Management Of Atopic Dermatitis Research Articles

A Mobile Health App for Facilitating Disease Management in Children With Atopic Dermatitis: Feasibility and Impact Study.

Inadequate control of atopic dermatitis (AD) increases the frequency of exacerbations and reduces the quality of life. Mobile health apps provide information and communication technology and may increase treatment adherence and facilitate disease management at home. The mobile health app, Atopic App, designed for patients and their caregivers, and the associated web-based patient education program, Atopic School, provide an opportunity for improving patients' and caregivers' engagement and adherence to the management of AD. This noninterventional, observational study aimed to explore the feasibility and potential impact on the management of AD in children by caregivers using the Atopic App mobile health app. The patient-oriented eczema measure (POEM) and numerical rating scale for the grading of pruritus were used as severity scores (scale range: 0-28). The artificial intelligence model of the app was used to assess the severity of AD based on the eczema area and severity index approach. The deidentified data enabled the analysis of the severity of AD, treatment plan history, potential triggers of flare-ups, usage of available features of the app, and the impact of patient education. During a 12-month period, of the 1223 users who installed the app, 910 (74.4%) registered users were caregivers of children with AD. The web-based Atopic School course was accessed by 266 (29.2%) caregivers of children with AD, 134 (50.4%) of whom completed the course. Usage of the app was significantly more frequent among those who completed the Atopic School program than among those who did not access or did not complete the course (P<.001). Users who completed a second POEM 21 to 27 days apart exhibited a significant improvement of AD severity based on the POEM score (P<.001), with an average improvement of 3.86 (SD 6.85) points. The artificial intelligence severity score and itching score were highly correlated with the POEM score (r=0.35 and r=0.52, respectively). The Atopic App provides valuable real-world data on the epidemiology, severity dynamics, treatment patterns, and exacerbation-trigger correlations in patients with AD. The significant reduction in the POEM score among users of the Atopic App indicates a potential impact of this tool on health care engagement by caregivers of children with AD.

Some Risk Factors of Atopic Dermatitis in Adults

Atopic dermatitis (AD) is an inflammatory skin disorder characterized by intense itching and eczematous lesions. The onset of AD usually occurs in childhood and AD symptoms can last into adulthood. An increasing prevalence of AD has been observed worldwide. The causes of AD are multifactorial and there are still not many systematic reviews of AD-related risk factors. This study uses a literature review method. Literature search was conducted using Google Scholar and PubMed. using keywords: atopic dermatitis, risk factors, adults, and observational studies. All literature was selected using inclusion and exclusion criteria to assess the suitability of the content and quality of the study. Patients with atopic dermatosis had a filaggrin mutation cause loss/change in the function of filaggrin (Filament Aggregating Protein). Risk factors for atopic dermatitis in adults include a history of atopy, food allergies, a history of atopy in the father or mother or both, history of AD in parents, having pets at home, younger age or early onset, being a former smoker, gender women and active smoking, as well as passive smokers, low education level (&lt;=12 years), socioeconomic status, and living in small places. Symptoms and clinical manifestations include pruritus, morphology and wide distribution of lesions, chronic and recurrent dermatitis, history of atopy and family history of atopy. Management of atopic dermatitis begins with education and skin care by taking regular baths and using emollients/moisturizers. Atopy and family history of atopy, smoking, low education, and socioeconomic are risk factors for AD in adults.

Sleep improvements following atopic dermatitis management in young children

The purpose of this pilot study was to assess improvements in associated sleep and caregiver mood following treatment of atopic dermatitisin young children. Participants included children (n=23; Mage =22.0months) and their caregivers. Topical management of atopic dermatitis was conducted for 2 weeks, with measures of skin, sleep (child, caregiver), and mood (caregiver) at baseline and day 14. Topical management resulted in significant improvements in child skin, with associated increases in sleep consolidation. There were similar improvements in caregiver nightwakings, with nighttime sleep duration improving by over an hour. Caregivers also reported more energy to engage with their family and feeling better rested. Overall, topical management significantly improved atopic dermatitis. There were concomitant improvements in sleep outcomes for children and their caregivers, as well as caregiver mood. Daily management of atopic dermatitis may result in improvements in not just skin health but also sleep and family well-being.

