Epidemiologic and Clinical Evaluation of the Bidirectional Link Between Molluscum Contagiosum and Atopic Dermatitis in Children.

The prevalence of atopic dermatitis has substantially increased in recent decades, and atopic dermatitis could lead to allergic airway inflammation later in life. A previous study found that inorganic arsenic exposure was associated with allergic airway inflammation in children aged 8 to 14 years. However, the association between prenatal exposure to arsenic and other metals and the risk of atopic dermatitis among young children remains unknown. To assess the association between prenatal exposure to arsenic and other metals and the occurrence of atopic dermatitis in children at age 4 years. In total, 1152 pregnant women were enrolled in the original Taiwan Maternal and Infant Cohort Study (TMICS), a multicenter birth cohort study conducted at 9 hospitals in northern, central, southern, and eastern Taiwan from October 2012 to May 2015. Of those, 586 mothers and children aged 4 years participated in follow-up questionnaire interviews from August 2016 to January 2019. After excluding 216 participants with missing data, the final statistical analysis of follow-up data included 370 mother and child pairs from the central and eastern regions of Taiwan. Data were analyzed from February 2 to August 12, 2021. Arsenic, cadmium, lead, cobalt, copper, nickel, thallium, and zinc during pregnancy. The outcome was parent-reported atopic dermatitis history among children aged 4 years. The presence of atopic dermatitis was defined as a positive response to the question, "Has your child ever had atopic dermatitis diagnosed by a physician?" During the initial TMICS study period, concentrations of arsenic, cadmium, lead, cobalt, copper, nickel, thallium, and zinc were measured in maternal urine during the third trimester of pregnancy using an inductively coupled plasma mass spectrometer. Estimated total inorganic arsenic exposure was calculated using a model that included data on both total arsenic and arsenic species (arsenite, arsenate, monomethylarsonate, and dimethylarsenate) obtained from a previous TMICS cohort. Among 370 children included in the analysis, the mean (SD) age was 3.94 (0.59) years; 208 children (56.2%) were male, and 267 children (72.2%) were from the central region of Taiwan. A total of 110 children (29.7%) had atopic dermatitis at age 4 years. Maternal estimated total inorganic arsenic exposure during pregnancy was associated with increased odds of atopic dermatitis among children at age 4 years (odds ratio [OR], 2.42 [95% CI, 1.33-4.39] for every doubled increase of total inorganic arsenic) after adjusting for parental allergies, child's sex, geographic area, maternal educational level, and exposure to tobacco smoke. Every increased unit in the weighted quantile sum index of maternal metal exposure was significantly associated with atopic dermatitis (OR, 1.63; 95% CI, 1.28-2.07). Arsenic (40.1%) and cadmium (20.5%) accounted for most of the metal mixture index. This cohort study found that prenatal exposure to inorganic arsenic and coexposure to inorganic arsenic and cadmium were associated with a higher risk of atopic dermatitis in young children. These findings suggest that prevention of exposure to inorganic arsenic and cadmium during pregnancy may be helpful for the control of atopic dermatitis and other potential allergies in children.

Background Previous studies reported the association between maternal psychological distress (PD) during or after pregnancy and atopic dermatitis in children. However, studies examining the association from both pre- and post-natal aspects are limited. Methods We analysed data from 6,366 mother-child pairs who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Japan. Mothers were categorised into four groups of PD (K6 scores ≥5) during early pregnancy and one year after delivery; no PD in both periods, prenatal PD only, postnatal PD only, and PD in both periods. Mothers reported on their children's atopic dermatitis at age two using the International Study of Asthma and Allergies in Childhood (ISAAC). Multivariate logistic regression analysis was conducted to examine the association between maternal PD and atopic dermatitis in children adjusting for maternal age at delivery, maternal education, maternal smoking during early pregnancy, maternal history of atopic diseases, paternal history of atopic diseases, preterm birth, parity, and child's sex. Results The study population included 51.9% without PD in both periods, 14.6% with prenatal PD only, 14.0% with postnatal PD only, and 19.4% with PD in both periods. The prevalence of atopic dermatitis in children at age two was 18.8%. Mothers with postnatal PD only and mothers with PD in both periods had higher risks of children's atopic dermatitis compared with mothers without PD in both periods; the adjusted odds ratios (95% confidence intervals) were 1.37 (1.14-1.65) and 1.38 (1.17-1.63), respectively. The corresponding odds ratio (95% confidence interval) of mothers with prenatal PD only was 1.08 (0.89-1.31). Conclusions Postnatal PD was associated with an increased risk of atopic dermatitis in children. This finding suggests the importance for monitoring mental health among postpartum women. Key messages Postnatal PD has significant effects on atopic dermatitis in children. This study is a first study to examine the association between maternal PD and children’s atopic dermatitis in Japan. Improvements of postnatal care including social support might be effective in preventing atopic dermatitis in children.

