Increasing Atopic Dermatitis Severity Research Articles

Does the severity of atopic dermatitis change with allergic sensitization? Is it real or a myth?

Atopic dermatitis (AD) is a chronic inflammatory skin disease that can occur at any age. This study aimed to evaluate the impact of food allergy on disease severity as well as clinical/laboratory findings in children with AD. Clinical and laboratory data of AD patients evaluated for food allergy between January 2021 and December 2022 were examined retrospectively. Of the 52 patients evaluated, 32 (61.5%) were males, with a median age of 6 months (2-118 months). Among them, 26 (50%) had food allergies (FA) and five (9.6%) had inhalant allergen sensitivity. No significant difference in AD severity was observed between patients with and without FA. However, the FA group showed higher serum lactate dehydrogenase (LDH) levels (343.3 ± 81.5 U/L vs 297.7 ± 77.4 U/L; P = 0.011) and lower red cell distribution width (RDW). Inhalant allergen sensitivity was associated with higher AD severity. While guidelines recommend investigating food allergies in moderate to severe AD, this study found no significant difference in the relationship between AD severity and the presence of FA. However, inhalant allergen sensitivity was linked to increased AD severity. Therefore, a comprehensive patient history should include an evaluation of food allergies in children with AD, regardless of disease severity. Elimination and provocation tests related to suspected food items should be performed, and allergenic foods should be removed from the diet if they are found to contribute to the allergy.

Temporal relationships between Staphylococcus aureus colonization, filaggrin expression, and pediatric atopic dermatitis.

Atopic dermatitis (AD) is characterized by Staphylococcus aureus (S. aureus) colonization. Longitudinal early life data delineating relationships of S. aureus colonization, barrier function, and AD outcomes are lacking. We define longitudinal S. aureus endotypes and AD pathogenesis in early life. We defined longitudinal S. aureus skin colonization phenotypes across two annual visits (non-colonized: V1- V2- , early transient: V1+ V2- , late-onset: V1- V2+ , persistent: V1+ V2+ ) in the Mechanisms of Progression of Atopic Dermatitis to Asthma in Children cohort. We analyzed AD severity, sensitization, and skin barrier function across phenotypes, and performed mediation analyses between colonization and FLG expression. Persistent S. aureus colonization was associated with increased SCORAD at V1 (33.5 vs. 19.0, p = .004) and V2 (40.1 vs.16.9, p < .001), and lower non-lesional (NL) FLG at V2 (1.77 vs. 4.09, p = .029) compared to the non-colonized phenotype, with early transient and late-onset colonization as intermediate phenotypes. Children colonized at V2 demonstrated a decrease in NL-FLG expression from V1 to V2 compared to those non-colonized at V2 (p = .0012), who maintained expression. This effect remained significant even after adjusting for V1 colonization and SCORAD (p = .011). Our findings are the first to present longitudinal quantitative FLG expression and S. aureus skin colonization in early life and suggest that a decrease in NL-FLG drives later colonization. Hence, therapies to maintain NL-FLG expression may prevent S. aureus colonization. Further, a longitudinal AD endotype of persistent colonization is characterized by increased AD severity, sensitization, and decreasing NL-FLG.

The disease burden of pediatric patients with atopic dermatitis in Japan.

Atopic dermatitis (AD) is a chronic skin condition that is associated with significant patient burden and decreased health-related quality of life (HRQoL). We report results of the real-world Epidemiology of Children with Atopic Dermatitis Reporting on their Experience study in Japanese pediatric patients, focusing on the impact of AD severity on disease burden. Children and adolescents aged 6 months to 17 years (or their caregivers/parents) completed an online survey between September 26, 2018, and March 5, 2019. Patients with diagnosed AD (i.e., met International Study of Asthma and Allergies in Childhood criteria and had a self-reported AD diagnosis) were evaluated for disease severity using the Patient-Oriented Eczema Measure (POEM). Impact of AD severity on AD symptoms (itching, pain, and sleep disturbance), disease flares, atopic comorbidities, healthcare resource utilization, school days missed, and HRQoL were assessed. Of 5702 Japanese pediatric patients, 547 had diagnosed AD and were included in this analysis. Based on POEM scores, AD severity was clear/mild in 346 patients (63.3%), moderate in 177 (32.5%), and severe in 24 (4.4%). Across all age groups (i.e., less than 6, 6-11, and 12-17 years), increased AD severity was associated with increased AD symptom severity, number of flares, atopic comorbidities, healthcare resource utilization, and school absences, as well as worsened HRQoL. This population-based study of Japanese children and adolescents showed that greater AD severity had a high impact on disease burden.

