Features of psychopathological component of clinical profile of patients with atopic dermatitis

Atopic dermatitis (AD) is a systemic, multifactorial disease that causes significant morbidity and health care burden in Latin America (LA). Data on AD are scarce in LA. Lack of disease registries and non-standardized study methodologies, coupled with region-specific genetic, immunological, and environmental factors, hamper data collection. A panel of LA experts in AD was given a series of relevant questions to address before a conference. Each narrative was discussed and edited through numerous rounds of deliberation until achieving consensus. Identified knowledge gaps in AD research were updated prevalence, adult-disease epidemiology, local phenotypes and endotypes, severe-disease prevalence, specialist distribution, and AD public health policy. Underlying reasons for these gaps include limited funding for AD research, from epidemiology and public policy to clinical and translational studies. Regional heterogeneity requires that complex interactions between race, ethnicity, and environmental factors be further studied. Informed awareness, education, and decision making should be encouraged.

Objective To evaluate the effect of an emollient containing Prinsepia utilis Royle oil extracts and other extracts on clinical symptoms and disease recurrence in children aged 2 - 12 years with atopic dermatitis (AD) in the remission period. Methods A multicenter, randomized, parallel-group, controlled clinical trial was conducted from December 2017 to September 2018. A total of 297 children aged 2 - 12 years with moderate AD were enrolled from 5 hospitals in China, and randomly divided into the test group (148 cases) and control group (149 cases) . In the acute stage, the two groups were both topically treated with mometasone furoate cream once a day on the skin lesions, and with an emollient containing Prinsepia utilis Royle oil extracts and other extracts twice a day throughout the whole body for 2 - 4 weeks. The children would be enrolled into the remission stage if their Investigator′s Global Assessment (IGA) score was ≤ 1 at following visits. In the remission stage, the test group was only topically treated with the emollient twice a day throughout the whole body, while mometasone furoate cream and the emollient were both withdrawn in the control group. At weeks 4, 8 and 12 in the remission stage, the recurrence of AD, eczema area and severity index (EASI) , children′s dermatology life quality index (CDQOL) and adverse events were evaluated. Statistical analysis was carried out with SAS 9.4 software by using t test for comparison of normally distributed continuous data between two groups, chi-square test for comparison of unordered categorical data, Kaplan-Meier method for analysis of survival rates, Cox regression analysis for evaluating the effect of different therapies on AD recurrence in children in the remission stage, and Logistic regression analysis for analysis of odds ratio (OR) of EASI or CDQOL at week 4 in the remission stage between the test group and control group. Results Of the 297 children with AD, 31 breached the clinical trial protocol, and 266 were included in the per protocol set (PPS) , including 132 in the test group and 134 in the control group. In the PPS, 114 and 106 patients completed the follow-up in the test group and control group respectively, and the recurrence rate was significantly lower in the test group (47, 41.23%) than in the control group (84, 79.25%; χ2 = 32.96, P 0.05) . Conclusion Maintenance treatment with the emollient containing Prinsepia utilis Royle oil extracts and other extracts can markedly reduce the recurrence risk in AD children, improve clinical symptoms, and enhance the quality of life. Key words: Dermatitis, atopic; Child; Randomized controlled trial; Remission period; Maintenance treatment; Emollients; Prinsepia utilis Royle oil

Head and neck severity index is associated to a significant worsening of quality of life in atopic dermatitis patients.

