Atopic Dermatitis In Children Research Articles

Single Nucleotide Polymorphism of Dectin-1 Gene Associates with Atopic Dermatitis in Children

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disease with complex and multifactorial pathophysiology, involving elements of barrier dysfunction, alterations in cell-mediated immune responses, IgE sensitization, and environmental factors. This encourages the search for predictors of disease development among both genetic markers and environment. AIM: The aim of the study was to examine if genetic factors of Malassezia recognition, or Malassezia colonization may be related to IgE sensitization or to severity of AD. METHODS: The study included 106 patients with eczema and 103 healthy children. Specific IgE against Malassezia mix (m227) was analyzed in 51 patients using immunochemiluminescent method on the ImmunoCAP 100 (Thermo Fisher Scientific Inc., Phadia, Sweden). Genotyping for rs7309123 in Dectin-1 was performed using Real-time PCR. The level of colonization by Malassezia in the scale samples was determined by a real-time PCR assay. RESULTS: Increased IgE to Malassezia spp. was observed in 29,4% of children with eczema. Higher Malassezia spp. – specific IgE titer positively correlated with severity of AD, age of onset, head–neck type of AD, and a higher total IgE. GG genotype rs7309123 Dectin-1 is significantly more often found in the patients than in the control group, but no correlation with IgE sensitization to Malassezia was found. Malassezia restricta and M. globosa were predominant in patients and controls, with some predominance of M. globosa over M. restricta among patients. CONCLUSION: Sensitization to Malassezia, genetic markers in Dectin-1, and Malassezia colonization of the skin can be tools for studying the gene-environment interactions in the pathogenesis of AD.

Genetic Variants in Epidermal Differentiation Complex Genes as Predictive Biomarkers for Atopic Eczema, Allergic Sensitization, and Eczema-Associated Asthma in a 6-Year Follow-Up Case-Control Study in Children.

Atopic eczema is the most common chronic inflammatory skin disease of early childhood and is often the first manifestation of atopic march. Therefore, one challenge is to identify the risk factors associated with atopic eczema that may also be predictors of atopic disease progression. The aim of this study was to investigate the association of SNPs in hornerin (HRNR) and filaggrin-2 (FLG2) genes with childhood atopic eczema, as well as other atopic phenotypes. Genotyping for HRNR and FLG2 was performed in 188 children younger than 2 years of age, previously screened for the FLG null mutations, and followed at yearly intervals until the age of 6. We demonstrated that risk variants of HRNR rs877776[C] and FLG2 rs12568784[T] were associated with atopic eczema, allergic sensitization, and susceptibility to the complex phenotype—asthma plus eczema. These effects seem to be supplementary to the well-known associations for FLG mutations and may be modulated by gene–gene interactions. Additionally, in children with eczema, these genetic variants may also be considered, along with FLG mutations, as predictive biomarkers for eczema-associated asthma. In conclusion, our results indicate that genetic variants in the epidermal differentiation complex gene could contribute to the pathogenesis of atopic eczema and progression to subsequent allergic disease.

Risk factors for food sensitization in children with atopic dermatitis: a single-center cross-sectional study.

To study the risk factors for food sensitization and the influence of food sensitization on quality of life and clinical signs in children with atopic dermatitis (AD). A retrospective analysis was performed on the medical data of 241 children with AD, including demographic features, age of onset, severity of AD, quality of life, physical examination results, skin prick test (SPT) results, serum total IgE levels, and eosinophil count. According to the results of SPT, the children were divided into a food sensitization group (n=127) and a non-food sensitization group (n=114). The multivariate logistic regression analysis was used to identify the risk factors for food sensitization in children with AD. The prevalence rate of food sensitization was 52.7% (127/241) in the children with AD. The multivariate logistic regression analysis showed that birth in autumn or winter, age of onset of AD<12 months, severe AD, and total IgE>150 IU/mL were risk factors for food sensitization (P<0.05). Compared with the non-food sensitization group, the food sensitization group had a significantly poorer quality of life (P=0.008) and significantly higher prevalence rates of non-specific hand/foot dermatitis and palmar hyperlinearity (P<0.05). Compared with the single food sensitization group, the multiple food sensitization group had more severe AD and a significantly higher proportion of children with exclusive breastfeeding or total IgE>150 IU/mL (P<0.05). The AD children born in autumn or winter, or those with early onset (<12 months), severe AD or total IgE>150 IU/mL have a higher risk of food sensitization. The AD children with food sensitization have a poorer quality of life and are more likely to develop non-specific hand/foot dermatitis and palmar hyperlinearity.

