Pediatric Atopic Dermatitis Patients Research Articles

Dupilumab Safety and Efficacy up to 1 Year in Children Aged 6 Months to 5 Years with Atopic Dermatitis: Results from a Phase 3 Open-Label Extension Study.

Pediatric patients with moderate-to-severe atopic dermatitis (AD) often experience a high disease burden and have a high risk of persistent disease. Standard-of-care immunosuppressive systemic treatments have been used off-label for AD in pediatric patients despite concerns for suboptimal safety with continuous use and risk of relapse upon discontinuation. The biologic agent dupilumab is the first systemic treatment approved for moderate-to-severe AD in children as young as 6 months. Long-term safety and efficacy data in this patient population are needed to inform continuous AD management. The purpose of this work was to determine the long-term safety and efficacy of dupilumab treatment up to 1 year in an open-label extension (OLE) study [LIBERTY AD PED-OLE (NCT02612454)] in children aged 6 months to 5 years with moderate-to-severe AD who previously participated in the 16-week, double-blind, phase 3 LIBERTY AD PRESCHOOL trial (NCT03346434 part B; parent study) and were subsequently enrolled in PED-OLE. In PED-OLE, patients received dupilumab every 4 weeks according to a weight-tiered regimen (body weight ≥ 5 kg to < 15 kg: 200 mg; ≥ 15 kg to < 30 kg: 300 mg). Data for 142 patients were analyzed, 60 of whom had completed the 52-week visit at time of database lock. Mean age at baseline was 4.1 y [SD, 1.13; range, 1.0-5.9 years]. A majority (78.2%) of patients reported ≥ 1 treatment-emergent adverse event (TEAE), most of which were mild or moderate and transient. The most frequently reported TEAEs were nasopharyngitis (19.7%), cough (15.5%), and pyrexia (14.1%). One TEAE led to treatment discontinuation (severe urticaria, which resolved in 1 day). By week 52, 36.2% of patients had achieved an Investigator's Global Assessment score of 0/1 (clear/almost clear skin), and 96.6%, 79.3%, and 58.6% had at least 50%, 75%, or 90% improvement, respectively, in Eczema Area and Severity Index scores. Consistent with results seen in adults, adolescents, and older children (aged 6-11 years), treatment with dupilumab for up to 1 year in children aged 6 months to 5 years with inadequately controlled moderate-to-severe AD demonstrated an acceptable long-term safety profile and sustained efficacy. These results support the long-term continuous use of dupilumab in this patient population. ClinicalTrials.gov Identifiers: NCT02612454 and NCT03346434 (part B).

Patch test in Brazilian children with a clinical diagnosis of atopic dermatitis: a cross-sectional study using an extended patch test battery.

Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease mainly affecting children. Similarly, Allergic contact dermatitis (ACD) is an inflammatory skin disease, but unlike AD it results from direct exposure to an external agent. Theoretically, the impaired skin barrier facilitates the penetration of potential allergens. Therefore, AD patients are at risk for an associated ACD, exacerbating their skin condition. Because eczema is similar, performing a patch test (PT) for the differential diagnosis is essential. In this cross-sectional transversal study, we performed a PT with 30 sensitizers in 26 children with AD, selected according to established criteria for suspected ACD, and treated at an AD center of a pediatric university hospital in Rio de Janeiro. Clinical presentation, patient profile, main sensitizers, and frequency of ACD caused by therapeutic skincare products were evaluated. In all, 23 (88.5%) patients reacted to at least one allergen, 21 (80.7%) had a relevant positive patch test, and 15 (57.7%) were polysensitized. The main positive sensitizers were nickel (38.5%), blue disperse (30.8%), fragrance mix (30.8%), and neomycin (23.1%). Nineteen (73%) patients reacted to substances present in therapeutic or skincare products. Our data underscore the importance of performing a PT in AD children whose eczema has atypical distribution. The expressive percentage of positive tests, especially of allergens in skincare products, indicates the constant need to review the proposed treatments. Therefore, we recommend a specific and expanded PT battery for pediatric AD patients, including a negative control, to increase sensitivity for diagnosing ACD.