Effects of Insurance Status on Infantile Atopic Dermatitis Severity and Parental Quality of Life

The association between insurance status and infantile atopic dermatitis (AD) severity is not fully understood. We hypothesized that parents of infants with Medicaid coverage would report increased AD severity as compared to parents of privately insured infants. We also performed exploratory analyses of associations between insurance status and quality of life (QOL).

Atopic Dermatitis Polypharmacy and Out-Of-Pocket Healthcare Expenses.

Atopic dermatitis (AD) out-of-pocket (OOP) expenses are substantial and impact household finances. Prescription polypharmacy and its association with OOP expenses in AD is poorly understood. To characterize prescription polypharmacy and its association with OOP healthcare expenses among individuals with AD. An online survey was administered to National Eczema Association members (N=113,502). Inclusion criteria (US resident, age &ge;18, self-reported or caregiver of individual with AD) was met by 77.3% (1,118/1,447) of respondents. Polypharmacy (&ge;5 prescription treatments for AD in the past year) was associated with increased AD severity, poorer control, increased flares, increased healthcare provider visits, and comorbid asthma, allergic rhinitis, food allergy, and skin infections (P&le;0.01). Polypharmacy noted with all prescription therapies was most associated with biologic (dupilumab), oral immunosuppressant (azathioprine, cyclosporine, methotrexate, corticosteroids), oral antimicrobial, and topical calcineurin inhibitor (P&le;0.0005) use. Respondents with polypharmacy had increased OOP expenditures across numerous categories, including office visit co-pays, prescription medications both covered and not covered by insurance, hospitalization, emergency room visits, mental health services, non-prescription health products such as sleep aids, analgesics, and supplements, and alternative medications (P&lt;0.005). Individuals with polypharmacy had elevated yearly OOP expenses (median [range]: $1200 [$0-$200,000]), higher monthly OOP costs than average, and more harmful household financial impact (P&lt;0.0001 for all). Individuals with AD report considerable polypharmacy, which is associated with increased OOP expenses and harmful financial impact. Strategies are needed to reduce polypharmacy, minimize OOP costs, and optimize clinical outcomes. J Drugs Dermatol. 2023;22(2): doi:10.36849/JDD.7038.

The financial burden of out-of-pocket healthcare expenses on caregivers of children with atopic dermatitis in the United States.

Atopic dermatitis (AD) is associated with elevated financial costs, including out-of-pocket (OOP) expenses. Yet, the full burden of OOP expenses in children with AD is poorly understood. We sought to characterise categories, impact, and associations of caregiver-reported OOP AD healthcare expenses for US children. An online survey was administered to National Eczema Association members (N=113502). Inclusion criteria (US resident; respondent age ≥18; self or caregiver report of AD diagnosis) was met by 77.3% (1118/1447) of those who completed the questionnaire. Caregivers of children (<18years) with AD reported increased healthcare provider (HCP) visits, comorbid food allergy, cutaneous infections, and topical antimicrobial use (p<0.005 for all), and increased OOP expenses for hospitalisation, emergency room visits, emollients, hygiene/bathing products, childcare, and specialised cleaning products, and clothing/bedding (p<0.05 for all) compared to adults with AD. Children with AD had increased median total yearly OOP expenditures ($860 vs. $500, p=0.002) and were more likely to spend ≥$1000 OOP per year (48.9% vs. 40.0%, p=0.03). In children, yearly OOP expenses ≥$1000 were associated with increased AD severity, flares, HCP visits, prescription polypharmacy, and step-up therapy use (p<0.005 for all) compared with adults. Predictors of harmful financial impact among children included black race (adjusted OR [95% confidence interval]: 3.86 [1.66-8.98] p=0.002) and ≥$1000 annual OOP expenditures (6.98 [3.46-14.08], p<0.0001). Children with AD have unique and increased OOP expenses that are associated with significant disease burden. Strategies are needed to reduce OOP costs and improve clinical outcomes in children with AD.

