Mild Atopic Dermatitis Research Articles

Emollients "Plus" are Beneficial in Both the Short and Long Term in Mild Atopic Dermatitis.

Atopic dermatitis (AD) is a chronic relapsing disease with a pathophysiology including skin barrier damage, microbiome disbalance and inflammation. Classically, emollients maintaining a healthy microbiome are recommended as the basis of any AD severity management. To assess the benefit of a light balm containing vitamin E, tocopherol and glycerine and enriched with Aqua posae filiformis and microresyl (Emollient+) in subjects with mild AD over a period of 168 days. For this open-label study, subjects above 3 years of age with mild and stable AD for at least 6 months before inclusion and with a SCORAD score of <25 were eligible. Assessments took place at baseline, D14, D28, D84 and D168, and included SCORAD, flare frequency, severity of clinical signs and symptoms, skin hydration status using a Corneometer and local tolerance. QoL was assessed using the DLQI or CDLQI questionnaire. Subjects used Emollient+ at least once daily. Overall, 56 subjects were included in this study. The mean age was 25.0±20.0 years (45% children); 69.6% were females. Except for erythema in the paediatric population, all clinical parameters had significantly (all p < 0.05) improved at D28. At D168, SCORAD, signs and symptoms had significantly (all p < 0.05) improved in the global, adult and paediatric population at D168 compared to baseline. So did flares, skin hydration and QoL. The regimen was very well tolerated. Emollient+ is highly beneficial and well tolerated in mild AD with early benefits in improving AD signs and symptoms and skin hydration as well as the QoL of subjects as soon as D28. NCT05783453.

Assessment of Anxiety, Depression, and Sleep Quality in Mothers of Children with Atopic Dermatitis: A Qualitative Questionnaire Study.

To compare the anxiety, depression and sleep quality of mothers of healthy control children and mothers of children with atopic dermatitis (AD) of varying severity, both before and after treatment. A total of 120 parent-child dyads participated in the study. These dyads were divided into four subgroups of 30 patients each: mild AD, moderate AD, severe AD, and control groups. The children's symptoms, their mothers' psychological status, and their mothers' sleep quality were evaluated using the Scoring of Atopic Dermatitis (SCORAD), the Hospital Anxiety and Depression Scale (HADS), and the Pittsburgh Sleep Quality Index (PSQI), respectively, before and after a one-month comprehensive treatment. SCORAD, representing differences in severity of children's AD, decreased significantly after one month's treatment (p < 0.001). Anxiety in mothers significantly decreased in all AD severity groups after treatment (p < 0.05). However, for depression, only the mothers in the mild and moderate AD groups showed a decrease after treatment (p < 0.05). The PSQI total score also decreased in the mild AD group after treatment (p < 0.05). The most severe effect was seen in the psychology and sleep quality of mothers of children with severe AD. After one month of treatment, the psychological health and sleep quality of the mothers in the mild AD group significantly improved, while those of mothers in the moderate and severe AD groups showed partial improvement.

Establishment and Characterization of Mild Atopic Dermatitis in the DNCB-Induced Mouse Model.

In dermatological research, 2,4-dinitrochlorbenzene (DNCB)-induced atopic dermatitis (AD) is a standard model as it displays many disease-associated characteristics of human AD. However, the reproducibility of the model is challenging due to the lack of information regarding the methodology and the description of the phenotype and endotype of the mimicked disease. In this study, a DNCB-induced mouse model was established with a detailed procedure description and classification of the AD human-like skin type. The disease was induced with 1% DNCB in the sensitization phase and repeated applications of 0.3% and 0.5% DNCB in the challenging phase which led to a mild phenotype of AD eczema. Pathophysiological changes of the dorsal skin were measured: thickening of the epidermis and dermis, altered skin barrier proteins, increased TH1 and TH2 cytokine expression, a shift in polyunsaturated fatty acids, increased pro-resolving and inflammatory mediator formation, and dysregulated inflammation-associated gene expression. A link to type I allergy reactions was evaluated by increased mast cell infiltration into the skin accompanied by elevated IgE and histamine levels in plasma. As expected for mild AD, no systemic inflammation was observed. In conclusion, this experimental setup demonstrates many features of a mild human-like extrinsic AD in murine skin.

