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Do H, Babbush Graber K, Chernoff KA, Melnick LE. Evolving Landscape of Biologic Therapy for Pediatric Psoriasis. Dermatol Clin 2024; 42:377-386. [PMID: 38796269 DOI: 10.1016/j.det.2024.02.003] [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: 05/28/2024]
Abstract
Pediatric psoriasis is a chronic inflammatory skin condition. Current treatment modalities include topical medications, phototherapy, and systemic drugs, including biological agents. In cases of moderate-to-severe psoriasis recalcitrant to other therapies, biological therapies are often an attractive option given their dosing schedules, safety profiles, and need for less frequent laboratory monitoring, when compared with traditional systemic therapies. This article reviews biological treatment options approved for pediatric psoriasis and identifies others actively under investigation.
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Affiliation(s)
- Huongly Do
- Weill Cornell Medical College, New York, NY, USA
| | - Kayla Babbush Graber
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, 9th Floor, New York, NY 10021, USA
| | - Karen A Chernoff
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, 9th Floor, New York, NY 10021, USA
| | - Laura E Melnick
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, 9th Floor, New York, NY 10021, USA.
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Cork MJ, Danby SG, Rossi AB, Bansal A. Dupilumab Treatment in Pediatric Patients Aged 6-11 Years with Severe Atopic Dermatitis Whose Disease Is Not Adequately Controlled: A Review. Drug Des Devel Ther 2024; 18:277-289. [PMID: 38333897 PMCID: PMC10849907 DOI: 10.2147/dddt.s426947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/03/2024] [Indexed: 02/10/2024] Open
Abstract
Atopic dermatitis (AD) is the most common inflammatory skin disease in children. Children with severe AD have a multidimensional disease burden characterized by skin lesions, itching, frequent infections, sleep deprivation, and a high rate of comorbidities. These impact the mental health and overall quality of life of not only the children but also of their parents and caregivers. There are few effective available treatment options for young children with severe AD that are suitable for long-term use. Due to their adverse effects, practice guidelines consider systemic agents inappropriate for this age group, although they are still used off-label in extreme cases. The biologic dupilumab has recently been approved for children aged 6-11 years with severe (EU) and moderate-to-severe (USA) AD, offering hope to this population of patients with a high unmet clinical need. The purpose of this review is to describe the unmet needs of AD patients aged 6-11 years prior to dupilumab approval and to summarize existing clinical data supporting dupilumab's safety and efficacy in these children.
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Affiliation(s)
- Michael J Cork
- Sheffield Dermatology Research, University of Sheffield, Sheffield, UK
- Sheffield Children’s Hospital, Sheffield, UK
| | - Simon G Danby
- Sheffield Dermatology Research, University of Sheffield, Sheffield, UK
- Sheffield Children’s Hospital, Sheffield, UK
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Xu Z, Liu Y, Qu H, Bai Y, Ma J, Hao J, Yu C, Dang E, Wang G, Shao S. Clinical characteristics and heterogeneity of generalized pustular psoriasis: A comparative study in a large retrospective cohort. Exp Dermatol 2024; 33:e14891. [PMID: 37493071 DOI: 10.1111/exd.14891] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 07/27/2023]
Abstract
Generalized pustular psoriasis (GPP) is a rare and potentially life-threatening skin disease and the clinical heterogeneity of which is largely unknown. Retrospective cohort analysis was conducted on hospitalized GPP patients between January 2010 and November 2022. A total of 416 patients with GPP and psoriasis vulgaris (PV) respectively were included, matched 1:1 by sex and age. The heterogeneity of GPP was stratified by PV history and age. Compared with PV, GPP was significantly associated with prolonged hospitalization (11.7 vs. 10.3 day, p < 0.001), elevated neutrophil lymphocyte ratio (NLR) (5.93 vs. 2.44, p < 0.001) and anemia (13.9% vs. 1.2%, p < 0.001). Moreover, GPP alone (without PV history) was a relatively severer subtype with higher temperature (37.6°C vs. 38.0°C, p = 0.002) and skin infections (5.2% vs. 11.4%, p = 0.019) than GPP with PV. For patients across different age, compared with juvenile patients, clinical features support a severer phenotype in middle-aged, including higher incidence of anaemia (7.5% vs. 16.0%, p = 0.023) and NLR score (3.83 vs. 6.88, p < 0.001). Interleukin-6 (r = 0.59), high density lipoprotein cholesterol (r = -0.56), albumin (r = -0.53) and C-reactive protein-to-albumin ratio (r = 0.49) were the most relevant markers of severity in GPP alone, GPP with PV, juvenile and middle-aged GPP, respectively. This retrospective cohort suggests that GPP is highly heterogeneous and GPP alone and middle-aged GPP exhibit severe disease phenotypes. More attention on the heterogeneity of this severe disease is warranted to meet the unmet needs and promote the individualized management of GPP.