VALUES AND PREFERENCES OF PATIENTS AND CAREGIVERS REGARDING TREATMENT OF ATOPIC DERMATITIS: A SYSTEMATIC REVIEW

<h3>Introduction</h3> Patient values and preferences can inform atopic dermatitis (AD) care. Systematic summaries of studies addressing patient and preferences have not been previously available. <h3>Methods</h3> Paired reviewers independently systematically screened MEDLINE, EMBASE, CENTRAL, PsychINFO, and CINAHL databases from inception until Feb 2022 for studies of patients with AD or their caregivers eliciting values and preferences about treatment, rated risk of bias, and extracted data. We used thematic and inductive content analysis to qualitatively synthesize the findings. GRADE-CERQual informed rating of quality of evidence. <h3>Results</h3> We identified 7780 studies of which 62 (n=19442; median age across studies 15 years [range 3-44]) proved eligible. High certainty evidence showed that patients and caregivers prefer to start with non-medical treatments and to step-up therapy with increasing AD severity. Moderate certainty evidence showed that side-effects from treatment are a significant concern. Low certainty evidence showed that patients and caregivers prefer odourless treatments that are not visible and have a low impact on daily life. Patients value treatments capable of relieving itching and burning skin and prefer to apply topical corticosteroids sparingly. Patients value a strong patient-provider relationship. <h3>Conclusion</h3> We systematically reviewed patient and caregiver values and preferences and identified 7 themes in relation to the management of AD: there is a preference to start with non-medical treatments, avoid negative side effects, relieve itching and burning, use steroids sparingly, use treatments with limited visibility or odour, use treatments with limited impact on daily activities, and a desire for a stronger patient-provider relationship.

Prospective Analysis of the Temporal Relationship between Psychological Distress and Atopic Dermatitis in Female Adults: A Preliminary Study

Atopic dermatitis (AD) has been associated with psychological distress, but few studies have examined the causal relationships. This study aimed to investigate whether stress, anxiety, or depression could lead to an increase in AD severity or vice versa in adults using a longitudinal study design. Daily diaries measuring psychological stress were completed over four weeks; validated questionnaires measuring stress, anxiety, depression, and AD severity were completed weekly for twelve weeks. Thirty-six participants (all female, aged 18–46 years) were recruited; complete data were returned from 19. Stress and disease severity were significantly correlated when measured daily and weekly for the duration of the study. Cross-lagged panel model (CLPM) analyses identified that for the weekly measures, stress, anxiety, and depression on week X significantly predicted disease severity on week X + 1. Disease severity on week X also predicted psychological stress, anxiety and depression on week X + 1 for the majority of the twelve weeks. There appears to be a bi-directional relationship between stress, anxiety and depression, and AD severity in women. High levels of distress should be identified so that optimum management strategies can be implemented to reduce the risk of increased AD severity and the resulting impact severity might have on psychological wellbeing.