Prenatal exposure to nickel and atopic dermatitis at age 3 years: a birth cohort study with cytokine profiles.

Nickel, the fifth most common element on Earth, is the leading inducer of contact allergies in humans, with potent immunological effects. Nickel-induced contact allergies predominantly affect females. Maternal exposure to nickel has been associated with several developmental abnormalities. However, how a maternal nickel exposure affects the development of atopic diathesis and immune abnormalities in children has never been addressed. We aimed to determine whether maternal nickel exposure affects the development of atopic dermatitis and immune abnormalities in their children. Using a birth cohort study, we analysed 140 mother-child pairs recruited in 2012-2015 from central Taiwan. Maternal exposure to nickel was estimated using urinary nickel levels measured by inductively coupled plasma mass spectrometry (ICP-MS). The serum levels of 65 analytes and IgE in 3-year-old children were profiled with a multiplex ELISA. The correlation between the maternal urinary nickel concentration and serum analyte levels was assessed using Spearmen's correlation. Multivariant regression analysis was performed to evaluate the association between maternal urinary nickel levels and serum analyte concentrations in their children. The geometric means of the maternal urinary nickel and the children's serum IgE levels were 2.27 μg/L and 69.71 IU/mL, respectively. The maternal nickel exposure was associated with increased serum levels of IL-1β, IL-2, TNF-α, and leukaemia inhibitory factor (LIF) but with decreased serum levels of matrix metalloproteinase-1 (MMP-1), IL-2R, and eotaxin-1 in the children. In addition, the development of childhood atopic dermatitis at 3 years old was significantly associated with the child's serum levels of IgE and IL-2R, but it was negatively associated with the maternal nickel exposure. This is the first study showing the potential immunological effects of maternal nickel exposure in their children at an early developmental stage.

265 Evaluating the safety and effectiveness of the COVID-19 vaccination among pediatric atopic dermatitis patients

Atopic dermatitis (AD) is a systemic inflammatory disease and the most common skin disorder among children. It has been found to be associated with several comorbidities. As COVID-19 cases continue to surge worldwide, especially among children, we aim to study the safety profile and efficacy of the COVID-19 vaccine in AD children, a topic with little data thus far. A retrospective analysis was done using TriNetX, a multicenter database of ∼80 million deidentified records. Children (<18 years) who were vaccinated with the BNT162b2 vaccine up to November 15th, 2021 were identified and split into AD and non-AD cohorts. A 1:1 matched propensity score analysis was conducted, adjusting for comorbidities and demographics, to generate adjusted risk ratios (aRR) and hazard ratios (aHR) with 95% CI for safety and efficacy outcomes respectively. Safety outcomes included 1-day anaphylaxis and 60-day follow-up for all-cause hospitalization, and FDA-defined adverse events of special interest (AESI). Efficacy was measured as 60-day risk of breakthrough infection (BI). From the 73,984 children who received a COVID-19 vaccine, 6% had AD. A matched cohort of 4505 AD children revealed no differences in safety outcomes for 1 day anaphylaxis (aRR[95%CI]=1.03[0.4,2.4]), 60-day hospitalization (1.25[0.6,2.7]) and AESI (1.02[0.3,2.4]) between cohorts. Additionally AD children did not have a higher risk of BI (aHR[95%CI]=1.7[0.8,3.3]) compared to controls. The results show that the COVID-19 vaccine is safe and effective for pediatric AD patients. Further research is warranted to examine if severity of AD could increase risk of adverse events.

Patch test results to extracts of synthetic garments in textile dye positive patients.