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Affiliation(s)
- Zhongrui Xu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Yanhua Liu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Huanhuan Qu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Yaxing Bai
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Jingyi Ma
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Junfeng Hao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Chen Yu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Erle Dang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Shuai Shao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
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Sánchez J, Cherrez-Ojeda I, Álvarez L, Ensina LF, Muñoz N, Muñoz D, Olivares-Gómez M, Muñoz D, Ramon G, Rocha-Felix MM, Torres P, Jaller-Raad R, de los Rios E, Rosário C, Ale I, Jiménez E, Rodríguez-Alvarez LA, Ricaurte M. Physician practices and attitudes towards atopic dermatitis in Latin America: A cross-sectional study. World Allergy Organ J 2023; 16:100832. [PMID: 37965095 PMCID: PMC10641564 DOI: 10.1016/j.waojou.2023.100832] [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: 04/17/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 11/16/2023] Open
Abstract
Background The prevalence of atopic dermatitis (AD) is increasing in developing countries. Different worldwide guidelines have been proposed, but their applicability for AD specialists in Latin American (LA) countries is unknown. Objective The objective of this study was to explore the medical approach to treating AD in LA countries. Methods The study population comprised AD specialists (allergists and dermatologists). They completed an electronic survey containing questions about the health system, diagnostic criteria, and pharmacotherapy approach to treating AD. The survey was constructed and validated by the Atopic Dermatitis Committee of the Latin American Society of Allergy Asthma and Immunology (SLAAI) in Spanish and Portuguese. Each member was responsible for distributing the questionnaire through different networks in their respective countries. Results A total of 284 AD specialists from 13 LA countries completed the questionnaire; among them, 67% were allergists and 33% were dermatologists. Less than 50% of the AD specialists strictly followed guideline recommendations. Among the AD specialists, the European and North American guidelines were more frequently used, and only 16% followed LA guidelines. Dermatologists used the local guidelines less frequently than allergists. Most physicians did not routinely use AD assessment tools (55%). The frequency of the diagnostic tests depends on symptom severity. The availability of some systemic treatments, such as biologics and Janus Kinase (JAK) inhibitors, is not universal in all LA countries. Conclusion There were marked differences between the specialists, and these differences seemed to be affected by their specialty and each country's healthcare system. New AD education strategies that consider the particularities of the region could allow patients to be more accurately managed. AD assessment tools may provide a way to enhance AD treatment and allow for shared decision-making, patient empowerment, and standardized care.