33843 Atopic dermatitis polypharmacy and out-of-pocket health care expenses in the United States

Background: Atopic dermatitis (AD) out-of-pocket (OOP) expenses are substantial and impact household finances. Prescription polypharmacy and its association with out-of-pocket (OOP) expenses in AD is poorly understood. Objective: To characterize prescription polypharmacy and its association with OOP health care expenses among individuals with AD. Methods: An online survey was administered to National Eczema Association members (N = 113,502). Inclusion criteria (U.S. resident, age ≥18, self-reported or caregiver of individual with AD) was met by 77.3% (1118/1447) of respondents. Results: Polypharmacy (≥5 prescription treatments for AD in the past year) was associated with increased AD severity, poorer control, increased flares, increased healthcare provider visits (HCP), and comorbid asthma, allergic rhinitis, food allergy, and skin infections (P ≤ .01). Polypharmacy was also associated with biologic (dupilumab), oral immunosuppressant (azathioprine, cyclosporine, methotrexate, corticosteroids), oral antimicrobial, and topical calcineurin inhibitor use (P ≤ .0005). Respondents with polypharmacy had increased OOP expenditures across numerous categories including office visit co-pays, prescription medications both covered and not covered by insurance, hospitalization, emergency room visits, mental health services, non-prescription health products such as sleep aids, analgesics, and supplements, and alternative medications (P < .005). Individuals with polypharmacy had elevated yearly OOP expenses (median [range]: $1200 [$0-$200,000]), higher monthly OOP costs, and more harmful household financial impact (P < .0001 for all). Similar results were observed with a less stringent definition of polypharmacy (≥3 prescription treatments). Conclusion: Individuals with AD report considerable polypharmacy, which is associated with increased OOP expenses and significant financial impact. Strategies are needed to reduce polypharmacy, minimize OOP costs, and optimize clinical outcomes.

Effects of disease severity on sleep and quality of life in Taiwanese patients with atopic dermatitis

To the Editor: Atopic dermatitis (AD) has been known to be associated with reduced sleep quality and impaired quality of life (QoL).1,2 A previous study demonstrated that increased AD severity was significantly correlated with both QoL and sleep quality.3 Sleep disturbance was also more strongly associated with QoL than with AD severity.4 Previous studies used the SCORing Atopic Dermatitis index to evaluate disease severity, which may repeatedly measure the effects of sleep disturbance because it includes subjective loss of sleep.

Biofilm Propensity of Staphylococcus Aureus Skin Isolates Is Associated With Increased Atopic Dermatitis Severity and Barrier Dysfunction in the MPAACH Pediatric Cohort

Atopic dermatitis (AD) patients are commonly colonized with Staphylococcus aureus, and staphylococcal biofilms have been described in adult AD lesions. The commensal Staphylococcus epidermidis can antagonize S aureus, but its role in AD is unclear. These investigators sought to characterize S aureus and S epidermidis colonization and biofilm propensity and determine their association with AD severity, barrier function, and epidermal gene expression in an early-life cohort of children with AD.The Mechanisms of Progression of Atopic Dermatitis to Asthma in Children (MPAACH) cohort consists of children aged 1 to 2 years in the greater Cincinnati, Ohio area with either physician-diagnosed AD or a positive parental response to all 3 questions on the Children’s Eczema Questionnaire.A total of 500 children are being enrolled. The current study was focused on the first 400 MPAACH participants. Demographic, environmental, asthma trigger, and personal and family allergy and asthma history data were compiled. AD severity was documented with the Scoring of Atopic Dermatitis scale. Topical medications were withheld the night before the visit. The biofilm propensity of staphylococcal isolates was assessed by crystal violet assays. Gene expression of filaggrin and antimicrobial alarmins S100A8 and S100A9 were measured in keratinocyte RNA extracted from skin tape strips. Staphylococcal biofilms were visualized with scanning electron microscopy.Among the entire 400 children, 26.5% had positive cultures for S aureus, whereas 71% were positive for S epidermidis. A total of 62% of staphylococcal isolates formed moderate or strong biofilms, whereas 68% of those co-colonized with both staphylococcal species exhibited strains that formed cooperative mixed-species biofilms. Scanning electron microscopy verified presence of biofilms. S aureus strains showing higher relative biofilm propensity compared with S epidermidis were associated with increased AD severity and increased lesional and nonlesional transepidermal water loss. Biofilm propensity was associated with decreased FLG expression, which otherwise encodes filaggrin, a structural protein essential to prevent water loss.Collectively, these data suggest that, although S. aureus colonization is associated with increased AD severity, it is the ability of S. aureus to form strong biofilms and the balance between biofilm-forming S. aureus and S epidermidis strains that are particularly important factors affecting AD severity and barrier dysfunction.Biofilms are important in many complex disease processes, and atopic dermatitis appears to be no exception. Whether through genetic (eg, allergy and filaggrin mutations), environmental, or other factors, the altered skin barrier predisposes to S aureus colonization. This jibes with the common clinical observation that acute AD flares are often responsive to a course of both systemic and topical antistaphylococcal therapy while aggressively employing moisturizing measures.

