Life Of Atopic Dermatitis Patients Research Articles

Quantifying Nocturnal Scratch in Atopic Dermatitis: A Machine Learning Approach Using Digital Wrist Actigraphy.

Nocturnal scratching substantially impairs the quality of life in individuals with skin conditions such as atopic dermatitis (AD). Current clinical measurements of scratch rely on patient-reported outcomes (PROs) on itch over the last 24 h. Such measurements lack objectivity and sensitivity. Digital health technologies (DHTs), such as wearable sensors, have been widely used to capture behaviors in clinical and real-world settings. In this work, we develop and validate a machine learning algorithm using wrist-wearing actigraphy that could objectively quantify nocturnal scratching events, therefore facilitating accurate assessment of disease progression, treatment effectiveness, and overall quality of life in AD patients. A total of seven subjects were enrolled in a study to generate data overnight in an inpatient setting. Several machine learning models were developed, and their performance was compared. Results demonstrated that the best-performing model achieved the F1 score of 0.45 on the test set, accompanied by a precision of 0.44 and a recall of 0.46. Upon satisfactory performance with an expanded subject pool, our automatic scratch detection algorithm holds the potential for objectively assessing sleep quality and disease state in AD patients. This advancement promises to inform and refine therapeutic strategies for individuals with AD.

Content validity of the EQ-5D-5L with skin irritation and self-confidence bolt-ons in patients with atopic dermatitis: a qualitative think-aloud study.

Two bolt-on dimensions (skin irritation, self-confidence) have been developed for the EQ-5D-5L to improve its content validity and responsiveness in psoriasis. However, the two bolt-ons are not strictly psoriasis-specific and are potentially relevant in other skin conditions. This study aims to explore the content validity of the EQ-5D-5L with two bolt-ons in patients with atopic dermatitis (AD). In 2021-2022, qualitative, semi-structured interviews were conducted with 20 adult AD patients at a university dermatology clinic in Hungary. We aimed for a heterogeneous sample in terms of age, gender, education and disease severity. Patients completed the EQ-5D-5L with two bolt-ons using a think-aloud protocol. Probing questions were posed to investigate item relevance, potential conceptual overlaps, missing concepts and the appropriateness of the recall period. Interview transcripts were subjected to thematic analysis. The EQ-5D-5L with the two bolt-ons covered the most important aspects of health-related quality of life in AD patients. Most patients found both the skin irritation and self-confidence bolt-ons relevant. Fifteen potential missing concepts were identified, but only two (social relationships, judgement by others) were identified by more than one patient. A smaller conceptual overlap was found between the skin irritation and pain/discomfort dimensions in 7 patients (35%). Half the patients expressed a preference for a recall period of 1week rather than of 'today'. The EQ-5D-5L with skin irritation and self-confidence bolt-ons showed good relevance, comprehensiveness and comprehensibility in patients with AD. However, in terms of comprehensiveness, social relationships and judgement by others (stigma) may be missing from the questionnaire.

Sodium thiosulfate ameliorates atopic dermatitis via inhibiting the activation of NLRP3 inflammasome

Atopic dermatitis (AD) is a common disease with a considerable impact on the patient's quality of life and limited treatment options. Sodium thiosulfate (STS) is a traditional medicine used in the rescue of cyanide poisoning, and some pruritus dermatosis. However, the exact efficacy and mechanism of its application on AD are not clear. In this work, comparing to other traditional therapy, STS was found to effectively improve the severity of skin lesions and the quality of life in AD patients with a dose-dependent manner. Mechanically, STS downregulated the expression of IL-4, IL-13, IgE in the serum of AD patients, as well as reduce the concentration of eosinophils. Furthermore, in the AD-like mice model triggered by ovalbumin (OVA) and calcitriol, STS was found to reduce the epidermal thickness, scratching times, and the infiltration of dermal inflammatory cells in AD mice, as well as the reactive oxygen species (ROS) production and the expression levels of inflammatory cytokines in the skin tissue. In HacaT cells, STS inhibited the accumulation of ROS and activation of NLRP3 inflammasome and its downstream IL-1β expression. Therefore, this study revealed that STS plays an important therapeutic role in AD, and the mechanism may be that STS inhibits the activation of NLRP3 inflammasome and the subsequent release of inflammatory cytokines. Thus, the role of STS in treating AD was clarified and the possible molecular mechanism was revealed.

