The effect of probiotic (Clostridium butyricum) on adult patients with atopic dermatitis: a retrospective cohort study from TriNetX

Atopic Dermatitis Is Associated with Dermatitis Herpetiformis and Celiac Disease in Children

Atopic Dermatitis in Latin America: A Roadmap to Address Data Collection, Knowledge Gaps, and Challenges.

One-year real-world clinical effectiveness, safety, and laboratory safety of dupilumab in Japanese adult patients with atopic dermatitis: A single-center retrospective study

BACKGROUND: Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss. AA frequently co-occurs with other inflammatory autoimmune conditions, presenting a significant clinical burden. OBJECTIVE: To compare the burden of illness, direct and indirect costs in adult patients with AA vs atopic dermatitis (AD). METHODS: This retrospective cohort study used US administrative claims data from the Merative MarketScan Commercial Claims and Encounters Database to compare commercially insured adults with AA to those with AD. Patients with an AA diagnosis between January 2017 and September 2019 were propensity score matched to patients with AD. Comorbidity burden, medication use, health care resource utilization, health care costs, and indirect costs during a 12-month follow-up period were compared between cohorts. RESULTS: Overall, 25,446 adult patients with AA were selected for the matched analysis with the AD cohort. Patients with AA generally had lower comorbidity burden than patients with AD; mean Deyo-Charlson Comorbidity Index scores were 0.36 (SD = 0.99) and 0.39 (SD = 0.92), for AA and AD, respectively (P = 0.007). Patients with AA had significantly lower proportions of allergic rhinitis, asthma, pruritus, skin infections, and urticaria, but higher proportions of thyroid disease, when compared with patients with AD (all P < 0.001). A smaller proportion of patients with AA had prescriptions for topical (45.3% vs 64.8%; P < 0.001) and oral (20.3% vs 29.6%; P < 0.001) corticosteroids and antianxiety and/or antidepressants (24.7% vs 29.7%; P < 0.001), but a significantly larger proportion for intralesional corticosteroids (triamcinolone) (49.6% vs 21.7%; P < 0.001), compared with patients with AD. Despite a lower comorbidity burden and generally less medication usage in patients with AA, total all-cause health care costs did not significantly differ between the AA and AD cohorts ($10,705 vs $10,816; P = 0.712), and outpatient costs were higher in patients with AA ($6,297 vs $5,859; P = 0.014). Female patients with AA had significantly greater costs for both outpatient and outpatient pharmacy when compared with female patients with AD. Patients with AA were more likely to have a claim for long-term disability (0.6% vs 0.3%; P = 0.001) and higher long-term disability-associated indirect costs ($73 [SD = $1,442] vs $25 [SD = $774]; P = 0.004) compared with patients with AD. CONCLUSIONS: We found similar total health care costs in patients with AA and AD, despite a lower proportion of comorbidities and prescription use in patients with AA. Outpatient costs were also significantly higher overall in patients with AA. Although often dismissed as a cosmetic condition, AA, an autoimmune disease, has a similar level of medical expenditure as AD. DISCLOSURES: This study was funded by Eli Lilly and Company. Mr Fenske and Drs Ding, Morrow, and Smith are employed by Eli Lilly and Company. Drs Manjelievskaia, Moynihan, and Silver are employed by Merative. Drs Manjelievskaia, Moynihan, and Silver were employed by IBM Watson Health at the time of study completion. IBM Watson Health received funding from Eli Lilly and Company to conduct this study.

Importance: Atopic dermatitis (AD) is a common chronic skin disease with significant comorbidities and a dramatic impact on quality of life. Despite this, there is little published information about healthcare utilization patterns for adults and children with AD. Objective: To examine healthcare utilization for patients with AD who are cared for in a regional academic medical center. Design: Retrospective cohort analysis. Setting: A mixed urban, suburban and rural catchment in the Western NY region. Participants: All patients seeking medical care for their AD from March of 2011 to September 2015. Exposure(s) for observational studies: Active AD. Main Measure(s): Age, sex, race, ethnicity, (demographics) and medical specialty (healthcare utilization). Patients were stratified and analyzed by age group. Results: Adult AD patients (n=767) accounted for 38.2% of the AD population seeking healthcare in our system with a mean age of 42.7 ± 18.7 years. Among adults, females were seen more commonly than males (65.3% vs. 34.7%). In contrast, both genders were equally represented in the pediatric population ( 18 years; 35.2%). Dermatologists cared for the majority of patients (35.2%), followed by pediatricians (25.7%) and family medicine physicians (10.1%). African-Americans were nearly 3 times more likely than Caucasians to visit primary care physicians for their initial AD management (p<0001). Conclusions and relevance: This study demonstrates that adult AD patients account for over a third of all AD visits in a regional academic medical center. Dermatologists managed the greatest number of AD patients, and the pediatric population was notable for a greater proportion of African American patients relative to the adults. This disparity between the proportions of African Americans in pediatric vs adult patients may reflect reduced access to care for adults. Alternatively, African-Americans may simply have a greater prevalence of pediatric onset AD coupled with greater disease resolution prior to adulthood. African-Americans also appear to seek

