 1.59-4.31) were associated with dispensation of TCS. CONCLUSIONS A large proportion of young adults with AD was undertreated or untreated. Sex and disease severity did affect the dispensing patterns of investigated drugs.
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Affiliation(s)
- P L Carmanius
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
| | - S Lundin
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - M Ödling
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - E Kimland
- The Swedish Medical Products Agency, Uppsala, Sweden
| | - N Ballardini
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - E Melén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - A Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm, Sweden
| | - E Dahlén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- The Swedish Medical Products Agency, Uppsala, Sweden
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12
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Khairnar P, Phatale V, Shukla S, Tijani AO, Hedaoo A, Strauss J, Verana G, Vambhurkar G, Puri A, Srivastava S. Nanocarrier-Integrated Microneedles: Divulging the Potential of Novel Frontiers for Fostering the Management of Skin Ailments. Mol Pharm 2024; 21:2118-2147. [PMID: 38660711 DOI: 10.1021/acs.molpharmaceut.4c00144] [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] [Indexed: 04/26/2024]
Abstract
The various kinds of nanocarriers (NCs) have been explored for the delivery of therapeutics designed for the management of skin manifestations. The NCs are considered as one of the promising approaches for the skin delivery of therapeutics attributable to sustained release and enhanced skin penetration. Despite the extensive applications of the NCs, the challenges in their delivery via skin barrier (majorly stratum corneum) have persisted. To overcome all the challenges associated with the delivery of NCs, the microneedle (MN) technology has emerged as a beacon of hope. Programmable drug release, being painless, and its minimally invasive nature make it an intriguing strategy to circumvent the multiple challenges associated with the various drug delivery systems. The integration of positive traits of NCs and MNs boosts therapeutic effectiveness by evading stratum corneum, facilitating the delivery of NCs through the skin and enhancing their targeted delivery. This review discusses the barrier function of skin, the importance of MNs, the types of MNs, and the superiority of NC-loaded MNs. We highlighted the applications of NC-integrated MNs for the management of various skin ailments, combinational drug delivery, active targeting, in vivo imaging, and as theranostics. The clinical trials, patent portfolio, and marketed products of drug/NC-integrated MNs are covered. Finally, regulatory hurdles toward benchtop-to-bedside translation, along with promising prospects needed to scale up NC-integrated MN technology, have been deliberated. The current review is anticipated to deliver thoughtful visions to researchers, clinicians, and formulation scientists for the successful development of the MN-technology-based product by carefully optimizing all the formulation variables.
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Affiliation(s)
- Pooja Khairnar
- Pharmaceutical Innovation and Translational Research Lab (PITRL), Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Telangana 500037, India
| | - Vivek Phatale
- Pharmaceutical Innovation and Translational Research Lab (PITRL), Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Telangana 500037, India
| | - Shalini Shukla
- Pharmaceutical Innovation and Translational Research Lab (PITRL), Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Telangana 500037, India
| | - Akeemat O Tijani
- Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee 37614, United States
| | - Aachal Hedaoo
- Pharmaceutical Innovation and Translational Research Lab (PITRL), Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Telangana 500037, India
| | - Jordan Strauss
- Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee 37614, United States
| | - Gabrielle Verana
- Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee 37614, United States
| | - Ganesh Vambhurkar
- Pharmaceutical Innovation and Translational Research Lab (PITRL), Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Telangana 500037, India
| | - Ashana Puri
- Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee 37614, United States
| | - Saurabh Srivastava
- Pharmaceutical Innovation and Translational Research Lab (PITRL), Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Telangana 500037, India
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13
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Gkalpakiotis S, Kannenberg S, Kingo K, Nada HR, Rakhmatulina MR, Lesiak A, Nicolescu AC, Darlenski R, Masri A, Zhou L, Albuquerque T, Hammad S, Almasry I. Real-World Clinical, Psychosocial, and Economic Burden of Atopic Dermatitis: Results From the ESSENTIAL AD Multicountry Study. Dermatol Ther (Heidelb) 2024; 14:1173-1187. [PMID: 38702528 PMCID: PMC11116285 DOI: 10.1007/s13555-024-01146-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/20/2024] [Indexed: 05/06/2024] Open
Abstract
INTRODUCTION Limited real-world evidence exists about the burden of atopic dermatitis (AD) in patients receiving systemic or non-systemic therapies in clinical practices. ESSENTIAL AD was an observational study that aimed to fill this information gap. METHODS ESSENTIAL AD enrolled (September 2021-June 2022) adult patients with physician-confirmed AD that was routinely managed with systemic and non-systemic treatment in a real-world setting from 15 countries in Eastern Europe, the Middle East, and Africa. Primary outcome variables were Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (SCORAD), and Dermatology Life Quality Index (DLQI) assessed during one office visit. RESULTS A total of 799 enrolled patients fulfilled selection criteria and were included in the study. Patients mean (standard deviation [SD]) age was 36.3 (14.4) years, 457 (57.2%) were female, and the majority of patients were white (647 [81.0%]). Mean (SD) time since AD diagnosis was 17.6 (15.2) years (median 16.5; interquartile range [IQR] 3.3-26.8). The mean (SD) EASI, SCORAD, and DLQI total scores were 11.3 (11.3 [median 8.1; IQR 3.6-15.8]), 37.8 (17.9 [median 35.5; IQR 24.2-49.0]), and 10.6 (7.2 [median 10.0; IQR 5.0-15.0]), respectively. Patients receiving systemic treatment had significantly higher disease burden (mean [SD] EASI 13.3 [13.0]; median [IQR] 9.6 [3.9-17.9]) versus non-systemic treatment (mean [SD] 9.3 [8.7]; median [IQR] 6.8 [3.0-13.2]; P < 0.0001). Results were similar for SCORAD (39.9 [19.6] vs 35.6 [15.7]; median [IQR] 38.6 [24.7-53.1] vs 32.6 [23.9-44.6]; P = 0.0017), and DLQI total scores (11.4 [7.4] vs 9.9 [6.9]; median [IQR] 11.0 [5.0-16.0] vs 9.0 [5.0-14.0]; P = 0.0033, respectively). CONCLUSION Patients with AD continue to have substantial disease burden despite treatment with systemic therapy, suggesting that a need for effective disease management remains, including effective therapies that improve psychological outcomes and reduce economic burden of AD, in Eastern Europe, the Middle East, and Africa.
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Affiliation(s)
- Spyridon Gkalpakiotis
- Department of Dermatovenereology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Czech Republic.
| | - Susanna Kannenberg
- Division of Dermatology, Stellenbosch University, Cape Town, South Africa
| | - Külli Kingo
- Department of Dermatology, University of Tartu, Tartu, Estonia
- Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia
| | - Hanan Rabea Nada
- Department of Dermatology, Faculty of Medicine, Cairo University, Giza, Egypt
| | | | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
- Laboratory of Autoinflammatory, Genetic and Rare Skin Disorders at the Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
| | - Alin C Nicolescu
- "Agrippa Ionescu" Emergency Clinical Hospital, Bucharest, Romania
| | - Razvigor Darlenski
- Department of Dermatology and Venereology, Medical University-Sofia, Sofia, Bulgaria
- Trakia University, Stara Zagora, Bulgaria
- ACK Tokuda Hospital-Sofia, Sofia, Bulgaria
| | - Alaa Masri
- AbbVie Biopharmaceuticals GmbH, Dubai, United Arab Emirates
| | | | | | - Shereen Hammad
- AbbVie Biopharmaceuticals GmbH, Dubai, United Arab Emirates
| | - Iman Almasry
- Department of Dermatology, As'ad Al-Hamad Dermatology Center, Kuwait City, Kuwait
- Faculty of Medicine, Menoufia University, Menofia, Egypt
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Napolitano M, Potestio L, Nocerino M, Patruno C. Considerations for managing elderly patients with atopic dermatitis. Expert Rev Clin Immunol 2024; 20:501-511. [PMID: 38193289 DOI: 10.1080/1744666x.2024.2301967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION Atopic dermatitis (AD) diagnosis in elderly is challenging, due to its clinical polymorphism and the lack of diagnostic biomarkers. Moreover, the chronicity of the disease and the complex pathogenetic mechanism, make elderly AD management challenging. AREAS COVERED A narrative review of the current literature was performed using the PubMed, Medline, Embase, and Cochrane Skin databases, by researching the following terms: 'atopic dermatitis,' 'clinical phenotypes,' 'eczema,' 'elderly patients,' 'elderly type atopic dermatitis,' 'eczema clinical presentation.' The aim was to report the current knowledge on pathogenesis, clinical presentation, and treatment options of elderly AD. EXPERT OPINION Elderly type AD has recently been identified as a separate entity, with an increasing prevalence. With aging, both immunosenescence and barrier alterations can cause or modify AD presentation. Moreover, a chronic proinflammatory state (so-called 'inflammaging') is often present in elderly subjects. Older patients with AD may present with peculiar immunophenotypic profile, making AD diagnosis challenging. Similarly, the chronicity of the disease and the complex pathogenetic mechanism, make AD management a challenge. Indeed, systemic therapies for AD are often contraindicated or not tolerated and the management of elderly type AD is often burdened with numerous difficulties, leading to undertreated disease. Even if dupilumab and tralokinumab represent a valuable therapeutic weapon, more data on safety of JAK inhibitors are required.
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Affiliation(s)
- Maddalena Napolitano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Mariateresa Nocerino
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Lee HJ, Oh HJ, Lee GN, Han KD, Lee JH, Park YM. Population-based cohort study to investigate the changes in prevalence, severity profile, and treatment modalities used in Korean atopic dermatitis patients. Sci Rep 2024; 14:7979. [PMID: 38575634 PMCID: PMC10995130 DOI: 10.1038/s41598-024-57777-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/21/2024] [Indexed: 04/06/2024] Open
Abstract
In this retrospective study spanning from 2002 to 2019, we analyzed data from 355,277 Korean patients diagnosed with atopic dermatitis (AD) through the National Health Insurance System. Our objective was to comprehensively analyze the trends in prevalence, severity profiles, and treatment approaches for AD in Korea over this 18-year period. Initially, AD prevalence stood at 3.88% in 2002 but notably rose to 5.03% by 2019. During the same period, while AD prevalence decreased in the 0-1-year-old group (from 34.52% to 24.83%), it remained relatively stable in the 1-11-year-old group. Conversely, the 12-19-year-old and 20 years or older age groups witnessed substantial increases in AD prevalence, climbing from 2.55 to 6.02% and 1.44% to 3.53%, respectively. Moreover, the proportion of patients classified as having moderate to severe AD grew from 30.96 to 39.78%. Surprisingly, the prescription pattern, predominantly based on corticosteroid administration, exhibited minimal change despite the rising prevalence of moderate and severe AD cases. These findings underline a persistent reliance on corticosteroid-based treatments for AD, even as the condition's severity escalates among Korean adolescents and adults. Consequently, there is a pressing need to develop novel treatment guidelines emphasizing biologics that offer enhanced safety and efficacy.
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Affiliation(s)
- Hyun Ji Lee
- Department of Dermatology, Yeouido St. Mary's Hospital, Seoul, Korea
| | - Hyun Ju Oh
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea
| | - Gyu Na Lee
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Kyung Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea
| | - Young Min Park
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea.
