Mean SCORing Atopic Dermatitis Research Articles

Real-World Clinical, Psychosocial, and Economic Burden of Atopic Dermatitis: Results From the ESSENTIAL AD Multicountry Study.

Limited real-world evidence exists about the burden of atopic dermatitis (AD) in patients receiving systemic or non-systemic therapies in clinical practices. ESSENTIAL AD was an observational study that aimed to fill this information gap. ESSENTIAL AD enrolled (September 2021-June 2022) adult patients with physician-confirmed AD that was routinely managed with systemic and non-systemic treatment in a real-world setting from 15 countries in Eastern Europe, the Middle East, and Africa. Primary outcome variables were Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (SCORAD), and Dermatology Life Quality Index (DLQI) assessed during one office visit. A total of 799 enrolled patients fulfilled selection criteria and were included in the study. Patients mean (standard deviation [SD]) age was 36.3 (14.4) years, 457 (57.2%) were female, and the majority of patients were white (647 [81.0%]). Mean (SD) time since AD diagnosis was 17.6 (15.2) years (median 16.5; interquartile range [IQR] 3.3-26.8). The mean (SD) EASI, SCORAD, and DLQI total scores were 11.3 (11.3 [median 8.1; IQR 3.6-15.8]), 37.8 (17.9 [median 35.5; IQR 24.2-49.0]), and 10.6 (7.2 [median 10.0; IQR 5.0-15.0]), respectively. Patients receiving systemic treatment had significantly higher disease burden (mean [SD] EASI 13.3 [13.0]; median [IQR] 9.6 [3.9-17.9]) versus non-systemic treatment (mean [SD] 9.3 [8.7]; median [IQR] 6.8 [3.0-13.2]; P < 0.0001). Results were similar for SCORAD (39.9 [19.6] vs 35.6 [15.7]; median [IQR] 38.6 [24.7-53.1] vs 32.6 [23.9-44.6]; P = 0.0017), and DLQI total scores (11.4 [7.4] vs 9.9 [6.9]; median [IQR] 11.0 [5.0-16.0] vs 9.0 [5.0-14.0]; P = 0.0033, respectively). Patients with AD continue to have substantial disease burden despite treatment with systemic therapy, suggesting that a need for effective disease management remains, including effective therapies that improve psychological outcomes and reduce economic burden of AD, in Eastern Europe, the Middle East, and Africa.

Efficacy and Tolerability of a Novel Topical Treatment Containing Pea Protein and Xyloglucan in the Management of Atopic Dermatitis in Children: A Prospective, Multicenter Clinical Study.

Atopic dermatitis (AD) is a chronic disease that occurs mainly in children. Topical corticosteroids are the main treatment for mild to moderate AD, although they can induce side effects. The efficacy and tolerability of xyloglucan and pea protein (XG-PP) was compared with hydrocortisone in pediatric patients with AD as a steroid-sparing solution. A prospective, multicenter, comparative study enrolled 42 patients (age 0.5-12years) with mild-to-moderate AD, assigned 1:1 to XG-PP or hydrocortisone ointment. Treatments were applied twice daily for 14 consecutive days and assessed at baseline, day8, and day15. Efficacy endpoints were AD Severity Index (ADSI) score, Scoring Atopic Dermatitis (SCORAD) index, and Patient-Oriented Eczema Measure (POEM). Tolerability was assessed by the occurrence of adverse events (AEs). Both treatments significantly improved ADSI mean score from baseline to day15; in the XG-PP arm, ADSI score decreased from 10.55 to 4.15 (p = 0.00001), and in the hydrocortisone arm, from 10.65 to 4.30 (p = 0.0001). In the XG-PP arm, the mean SCORAD score decreased from 65.86 to 30.26 (p = 0.00001) and in the hydrocortisone arm from 68.84 to 31.19 (p = 0.0001) at day15. An overall decrease from moderate to mild AD for both arms (p = 0.0001) was observed with POEM. For all the three indexes evaluated, no statistical significant differences between the study arms evolution from baseline to day8 or to day15 were found. No AEs were reported. XG-PP provided a comparable efficacy to hydrocortisone ointment in managing AD, thus representing a safe and effective steroid-sparing alternative in pediatric patients with AD. Retrospectively registered on 24 November 2021 in the ISRCTN registry: 11118799.