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

Tacrolimus: A new topical immunomodulatory therapy for atopic dermatitis

Lichen amyloidosis is a chronic pruritic skin disorder associated with atopic dermatitis, however, the pathogenetic link between these two conditions remains to be elucidated. Only limited research has been performed on patients diagnosed with both pruritic dermatological conditions. This study aimed to analyze the clinical features of lichen amyloidosis associated with atopic dermatitis. We conducted a matched case-control study of incident lichen amyloidosis with atopic dermatitis between March 2020 and February 2022. Among the 2,481 patients with atopic dermatitis, 20 patients diagnosed with lichen amyloidosis and atopic dermatitis were included as case patients, and 20 patients diagnosed with atopic dermatitis were enrolled as controls. The controls were matched to cases (1:1) by age and sex. We retrospectively reviewed the medical records of the patients. The prevalence of lichen amyloidosis associated with atopic dermatitis was approximately 0.8%, with a male:female sex ratio of 2.33:1. The recorded onset of lichen amyloidosis associated with atopic dermatitis was more common in adult patients, with moderate-to-severe atopic dermatitis. Lichen amyloidosis lesions in patients with atopic dermatitis were most commonly found on the extremities, sparing the head and neck region. The presence of lichen amyloidosis had no significant impact on severity of atopic dermatitis. In patients with lichen amyloidosis associated with atopic dermatitis, the clinical manifestations of lesions are similar to those of conventional lichen amyloidosis lesions in terms of morphology and regional distribution. Further research is required to elucidate the link between the pathogenesis of these two pruritic dermatological conditions.

BackgroundProbiotics, as common regulators of the gut microbiota, have been used in research to alleviate clinical symptoms of atopic dermatitis (AD).ObjectiveOur research team has previously identified a potential relieving effect of Clostridium butyricum on the treatment of AD, but the specific mechanism of how Clostridium butyricum alleviates AD has not yet been confirmed.MethodsIn this study, we explored the relieving effect of Clostridium butyricum on AD through in vivo and in vitro experiments. AD mice induced by 2,4-dinitrofluorobenzene (DNFB) were orally administered with 1 × 108 CFU of Clostridium butyricum for three consecutive weeks.ResultsOral administration of Clostridium butyricum reduced ear swelling, alleviated back skin lesions, decreased mast cell and inflammatory cell infiltration, and regulated the levels of inflammation-related cytokines. Clostridium butyricum activated the intestinal immune system through the TLR4/MyD88/NF-κB signaling pathway, suppressed the expression of inflammatory factors IL-10 and IL-13, and protected the damaged intestinal mucosa.ConclusionClostridium butyricum administration improved the diversity and abundance of the gut microbiota, enhanced the functionality of the immune system, and protected the epidermal barrier.

Atopic dermatitis

Introduction Dupilumab inhibits signaling of IL-4 and IL-13, key drivers of Type 2 inflammatory diseases such as atopic dermatitis (AD), asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP), eosinophilic esophagitis (EoE), prurigo nodularis (PN), and Chronic Spontaneous Urticaria (CSU).1,2 Adults with AD have a significant and disease severity-dependent increased risk of developing ocular surface diseases, including conjunctivitis and keratitis, compared with the general population.3 In randomized placebo-controlled trials of dupilumab in patients with moderate-to-severe AD, more conjunctivitis events were reported in patients who received dupilumab treatment than in placebo-treated patients.4,5 Objective This analysis reviewed the incidence, severity, and resolution of conjunctivitis adverse events (AEs) in patients from clinical trials evaluating dupilumab in AD, asthma, CRSwNP, EoE, PN, and CSU. Methods “Conjunctivitis” refers to the group of MedDRA Preferred Terms (PTs) that include the term ‘conjunctivitis’, namely conjunctivitis, allergic conjunctivitis, bacterial conjunctivitis, viral conjunctivitis, adenoviral conjunctivitis, and atopic keratoconjunctivitis. All cases of conjunctivitis were included regardless of etiology (including blepharoconjunctivitis, which was coded as the MedDRA PT conjunctivitis, and excluding blepharitis in the absence of conjunctivitis. This analysis excludes events of keratitis. Randomized, double-blinded, placebo-controlled trials included in this analysis were: Liberty AD Solo 1, Liberty AD Solo 2, Liberty AD Chronos, LIBERTY AD ADOL, LIBERTY AD PEDS, LIBERTY AD PRESCHOOL Part B (AD); Liberty Asthma Quest, Liberty Asthma Venture (asthma); Liberty NP Sinus-24, Liberty NP Sinus-52 (CRSwNP); Liberty EoE Treet (EoE); Liberty PN Prime, Liberty-PN Prime2 (PN); and Liberty-CSU Cupid Part A (CSU). Results Overall conjunctivitis incidence was higher in patients receiving dupilumab vs placebo in all randomized AD trials, with 7.9% to 19.4% of adult dupilumab-treated patients and 4.8% to 14.8% of dupilumab-treated patients aged 6 months to &amp;lt;18 years experiencing conjunctivitis events. In contrast, conjunctivitis rates were &amp;lt;5% and similar between dupilumab and placebo in the asthma, CRSwNP, EoE, PN, and CSU trials. Most conjunctivitis cases observed in adult patients with AD receiving dupilumab treatment were mild to moderate in severity, with severe conjunctivitis being reported at rates of ≤0.6%. A majority of all conjunctivitis cases in dupilumab-treated adults with AD were resolved during the treatment period. Conclusions Overall conjunctivitis events were more frequent in dupilumab-treated vs placebo-receiving patients in AD trials across ages, whereas rates were low and similar between dupilumab and placebo groups in the asthma, CRSwNP, EoE, PN, and CSU trials. Most conjunctivitis cases observed in adult patients with AD receiving dupilumab treatment were mild to moderate in severity and resolved by the end of the study period. Current evidence suggests that conjunctivitis associated with dupilumab occurs predominantly in patients with AD. It is possible that pre-existing ocular disorders and a dupilumab–AD disease-specific interaction may be responsible for this increased incidence in dupilumab-treated patients with AD.