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Christensen MO, Yüksel YT, Vittrup I, Nymand LK, Thein D, Nørreslet LB, Toft-Hansen JM, Janstrup AK, Zachariae C, Sommerlund M, Bregnhøj A, Egeberg A, Agner T, Thomsen SF, Thyssen JP. Demographics, characteristics and medical treatment among adults with hand eczema in Denmark. A cross-sectional validation and registry-based study. Contact Dermatitis 2024; 90:350-364. [PMID: 37990822 DOI: 10.1111/cod.14456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND The international classification of diseases, 10th revision (ICD-10) includes several unvalidated diagnostic codes for hand eczema (HE). Knowledge is sparse on HE patient characteristics. OBJECTIVES To validate selected HE ICD-10 codes in the Danish National Patient Registry (DNPR) and describe disease characteristics, lifestyle factors and medication use in adult HE patients. METHODS Nineteen HE ICD-10 codes were selected and validated based on patient charts. Five cohorts were constructed based on the diagnostic code, DL30.8H (HE unspecified), in the DNPR: (i) patients with DL30.8H code (n = 8386), (ii) patients with DL30.8H code, but without atopic dermatitis (AD) (n = 7406), (iii) sex- and age-matched general population (n = 8386) without HE. Two additional cohorts nested in the DNPR included participants from the Danish Skin Cohort, (iv) patients with DL30.8H code but without AD (n = 1340) and (v) general population cohort (n = 9876). RESULTS ICD-10 codes revealed positive predictive values ≥90% except irritant contact dermatitis (unspecified) (79.7%) and hyperkeratotic hand and foot eczema (84.1%). HE patients were most often women, middle-aged or older, of Danish ethnicity, had an atopic medical history and were smokers. Topical corticosteroid prescriptions were almost doubled in HE cohorts compared to general populations. CONCLUSION We validated several HE ICD-10 codes and identified important HE patient characteristics.
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Affiliation(s)
- Maria Oberländer Christensen
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Yasemin Topal Yüksel
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ida Vittrup
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lea Krog Nymand
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - David Thein
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Line Brok Nørreslet
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Maarbjerg Toft-Hansen
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anne Klose Janstrup
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mette Sommerlund
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Bregnhøj
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Alexander Egeberg
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Tove Agner
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Pontoppidan Thyssen
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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Zhang H, Li Z, Sun Y, Li W, Sun X, Zhang Y, Liu L, Ma S. Mechanisms of action of Shizhenqing granules for eczema treatment: Network pharmacology analysis and experimental validation. Heliyon 2024; 10:e27603. [PMID: 38496849 PMCID: PMC10944262 DOI: 10.1016/j.heliyon.2024.e27603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024] Open
Abstract
Background Jiuwan decoction has been used to treat chronic eczema since the Qing Dynasty. According to clinical experience, Shizhenqing granules (SZQG), derived from the Jiuwan decoction, exert beneficial clinical effects on acute eczema and reduce recurrence. Therefore, we elucidated the underlying mechanisms of SZQG through network pharmacology, molecular docking, and experimental validation. Methods The main chemical components of SZQG were identified by ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). And the targets of SZQG against eczema were screened out through online databases. Then, the regulatory network map of the "herbal compound-potential target" and the target protein-protein interaction (PPI) network was constructed. The Gene Ontology (GO) analysis and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were conducted using by R language. Additionally, the interaction between the active compounds and the targets was verified by molecular docking technology. Finally, an experiment in vivo was used to verify the effect and mechanism of SZQG on eczema. Results Using UHPLC-MS/MS, 158 main chemical compounds of SZQG were identified, and 72 compounds were selected according to the criteria for further analysis. All 237 potential targets of SZQG in eczema were explored using multiple online databases. The network with 14 core targets was screened out, including STAT3, RELA, TNF, JUN, MAPK3, IL-6, PIK3CA, STAT1, MAPK14, MAPK1, IL-4, NFKBIA, IL1B, and MYC. KEGG analyses indicated that the therapeutic effects of SZQG on eczema were predominantly associated with cytokine-cytokine receptor interaction, TNF, MAPK, NF-κB, toll-like receptor, T cell receptor, and Th1 and Th2 cell differentiation signaling pathways. Furthermore, the good affinity between the core compounds and core targets was verified by molecular docking technology, particularly for RELA and MAPK. Animal experiments revealed that SZQG downregulated MAPK14, RELA, T-bet, and GATA3 mRNA expression, reduced immunoglobulin E (IgE) and interleukin-4 (IL-4) serum concentrations, and improved eczema-like lesions in model rats. Conclusion This study identified potential targets and signaling pathways of SZQG in the treatment of eczema, whereby RELA and MAPK14 may constitute the main therapeutic targets of SZQG in cytokine regulation and reduction of inflammatory responses.
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Affiliation(s)
- Hairong Zhang
- Department of Integrated Chinese and Western Medicine, Yantai Yuhuangding Hospital, Yantai, 264000, Shandong, China
| | - Zhenbo Li
- Oregon College of Oriental Medicine, Portland, OR, 97209, USA
| | - Yike Sun
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Wenna Li
- Department of Acupuncture and Minimally Invasive Oncology, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China
| | - Xiao Sun
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Yapeng Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Leilei Liu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Shuran Ma
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China
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Ortiz de Frutos FJ, Silvestre JF. Recommendations on the Use of Moisturizing Products Prepared by Spanish Dermatologists Using the Delphi Method. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00266-7. [PMID: 38554751 DOI: 10.1016/j.ad.2024.03.020] [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: 12/28/2023] [Revised: 02/27/2024] [Accepted: 03/13/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Moisturizing products are widely used in conditions affecting skin hydration. However, the lack of scientific evidence leads to discrepancies and great variability in the recommendations used by different health professionals. The aim of this consensus document is to generate recommendations based on the evidence and experience of dermatologists to unify and facilitate the use of moisturizing products in the routine clinical practice. MATERIALS AND METHODS A 49-statement questionnaire on moisturizing products was prepared and, then, arranged in 5 blocks: 1) concept; 2) characteristics, 3) frequency and quantity, 4) product use and areas of application, and 5) special populations. Twenty-two expert dermatologists in the management of patients with eczema answered to the survey using a 2-round Delphi methodology (adding an item on the 2nd round). RESULTS Consensus was reached on 27 statements (54%), most (n=23) via agreement. The highest level of agreement was reached in the blocks on quantity, product use and areas of application (77.8%), followed by the blocks on characteristics (73%) and frequency (62.5%). Regarding the blocks on concept and special populations, the level of consensus on the items proposed was 37.5% and 10%, respectively. Consensus on the use of emollients for xeroderma (71%) was higher vs atopic dermatitis (64%) and inflamed skin (33.3%). CONCLUSIONS Consensus recommendations can help all prescribers and improve the available evidence regarding their use.
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Affiliation(s)
- F J Ortiz de Frutos
- Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
| | - J F Silvestre
- Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, España
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Krontoft ASB, Skov L, Ammitzboell E, Lomborg K. Self-management Support for Patients with Atopic Dermatitis: A Qualitative Interview Study. J Patient Exp 2024; 11:23743735241231696. [PMID: 38464888 PMCID: PMC10921857 DOI: 10.1177/23743735241231696] [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] [Indexed: 03/12/2024] Open
Abstract
Patients with a chronic skin disease, eg, atopic dermatitis, need self-management skills to increase their quality of life. We explored patients' needs for self-management support from healthcare professionals and how these needs can be met in a dermatology setting. Interpretive description methodology was chosen for iterative data collection and analysis of qualitative interviews with patients with atopic dermatitis. Two mutually dependent themes were found to be supportive of patients' self-management. Personal and disease-related recognition was fundamental to successful support. However, guidance for agenda-setting from healthcare professionals was also needed on the wide range of topics that could be covered in the consultation based on individual needs. Patients need self-management support in addition to what can be found with family, friends, or peers. It is crucial that the support is delivered with an appreciative approach by healthcare professionals with profound knowledge of atopic dermatitis. Equally important is guidance towards agenda-setting, a way to co-construct the consultation with a clear focus on the specific patient's needs.
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Affiliation(s)
- Anna Sophie Belling Krontoft
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev-Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev-Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | | | - Kirsten Lomborg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
- Department of Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
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Veverka KA, Thng STG, Silverberg JI, Armstrong AW, Menezes J, Kaoukhov A, Blauvelt A. Safety and efficacy of eblasakimab, an interleukin 13 receptor α1 monoclonal antibody, in adults with moderate-to-severe atopic dermatitis: A phase 1b, multiple-ascending dose study. J Am Acad Dermatol 2024; 90:504-511. [PMID: 37866456 DOI: 10.1016/j.jaad.2023.10.026] [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: 06/12/2023] [Revised: 09/12/2023] [Accepted: 10/01/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Eblasakimab, an interleukin (IL)-13 receptor α1 antagonist, blocks IL-4 and IL-13 signaling through the type 2 receptor. OBJECTIVE The safety and efficacy of eblasakimab was evaluated in adults with moderate-to-severe atopic dermatitis (AD). METHODS In this phase 1b randomized, double-blinded study, 52 patients with moderate-to-severe AD received weekly subcutaneous injections of eblasakimab 200, 400, or 600 mg, or placebo for 8 weeks. Primary outcome was the incidence of treatment-emergent adverse events. Secondary outcomes included percentage change in the Eczema Area and Severity Index from baseline; Eczema Area and Severity Index improvement of at least 50%, 75%, or 90% from baseline; and percentage change in the peak-pruritus numeric rating scale score from baseline. RESULTS Treatment-emergent adverse events were reported in 47% placebo and 71% eblasakimab patients; most were considered mild or moderate and did not lead to study discontinuation. At week 8 eblasakimab 600 mg showed statistically significant improvement in mean percentage change in Eczema Area and Severity Index versus placebo (-65% vs -27%, P = .014). Other key secondary physician- and patient-reported end points were met. LIMITATIONS Longer studies are required to confirm eblasakimab safety and efficacy in AD patients. CONCLUSIONS Treatment of adults with moderate-to-severe AD with eblasakimab was well-tolerated and associated with significant clinical improvements versus placebo.