Ocular manifestations of children with atopic dermatitis in Saudi Arabia.

To examine the incidence of ocular abnormalities in children with atopic dermatitis (AD) in Saudi Arabia and its association with the severity of AD. This is a cross-sectional study on 50 children with AD who were between 5 and 16 years of age. The severity of AD was evaluated using the SCORing Atopic Dermatitis (SCORAD) index. All the children underwent slit lamp exams, visual acuity assessment, intraocular pressure measurement, and corneal topography. The children were considered to have an ophthalmic abnormality if one or more of the following signs were present: glaucoma, keratoconus suspicion, in addition to lid, conjunctival, corneal, lenticular, or retinal abnormalities. Based on the SCORAD severity index, 14% of children had mild AD (7/50), 38% had moderate AD (19/50), and nearly half had severe AD. More than half the children exhibited facial involvement, and half had peri-orbital signs. The mean SCORAD index was 35.75. The mean age was 10.48±3.6y, and the cohort showed a slight male predominance (54% males). Both eyes of the 50 children in the cohort were studied. Based on the ocular examinations, 92% of the patients showed ocular abnormalities: lid abnormalities (27/50) followed by keratitis (22/50). Four patients had moderate risk for keratoconus in one eye and eight patients were suspected to have keratoconus. However, SCORAD severity index was not associated with age, sex, or the number or presence of ophthalmic abnormalities. This is the first study in Saudi Arabia to evaluate the prevalence of ocular manifestations in children with AD. The results indicate that the majority of children with AD have ocular abnormalities that mainly include lid abnormalities. Based on these findings, larger scale studies are needed to affirm whether regular screening for ophthalmic abnormalities would be beneficial for children with AD in terms of early intervention and prevention of sight-threatening complications.

34297 Dupilumab provides long-term improvement in sleep loss in children, adolescents, and adults with atopic dermatitis

Background: Sleep disturbance impacts quality-of-life and overall health of patients with atopic dermatitis (AD). In adults, adolescents, and children with AD, we evaluated the efficacy of dupilumab treatment up to 1 year (1Y; adults = 52 weeks; adolescents/children = 48 weeks) on sleep, using SCORing AD (SCORAD) sleep loss score (0 [no sleeplessness]–10 [worst imaginable sleeplessness], recall period: 3 days/nights). Methods: Data of patients who continuously received dupilumab in the 16-week parent studies and subsequent extension trials are reported. We included 80 adults with moderate-to-severe AD who optimally responded (achieved Investigator’s Global Assessment score 0/1 or 75% improvement from baseline in EASI) to dupilumab 300 mg every 2 weeks (q2w) in LIBERTY AD SOLO 1/2 (NCT02277743/NCT02277769) and continued dupilumab monotherapy in SOLO-CONTINUE (NCT02395133); 73 adolescents (aged 12-17) with moderate-to-severe AD who received dupilumab 200/300 mg-q2w monotherapy (weight-dependent) in LIBERTY AD ADOL (NCT03054428) and continued with dupilumab 300 mg-q4w in LIBERTY AD PED-OLE (NCT02612454); and 162 children (aged 6-11) with severe AD who received dupilumab+TCS (<30 kg:300 mg-q4w/≥30 kg:300 mg-q4w/≥30 kg:200 mg-q2w) in LIBERTY AD PEDS (NCT03345914) and continued with dupilumab 300 mg-q4w in PED-OLE. Results: Patients in all age groups reported sustained improvement in sleep up to 1Y. Baseline/Wk16/1Y mean SCORAD sleep loss scores for adults and adolescents were 5.2/0.9/1.1 and 5.3/2.0/1.3, respectively. In children (<30 kg-q4w/≥30 kg-q4w/≥30 kg-q2w; q4w in PED-OLE), corresponding scores were 6.7/6.8/5.4 (baseline); 2.1/2.3/1.3 (Wk16); and 1.5/1.8/1.4 (1Y). Dupilumab was generally well tolerated with a favorable safety profile. Conclusion: Dupilumab treatment up to 1Y provided sustained improvement in sleep loss in children with severe AD, and adolescents and adults with moderate-to-severe AD.

