Severity Of Atopic Dermatitis In Children Research Articles

Effectiveness of Vitamin D Supplementation in Reducing Atopic Dermatitis Severity in Children: A Meta-Analysis

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that commonly affects children, with increasing prevalence worldwide. Vitamin D has demonstrated immunomodulatory effects, suggesting a potential role in AD management. This meta-analysis aimed to evaluate the effectiveness of vitamin D supplementation in reducing AD severity in children. Methods: A systematic search of PubMed, Science Direct, and Cochrane databases was conducted for randomized controlled trials (RCTs) published between 2012 and 2024, investigating the effects of vitamin D supplementation on AD in children. The primary outcome was the change in SCORAD (SCORing Atopic Dermatitis) or EASI (Eczema Area and Severity Index) scores. Meta-analysis was performed using Review Manager (RevMan 5.4) software. Results: Four RCTs met the inclusion criteria, comprising a total of 234 participants. The meta-analysis revealed a significant reduction in SCORAD scores (-2.83; 95% CI: -4.9, -0.76) and EASI scores (-0.41; 95% CI: -0.70, -0.13) in the vitamin D supplementation groups compared to the control groups. A combined analysis of both scoring systems further confirmed the overall significant effect of vitamin D in reducing AD severity (-1.57; 95% CI: -2.78, -0.36). Conclusion: Vitamin D supplementation is effective in improving AD symptoms in children. Further large-scale RCTs are warranted to determine the optimal dosage and duration of vitamin D supplementation for AD management in children.

Vitamin D Supplementation for Treating Atopic Dermatitis in Children and Adults: A Systematic Review and Meta-Analysis.

Atopic dermatitis (AD) is a chronic inflammatory skin disease affecting up to 20% of children and 10% of adults worldwide. Current research suggests a correlation between serum vitamin D level and AD severity and that vitamin D supplementation could have a potential therapeutic effect on AD. To conduct a systematic review and meta-analysis of studies of vitamin D supplementation for disease improvement in children and adults with AD. PubMed, EMBASE, and Cochrane were searched from 19 April to 20 April 2024. We included randomized controlled trials (RCTs) of patients with AD comparing an intervention group with a control group. The risk of bias of the selected studies was assessed using the Cochrane risk-of-bias tool for randomized trials. All analyses were conducted in R (v4.1.2; R Core Team 2021). Eleven RCTs with 686 participants were included. The included trials had measured AD severity by using the SCOring Atopic Dermatitis (SCORAD) or the Eczema Area and Severity Index (EASI). Vitamin D supplementation significantly reduced AD severity compared with the control group (standardized mean difference = -0.41, 95% CI: -0.67 to -0.16, I2 = 58%, p < 0.01). Vitamin D supplementation reduces AD severity in children and adults. Larger-scale and longer-term studies are still needed to confirm this conclusion. This study has been registered on PROSPERO (CRD42024535014).

MicroRNA-155 is a potential predictive tool for atopic dermatitis severity in children: A preliminary study

MicroRNA-155 is a potential predictive tool for atopic dermatitis severity in children: A preliminary study

Association Between Increased Body Mass Index (BMI) and Atopic Dermatitis in Children Attending a Tertiary Referral Center: A Case-Control Study.

Background Atopic dermatitis (AD) and obesity represent chronic diseases, with growing worldwideprevalence, that rely on a common pathophysiological background: perpetual inflammation. Moreover, AD is considered more and more to be a beyond-the-skin disease with various associated comorbidities. This study aimed to investigate a potential link between overweight/obese status and AD in children. Methods A case-control study was performed on 130 AD patients and 130 exact age and sex match controls that attended the Pediatric Dermatology Department of Colentina Clinical Hospital. Based on the weight (in kilograms) and height (in centimeters), the body mass index (BMI), and the corresponding age and gender percentiles were assessed in both groups; study participants were divided as normal-weight, underweight, overweight, or obese. AD severity was evaluated using the Scoring Atopic Dermatitis Index (SCORAD), and quality of life impairment was assessed with the Dermatology Life Quality Index (DLQI).Descriptive statistics, t-tests, and logistic regression with odds ratios (OR) and associated 95% confidence intervals (CI) were used for data analysis. Results A statistically significantly higher BMI was identified in the AD group compared to controls (p=0.027). The relative risk for overweight/obese status in the AD group compared to controls was three times more frequent (OR 3.61, 95% CI 1.45-10.3, p<0.01). Additionally, the increased BMI in the AD group correlated significantly with disease severity as determined by SCORAD (p<0.05), with a relative risk for overweight/obese status in the moderate-severe AD subgroup being 20 times more frequent as compared to mild AD (OR 20.4, 95% CI 6.53-90.7, p<0.001). Conclusions To our knowledge, this is the first study to evaluate the correlation between AD and BMI in Romanian children. Statistically significant correlations between increased BMI, AD development, and AD severity in children were identified in our study population. This study's small sample size and single-center study design represent possible limitations. Additional, larger, multicentric studies are required to establish a more precise correlation between AD and obesity. Physicians should be aware of this potential association in order to perform obesity screening in AD children for more appropriate multidisciplinary management of such patients.