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Affiliation(s)
| | - Steven T G Thng
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, National Skin Center, Singapore
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - April W Armstrong
- Division of Dermatology, University of California, Los Angeles, Los Angeles, California
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Paller AS, Pinter A, Wine Lee L, Aschoff R, Zdybski J, Schnopp C, Praestgaard A, Bansal A, Shumel B, Prescilla R, Bastian M. Efficacy and Safety of Dupilumab Treatment with Concomitant Topical Corticosteroids in Children Aged 6 Months to 5 Years with Severe Atopic Dermatitis. Adv Ther 2024; 41:1046-1061. [PMID: 38194047 PMCID: PMC10879230 DOI: 10.1007/s12325-023-02753-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/27/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION Treatment options for children younger than 6 years with severe atopic dermatitis (AD) are limited, as systemic immunosuppressants may present safety concerns in this young age group. Dupilumab is the first systemic treatment option approved for infants and young children with severe AD in the European Union. This study reports the efficacy and safety of dupilumab with concomitant low-potency corticosteroids in children aged 6 months to 5 years with severe AD. METHODS This was a pre-specified subgroup analysis of data for patients aged 6 months to 5 years with severe AD at baseline (Investigator's Global Assessment [IGA] = 4) from a randomised, double-blind, placebo-controlled, phase III trial of dupilumab. Patients were randomised to either subcutaneously administered dupilumab (200/300 mg) or matched placebo every 4 weeks, plus low-potency topical corticosteroids for 16 weeks. Co-primary endpoints at week 16 were the proportion of patients with IGA ≤ 1 (clear or almost clear skin) and the proportion of patients with ≥ 75% improvement from baseline in Eczema Area and Severity Index (EASI-75). Secondary endpoints at week 16 included mean changes in EASI, pruritus, skin pain, sleep loss and quality of life. RESULTS The analysis included 125 patients (63 receiving dupilumab vs. 62 placebo). At week 16, significantly more patients receiving dupilumab vs. placebo had achieved IGA ≤ 1 (14.3% vs. 1.6%; P = 0.0085) and EASI-75 (46.0% vs. 6.6%; P < 0.0001). Significant improvements with dupilumab were observed in all secondary endpoints, including a least squares mean 48.9% reduction in pruritus. The overall incidence of adverse events (AEs) was similar between the dupilumab and placebo groups (66.7% vs. 73.8%). No dupilumab-related AEs were serious or led to treatment discontinuation. CONCLUSION Dupilumab significantly improved AD signs, symptoms and quality of life in children aged 6 months to 5 years with severe AD with acceptable safety. TRIAL REGISTRATION The trial was registered with ClinicalTrials.gov with ID number NCT03346434, part B.
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Affiliation(s)
- Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Andreas Pinter
- University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Lara Wine Lee
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Jacek Zdybski
- Klinika Zdybski Dermedic, Ostrowiec Świętokrzyski, Poland
| | | | | | | | - Brad Shumel
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
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Paller AS, Siegfried EC, Cork MJ, Arkwright PD, Eichenfield LF, Ramien M, Khokhar FA, Chen Z, Zhang A, Cyr SL. Infections in Children Aged 6 Months to 5 Years Treated with Dupilumab in a Placebo-Controlled Clinical Trial of Moderate-to-Severe Atopic Dermatitis. Paediatr Drugs 2024; 26:163-173. [PMID: 38267692 PMCID: PMC10890978 DOI: 10.1007/s40272-023-00611-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Patients with atopic dermatitis (AD), particularly infants and young children, are at greater risk of developing skin infections. In this study, we assessed infection rates in AD patients aged 6 months to 5 years treated with dupilumab. METHODS In LIBERTY AD PRESCHOOL, a double-blind, placebo-controlled, phase III clinical trial, children aged 6 months to 5 years with moderate-to-severe AD were randomized 1:1 to subcutaneous dupilumab or placebo, with concomitant low-potency topical corticosteroids, every 4 weeks for 16 weeks. Exposure-adjusted infection rates were used to compare treatment groups. RESULTS The analysis included 162 patients, of whom 83 received dupilumab and 79 received placebo. Total infection rates were not significantly different between the dupilumab and placebo groups (rate ratio [RR] 0.75, 95% CI 0.48-1.19; p = 0.223). Non-herpetic adjudicated skin infections and bacterial infections were significantly less frequent with dupilumab versus placebo (non-herpetic skin infections: RR 0.46, 95% CI 0.21-0.99; p = 0.047; bacterial infections: RR 0.09, 95% CI 0.01-0.67; p = 0.019), and the number of patients using systemic anti-infective medication was significantly lower in the dupilumab group (RR 0.52, 95% CI 0.30-0.89; p = 0.019). There were no significant differences in the number of herpetic infections between the dupilumab and placebo groups (RR 1.17, 95% CI 0.31-4.35; p = 0.817). The number of patients with two or more infection events was significantly higher in the placebo group (RR 0.29, 95% CI 0.12-0.68; p = 0.004), and no severe or serious infections (including eczema herpeticum) were observed among patients receiving dupilumab. CONCLUSIONS These data suggest that dupilumab treatment in infants and children younger than 6 years with AD does not increase overall risk of infections and is associated with a reduced risk of bacterial and non-herpetic skin infections compared with placebo, resulting in a reduced need for anti-infective medication. TRIAL REGISTRATION The trial was registered with ClinicalTrials.gov with ID number NCT03346434 on November 17, 2017. INFOGRAPHIC.
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Affiliation(s)
- Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Elaine C Siegfried
- Saint Louis University School of Medicine, St. Louis, MO, USA
- Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Michael J Cork
- Sheffield Dermatology Research, University of Sheffield, Sheffield, UK
- Sheffield Children's Hospital, Sheffield, UK
| | - Peter D Arkwright
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Michele Ramien
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Section of Community Pediatrics, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | | | - Zhen Chen
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | | | - Sonya L Cyr
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA.
- Regeneron Pharmaceuticals Inc., 1 Rockwood Road, Sleepy Hollow, NY, 10591, USA.
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23
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Pareek A, Kumari L, Pareek A, Chaudhary S, Ratan Y, Janmeda P, Chuturgoon S, Chuturgoon A. Unraveling Atopic Dermatitis: Insights into Pathophysiology, Therapeutic Advances, and Future Perspectives. Cells 2024; 13:425. [PMID: 38474389 DOI: 10.3390/cells13050425] [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: 12/21/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Atopic dermatitis (AD) is an inflammatory skin condition that frequently develops before the onset of allergic rhinitis or asthma. More than 10% of children are affected by this serious skin condition, which is painful for the sufferers. Recent research has connected the environment, genetics, the skin barrier, drugs, psychological factors, and the immune system to the onset and severity of AD. The causes and consequences of AD and its cellular and molecular origins are reviewed in this paper. The exploration of interleukins and their influence on the immunological pathway in AD has been facilitated by using relevant biomarkers in clinical trials. This approach enables the identification of novel therapeutic modalities, fostering the potential for targeted translational research within the realm of personalized medicine. This review focuses on AD's pathophysiology and the ever-changing therapeutic landscape. Beyond the plethora of biologic medications in various stages of approval or development, a range of non-biologic targeted therapies, specifically small molecules, have emerged. These include Janus kinase (JAK) inhibitors like Baricitinib, Upadacitinib, and Abrocitinib, thus expanding the spectrum of therapeutic options. This review also addresses the latest clinical efficacy data and elucidates the scientific rationale behind each targeted treatment for atopic dermatitis.
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Affiliation(s)
- Ashutosh Pareek
- Department of Pharmacy, Banasthali Vidyapith, Banasthali 304022, India
| | - Lipika Kumari
- Department of Bioscience and Biotechnology, Banasthali Vidyapith, Banasthali 304022, India
| | - Aaushi Pareek
- Department of Pharmacy, Banasthali Vidyapith, Banasthali 304022, India
| | - Simran Chaudhary
- Department of Pharmacy, Banasthali Vidyapith, Banasthali 304022, India
| | - Yashumati Ratan
- Department of Pharmacy, Banasthali Vidyapith, Banasthali 304022, India
| | - Pracheta Janmeda
- Department of Bioscience and Biotechnology, Banasthali Vidyapith, Banasthali 304022, India
| | - Sanam Chuturgoon
- Northdale Hospital, Department of Health, Pietermaritzburg 3200, South Africa
| | - Anil Chuturgoon
- Discipline of Medical Biochemistry, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
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24
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Dai A, Kim SJ. Systemic calcineurin inhibitors tacrolimus and voclosporin: A review of off-label dermatologic uses. J Am Acad Dermatol 2024; 90:358-367. [PMID: 37307993 DOI: 10.1016/j.jaad.2023.05.074] [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: 08/22/2022] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Systemic calcineurin inhibitors, cyclosporine, tacrolimus, and voclosporin, have been utilized in various dermatologic conditions. Although there have been numerous off-label dermatologic indications with published guidelines for cyclosporine, there is no established strong consensus for tacrolimus and voclosporin. OBJECTIVE To conduct a review of off-label use of systemic tacrolimus and voclosporin in various dermatoses to better inform treatment methods. METHODS A literature search was conducted using PubMed and Google Scholar. Relevant clinical trials, observational studies, case series, and reports regarding off-label dermatologic uses of systemic tacrolimus and voclosporin were included. RESULTS Tacrolimus shows promise for numerous dermatologic conditions, including psoriasis, atopic dermatitis/eczema, pyoderma gangrenosum, chronic urticaria, and Behcet's disease. Randomized controlled trial data are only available for voclosporin in psoriasis, which showed efficacy but did not meet noninferiority to cyclosporine. LIMITATIONS Data were limited and extracted from published papers. Studies differed in methodology, and nonstandardized outcomes limited the conclusions drawn. CONCLUSIONS In comparison to cyclosporine, tacrolimus can be considered for treatment-refractory disease or in patients with cardiovascular risk factors or inflammatory bowel disease. Voclosporin has only been utilized in psoriasis currently, and clinical trials in psoriasis show voclosporin's efficacy. Voclosporin can be considered for patients with lupus nephritis.
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Affiliation(s)
- Annie Dai
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
| | - Soo Jung Kim
- Department of Dermatology, Baylor College of Medicine, Houston, Texas.
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25
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Eyerich K, Gooderham MJ, Silvestre JF, Shumack SP, Mendes-Bastos P, Aoki V, Ortoncelli M, Silverberg JI, Teixeira HD, Chen SH, Calimlim BM, Takemoto S, Sancho C, Fritz B, Irvine AD. Real-world clinical, psychosocial and economic burden of atopic dermatitis: Results from a multicountry study. J Eur Acad Dermatol Venereol 2024; 38:340-353. [PMID: 37669868 DOI: 10.1111/jdv.19500] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 08/22/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Atopic dermatitis (AD), a relapsing, inflammatory skin disease, is associated with pruritus that can negatively affect patients' quality of life. Understanding the burden of AD is critical for informing and tailoring treatment and disease management to improve patient outcomes. This study characterized global treatment patterns and the clinical, psychosocial and economic burden of moderate-to-severe AD. METHODS MEASURE-AD was a cross-sectional 28-country study in patients with physician-confirmed moderate-to-severe AD who were either receiving or eligible for systemic therapy for AD. Patients ≥12 years were enrolled between December 2019 and December 2020 while attending routine office or clinic visit. Primary outcomes included Worst Pruritus Numeric Rating Scale (WP-NRS; range: 0-10) and Dermatology Life Quality Index (DLQI; range: 0-30) and Children's DLQI (CDLQI; range: 0-30). Secondary outcomes included physician- and patient-reported clinical, psychosocial and economic burden. RESULTS Of the 1591 patients enrolled, 1558 (1434 adults and 124 adolescents) fulfilled all patient selection criteria and were included in this analysis. Almost all patients (98.4%) in the total population were using AD medications and more than half (56%) were receiving systemic medication (15% systemic monotherapy). The most used systemic therapies were dupilumab (56.3%), systemic glucocorticoids (18.1%) and methotrexate (16.2%). Mean WP-NRS was 5.3 in the total population, and most patients (≥55%) reported moderate-to-severe pruritus (WP-NRS ≥4). Mean DLQI was 10.8 and mean CDLQI was 9.6. Secondary endpoints demonstrated substantial clinical, psychosocial, and economic burden of disease. Subgroup analysis demonstrated that patients receiving systemic therapy had lower disease burden than those not taking systemic medications. CONCLUSIONS While systemic therapy lowers overall disease burden, patients with moderate-to-severe AD continue to have substantial multidimensional disease burden and uncontrolled disease. Overall, there is a need for effective disease management, including effective treatments that improve patients' psychosocial outcomes and reduce the economic burden of AD.
