1
|
Amerio P, Ferrucci SM, Galluzzo M, Napolitano M, Narcisi A, Levi A, Di Fino S, Palladino C, Patruno C, Rossi M. A Multidisciplinary Approach Is Beneficial in Atopic Dermatitis. Dermatol Ther (Heidelb) 2024; 14:1443-1455. [PMID: 38811470 PMCID: PMC11169114 DOI: 10.1007/s13555-024-01185-1] [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: 04/18/2024] [Accepted: 05/10/2024] [Indexed: 05/31/2024] Open
Abstract
Atopic dermatitis (AD) is a highly heterogeneous chronic inflammatory skin disorder that is frequently associated with a plethora of comorbidities. AD is, therefore, considered a systemic disease impacted by a considerable burden and leading to poor quality of life, especially in patients with moderate-to-severe disease. Since atopic and non-atopic comorbidities can further worsen the disease course, accurate establishment of the patient's individual intrinsic risk profile and needs is crucial and may help in guiding the selection of the best treatment option. Better quality of care for patients with AD can be delivered through a multidisciplinary team led by a dermatologist, for comprehensive patient management. The implementation of a multidisciplinary approach for AD could enhance the delivery of optimised and safe treatments, improve the standard of care and patient outcomes in the short and long term, and prevent or delay the lifelong impact of uncontrolled AD. Understanding the unmet needs, assessing correctly the patient risk profile and enhancing the shared patient-physician decision-making process can lead to disease control and quality-of-life improvement, especially in the context of the introduction of newer treatment for AD. This narrative review is a call for more data to establish standardised patient profiles and multidisciplinary strategies in AD management. In view on the fast-evolving treatments for AD, this review aims at highlighting the importance of a multidisciplinary approach to a comprehensive assessment and holistic care in patients with moderate-to-severe AD.
Collapse
Affiliation(s)
- Paolo Amerio
- Dermatology Unit, Department of Medicine and Aging Science, University of Chieti Pescara, 66100, Chieti, Italy
| | - Silvia Mariel Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Galluzzo
- Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Maddalena Napolitano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
| | | | | | | | | | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Mariateresa Rossi
- Department of Clinical and Experimental Sciences, Dermatology Unit, University of Brescia, Brescia, Italy
| |
Collapse
|
2
|
Argenziano G, Mercuri SR, Savoia P, Amerio P, Fortina AB, Bongiorno MR, De Felici Del Giudice MB, Parodi A, Pimpinelli N, Stingeni L, Ortoncelli M, Stinco G, Gualberti G, Levi A, Scuderi V, Bianchi L, Malara G. Burden of Disease in the Real-Life Setting of Patients with Atopic Dermatitis: Italian Data From the MEASURE-AD Study. Dermatol Pract Concept 2024; 14:dpc.1401a79. [PMID: 38048260 PMCID: PMC10868859 DOI: 10.5826/dpc.1401a79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 12/06/2023] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic inflammatory skin disease that negatively impacts the quality of life and work productivity of patients. OBJECTIVES We sought to evaluate the real-world burden of AD patients in Italy. METHODS This sub-analysis of the MEASURE-AD multicountry study conducted between December 2019-2020 included patients diagnosed with moderate-to-severe AD eligible for or receiving systemic therapy in the previous 6 months. During a single visit, physician and patient-reported questionnaires were used. RESULTS A total of 118 adult patients were enrolled and 57.6% (N = 68) of patients had moderate-to-severe AD at the time of enrolment according to the Eczema Area and Severity Index. Sleep disorders interfered with daily function in the previous week in 58.5% (N = 69) of patients, pruritus was severe in 50% (N = 59) and 42.4% (N = 50) reported a flare lasting >7 days in the previous 6 months. According to the Dermatology Quality of Life Index, 37.3% (N = 44) of patients reported a severe impact of AD and approximately 10% had clinical depression/anxiety. Current drug therapy was considered inadequate in controlling AD in 26.3% (N=31) of patients. Work activity impairment was 38.6±31.7% and monthly AD-related expenses were 148.6±134.6 Euros per patient. CONCLUSIONS This real-life study documents a high burden of disease in patients with moderate-severe AD in Italy.