Patients' and Caregivers' Experiences Navigating the Burden of Atopic Dermatitis in Argentina.

Background and Objectives: Little is known about patients' and caregivers' experiences with atopic dermatitis (AD) in Argentina, so a survey was administered to learn more. Materials and Methods: A 53-item anonymous survey was administered in Spanish to adult AD patients (n = 334) and caregivers (n = 339) of pediatric AD patients in Argentina (total n = 673). Demographics, healthcare provider information, financial burden, disease severity, disease burden, level of disease-specific education, and experience with shared physician/patient decision making were collected. Linear and logistic regression models were used for statistical comparisons. Results: Survey respondents were overwhelmingly female (90.8%), as was the overall patient population (72.8%). Patients were seen mostly by healthcare specialists (66.8% dermatologists, 13.5% pediatricians, 7.7% allergists, and 7.2% general practitioners). Only 2.8% of respondents reported no symptoms, while 33.3%, 52.4%, and 11.5% reported mild, moderate, and severe AD disease, respectively. Anxiety/depression and pain/discomfort were the most impactful on respondents' quality of life. Caregivers of children with moderate to severe AD and adult patients with severe AD reported a significant financial burden, including using savings or not purchasing food or other essentials to afford medical care. Few people reported receiving disease-specific education or having their own treatment priorities taken into consideration. For adult patients, receiving disease education and being asked about treatment priorities were associated with higher treatment satisfaction and AD control. Discussion: Mental health, pain/discomfort, and financial worries are the most important burdens for adult AD patients and caregivers of children with AD in Argentina. We recommend prioritizing disease-specific education and shared decision making to improve AD care in Argentina.

Burden of atopic dermatitis in paediatric patients: aninternational cross-sectional study.

Few large-scale international studies have broadly characterized the burden of atopic dermatitis (AD) across age groups among children and adolescents. To better characterize the AD burden in paediatric patients by disease severity. This cross-sectional, web-based survey of paediatric patients (6 months to < 18 years old) was conducted in 18 countries representing North America, Latin America, Europe, Middle East/Eurasia and East Asia. Patients with diagnosed AD were identified based on the International Study of Asthma and Allergies in Childhood criteria and self-/parent-report of ever being told by a physician that they or their child had eczema. AD severity was assessed using the Patient-Oriented Eczema Measure and Patient Global Assessment. Outcomes included measures of itch, skin pain, sleep, health-related quality of life (HRQoL), missed school days and atopic comorbidities. The survey included 1489 children aged 6 months to < 6 years; 2898 children aged 6 to < 12 years; and 3078 adolescents aged 12 to < 18 years diagnosed with AD. Although the burden of mild AD was substantial, paediatric patients with moderate or severe AD had more itch, skin pain, sleep problems and impaired HRQoL, and missed more school days relative to those with mild AD; greater burden was observed among those with severe relative to moderate AD. At least one atopic comorbidity was present in 92.5% of all respondents. These results highlight the burden of AD in paediatric patients, especially those with moderate-to-severe disease, and suggest the need for assessments that include the impact of AD on function and daily life.

Lebrikizumab: a novel approach in managing atopic dermatitis in pediatric patients

Atopic dermatitis is a prominent dermatological condition in children that frequently affects their lifestyle. Conventional treatments frequently prove inadequate, necessitating the use of biological agents like Lebrikizumab to address the condition at its core pathophysiological level. The introduction of biologic drugs has broadened the spectrum of treatment options for patients with moderate to severe atopic dermatitis, especially those who have not achieved satisfactory results with conventional monotherapy or combination therapies, or those with contraindications to systemic immunosuppressive agents. Lebrikizumab appears to be a promising option for the treatment of atopic dermatitis, showing a strong response in clinical trials. It offers the potential for improved long-term efficacy and a reduction in adverse effects. This article provides an overview of Lebrikizumab's role in addressing the pathogenesis of atopic dermatitis and highlights its current advancements.