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

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

Stratification of atopic dermatitis patients by patterns of response to proactive therapy with topical tacrolimus: low serum IgE levels and inadequately controlled disease activity at the start of treatment predict its failure

Purpose Topical calcineurin inhibitors (TCIs) are an important anti-inflammatory drug for treating atopic dermatitis (AD). However, those treatment responses are variable. In this study, we stratified AD patients by patterns of response to remission maintenance therapy (proactive therapy) with topical tacrolimus, a typical TCI. Thereafter, we explored patient features that predict the success or failure of proactive therapy using TCI (TCI proactive therapy). Methods A single-arm open-label clinical study aimed to evaluate the efficacy of TCI proactive therapy was conducted in 31 patients with AD. Patients were treated with TCS to induce remission (remission-induction period) followed by daily TCI ointment (0.1% tacrolimus) application for 4 weeks (maintenance therapy period), and twice-weekly application for 12 weeks (proactive therapy period). Based on its results, treatment outcomes were correlated with the patients’ clinical and laboratory findings. Results Of the 31 patients enrolled in the study, 21 successfully completed maintenance therapy (TCI responders). Among them, 13 completed (proactive-completed group) and 8 failed proactive therapy (proactive-dropout group). At the beginning of maintenance therapy, the serum IgE level was significantly higher in the TCI responders than in those who failed maintenance therapy (p = 0.049). At the beginning of proactive therapy, the mean-SCORing Atopic Dermatitis (SCORAD) score was significantly different between the proactive-completed (11.7 ± 4.6) and proactive-dropout (16.6 ± 4.2) groups (p = 0.025). In proactive-dropout group patients, worsened disease activity correlated well with the elevation of serum lactate dehydrogenase (LDH) and Thymus and activation-regulated chemokine (TARC) levels and peripheral eosinophil count. Conclusion AD patients were stratified into three different response patterns to TCI proactive therapy. Patients with less involvement of IgE in the pathogenesis and inadequate remission induction by TCS may not be expected to respond well to TCI proactive therapy. Key messages AD patients can be stratified into three types according to their pattern of responsiveness to TCI proactive therapy. The efficacy of TCI proactive therapy is lower in AD patients with lower serum IgE levels. TCI proactive therapy should be done after the achievement of adequate remission induction by TCS.

Multidisciplinary management of chronic atopic dermatitis in children and adolescents: a prospective pilot study

Background Atopic dermatitis (AD) is a chronic, pruritic disorder affecting 10–20% of children and is associated with psychological issues and impaired quality of life (QoL). The role of psychosocial support in the treatment of AD is increasingly important. We studied the impact of a multidisciplinary clinic (MDC) in the management of AD in a tertiary children’s hospital in Singapore. Methods We performed a prospective pilot interventional study on 34 pediatric patients with AD and concomitant psychosocial impairment. Patients were recruited into an MDC, comprising a dermatologist, clinical psychologist and medical social worker. AD severity was scored using Scoring Atopic Dermatitis (SCORAD), while QoL was assessed using the Children’s Dermatology Life Quality Index Questionnaire (CDLQI) and Family Dermatology Life Quality Index Questionnaire (FDLQI). Biopsychosocial assessments and interventions were also performed. Eighty-three percent of patients received cognitive behavioral therapy, while 40% received social work intervention. Results There was an overall improvement in mean SCORAD, CDLQI, and FDLQI scores across MDC visits. A correlation between AD severity and QoL was established. A patient satisfaction survey showed improvement in severity, understanding, and control of the disease. Conclusion Our study suggests the effectiveness of a multidisciplinary approach in managing pediatric AD patients with psychosocial co-morbidities.