Collapse
Affiliation(s)
- Giuseppe Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Paola Savoia
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Paolo Amerio
- Dermatologic Clinic, Department of Medicine and Aging Science and Dermatologic Clinic, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Anna Belloni Fortina
- Unit of Pediatric Dermatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Maria Rita Bongiorno
- Section of Dermatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | | | - Aurora Parodi
- Division of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa Italy and Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Nicola Pimpinelli
- Dermatology Unit, Department Health Sciences, University of Florence, Florence, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Michela Ortoncelli
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | | | | | - Anna Levi
- AbbVie SrL, Campoverde di Latina, Italy
| | | | - Luca Bianchi
- Dermatology Unit, Tor Vergata University Hospital, Rome, Italy
| | - Giovanna Malara
- UOC of Dermatology, Grande Ospedale Metropolitano "Bianchi Melacrino Morelli", Reggio Calabria, Italy
| |
Collapse
|
3
|
Colombo D, Rigoni C, Cantù A, Carnevali A, Filippetti R, Franco T, Grassi A, Loi C, Mazzotta A, Patroi I, Raone B, Tomassini MA, Amoruso A, Pane M, Damiani G. Probiotics and Prebiotics Orally Assumed as Disease Modifiers for Stable Mild Atopic Dermatitis: An Italian Real-Life, Multicenter, Retrospective, Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2080. [PMID: 38138183 PMCID: PMC10744411 DOI: 10.3390/medicina59122080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023]
Abstract
The role of the skin-gut axis in atopic dermatitis (AD) remains a subject of debate, limiting non-pharmacological interventions such as probiotics and prebiotics. To improve understanding of their potential as a monotherapy for stable mild cases, we conducted a real-life, multicenter, retrospective observational study in Italy. We administered three selected bacteria (Bifidobacterium animalis subsp. lactis BS01, Lactiplantibacillus plantarum LP14, and Lacticaseibacillus rhamnosus LR05) orally to patients with mild atopic dermatitis without a placebo control group, following up for 12 weeks. Clinical assessments using the Scoring Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), and Three-Item Severity (TIS) score were conducted on 144 enrolled patients (average age: 25.1 ± 17.6 years). Notably, both pruritus and AD-related lesions (erythema, edema/papules, excoriation) exhibited significant clinical and statistical improvement (p < 0.001) after 12 weeks of exclusive probiotic and prebiotic use. These preliminary results suggest a potential link between the skin-gut microbiome and support the rationale for using specific probiotics and prebiotics in mild AD, even for maintenance, to reduce flares and dysbiosis.
Collapse
Affiliation(s)
- Delia Colombo
- Independent Researcher, Private Practice, Via Livigno 6, 20158 Milan, Italy;
| | - Corinna Rigoni
- Independent Researcher, Private Practice, Corso Monteforte 40, 20122 Milan, Italy;
| | - Alessandra Cantù
- Independent Researcher, Private Practice, Via Domodossola 9/A, 20145 Milan, Italy;
| | - Antonello Carnevali
- Independent Researcher, Private Practice, Str. Colomba Pecorari 32/a, 06134 Perugia, Italy;
| | | | - Tiziana Franco
- Independent Researcher, Private Practice, Viao Veio, 04100 Latina, Italy;
| | - Alessandra Grassi
- Independent Researcher, Private Practice, Via Coletti 19, 00191 Rome, Italy;
| | - Camilla Loi
- Independent Researcher, Private Practice, Via X Settembre 1943 7 and 9, 40011 Anzola dell’Emilia, Italy;
| | - Annamaria Mazzotta
- Independent Researcher, Private Practice, Viale di Villa Massimo 48, 00161 Rome, Italy;
| | - Ivona Patroi
- Independent Researcher, Private Practice, Via del Tritone 102, 00187 Rome, Italy;
| | - Beatrice Raone
- Independent Researcher, Private Practice, Via Ruggero Leoncavallo 5, 40137 Bologna, Italy;
| | | | - Angela Amoruso
- Independent Researcher, Probiotical Research srl, Via Mattei 3, 28100 Novara, Italy; (A.A.); (M.P.)