Correlation between immunoglobulin index level and disease severity and clinical manifestations in children with atopic dermatitis as a chronic inflammatory.

It was to analyze the clinical characteristics of atopic dermatitis (AD) in children and its relationship with immunoglobulin (IgG, IgA, IgM, IgE) levels. 400 children with AD in the dermatology clinic of Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital(SCMC-FMU) were the study subjects, and 200 normal children were enrolled as the blank control. The clinical data of the included children were collected, and the serum immunoglobulin levels and other related indicators were measured. The results showed that the IgE level was higher observably in group A when we compared it with group A0, the IgE level was much higher in group B in comparison to group B0, group C showed higher IgE level C than in group C0, and it was the same case in groups D and D0(P < 0.05). The IgM level was decreased greatly in group C than that in normal children in group C0 (P < 0.05), but showed no visible difference among other groups (P > 0.05). The O-SCORAD scores of groups A, B, C, and D were significantly positively correlated with IgE level (P < 0.05). No great correlation was observed between skin dryness and IgE-specific allergen, IgG, IgA, IgM, and IgE levels in groups A - D (P > 0.05). Immunoglobulin deficiency was present in AD children compared with normal children, and IgE could be used as an efficient indicator to assess the severity of AD in children.

Evaluation of the Impact of Serum Vitamin D Levels on the Scoring Atopic Dermatitis Index in Pediatric Atopic Dermatitis.

Atopic dermatitis (AD) is a chronic and recurrent inflammatory skin condition characterized by itching, eczematous plaques, and dry skin. Despite ongoing research, its exact cause remains elusive. In this study, we aimed to explore the factors that influence the severity of AD in children and assess the relationship between serum vitamin D levels and the disease's severity. We enrolled 96 AD patients in our investigation, evaluated their clinical condition using the Scoring Atopic Dermatitis (SCORAD) index, and compared them to a group of 90 healthy controls. Our analysis revealed that serum vitamin D levels and eosinophil counts significantly impacted the SCORAD index (p < 0.001). According to standardized regression coefficients, for each incremental unit in serum vitamin D levels, the SCORAD index exhibited a decrease of 0.449 units. Similarly, a one-unit increase in eosinophil count resulted in a 0.009 unit increase in the SCORAD index. It is worth noting that the influence of serum vitamin D levels on disease severity surpasses that of eosinophil counts and atopic conditions. In our patient cohort, we uncovered a negative correlation (r = -0.419, p < 0.001) between serum vitamin D levels and the SCORAD index. Our findings suggest that low serum vitamin D levels may have a more substantial impact on AD severity than atopic conditions and eosinophilia. Furthermore, we observed a negative association between the severity of AD and serum 25(OH)D3 levels.

Single-Strain Probiotic Lactobacilli for the Treatment of Atopic Dermatitis in Children: A Systematic Review and Meta-Analysis.