Biologicals for pediatric patients with atopic dermatitis: practical challenges and knowledge gaps

Biologicals are becoming increasingly important in the therapeutic landscape of pediatric patients with moderate-to-severe atopic dermatitis (AD). Currently, dupilumab and tralokinumab are registered for the treatment of moderate-to-severe AD, and novel biologicals are expected to follow. Dupilumab was the first biological registered for AD in pediatric patients and was recently approved for patients aged six months to five years. Current and emerging biologicals may address the unmet need for effective and safe treatment options for pediatric AD patients, however, little is known about the practical implementation of biologicals in infants and preschoolers (aged <6 years), including the timing of treatment initiation, discontinuation, and long-term administration of the subcutaneous injections. Currently, only a small number of biologicals are approved for the treatment of infants and preschoolers for other inflammatory diseases. Consequently, data on the practical implementation of biological treatment remain scarce. In addition, long-term effects, impact on co-morbidities, and impact on live-accentuated vaccination are still unknown. With the introduction of biologicals for AD from the age of six months, potential challenges within the implementation of biologicals may arise. Therefore, we aim to discuss current practical challenges and knowledge gaps of the treatment with biologicals in infants and preschoolers with AD.

Improvements in Gut Microbiome Composition Predict the Clinical Efficacy of a Novel Synbiotics Formula in Children with Mild to Moderate Atopic Dermatitis.

Atopic dermatitis (AD) is a common chronic inflammatory skin disease with a significant association with various type-2 inflammation-related comorbidities. Ongoing research suggests the crucial involvement of gut microbiome, especially in childhood onset AD, and hence, probiotics have emerged as a potential non-steroid-based therapeutics option to complement existing AD management plans. In order to delineate the impact of probiotics in the gut microbiome of pediatric AD patients from southern China, targeted 16S rRNA sequencing and thorough bioinformatic analysis were performed to analyze the gut microbiome profiles of 24 AD children after taking an orally administered novel synbiotics formula with triple prebiotics for 8 weeks. A notable improvement in Eczema Area and Severity Index (EASI) (p = 0.008) was observed after taking an 8-week course of probiotics, with no adverse effects observed. The relative abundances of key microbial drivers including Bacteroides fragilis and Lactobacillus acidophilus were significantly increased at week 8. We also found that the positive responsiveness towards an 8-week course of probiotics was associated with improvements in the gut microbiome profile with a higher relative abundance of probiotic species. Over-represented functional abundance pathways related to vitamin B synthesis and peptidoglycan recycling may imply the underlying mechanism. In summary, our study suggests how the gut microbial landscape shifts upon probiotic supplementation in AD children, and provides preliminary evidence to support targeted probiotic supplementation for the management of childhood AD.

476 High loading-dose of dupilumab rapidly controls pruritus in pediatric atopic dermatitis patients

476 High loading-dose of dupilumab rapidly controls pruritus in pediatric atopic dermatitis patients

Atopic Dermatitis and its Management by the First Contact Doctor

Atopic dermatitis is a chronic inflammatory skin disease that affects a large number of pediatric patients between 2 and 17 years of age. Typical symptoms include intense itching, erythema, and scaling of the skin. Atopic dermatitis has been found to be associated with decreased quality of life for patients and their families. Diagnosis is made by clinical evaluation and differential diagnosis with other dermatologic diseases. Treatment is based on the severity of the disease and the age of the patient. Topical treatments are the first line of treatment, while systemic treatments are reserved for patients with severe atopic dermatitis who do not respond to topical treatments. In addition, other treatments, such as light therapy, biological therapy and allergen-specific immunotherapy, have been evaluated in patients with atopic dermatitis. A multidisciplinary approach and appropriate patient and family education are critical to the successful management of atopic dermatitis in pediatric patients.