The Role of Clinical Pharmacists in the Management of Atopic Dermatitis

Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by itchy, inflamed skin that affects a significant portion of the population, particularly children, and can significantly impact quality of life. The role of clinical pharmacists in managing AD has gained prominence due to their expertise in medications, patient education, and collaborative care. This article explores the various ways clinical pharmacists contribute to the comprehensive management of AD, emphasizing patient education, medication management, and interprofessional collaboration.

Assessment and Management of Atopic Dermatitis in Primary Care Settings

An increasingly common chronic inflammatory skin condition is atopic dermatitis (AD). It exhibits severe itching as well as recurring eczematous lesions. New difficulties for treatment selection and approach occur with the expansion of available therapy alternatives for healthcare professionals and patients. The article highlights recent developments in scientific research on atopic dermatitis diagnosis and assessment that have led to the identification of novel therapeutic targets and the development of targeted therapies, both of which have the potential to completely change the way AD is treated, particularly in a primary care setting.

Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies

For people with atopic dermatitis (AD) refractory to topical therapies, treatment with phototherapy and systemic therapies can be considered. Multiple biologic therapies and Janus kinase (JAK)inhibitors have been approved since 2014 to treat AD. These guidelines update the 2014 recommendations for management of AD with phototherapy and systemic therapies. To provide evidence-based recommendations on the use of phototherapy and systemic therapies for AD in adults. A multidisciplinary workgroup conducted a systematic review and applied the GRADE approach for assessing the certainty of evidence and formulating and grading recommendations. The workgroup developed 11 recommendations on the management of AD in adults with phototherapy and systemic agents, including biologics, oral JAK inhibitors, and other immunomodulatory medications. Most randomized controlled trials of phototherapy and systemic therapies for AD are of short duration with subsequent extension studies, limiting comparative long-term efficacy and safety conclusions. We make strong recommendations for the use of dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib. We make conditional recommendations in favor of using phototherapy, azathioprine, cyclosporine, methotrexate, and mycophenolate, and against the use of systemic corticosteroids.

Executive summary: Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies

The summarized guidelines update the 2014 recommendations for the management of AD with phototherapy and systemic therapies. A multidisciplinary workgroup conducted a systematic review and applied the GRADE approach for assessing the certainty of the evidence and formulating and grading recommendations. The workgroup developed 11 recommendations on the management of AD in adults with phototherapy and systemic therapies, including biologics, oral Janus Kinase inhibitors, and other immunomodulatory medications. The evidence supported strong recommendations for the use of dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib and conditional recommendations in favor of using phototherapy, azathioprine, cyclosporine, methotrexate, and mycophenolate, and against the use of systemic corticosteroids.

Biologics in the Management of Sever Atopic Dermatitis

Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases, it is presented with heterogeneous clinical phenotypes that can alter by severity, age, and ethnic background. The chronic nature of AD necessitates safer, and newer treatment that is effective in improving quality of life [1]. A new era of therapeutics is in innovation phase including Biologic treatment and it is essential to provide a comprehensive understanding of this modality of treatment. Hence, this review presents an overview of up to date biologics that are approved or are in development for the treatment of AD.

Skin Microbiome Composition and Key Factors of its Barrier Function

The skin is the largest organ of the human body, it creates protective barrier between the internal and external environment. Skin barrier damage may result in homeostasis imbalance, inflammation, or bacterial infection. The microbiome plays a crucial role in maintaining normal skin functioning: control of pathogenic diversity of microorganisms, stimulate immune cells, and modulate chronic dermatoses development. There are various mechanisms for restoring skin barrier function. They are associated with the microorganisms’ activity. Thus, skin restoration is an important task included in the general concept of atopic dermatitis management. One of such methods is the skin surface colonization with commensals, so significant role is assigned to the new dermatological drugs. The normalization of the microbiome in affected skin areas with cosmetic care products can significantly affect the result of skin barrier restoration.

Effectiveness of antibacterial therapeutic clothing vs.nonantibacterial therapeutic clothing in patients withmoderate-to-severe atopic dermatitis: arandomizedcontrolled observer-blind pragmatic trial(ABC trial).