Severity of atopic dermatitis (AD) itch and lesions is associated with poor quality of life. However, there is limited evidence describing the combined impact of itch and skin severity on patient outcomes in AD. This study aims to assess the independent and combined effects of itch and skin severity on patient-reported symptoms and quality-of-life outcomes. The study included adult participants (age ≥18 years) with AD enrolled in TARGET-DERM AD, an observational, longitudinal study of more than 3158 participants across 43 academic/community centers in the USA and Canada. Itch severity was assessed by the Patient-Reported Outcome Measurement Information System Itch-Severity, specifically the item evaluating ‘itch at its worst’, a 0–10 numeric rating scale. A score of 0 or 1 was interpreted as no/minimal itch. Skin severity was assessed by the validated Investigators Global Assessment of AD (vIGA-AD), with a score of 0 or 1 representing clear/almost clear skin (vIGA-AD 0/1). The association of AD symptoms representing patient-reported clear/almost clear disease [Patient-Oriented Eczema Measure (POEM) 0–2] and no impact of AD on quality of life [Dermatology Life Quality Index (DLQI) 0/1] with itch and skin severity was assessed using descriptive statistics and logistic regression models that included main and interaction effects for itch and skin severity. Among adult participants (n = 1795; 59% female; 60% non-Hispanic White; mean age 44.5 years), vIGA-AD, POEM, Worst Itch and DLQI data at enrollment were available for 95% (1702), 44% (792), 43% (783) and 43% (783) of participants, respectively. The proportion reporting POEM 0–2 and DLQI 0/1 was highest among those with no/minimal worst itch (73% POEM 0–2; 72% DLQI 0/1) and clear/almost clear skin (46% POEM 0–2; 45% DLQI 0/1), with decreasing proportions observed at greater itch and skin severity levels. Among those with both no/minimal itch and clear/almost clear skin, 87.5% (42/48) and 95.8% (46/48) reported POEM 0–2 and DLQI 0/1, respectively. Logistic regression results suggest that no/minimal itch and clear/almost clear skin are significantly associated with POEM 0–2 and DLQI 0/1, though the interaction effect was not statistically significant in despite all models assessed. Relative to those who did not have either no/minimal itch or clear/almost clear skin, the odds ratio of reporting POEM 0–2 and DLQI 0/1 was highest among those with both no/minimal itch and clear/almost clear skin (82.9 for POEM 0–2; 35.4 for DLQI 0/1), followed by no/minimal itch only (15.9 for POEM 0–2; 10.5 for DLQI 0/1) and clear/almost clear skin only (5.9 for POEM 0–2; 3.8 for DLQI 0/1). Complete or almost complete relief of itch and skin lesions is associated with greater odds of achieving ideal states in PROs (POEM and DLQI) with itch relief exhibiting a relatively higher impact than skin clearance. These results underscore the importance of assessing and documenting both itch severity and skin clearance to support shared decision-making. Moreover, clearance of both itch and skin lesions should be considered when setting treatment goals in patients with AD. Future research should include analyzing discrepant data (e.g. patients with no/minimal itch, but some skin lesions) to more precisely identify which aspect drives the patient-reported outcomes.

Beyond quality of life: A call for patients' own willingness to pay in chronic skin disease to assess psychosocial burden—A multicenter, cross-sectional, prospective survey

IntroductionAtopic dermatitis (AD) is featured by pruritus, which causes diminished quality of life. Little clinical data exists concerning the use, efficacy and side effects of UVA1 phototherapy in AD patients.AimTo determine the effectiveness of medium-dose UVA1 phototherapy in AD treatment.Material and methodsThirty-six patients with AD were irradiated with medium-dose UVA1 (45 J/cm2) as monotherapy for 4 weeks for a total of 20 sessions (daily irradiations during weekdays only). Clinical status was evaluated with the visual analogue scale for pruritus, Dermatology Life Quality Index (DLQI) for evaluating general well-being and the SCORAD index. All parameters were measured twice: before and after phototherapy.ResultsUVA1 phototherapy resulted in a significant (p < 0.001) decrease in pruritus, improvement in DLQI (p < 0.001) and SCORAD (p < 0.001). Before phototherapy, the intensity of pruritus and SCORAD index correlated with DLQI (r = 0.34, p < 0.05 and r = 0.61, p < 0.05, respectively). Similarly, after irradiation, pruritus correlated with DLQI, and SCORAD index correlated with DLQI (r = 0.51, p < 0.05 and r = 0.55, p < 0.05, respectively). No severe adverse effects were noted during the study.ConclusionsPhototherapy with medium-dose UVA1 irradiation exerts a significant antipruritic effect, decreases the severity of the disease and improves the quality of life of AD patients. This technique can therefore be used as a safe and effective treatment method.