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Affiliation(s)
- Kilian Eyerich
- Department of Dermatology and Venereology, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Melinda J Gooderham
- SKiN Centre for Dermatology, Peterborough, Ontario, Canada
- Queen's University, Kingston, Ontario, Canada
- Probity Medical Research Inc, Waterloo, Ontario, Canada
| | | | - Stephen P Shumack
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - Valeria Aoki
- Department of Dermatology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Michela Ortoncelli
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | | | | | | | | | - Björn Fritz
- AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
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26
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von Kobyletzki L, Henrohn D, Ballardini N, Neary MP, Ortsäter G, Rieem Dun A, Geale K, Lindberg I, Theodosiou G, Neregård P, De Geer A, Cha A, Cappelleri JC, Thyssen JP. Comorbidities in childhood atopic dermatitis: A population-based study. J Eur Acad Dermatol Venereol 2024; 38:354-364. [PMID: 37824103 DOI: 10.1111/jdv.19569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 08/29/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease that is associated with allergic comorbidities. However, studies examining comorbidities in childhood AD are incomplete, which may contribute to suboptimal care. OBJECTIVE The objective was to compare the risk of developing different allergic and non-allergic comorbidities among children with AD to that of a matched non-AD reference cohort in Sweden. METHODS This was a nationwide population-based cohort study using longitudinal data from primary and specialist care registers. Patients with AD were identified by confirmed diagnosis in primary or specialist care. The non-AD reference cohort was randomly drawn from the general population and matched 1:1 with the AD patients. The risk of developing the following conditions was evaluated: hypersensitivity and allergic disorders, neurological disorders, psychiatric disorders, infections, immunological and inflammatory disorders, Type 1 diabetes (T1D), endocrine and metabolic disorders, skeletal disorders, ocular disorders and malignancies. RESULTS This study included 165,145 patients with AD (mild-to-moderate [n = 126,681] and severe [n = 38,464]) and an equally sized reference cohort. Patients with AD displayed a higher risk of developing comorbid conditions for all investigated categories, except for T1D and skeletal disorders, compared with the reference cohort. The highest risk compared with the reference cohort was observed for hypersensitivity and allergic disorders (hazard ratio [HR]: 3.87), followed by malignancies (HR: 2.53) and immunological and inflammatory disorders (HR: 2.36). Patients with AD also had higher risk of developing multiple comorbidities (≥2). The risk of comorbidity onset increased alongside AD severity and patients with active AD were associated with increased risk of comorbidity onset compared with patients in remission. CONCLUSIONS The clinical burden of AD is substantial for children with AD and patients are at an increased risk of developing several comorbid conditions extending beyond the atopic march. Our results also showed a positive association between worsening severity of AD and an increased risk of comorbidity onset.
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Affiliation(s)
- Laura von Kobyletzki
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Dan Henrohn
- Inflammation and Immunology, Pfizer AB, Stockholm, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Natalia Ballardini
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology and Sexual Health, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Maureen P Neary
- Inflammation and Immunology, Pfizer Inc., Collegeville, Pennsylvania, USA
| | | | | | - Kirk Geale
- Quantify Research AB, Stockholm, Sweden
- Dermatology and Venereology, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | - Petra Neregård
- Inflammation and Immunology, Pfizer AB, Stockholm, Sweden
| | - Anna De Geer
- Inflammation and Immunology, Pfizer AB, Stockholm, Sweden
| | - Amy Cha
- Inflammation and Immunology, Pfizer Inc., New York, New York, USA
| | - Joseph C Cappelleri
- Global Biometrics and Data Management (Statistics), Pfizer Inc., Groton, Connecticut, USA
| | - Jacob P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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27
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Lapeere H, Speeckaert R, Baeck M, Dezfoulian B, Lambert J, Roquet-Gravy PP, Stockman A, White J, Castelijns F, Gutermuth J. Belgian atopic dermatitis guidelines. Acta Clin Belg 2024; 79:62-74. [PMID: 37997950 DOI: 10.1080/17843286.2023.2285576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/13/2023] [Indexed: 11/25/2023]
Abstract
Atopic dermatitis (AD) is one of the most common, bothersome and difficult to treat skin disorders. Recent introduction of new systemic treatments has revolutionized the management of AD. The goal of this guideline is to provide evidence-based recommendations for the management of patients suffering from atopic dermatitis that easily can be implemented in clinical practice. These recommendations were developed by 11 Belgian AD experts. Comments of all experts on the proposed statements were gathered, followed by an online voting session. The most relevant strategies for the management and treatment of AD in the context of the Belgian health care landscape are discussed. General measures, patient education and adequate topical treatment remain the cornerstones of AD management. For moderate to severe AD, the introduction of biologics and JAK inhibitors show unprecedented efficacy, although currently access is limited to a subgroup of patients meeting the reimbursement criteria.
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Affiliation(s)
- Hilde Lapeere
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | | | - Marie Baeck
- Department of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Bita Dezfoulian
- Department of Dermatology, Liège University Hospital, Liège, Belgium
| | - Julien Lambert
- Department of Dermatology, University Hospital Antwerp (UZA), Edegem, Belgium
| | | | - Annelies Stockman
- Department of Dermatology, AZ Delta campus Rembert Torhout, Torhout, Belgium
| | - Jonathan White
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Jan Gutermuth
- Vrije Universiteit Brussel (VUB), Department of Dermatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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28
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Zhang S, Zhang B, Liu Y, Li L. Adipokines in atopic dermatitis: the link between obesity and atopic dermatitis. Lipids Health Dis 2024; 23:26. [PMID: 38263019 PMCID: PMC10804547 DOI: 10.1186/s12944-024-02009-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
Atopic dermatitis (AD) is a chronic skin condition with intense pruritus, eczema, and dry skin. The recurrent intense pruritus and numerous complications in patients with AD can profoundly affect their quality of life. Obesity is one of its comorbidities that has been confirmed to be the hazard factor of AD and also worsen its severity. Nevertheless, the specific mechanisms that explain the connection between obesity and AD remain incompletely recognized. Recent studies have built hopes on various adipokines to explain this connection. Adipokines, which are disturbed by an obese state, may lead to immune system imbalances in people with AD and promote the development of the disease. This review focuses on the abnormal expression patterns of adipokines in patients with AD and their potential regulatory molecular mechanisms associated with AD. The connection between AD and obesity is elucidated through the involvement of adipokines. This conduces to the in-depth exploration of AD pathogenesis and provides a new perspective to develop therapeutic targets.
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Affiliation(s)
- Shiyun Zhang
- Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China, No. 1 Shuaifuyuan, 100730
| | - Bingjie Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China, No. 1 Shuaifuyuan, 100730
| | - Yuehua Liu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China, No. 1 Shuaifuyuan, 100730
| | - Li Li
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China, No. 1 Shuaifuyuan, 100730.
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29
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Pezzolo E, Ortoncelli M, Ferrucci SM, Guanti MB, Schena D, Napolitano M, Rossi M, Foti C, D’Amico D, Amoruso GF, Morrone P, Ribero S, Barei F, Biagi M, Pascucci E, Patruno C, Calzavara Pinton P, Romita P, Gargiulo L, Narcisi A, Naldi L. Drug Survival of Upadacitinib and Predicting Factors of Discontinuation in Adult Patients Affected by Moderate-to-Severe Atopic Dermatitis: An Italian Multicenter Analysis. J Clin Med 2024; 13:553. [PMID: 38256686 PMCID: PMC10816142 DOI: 10.3390/jcm13020553] [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: 12/24/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Background: Limited real-world data are available on upadacitinib drug survival in patients with atopic dermatitis (AD). Objectives: To investigate upadacitinib drug survival, and the reasons and predictors of drug discontinuation in AD patients. Methods: All consecutive patients aged 18-75 years, affected by moderate-to-severe AD, and treated with upadacitinib for more than 1 month at dermatological clinics were included during November 2020-August 2023. Upadacitinib survival was investigated through Kaplan-Meier survival analysis and the predictors through multivariable logistic regression analysis. Results: Overall, 325 adult AD patients (mean (SD) age, 38.6(15.6) years) had a 1-year and 1.5-year upadacitinib drug survival of 91.5% and 80.2%, respectively. The main reasons for drug discontinuation (25/325, 7.7%) were adverse events (4.9%), including cutaneous or infectious diseases (1.5%), such as acne and herpes zoster; blood test changes (1.2%), including hypercholesterolemia, creatine phosphokinase or liver enzyme elevation, and lymphopenia; urinary or respiratory infections (0.9%); deep venous thrombosis (0.3%); malignancies (0.3%); loss of consciousness (0.3%); and arthralgias (0.3%); followed by ineffectiveness (0.6%). No specific characteristic was significantly associated with an increased risk of upadacitinib discontinuation. Conclusions: Our findings show that upadacitinib was effective in moderate-to-severe AD after more than 1 year of continuous treatment but point to the need for clinical and laboratory monitoring of patients.
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Affiliation(s)
- Elena Pezzolo
- Dermatology Unit, Ospedale San Bortolo, 36100 Vicenza, Italy
- Study Centre of the Italian Group for Epidemiologic Research in Dermatology (GISED), 24128 Bergamo, Italy
| | - Michela Ortoncelli
- Dermatology Clinic, Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | - Silvia Mariel Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Mario Bruno Guanti
- Department of Dermatology, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Donatella Schena
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37100 Verona, Italy
| | - Maddalena Napolitano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | | | - Caterina Foti
- Unit of Dermatology, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Domenico D’Amico
- UOC Dermatologia, AOU “R. Dulbecco”, Ospedale ‘A. Pugliese’, 88100 Catanzaro, Italy
| | | | - Pietro Morrone
- UOC Dermatologia, Azienda Ospedaliera Cosenza, 87100 Cosenza, Italy
| | - Simone Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | - Francesca Barei
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Matteo Biagi
- Department of Dermatology, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Enrico Pascucci
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37100 Verona, Italy
| | - Cataldo Patruno
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy;
| | | | - Paolo Romita
- Unit of Dermatology, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Luigi Gargiulo
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
- Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
| | - Alessandra Narcisi
- Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
| | - Luigi Naldi
- Dermatology Unit, Ospedale San Bortolo, 36100 Vicenza, Italy
- Study Centre of the Italian Group for Epidemiologic Research in Dermatology (GISED), 24128 Bergamo, Italy
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30
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Barei F, Zussino M, Tavecchio S, Angileri L, Rizzo A, Calzari P, Marzano AV, Ferrucci S. Assessment of Patient-Reported Outcomes at 48 Months of Treatment with Dupilumab for Severe Atopic Dermatitis: A Single-Center Real-Life Experience with 126 Patients. Pharmaceuticals (Basel) 2024; 17:117. [PMID: 38256950 PMCID: PMC10821420 DOI: 10.3390/ph17010117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/29/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The main objective was to analyze patient-reported outcomes (PRO) trends over a four-year period in severe atopic dermatitis (AD) patients treated with dupilumab. METHODS data from 126 severe patients receiving dupilumab for at least 48 months were collected. The clinical scores assessed included the Eczema Area and Severity Index (EASI), Pruritus Numerical Rating Scale (NRS), Sleep NRS, Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), and Atopic Dermatitis Control Tool (ADCT). RESULTS the study compellingly demonstrates dupilumab's effectiveness in reducing EASI and improving PROs, with sustained enhancements observed beyond the initial twelve months of treatment. Univariate and multivariate regression analyses show that baseline factors do not significantly increase the risk of adverse outcomes related to Pruritus NRS, POEM, or ADCT at T48. The robust correlation between ADCT and other PROs suggests closely aligned changes. CONCLUSION Dupilumab's benefits endure beyond the first year, emphasizing its long-term efficacy, and consistently improves AD outcomes regardless of individual characteristics or clinical variables. ADCT appears to be a practical and versatile tool for the streamlined assessment of AD treatment outcomes.