Economic and Humanistic Burden in Paediatric Patients with Atopic Dermatitis.

Data concerning the economic and humanistic burden in patients with paediatric atopic dermatitis (AD) and their families are scarce. This retrospective study investigated these burdens in paediatric patients with AD using maintenance treatment with topical corticosteroids and/or conventional systemic immunosuppressants. Patient-reported outcomes regarding quality of life, AD severity, and parental work-related impairment were completed at inclusion. Data on healthcare resource utilization and medication prescription were collected retrospectively over the previous 12 months. Patients were categorized into mild, moderate or severe AD, based on Eczema Area and Severity Index score and medication use. Costs per patient per year per AD severity category were calculated. A total of 101 patients (median age 11.0 years (interquartile range 7.5-14.0), 47.5% men) were included, of whom 38 had mild AD, 37 moderate AD, and 26 severe AD. Mean ± standard deviation (SD) total costs patient per year for mild, moderate and severe AD were €1,812 ± €1,280, €2,680 ± €3,127, and €5,861 ± €3,993, respectively. Highest total direct and indirect costs were found in patients with severe AD, mainly due to higher healthcare and medication costs. Highest humanistic burden was found in patients with moderate AD. For example, the median (interquartile range) Patient-Oriented Eczema Measure score was significantly higher in these patients compared with mild and severe AD (19.0 (15.0-24.0) vs 12.0 (8.8-15.0) and 17.0 (9.5-22.0), respectively). AD in paediatric patients incurs considerable direct and indirect costs, especially in patients with severe AD. The high humanistic burden in patients with moderate AD underlines the need for effective and safe new treatment options for children with AD.

Sleep Disturbances in Children With Atopic Dermatitis: A Scoping Review.

Atopic dermatitis (AD) is associated with various quality of life concerns including poor sleep. Sleep impairments in children with AD are associated with increased risk of short stature, metabolic syndrome, mental illness and neurocognitive dysfunction. Although the association between AD and sleep disturbance is well established, the specific types of sleep disturbance in pediatric AD patients and their underlying mechanisms are not fully understood. A scoping literature review was performed to characterize and summarize the types of sleep disturbance in children (less than 18 years of age) with AD. 31 papers met inclusion criteria and extracted data were analyzed in an iterative manner. Two types of sleep disturbances were found to be more prevalent in pediatric AD patients in comparison to controls. One category was related to loss of sleep (increased frequency or duration of awakenings, increased sleep fragmentation, delayed sleep onset, decreased total sleep duration, and decreased sleep efficiency). Another category was associated with unusual behaviors during sleep (restlessness/limb movement/scratching, sleep-disordered breathing including obstructive sleep apnea and snoring, nightmares, nocturnal enuresis and nocturnal hyperhidrosis). Some mechanisms underlying these sleep disturbances include pruritus and induced scratching and increased proinflammatory markers induced by sleep loss. Sleep disturbance appears to be associated with AD. We recommend clinicians to consider interventions that may reduce sleep disturbances in children with AD. Further investigation of these sleep disturbances is needed to elucidate pathophysiology, develop additional treatments, and reduce negative impacts on the health outcomes and quality of life in pediatric AD patients.

Atopic dermatitis in pediatric patients in Saudi Arabia: a systematic review

There has been a dramatic rise in the prevalence of atopic diseases in both developed and developing countries, especially children. Atopic dermatitis (AD), a specific form of eczema, is the most common chronic inflammatory skin disease. AD has significant morbidity, and the prevalence of the disorder has been increasing over the past few decades. This study was aimed at reviewing in detail AD in pediatric patients in Saudi Arabia. PubMed, Web of Science, Science Direct, Elton B Stephens Company, and Cochrane library were searched. Study articles were screened by title and abstract using Rayyan Qatar Computing Research Institute then a full-text assessment was implemented. A total of 14 studies including both sexes and 0-18 years of age patients diagnosed with AD were included in this review; more than half were males. We estimated a widely ranging prevalence around the different districts of Saudi Arabia, which may be explained by the marked variations in topographical, meteorological, and climatic conditions. Distribution of allergens may vary with different geographic areas, local climates, environments, and lifestyles; critical regional variations in allergic disease prevalence can be observed. Also, we estimated an increasing prevalence of AD among children in Saudi Arabia with elevating stress levels of both the patients and the parents and a significant effect on their quality of life.