Disperse dyes (DDs) are the most prevalent causes of textile-related allergic contact dermatitis and are used for colouring synthetic textile materials based on fibres such as polyester, acrylic, acetate and polyamide. Eight DDs are included in a textile dye mix (TDM) 6.6% petrolatum (pet.) in the European baseline patch test series. The aim of this study was to patch test TDM 6.6% pet. positive individuals with the extracts of synthetic fibre clothes that do not contain any of the pure DDs present in the TDM 6.6% to study the reactivity pattern. Seventy-three TDM-positive former patients tested between 2012 and 2017 at the Department of Occupational and Environmental Dermatology in Malmö, Sweden were invited to join the study, 10 participated. Twenty-four textile items (collected in nine countries in Europe, Asia and North America in 2012) were extracted in dichloromethane. The TDM 6.6% was patch tested simultaneously with the 24 textile item preparations in petrolatum made from the extracts. Prior to patch testing the participants filled the 7-question questionnaire regarding possible symptoms from textile exposure. Ten individuals, agreed to join the study. Eight of them reacted to TDM 6.6%. Nine participants reacted to 20 of 24 extracts. One reacted to 19 extracts, another to 14, 3 to 5 extracts, 1 to 4, 1 to 3 extracts and 2 to 2 extracts. One was negative to all tested preparations including TDM 6.6%. The participants mainly reacted to six textile extracts. All controls tested negatively to tested extracts. Four individuals of the 10 TDM-allergic individuals previously had had problems after wearing clothes. Four out of the 10 participants had had atopic eczema in childhood. All women had dyed their hair with permanent hair dyes but none of the males. TDM-positive patients react to textile extracts made from synthetic garments, even if they do not contain any of the pure DDs present in TDM 6.6%. More studies are needed to pin-point the culprit haptens in these extracts.

175 Impact of childhood atopic dermatitis on cognition and achievement

Atopic dermatitis (AD) often arises in early childhood during a critical period of cognitive development and has been linked to attention deficit hyperactivity disorder, sleep disruptions, and neuropsychiatric comorbidities. However, less is known about the impact of AD on cognition and academic achievement. In a birth cohort of U.S. children followed in the Study of Early Child Care and Youth Development from 1991 to 2007, we conducted a retrospective cohort study comparing 116 children with AD and 1,104 children without AD with respect to the Wechsler Abbreviated Scale of Intelligence in 4th grade and Woodcock-Johnson-Revised (WJ-R) tests of achievement in 3rd and 5th grades.

Systemic treatment of children and adolescents with atopic dermatitis aged ≥2 years: a Delphi consensus project mapping expert opinion in Northern Europe.

Paediatric atopic dermatitis (AD) can be burdensome, affecting mental health and impairing quality of life for children and caregivers. Comprehensive guidelines exist for managing paediatric AD, but practical guidance on using systemic therapy is limited, particularly for new therapies including biologics and Janus kinase (JAK) inhibitors, recently approved for various ages in this indication. This expert consensus aimed to provide practical recommendations within this advancing field to enhance clinical decision-making on the use of these and other systemics for children and adolescents aged ≥2 years with moderate-to-severe AD. Nineteen physicians from Northern Europe were selected for their expertise in managing childhood AD. Using a two-round Delphi process, they reached full or partial consensus on 37 statements. Systemic therapy is recommended for children aged ≥2 years with a clear clinical diagnosis of severe AD and persistent disease uncontrolled after optimizing non-systemic therapy. Systemic therapy should achieve long-term disease control and reduce short-term interventions. Recommended are cyclosporine A for short-term use (all ages) and dupilumab or methotrexate for long-term use (ages ≥6 years). Consensus was not reached on the best long-term systemics for children aged 2-6 years, although new systemic therapies will likely become favourable: New biologics and JAK inhibitors will soon be approved for this age group, and more trial and real-world data will become available. This article makes practical recommendations on the use of systemic AD treatments for children and adolescents, to supplement international and regional guidelines. It considers the systemic medication that was available for children and adolescents with moderate-to-severe AD at the time this consensus project was done: azathioprine, cyclosporine A, dupilumab, methotrexate, mycophenolate mofetil and oral glucocorticosteroids. We focus on the geographically similar Northern European countries, whose healthcare systems, local preferences for AD management and reimbursement structures nonetheless differ significantly.