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Affiliation(s)
- Francesca Barei
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Martina Zussino
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Simona Tavecchio
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Luisa Angileri
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Arianna Rizzo
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paolo Calzari
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Angelo V. Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Silvia Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Werfel T, Heratizadeh A, Aberer W, Augustin M, Biedermann T, Bauer A, Fölster-Holst R, Kahle J, Kinberger M, Nemat K, Neustädter I, Peters E, von Kiedrowski R, Schmid-Grendelmeier P, Schmitt J, Schwennesen T, Simon D, Spindler T, Traidl-Hoffmann C, Werner RN, Wollenberg A, Worm M, Ott H. S3 Guideline Atopic dermatitis: Part 1 - General aspects, topical and non-drug therapies, special patient groups. J Dtsch Dermatol Ges 2024; 22:137-153. [PMID: 38171719 DOI: 10.1111/ddg.15230] [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: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 01/05/2024]
Abstract
This S3 guideline was created based on the European S3 guideline, with special consideration of the medical conditions in the German-speaking region and incorporating additions from the previous German-language version. The interdisciplinary guideline commission consisted of representatives from the German Dermatological Society, the Professional Association of German Dermatologists, the Austrian Society of Dermatology and Venereology, the Swiss Society of Dermatology and Venereology, the German Society for Allergology and Clinical Immunology, the German Society for Pediatric and Adolescent Medicine, the Professional Association of Pediatricians and Adolescent Medicine, the Society for Pediatric Allergology and Environmental Medicine, the German Society for Pediatric Rehabilitation and Prevention, the German Society for Psychosomatic Medicine and Medical Psychotherapy, the German Network for Health Services Research, the German Eczema Association and the German Allergy and Asthma Association. This first part of the guideline focuses on the definition and diagnostic aspects of atopic dermatitis (AD), addressing topical therapy as well as non-pharmacological treatment approaches such as UV therapy, psychoeducational therapy, dietary interventions for AD, allergen immunotherapy for AD, and complementary medicine. This part of the guideline also covers specific aspects of AD in children and adolescents, during pregnancy and lactation, and in the context of family planning. Additionally, it addresses occupational aspects of AD and highlights the perspective of the patients. The second part of the guideline, published separately, addresses the systemic therapy of AD.
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Affiliation(s)
- Thomas Werfel
- Department of Dermatology, Allergology and Venereology, Hannover Medical School, Hannover, Germany
| | - Annice Heratizadeh
- Department of Dermatology, Allergology and Venereology, Hannover Medical School, Hannover, Germany
| | - Werner Aberer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Matthias Augustin
- Competence Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergology, University Medical Center, Technical University of Munich, Munich, Germany
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Regina Fölster-Holst
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Julia Kahle
- German Allergy and Asthma Association (DAAB), Mönchengladbach, Germany
| | - Maria Kinberger
- Department of Dermatology, Venereology and Allergology, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katja Nemat
- Office for Pediatric Pneumology and Allergology, Pediatric Center Dresden-Friedrichstadt (Kid), Dresden, Germany
| | - Irena Neustädter
- Hospital Hallerwiese, Cnopfsche Kinderklinik, Nuremberg, Germany
| | - Eva Peters
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Gießen, Gießen, Germany
| | | | | | - Jochen Schmitt
- Center for Evidence-Based Healthcare (ZEGV), Medical Faculty Gustav Carus, Technical University Dresden, Dresden, Germany
| | | | - Dagmar Simon
- Department of Dermatology, Inselspital Bern, Bern, Switzerland
| | - Thomas Spindler
- Specialized Clinic for Pediatric Pneumology and Allergology, Wangen, Germany
| | | | - Ricardo Niklas Werner
- Department of Dermatology, Venereology and Allergology, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Wollenberg
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
- Department of Dermatology and Allergy, Ludwig Maximilian University Munich, Munich, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hagen Ott
- Department of Pediatric Dermatology and Allergology, Children's and Adolescents' Hospital Auf der Bult, Hannover, Germany
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Komori T, Hisaoka T, Kotaki A, Iwamoto M, Miyajima A, Esashi E, Morikawa Y. Blockade of OSMRβ signaling ameliorates skin lesions in a mouse model of human atopic dermatitis. FASEB J 2024; 38:e23359. [PMID: 38102969 DOI: 10.1096/fj.202301529r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/03/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by severe pruritus and eczematous skin lesions. Although IL-31, a type 2 helper T (Th2)-derived cytokine, is important to the development of pruritus and skin lesions in AD, the blockade of IL-31 signaling does not improve the skin lesions in AD. Oncostatin M (OSM), a member of IL-6 family of cytokines, plays important roles in the regulation of various inflammatory responses through OSM receptor β subunit (OSMRβ), a common receptor subunit for OSM and IL-31. However, the effects of OSM on the pathogenesis of AD remain to be elucidated. When AD model mice were treated with OSM, skin lesions were exacerbated and IL-4 production was increased in the lymph nodes. Next, we investigated the effects of the monoclonal antibody (mAb) against OSMRβ on the pathogenesis of AD. Treatment with the anti-OSMRβ mAb (7D2) reduced skin severity score in AD model mice. In addition to skin lesions, scratching behavior was decreased by 7D2 mAb with the reduction in the number of OSMRβ-positive neurons in the dorsal root ganglia of AD model mice. 7D2 mAb also reduced the serum concentration of IL-4, IL-13, and IgE as well as the gene expressions of IL-4 and IL-13 in the lymph nodes of AD model mice. Blockade of both IL-31 and OSM signaling is suggested to suppress both pruritus and Th2 responses, resulting in the improvement of skin lesions in AD. The anti-OSMRβ mAb may be a new therapeutic candidate for the treatment of AD.
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Affiliation(s)
- Tadasuke Komori
- Department of Anatomy & Neurobiology, Wakayama Medical University, Wakayama, Japan
| | - Tomoko Hisaoka
- Department of Anatomy & Neurobiology, Wakayama Medical University, Wakayama, Japan
| | - Ayumi Kotaki
- Ginkgo Biomedical Research Institute, R&D Department, SBI Biotech Co. Ltd, Fujisawa, Japan
| | - Miki Iwamoto
- Department of Pediatrics, Kainan Municipal Medical Center, Kainan, Japan
| | - Atsushi Miyajima
- Laboratory of Cell Growth and Differentiation, Institute for Quantitative Biosciences, The University of Tokyo, Tokyo, Japan
| | - Eiji Esashi
- Ginkgo Biomedical Research Institute, R&D Department, SBI Biotech Co. Ltd, Fujisawa, Japan
| | - Yoshihiro Morikawa
- Department of Anatomy & Neurobiology, Wakayama Medical University, Wakayama, Japan
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Tai LR, Chiang YF, Huang KC, Chen HY, Ali M, Hsia SM. Hinokitiol as a modulator of TLR4 signaling and apoptotic pathways in atopic dermatitis. Biomed Pharmacother 2024; 170:116026. [PMID: 38128179 DOI: 10.1016/j.biopha.2023.116026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Atopic dermatitis (AD) poses a significant global health challenge, characterized by dysregulated inflammation and apoptotic processes. This study explores the therapeutic efficacy of hinokitiol, employing a comprehensive in vivo and in vitro approach. Assessment of inflammation-related markers in the animal model included observation of physical appearance, Western blotting, ELISA, and H&E staining. Additionally, the cell culture model enabled the evaluation of apoptosis and ROS levels using MTT assay, crystal violet staining, Western blot, and DCFDA assays. The results revealed hinokitiol's proficiency in ameliorating ear and skin morphology in the DNCB-induced AD model, mediated through the TLR4/MyD88 pathway. Notably, hinokitiol intervention led to a reduction in both M1 and M2 macrophage phenotypes. In vitro investigations demonstrated hinokitiol's ability to enhance cell viability and morphology under TNF-α and IFN-γ induction. Mechanistically, hinokitiol exhibited regulatory effects on apoptosis-related proteins, including Bax, Cytochrome c, Caspase-3, and PARP, thereby averting cellular damage. These findings suggest that hinokitiol is a promising natural compound with significant potential for alleviating inflammation and apoptosis in AD, indicating potential avenues for future therapeutic developments.
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Affiliation(s)
- Ling-Ray Tai
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan
| | - Yi-Fen Chiang
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan
| | - Ko-Chieh Huang
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan
| | - Hsin-Yuan Chen
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan
| | - Mohamed Ali
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, 11566 Cairo, Egypt; Deaprtment of Obstertrics and Gynecology, University of Chicago, 60637, Chicago, IL, USA
| | - Shih-Min Hsia
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan; Graduate Institute of Metabolism and Obesity Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan; School of Food Safety, Taipei Medical University, Taipei 11031, Taiwan; Nutrition Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan; TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan.
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Werfel T, Heratizadeh A, Aberer W, Augustin M, Biedermann T, Bauer A, Fölster-Holst R, Kahle J, Kinberger M, Nemat K, Neustädter I, Peters E, von Kiedrowski R, Schmid-Grendelmeier P, Schmitt J, Schwennesen T, Simon D, Spindler T, Traidl-Hoffmann C, Werner RN, Wollenberg A, Worm M, Ott H. S3-Leitlinie Atopische Dermatitis: Teil 1- Allgemeine Aspekte, topische und nichtmedikamentöse Therapien, besondere Patientengruppen: S3 guideline Atopic dermatitis: Part 1- General aspects, topical and non-drug therapies, special patient groups. J Dtsch Dermatol Ges 2024; 22:137-155. [PMID: 38212907 DOI: 10.1111/ddg.15230_g] [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: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 01/13/2024]
Abstract
ZusammenfassungDiese S3‐Leitlinie wurde auf der Basis der europäischen S3‐Leitlinie unter besonderer Berücksichtigung der medizinischen Gegebenheiten im deutschsprachigen Raum und mit Ergänzungen der deutschsprachigen Vorgängerversion erstellt. Die interdisziplinäre Leitlinienkommission bestand aus Vertretern der Deutschen Dermatologischen Gesellschaft, dem Berufsverband der Deutschen Dermatologen, der Österreichischen Gesellschaft für Dermatologie und Venerologie, der Schweizerischen Gesellschaft für Dermatologie und Venerologie, der Deutschen Gesellschaft für Allergologie und Klinische Immunologie, der Deutschen Gesellschaft für Kinder‐ und Jugendmedizin, dem Berufsverband der Kinder‐ und Jugendärzte, der Gesellschaft für Pädiatrische Allergologie und Umweltmedizin, der Deutschen Gesellschaft für Pädiatrische Rehabilitation und Prävention, der Deutschen Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie, dem Deutschen Netzwerk Versorgungsforschung, dem Deutschen Neurodermitis Bund und dem Deutschen Allergie‐ und Asthmabund. Dieser erste Teil der Leitlinie geht auf die Definition und die diagnostischen Aspekte der atopischen Dermatitis (AD) ein, behandelt die topische Therapie sowie die nichtmedikamentösen Therapieverfahren wie die UV‐Therapie, die psychoedukative Therapie, diätische Interventionen bei AD, die Allergen‐spezifische Immuntherapie bei AD und die Komplementärmedizin. Auch behandelt dieser Teil der Leitlinie die besonderen Aspekte der AD bei Kindern und Jugendlichen, in der Schwangerschaft und in der Stillzeit sowie bei Kinderwunsch. Außerdem wird auf berufsbezogene Aspekte der AD eingegangen und die Perspektive der Patienten hervorgehoben. Der zweite, separat publizierte Teil der Leitlinie adressiert die systemische Therapie der AD.