Dead Sea climatotherapy versus topical steroid treatment for atopic dermatitis children: long-term follow-up study

The aim of this study was to compare long-term results of 4 weeks Dead Sea climatotherapy at the Deutsches Medizinisches Zentrum, Israel to those obtained by classical topical treatment for moderate-to-severe atopic dermatitis. Seventy-two children from the Czech Republic were divided into three groups of 24 and treated during three periods (March 2014, October 2014 and March 2015) with gradually increasing sun exposure during 28 consecutive days. Forty-four children were treated with steroid creams at the Department of Dermatovenereology, Third Faculty of Medicine, Charles University and University Hospital of Kralovske Vinohrady, Prague, Czech Republic. The primary outcome was the change in the SCORing Atopic Dermatitis (SCORAD) index, recorded after 1 month of treatment (immediately after DSC) and 3, 6, 9, 12, and 18 months later in Prague. The mean SCORAD improvement was 87.5 ± 13.4% after 4 weeks at the Dead Sea and 86.1 ± 11.3% after 1 month of treatment with steroid creams in the Czech Republic. All 44 patients treated in Prague participated in this 18-month follow-up study, whereas only 47 patients (65.3%) after DSC treatment. Good clinical results were maintained in both groups and mean SCORAD values were stable and low, around 5.

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

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

Clinicoepidemiologic Profile and the Cutaneous and Nasal Colonization with Methicillin-Resistant Staphylococcus aureus in Children with Atopic Dermatitis from North India.

Background:There is a paucity of literature about the atypical clinical manifestations in children with atopic dermatitis (AD) in Asian setting, and colonization with methicillin-resistant Staphylococcus aureus (MRSA), and its association with disease severity, if any.Objective:To elucidate atypical clinical patterns of AD in children and to determine the MRSA isolation and its association with disease severity.Methods:We studied 55 pediatric patients from 2 months to 10 years of age, of either sex, diagnosed with AD based on the diagnostic criteria of Hanifin and Rajka. History, clinical examination (including atypical features), and severity score using SCORing Atopic Dermatitis (SCORAD) severity index were recorded. Swabs from the cutaneous lesion and anterior nares were collected from each case and processed. Statistical analysis was done by SPSS (V 17).Observations and Results:Atypical clinical features were seen in 52.7% of cases. Retroauricular fissures (among atypical features), oozing, crusting, darkening, early age at onset, and nipple eczema were found to be significantly associated with disease severity (P < 0.05). The majority of the cases (56.4%) fell in the moderate disease severity (mean SCORAD 32.02). MRSA showed an isolation frequency of 7.27% from the skin swabs and 10.90% from the nares. No significant association was found between Staphylococcus aureus isolates (including MRSA) and disease severity in our study. A high degree of fluoroquinolone resistance was noted in MRSA isolates.Limitation:Further characterization of S. aureus by superantigen profiling was not done.Conclusion:Patients with AD need to be evaluated for atypical features which may serve as markers of severe disease.

The efficacy of wet wrap therapy in children with atopic dermatitis in a single center

Purpose: Wet wrap therapy is a well-known treatment for severe atopic dermatitis (AD). However, wet wrap therapy with usual ban dage was a troublesome and time-consuming process of application. The aim of this study was to evaluate the efficacy, safety and convenience of wet wrap therapy with new garments in children with moderate-to-severe AD. Methods: We compared 56 AD children treated with wet wrap therapy and 14 AD children treated with only conventional therapy. We retrospectively reviewed the clinical features, change of SCORing Atopic Dermatitis (SCORAD) index, adverse effects and par ent’s reports. Results: The initial mean SCORAD index was 60.3±15.3 points. No significant differences in sex, age, initial SCORAD index, total eo sinophil count, total IgE level, food allergen sensitization, inhalant allergen sensitization or associated allergic diseases were found between the wet wrap and conventional groups. The pharmacological and nonpharmacological interventions except wet wrap therapy were same in the 2 groups. Wet wrap therapy with garments or tubular bandage was easily done one time per day over night in 10.6±3.5 days by parents. Improvement in total SCORAD index, intensity, subjective symptoms and pruritus were signifi cantly higher in the wet wrap group than in the conventional group (36.2 vs. 26.9, 6.0 vs. 4.0, 9.9 vs. 7.4, and 4.8 vs. 3.6 points). No fol liculitis and serious adverse effects were reported. Conclusion: Wet wrap therapy with new garments could be easily done by parents. Wet wrap therapy may be effective and safe in controlling moderate-to-severe AD in children. (Allergy Asthma Respir Dis 2019;7:13-21)