Severity strata for POEM, PO-SCORAD, and DLQI in US adults with atopic dermatitis

Objectives: Given that the effect of omalizumab in atopic dermatitis (AD) is controversial, the aim of this study was to evaluate its efficacy. Methods: We retrospectively reviewed the medical records of twelve patients with severe refractory AD who had received either dose of 150 or 300mg omalizumab therapy between 2012 and 2015. Scoring atopic dermatitis (SCORAD) and dermatology life quality index (DLQI) scores were evaluated before and 3 months after omalizumab therapy. Results: All our 12 patients had severe refractory AD (SCORAD ＞ 40). The SCORAD and DLQI scores after 3 months of omalizumab therapy were from 64.9 ± 12.3 to 38.9 ± 8.4 (p ＜ 0.001), and 21.9 ± 3.3 to 13.0 ± 4.5 (p ＜ 0.001) respectively. There was no statistically significant difference in the values of SCORAD and DLQI between patients treated with 150mg and 300mg omalizumab (SCORAD, p = 0.485; DLQI, p = 0.818). The reduction of SCORAD by omalizumab was significantly greater in AD patients with a very high SCORAD score (SCORAD ＞ 60) compared to those with a low SCORAD score (32.8 ± 8.1% vs. 16.5 ± 10.4%, p = 0.010). In addition, the degree of reduction of SCORAD or DLQI did not achieve significant difference between patients with or without received systemic glucocorticoid (SCORAD, p = 0.310; DLQI, p = 0.937). Conclusion: Omalizumab may be an effective therapy for AD patients, but further studies are needed to substantiate our findings.

It is unknown how the quality of life (QOL) is affected in patients with pityriasis rosea (PR), and whether it is related to rash severity. We constructed a valid and reliable Cantonese version of the Dermatology Life Quality Index (DLQI). We recruited patients with PR, with atopic dermatitis and with acne vulgaris, and controls of the same sex and comparable age. We applied the DLQI and the Pityriasis Rosea Severity Score (PRSS) to the patients with PR, the DLQI and the SCORing Atopic Dermatitis Index (SCORAD) to the controls with atopic dermatitis, and the DLQI and the Leeds Acne Grading System (LAGS) to the controls with acne vulgaris. Total DLQI scores of the 22 patients with PR (mean: 6.36, SD: 5.79) were significantly lower than those of the 22 controls with atopic dermatitis (mean: 12.00, SD: 5.38) (P = 0.021), but were insignificantly different from those of the 22 controls with acne vulgaris (mean: 6.86, SD: 4.53) (P = 0.57). Correlation between the total DLQI and PRSS scores was weak (gamma(s) = +0.19) and insignificant (P = 0.40). All six DLQI parameters were insignificantly correlated with the PRSS scores. In contrast, the total DLQI scores and most of the DLQI parameters were strongly correlated with the rash severity scores for the control subjects. Significantly more patients with PR have concerns regarding disease etiology and infectivity. The QOL of the patients with PR was significantly less affected than that for the patients with atopic dermatitis, but was insignificantly different from the patients with acne vulgaris. Unlike atopic dermatitis and acne vulgaris, the effects on the QOL in PR are insignificantly correlated with rash severity. These results bear important implications on clinical management.

The role of thymus and activation-regulated chemokine as a marker of severity of atopic dermatitis

Anti-pruritic and anti-inflammatory effects of Sopoongsan on atopic or seborrheic dermatitis: A pilot randomized, placebo-controlled clinical trial and translational research using in vitro and in vivo models.

SummaryBackgroundBetter understanding of the relationship between atopic dermatitis (AD) severity and health‐related quality of life (HRQoL) could help improve knowledge of a more effective treatment for people with AD.ObjectivesTo assess the relationship between AD severity and HRQoL and perception of AD symptoms in adults with moderate‐to‐severe AD in Europe and the U.S.A.MethodsParticipants for this cross‐sectional, internet‐based survey were recruited from the larger population‐based National Health and Wellness Survey. AD severity was measured by Patient‐Oriented SCORing of AD. HRQoL was measured by the five‐level EuroQol‐5D, Dermatology Life Quality Index (DLQI) and Patient‐Oriented Eczema Measure (POEM).ResultsAltogether, 1232 respondents were included: 1098 (89·1%) with moderate‐to‐severe AD [221 (20·1%) from France, 209 (19·0%) from Germany, 118 (10·7%) from the U.K. and 550 (50·1%) from the U.S.A.]. An additional 134 (10·9%) respondents with mild AD were included. Sociodemographic and clinical AD characteristics were similar between countries. In adults with moderate‐to‐severe AD, higher AD severity correlated with poorer HRQoL (Spearman's r = –0·38 and 0·61 for EQ‐5D and DLQI, respectively; both P < 0·001). AD severity was positively correlated with POEM (Spearman's r = 0·51; P < 0·001). People with moderate‐to‐severe vs. those with mild AD had poorer health outcomes (EQ‐5D, DLQI and POEM, P < 0·001 for all). These results were similar and consistent for the European and the U.S. populations separately.ConclusionsHigher AD severity is associated with poorer HRQoL across Europe and the U.S.A. This is a burden for patients and may provide encouragement for more effective management of AD.What's already known about this topic?Atopic dermatitis (AD) is associated with a detrimental effect on health‐related quality of life (HRQoL), including sleep disturbance, anxiety and depression.Limited data describing the relationship between different levels of AD severity and self‐reported HRQoL have been published.What does this study add?There is a positive association between increasing AD severity (Patient‐Oriented SCORing of AD) and decreasing HRQoL (EQ‐5D and Dermatology Life Quality Index) and the perception of AD symptoms (Patient‐Oriented Eczema Measure) from the patient's perspective.AD severity according to geographic locations was explored (France, Germany, the U.K., and the U.S.A.), showing that the decreasing HRQoL associated with increasing AD severity was quite consistent between the geographic locations.What are the clinical implications of this work?The results of this study showed that higher AD severity is associated with poorer HRQoL from the subject’s perspective in both Europe and the US. This fact confirms that there is a burden for these patients and may provide encouragement for a more effective management of AD, especially among those with greater AD severity.