Probiotics are known for their positive effects on the gut microbiota. There is growing evidence that the infant gut and skin colonization have a role in the development of the immune system, which may be helpful in the prevention and treatment of atopic dermatitis. This systematic review focused on evaluating the effect of single-strain probiotic lactobacilli consumption on treating children's atopic dermatitis. Seventeen randomized placebo-controlled trials with the primary outcome of the Scoring Atopic Dermatitis (SCORAD) index were included in the systematic review. Clinical trials using single-strain lactobacilli were included. The search was conducted until October 2022 using PubMed, ScienceDirect, Web of Science, Cochrane library and manual searches. The Joanna Briggs Institute appraisal tool was used to assess the quality of the included studies. Meta-analyses and sub meta-analyses were performed using Cochrane Collaboration methodology. Due to different methods of reporting the SCORAD index, only 14 clinical trials with 1124 children were included in the meta-analysis (574 in the single-strain probiotic lactobacilli group and 550 in the placebo group) and showed that single-strain probiotic lactobacilli statistically significantly reduced the SCORAD index compared to the placebo in children with atopic dermatitis (mean difference [MD]: -4.50; 95% confidence interval [CI]: -7.50 to -1.49; Z = 2.93; p = 0.003; heterogeneity I2 = 90%). The subgroup meta-analysis showed that strains of Limosilactobacillus fermentum were significantly more effective than strains of Lactiplantibacillus plantarum, Lacticaseibacillus paracasei or Lacticaseibacillus rhamnosus. A longer treatment time and younger treatment age statistically significantly reduced symptoms of atopic dermatitis. The result of this systematic review and meta-analysis shows that certain single-strain probiotic lactobacilli are more successful than others in reducing atopic dermatitis severity in children. Therefore, careful consideration to strain selection, treatment time and the age of the treated patients are important factors in enhancing the effectiveness of reducing atopic dermatitis in children when choosing probiotic single-strain lactobacilli.

Study of the effect of using a foam form with ceramides and a cholesterol-phytosterol complex in patients with atopic dermatitis

Background. In developed countries more than 20% of children have atopic dermatitis (AD). Clinical guidelines unite in the recommendation to use moisturizers/emollients as therapy mainstay. Deeper understanding of AD pathogenesis stimulates development of new, therapeutic moisturizers. To such moisturizers belong ceramide-containing moisturizers, in particular foam for moisturizing and nourishing dry sensitive skin with ceramides and a cholesterol-phytosterol complex. Aim. To study effects of foam for moisturizing and nourishing dry sensitive skin with ceramides and a cholesterol-phytosterol complex on the course mild to moderate severity AD. Materials and methods. In this prospective cohort study 30 children 3 to 17 years of age with mild to moderate severity AD were enrolled. They applied moisturizing foam skin lesion, surrounding skin and dry skin areas for 4 weeks. For all participants severity of AD was scored with SOCARD, EASI, IGA, skin pH, moisture and transepidermal water loss (TEWL) were measured and severity of itching and xerosis was elicited with visual analogue scale. Results. Severity of AD in children who applied foam decreased on 22.8 score points with SCORAD, and on 3.1 points with EASI (for both indices p0.001). Skin moisture during treatment period increased (23.5% to baseline; p0.001), and TEWL decreased (for 5.45 g/hm2; p0.001); skin pH decreased 0.2 unit to normal values (р=0.002). It was found that skin moisture and TEWL correlate with AD severity so that less severe AD associated with moisture increase and TEWL decrease. As good and excellent rated foam smell 100% (95% CI 88.4100%) respondents, consistence 90% (95% CI 73.598.0%), and ease of use 97% (95% CI 82.899.9%) respondents. Conclusion. Moisturizing foam with ceramides and a cholesterol-phytosterol complex might be used in AD therapy.

Clinical Characteristics of Atopic Dermatitis in Korean School-Aged Children and Adolescents According to Onset Age and Severity