BackgroundMaternal mental health problems in each of the prenatal period and postnatal period have been demonstrated as possible risk factors for atopic dermatitis (AD) in children. However, the cumulative impacts of maternal psychological distress in the prenatal and postnatal periods on AD in children remain unclear. This study examined the association between cumulative exposure to maternal psychological distress in the prenatal and postnatal periods and the development of AD in children.MethodsData were derived from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Japan. In total, 8377 mother-child pairs in which the child had no AD at the age of 1 year were analyzed. Maternal psychological distress in early pregnancy and 1 year after delivery was defined as a K6 score ≥ 5, and the participants were categorized into four groups: no psychological distress in both the prenatal and postnatal periods; only the prenatal period; only the postnatal period; and both periods. The development of AD was defined as the presence of AD in a 2-year-old child without AD reported at the age of 1 year using the International Study of Asthma and Allergies in Childhood questionnaire. Generalized linear model analyses were conducted to examine the association between maternal psychological distress and the development of AD in children adjusted for age at delivery, educational attainment, smoking status in pregnancy, maternal history of AD, paternal history of AD, parity, maternal body mass index, and child sex.ResultsBetween the ages of 1 and 2 years, 14.0% of children developed AD. Maternal psychological distress in both prenatal and postnatal periods was associated with an increased risk of AD in children compared to no psychological distress in both periods (relative risk (RR), 95% confidence interval (CI): 1.34, 1.20–1.47). Maternal psychological distress in only the postnatal period was associated with an increased risk of AD in children (RR, 95% CI: 1.23, 1.07–1.39), but not in only the prenatal period (RR, 95% CI: 1.14, 0.98–1.30).ConclusionsCumulative exposure to maternal psychological distress in the prenatal and postnatal periods was associated with the development of AD in children.

Background. Atopic dermatitis is a common chronic inflammatory skin disease affecting 2.6 % of the global population (204.05 million people), of which 102.78 million are children. Atopic dermatitis has a complex multifactorial nature. According to current understanding, the development of the disease is influenced by genetic predisposition, skin barrier dysfunction, imbalance of surface microflora, immune mechanisms, food allergies, and sensitization to aeroallergens. There is a challenge in determining the contribution of each of these mechanisms to the development of atopic dermatitis. The purpose was to analyze and systematize current data on the etiology, pathogenesis, and stages of atopic dermatitis development in children. Materials and methods. A comprehensive analysis of current scientific sources concerning various aspects of atopic dermatitis pathogenesis was conducted, including genetic, immunological, microbiological, and environmental factors. Some interest was given to studying the possibilities of fetal food sensitization. Results. It has been found that atopic dermatitis has a multifactorial nature with a key role played by genetic predisposition, particularly mutations in the filaggrin gene, which leads to impaired skin barrier function. The pathogenesis includes immune mechanisms with predominance of T helper 2 cells in the acute phase and production of pro-inflammatory cytokines (IL-4, IL-5, IL-13). Imbalance of skin and gut microbiome, epicutaneous sensitization to food and aeroallergens, intrauterine sensitization, as well as environmental factors (birth season, vitamin D levels, air pollutants) are important modifying factors for the development of atopic dermatitis. Conclusions. Atopic dermatitis is a complex and multifaceted disease caused by a combination of various pathological mechanisms, which cumulatively may contribute to the early formation of the disease with clinical manifestation in the first years of a child’s life. A leading role in the formation of atopic dermatitis is played by a defect in the gene encoding filaggrin protein synthesis. This, in turn, leads to a defect in the skin barrier functions, through which transepidermal water loss increases, leading to the penetration of allergens, pathogenic microorganisms, and pollutants into the skin. Epicutaneous sensitization through an altered skin barrier forms food allergies, and food allergies lead to exacerbations of atopic dermatitis. The shift of the immune response from T helper 1 cells in favor of T helper 2 cells stimulates the release of pro-inflammatory cytokines and promotes the activation of atopic dermatitis exacerbation. Depleted skin and gut microbiome, negative influences on the mother’s body during pregnancy (alcohol consumption, smoking, stress, excessive consumption of potentially allergenic food products), and air pollutants all stimulate the development of atopic dermatitis in the newborn child. Therefore, the formation of atopic dermatitis is the result of a complex interaction between genetic predisposition, immune dysregulation, significant disruption of skin and gut microbiome, as well as intrauterine exposure to negative factors, sensitization to food and aeroallergens, and other less significant factors. Understanding and further study of this interaction is necessary for developing effective approaches to the prevention and treatment of atopic dermatitis.