Position statement on the role of nurses in therapeutic patient education in atopic dermatitis.

In chronic skin diseases such as atopic dermatitis (AD), therapeutic failure due to poor patient adherence to treatment is commonly reported. Therapeutic patient education (TPE) is an approach to improve self-management and adherence. Several studies demonstrated that TPE programmes have positive effects on disease management resulting in decreased disease severity and improved quality of life in AD patients. Various healthcare professionals (dermatologists, nurses, psychologists, dieticians) have been involved. TPE performed by trained dermatology nurses are highly efficient and improve various health-related outcomes. The aim of this position paper is to analyse the aims, modalities and efficacy of TPE in AD, to identify specific roles of dermatology nurses, to assess qualification requirements, and to propose practical recommendations. Potential activities of nurses in ongoing and future TPE programmes for AD patients will be discussed.

Work ability and quality of working life in atopic dermatitis patients treated with dupilumab.

Atopic dermatitis is associated with work productivity loss. Little is known about how patients perceive their work ability and quality of working life, and how this is affected by treatment. Our primary objective was to investigate work ability and quality of working life at baseline and during treatment in the long term. A registry‐embedded prospective observational cohort study was conducted consisting of patients with atopic dermatitis starting dupilumab in routine clinical care. The instruments used were the Work Ability Index (WAI; questions 1, 2, and 3) and the Quality of Working Life Questionnaire (QWLQ). Ninety‐three patients were included of whom 72 were (self‐)employed (77%). From baseline to 48 weeks, the mean WAI‐1 score (general work ability, range 0–10) improved from 6.8 (±2.0) to 7.9 (±1.3), WAI‐2 (physical work ability, range 1–5) from 3.7 (±0.9) to 4.3 (±0.7), and WAI‐3 (mental/emotional work ability, range 1–5) from 3.4 (±0.9) to 3.9 (±0.8) (p = 0.001, p = 0.005, p < 0.001, respectively). The mean QWLQ total score improved from 74.0 (±9.1) to 77.5 (±9.6) and subscale “Problems due to health situation” improved from 37.4 (±22.3) to 61.5 (±23.1) (range 0–100; p = 0.032, p < 0.001, respectively). In conclusion, patients with moderate‐to‐severe atopic dermatitis starting dupilumab report decreased work ability and quality of working life, mainly due to health‐related problems. Significant improvement of work ability and quality of working life is observed with dupilumab treatment.

Effectiveness of antihistamines for itch and sleep disturbance in atopic dermatitis: a retrospective cohort study

Introduction: Atopic dermatitis (AD) is a common and debilitating condition, with pruritus being the hallmark symptom responsible for negative quality of life in AD patients. Oral antihistamines are commonly used to manage itch in AD, but evidence of its efficacy is lacking and debatable. Methods: A retrospective cohort study on patients with AD treated with antihistamines was conducted at the National Skin Centre from January 2015 to December 2018. Severity of disease was measured using the SCORing Atopic Dermatitis (SCORAD) index. Data was analyzed using a mixed-effects linear model to account for repeated measures on the same individual. Results: There were 161 unique patients with 380 treatment outcomes included in our analysis. Patients who were treated with antihistamines had higher baseline itch and sleep disturbance scores compared with those who were not. We found that the use of antihistamines resulted in significant improvement in itch and sleep disturbance scores with respective mean decreases of 0.67 [95% confidence interval (CI): 0.07, 1.27; P=0.03] and 0.87 (95% CI: 0.22, 1.52; P=0.01) compared with patients not treated with antihistamines. Specifically, second-generation antihistamines improved itch and sleep disturbance scores better than first-generation antihistamines, with a decrease of 0.65 (95% CI: −0.59, 1.88) and 0.61 (95% CI: −0.66, 1.88), respectively, although the difference in effect was not significant. Meanwhile, antihistamine use did not significantly improve total SCORAD and objective SCORAD scores. Conclusion: Treatment with second-generation antihistamines, may be an appropriate treatment modality for managing itch and sleep disturbance in patients with AD.

Importance of food in the control of inflammation in atopic dermatitis.