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Affiliation(s)
- Jorge Sánchez
- Group of Clinical and Experimental Allergy (GACE), Hospital (Alma Mater de Antioquia), University of Antioquia, Medellín, Colombia
| | - Iván Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Guayas, Ecuador
- Respiralab Research Group, Guayaquil, Ecuador
| | - Leidy Álvarez
- Group of Clinical and Experimental Allergy (GACE), Hospital (Alma Mater de Antioquia), University of Antioquia, Medellín, Colombia
- Group of Economic Technologies in Health, SURA Group, Medellín, Colombia
| | | | - Nelson Muñoz
- Clínica de Alergias “Muñoz Alergias y Pediatría”, Riobamba, Ecuador
| | - Daniela Muñoz
- Clínica de Alergias “Muñoz Alergias y Pediatría”, Riobamba, Ecuador
| | - Margarita Olivares-Gómez
- Clínica Medellín Poblado, Unidad Alergológica, Grupo de Inmunodeficiencias Primarias, Universidad de Antioquia, Medellín, Colombia
| | - Danny Muñoz
- Hospital Teodoro Maldonado Carbo, Guayaquil, Ecuador
| | - German Ramon
- Hospital Italiano Regional del Sur, Instituto de Alergia e Inmunología del Sur, Buenos Aires, Argentina
| | | | - Pablo Torres
- Universidad de Especialidades Espíritu Santo (UEES), Departamento de Alergología de Nucleomed, Guayaquil, Ecuador
| | | | | | | | - Iris Ale
- Universidad de la Republica Uruguay, Uruguay
| | - Emilio Jiménez
- Consultorio Médico Natividad Rio Grande Tierra de Fuego, Tierra del Fuego, Argentina
| | | | - Marcela Ricaurte
- Hospital das Clínicas de la Universidad de Sao Paulo, Departamento de Dermatología de Nucleomed, Guayaquil, Ecuador
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5
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Siegfried EC, Arkin LM, Chiu YE, Hebert AA, Callen JP, Castelo-Soccio L, Co DO, Cordoro KM, Curran ML, Dalrymple AM, Flohr C, Gordon KB, Hanna D, Irvine AD, Kim S, Kirkorian AY, Lara-Corrales I, Lindstrom J, Paller AS, Reyes M, Begolka WS, Tom WL, Van Voorhees AS, Vleugels RA, Lee LW, Davies OMT, Brandling-Bennett HA. Methotrexate for inflammatory skin disease in pediatric patients: Consensus treatment guidelines. Pediatr Dermatol 2023; 40:789-808. [PMID: 37316462 DOI: 10.1111/pde.15327] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/26/2023] [Indexed: 06/16/2023]
Abstract
Methotrexate (MTX) is a readily accessible drug, first used in 1948 and employed for a wide variety of indications since then. However, despite widespread off-label use, FDA labeling does not include approved indications for the use of MTX for many inflammatory skin diseases in pediatric patients, including morphea, psoriasis, atopic dermatitis, and alopecia areata, among others. Without published treatment guidelines, some clinicians may be hesitant to use MTX off-label, or uncomfortable prescribing MTX in this population. To address this unmet need, an expert consensus committee was convened to develop evidence- and consensus-based guidelines for use of MTX to treat pediatric inflammatory skin disease. Clinicians with experience and expertise in clinical research, drug development, and treating inflammatory skin disease in pediatric patients with MTX were recruited. Five committees were created based on major topic areas: (1) indications and contraindications, (2) dosing, (3) interactions with immunizations and medications, (4) adverse effects (potential for and management of), and (5) monitoring needs. Pertinent questions were generated and addressed by the relevant committee. The entire group participated in a modified Delphi process to establish agreement on recommendations for each question. The committee developed 46 evidence- and consensus-based recommendations, each with >70% agreement among members, across all five topics. These are presented in tables and text, along with a discussion of supporting literature, and level of evidence. These evidence- and consensus-based recommendations will support safe and effective use of MTX for the underserved population of pediatric patients who may benefit from this valuable, time-honored medication.