Atopic dermatitis is a chronic inflammatory skin disease significantly affecting patients' and their parents' lives. Mothers are mostly responsible for the long-term treatment and their wellbeing is essential. The major objective of this cross-sectional study was to investigate the relationship between atopic dermatitis in children, especially concomitant itch, and the quality of life, stress, sleep quality, anxiety, and depression of their mothers. The study included 88 mothers of children with atopic dermatitis and 52 mothers of children without atopic dermatitis. All mothers completed sociodemographic questionnaire, the Perceived Stress Scale, the Athens Insomnia Scale and the Hospital Anxiety and Depression Scale. Additionally, mothers of children with atopic dermatitis filled in the Family Dermatology Life Quality Index. The severity of atopic dermatitis and pruritus intensity were evaluated by the Scoring Atopic Dermatitis Index and the Numerical Rating Scale, respectively. The severity of atopic dermatitis and itch significantly correlated with the quality of life, insomnia, and perceived stress of the mothers. Mothers whose children had had atopic dermatitis for more than 6 months had significantly higher scores of anxiety and depression. The results highlight the importance of screening mothers for functional impairment to provide adequate support. More attention should be directed to the standardization of stepped care interventions addressing factors resulting in the impaired functioning of mothers.

Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report

Background: Atopic dermatitis is a major public health issue worldwide, but data on trends in prevalence in children in European countries are sparse. The aim of this study was to assess the trends in the prevalence of atopic dermatitis in children under 5 in the Central, Eastern, and Western European sub-regions from 1990 to 2019. Methods: In this study, a descriptive, observational epidemiological method was applied. In addition, an ecological study design was used. Joinpoint regression analysis was used to assess trends. Results: A total of 118 million (54 million males and 64 million females) prevalent cases of atopic dermatitis in children under 5 were reported in European countries in 1990–2019. More than half of all cases of atopic dermatitis in children under 5 in Europe were recorded in the Western European sub-region. The highest prevalence rates of atopic dermatitis in children under 5 were observed in the Eastern European sub-region, with the highest rates in both males and females recorded in Estonia (equally at about 15,000 per 100,000), followed by the Russian Federation (equally at about 12,000 per 100,000). Moreover, the lowest prevalence rates were reported in the Eastern European sub-region (equally at about 5000 per 100,000 in Romania and Latvia). A sex disparity in the prevalence and trends of atopic dermatitis in children under 5 was observed. A significantly increased trend in atopic dermatitis prevalence in children under 5 was recorded in the Eastern European sub-region from 1990 to 2019 (by +0.3% per year in males and by +0.1% per year in females). Conversely, in the Western and Central European sub-regions, trends in the prevalence of atopic dermatitis in children under 5 slightly decreased (about −0.1% per year). The Pearson coefficient showed a significant negative correlation between the prevalence of atopic dermatitis in children under 5 and the Human Development Index in most countries in the Eastern European sub-region, while a significant positive correlation was reported between the prevalence and HDI in high-income countries in the Western European sub-region. Conclusions: High prevalence rates and mostly stable trends during the last three decades make atopic dermatitis still a major health issue in children under 5 in European countries.