State of liver functional activity in children with atopic dermatitis

BACKGROUND: The problem of atopic dermatitis today remains one of the unsolved problems of pediatrics and pediatric allergology. Among the etiopathogenetic mechanisms of atopic dermatitis, the role of endo-allergens formed as a result of impaired digestion and absorption processes in the gastrointestinal tract of a child is separately noted. In such conditions, the load on the detoxification function of the liver increases. In connection with this circumstance, the study of the functional activity of the liver in children with atopic dermatitis is of particular interest. One of its criteria is the nature of intrahepatic hemodynamics.&#x0D; AIM: To find out the features of intrahepatic hemodynamics in the development of atopic dermatitis in children.&#x0D; MATERIALS AND METHODS: 83 children aged 6 months to 5 years with a diagnosis of atopic dermatitis, who made up the main research group, and 33 practically healthy children of the same age, who formed a control group, were examined. The nature of heredity for allergic pathology and morbidity of the gastrointestinal tract was found out in all patients. To obtain information about the functional activity of the liver in all children, hepatic blood flow in the hepatic artery and hepatic vein was studied.&#x0D; RESULTS: Violation of intrahepatic hemodynamics was revealed in children with atopic dermatitis. The blood flow in the hepatic artery in them was characterized by a decrease, and the blood flow in the hepatic vein was characterized by an increase in speed indicators. The detected violations of intrahepatic hemodynamics in children with atopic dermatitis are regarded by the authors of this study as a manifestation of a decrease in the functional activity of hepatocytes in conditions of increased allergenic load.&#x0D; CONCLUSIONS: The study clearly demonstrated a violation of the functional state of hepatocytes in children suffering from atopic dermatitis, expressed in the suppression of hepatic hemodynamics. The question of the primary or secondary nature of this violation is the subject of discussion and further scientific research.

Caregiver Preferences and Barriers Toward Accessing Pediatric Dermatology Care for Childhood Atopic Dermatitis.

Atopic dermatitis (AD) is a common chronic childhood illness. It is often treated by primary care providers (PCPs) though it may require referral to a dermatology specialist. We administered an exploratory survey to 50 caregivers of children aged 0-17 years with AD to assess their preferences and barriers toward accessing dermatology specialty care for their child's AD. Caregivers felt PCPs and specialists equally listened to their child's AD concerns. However, many felt there was a difference in the care provided and control of the AD and preferred to see a specialist for ongoing management. Caregivers may benefit from their children being referred to dermatology specialists earlier and more often for their AD. Further work must be done to characterize preferences and barriers toward AD care across race and ethnicity.

O06: A randomized controlled trial assessing the effectiveness and safety of ciclosporin vs. methotrexate in the treatment of severe atopic eczema in children and young people: the TREatment of severe Atopic eczema Trial (TREAT)

O06: A randomized controlled trial assessing the effectiveness and safety of ciclosporin vs. methotrexate in the treatment of severe atopic eczema in children and young people: the TREatment of severe Atopic eczema Trial (TREAT)

Probiotics effect in prevention and treatment of atopic dermatitis and eczema in children

The composition of the intestinal microbiota plays an important role in the occurrence of allergies. Based on the immunomodulating capabilities of bacteria, various studies have investigated the potential role of probiotics in the prevention of eczema and atopic dermatitis in children. Atopic dermatitis (AD) is one of the first manifestations in the evolution of allergies, with a continuously increasing incidence worldwide. In the literature, various risk factors are described to play a role in the occurrence of DA, but the actual cause of the disease is still unknown. The intestinal flora seems to be involved in the development of AD, as patients with AD show quantitative, qualitative and functional changes. An imbalance of the human gut microbiota in the first years of life is a possible risk factor for immune-mediated disorders such as allergies. With the aim of modulating the gut microbiota, probiotic supplementation in the first months of life has been used to prevent allergic diseases in infants, with variable success. However, not much is known about the long-term consequences of the use of probiotics in the newborn on the composition of the gut microbiota. The aim of this paper is to highlight the positive links between the use of probiotics and the prevention or cure of eczema and atopic dermatitis.

Factors Associated with the Incidence of Atopic Dermatitis in School-Age Children in the Working Area of the Waai Health Center in 2022

Background: Atopic dermatitis is a global health issue if it is seen from the increasing prevalence and high cost of treating atopic dermatitis. Atopic dermatitis is an inflammation of the skin in the form of chronic residive dermatitis, accompanied by itching, and affecting certain body parts, especially in the face in infants (infantile phase) and sural parts of the extremities (in the child phase). Several triggering factors for atopic dermatitis include intrinsic factors such as genetics, characteristics of atopic skin, immunological disorders, stress, and extrinsic factors such as the environment, irritants, allergens, food, microorganisms, and weather.&#x0D; Objectives: The purpose of this study was to determine the relationship between genetics, food allergies, and the environment with the incidence of atopic dermatitis in the working area of ​​the Waai Health Center.&#x0D; Methods: The research design used was descriptive-analytical with a cross-sectional study approach. The population is all Elementary School 163 Central Maluku, Elementary School 224 Central Maluku, and Elementary School 25 Central Maluku which are in the working area of ​​the Waai Health Center, there are 433 children. Sampling with accidental sampling technique. The sample in this study found 208 children.&#x0D; Results: The results obtained a significant relationship between genetics, food allergies, and environment with the incidence of atopic dermatitis with a value (p = 0.000).&#x0D; Conclusion: It is recommended for families to supervise and supervise children if there is a history of atopy in family members to reduce the risk factors for atopic dermatitis in children because this atopic dermatitis cannot be cured but its recurrence can be controlled.