Objective — to study the dynamics of peripheral blood lymphocytic populations in adult patients with atopic dermatitis (AD) with the onset of the disease in childhood, depending on the level of IgE secretion and the method of treatment.&#x0D; Materials and methods. We examined 67 adult patients with AD, which were divided into 4 groups depending on the level of total serum IgE and the basic treatment or treatment in combination with Glycine and Ketotifen. The severity of AD was determined by the SCORAD index. The content of peripheral blood lymphocytes according to the phenotype CD3+, CD4+, CD8+, CD19+, CD65+, HLADR+ and CD95+ was assessed during hospitalization of patients, at the end of the inpatient stage of treatment and after 1 month of outpatient follow-up. The obtained data were compared with the indices of the control group and between the groups of examined patients with AD in the dynamics of their treatment and observation. The results were processed statistically using the methods of parametric and nonparametric statistics.&#x0D; Results and discussion. The indices of the number of cells of peripheral lymphocytic populations of different CD pheno­type in the groups in the dynamics of observation were determined, their relationship with the severity of the course of AD was established, and differences were found depending on the pathogenetic variant of AD. Against the background of an exacerbation of AD, a significant increase in the number of cells in most of the defined populations was revealed, with its gradual decrease as the clinical manifestations of AD subsided. It was established that 1 month after achievement of clinical/subclinical remission, a part of the peripheral blood lymphocytic populations was characterized by higher values compared to the norm. In patients with an IgE-dependent AD variant, aggravation is accompanied by high levels of peripheral lymphocytes with CD3+, CD4+, CD8+, CD19+ and HLA-DR phenotypes, which more often than in the case of an IgE-independent variant of AD, remain above the norm after 1 month of outpatient monitoring. Introduction of glycine and ketotifen to the treatment complex for patients with AD is accompanied by a faster return of peripheral lymphocyte cells to normal values, which is more evident in patients with an IgE-dependent variant of AD.&#x0D; Conclusions. In adult AD patients, the dynamics of the number of peripheral lymphocyte population cells depends on the severity of the disease, its pathogenetic variant and the treatment received by the patient. Against the background of the use of glycine and ketotifen, the normalization of indicators of peripheral lymphocytic populations occurs significantly faster than with only standard basic therapy.

IntroductionAtopic dermatitis (AD) is an inflammatory skin disease affecting people globally, with a prevalence exceeding 15%. Despite its common occurance, further research is necessary to fully understand its characteristics and risk factors, especially across different age groups.ObjectivesThis study aims to determine the prevalence, clinical characteristics, risk factors, and systemic involvement of AD in adult and pediatric patients in a tertiary care setting at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia.MethodsThis cross-sectional, retrospective study was conducted on all atopic dermatitis patients at KAMC in Riyadh, Saudi Arabia. Data were collected from medical records and the BESTCare system and analyzed with SPSS version 26.ResultsA total of 603 AD patients were collected, with 53.4% being female and 46.6% male. The mean age of the patients was 25.3 years, with 52.7% consisting of pediatric patients (< 18 years). Adult patients had higher BMI levels and a longer duration of AD, whereas pediatric patients had higher IgE levels. AD was more prevalent in childhood than in adults, and adult patients with comorbidities were more affected by AD than the general population.ConclusionsIn conclusion, the study findings highlighted that atopic dermatitis is more common in pediatric patient, however it poses a great impact in adults with comorbidities. The study's findings imply that a prospective investigation is required to confirm the cause and effect of this condition, especially in adult patients with comorbidities.

What's new in atopic dermatitis?

The Editors' Choice