Increased Staphylococcus aureus (SA) colonization is considered an important factor in the pathogenesis of atopic dermatitis (AD). Antibacterial therapeutic clothing aims to reduce SA colonization and AD inflammation; however, its role in the management of AD remains poorly understood. To investigate the effectiveness of antibacterial therapeutic clothing + standard topical treatment in patients with moderate-to-severe AD vs. standard therapeutic clothing + standard topical treatment; and, if effectiveness was demonstrated, to demonstrate its cost-effectiveness. A pragmatic double-blinded multicentre randomized controlled trial (NCT04297215) was conducted in patients of all ages with moderate-to-severe AD. Patients were centrally randomized 1 : 1 : 1 to receive standard therapeutic clothing or antibacterial clothing based on chitosan or silver. The primary outcome was the between-group difference in Eczema Area and Severity Index (EASI) measured over 52weeks. Secondary outcomes included patient-reported outcomes (PROs), topical corticosteroid (TCS) use, SA colonization, safety and cost-effectiveness. Outcomes were assessed by means of (generalized) linear mixed-model analyses. Between 16 March 2020 and 20 December 2021, 171 patients were enrolled. In total, 159 patients were included (54 in the standard therapeutic clothing group, 50 in the chitosan group and 55 in the silver group). Adherence was high [median 7 nights a week wear (interquartile range 3-7)]. Median EASI scores at baseline and at 4, 12, 26 and 52 weeks were 11.8, 4.3, 4.6, 4.2 and 3.6, respectively, in the standard therapeutic clothing group vs. 11.3, 5.0, 3.0, 3.0 and 4.4, respectively, in the chitosan group, and 11.6, 5.0, 5.4, 4.6 and 5.8, respectively, in the silver group. No differences in EASI over 52 weeks between the standard therapeutic clothing group, the chitosan group [-0.1, 95% confidence interval (CI) -0.3 to 0.2; P = 0.53] or the silver group (-0.1, 95% CI -0.3 to 0.2; P = 0.58) were found. However, a small significant group × time interaction effect between the standard and silver groups was found (P = 0.03), in which the silver group performed worse after 26 weeks. No differences between groups were found in PROs, TCS use, SA skin colonization and healthcare utilization. No severe adverse events or silver absorption were observed. The results of this study suggest no additional benefits of antibacterial agents in therapeutic clothing in patients with moderate-to-severe AD.

252 Successful management of atopic dermatitis with phototherapy: a case report

252 Successful management of atopic dermatitis with phototherapy: a case report

The Social and Home Environment: Impacts of Determinants of Health on Atopic Dermatitis, Pathways Toward Solutions, and Unique Considerations for Rural and Remote North American Indigenous Populations

Disparities in environmental and social determinants of health (DOH) are associated with morbidity in atopic dermatitis (AD). The socioecological model (SEM) is a framework that can be applied to better understand how DOH impacts patients with AD. We include a case scenario of a remote Indigenous patient reflective of real-world situations of living with AD and examine relevant impact, gaps in knowledge, and further research needs. This review highlights a variety of social and environmental exposures as important DOH which must be addressed to achieve optimal management in AD. The "Rainbow model” is a modified framework to help illustrate how complex environmental and social forces impact both AD presentation and therapeutic success. However, practical applications and outcome metrics for health promotion are limited.1 An inter- and transdisciplinary approach is paramount to address the complex challenges associated with AD care, as well as multistakeholder approach integrating culturally-competent equitable health frameworks. This review underscores the importance of expanding the focus of AD management beyond basic science and clinical trials to recognize and address health disparities and to promote optimal health and well-being in patients with AD, and contributes a working approach to mapping the complex interventions and patient-oriented research needed using a focus on remote North American Indigenous patients affected by AD.