| | - Marco Pane
- Independent Researcher, Probiotical Research srl, Via Mattei 3, 28100 Novara, Italy; (A.A.); (M.P.)
| | - Giovanni Damiani
- Department of Biomedical, Surgical and Dental Sciences University of Milan, 20122 Milan, Italy
- Department of Pharmaceutical and Pharmacological Sciences, PhD Degree Program in Pharmacological Sciences, University of Padua, 35122 Padua, Italy
| |
Collapse
|
4
|
Mesjasz A, Kołkowski K, Wollenberg A, Trzeciak M. How to Understand Personalized Medicine in Atopic Dermatitis Nowadays? Int J Mol Sci 2023; 24:ijms24087557. [PMID: 37108720 PMCID: PMC10145758 DOI: 10.3390/ijms24087557] [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: 03/11/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Atopic dermatitis (AD) is a heterogeneous disease in terms of its phenotypical, barrier, and immunological presentation. Emerging therapies are undoubtedly contributing to a new chapter in the treatment of AD, bringing an excellent possibility of individualization, and thereby creating a tailored approach. The two most promising substance groups are biological drugs (dupilumab, tralokinumab, lebrikizumab, nemolizumab) and Janus kinase inhibitors (JAKis) (baricitinib, upadacitinib, and abrocitinib). The vision that certain well-defined phenotypes and endotypes, as well as personal preferences, may guide the future treatment of AD is both tempting and appealing, but not yet reality. The accessibility of new drugs such as biologics and small molecules has opened up the discussion regarding personalized medicine, referring to the complex nature of AD as well as the experiences from clinical trials and real-world evidence. We have now reached the point of creating new strategies and AD treatment goals by increasing the amount of new information concerning the efficacy and safety of new drugs. This article has reviewed the novel treatment options for AD in the light of the heterogeneity of this disease and proposes a broader vision on the strategy of personalized treatment of AD.
Collapse
Affiliation(s)
- Alicja Mesjasz
- Dermatological Students Scientific Association, Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, 80-214 Gdansk, Poland
| | - Karol Kołkowski
- Dermatological Students Scientific Association, Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, 80-214 Gdansk, Poland
| | - Andreas Wollenberg
- Department of Dermatology, Venereology and Allergology, University Hospital, Ludwig Maximilian University, Frauenlobstr. 9-11, 80337 Munich, Germany
- Department of Dermatology, Free University Brussels, University Hospital Brussels, Bd de la Plaine 2, 1050 Brussels, Belgium
| | - Magdalena Trzeciak
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, 80-214 Gdansk, Poland
| |
Collapse
|
5
|
Multiplex Proteomic Evaluation in Inborn Errors with Deregulated IgE Response. Biomedicines 2023; 11:biomedicines11010202. [PMID: 36672710 PMCID: PMC9855860 DOI: 10.3390/biomedicines11010202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/23/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
(1) Background: Atopic dermatitis constitutes one of the most common inflammatory skin manifestations of the pediatric population. The onset of many inborn errors occurs early in life with an AD-like picture associated with a deregulated IgE response. The availability of proteomic tests for the simultaneous evaluation of hundreds of molecules allows for more precise diagnosis in these cases. (2) Methods: Comparative genomic hybridization microarray (Array-CGH) analysis and specific IgE evaluation by using allergenic microarray (ISAC) and microarray (ALEX2) systems were performed. (3) Results: Proteomic investigations that use multiplex methods have proven to be extremely useful to diagnose the sensitization profile in inborn errors with deregulated IgE synthesis. Four patients with rare diseases, such as recessive X-linked ichthyosis (RXLI, OMIM 308100), Comel-Netherton syndrome (NS, OMIM256500), monosomy 1p36 syndrome (OMIM: 607872), and a microduplication of Xp11.4 associated with extremely high levels of IgE: 7.710 kU/L, 5.300 kU/L, 1.826 kU/L, and 10.430 kU/L, respectively, were evaluated by micro- and macroarray multiplex methods. Polyreactivity to both environmental and food allergens was observed in all cases, including the first described case of association of X-chromosome microduplication and HIE. (4) Conclusions: Extensive use of proteomic diagnostics should be included among the procedures to be implemented in inborn errors with hyper-IgE.
Collapse
|