Analysis of the Serum Profile of Cytokines Involved in the T-Helper Cell Type 17 Immune Response Pathway in Atopic Children with Food Allergy.

The main risk factor for the development of food allergies (FAs) in children is atopic dermatitis (AD). AD is usually recognized as the Th1/Th2 paradigm of allergic disease. Recently, the Th1/Th2 paradigm in allergy and autoimmunity has been revised, including the role of the Th17 cell population and related cytokines. However, there are only a few studies that have found Th17 cytokine involvement in the allergic inflammatory response, especially with food allergens. This research aimed to analyze the serum profile of cytokines involved in the T-helper cell type 17 immune response pathway in young, atopic children with an IgE-mediated and delayed-type FA. The study involved 76 children (0–5 years old) with chronic AD. We used the Bio-Plex system to simultaneously determine the concentrations of 15 different cytokines in one experiment. In accordance with complete dermatological and allergological examination, including OFC testing and ALEX2 assays, participants were divided into 3 groups: IgE-mediated FA, delayed-type FA, and the control group. Data were analyzed using univariate statistical tests. In the IgE-mediated FA group, the circulating levels of tested cytokines had increased compared with those of other patients; however, a statistically significant difference was only obtained for IL-1beta (p < 0.05). According to the ROC curves, IL-1beta may be considered an effective predictor of IgE-mediated FA in AD children (p < 0.05; AUC = 0.67). In the delayed-type FA group, the concentration of most cytokines had slightly decreased compared to the control group. The obtained results suggest that FA influences the Th17-related cytokine profile in the serum of AD children. More advanced studies are needed to confirm the involvement of Th17 cytokines in the allergic inflammatory response and to prove their usefulness in clinical practice.

Cost-Utility Analysis of Dupilumab for the Treatment of Severe Atopic Dermatitis in Children and Adolescents in Italy

BACKGROUND AND OBJECTIVE: Atopic dermatitis (AD) is a chronic, multifactorial, inflammatory condition characterized by a significant impact on patients’ quality of life. Dupilumab is reimbursed by the Italian Medicines Agency (AIFA) for the treatment of adolescent and adult patients with severe AD (according to AIFA registry criteria). Recently, dupilumab has been reimbursed in the treatment of children with severe AD. The objective of this analysis was to estimate the incremental cost-utility ratio (ICUR) of dupilumab compared to current supportive care (SC), for the treatment of severe AD in children (6-11 years) and adolescents (12-17 years) in Italy.MATERIALS AND METHODS: Cost-effectiveness analysis was conducted using a 1-year decision tree followed by a Markov model over a lifetime period. The base case analysis was performed on the overall population of the LIBERTY AD ADOL (NCT03054428) and LIBERTY AD PEDS (NCT03345914) studies, adopting the National Health Service (NHS) perspective. The following costs were considered: acquisition of treatment, management of disease, adverse events and complications. The robustness of the model was tested through sensitivity analysis. In addition, a scenario analysis adopting the social perspective was performed.RESULTS: In the base case, over a lifetime, dupilumab was more effective than SC in both children and adolescents (+2.44 and +1.62 quality-adjusted life years—QALYs, respectively). The introduction of dupilumab generated an increase in treatment costs (+€ 64,800 and +€ 52,853 € for children and adolescents, respectively), partially offset by a decrease in the costs of disease management and complications. Incremental cost-utility ratios (ICURs) were € 21,189 per QALY gained, for children, and € 26,569 per QALY gained, for adolescents. In both cases, the ICUR was lower than the willingness to pay threshold considered in Italy (€ 50,000 per QALY gained). Both the deterministic and probabilistic sensitivity analysis confirmed the robustness of the base case results. Finally, the scenario analysis, adopting the social perspective, showed coherent results compared to the base case.DISCUSSION: Dupilumab is a cost-effective option for the treatment of children and adolescents with severe AD eligible for systemic treatment in Italy compared to SC, from both the NHS and social perspective, confirming the results obtained in the adult population.