Effect of synbiotic supplementation on children with atopic dermatitis: an observational prospective study

The objective of this observational single-cohort prospective study was to assess the effect of synbiotic supplementation for 8 weeks in children with atopic dermatitis (AD). The synbiotic product contained Lactobacillus casei, Bifidobacterium lactis, Lactobacillus rhamnosus, Lactobacillus plantarum, fructooligosaccharide, galactooligosaccharide, and biotin. Patients were examined at baseline and at 8 weeks. Effectiveness of treatment was assessed with the Scoring Atopic Dermatitis (SCORAD) index. A total of 320 children (mean age 5.1 years, range 0–12 years) were included. The mean (SD) SCORAD index decreased from 45.5 (15.5) at baseline to 19.4 (14.6) at the end of treatment (P < 0.001), VAS score for pruritus decreased from 5.7 (2.2) to 2.3 (2.2) (P < 0.001), and VAS score for sleep decreased from 3.1 (2.5) to 1.1 (1.8) (P < 0.001). Percentage of children with moderate-severe disease decreased from 92.4% at baseline to 28.1% at week 8. In the multiple linear regression analysis, higher baseline SCORAD index (OR 0.51; 95% CI 0.41–0.61) and higher adherence (OR 7.29; 95% CI 1.85–12.73) were significantly associated with greater decrease in SCORAD index.Conclusion: Supplementation with the multistrain synbiotic product may improve AD in children.What is known: • Pediatric atopic dermatitis (AD) is a common, troublesome condition with limited treatment options, which has been shown to be associated with dysbiosis in the intestinal microflora. • Results of controlled clinical trials (RCTs) on the effect of probiotics in children with AD have been disparate, although overall, the data favor probiotics over placebo, with multistrain supplements associated with better improvements in AD.What is new: • The results of this observational, prospective, open-label, single-cohort study on 320 children with AD younger than 12 years old suggest that supplementation with multistrain synbiotics (Lactobacillus casei, Bifidobacterium lactis, Lactobacillus rhamnosus, Lactobacillus plantarum, fructooligosaccharide, galactooligosaccharide, and biotin) helps to improve AD symptoms in children. • More than 80% of children experienced improvement in AD symptoms, as measured by Severity Scoring of Atopic Dermatitis (SCORAD) index and assessed by parents and physicians. The main predictive factors for improvement was adherence to synbiotic treatment and high baseline SCORE index; the change in SCORAD did not depend on age, gender, presence of concomitant treatment, duration, and type of AD (persistent vs with flares), other concomitant allergies or history of parental allergy.

Therapeutic patient education in children with moderate to severe atopic dermatitis: A multicenter randomized controlled trial in China.

Therapeutic patient education is a continuous, systematic, patient-centered learning process to help patients and their families acquire and maintain the skills they need to manage their lives with a chronic disease. It has been proven effective in increasing treatment adherence and improving quality of life for patients with atopic dermatitis (AD) in Western countries. We introduce the first multicenter, randomized controlled clinical trial of therapeutic patient education in Chinese children with AD. To evaluate the effects of therapeutic patient education on the severity of AD, quality of life, and understanding and successful use of emollients in Chinese children with eczema. We recruited 580 children, ages 2-14 years, with moderate to severe AD from six hospitals in China. Participants were randomized (1:1) to an intervention (n = 293) or control (n = 249) group. In addition to the severity of AD, data on quality of life and a questionnaire on family and patient knowledge of emollients were evaluated at the 6-month follow-up. On study completion, we found that the intervention group showed a significantly greater reduction in mean SCORing Atopic Dermatitis (P < .001) and Infant's Dermatology Life Quality Index (P = .030) scores than the control group. In addition, knowledge about the use of emollients improved significantly in the intervention group. There was no significant difference between groups in Children's Dermatology Life Quality Index scores. The first randomized controlled trial of a therapeutic patient education program in China had positive long-term effects on decreasing eczema severity and improvement of quality of life in children 2-4 years of age with AD, as well as in promoting greater understanding of the use of emollients.