BackgroundAtopic dermatitis (AD) is a heterogeneous disease with different age of onset, disease course, clinical symptoms, severity, and risk of comorbidity. The characteristics of children with AD also vary by age or country. However, little is known about the clinical characteristics of AD in Korean school-aged children and adolescents. Furthermore, there are few studies on phenotypic differences according to onset age. This study aimed to explore the clinical characteristics and phenotypes according to onset age and severity of AD in children and adolescents in Korea.MethodsAD patients aged 6–18 years who presented to 18 hospitals nationwide were surveyed. The patients were examined for disease severity by pediatric allergy specialists, and data on history of other allergic diseases, familial allergy history, onset age, trigger factors, lesion sites, treatment history and quality of life were collected. The results of the patient’s allergy test were also analyzed. The patients were classified into infancy-onset (< 2 years of age), preschool-onset (2–5 years of age), and childhood-onset (≥ 6 years of age) groups. Study population was analyzed for clinical features according to onset-age groups and severity groups.ResultsA total of 258 patients with a mean age of 10.62 ± 3.18 years were included in the study. Infancy-onset group accounted for about 60% of all patients and presented significantly more other allergic diseases, such as allergic rhinitis and asthma (P = 0.002 and P = 0.001, respectively). Food allergy symptoms and diagnoses were highly relevant to both earlier onset and more severe group. Inhalant allergen sensitization was significantly associated with both infancy-onset group and severe group (P = 0.012 and P = 0.024, respectively). A family history of food allergies was significantly associated with infancy-onset group (P = 0.036). Severe group was significantly associated with a family history of AD, especially a paternal history of AD (P = 0.048 and P = 0.004, respectively). Facial (periorbital, ear, and cheek) lesions, periauricular fissures, hand/foot eczema, and xerosis were associated with infancy-onset group. The earlier the onset of AD, the poorer the quality of life (P = 0.038). Systemic immunosuppressants were used in only 9.6% of the patients in the severe group.ConclusionThis study analyzed the clinical features of AD in Korean children and adolescents through a multicenter nationwide study and demonstrated the phenotypic differences according to onset age and severity. Considering the findings that the early-onset group is more severe and accompanied by more systemic allergic diseases, early management should be emphasized in young children and infants.

Improvement in Disease Severity and Pruritus Outcomes With Crisaborole Ointment, 2%, by Baseline Atopic Dermatitis Severity in Children and Adolescents With Mild-to-Moderate Atopic Dermatitis

To assess improvement of mild-to-moderate atopic dermatitis (AD) disease severity and pruritus with the use of crisaborole ointment 2%.In the study, the researchers included pediatric patients aged ≥2 years with mild-to-moderate AD from 2 phase 3 studies. The severity of AD was determined by Investigator’s Static Global Assessment (ISGA) score.Patients were randomly assigned 2:1 to receive either crisaborole or vehicle twice daily applied to affected areas (excluding the scalp) for 28 days in 2 identically designed, multicenter, double-blinded, vehicle-controlled phase 3 study. The ISGA outcomes included the number of patients and time to reaching an ISGA score of clear (0) or almost clear (1) with ≥2-grade improvement from the baseline. Moreover, on study days 8, 15, 22, and 29, investigators evaluated the share of patients achieving ISGA clear or almost clear and/or ≥1-grade improvement in ISGA. The Severity of Pruritus Scale (SPS) outcomes included the number of patients who reach SPS success. SPS success was defined as SPS score ≤ 1with ≥ 1-grade improvement from baseline and the time to reach that success. Furthermore, at weeks 1, 2, 3, and 4, the proportion of patients attaining a ≥1-grade improvement in SPS score from the baseline were stratified. An electronic diary was used by patients or caregivers to evaluate SPS twice daily through day 29. If there were <2 SPS assessment entries on day 1 for a patient, they were excluded from the data set.Of the 1016 patients enrolled, 874 (86%) were pediatric ages 2 to 17 years and included in this post hoc subanalysis. Demographics and baseline disease characteristics were similar between both study arms. Irrespective of the baseline disease severity, a significantly greater proportion of crisaborole-treated patients reached ISGA success on day 8, when compared with vehicle-treated patients. This significant difference continued to be true for those patients with moderate baseline ISGA until day 29. However, after day 8, those with a mild baseline ISGA did not have a significant ISGA difference until day 22. Throughout the study, a significantly larger number of the crisaborole-treated arm reached ISGA clear or almost clear compared with the vehicle-treated arm in both baseline disease severity subgroups. Similarly, in both disease severity groups, crisaborole-treated patients achieved a ≥1-grade improvement in ISGA, compared with that of vehicle-treated patients. SPS outcomes also revealed significant improvement in the crisaborole-treated arm, compared with that of the vehicle-treated arm, on day 8. These SPS outcomes persisted again for the moderate baseline ISGA subgroups through the end of the study. Furthermore, crisaborole-treated patients of both subgroups achieved a ≥1-point SPS score improvement in a significantly shorter median time than vehicle-treated patients did.Pediatric patients with mild-to-moderate baseline AD saw an improvement in ISGA and SPS outcomes with the use of crisaborole.With this study, the authors continue to prove crisaborole as a suitable choice as a nonsteroid management option for mild-to-moderate AD. Naturally, independent studies in which researchers comparing crisaborole to corticosteroid standard of care options as well as time to reoccurrence of flares would be of value.