Асоціації SNP rs_7927894 гена FLG та TARC/CCL17 з атопічним дерматитом у дітей

One of the main genetic factors of the development of atopic dermatitis (AD) in children are single nucleotide polymorphisms (SNP) of the filagrin gene (FLG), particularly rs_7927894 FLG. One of the mostly studied and promising AD marker chemokines (CK) is the thymusE and activation regulated chemokine (TARC/CCL17). Purpose – to detect the associations and role of different variants of SNP rs_7927894 FLG gene and TARC/CCL17 in children suffering different AD clinical proE files (CP) – isolated or combined with comorbid atopic disorders (AtD). Materials and methods. The main group comprised 39 patients aged 3 to 18 years, suffering the isolated AD or combined with comorbid AtD. The control group comprised 47 patients aged 3 to 18 years, suffering the pathology of gastrointestinal tract without clinical signs of atopy. All the patients of the main and control groups had undergone detection of the genotype variants of SNP rs_7927894 FLG gene by real-time polymerase chain reaction and detection of TARC/CCL17 serum concentrations in venous blood. The cutEoff value of statistical significance was set as p&lt;0.05. Results. The incidence and association of genotype variants C/C, C/T and T/T SNP rs_7927894 FLG gene in patients of cohorts of the studied groups were detected as follows: C/T rs_7927894 FLG was significantly the most common in the general main group (56.4%, p&lt;0.05), within the cohort of CP AD isolated (61.1%, p&lt;0.05) and CP of AD combined with comorbid AtD (52.4%, p&lt;0.05). There were detected the associations of studied SNP with AD: C/T rs_7927894 FLG is significantly directly associated with AD (r=0.291, p&lt;0.05), C/C rs_7927894 FLG has a reverse association with a trend to significance (r=-0.194, p=0.07). Mean serum concentrations of TARC/CCL17 did not differ significantly among patients cohorts of the main and control groups, respectively: general main group — 615.8 pg/ml, main with a CP AD isolated — 651.3 pg/ml, main with a CP of AD combined with comorbid AtD — 585.4 pg/ml, control — 608.4 pg/ml (p&gt;0.05). Associations of serum TARC/CCL17 concentrations were determined as follows: elevation trending to significance within increasing AD severity degree (r=0.290, p=0.07) and significant elevation within the AD exhacerbation period (r=0.426, p&lt;0.05). No significant association of TARC/CCL17 as to AD patients compared to the control group was detected in our study (r=-0.027, p&gt;0.05). Conclusions. The genotype heterozygote variant C/T rs_7927894 FLG is significantly the most common and associated with all AD CP in children — isolated and combined with comorbid AtD. Variant C/C rs_7927894 of FLG gene is significantly reversely associated with AD in children. Serum concentrations of TARC/CCL17 did not reveal any significant differences between the AD patients and nonEatopic ones. However, they significantly elevate within AD exacerbation phase and trending to significance within AD severity degree increase in children. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: atopic dermatitis, children, associations, polymorphism, filaggrin, thymus- and activation regulated chemokine.

Impact and Associations of Atopic Dermatitis Out-of-Pocket Health Care Expenses in the United States.