A Cross-Sectional Study Comparing Application of Hanifin and Rajka Criteria in Indian Pediatric Atopic Dermatitis Patients to that of Other Countries.

Hanifin and Rajka criteria are considered to be the gold standard for atopic dermatitis diagnosis. However, the exhaustive nature limits its use in clinical settings. To determine the frequency of Hanifin and Rajka criteria commonly found in Indian pediatric atopic dermatitis patients and variation from the findings of other studies. An observational, descriptive study with a sample size of 52 pediatric atopic dermatitis patients. Patients were divided into infantile, childhood, and adolescent. Overall, xerosis, early age of onset, Dennie-Morgan fold, aggravation because of environmental factors, palmar hyper-linearity, ichthyosis vulgaris, keratosis pilaris, pityriasis alba, and orbital darkening were found in more than 50% of patients. Dennie-Morgan fold was more commonly found in Indian pediatric atopic dermatitis patients. Peri-follicular accentuation was less prevalent in Indian patients as compared to other Asian studies. None of the parents reported food intolerance, which was seen in studies from other countries. A small sample size and ophthalmological evaluation was not performed in all patients. The frequency of different Hanifin and Rajka minor criteria varies widely among different study populations. Hence, the criteria specifically applicable to the Indian population need to be derived for ease of diagnosis.

Dupilumab in daily practice for the treatment of pediatric atopic dermatitis: 28-week clinical and biomarker results from the BioDay registry.

Dupilumab has proven to be an effective and safe treatment for atopic dermatitis (AD) in pediatric patients in clinical trials. However, few daily practice studies are available. The aim of this study is to evaluate the effect of 28 weeks dupilumab treatment on effectiveness, safety, and serum biomarkers in pediatric patients with moderate-to-severe AD in daily practice. Patients visited the outpatient clinic at baseline, 4, 16, and 28 weeks of treatment. Disease severity was assessed by the Eczema Area and Severity Index (EASI), Investigator Global Assessment (IGA), Numeric Rating Scale (NRS)-pruritus and -pain, and the Patient-Oriented Eczema Measure (POEM). Side effects were evaluated. Nineteen severity-associated serum biomarkers were measured. Predicted-EASI (p-EASI) was calculated. Sixty-one patients were included. Respectively 75.4%, 49.2%, and 24.6% reached EASI-50, EASI-75, and EASI-90 and 36.1% achieved an IGA-score (almost) clear. Improvement of ≥4 points on POEM, NRS-pruritus, and NRS-pain was reached by 84.7%, 45.3%, and 77.4%, respectively. Most reported side effects were conjunctivitis (n= 10) and headache (n= 4). Biomarkers TARC, PARC, periostin, sIL-2Ra, and eotaxin-3 significantly decreased during treatment. The p-EASI showed a significant correlation with disease severity. Dupilumab treatment significantly improved disease severity and disease-associated symptoms and decreased severity-associated serum biomarkers in pediatric AD patients in daily practice.

Prevalence of Type 2 Inflammatory Diseases in Pediatric Patients With Atopic Dermatitis: Real-world Evidence