Vitamins A, E, D play an extremely important role in ensuring the normal functioning of the skin and mucous membranes, an adequate immune response, and maintaining resistance to various adverse external factors. The impact of vitamins A, E, D, and the relationship between their availability and the susceptibility to skin allergies continues to be studied. Peach oil is widely used in medicinal ointments and creams for dermatitis, and vitamins are successfully used in the systemic treatment of atopic dermatitis in children. The possibility of combined external application of peach oil and vitamins A, E, D to the skin in atopic dermatitis in children is of scientific interest. Purpose - to study, evaluate and analyze the clinical effect of combined external application of peach oil and vitamins A, E, D on the skin in atopic dermatitis in children. Materials and methods. During the research, 64 children with atopic dermatitis and 32 children of the control group aged from 1 to 17 years were examined. Сomparative assessment of the clinical effect of traditional and improved complex therapy of 64 children with atopic dermatitis. Improved complex therapy included the external application on the skin of peach oil with vitamins A, E, D twice a day during four weeks. General clinical, immunological, questionnaires and statistical research methods were used. Results. The research of different variants for the treatment of atopic dermatitis in children showed better clinical effect of improved complex therapy with the external application on the skin of peach oil with vitamins A, E, D, which was accompanied by a decrease in the prevalence and intensity of skin manifestations, itching, normalization of sleep and it was confirmed by a decrease in the SCORAD index, a decrease markers of allergic inflammation - concentrations of leukocytes, eosinophils and histamine in the blood. The significant improvement in the course of the disease was noted under the influence of improved complex treatment compared to traditional therapy. Conclusions. The combined external application on the skin of peach oil and vitamins A, E, D with atopic dermatitis in children contributes to a significantly faster reduction of the skin signs such as dryness / flaking, xerosis/hyperkeratosis, lichenization/lichenification, erythema/hyperemia, edema/papules, excoriations/scratches, microvesiculation, exudation/wetting, hemorrhagic and serous crusts, hyperpigmentation, compared to traditional therapy of atopic dermatitis in children. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

The prevalence of atopic dermatitis (AD) in children has steadily increased over time, yet it remains largely unknown how maternal factors during pregnancy are associated with child AD. Few studies have specifically assessed the relationship between prenatal stress and child AD, with inconsistent findings. In this prospective cohort study following 426 mother-child dyads from pregnancy to middle childhood, women reported stressful life events (SLEs) experienced during the 12 months before delivery and AD outcomes in children aged approximately 4–6 years, including current, location-specific, and ever AD. We used Poisson regression to estimate risk ratios (RRs) and corresponding 95% confidence intervals (CIs) associated with a 1-unit increase in prenatal SLEs, adjusting for potential confounders. We also assessed whether the association between prenatal SLEs and child AD was modified by child sex, history of maternal atopy, or prenatal maternal resilient coping. The mean (standard deviation) of prenatal SLEs reported in the overall sample was 1.4 (1.6), with 37.1% of women reporting none. A 1-unit increase in prenatal SLEs was not significantly associated with current AD (RR: 1.08, 95% CI: 0.89, 1.31), location-specific AD (RR: 1.09, 95% CI: 0.78, 1.52), or ever AD (RR: 0.97, 95% CI: 0.87, 1.09). We did not find evidence of effect modification. Findings from this study suggest no association between prenatal SLEs and AD in middle childhood, although larger longitudinal studies with enhanced case definition and higher variability of SLE experience may more fully inform this question.