Subjective Evaluation Using Patient-Oriented Eczema Measure of the Clinical Effects of 1-Kestose on Atopic Dermatitis in Children: A Pilot Study

Several objective evaluation methods are used to evaluate treatment outcomes in atopic dermatitis clinical trials. We previously demonstrated the clinical efficacy of 1-kestose, the smallest fructooligosaccharide, in the treatment of atopic dermatitis in infants using an objective evaluation method. The utility of the Patient-Oriented Eczema Measure, in which patients themselves or their guardians evaluate the pathophysiology of atopic dermatitis, has recently been reported. In the present study, we used the Patient-Oriented Eczema Measure to confirm the efficiency of the clinical effect of 1-kestose on pediatric atopic dermatitis. An open pilot study was conducted on 22 children with atopic dermatitis. Subjects were orally administered 2 g of 1-kestose daily for 12 weeks and the symptoms of atopic dermatitis were evaluated using the Patient-Oriented Eczema Measure. The median total score of the Patient-Oriented Eczema Measure was significantly decreased by the 1-kestose treatment from 14.2 to 7.7 (P &lt; 0.001). There was no correlation between decreases in the total score of the Patient-Oriented Eczema Measure and the age of subjects. Although the present study was a small pilot study, results suggest that 1-kestose may have attenuated atopic dermatitis to a degree that the patients themselves could recognize.

Medihoney Derma Cream Treatment for Mild to Moderate Atopic Dermatitis in Children: An Open-Label Randomized Pilot Study.

To the Editor: Topical corticosteroids are considered the main treatment for atopic dermatitis (AD), especially during a flare.1 Although topical corticosteroids have enormous benefits in reducing inflammation, they may be accompanied by significant adverse effects. In addition, the worldwide prevalence of topical corticosteroids phobia is extremely high, ranging from 31% to 95.7%,2 and may lead to poor adherence, resulting in persistent disease and rapid escalation to systemic agents.2 To avoid these adverse effects and the excess use of topical corticosteroids, other topical treatment modalities for AD are needed.3 Medihoney Derma Cream (Med-D-Cream) is a topical emollient cream containing 30% Medihoney antibacterial honey, coconut oil, German chamomile flower extract, evening primrose oil, aloe vera, vitamin E, glucose oxidase, and Leptospermum compounds. It has broad antibacterial and antipruritic activity,4 and by preserving skin barrier integrity and moisture, it aids in maintaining skin pH. Med-D-Cream is licensed for skin and wound care in Australia, Europe, and the United States. To offer an alternative corticosteroid-sparing option for treating mild to moderate AD in children, we conducted a trial comparing the safety and efficacy of Med-D-Cream to a common mild potency corticosteroid cream used worldwide for the treatment of AD (hydrocortisone 1% cream). The trial comprised children aged 2 to 18 years diagnosed with mild to moderate AD, with an Investigator Global Assessment (IGA) score of 2 to 3 and body surface area (BSA) of 1% to 10%, including 30 patients, 20 using Med-D-Cream, and 10 as controls using hydrocortisone 1% cream. Patients applied creams for 2 weeks and were then followed up for 2 more weeks to measure responses using IGA, BSA, Eczema Area and Severity Index score, SCORing Atopic Dermatitis, and Visual Analogue Scale pruritus (Fig. 1). The duration of treatment was limited to 2 weeks to avoid prolonged use of a topical steroid. The response rate (IGA score of 0 or 1 with at least 1-grade reduction after 2 weeks of treatment) was 47.4% (9/19) in the intervention group (Med-D-Cream) and 60% (6/10) in the control group (hydrocortisone 1% cream). There was no statistically significant difference between the 2 arms in response rates. No significant changes were found between the 2 groups regarding the secondary outcomes (BSA, Eczema Area and Severity Index score, SCORing Atopic Dermatitis, and Visual Analogue Scale pruritus). In the Med-D-Cream group, 2 of the 20 patients (10%) had adverse events, which resulted in 1 patient's withdrawal. No adverse events were seen in the hydrocortisone group. Our study had some limitations. First, we had a small sample size because it was a pilot study; however, the cohort size did allow us to draw statistical conclusions. Second, the study had relatively short treatment and follow-up periods (4 weeks overall), limiting the ability to observe potential allergic contact dermatitis and properly assess Med-D-Cream's effect on barrier function. Despite these limitations, this is the first randomized study designed to explore Med-D-Cream clinical activity and compare it with a topical corticosteroid in the pediatric population.Figure 1: Flowchart of the study design and population.In conclusion, the study demonstrated that Med-D-Cream, an emollient, is safe and effective in treating pediatric mild to moderate AD. Although it failed to show that Med-D-Cream had superiority over hydrocortisone 1% cream, it showed comparable clinical efficacy. Amir Horev Pediatric Dermatology Service Soroka University Medical Center Beer Sheva, Israel Faculty of Health Sciences Ben-Gurion University of the Negev Beer Sheva, Israel [email protected]Maayan SherSarah Weissmann Faculty of Health Sciences Ben-Gurion University of the Negev Beer Sheva, IsraelLior Golan Faculty of Health Sciences Ben-Gurion University of the Negev Beer Sheva, Israel Clinical Research Unit Soroka University Medical Center Beer Sheva, IsraelAnat Horev Neurology Department Soroka University Medical Center Beer Sheva, Israel