A review of biological agents and small molecules in the management of atopic dermatitis

Atopic dermatitis (AD) is a recurrent, chronic, and non-infectious inflammatory dermatoses characterized by persistent itching of the skin. It has multifactorial causes characterized by a tetrad of a (i) genetic predisposition, (ii) disturbed epidermal barrier, (iii) immune dysregulation, and (iv) deranged skin microbiome. At present, treatment is aimed at maintaining the epidermal barrier function by the use of emollients, sedative, and non-sedative antihistamines targeting the itch pathway, immunosuppressants in the form of steroids as well as steroid sparing agents to control the chronic persistent inflammatory response. However, newer emerging therapy in the form of biologics gives a promising approach to control the chronic, persistent inflammatory response by targeting the specific cytokines involved in pathogenesis of AD.

Aloe vera, wheat germ oil, tea tree extract and honey-based emollient cream in the management of atopic dermatitis: a post-hoc analysis

Background: Atopic dermatitis is a chronic skin condition characterized by dry, itchy and inflamed skin. This study evaluated the complementary benefits efficacy and tolerability of emollient c containing Aloe vera, Wheat germ oil, tea tree extract, and honey in patients with dry skin conditions. Methods: Cross-sectional analysis for clinical cases with dry skin receiving moisturizing cream formulation was undertaken at 156 centres. 286 case records of atopic dermatitis receiving standard of care as cleansers, Topical corticosteroids, moisturizers were further analysed for improvement in skin dryness and itchiness. Results: Regular use of Emollient formulation containing aloe vera, wheat germ oil, tea tree extract, honey was further analysed along with safety assessment over 8 weeks of observation period. The mean age of the study participants was 36.58 years. There was significant change in VAS score for dryness (p-value&lt; 0.01), itch (p-value &lt;0.01) with Patient Global Assessed rating as good (64.23%) for effectiveness and ease of application. Mild stinging, mild burning and irritation was experienced by 5 (1.75%) patients. Conclusions: The aloe vera, wheat germ oil, tea tree extract, honey enriched emollient formulation was efficacious and well tolerable in study participants in providing moisturizing, antimicrobial, and anti-inflammatory effects making it a preferred complementary therapy for managing atopic dermatitis following the short course therapy with TCS as a pertinent clinical strategy to avoid the atopic flares in such cases.

Therapeutic clothing use in atopic dermatitis in the Netherlands: A population based cohort study.

National prescription data for therapeutic clothing in atopic dermatitis was analysed to investigate the role of therapeutic clothing in atopic dermatitis. Therapeutic clothing is most frequently prescribed by dermatologists in a hospital setting. Most patients only receive one prescription of therapeutic clothing, suggesting a limited role for therapeutic clothing in the long-term management of atopic dermatitis.

Diagnosis, assessment and management of atopic dermatitis in children with skin of colour.

It is important to be able to manage patients regardless of ethnicities. The understanding of skin diseases, including atopic dermatitis, in patients with skin of colour (SOC) is lagging compared with that in patients with lighter skin and has been identified as an educational gap among medical practitioners. This paper synthesises the latest literature on the diagnosis, assessment, treatment outcomes and cultural considerations for managing atopic dermatitis in children with SOC in the general practice setting. Atopic dermatitis in children with SOC can vary from traditional descriptions andappear psoriasiform, lichenoid, scaly, papular, hypopigmented or violaceous. Itcan be misdiagnosed and its severity underestimated. Complications from atopic dermatitis, as well as the treatments provided, might result in inadequate treatment unless the treating doctor is aware of specific nuances in children with SOC.

Is corticophobia spreading among pediatricians?-Insights from a self-efficacy survey on the management of pediatric atopic dermatitis.

Atopic dermatitis (AD) is a chronic dermatological condition, often diagnosed and managed by pediatricians. However, pediatricians have difficulties with adhering to guidelines, which recommend the use of topical corticosteroids (TCS) as a first-line treatment and oral corticosteroids (OCS) for resistant cases. Our aim was to assess pediatricians' self-confidence in using steroids in the management of pediatric AD, and investigate which characteristics are related to high self-confidence in prescribing corticosteroids (CS). We conducted a cross-sectional questionnaire study among Israeli pediatricians between April 2022 and June 2022. Participants were asked to answer questions dealing with self-assessment of prescribing CS in the management of AD. A total of 171 residents and pediatricians participated in the survey; 86.6% and 28.1% admitted feeling either average or below-average confidence in the prescription of OCS and TCS, respectively. Physicians who were exposed to higher AD patients (P=0.048) and worked at the clinics (88.2% vs. 60.4%, P<0.001) had high self-confidence in treating AD with TCS. Males (20.3% vs. 8%, P=0.03), and having gone to medical school outside Israel (22.2% vs. 10.4%, P=0.09) were all related to high self-efficacy in prescribing OCS. In total, 11.7% of participants confessed to refraining from prescribing steroids because of fear of side effects. Most pediatricians have below-average confidence in prescribing OCS for the treatment of AD. Males, working in a community setting, and previous exposure improve the confidence level and can be easily considered in future pediatric training programs.