Background: Vitamin D seems to influence the evolution of atopic dermatitis (AD) in children. Methods: We tested the vitamin D serum levels of 39 children with AD (AD group t₀) and of 20 nonallergic healthy controls (C group). AD severity was evaluated using the AD scoring system (SCORAD index). Cytokine serum levels (IL-2, IL-4, IL-6, IFN-γ, TNF-α) and atopy biomarkers were also measured. The patients were then treated with vitamin D oral supplementation of 1,000 IU/day (25 mg/day) for 3 months. We then reevaluated the vitamin D serum levels, AD severity and cytokine serum levels in all of the treated children (AD group t₁). Results: The cross-sectional analysis on patients affected by AD (AD group t₀) showed that the initial levels of all the tested cytokines except for TNF-α were higher than those of the healthy control group (C group), falling outside the normal range. After 3 months of supplementation the patients had significantly increased vitamin D levels (from 22.97 ± 8.03 to 29.41 ± 10.73 ng/ml; p = 0.01). A concomitant significant reduction of both the SCORAD index (46.13 ± 15.68 at the first visit vs. 22.57 ± 15.28 at the second visit; p < 0.001) and of all the altered cytokines (IL-2, IL-4, IL-6, IFN-γ) was also found. Conclusions: This study showed vitamin D supplementation to be an effective treatment in reducing AD severity in children through normalization of the Th1 and Th2 interleukin serum pattern.

Background: Atopic dermatitis is a global health issue if it is seen from the increasing prevalence and high cost of treating atopic dermatitis. Atopic dermatitis is an inflammation of the skin in the form of chronic residive dermatitis, accompanied by itching, and affecting certain body parts, especially in the face in infants (infantile phase) and sural parts of the extremities (in the child phase). Several triggering factors for atopic dermatitis include intrinsic factors such as genetics, characteristics of atopic skin, immunological disorders, stress, and extrinsic factors such as the environment, irritants, allergens, food, microorganisms, and weather. Objectives: The purpose of this study was to determine the relationship between genetics, food allergies, and the environment with the incidence of atopic dermatitis in the working area of ​​the Waai Health Center. Methods: The research design used was descriptive-analytical with a cross-sectional study approach. The population is all Elementary School 163 Central Maluku, Elementary School 224 Central Maluku, and Elementary School 25 Central Maluku which are in the working area of ​​the Waai Health Center, there are 433 children. Sampling with accidental sampling technique. The sample in this study found 208 children. Results: The results obtained a significant relationship between genetics, food allergies, and environment with the incidence of atopic dermatitis with a value (p = 0.000). Conclusion: It is recommended for families to supervise and supervise children if there is a history of atopy in family members to reduce the risk factors for atopic dermatitis in children because this atopic dermatitis cannot be cured but its recurrence can be controlled.

Atopic dermatitis: Therapeutic concepts evolving from new pathophysiologic insights

Although some preliminary work exists examining the impact of atopic dermatitis (AD) in children on their families, there is no empirical work examining specific parent caregiver factors that could contribute to the family impact of this condition. We conducted a cross-sectional, exploratory analysis of how parent caregivers are affected by their child's AD, and how certain parent caregiver characteristics and perceptions affect the family impact of this condition. Parent caregivers of children with AD (n = 49) were administered a survey to collect detailed data on socioeconomic status, health perceptions, and caregiving issues. Family impact of the child's AD was measured using a modified AD Family Impact Scale. Multiple regression analyses revealed that three major factors associated with the parent caregiver were correlated with large increases in the family impact scores: 1) perception that the child's condition is severe (13%, p < 0.01), 2) high use of nonmedical services for child's condition (21%, p < 0.01), and 3) financial concern about the child's condition (18%, p < 0.01). These preliminary data indicate distinct characteristics of the parent caregiver that are associated with higher family impact of AD in children. These parent caregiver factors may be important in identifying suitable audiences and areas for education for optimal management of children's AD.