What plays a role in the severity of atopic dermatitis in children?

Background/aim Determining the characteristics and risk factors of severe disease is extremely important to combat atopic dermatitis (AD), which has recently shown increasing prevalence. In this study, we aimed to investigate the clinical characteristics of pediatric patients with AD and identifying the factors associated with the severity of the disease.Materials and methods A total of 304 pediatric patients diagnosed with atopic dermatitis were included in the study. The patients’ age at admission, age at onset of symptoms, the presence of atopy history in their family, eosinophil levels obtained from blood counts were recorded, together with the data of cigarette exposure, and area of residence. Disease severity was determined according to the SCORAD index. Epidermal prick tests (EPT) were applied to all patients.Results There was a negative correlation between the SCORAD score and both age at admission (r = 0.277, p < 0.001) and age at onset of the symptoms (r = –0.474, p < 0.001). Food sensitization rates were higher in individuals with moderate-severe disease (90.7% vs. 23.1%; p < 0.001) and patients with food allergy (FA) had significantly higher SCORAD scores [33 (IQR: 22–44) vs. 14 (IQR: 12–16); p < 0.001]. SCORAD scores of the individuals living in rural areas were higher than the ones living in urban [22 (IQR: 15–39.5) vs. 15 (IQR: 12–22); p < 0.001]. Familial atopy history was more common in patients with moderate-severe disease (66.5% vs. 17.5%; p < 0.001). The SCORAD scores were higher in patients exposed to passive smoking [21 (IQR:14.75–38) vs. 13 (IQR: 12–16); p < 0.001]. The eosinophil count found to be positively correlated with SCORAD scores (r = 0.531, p < 0.001).Conclusion Our findings show that early-onset, food sensitivity, living in rural areas, having familial atopy history and passive cigarette smoke exposure play a role in severe AD. Since it is remarkably correlated with SCORAD scores, eosinophil count can be used as a marker to assess the severity of AD in children.

9.6 Can Psychological and Educational Interventions Reduce Atopic Dermatitis Severity in Children?

9.6 Can Psychological and Educational Interventions Reduce Atopic Dermatitis Severity in Children?

1

1

Relationship of Substance P with the Degree of Atopic Dermatitis Severity.

IntroductionAtopic dermatitis (AD) is a chronic inflammatory skin disease that starts during childhood with a varied course. Itching or incessant itching in severe cases, sleep disturbance, and infection-prone skin are the typical symptoms of this disease. Substance P is postulated to have an important role in AD. Increasing levels of substance P in AD induce the release of IFN-γ, IL-4, tumor necrosis factor-α (TNF-α), and IL-10 from peripheral blood mononuclear leukocytes, inducing an itching response.MethodsThis study is a cross-sectional study that aims to analyze the relationship between serum substance P levels and AD severity in children using Score of AD (SCORAD), and to determine the mean serum substance P levels and severity of AD in patients with AD. This study also aims to find out the correlation of substance P levels with the SCORAD values.ResultsForty-six children (29 males; 17 females) with a mean age of 10.35 years (standard deviation (SD) = 4.01) were diagnosed with AD. The SCORAD index assessment was conducted to analyze AD (mean value, 23.15; SD = 9.42), and mild AD obtained the highest degree. The level of substance P was also examined (mean value, 300.88; SD = 127.55).DiscussionThis study did not find a significant relationship between substance P levels and AD severity (p-value = 0.880), and there was no significant correlation between substance P levels and SCORAD values (p-value = 0.233; r = −0.179). The limitations of this study include a small number of cases, no control group, and we only found two cases of severe AD. To generalize the results, further studies with wide range population and AD severity might be done in the future.