The efficacy and safety of autologous activated platelet-rich plasma therapy as adjuvant treatment of atopic dermatitis in pregnant woman

Introduction: Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disorder which involves skin barrier and immune dysregulation. The management of AD involves the use of moisturizers and immunosuppressant which are only used for temporary symptom relief and may potentially harm the fetal growth. Autologous activated platelet-rich plasma (aaPRP) is a potential adjuvant treatment for symptom control in pregnant AD patient. This report examines a case of a pregnant patient with AD treated with aaPRP and the monitoring of fetal growth until birth. Case Report: A 37-year-old pregnant patient with a history of AD when in contact with latex or consumption of dairy products came to Hayandra Clinic. As she had been working as anesthesiologist continuously in contact with latex gloves, she underwent routine aaPRP therapy for 3 years and had 15 aaPRP treatments over the course of her pregnancy. The patient had lesser lesions when AD was induced, no exacerbation of symptoms during pregnancy, and the baby was healthy during pregnancy to birth. Conclusion: The use of aaPRP therapy for the management of AD may be indicated as it controls the symptoms yet is safe for the patient during pregnancy. There was also no harm effect showing on the fetal development. A larger study such as randomized controlled trial is required to evaluate our findings.

A practical approach to caring for atopic dermatitis in children.

Atopic dermatitis is a chronic, systemic disease with primary cutaneous clinical manifestations and is commonly attributed to an exaggerated Th2 inflammatory response. Recent research regarding risk factors, prevention, clinical features, and management of atopic dermatitis will be reviewed. In the last decade, advances have been made in identifying the factors that either confer increased risk for or protection from atopic dermatitis and associated atopy. Progress has also been made in the clinical management of this disease. Promising biomarkers and therapeutically informative characteristics of this disease have been identified in young children with and without the presence of eczema, but much has yet to be elucidated. Progress has also been made in clarifying the advantages and disadvantages of respective medical managements, including but not limited to topical corticosteroids, topical calcineurin inhibitors, phototherapy, systemic immunosuppressants, and targeted immunotherapy. Given that medical management may show variable efficacy in a child, an optimized skin care regimen is of utmost importance as well. Atopic dermatitis is a challenging, chronic systemic disease that incurs significant morbidity in affected children. Although management options have been somewhat disappointing in years past, promising results have been observed in recent advances in targeted immunotherapy.

GDU-952, a novel AhR agonist ameliorates skin barrier abnormalities and immune dysfunction in DNFB-induced atopic dermatitis in mice

The aryl hydrocarbon receptor (AhR) is widely expressed in the skin. It controls immune-mediated skin responses to various external environmental signals, promote terminal differentiation of epidermal keratinocytes and participates the maintenance of the skin barrier function. As a therapeutic target, AhR activation modulates many diseases progression driven by immune/inflammatory processes such as atopic dermatitis (AD) and psoriasis. In this study, we revealed that GDU-952 is a novel AhR agonist, which is able to decreases IgE serum levels, to inhibit pro-inflammatory cytokines such as IL-6 and TNF-α and to induce immunoregulatory effects through restoring Th1/Th2 immune balance and promoting CD4+FOXP3+regulatory T (Treg) populations in AD skin lesions. Furthermore, GDU-952 can strengthen the skin barrier function through upregulating epidermal differentiation-related and tight junction proteins. This may alleviate AD symptoms, such as dermatitis scores, epidermal hyperplasia and mast cell infiltration. These results offer a rationale for further preclinical/clinical studies to evaluate the possible use of GDU-952 in the management of AD.