Source: Foolad N, Brezinski EA, Chase EP, et al. Effect of nutrient supplementation on atopic dermatitis in children. JAMA Dermatol. 2013; 149(3): 350-355; doi: 10.1001/jamadermatol.2013.1495Investigators from the University of California at Davis performed a systematic literature review to determine the impact of nutrient supplementation on the prevention or reduction in severity of atopic dermatitis (AD) in children. The investigators searched the Cochrane Central Register of Controlled Trials, MEDLINE, and the Latin American and Caribbean Health Science Literature databases for clinical trials and cohort studies published between 1946 and 2012. For inclusion, studies needed to involve children <3 years old with or at risk for AD, and report the prevalence, incidence, or AD severity. Studies that met selection criteria were independently reviewed by 2 investigators. Data abstracted from each study included type of nutrient and primary outcome measures. The risk of bias for all included studies was also assessed.There were 21 studies that met selection criteria, 20 of which were randomized controlled trials. The studies included 6,859 participants, infants or mothers who were pregnant or breastfeeding, who received nutrient supplementation; there were 4,134 controls. Selected studies examined the effect of 4 different nutrient supplementations: probiotics, prebiotics, formula, and fatty acids. There was a low risk of bias among the selected studies.Of the 21 selected studies, nutrient supplementation was found to prevent the development of AD in 11 of 17 studies and decrease the severity of AD in 5 of 6 studies. Specifically, 6 of 10 studies on the effect of probiotics found that they reduced the incidence of AD. The results of other included studies suggested that partially hydrolyzed whey and extensively hydrolyzed casein formulas were effective in preventing the development of AD, especially among infants without a family history. Certain fatty acids, such as γ-linolenic acid, reduced AD severity but not its development, while prebiotics reduced AD incidence but not severity.The investigators conclude that certain nutrient supplements appear to decrease AD incidence and severity, but further research is needed to validate these findings and determine their mechanism of action.Dr Wright has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The incidence of AD in infants has increased and reached an estimated 20% over the past 30 years.1 Multiple studies have attempted to examine the effects of dietary nutrient supplementation on the development and severity of AD. To date, this topic has been somewhat controversial and study designs and conclusions have varied. This review summarizes the results of 20 randomized controlled trials addressing this question. Although not all included studies found nutrient supplementation to be helpful in decreasing the incidence and/or severity of AD, many did. Interventions with the most compelling supporting evidence used supplementation with certain probiotics.Although these conclusions are certainly intriguing, no studies to date have adequately addressed the question of mechanism of action for nutritional supplementation. Also, no studies have established a causal link between ingestion of certain nutrients, concomitant changes in the intestinal flora, and positive effects on the frequency and severity of AD. Further studies are needed to investigate these questions, as well as to establish whether nutrient supplementation has any lasting preventive effects. In addition, if the benefits of nutrient supplementation are further confirmed, recommended guidelines for nutrient supplementation will need to be established.

Dupilumab is the first biologic approved for the treatment of moderate-to-severe atopic dermatitis (AD) in children and adolescents. Previous systematic reviews explored the effectiveness and safety of dupilumab in adults with AD. However, the underlying mechanisms of AD can vary among different age groups, emphasizing the need for separate investigation into the use of dupilumab in children and adolescents with AD. To evaluate the efficacy and safety of dupilumab in children and adolescents with AD based on evidence from clinical trials and observational studies. The process of meta-analysis was conducted according to preferred reporting items for systematic reviews and meta-analyses guidelines. Seven clinical trials and 11 observational studies involving 1275 children and adolescents with AD were eligible for quantitative analysis. Overall, the pooled percentages of eczema area and severity index (EASI) 50, EASI 75, EASI 90, EASI 100, and investigator's global assessment (IGA) 0/1 were 72.9% (95% CI: 61.6%-81.9%), 57.4% (48.1%-66.2%), 31.3% (24.0%-39.7%), 29.7% (23.3%-37.0%), and 35.2% (29.3%-41.5%). With prolonged treatment time, an increase was seen in the pooled rate of EASI response, indicating that dupilumab may provide sustained benefits for children and adolescents over the long term. The reported adverse events were primarily mild and manageable, with an overall incidence rate of 7.2% across clinical trials and 7.6% across observational studies. Dupilumab was an effective and safe treatment option for children and adolescents with AD, with positive results observed from long-term use and an acceptable safety profile. More long-term, high-quality, controlled studies in different regions are needed for further verification.