Atopic dermatitis (AD) is associated with substantial financial cost, including increased out-of-pocket (OOP) expenses. Associations and impact of OOP costs are poorly understood. The aim of the study was to characterize the impact and associations of OOP health care expenses for AD. A 25-question online survey was administered to National Eczema Association members (N = 113,502). Inclusion criteria (US residents aged ≥18 years; self-reported AD or primary caregiver of individual with AD) were met by 77.3% (1118 of 1447). Respondents with monthly OOP expenses greater than $200 were more likely to have increased AD severity, flares, health care provider visits, prescription polypharmacy, use of step-up therapy, frequent skin infections, and poorer disease control ( P < 0.005 for all). Respondents with OOP yearly expenditures greater than $1000 had similar associations and additionally increased rates of comorbid asthma, allergic rhinitis, and anxiety/depression ( P < 0.005 for all). A total of 64.6% (n = 624) reported harmful household financial impact of OOP expenses. Predictors of harmful impact included severe AD (adjusted odds ratio [95% confidence interval], 2.62 [1.11-6.19], P = 0.04), comorbid asthma (1.42 [1.07-1.87], P = 0.03), 5 health care provider visits or more in a year (2.80 [1.62-4.82], P = 0.0007), greater than $200 OOP monthly expenditures (2.16 [1.45-3.22], 0.0006), and $1000 annual OOP expenditures or more (4.56 [3.31-6.27], P < 0.0001). Out-of-pocket expenses for AD significantly impact household finances. Clinical interventions are needed to minimize OOP expenses while optimizing care outcomes.Capsule Summary:• Atopic dermatitis (AD) is associated with significant financial cost, including increased out-of-pocket (OOP) expenses, although the impact and associations of OOP health care expenses for AD management are not well understood.• The OOP health care expenses related to AD are associated with increased disease severity and health care utilization and significantly impact the household finances of patients and caregivers.• Health care providers should be mindful of the OOP financial burden related to AD management and engage in shared decision making to create a treatment plan that is practical and effective and minimizes household financial impact.

Evaluation of Plasma C-Reactive Protein as a Biomarker in Dogs with Atopic -Dermatitis Receiving Allergen-Specific Immunotherapy: A Pilot Study.

In this pilot study, we wished to determine if C-reactive protein (CRP) levels could be a useful severity or treatment biomarker for canine atopic dermatitis (AD). Nine atopic dogs received allergen immunotherapy for 1 year. Blood was collected before and at four re-evaluation visits. At each time point, the skin lesions were graded with the Canine Atopic Dermatitis Extent and Severity Index (CADESI) 4, and the plasma CRP levels were measured by Enzyme-linked Immunosorbent Assay (ELISA). We found a significant yet minimal correlation between the CRP levels and the CADESI4 scores. The CRP levels were not significantly different between dogs with AD of increasing severity. Finally, there was no correlation between the percentage change in CADESI4 and CRP values during immunotherapy. In conclusion, the lack of significant difference in CRP levels between dogs of increasing AD severity and lack of correlation between percentage changes in skin lesion and CRP values suggest that this protein would not be a clinically-useful biomarker in atopic dogs.

Treatment of adult atopic dermatitis patients according to disease characteristics and demographics.

Little is currently known about possible associations between disease specific characteristics of atopic dermatitis (AD) and use of medical treatments. We explored the use of AD treatments within the past 12 months in Danish adults according to distinct patient characteristics. Patients who had received a diagnosis of AD in a hospital in- or outpatient setting as adults were surveyed and data cross-linked to a national prescription registry. AD severity was measured by the Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD). A total of 3834 patients participated. Use of topical medication in the past 12 months increased with increasing AD severity, whereas no difference was observed for systemic medication use. Positive associations between AD in the face and neck, and use of mild and moderately potent topical corticosteroids were observed, while involvement of palms and chest was associated with use of more potent topical corticosteroids. The mean DLQI, skin pain, and itch severity scores were lower in patients managed only with topical corticosteroids (5.5, 3.2, and 4.3, respectively) compared to patients treated with both oral and topical medication (7.1, 3.8, and 5.0, respectively). Patients with frequent topical corticosteroid use tended to be older (50.7 vs 48.6 years), males (50.0% vs 33.6%), current daily smokers (17.3% vs 13.7%), and having asthma (59.1% vs 43.8%) compared with infrequent users of topical corticosteroids. We found a disconnect between the severity of AD signs and symptoms, and use of AD therapies. In particular, a very modest use of systemic immunosuppressants was seen even among patients with severe AD symptoms. However, the underlying clinical decisions and reasons behind this disconnect is not clear based on the current data.