Melatonin and Sleep Disturbances in Children With Atopic Dermatitis.

ObjectiveTo evaluate the correlation between melatonin levels and sleep quality, based on the Children’s Sleep Habit Questionnaire (CSHQ), among children with atopic dermatitis (AD).MethodsThis was an analytic study with a cross-sectional design involving two groups, AD children as the case group and participants without AD as the control group, conducted at the Pediatric Dermatology Clinic of Dr. Hasan Sadikin Hospital, Bandung, Indonesia. Melatonin levels and CSHQ score in the case group were compared to that in the control group. Correlation analysis was performed between melatonin levels and sleep quality based on CSHQ in the case group.ResultsParticipants in this study consisted of 19 children with moderate AD, (no patient with mild and severe AD was recruited), and 19 participants without AD. The mean CSHQ score in the case group was significantly higher than the control group (47.84 vs 36.79; p<0.05). The mean melatonin level in the case group was significantly lower than the control group (320.18 pg/mL vs 383.86 pg/mL; p<0.05). Comparative analysis was conducted using independent t-test. There was a significant Pearson’s correlation index between SCORAD and CSHQ (p<0.05). However, there was no correlation between melatonin levels and CSHQ, as well as between melatonin levels and SCORAD (p<0.05).ConclusionChildren with moderate AD have impaired sleep quality and lower melatonin levels compared to controls. No correlation was found between melatonin levels and CSHQ, as well as melatonin levels and SCORAD, although there was a strong and significant correlation between SCORAD and CSHQ. Therefore, melatonin levels may not be the main cause of sleep disturbances in children with moderate AD.

Refractory nummular eczema in child successfully treated with NB‐UVB and topical delgocitinib

Refractory nummular eczema with atopic dermatitis in child successfully treated with narrowband ultraviolet B (NB‐UVB) and topical delgocitinib was reported. The combination of NB‐UVB and topical delgicitinib can be one of alternative treatments for refractory nummular eczema in children.

Association of Probiotics with Atopic Dermatitis among Infant: A Meta-analysis of Randomized Controlled Trials.

Background Previous studies have explored the relationship between probiotics and risk of atopic dermatitis among infant; however, the results are still inconclusive. We aimed to assess the abovementioned association. Methods PubMed, Web of Science, Embase, and China National Knowledge Infrastructure were retrieved for association between probiotics and atopic dermatitis with randomized controlled trials (RCTs) until Nov 20, 2021. The effect size was pooled by using random or fixed effect models according to the heterogeneity. Stata 12.0 was used for meta-analysis, sensitivity analysis, and bias analysis. Results At the end of the screening article, 2575 infants were extracted from 8 trials and finally met the qualification criteria. In comparison to placebo, probiotics dramatically reduced incidence of childhood atopic dermatitis (RR = 0.86, 95% CI = 0.78-0.95). However, probiotics did not exhibit benefit over placebo in preventing the development of either IgE-associated infant AD (RR = 0.98, 95% CI = 0.79-1.22) or sensitive constitution (RR = 0.93, 95% CI = 0.81-1.08). From the results of sensitivity and publication bias, we found that these results were robust with little publication bias. Conclusion During the late stages of pregnancy, women taking probiotics could lower the risk of infantile atopic dermatitis, but not for IgE-associated infant AD or sensitive constitution. The results could provide evidence for the fibrosis. Future studies are needed to confirm the results.