To analyze the prevalence and incidence of type 2 inflammatory disease in pediatric patients with atopic dermatitis (AD) compared with a similar population of patients without AD, utilizing a large United States commercially insured database.The study included 244 776 pediatric AD patients matched 1:1 with non-AD patients from the IBM MarketScan Commercial Database from 2013 to 2017. This US database included representation from a variety of commercial insurance plan types throughout the country with 44% of patients from the South.This was a retrospective study conducted over a 12-month period that used a commercial database of select the patient populations. This database included diagnostic codes entered by clinicians for billing from a variety of providers, including primary care (pediatricians and family practitioners), subspecialists (allergy and dermatology), and emergency department or urgent care clinicians. Date of AD diagnosis was used for patients with AD and a random date for non-AD patients with required insurance 6 months prior and 12 months after date. AD patients were defined as <18 years with ICD 9 code (691.8) or ICD 10 code (L20×) and matched controls had no diagnosis of AD for the entirety of the study. Severity of disease was divided into 3 levels based on treatment. Level 1 included low potency topical steroids (class 5–7) or calcineurin inhibitors, level 2 included mid potency topical steroids or calcineurin inhibitors, and level 3 includes systemic steroids, phototherapy, immunosuppressants, or intravenous immunoglobulin. The prevalence of type 2 diseases including asthma, allergic conjunctivitis, chronic rhinosinusitis, nasal polyps, eosinophilic esophagitis, allergic rhinitis and urticaria was evaluated in 2 comparison groups: severity of disease (level 3 AD versus level 1 and 2) and presence or absence of AD. Furthermore, food allergy was omitted from the evaluation as it was felt it was poorly defined and without standardization. Logistic regression models were used for statistical comparison. Kaplan-Meier curves were used to show time to development of type 2 disease. Hazard ratios using a Cox proportional hazard model were reported for the risk of type 2 disease in AD versus non-AD patients.In this population database, patients who had AD at time of diagnosis (index) were more likely to develop type 2 inflammatory disease compared with patients without AD (odds ratio [OR] of 2.17, [2.15–2.20], P < .001). Asthma, eosinophilic esophagitis, urticaria and rhinitis were among conditions that were twice as likely diagnosed in AD patients. Chronic rhinosinusitis and nasal polyps had a slightly higher likelihood in AD patients (OR 1.10, [1.06–1.13]; P < .001). Patient with level 3 severity had 4 times the likelihood of asthma (OR 4.43, [4.32–4.54]; P < .001). Infants with AD demonstrate a higher risk for development of type 2 disease, with a hazard ratio of 1.47 (1.45–1.50) compared with non-AD patients. Based on the Kaplan-Meier curves, patients with AD had a 51.7% probability of developing type 2 inflammatory disease compared with non-AD patients who had a 38.9% probability.The relative prevalence of type 2 inflammatory disease was higher in pediatric patients with AD in a very large insurance-based database. In addition, the risk of developing type 2 inflammatory disease was higher in infants with AD over a 1-year period. Severity of AD was found to increase both the prevalence and risk.This study used a large national insurance database to examine the prevalence and incidence of type 2 inflammatory diseases (asthma, rhinitis, conjunctivitis, urticaria, eosinophilic esophagitis, and chronic rhinosinusitis or nasal polyps) in pediatric patients with AD. Authors analyzed an impressive cohort size and found a statistically significant higher incidence and prevalence of other allergic diseases within pediatric AD. There were a few limitations to further consider. First, authors were unable to quantify food allergy in this cohort due to concerns of nonstandardization of food allergy diagnostic criteria and associated codes. Though quantifying food allergy was a challenge, perhaps adding epinephrine prescription or food anaphylaxis may have been helpful. Secondly, the scoring of AD severity was based upon treatment regimens which, consequently, grouped all ages into 1 cohort. Patients on a high potency topical steroid were all considered level 2 (on a 1 to 3 scale), whereas in many cases an infant or toddler receiving this treatment would be considered severe. In addition, it was difficult to know if eczema was indeed the indication for the prescriptions. For example, in patients considered severe or level 3, treatments such as systemic steroids may have been given for asthma exacerbation and immunoglobulin replacement may have been used to treat an underlying immunodeficiency. Finally, extending the 1-year observation period would have provided a more complete evaluation of the incidence of other atopic conditions in infants and toddlers less than 2 years of age. This retrospective study added to work establishing an increased burden of type 2 inflammatory diseases found in patients with AD.URL: www.pediatrics.org/cgi/doi/10.1542/peds.10.1016/j.jaad.2021.10.038