Biofilm propensity of Staphylococcus aureus skin isolates is associated with increased atopic dermatitis severity and barrier dysfunction in the MPAACH pediatric cohort.

Atopic dermatitis (AD) patients are often colonized with Staphylococcus aureus, and staphylococcal biofilms have been reported on adult AD skin lesions. The commensal Sepidermidis can antagonize Saureus, although its role in AD is unclear. We sought to characterize Saureus and Sepidermidis colonization and biofilm propensity and determine their associations with AD severity, barrier function, and epidermal gene expression in the first US early-life cohort of children with AD, the Mechanisms of Progression of Atopic Dermatitis to Asthma in Children (MPAACH). The biofilm propensity of staphylococcal isolates was assessed by crystal violet assays. Gene expression of filaggrin and antimicrobial alarmins S100A8 and S100A9 was measured in keratinocyte RNA extracted from skin tape strips. Staphylococcal biofilms sampled from MPAACH skin were visualized using scanning electron microscopy. Sixty-two percent of staphylococcal isolates (sampled from 400 subjects) formed moderate/strong biofilms. Sixty-eight percent of subjects co-colonized with both staphylococcal species exhibited strains that formed cooperative mixed-species biofilms. Scanning electron microscopy verified the presence of staphylococcal biofilms on the skin of MPAACH children. Staphylococcus aureus strains showing higher relative biofilm propensity compared with Sepidermidis were associated with increased AD severity (P=.03) and increased lesional and nonlesional transepidermal water loss (P=.01, P=.03). Our data suggest a pathogenic role for Saureus biofilms in AD. We found that strain-level variation in staphylococcal isolates governs the interactions between Sepidermidis and Saureus and that the balance between these two species, and their biofilm propensity, has important implications for AD.

Higher self-reported severity of atopic dermatitis in adults is associated with poorer self-reported health-related quality of life in France, Germany, the U.K. and the U.S.A.

SummaryBackgroundBetter understanding of the relationship between atopic dermatitis (AD) severity and health‐related quality of life (HRQoL) could help improve knowledge of a more effective treatment for people with AD.ObjectivesTo assess the relationship between AD severity and HRQoL and perception of AD symptoms in adults with moderate‐to‐severe AD in Europe and the U.S.A.MethodsParticipants for this cross‐sectional, internet‐based survey were recruited from the larger population‐based National Health and Wellness Survey. AD severity was measured by Patient‐Oriented SCORing of AD. HRQoL was measured by the five‐level EuroQol‐5D, Dermatology Life Quality Index (DLQI) and Patient‐Oriented Eczema Measure (POEM).ResultsAltogether, 1232 respondents were included: 1098 (89·1%) with moderate‐to‐severe AD [221 (20·1%) from France, 209 (19·0%) from Germany, 118 (10·7%) from the U.K. and 550 (50·1%) from the U.S.A.]. An additional 134 (10·9%) respondents with mild AD were included. Sociodemographic and clinical AD characteristics were similar between countries. In adults with moderate‐to‐severe AD, higher AD severity correlated with poorer HRQoL (Spearman's r = –0·38 and 0·61 for EQ‐5D and DLQI, respectively; both P < 0·001). AD severity was positively correlated with POEM (Spearman's r = 0·51; P < 0·001). People with moderate‐to‐severe vs. those with mild AD had poorer health outcomes (EQ‐5D, DLQI and POEM, P < 0·001 for all). These results were similar and consistent for the European and the U.S. populations separately.ConclusionsHigher AD severity is associated with poorer HRQoL across Europe and the U.S.A. This is a burden for patients and may provide encouragement for more effective management of AD. What's already known about this topic? Atopic dermatitis (AD) is associated with a detrimental effect on health‐related quality of life (HRQoL), including sleep disturbance, anxiety and depression.Limited data describing the relationship between different levels of AD severity and self‐reported HRQoL have been published. What does this study add? There is a positive association between increasing AD severity (Patient‐Oriented SCORing of AD) and decreasing HRQoL (EQ‐5D and Dermatology Life Quality Index) and the perception of AD symptoms (Patient‐Oriented Eczema Measure) from the patient's perspective.AD severity according to geographic locations was explored (France, Germany, the U.K., and the U.S.A.), showing that the decreasing HRQoL associated with increasing AD severity was quite consistent between the geographic locations. What are the clinical implications of this work? The results of this study showed that higher AD severity is associated with poorer HRQoL from the subject’s perspective in both Europe and the US. This fact confirms that there is a burden for these patients and may provide encouragement for a more effective management of AD, especially among those with greater AD severity.