Anxiety and Depression in Patients with Atopic Dermatitis in a Southeast Asian Tertiary Dermatological Centre

This study aimed to assess the frequency of anxiety and depression in a cohort of adult patients with atopic dermatitis (AD) in a tertiary dermatological centre, using the Hospital Anxiety and Depression Scale (HADS). We looked for any correlation between anxiety and depression with skin disease severity. Patients with AD were recruited from the National Skin Centre, Singapore, from 2008 to 2009 for a prospective cross-sectional study. The scoring atopic dermatitis (SCORAD) grade was determined and the HADS was administered via interviews. A total of 100 patients (78 males, 22 females) were enrolled (92% Chinese, 4% Malays and 4% Indians). Their average age was 25.7 years. Sixty-five percent used topical steroids, 14% had previously taken oral prednisolone for the control of disease flares, and 20% were on concurrent systemic therapy. The mean SCORAD was 55.0, with 99% of patients having moderate or severe AD. The mean HADS anxiety score was 7.2 and the mean depression score was 5.0. The level of anxiety correlated well with that of depression (Spearman's rank correlation coefficient, ρ = 0.59, P <0.05); 18% were considered as cases of anxiety and 5% as cases of depression. These patients also had higher SCORAD values compared to other patients with lower scores for anxiety or depression (P <0.05). Linear regression demonstrated a statistically significant positive relationship between anxiety and depression scores, and SCORAD scores. Our study identified, by means of the HADS, the frequency of anxiety and depression amongst a cohort of Singaporean patients with AD. More severe skin disease correlated to greater psychological burden. The HADS is a useful screening tool that can constitute part of the overall holistic management of patients with AD so as to improve patient care.

Family quality of life among families of children with atopic dermatitis.

BackgroundAtopic dermatitis (AD) may cause emotional distress and impairs the quality of life (QoL) in children and their families.ObjectiveWe examined family QoL of children with AD and explored associated factors such as disease severity and psychosocial factors among parents of children with AD.MethodsStudy participants were 78 children (1 month to 16 years old) diagnosed with AD and their parents visiting an outpatient clinic of the Department of Pediatrics in Inha University Hospital. Data were collected using structured questionnaires and medical record review. Parents completed the Dermatitis Family Impact questionnaire (DFI), the Positive Affect and Negative Affect Schedule, the Satisfaction with Life Scale, and the Korean Parenting Stress Index. For children aged below 6-year-old, parents were asked to complete the Infants' Dermatologic Quality of Life. SCOring Atopic Dermatitis (SCORAD), Children's Dermatology Life Quality Index, and the Pediatric Quality of Life Inventory version 4.0 Generic Core Scale were also completed.ResultsThe mean age of parents and children were 37.4 ± 5.3 years and 65.1 ± 45.7 months, respectively. Among them, 87.2% of parents were mothers and 60.3% of children were boys. The mean score of DFI was 11.2 ± 6.0. The mean SCORAD score was 28.3 ± 16.1. Family who experienced strong negative emotionality had a 3.8 times higher probability of experiencing a lower QoL than parents who did not (odds ratio [OR], 3.82; p = 0.041). Family of children with higher severity of AD had a 6.6 times (OR, 6.55; p = 0.018) higher probability of experiencing a low family QoL than their less-severe counterparts. Families of girls with AD had a lower QoL (OR, 8.40; p = 0.003) than families of boys.ConclusionFamily QoL among parents of children with AD was low and associated with parent’s psychosocial characteristics as well as disease severity of the children. Considering parental involvement in AD management for children, emotional support for parents can be helpful in long journey of disease management.

Serum clusterin level in children with atopic dermatitis.