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Affiliation(s)
- Thomas Werfel
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Deutschland
| | - Annice Heratizadeh
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Deutschland
| | - Werner Aberer
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Matthias Augustin
- Kompetenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Deutschland
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Deutschland
| | - Regina Fölster-Holst
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland
| | - Julia Kahle
- Deutscher Allergie- und Asthmabund (DAAB) e. V., Mönchengladbach, Deutschland
| | - Maria Kinberger
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Katja Nemat
- Praxis für Kinderpneumologie und Allergologie, Kinderzentrum Dresden-Friedrichstadt (Kid), Dresden, Deutschland
| | - Irena Neustädter
- Klinik Hallerwiese, Cnopfsche Kinderklinik, Nürnberg, Deutschland
| | - Eva Peters
- Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Gießen (UKGM), Gießen, Deutschland
| | | | | | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Medizinische Fakultät Gustav Carus, Technische Universität Dresden, Deutschland
| | | | - Dagmar Simon
- Universitätsklinik für Dermatologie, Inselspital Bern, Bern, Schweiz
| | - Thomas Spindler
- Fachklinik für Pädiatrische Pneumologie und Allergologie, Wangen, Deutschland
| | | | - Ricardo Niklas Werner
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Andreas Wollenberg
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwigs-Maximilians-Universität, München, Deutschland
| | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Hagen Ott
- Fachbereich Pädiatrische Dermatologie und Allergologie, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
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Au CY, Leow SY, Yi C, Ang D, Yeo JC, Koh MJA, Bhagat AAS. A Sensorised Glove to Detect Scratching for Patients with Atopic Dermatitis. SENSORS (BASEL, SWITZERLAND) 2023; 23:9782. [PMID: 38139628 PMCID: PMC10748247 DOI: 10.3390/s23249782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
In this work, a lightweight compliant glove that detects scratching using data from microtubular stretchable sensors on each finger and an inertial measurement unit (IMU) on the palm through a machine learning model is presented: the SensorIsed Glove for Monitoring Atopic Dermatitis (SIGMA). SIGMA provides the user and clinicians with a quantifiable way of assaying scratch as a proxy to itch. With the quantitative information detailing scratching frequency and duration, the clinicians would be able to better classify the severity of itch and scratching caused by atopic dermatitis (AD) more objectively to optimise treatment for the patients, as opposed to the current subjective methods of assessments that are currently in use in hospitals and research settings. The validation data demonstrated an accuracy of 83% of the scratch prediction algorithm, while a separate 30 min validation trial had an accuracy of 99% in a controlled environment. In a pilot study with children (n = 6), SIGMA accurately detected 94.4% of scratching when the glove was donned. We believe that this simple device will empower dermatologists to more effectively measure and quantify itching and scratching in AD, and guide personalised treatment decisions.
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Affiliation(s)
- Cheuk-Yan Au
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore (NUS) MD6, 14 Medical Drive, #14-01, Singapore 117599, Singapore; (C.-Y.A.); (C.Y.); (J.C.Y.)
| | - Syen Yee Leow
- Department of Dermatology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore (M.J.A.K.)
| | - Chunxiao Yi
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore (NUS) MD6, 14 Medical Drive, #14-01, Singapore 117599, Singapore; (C.-Y.A.); (C.Y.); (J.C.Y.)
| | - Darrion Ang
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore (NUS) MD6, 14 Medical Drive, #14-01, Singapore 117599, Singapore; (C.-Y.A.); (C.Y.); (J.C.Y.)
| | - Joo Chuan Yeo
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore (NUS) MD6, 14 Medical Drive, #14-01, Singapore 117599, Singapore; (C.-Y.A.); (C.Y.); (J.C.Y.)
| | - Mark Jean Aan Koh
- Department of Dermatology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore (M.J.A.K.)
| | - Ali Asgar Saleem Bhagat
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore (NUS) MD6, 14 Medical Drive, #14-01, Singapore 117599, Singapore; (C.-Y.A.); (C.Y.); (J.C.Y.)
- Department of Biomedical Engineering, National University of Singapore (NUS), 4 Engineering Drive 3, Singapore 117583, Singapore
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Wang MC, Chou YT, Kao MC, Lin QY, Chang SY, Chen HY. Topical Chinese herbal medicine in treating atopic dermatitis (eczema): A systematic review and meta-analysis with core herbs exploration. JOURNAL OF ETHNOPHARMACOLOGY 2023; 317:116790. [PMID: 37328084 DOI: 10.1016/j.jep.2023.116790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/18/2023] [Accepted: 06/13/2023] [Indexed: 06/18/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Topical Chinese herbal medicine (CHM) is commonly used to relieve atopic dermatitis (AD); however, the up-to-date evidence concerning the effectiveness of topical CHM on treating AD is lacking. Moreover, the CHM prescriptions are often too complicated to realize the overall mechanisms of CHM, especially when compared to western medicines (WM). AIM OF THE STUDY To evaluate the effectiveness of topical CHM for treating AD by conducting a meta-analysis on randomized clinical trials (RCTs). METHODS Twenty RCTs comparing topical CHM to active control/placebo were included in the final analysis. The primary outcome was the symptom scores changed from baseline and the effectiveness rate was the secondary outcome. Subgroup analysis on different initial symptom severity and the different interventions in control groups was performed. System pharmacology analysis was performed to explore core CHM and possible pharmacological mechanisms of CHM for AD. RESULTS Compared with active/blank placebo, topical CHM seemed more effective (SMD: -0.35, 95 %CI: -0.59 to -0.10, p-value = 0.005, I2 = 60%). The effectiveness rate was higher (RR: 1.29, 95 %CI 1.15-1.44, p-value <0.00001, I2 = 71%). In subgroup analysis, mild and moderate AD patients with topical CHM were more effective than placebo (SMD: -0.28, 95 %CI -0.56 to -0.01, p-value = 0.04, I2 = 5%; -0.34, 95%CI -0.64 to -0.03, p-value = 0.03, I2 = 0%, separately). Topical CHM has 1.25 times more effective than the topical glucocorticoid (95 %CI 1.09-1.43, p-value = 0.001, I2 = 64%). Core CHMs, such as Phellodendron chinense C.K. Schneid., Sophora flavescens Ait., Cnidium monnieri (L.) Cusson, and Dictamnus dasycarpus Turcz., had effects on the pathways on immune and metabolism systems different from WM. CONCLUSION Our results exploit the potential role of CHM on treating AD, especially for mild and moderate AD.
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Affiliation(s)
- Meng-Chun Wang
- Department of Traditional Chinese Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Yu-Ting Chou
- Fengze Chinese Medicine Clinic, Taoyuan, Taiwan.
| | - Ming-Chen Kao
- Department of Traditional Chinese Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Qian-Ying Lin
- Traditional Chinese Medicine Pharmacy, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan.
| | - Sing-Ya Chang
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Hsing-Yu Chen
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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37
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Silverberg JI, Pierce E, Feely M, Atwater AR, Schrader A, Jones EA, Dave SS, Simpson EL. Disease burden among patients with atopic dermatitis treated with systemic therapy for 4-12 months: results from the CorEvitas Atopic Dermatitis Registry. J DERMATOL TREAT 2023; 34:2246601. [PMID: 37691405 DOI: 10.1080/09546634.2023.2246601] [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: 06/14/2023] [Accepted: 08/05/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Real-world data on the effectiveness of systemic therapy in atopic dermatitis (AD) are limited. METHODS Adult patients with AD in the CorEvitas AD registry (2020-2021) who received systemic therapies for 4-12 months prior to enrollment were included based on disease severity: body surface area (BSA) 0%-9% and BSA ≥10%. Demographics, clinical characteristics, and outcomes were assessed using descriptive statistics. Pairwise effect sizes (ES) were used to compare BSA groups. RESULTS The study included 308 patients (BSA 0%-9%: 246 [80%]; BSA ≥10%: 62 [20%]). Despite systemic therapy, both BSA groups reported the use of additional topical therapy and the presence of lesions at difficult locations. Moderate-to-severe AD (vIGA-AD®) was reported by 11% (BSA 0%-9%) and 66% (BSA ≥10%; ES = 0.56) of patients. Mean disease severity scores: total BSA (2% and 22%; ES = 3.59), EASI (1.1 and 11.1; ES = 2.60), and SCORAD (12.1 and 38.0; ES = 1.99). Mean scores for PROs: DLQI (3.7 and 7.5; ES = 0.75), and peak pruritus (2.2 and 4.5; ES = 0.81). Inadequate control of AD was seen in 27% and 53% of patients (ES = 0.23). CONCLUSIONS Patients with AD experience a high disease burden despite systemic treatment for 4-12 months. This study provides potential evidence of suboptimal treatment and the need for additional effective treatment options for AD.
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Affiliation(s)
| | | | - Meghan Feely
- Eli Lilly and Company, IN, USA
- Mount Sinai Hospital, NY, USA
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38
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Kortekaas Krohn I, Badloe FMS, Herrmann N, Maintz L, De Vriese S, Ring J, Bieber T, Gutermuth J. Immunoglobulin E autoantibodies in atopic dermatitis associate with Type-2 comorbidities and the atopic march. Allergy 2023; 78:3178-3192. [PMID: 37489049 DOI: 10.1111/all.15822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Autoreactive immunoglobulin E (IgE) antibodies to self-peptides within the epidermis have been identified in patients with atopic dermatitis (AD). Prevalence, concomitant diseases, patient characteristics, and risk factors of IgE autoantibody development remain elusive. We aimed to determine IgE autoantibodies in serum samples (n = 672) from well-characterized patients with AD and controls (1.2-88.9 years). METHODS Atopic dermatitis patients were sub-grouped in AD with comorbid Type-2 diseases ("AD + Type 2"; asthma, allergic rhinitis, food allergy, n = 431) or "solely AD" (n = 115). Also, subjects without AD but with Type-2 diseases ("atopic controls," n = 52) and non-atopic "healthy controls" (n = 74) were included. Total proteins from primary human keratinocytes were used for the immunoassay to detect IgE autoantibodies. Values were compared to already known positive and negative serum samples. RESULTS Immunoglobulin E autoantibodies were found in 15.0% (82/546) of all analyzed AD-patients. "AD + Type 2" showed a higher prevalence (16.4%) than "solely AD" (9.6%). "Atopic controls" (9.6%) were comparable with "solely AD" patients, while 2.7% of healthy controls showed IgE autoantibodies. Of those with high levels of IgE autoantibodies, 15 out of 16 were patients with "AD + Type 2". AD patients with IgE autoantibodies were younger than those without. Patients with IgE autoreactivity also displayed higher total serum IgE levels. Factors that affected IgE autoantibody development were as follows: birth between January and June, cesarean-section and diversity of domestic pets. CONCLUSIONS Immunoglobulin E autoantibodies in AD seem to associate with the presence of atopic comorbidities and environmental factors. The potential value of IgE autoantibodies as a predictive biomarker for the course of AD, including the atopic march, needs further exploration.