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Affiliation(s)
- Elaine C Siegfried
- SSM Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Lisa M Arkin
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Yvonne E Chiu
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Adelaide A Hebert
- UTHealth McGovern Medical School at Houston, Houston, Texas, United States
| | - Jeffrey P Callen
- University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Leslie Castelo-Soccio
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dominic O Co
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Megan L Curran
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Austin M Dalrymple
- SSM Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Carsten Flohr
- Department of Paediatric Dermatology, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Ken B Gordon
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Susan Kim
- University of California, San Francisco, California, USA
| | - A Yasmine Kirkorian
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
| | | | - Jill Lindstrom
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Melissa Reyes
- US Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland, USA
| | | | - Wynnis L Tom
- University of California, San Diego School of Medicine, San Diego, California, USA
- Rady Children's Hospital-San Diego, San Diego, California, USA
| | | | - Ruth Ann Vleugels
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lara Wine Lee
- Medical University of South Carolina, Charleston, South Carolina, USA
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6
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Walsh C, Leavey G, Mc Laughlin M, Paller AS, Irvine AD, Browne F, Mellerio JE, Bewley A. Novel mixed-method, inclusive protocol involving global key stakeholders, including carers as experts, to co-develop relevant Caregiver-Reported Outcome Domains (CRODs) in skin disease. BMJ Open 2023; 13:e068893. [PMID: 36657764 PMCID: PMC9853252 DOI: 10.1136/bmjopen-2022-068893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Ichthyoses comprise a heterogenous group of rare genetic skin disorders that involves the entire skin surface, often with additional syndromic features, and pose many clinical challenges. Without curative intervention, the mainstay of life-long symptom management is supportive in nature and can remain the responsibility of the caregiver. Although impact on the wider family is considered an important outcome of policies and services, there is a lack of caregiver consensus on what outcome domains to measure to fully assess the impact of ichthyosis on the patient and the caregiver. This project aims to identify a set of core outcome domains towards a core outcome set for ichthyosis that can measure all relevant concepts of ichthyosis in clinical practice, service delivery and research. METHODS AND ANALYSIS Following the COMET (Core Outcome Measures in Effectiveness Trials) initiative, this project will employ a mixed-method study design which was developed using public and patient involvement and an international multidisciplinary expert group (clinical experts, patients and their representatives, policymakers, researchers and service providers). Experts by experience, or caregivers, will be recruited through online ichthyosis support groups. Phase one will focus on item generation and involve: (1) a systematic literature review, (2) a multimethods international qualitative study with ichthyosis caregivers and (3) co-development of items for an e-survey. Phase two, item refinement, will employ a novel four-pronged consensus approach: (1) an e-Delphi survey, (2) statistical analysis of e-Delphi survey results, (3) online qualitative feedback and (4) an online consensus discussion. All methodological considerations will be clearly linked with each Core Outcome Set-STAndards for Developing recommendation. ETHICS AND DISSEMINATION Research Ethics Committee approval obtained from the School of Psychology, Ulster University (UK)(Ref:REC/20/0004). Results will be presented in published international peer-reviewed journals, at scientific meetings and support groups. REGISTRATION COMET database (January 2019).