Atopic dermatitis (AD) is a chronic inflammatory skin disease. Clusterin is a sensitive cellular biosensor of oxidative stress and has been studied as a marker to assess inflammatory diseases. The clusterin levels in AD have not been evaluated thus far. We evaluated serum clusterin levels in children with AD and assessed the relationship between serum clusterin levels and the severity of AD. The study enrolled a total 140 children, of whom 100 had AD (n = 100) and 40 were healthy (n = 40). The severity of AD was scored by using the SCORing Atopic Dermatitis (SCORAD). Total serum immunoglobulin E and specific immunoglobulin E levels against egg whites, cow's milk, peanuts, soybeans, wheat, and Dermatophagoides farinae were measured. Clusterin levels in serum were measured by enzyme-linked immunosorbent assay. The mean (interquartile range) age of the children was 5.1 years (1.3-8.4 years), and 92 (69.3%) of the children were boys. The mean (standard deviation) SCORAD index was 50.4 ± 17. The mean (standard deviation) clusterin level of children with AD was higher than that in the healthy control group children (148.13 ± 4.3 pg/mL versus 144.85 ± 5.1 pg/mL; p = 0.001). Serum clusterin levels were correlated with the SCORAD index (r = 0.327, p = 0.002). The serum clusterin level was higher in children with AD than in the healthy control group and increased with the severity of AD. Serum clusterin may be a candidate molecule that reflects AD and its severity.

Epidermal thymic stromal lymphopoietin predicts the development of atopic dermatitis during infancy

Epidermal thymic stromal lymphopoietin predicts the development of atopic dermatitis during infancy

Outpatient Home-based Wet Wrap Dressings with Topical Steroids with Children with Severe Recalcitrant Atopic Dermatitis: A Feasibility Pilot Study.

Wet wrapping (WW) appears to be effective in severe atopic dermatitis (AD) in children resistant to topical treatment. Seventeen children were included and were directed to use WW every night (≥6hr) until lesions disappeared, followed by maintenance treatment of two to threetreatments per week. The mean Scoring Atopic Dermatitis (SCORAD) score at baseline was 48.9. After 1month of treatment the mean SCORAD score was 18.9, and efficacy was maintained after 3months of treatment. The majority of patients were satisfied (91.7%) with the WW treatment; 92% considered it to be much more effective than the previous treatments received. WW was easy to perform for 75% of patients, 83% of patients stated that it was better tolerated, and 17% considered it to be tolerated equally to dermatologic corticosteroids without WW. The home WW program was continued on a maintenance basis for 75% of patients. This open-label study showed that this program was a feasible and well-tolerated alternative for the treatment of severe, refractory AD in children and adolescents.

Anti-IgE therapy and severe atopic dermatitis: A pediatric perspective

Anti-IgE therapy and severe atopic dermatitis: A pediatric perspective

지방자치단체 중심의 아토피 예방관리 프로그램 효과 평가

Objectives: We evaluated the effects of an allergy control program on children with atopic dermatitis (AD) in five schools located within Gyeonggi-do. Methods: Based on the results of the 12-month prevalence of AD symptoms from an International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire of all students (n=2109; 1040 boys, 1069 girls) at five randomly selected schools, 227 students with AD symptoms were screened. Finally, 188 students with greater than 1 on SCORAD (SCORing Atopic Dermatitis) determined by a physician were selected. The allergy control program includes education related to allergic diseases, skin prick tests, and SCORAD evaluation, as well as keeping a daily journal to check the usage of moisturizer at least once a day. To determine the effectiveness of the allergy control program, SCORAD evaluation was performed again six weeks later. Results: The most common symptom for 12-month prevalence was rhinorrhea (33.9%), followed by atopic skin lesions (14.8%) and wheezing (4.0%). The 12-month prevalences of the three allergic diseases were higher for boys than for girls, and a significant difference was found for allergic rhinitis (P<0.001). The mean SCORAD index decreased significantly from 26.1 to 17.5 after the completion of the six-week control program (P<0.01). In particular, these differences were more pronounced for the group which used the daily journal (P<0.001). Conclusions: Our findings indicate that the allergy control program including usage of a daily journal as well as regular monitoring could be a promising tool for preventing and alleviating the symptoms of allergic diseases.