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Affiliation(s)
- Inge Kortekaas Krohn
- Skin Immunology & Immune Tolerance (SKIN) Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Fariza Mishaal Saiema Badloe
- Skin Immunology & Immune Tolerance (SKIN) Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Nadine Herrmann
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Laura Maintz
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Shauni De Vriese
- Skin Immunology & Immune Tolerance (SKIN) Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Johannes Ring
- Department Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
- Davos Biosciences, Davos, Switzerland
| | - Jan Gutermuth
- Skin Immunology & Immune Tolerance (SKIN) Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Ragamin A, van Halewijn KF, Schuttelaar ML, Lugtenberg M, Pasmans SG, Elshout G, Schappin R. Perceived adherence and associated barriers to the national atopic dermatitis guideline: A survey among general practitioners. Eur J Gen Pract 2023; 29:2242583. [PMID: 37603039 PMCID: PMC10443994 DOI: 10.1080/13814788.2023.2242583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/12/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND General practitioners (GPs) have an important role in managing patients with atopic dermatitis (AD). Although pivotal, adherence to dermatological guidelines in general practice has not been assessed. OBJECTIVES To assess GPs' perceived adherence and barriers to the Dutch AD guideline. METHODS A survey was conducted among 391 GPs in the Netherlands between December 2021 and May 2022. GPs rated their perceived adherence and perceived barriers concerning five key recommendations of the AD guideline, following an existing framework. The correlation between perceived adherence and barriers was investigated using Spearman's rank correlation. RESULTS A total of 213 GPs (54%) participated. Perceived adherence rates varied across recommendations (43.7% to 98.1%). Lowest adherence was reported for recommendations concerning topical corticosteroids (TCS). Across all recommendations, patient factors (65.6%; SD 11.6) and lack of applicability to specific patient groups (29.5%; SD 10.5) were reported most frequently as barriers. The overall correlation between adherence and barriers was strongest for knowledge (ρ .55; SD .10) and attitude-related factors (range: ρ .40--.62). CONCLUSION GPs' perceived adherence and barriers vary substantially across recommendations of the AD guideline. In particular, GPs reported lower adherence to recommendations concerning TCS. Next to patient-related factors, strong correlations between adherence perceived by GPs and knowledge and attitude-related barriers suggest the importance of addressing these factors as well to improve adherence.
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Affiliation(s)
- Aviël Ragamin
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Dermatology, Center of Pediatric Dermatology, Sophia Children’s Hospital, Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Karlijn F. van Halewijn
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marie L.A. Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjolein Lugtenberg
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Suzanne G.M.A. Pasmans
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Dermatology, Center of Pediatric Dermatology, Sophia Children’s Hospital, Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Gijs Elshout
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Renske Schappin
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Dermatology, Center of Pediatric Dermatology, Sophia Children’s Hospital, Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital, Rotterdam, The Netherlands
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Liu X, Wang Y, Xi R, Guo D, Guo W, Cheng L, Du T, Lu H, Wang P, Duan Y, Zhu J, Li F. Identification of IRF1 as a Novel Pyroptosis-Related Prognostic Biomarker of Atopic Dermatitis. Genet Test Mol Biomarkers 2023; 27:370-383. [PMID: 38156909 DOI: 10.1089/gtmb.2023.0264] [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] [Indexed: 01/03/2024] Open
Abstract
Purpose: The aim of this study was to characterize key biomarkers associated with pyroptosis in atopic dermatitis (AD). Materials and methods: To identify the differentially expressed pyroptosis-related genes (DEPRGs), the gene expression profiles GSE16161 and GSE32924 from the Gene Expression Omnibus (GEO) database were utilized. Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were conducted to determine the potential biological functions and involved pathways. Furthermore, protein-protein interaction network analyses were performed to identify hub genes. The types and proportions of infiltrating immune cells were detected by immune filtration analysis using CIBERSORT. A 12-axis competing endogenous RNA (ceRNA) network was constructed utilizing the miRNet database. Immunohistochemistry (IHC) further validated the differential expression of a key gene IRF1 in the skin tissues collected from AD patients. The collection of skin tissue from human subjects in this study were reviewed and approved by the IRB of Yueyang Integrated Chinese and Western Medicine Hospital (KYSKSB2020-125). Results: The study identified a total of 76 DEPRGs, which were enriched in genes associated with the inflammatory response and immune regulation. There was a higher percentage of activated dendritic cells and a lower percentage of resting mast cells in AD samples. PVT1 expression was associated with upregulation of hub genes including CXCL8, IRF1, MKI67, and TP53 in the ceRNA network and was correlated with activated dendritic cells in AD. As a transcription factor, IRF1 could regulate the production of downstream inflammatory factors. The IHC study revealed that IRF1 was overexpressed in the skin tissues of AD patients, which were consistent with the results of the bioinformatic study. Conclusions: IRF1 and its related genes were identified as key pyroptosis-related biomarkers in AD, which is a crucial pathway in the pathogenesis of AD.
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Affiliation(s)
- Xin Liu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yi Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ruofan Xi
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Dongjie Guo
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wanjun Guo
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Linyan Cheng
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ting Du
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hanzhi Lu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Peiyao Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanjuan Duan
- Department of Dermatology, Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianyong Zhu
- Department of Pharmacy Research, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fulun Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Barrett R, Barry M, McCullagh L. Health technology management: the experience of a managed access approach to the reimbursement of dupilumab in Ireland. Ir J Med Sci 2023; 192:2829-2837. [PMID: 37156985 PMCID: PMC10692243 DOI: 10.1007/s11845-023-03378-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Dupilumab was the first biological medicine to receive marketing authorisation, in Ireland, for the treatment of atopic dermatitis (AD). In 2019, Ireland's National Centre for Pharmacoeconomics recommended that dupilumab not be reimbursed at the submitted price; it was not cost effective. Following confidential price negotiations, the Health Service Executive (HSE) reimbursed dupilumab subject to a HSE-Managed Access Protocol (MAP). Patients with refractory, moderate-to-severe AD were deemed eligible to receive treatment under the MAP; the cohort for which dupilumab is expected to be most effective and most cost effective (versus standard of care). Approval, for treatment, is granted on an individual patient basis by the HSE-Medicines Management Programme. AIMS Applications for approval of treatment with dupilumab were analysed to determine the percentage of patients deemed eligible. Key characteristics of this population were investigated. METHODS Data from individual patient applications were analysed. Key characteristics of the approved population were investigated using IBM SPSS Statistics® version 27. Data were derived from the HSE-Primary Care Reimbursement Service pharmacy claims database. The number of patients who received dupilumab over the study period was determined. RESULTS In total, 96% of submitted applications were deemed eligible. Of these, 65% were male and 87% were adults. In the main, the approved patient population had severe refractory AD; the mean Eczema Area Severity Index score was 28.72. CONCLUSION The majority of applications submitted were approved. This work highlights how a MAP can facilitate access to treatment in patients who are deemed eligible whilst containing overall expenditure.
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Affiliation(s)
- Rosealeen Barrett
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland.
- Medicines Management Programme, Health Service Executive, St. James's Hospital, Dublin 8, Ireland.
| | - Michael Barry
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
- Medicines Management Programme, Health Service Executive, St. James's Hospital, Dublin 8, Ireland
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland
| | - Laura McCullagh
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland
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Günther C. Neue Empfehlungen für die Versorgung von Patienten mit atopischer Dermatitis. J Dtsch Dermatol Ges 2023; 21:1441-1442. [PMID: 38082511 DOI: 10.1111/ddg.15319_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Claudia Günther
- Klinik und Poliklinik für Dematologie, Universitätsklinikum Carl Gustav Carus, Technische Univeristät Dresden, Dresden, Deutschland, Germany
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Hanada S, Muraki M, Kawabata Y, Yoshikawa K, Yamagata T, Nagasaki T, Ohara Y, Oiso N, Matsumoto H, Tohda Y. Significance of Self-Injectable Biologics in Japanese Patients with Severe Allergic Diseases: Focusing on Pen-Type Devices and Copayment. Patient Prefer Adherence 2023; 17:2847-2853. [PMID: 37953978 PMCID: PMC10638892 DOI: 10.2147/ppa.s430038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/24/2023] [Indexed: 11/14/2023] Open
Abstract
Patients and Methods A questionnaire survey was administered to 18, 14, and 3 patients introduced to home self-injection of dupilumab or mepolizumab using a pen-type device for atopic dermatitis, asthma alone, and asthma plus chronic rhinosinusitis with nasal polyps, respectively. Results All but one participant wished to continue self-injection. Most participants affirmed the reduction in copayment (88.6%) and saving time and labor for hospital visits (88.6%). Six patients who received dupilumab complained of side effects, but all, except for one, continued the treatment. Of the 13 patients who had previously used a syringe-type device, 10 preferred the pen type because of its ease of use, while 3 (23%) preferred the syringe type because of the self-adjustable injection speed for pain control. Conclusion Administration of biologics using pen-type devices is easier, and the introduction of home self-injection leads to a reduction in outpatient visits and copayment.
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Affiliation(s)
- Soichiro Hanada
- Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Masato Muraki
- Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Yoshiyuki Kawabata
- Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Kazuya Yoshikawa
- Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Toshiyuki Yamagata
- Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Tadao Nagasaki
- Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Yushiro Ohara
- Department of Dermatology, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Naoki Oiso
- Department of Dermatology, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Hisako Matsumoto
- Department of Respiratory Medicine and Allergology, Kindai University Hospital, Osakasayama, Osaka, Japan
| | - Yuji Tohda
- Kindai University Hospital, Osakasayama, Osaka, Japan
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Cho A, Paulitschke V, Knobler R. Mode of action, indications and recommendations on extracorporeal photopheresis (ECP). J Dtsch Dermatol Ges 2023; 21:1369-1380. [PMID: 37723908 DOI: 10.1111/ddg.15167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/02/2023] [Indexed: 09/20/2023]
Abstract
Extracorporeal photopheresis (ECP) has gained importance in the treatment of several diseases. Initially introduced as a new therapeutic modality for the treatment of patients with cutaneous T-cell lymphoma, the indications for the use of ECP have expanded to include hematology and transplantation immunology. Extracorporeal photopheresis has found its place in the treatment plan of cutaneous T-cell lymphoma, systemic sclerosis, graft-versus-host disease, organ transplantation such as heart and lung, sometimes as first-line therapy and very often in combination with various systemic immunosuppressive therapies. The procedure basically consists of three steps: leukapheresis, photoactivation and reinfusion. The following article presents possible theories about the mechanism of action, which is not yet fully understood, and discusses the five most common indications for ECP treatment with corresponding therapy recommendations.