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Affiliation(s)
- Carleen Walsh
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Coleraine, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Coleraine, UK
| | | | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alan D Irvine
- Department of Clinical Medicine, University of Dublin Trinity College, Dublin, Ireland
| | - Fiona Browne
- Department of Dermatology, Children's Health Ireland (CHI), Dublin, Ireland
| | - Jemima E Mellerio
- Department of Dermatology, St. John's Institute of Dermatology, St. Thomas' Hospital, London, UK
| | - Anthony Bewley
- Department of Clinical Medicine, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
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Augustin M, Misery L, von Kobyletzki L, Armario-Hita JC, Mealing S, Redding M. Unveiling the true costs and societal impacts of moderate-to-severe atopic dermatitis in Europe. J Eur Acad Dermatol Venereol 2022; 36 Suppl 7:3-16. [PMID: 35801296 DOI: 10.1111/jdv.18168] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/01/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022]
Abstract
Atopic dermatitis (AD) is a chronic, auto-immune condition that imposes a high burden on individuals, society, and the healthcare system. Approximately 4.4% of adults and up to 18.6% of children/adolescents have AD in Europe, with 20% of all cases accounting for moderate-to-severe forms. This form of the condition in adults results in annual societal costs across Europe of an estimated €30 billion; €15.2 billion related to missed workdays or reduced work productivity, €10.1 billion related to direct medical costs and €4.7 billion related to personal expenditure of patients/families. AD can also substantially impact physical, emotional, and social quality-of-life. Several studies have shown the debilitating itch-scratch cycle is the main cause of the multifaceted burden, as it causes substantial sleep deprivation and stigmatisation due to the physical appearance of the skin, and confidence issues. These factors lead to psychosocial issues and can cumulate over time and prohibit patients reaching their 'full life potential'. Despite this, many patients with the condition are undertreated, resulting in uncontrolled symptoms and a further strain placed on patients, society, and the economy. The authors of this White Paper comprise the European Atopic Dermatitis Working Group, which is a network of international specialists with expertise in dermatology and healthcare policy decisions. Their programme of action is focused on harnessing their expertise to build consensus, advance research, share knowledge, and ultimately seek to improve AD care outcomes through achieving long-term symptom control. This White Paper presents a systematic evaluation of the overall financial and humanistic burden of moderate-to-severe AD and the current challenges that exist with AD care. It introduces recommendations for how, collaboratively, key stakeholders and policy makers can support improvements in AD management to achieve better disease control, thus reducing the costs and associated burden placed on individuals, society, and the economy.
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Affiliation(s)
- M Augustin
- University Medical Center Hamburg, Hamburg, Germany
| | - L Misery
- University Hospital of Brest, Brest, France
| | | | | | - S Mealing
- York Health Economics Consortium (YHEC), York, UK
| | - M Redding
- Eczema Outreach Support, Linlithgow, UK
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Leong K, Ong TWY, Foong YW, Wong YP, Lim W, Liew HM, Koh MJA. Multidisciplinary management of chronic atopic dermatitis in children and adolescents: a prospective pilot study. J DERMATOL TREAT 2020; 33:822-828. [PMID: 32530338 DOI: 10.1080/09546634.2020.1782321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Atopic dermatitis (AD) is a chronic, pruritic disorder affecting 10-20% of children and is associated with psychological issues and impaired quality of life (QoL). The role of psychosocial support in the treatment of AD is increasingly important. We studied the impact of a multidisciplinary clinic (MDC) in the management of AD in a tertiary children's hospital in Singapore.Methods: We performed a prospective pilot interventional study on 34 pediatric patients with AD and concomitant psychosocial impairment. Patients were recruited into an MDC, comprising a dermatologist, clinical psychologist and medical social worker. AD severity was scored using Scoring Atopic Dermatitis (SCORAD), while QoL was assessed using the Children's Dermatology Life Quality Index Questionnaire (CDLQI) and Family Dermatology Life Quality Index Questionnaire (FDLQI). Biopsychosocial assessments and interventions were also performed. Eighty-three percent of patients received cognitive behavioral therapy, while 40% received social work intervention.Results: There was an overall improvement in mean SCORAD, CDLQI, and FDLQI scores across MDC visits. A correlation between AD severity and QoL was established. A patient satisfaction survey showed improvement in severity, understanding, and control of the disease.Conclusion: Our study suggests the effectiveness of a multidisciplinary approach in managing pediatric AD patients with psychosocial co-morbidities.