Disease characteristics, comorbidities, treatment patterns and quality of life impact in children <12 years old with atopic dermatitis: Interim results from the PEDISTAD Real-World Registry

Anxiety is a prevalent psychological factor associated with atopic dermatitis (AD). AD patients generally suffer from a high anxiety level, and psychological treatment documents a positive effect on the anxiety level, as well as the course and management of the disease. The Dermatology Life Quality Index (DLQI) has been suggested as a relevant clinical measure in AD. This study investigated the relationship between the severity of AD, dermatological life quality and anxiety. Thirty-two adults suffering from AD were examined using the Severity Scoring of AD Index (SCORAD), the DLQI and the Spielberger State-Trait Anxiety Index (STAI). Twenty-two healthy controls were examined using the DLQI and STAI. Results showed that the AD group had higher anxiety and lower dermatological life quality than the control group. In the AD group a significant positive correlation was found between SCORAD and DLQI and between DLQI and STAI. However, no correlation was found between SCORAD and STAI. The results suggest that: (i) both severity of eczema and anxiety are important for dermatological life quality; (ii) psychological inferences should not be made from the severity of eczema, but from the psychological measures, and vice versa; and (iii) both dermatological and psychological assessment is important in AD.

Atopic dermatitis (AD) is a multifactorial, genetically determined disease with a chronic relapsing course and a predisposition to hyperimmunoglobulinemia E. Abnormal colonization of Staphylococcus aureus, Malassezia furfur, and Herpes Simplex plays a significant role in maintaining inflammation in AD. Objective — to determine the frequency of bacterial, mycotic and viral complications in a group of patients with moderate and severe AD. Materials and methods. From 2018 to 2023, 80 patients with AD (moderate and severe forms) aged from 1 year to 53 years (average age 14.6 years) were under our observation. Patients with a SCORAD index ≥ 25 were included in the study. To confirm the nature of the infectious complication, additional examination methods were used: microscopy, bacteriological culture, amplification methods of research, dermatoscopy, immunoenzyme analysis. Results and discussion. An analysis of the total number of relapses of AD during the year was carried out, depending on the age and gender of the patients. The largest number of relapses was observed in the age group from 6 to 10 years — 9.4 ± 0.6. The frequency of AD relapses had a certain correlation with the severity of the course of dermatosis — the SCORAD index increased to 31.2 ± 0.4 in the group of patients with the highest frequency of disease relapses (9.4 ± 0.6) per year and, as a result, increase in the frequency of infectious complications. The conducted analysis showed that each age group of AD patients had its own characteristic spectrum of bacterial, mycotic and viral complications. The most frequent infectious complications of AD observed in the examined patients were streptostaphyloderma (18.8 %), molluscum contagiosum (11.3 %), mycotic lesions (10.0 %), herpes infection (6.3 %), Coxsackie virus (3.8 %), EBV ­infection (2.5 %). Conclusions. As a result of the clinical study, it was established that infectious complications in AD have age, gender, and topographic features that can change the course and prognosis of dermatosis. Against the background of reduced immunoreactivity, the risk of disseminated, life­threatening forms of infections increases in patients with atopic dermatitis.