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Affiliation(s)
- Ara Cho
- University Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Verena Paulitschke
- University Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Robert Knobler
- University Department of Dermatology, Medical University of Vienna, Vienna, Austria
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45
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Wahl J, Jost M, Apfelbacher C. [Information needs of patients with atopic eczema-a qualitative study]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:875-884. [PMID: 37644330 DOI: 10.1007/s00105-023-05211-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Often patient information in atopic eczema (AE) does not meet the criteria of evidence-based patient information. What are the information needs of affected patients? OBJECTIVE The aim of the study was to analyze opinions and experiences of AE patients regarding their personal information needs. METHODS In all, 16 semi-structured interviews were conducted with patients with AE based on an interview guide. Subsequently the audio-taped interviews were transcribed and analyzed using deductive-inductive methods. Standards of qualitative research were ensured using the consolidated criteria for reporting qualitative research (COREQ). RESULTS In all, 21 persons participated in the 16 interviews, including patients and relatives. Gender ratio was 2 : 1 (female/male); age varied between 19 and 75 years. The interviews revealed a gap in care for patient information about AE. Especially the lack of time in the physician-patients encounter was criticized. Many of the affected felt left alone and forced to take a more active role in the search for information and therapy itself. Depending on stage and duration of the disease, some persons had the impression that their search for information was too time-consuming in relation to the possible benefits. CONCLUSION Patients perceived their doctor to be the most important contact person during the information seeking process. Within our study group, feeling a lack of a caring contact person as well as a lack of knowledge often led to not complying with a standardized, guideline-orientated therapy and of self-treatment. Filling this care gap seems to be an important approach to optimized patient care.
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Affiliation(s)
- Josepha Wahl
- Kinder- und Jugendzentrum Coburg, Dr. med. R. Frank und M. Zimmer, Bahnhofstr. 10, 96450, Coburg, Deutschland.
| | - Marion Jost
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Kiel, Campus Kiel, Deutschland
| | - Christian Apfelbacher
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto-von-Guericke-Universität, Magdeburg, Deutschland
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Cho A, Paulitschke V, Knobler R. Wirkweise, Indikationen und Therapieempfehlungen der extrakorporalen Photopherese (ECP). J Dtsch Dermatol Ges 2023; 21:1369-1381. [PMID: 37946642 DOI: 10.1111/ddg.15167_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/02/2023] [Indexed: 11/12/2023]
Abstract
ZusammenfassungDie extrakorporale Photopherese (ECP) hat in jüngster Zeit bei der Behandlung verschiedener Krankheiten an Bedeutung gewonnen. Ursprünglich als neue Therapie zur Behandlung von Patienten mit kutanem T‐Zell‐Lymphom vorgestellt, hat sich der Indikationsbereich für die ECP auf Hämatologie und Transplantationsimmunologie erweitert. Die ECP hat ihren festen Platz im Therapieplan bei kutanen T‐Zell‐Lymphomen, systemischer Sklerose, Graft‐versus‐Host‐Erkrankung, Organtransplantationen wie Herz und Lunge, teilweise als Erstlinientherapie und sehr häufig in Kombination mit verschiedenen systemischen immunsuppressiven Therapien. Das Verfahren besteht im Wesentlichen aus drei Schritten: Leukapherese, Photoaktivierung und Reinfusion. Im folgenden Artikel werden die noch nicht vollständig verstandenen Wirkmechanismen dargestellt, die fünf häufigsten Indikationen für die Behandlung mit ECP diskutiert und Therapieempfehlungen für die jeweilige Indikation gegeben.
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Affiliation(s)
- Ara Cho
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Verena Paulitschke
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Robert Knobler
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
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Wilken B, Zaman M, Asai Y. Patient education in atopic dermatitis: a scoping review. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:89. [PMID: 37833754 PMCID: PMC10576377 DOI: 10.1186/s13223-023-00844-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects children and adults. Poor treatment adherence in AD requires interventions to promote self-management; patient education in chronic diseases is key to self-management. Many international AD management guidelines published to date include a recommendation for educating patients as part of their treatment but there are no formal recommendations on how to deliver this knowledge. MAIN: We performed a scoping review to map the existing literature on patient education practices in AD and to highlight the clinical need for improved patient education in AD. The literature search was performed with the online databases MEDLINE, Embase, Grey Matters, ClinicalTrails.gov and the International Clinical Trials Registry Platform (ICTRP). The search strategy yielded 388 articles. Of the 388 articles screened, 16 studies met the eligibility criteria, and the quantitative data was summarized by narrative synthesis. The majority of studies were randomized controlled trials conducted in Europe, Asia and North America. Since 2002, there have been limited studies evaluating patient education in the treatment of AD. Frequent education methods used included group-based educational programs, educational pamphlets, individual consultations and online resources. Education was most commonly directed at caregivers and their children. Only one study compared the efficacy of different education methods. In all included studies, the heterogenous nature of outcome measures and study design limited the consistency of results. Despite the heterogeneity of studies, patient education was shown to improve quality of life (QoL), disease severity and psychological outcomes in AD patients. CONCLUSION This scoping review highlights that patient education is effective in a variety of domains relevant to AD treatment. Further comparative studies and randomized trials with longer-term follow-up are needed to provide validated and consistent patient education recommendations for AD; these may depend on age and population.
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Affiliation(s)
- Bethany Wilken
- Translational Institute of Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada.
| | - M Zaman
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Y Asai
- Division of Dermatology, Department of Medicine, Queen's University, Kingston, ON, Canada
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Mostafa N, Smith SD. Improving Psychological Health Outcomes in Children with Atopic Dermatitis. Clin Cosmet Investig Dermatol 2023; 16:2821-2827. [PMID: 37841063 PMCID: PMC10576503 DOI: 10.2147/ccid.s393254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
Introduction Atopic dermatitis (AD) is a chronic inflammatory skin disease that usually develops in early childhood. AD has a significant impact on quality of life and psychological health outcomes in both adults and children. There are increased reported rates of psychiatric comorbidities including anxiety, depression, ADHD and suicidal ideation compared to the general population. Primary caregivers of children with pediatric eczema and their families may also have derangements in psychological health and quality of life. A number of interventions exist for AD and address wellbeing outcomes as an important aspect of effective treatment. Methods A comprehensive literature search was conducted using PubMed/Medline, Embase, the Cochrane Central Register of Controlled Trials in February 2023. Published studies up to April 2023 were included related to interventions for childhood AD that included psychological health or quality of life outcomes. These interventions were stratified according to type and evidence quality. Results Search strategy revealed a wide variety of interventions with demonstrated improvements in quality of life or wellbeing of patients with pediatric AD or their families. Both pharmacological and non-pharmacological interventions demonstrated effectiveness in improving disease outcomes. Conclusion A variety of both pharmacological and non-pharmacological interventions may be employed to improve psychological health outcomes in children with AD.
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Affiliation(s)
- Niyaz Mostafa
- Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Saxon D Smith
- ANU Medical School, ANU College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
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Haertlé J, Kienlin P, Begemann G, Werfel T, Roesner LM. Inhibition of IL-17 ameliorates keratinocyte-borne cytokine responses in an in vitro model for house-dust-mite triggered atopic dermatitis. Sci Rep 2023; 13:16628. [PMID: 37789035 PMCID: PMC10547677 DOI: 10.1038/s41598-023-42595-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
A subgroup of patients suffering from atopic dermatitis (AD) does not respond to biologics therapy targeting the key players of type-2 inflammation, and it is an ongoing discussion whether skin-infiltrating Th17 cells may underlie this phenomenon. This study aimed to investigate the potential of allergen-induced, immune-cell derived IL-17 on the induction of inflammatory processes in keratinocytes. Peripheral blood mononuclear cells derived from respectively sensitized AD patients were stimulated with house dust mite (HDM) extract and cell culture supernatants were applied subsequently in absence or presence of secukinumab to primary human keratinocytes. Hereby we confirm that the immune response of sensitized AD patients to HDM contains aside from type-2 cytokines significant amounts of IL-17. Blocking IL-17 efficiently reduced the stimulation-induced changes in keratinocyte gene expression. IL-17-dependent transcriptional changes included increased expression of the cytokines IL-20 and IL-24 as well as Suppressor of Cytokine Siganling 3 (SOCS3), a negative feedback-regulator of the STAT3/IL-17/IL-24 immune response. We conclude that the immune response to HDM can induce pro-inflammatory cytokines from keratinocytes in AD, which in part is mediated via IL-17. Targeting IL-17 may turn out to be a reasonable alternative therapy in a subgroup of patients with moderate to severe AD and HDM sensitization.
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Affiliation(s)
- Juliane Haertlé
- Department of Dermatology and Allergy, Hannover Medical School (MHH), Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Petra Kienlin
- Department of Dermatology and Allergy, Hannover Medical School (MHH), Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Gabriele Begemann
- Department of Dermatology and Allergy, Hannover Medical School (MHH), Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Thomas Werfel
- Department of Dermatology and Allergy, Hannover Medical School (MHH), Carl-Neuberg-Str.1, 30625, Hannover, Germany
- Cluster of Excellence RESIST (EXC 2155), Hannover Medical School (MHH), Hannover, Germany
| | - Lennart M Roesner
- Department of Dermatology and Allergy, Hannover Medical School (MHH), Carl-Neuberg-Str.1, 30625, Hannover, Germany.
- Cluster of Excellence RESIST (EXC 2155), Hannover Medical School (MHH), Hannover, Germany.
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Teng Y, Zhong H, Yang X, Tao X, Fan Y. Current and Emerging Therapies for Atopic Dermatitis in the Elderly. Clin Interv Aging 2023; 18:1641-1652. [PMID: 37810952 PMCID: PMC10558003 DOI: 10.2147/cia.s426044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023] Open
Abstract
Atopic dermatitis (AD) in the elderly has recently emerged as a distinct subgroup of AD, garnering widespread concern due to its increasing global incidence rate. Epidermal barrier dysfunction, inflammatory response, and chronic pruritus interact with each other, contributing to the pathogenesis and pathophysiology of AD in the elderly. Although fundamental medications are essential for managing AD in the elderly, older adults often struggle with regular usage of moisturizing emollients, topical medications, and avoidance of environmental triggers, leading to recurrent or even exacerbated disease progression. Therefore, a systematic medication approach is necessary to control pruritus and skin lesions. Traditional systemic treatments may not adequately meet the treatment needs of moderate and severe AD in the elderly and may even pose certain safety risks. Biologics and Janus kinase (JAK) inhibitors, exhibiting excellent clinical efficacy, have made significant breakthroughs in AD treatment. Existing evidence suggests that dupilumab, a human monoclonal IgG4 antibody, has been confirmed as an effective and safe first-line systematic treatment for moderate to severe AD in the elderly, with no notable differences between adults and the elderly. However, the limited inclusion of elderly patients in related clinical studies hinders the generalizability of these findings. As older patients face a higher risk of adverse events with JAK inhibitors, JAK inhibitors are recommended when no other suitable treatment options are available. Obtaining population-specific data is crucial for making evidence-based treatment choices when managing AD in older adults with JAK inhibitors.
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Affiliation(s)
- Yan Teng
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital of Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Huiting Zhong
- Department of Dermatology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People’s Republic of China
| | - Xianhong Yang
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital of Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Xiaohua Tao
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital of Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Yibin Fan
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital of Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
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