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Affiliation(s)
- Kylie Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Thomas W Y Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yee-Wah Foong
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yen-Peng Wong
- Psychology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Winnie Lim
- Medical Social Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Hui-Min Liew
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark J A Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
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Hu C, Nijsten T, Pasmans SGMA, de Jongste JC, Jansen PW, Duijts L. Associations of eczema phenotypes with emotional and behavioural problems from birth until school age. The Generation R Study. Br J Dermatol 2019; 183:311-320. [PMID: 31730242 PMCID: PMC7496612 DOI: 10.1111/bjd.18705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2019] [Indexed: 01/04/2023]
Abstract
Background Eczema phenotypes and emotional and behavioural problems are highly prevalent in childhood, but their mutual relationship is not fully clear. Objectives To examine the associations of eczema phenotypes with school‐age emotional and behavioural problems, and the bidirectional associations of eczema and emotional and behavioural problems from birth until 10 years. Methods This study among 5265 individuals was embedded in a prospective population‐based cohort study. Never, early transient, mid‐transient, late transient and persistent eczema phenotypes were identified based on parent‐reported, physician‐diagnosed eczema from age 6 months until 10 years. Emotional (internalizing) and behavioural (externalizing) problems were measured repeatedly using the Child Behavior Checklist from age 1·5 to 10 years. Cross‐lagged models were applied for bidirectional analyses. Results All eczema phenotypes were associated with more internalizing problems and attention problems at age 10 years, compared with never having eczema: range of Z‐score differences 0·14 [95% confidence interval (CI) 0·01–0·27] to 0·39 (95% CI 0·18–0·60). Children with early transient eczema had more aggressive behaviour symptoms at age 10 years (Z = 0·16, 95% CI 0·05–0·27). Bidirectional analysis showed that eczema at 0–2 years was associated with more internalizing and externalizing problems at ages 3–6 and 10 years, while, inversely, only internalizing problems at 0–2 years were associated with an increased risk of eczema at age 10 years. Conclusions Eczema phenotypes are very modestly associated with more somatic symptoms and attention problems at school age. Early transient eczema is associated with more aggressive behaviour symptoms. Directional effects seem to occur from early‐life eczema to later‐life internalizing and externalizing problems, rather than the reverse. What's already known about this topic? Previous cohort studies using non‐data‐driven methods to define eczema phenotypes observed that children with early‐onset and persistent eczema had a higher risk of emotional and behavioural problems in preadolescence. Alternatively, previous cohort studies showed that children with emotional and behavioural problems had more severe eczema and eczema exacerbations in childhood. The direction of effects between eczema and emotional and behavioural problems is not fully clear.
What does this study add? Taking the variability of eczema onset and persistence within and between children over time into account, all identified eczema phenotypes were very modestly associated with more somatic symptoms and attention problems at school age. Directional effects seem to occur from eczema leading to emotional and behavioural problems, rather than the reverse. Future research should focus on the effect of early optimal eczema management on mental health disorders in children later in life.
Plain language summary available online
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Affiliation(s)
- C Hu
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - T Nijsten
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J C de Jongste
- Department of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - P W Jansen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - L Duijts
- Department of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Paediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Quality of Life and Disease Impact of Atopic Dermatitis and Psoriasis on Children and Their Families. CHILDREN-BASEL 2019; 6:children6120133. [PMID: 31810362 PMCID: PMC6955769 DOI: 10.3390/children6120133] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/08/2019] [Accepted: 11/25/2019] [Indexed: 12/11/2022]
Abstract
Atopic dermatitis (AD) and psoriasis are common chronic skin diseases affecting children. These disorders negatively impact the quality of life (QoL) of patients in health-related aspects such as physical, psychosocial, and mental functioning. This health impact is more accurately represented when accounting for the numerous comorbidities associated with each disorder, and the impact the disorders have on patients’ families. A number of QoL tools have been developed and can be routinely implemented in the evaluation of QoL in pediatric patients and their caregivers. Ways to improve QoL include a multidisciplinary approach to care, education, and psychological support.