Patients that suffer from inflammatory diseases need to pay special attention to nutrition. For this reason, it is very important to change the approach of both health professionals and food industry specialists. There must be a close collaboration, starting from research, the development phase of foods for special nutrition states. Our primary objective was to identify foods or potential dietary ingredients, which efficacy in the treatment of atopic dermatitis had been scientifically demonstrated in vitro, in vivo and clinically. Furthemore, our perspective is presented regarding the research and development of foods for special nutritional states in atopic dermatitis. The PubMed database was analyzed for the period 2018-2020, as well as the European Legislation regarding the appropriate requirements for the composition and knowledge applicable to foods destined for use in special medical purposes. The search criteria were 'chronic dermatitis', 'atopic dermatitis', 'psoriasis', 'alternative treatments', 'natural treatments', 'complementary treatments', 'treatments for chronic dermatitis'. We also looked for undesirable effects or side effects of the foods included in the research in order to treat atopic dermatitis. The results showed that prebiotics, probiotics and certain plant extracts had a high efficacy in controlling inflammation in atopic dermatitis. The food development research for special nutrition states (atopic dermatitis) involves a multidisciplinary team. We started with the establishment of the general objective and continued with the consultation of the PubMed, EMBASE and other databases, and with the in vitro, preclinical and/or clinical determination of the efficacy of new developed foods, that must be protected with patents. The development of foods for special nutrition states represents a solution for improving the quality of life of atopic dermatitis patients.

Direct-Access Online Care for the Management of Atopic Dermatitis: A Randomized Clinical Trial Examining Patient Quality of Life.

Atopic dermatitis (AD) is a chronic disease requiring regular follow-up. To increase access to dermatological care, online management of AD is being studied. However, a critical knowledge gap exists in determining AD patients' quality of life in direct-to-patient online models. In this study, we examined quality of life in AD patients managed through a direct-access online model. We randomized 156 patients to receiving care through a direct-access online platform or in person. Patients were seen for six visits over 12 months. At each visit, the patients completed Dermatology Life Quality Index/Children's Dermatology Life Quality Index (DLQI/CDLQI), and Short Form (SF-12). Between baseline and 12 months, the mean (standard deviation, SD) within-group difference in DLQI score in the online group was 4.1 (±2.3); for the in-person group, the within-group difference was 4.8 (±2.7). The mean (SD) within-group difference in CDLQI score in the online group was 4.7 (±2.8); for the in-person group, the within-group difference was 4.9 (±3.1). The mean (SD) within-group difference in physical component score (PCS) and mental component score (MCS) SF-12 scores in the online group was 6.5 (±3.8) and 8.6 (±4.3); for the in-person group, it was 6.8 (±3.2) and 9.1(±3.8), respectively. The difference in the change in DLQI, CDLQI, SF-12 PCS, and SF-12 MCS scores between the two groups was 0.72 (95% confidence interval [90% CI], -0.97 to 2.41), 0.23 (90% CI, -2.21 to 2.67), 0.34 (90% CI, -1.16 to 1.84), and 0.51 (90% CI, -1.11 to 2.13), respectively. All differences were contained within their equivalence margins. Adult and pediatric AD patients receiving direct-access online care had equivalent quality of life outcomes as those see in person. The direct-access online model has the potential to increase access to care for patients with chronic skin diseases.

The Psychosocial Impact of Atopic Dermatitis.

Atopic dermatitis is a chronic skin condition which has significant psychosocial and quality of life impact. The condition causes physical discomfort, emotional distress, embarrassment, social stigma and daily activity limitation. In an effort to assess these aspects of disease burden, quality of life measurement tools were developed. Through use of these tools, we have expanded our knowledge of the psychosocial and quality of life burden of this condition. A variety of quality of life assessment tools exist, yet there is no consensus on which tool is best suited to assess the quality of life impact of atopic dermatitis. Research studies assessing quality of life in atopic dermatitis patients utilize a variety of quality of life measurement tools; this complicates comparisons across research studies. Though comparison across studies is difficult, the data echoes tremendous overall burden of disease, especially pertaining to psychosocial status and life quality.