Clinical factors associated with peanut allergy in a high-risk infant cohort.

Prognostication of peanut allergy (PNA) is relevant for early interventions. We aimed to determine baseline parameters associated with the development of PNA in 3- to 15-month-olds with likely egg and/or milk allergy, and/or moderate to severe atopic dermatitis (AD) and a positive egg/milk skin prick test (SPT), but no known PNA. The primary endpoint was PNA [confirmed/convincing diagnosis or last classified as serologic PNA (<2years, ≥5kUA/L, otherwise ≥14kUA/L, peanut IgE)] among 511 participants (median follow-up, 7.3years). Associations were explored with univariate logistic regression; factors with P<0.15 were analyzed by stepwise multiple logistic regression, using data stratified by PNA status and randomly assigned to development and validation datasets. 205/511 (40.1%) had PNA. Univariate factors associated with PNA (P<0.01) included increased AD severity, larger egg and peanut SPT, greater egg, milk, peanut, Ara h1-h3 IgE, higher peanut IgG and IgG4, and increased pregnancy peanut consumption. P-values were between 0.01 and 0.05 for younger age, non-white race, lack of breastfeeding, and increased lactation peanut consumption. Using a development dataset, the multivariate model identified younger age at enrollment, greater peanut and Ara h2 IgE, and lack of breastfeeding as prognosticators. The final model predicted 79% in the development and 75% in the validation dataset (AUC=0.83 for both). Models using stricter or less strict PNA criteria both found Ara h2 as predictive. Key factors associated with PNA in this high-risk population included lack of breastfeeding, age, and greater Ara h2 and peanut-specific IgE, which can be used to prognosticate outcomes.

Nocturnal movements in children with atopic dermatitis have a timing pattern: A case-control study

Nocturnal movements in children with atopic dermatitis have a timing pattern: A case-control study

Atopic dermatitis characteristics and medication-use patterns in school-age children with AD and asthma symptoms.

Atopic dermatitis (AD) and asthma often coexist. Both diseases can have a major impact on the lives of children with AD and their caregivers. To investigate the association of patient characteristics, comorbidities and impact of AD on children who have both asthma and AD. Children with AD (n = 140) were selected from a larger cohort of children with a reported use of asthma medication. The Children's Dermatology Life Quality Index (CDLQI) was used to assess Quality of Life (QoL), and the Self-Assessed Eczema Area and Severity Index (SA-EASI) was used to measure AD severity. Characteristics assessed included: age, sex, and the number and type of atopic comorbidities. Medication use for AD was defined using the total number of AD prescriptions, the number of different topical AD prescriptions and the highest potency topical corticosteroid (TCS) used. Determinants of AD severity and QoL were evaluated using Spearman rank tests. The following factors were most strongly associated with a lower QoL: characteristics of AD lesions (Spearman Rs = 0.61-0.69, P < 0.01), a higher SA-EASI score (Rs = 0.54, P < 0.01) and a larger number of different topical AD prescriptions (Rs = 0.38, P < 0.01). The following factors were correlated with more severe AD: age (Rs = -0.36, P < 0.01), larger number of different TCS preparations used (Rs = 0.27, P < 0.05) and larger number of TCS prescriptions (Rs = 0.25, P < 0.05). In children with asthma and AD, the number of TCS preparations used is associated with lower QoL and increased AD severity.