A NOVEL EFFICIENT APPROACH TO ASSESSING ATOPIC DERMATITIS DISEASE SEVERITY: VIGAXBSA COMPARED TO EASI

<h3>Introduction</h3> Disease severity assessment is essential in determining the course of care and treatment for Atopic Dermatitis (AD). The Eczema Area Severity Index (EASI) is an extensive evaluation assessing the body for various eczematous symptoms: lichenification, erythema, edema/papulation, and excoriation. While a standard evaluation in the clinic trial setting, EASI scoring is time intensive and not feasible for most clinic visits. We investigated the validated Investigator Global assessment (vIGA) multiplied by Body Surface Area (BSA) as a more rapid alternative to EASI to evaluate AD severity and disease extent. <h3>Methods</h3> 65 difficult-to-control pediatric AD patients were longitudinally followed in a Multidisciplinary AD Clinic from July 2019 to May 2022. At each visit the following evaluations were collected: vIGA, BSA, and EASI scores. Correlation between evaluation type was analyzed via Pearson's r correlation for each individual visit. <h3>Results</h3> EASI had the strongest correlation to vIGAxBSA (r=0.934, p<0.001) for each visit compared to BSA (r=0.924, p<0.001) and vIGA (r=0.793, p<0.001). vIGAxBSA had the weakest correlation (r=0.633, p=<0.001) to EASI scores for scores less than 7 (clear to mild), but had the strongest correlation (r=0.891, p<0.001) for EASI scores greater than 7 (moderate to severe). <h3>Conclusion</h3> Given the limited time in traditional clinic settings, EASI evaluations are not viable for every patient even though it is a more comprehensive measurement of disease severity. Correlation of EASI to vIGAxBSA was significant and stronger than vIGA or BSA alone, showing potential for vIGAxBSA as an alternative to quantitatively evaluate severity of AD in the clinic setting.

Intravenous immunoglobulin therapy in children with severe atopic dermatitis.

Children with severe atopic dermatitis (AD) can benefit from intravenous immunoglobulin (IVIG) therapy. This study aimed to identify the efficacy and safety of IVIG therapy in children with severe AD. Twenty pediatric AD patients were enrolled in this study. Patients with an Investigator's Global Assessment score of 0 or 1 or a reduction of 2 points after treatment were defined as high-responders (HRs), otherwise, they were defined as low-responders (LRs). Twelve patients (60%) achieved an excellent treatment response after 2months, while eight (40%) had a low response. The Scoring Atopic Dermatitis index had improved significantly at 2months post-treatment compared with baseline (p < 0.001). Baseline total serum IgE levels and eosinophil counts were elevated in all subjects and decreased significantly at 2months post-treatment (p=0.004 and 0.021, respectively). Baseline IgE levels were significantly higher in the HR group compared with the LR group (p=0.020). The treatment was well tolerated. Fever was the most common adverse event and occurred in five patients (25%). In conclusion, IVIG could be a safe and effective therapy for children with severe AD and may be more effective in patients with higher IgE levels. Further studies are needed to investigate the different therapeutic responses in patients with different AD phenotypes.

The effect of fatty acids, vitamins, and minerals on pediatric atopic dermatitis: A systematic review.