適切な顔面のスキンケアがアトピー性皮膚炎患者の皮膚生理機能と QOL に及ぼす影響

2009 年 11 月から 2010 年 5 月の間，東北大学病院および島根大学医学部附属病院を定期的に受診し外用ならびに内服治療によって症状が安定している 20 歳以上のアトピー性皮膚炎患者 40 例の顔面に対し，スキンケア指導とともにスキンケア剤を 8 週間使用した。担当医師は，試験開始時に患者に対し洗顔や保湿方法を指導し，スキンケア剤として乾燥性皮膚に対し開発された「ノブ ® シリーズ」を使用させるとともに皮膚生理機能と QOL への影響を検討した。全例において 8 週間の継続使用ができた。1 例において塗布部位での紅斑と乾燥の軽度の悪化を認めたが，試験品との因果関係は不明であった。試験開始時および終了時に担当医師による皮膚所見を得て，さらに角層水分量，経表皮水分喪失量，皮表脂質量，テープストリッピングにより得た皮表角層細胞の細胞面積，角層中のセラミドおよびロリクリンなどを測定し，皮膚疾患特異的 QOL 尺度である Skindex-16 とともにそれぞれに有意な差を認めた。これらの結果から，医療治療によって症状が安定しているアトピー性皮膚炎患者に対し，適切なスキンケア (スキンケア指導およびスキンケア剤) が皮膚生理機能と QOL を改善することが明らかとなった。

Effectiveness of the Atopy Camp for Primary School Students in Seoul

Purpose:In this study, we attempted to analyze the effectiveness of the atopic dermatitis camp for primary school students in the Seoul area. Methods:Seoul city's atopy camp 2010 was conducted 10 times from May 22nd to October 24th for primary school students at an atopy friendly school and their parents. A total of 374 atopic dermatitis patients participated in the camp and questionnaires for 363 were analyzed, except 11 participants who had left several questions unanswered. In a 3-month follow-up survey, 167 partici- pants out of 374 responded to the mailing questionnaire to evaluate the efficiency of the camp. The response rate was 44.7%. Results:Satisfaction with the educational program of the camp was higher for lower grade students than for higher grade students.(P 0.001) Before camp, higher grade students ( ˂ P 0.001) or students ˂ with severe symptoms were more knowledgeable of atopic dermatitis.(P 0.01) After the camp, ˂ the higher the grade, the more the knowledge the student had about atopic dermatitis.(P 0.001) ˂ Three months after the camp, there was positive change in the lifestyle of atopic dermatitis patients.(P 0.001) ˂ Conclusion: Knowledge on atopic dermatitis increased and the lifestyle of atopic dermatitis patients was improved due to the camp. Consequently, Seoul city's atopy camp can be utilized as a method to improve the quality of life of atopic dermatitis patients and their family. And Seoul city's atopy camp is expected to be a model for atopy camps in other local communities. (Pediatr Allergy Respir Dis(Korea) 2012;22:154-162)

Clinical analyses of atopic dermatitis in the aged

The aim of the present study was to analyze the characteristics of atopic dermatitis (AD) in the senile phase. Subjects were comprised of 16 patients investigated for clinical features, serum immunoglobulin (Ig)E levels and skin manifestations. Mean age was 76.9 +/- 6.2 years (range, 68-87), with a man : woman ratio of 3:1. Mean age at onset was 67.7 +/- 15.7 years. Eight patients (50%) had personal histories of chronic eczema until the young adult phase and three patients (18.8%) showed the classic course of child AD. Eczematous erythroderma in 10 patients (62.5%) and unclassified chronic eczema in five patients (31.3%) were the predominant clinical presentations. Mean total IgE level in sera of the 16 patients was 8810 +/- 13 511 IU/mL (range, 5-53 605). Fourteen patients showed positive results for antigen-specific IgE antibodies, and the mean total IgE level for these patients was 10 056 +/- 14 044 IU/mL. Specific IgE to the main antigen, Dermatophagoides farinae, was observed in 12 patients (85.7%), representing the principal antibody in eight patients (57.1%). Eczematous dermatitis manifested predominantly in the face and neck, trunk and extensor and flexure sites of extremities, and less commonly in the antecubital and popliteal areas. Other stigmata of AD were observed as follows: red face in 10 patients (62.5%); Hertoghe's sign in six (37.5%); goose-skin in four (25%); facial pallor in three (18.8%); and dirty neck in one (6.3%). These results indicate that senile-type AD represents a characteristic subgroup of AD that appears in the last stage of life in AD patients.

Quality of Life in Atopic Dermatitis Patients and Evidence Based Medicine

Quality of Life in Atopic Dermatitis Patients and Evidence Based Medicine