Correlation of low vitamin D status with atopic dermatitis severity in children

Introduction: Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disorder. Vitamin D has some roles in immunologic mechanisms. Vitamin D may influence the severity of AD. Previous studies of vitamin D correlation in children with atopic dermatitis have revealed conflicting results. This study determines the correlation between low vitamin D status with the severity of atopic dermatitis in children. Methods: This is a cross-sectional analytical study with a cross-sectional approach that involved DA subjects aged ≤17 years with low vitamin D status. The recording of basics data and examination of subjects included assessing the scoring atopic dermatitis (SCORAD) score and measuring 25-hydroxyvitamin D (25(OH)D) level for all subjects. Statistical analyses were performed using Pearson's correlation coefficients, with P&lt;0.05 was considered statistically significant. Result: A total of 30 subjects with AD with the most extensive distribution was in the age group of 11–17 years (53.33%), sex proportions were equal both male (50%) and female (50%), all subjects have an atopic family history (100%). The mean vitamin D level was 18,02 ± 4,56 ng/ ml (deficiency), and the mean SCORAD score was 20,03 ± 5,80 (mild). There was a significantly strong negative correlation between low serum vitamin D level and severity of AD in children (r = -0.666, p = 0.001). Conclusion: Lower vitamin D status is inversely associated with the severity of AD in children.Â

Improvement in disease severity and pruritus outcomes with crisaborole ointment, 2%, by baseline atopic dermatitis severity in children and adolescents with mild-to-moderate atopic dermatitis.

Background/ObjectivesCrisaborole ointment, 2%, is a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of mild‐to‐moderate atopic dermatitis (AD). This pooled post hoc analysis of two phase 3 trials (NCT02118766, NCT02118792) assessed improvement and time to improvement in Investigator's Static Global Assessment (ISGA) and Severity of Pruritus Scale (SPS) outcomes in pediatric patients with mild‐to‐moderate AD.MethodsPatients aged ≥2 years were randomly assigned 2:1 to receive twice‐daily crisaborole or vehicle for 28 days. Patients aged 2‐17 years were pooled for this analysis. Proportions of patients and time to achieving ISGA success (clear [0] or almost clear [1] with ≥2‐grade improvement from baseline), ISGA clear/almost clear, ≥1‐grade improvement in ISGA, SPS success (SPS score ≤1 with ≥1‐grade improvement), or ≥1‐grade improvement in SPS score were analyzed and stratified by baseline ISGA.ResultsAt first postbaseline assessment (day 8), significantly higher proportions of crisaborole‐ than vehicle‐treated patients achieved ISGA success, ISGA clear/almost clear, ≥1‐grade ISGA improvement, SPS success, or ≥1‐grade improvement in SPS regardless of baseline ISGA. Differences were significantly greater over time for all outcomes for patients with moderate baseline ISGA and numerically greater for those with mild baseline ISGA. Median times to ISGA and SPS outcomes were shorter for crisaborole versus vehicle.ConclusionImprovement in ISGA and SPS outcomes were observed with crisaborole in pediatric patients with mild‐to‐moderate baseline AD.

Product of Investigator Global Assessment and Body Surface Area (IGAxBSA): A practice-friendly alternative to the Eczema Area and Severity Index to assess atopic dermatitis severity in children

Accuratelydocumenting pediatric atopic dermatitis (AD) severity is important, but research tools, such as Eczema Area and Severity Index (EASI), are too time consuming for clinical settings. Product of the Physician Global Assessment and affected percentage of body surface area (PGA×BSA) is a new, rapid measure of psoriasis severity. To evaluate an Investigator Global Assessment and body surface area product (IGA×BSA) as an easy-to-use severity measure for pediatric AD. Patient-reported and objective disease severity measures were collected from 195 caretaker/child dyads (childage range, 5-17years) with almost clear (Validated Investigator Global Assessment for AD [vIGA] of 1) to severe (vIGA of 4) AD. Data were assessed with Spearman coefficients and plots. Severity strata were proposed by using an anchoring approach based on the EASI. IGA×BSA correlates better with the EASI than IGA alone (r=0.924 vs r=0.757, P<.001). Bland-Altman plot indicates high and consistent agreement between IGA×BSA and the EASI. Suggested severity strata for IGA×BSA are 0-30, mild; 30.1-130, moderate; and 130.1-400, severe (κ=0.760). The patient cohort was predominantly from the midwestern United States. IGA×BSA (using the vIGA) is a simple measure that correlates well with the EASI in patients with mild to severe pediatric AD. Future work is needed to affirm reliability across IGA scales and responsiveness to change.