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Damiani G, Pacifico A, Linder DM, Pigatto PDM, Conic R, Grada A, Bragazzi NL. Nanodermatology-based solutions for psoriasis: State-of-the art and future prospects. Dermatol Ther 2019; 32:e13113. [PMID: 31600849 DOI: 10.1111/dth.13113] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/04/2019] [Indexed: 12/24/2022]
Abstract
Nanodermatology is an emerging, multidisciplinary science, arising from the convergence of nanotechnology, pharmacology, physics/biophysics, chemistry/biochemistry, chemical engineering, material science, and clinical medicine. Nanodermatology deals with (a) skin biology, anatomy, and physiology at the nanoscale ("skin nanobiology"), (b) diagnosis performed by means of novel diagnostic devices, assisted by nanobiotechnologies ("nanodiagnosis"), and (c) treatment through innovative therapeutic agents, including phototherapy ("photonanotherapy"/"photonanodermatology") and systemic/topical drug administration ("nanotherapy") at the nanoscale, and drug delivery-such as transdermal or dermal drug delivery (TDDD/DDD)-enhanced and improved by nanostructures and nanodrugs ("nanodrug delivery"). Nanodermatology, as a super-specialized branch of dermatology, is a quite recent specialty: the "Nanodermatology Society" founded by the eminent dermatologist Dr. Adnan Nasir, was established in 2010, with the aim of bringing together different stakeholders, including dermatologists, nanotechnology scientists, policy-makers and regulators, as well as students and medical residents. Psoriasis has a prevalence of 2-3% worldwide and imposes a severe clinical and societal burden. Nanodermatology-based solutions appear promising for the proper treatment and management of psoriasis, assisting and enhancing different steps of the process of health-care delivery: from the diagnosis to the therapeutics, paving the way for a personalized approach, based on the specific dysregulated biomarkers.
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Affiliation(s)
- Giovanni Damiani
- Young Dermatologists Italian Network (YDIN), Centro Studi GISED, Bergamo, Italy.,Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | | | | | - Paolo D M Pigatto
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Rosalynn Conic
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Ayman Grada
- Department of Dermatology, Laboratory of Cutaneous Wound Healing, Boston University School of Medicine, Boston, Massachusetts
| | - Nicola L Bragazzi
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Maksimovic N, Zaric M, Reljic V, Nikolic M, Gazibara T. Factors associated with improvement of quality of life among parents of children with atopic dermatitis: 1-year prospective cohort study. J Eur Acad Dermatol Venereol 2019; 34:325-332. [PMID: 31494995 DOI: 10.1111/jdv.15939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/23/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Previous studies exploring the impact of atopic dermatitis (AD) in children focused on factors associated with parental quality of life at one point in time. OBJECTIVE To examine factors associated with change of quality of life among parents of children affected with AD. METHODS The study cohort comprised 98 parent-children pairs treated for AD at the Clinic of Dermatovenereology; however, 18 parents (18.4%) were lost to follow-up after 1 year. Children were assessed with SCORing Atopic Dermatitis Index (SCORAD) and Children Dermatology Life Quality Index (CDLQI) or the Infants' Dermatitis Quality of Life Index (IDQOL), depending on their age. Parents filled in socio-demographic questionnaire and Dermatitis Family Impact Questionnaire (DFI). After 1 year, both children and parents were reassessed using the same AD-related battery of questionnaires. RESULTS After follow-up, a significant improvement in the average total DFI score was observed, especially for domains of fatigue/exhaustion, emotional distress and impact of helping in child treatment. Lower baseline SCORAD, greater improvement of SCORAD over follow-up, better CDLQI/IDQOL at baseline, greater improvement in CDLQI/IDQOL over follow-up, not having asthma and having older child with AD were associated with better parental quality of life after 1 year of follow-up. Parental higher education level, shorter AD duration, better baseline SCORAD and greater improvement in CDLQI/IDQOL over follow-up were associated with greater improvement in parental life quality over 1 year of follow-up. CONCLUSION Contributors to parental quality of life after 1 year included clinical features of AD and child's comorbidity (asthma), but also the perception of child's quality of life and its improvement.
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Affiliation(s)
- N Maksimovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - M Zaric
- Parexel International, Belgrade, Serbia
| | - V Reljic
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - M Nikolic
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - T Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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