A body of research has examined the role of fatty acid (FA), vitamin, and mineral supplementation as adjunctive treatment for atopic dermatitis (AD); however, results are conflicting and concrete recommendations are lacking. The objective of this study is to highlight the role of these nutrients in alleviating AD severity and provide the clinician with consolidated information that can be used to make recommendations to the pediatric patient and caretaker, where this topic is of high interest. A review of the PubMed and Embase databases was conducted to identify and qualitatively analyze all randomized controlled trials, systematic reviews, and meta-analyses conducted within the last 21 years regarding use of these nutrients to alleviate symptoms of AD. Inclusion criteria include AD diagnosis, non-infant age groups, and AD severity outcomes; exclusion criteria include preventative studies, predominantly maternal or infant demographics, or nonclinical outcomes. Sixty-nine studies were included. Evidence regarding FA supplementation is inconclusive; however, targeting an ideal omega-3:omega-6 FA ratio may play a small role in alleviating AD symptoms. Studies results regarding vitamin/mineral supplementation are inconsistent and supplementation should not be advised unless the patient has a documented deficiency. Pediatric AD patients should lead a healthy lifestyle with an emphasis on consumption of wholesome foods. Nutritional supplementation can play a role in improving AD symptoms; however, this should be evaluated on a case-by-case basis. Limitations include heterogeneity of studies.

Plasma Exosomes from Children with Atopic Dermatitis May Promote Apoptosis of Keratinocytes and Secretion of Inflammatory Factors in vitro.

PurposeExosomes are important regulators of keratinocytes (KCs) that have been implicated in a variety of skin disorders. The effect of circulatory exosomes on KCs in pediatric atopic dermatitis (AD) has not been well studied. This study aims to explore the effect of plasma exosomes on KC activation, apoptosis and inflammation in pediatric AD patients.Patients and MethodsExosomes were extracted from plasma collected from 20 pediatric AD patients and 20 age-matched healthy controls. AD-exosomes were added with KCs at concentrations of 0 g/L, 10 g/L, 20 g/L and 30 g/L. Proliferation of KCs in each group was measured using Ki67 staining flow cytometry. Apoptosis was measured using Annexin V-FITC/PI double staining flow cytometry. KCs were divided into three groups according to the source of the exosomes they were cultured with: patients with AD, healthy controls and blank controls. Q-PCR was used to detect the activation (K6) and differentiation (K10) of cells, as well as inflammatory indicators (thymic stromal lymphopoietin (TSLP) and IL-33).ResultsThe proliferation rate of KCs treated with 20 g/L exosomes from AD patients was significantly lower than that of other groups, while the apoptosis rate was significantly increased. Additionally, expression levels of K6, K10, TSLP and IL-33 were all up-regulated compared to keratinocytes treated with exosomes from healthy controls.ConclusionExosomes from the peripheral blood of pediatric AD patients can regulate the activation, apoptosis and inflammatory cytokine secretion of KCs in vivo, which may participate in the pathogenesis of AD.

Efficacy and safety of dupilumab in pediatric patients with moderate to severe atopic dermatitis: a real-world study.

Dupilumab is the first human monoclonal antibody that treats atopic dermatitis (AD) by blocking interleukin 4 (IL-4) and interleukin 13 (IL-13), which can suppress the Th2 inflammatory reaction. Effective treatments for pediatric AD patients are limited; therefore, we aimed to assess the efficacy and safety of dupilumab in pediatric AD patients. Fifteen pediatric patients diagnosed with moderate to severe AD and treated with dupilumab were enrolled in this study. SPSS was used to analyze data and obtain the average values of Eczema Area and Severity Index (EASI), SCORing AD (SCORAD), and Children's Dermatology Life Quality Index (CDLQI). GRAPHPAD was used to analyze and plot the statistics. The average EASI values were 19.23 ± 3.03 and 1.69 ± 0.54 at baseline and at following up for 6months after standardized treatment protocol, respectively. The average SCORAD values were 43.27 ± 4.63 and 6.13 ± 1.41 at baseline and at following up for 6months after standardized treatment protocol, respectively. The average CDLQI value at baseline was 13.53 ± 2.88 and following up for 6months after standardized treatment protocol was 1.60 ± 0.63. The most frequent adverse event was conjunctivitis. No serious adverse events occurred during the treatment period. Dupilumab could reduce symptoms and improve pruritus in pediatric AD patients, and the frequent adverse events were reversible. It has a definite therapeutic effect on AD; nevertheless, further studies should be conducted to obtain information on its the long-term efficacy and safety.