Neutrophil-Lymphocyte Ratio and the Platelet Parameters as Biomarkers of Atopic Dermatitis Severity in Children

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease with a specific immune and inflammatory mechanism. This study investigates inflammatory biomarkers and their correlation with disease severity. Objectives: The aim of this study is to determine the relationship between platelet parameters [(mean platelet volume (MPV), platelet distribution width (PDW)], the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), and AD severity in children. Methods: In this retrospective study, we reviewed patients diagnosed with AD and a healthy control group at the department of pediatrics at Health Sciences in a university-affiliated hospital in Istanbul, Turkey, between January 2015 and December 2016. The study included 79 children with AD and 75 healthy controls. AD severity was graded using the Scoring Atopic Dermatitis (SCORAD) index. Complete blood count was measured, and NLR and PLR were calculated. NLR, PLR, MPV, PDW were compared between AD patients and healthy controls, and the correlations between these indexes and clinical characteristics were analyzed. Results: No significant difference was observed between patients and controls for MPV, NLR, and PLR (P = 0.708, P = 0.340, P = 0.179, respectively). In the AD group, PDW was lower than controls (17.39 ± 1.45, 18.04 ± 1.65, P = 0.006). In the severe AD group, MPV was higher (7.62 ± 1.81, 6.64 ± 1.16, P = 0.035) and PDW was lower than in the mild AD group (16.52 ± 1.49, 17.93 ± 1.44, P = 0.0001). Conclusions: Mean MPV and PDW levels are correlated with atopic dermatitis severity in children.

Nasal and skin microbiomes are associated with disease severity in paediatric atopic dermatitis.

Alterations of the skin microbiome have been associated with atopic dermatitis (AD) and its severity. The nasal microbiome in relation to AD severity is less well studied. We aimed to characterize the nasal and skin microbiomes in children with AD in relation to disease severity. In addition, we explored the differences and correlations between the nasal and skin communities. We characterized the microbial composition of 90 nasal and 108 lesional skin samples cross-sectionally from patients with AD, using 16S-rRNA sequencing. In addition, a quantitative polymerase chain reaction was performed for Staphylococcus aureus and Staphylococcus epidermidis on the skin samples, and AD severity was estimated using the self-administered Eczema Area and Severity Index. We found an association between the microbial composition and AD severity in both the nose and skin samples (R2 =2·6%; P=0·017 and R2 =7·0%; P=0·004), strongly driven by staphylococci. However, other species also contributed, such as Moraxella in the nose. Skin lesions were positive for S. aureus in 50% of the children, and the presence and the load of S. aureus were not associated with AD severity. Although the nose and skin harbour distinct microbial communities (n=48 paired samples; P < 0·001), we found that correlations exist between species in the nose and (other) species on the skin. Our results indicate that both the nasal and the skin microbiomes are associated with AD severity in children and that, next to staphylococci, other species contribute to this association.

A controlled crossover study to assess the role of dietary eliminations in reducing the severity of atopic dermatitis in children

Background: In the pathogenesis of atopic dermatitis (AD), immune sensitization to food-derived allergens has a role. However, the evidence of allergen sensitization is not a proof of clinically relevant allergy and it has to be confirmed by food challenges so that unnecessary food restrictions in growing children can be avoided. Aims and Objectives: This study was conducted to assess the clinical severity of AD in children after certain dietary modifications and to correlate absolute eosinophil count (AEC) with dietary modification. Materials and Methods: A total of thirty AD children were enrolled randomly into a trial period of egg and cow's milk exclusion diet or control period of egg and cow's milk inclusion diet of 3 weeks. At the end of 3 weeks, patients resumed their normal diet to minimize any carryover effect for next 3 weeks. In the last 3 weeks, the trial and the control groups were crossed over. Patients were assessed at baseline and at the end of each 3-week period using SCORing AD (SCORAD) index and AEC. The data were analyzed using paired t-test. Results: The mean SCORAD at the end of control and trial period was 18.3 and 14.3, respectively, with a mean difference of 3.4, which is statistically not significant (P = 0.165). The mean AEC at the end of control and trial period was 836.5 and 799.6, respectively, the reduction being statistically not significant. Conclusion: Our study could not confirm the beneficial effects of an allergen avoidance diet in AD. We propose that dietary elimination advices should be given only to patients with a definite history of food-induced exacerbations of the disease.