The risk of venous thromboembolism in atopic dermatitis: A matched cohort analysis in UK primary care.

Atopic dermatitis (AD) is a common chronic inflammatory skin condition. Whilst other chronic inflammatory conditions are associated with increased risk of venous thromboembolism (VTE), associations between AD and VTE have not been established. We examined whether AD is associated with increased risk of VTE in a population-based study. Electronic health records were extracted from UK general practices contributing to Optimum Patient Care Research Database. All adults with AD over 2010-2020 identified (n=150,975), and were age and sex matched with unaffected controls (n=603,770). Risk of VTE, consisting of pulmonary embolism (PE) or deep vein thrombosis (DVT), were compared in people with AD versus controls using Cox proportional hazard models. PE and DVT were examined separately as secondary outcomes. 150,975 adults with active AD were identified and matched with 603,770 unaffected controls. During the study, 2,576 of the people with active AD and 7,563 of the matched controls developed VTE. Individuals with AD had a higher risk of VTE than controls (adjusted hazard ratio [aHR] 1.17, 95% Confidence Interval [CI] 1.12-1.22). When assessing VTE components, AD was associated with a higher risk of DVT (aHR 1.30, 95%CI 1.23-1.37) but not PE (aHR 0.94, 95%CI 0.87-1.02). VTE risk was greater in older people with AD (≥65 years: aHR 1.22, 95%CI 1.15-1.29; 45-65 years: aHR 1.15, 95%CI 1.05-1.26; <45 years: aHR 1.07, 95%CI 0.97-1.19) and those with obesity (BMI≥30: aHR 1.25, 95%CI 1.12-1.39; BMI <30: aHR 1.08, 95%CI 1.01-1.15). Risk was broadly consistent across mild, moderate or severe AD. AD is associated with a small increase in risk of VTE and DVT, with no increase in risk of PE. The magnitude of this risk increase is modest in younger people, and those without obesity.

PA14 Aquagenic palmar wrinkling in a 15-year-old swimmer

Abstract A 15-year-old girl presented with a 1-year history of recurrent palmar wrinkling on contact with water. This was associated with a burning sensation within minutes of water exposure and progressive persistent thickening of the palmar skin. She was otherwise well, with no family history of note, including cystic fibrosis (CF). She had no regular medication or newly introduced medications before the onset of wrinkling. Moderate improvement in hyperkeratosis was seen with twice-daily use of urea 10% and salicylic acid 10% creams; however, the discomfort experienced in water was negatively affecting her ability to continue competitive swimming. On examination, there was palmar hyperlinearity with focal hyperkeratosis over the thenar and hypothenar eminences. Immersion of the hands in lukewarm water resulted in wrinkling within 2 min and peaking at 3 min, at which point the patient reported a burning sensation. Wrinkling resolved within 30 min of drying her hands. Baseline laboratory investigations were normal. Biopsy of the palm in the wrinkled state showed subtle prominence and dilation of sweat gland ducts. A diagnosis of aquagenic syringeal keratoderma (ASK) was made. At the 3- and 6-month reviews, the patient reported spontaneous resolution of wrinkling on contact with water, which was confirmed clinically. Residual hyperkeratosis had similarly resolved, although subtle palmar hyperlinearity persisted. She was able to resume competitive swimming activities without symptoms. The ASK is a rare condition, classically affecting the palms of young women, in which palmar wrinkling occurs within minutes of immersion in water. It may be asymptomatic or associated with stinging, burning or paraesthesia. Palmar wrinkling typically resolves after drying of the hands without persisting signs. The mechanism for this phenomenon is unclear, with theories including acquired abnormalities in eccrine glands, an underlying primary keratoderma, or potential induction by cyclooxygenase. Aquagenic palmar wrinkling is also recognized in association with CF, both in individuals with the disease and carriers, with more rapid onset of wrinkling in the former. In this case, there was no suggestion of personal or family histories of CF, and hyperkeratosis persisted for months at a time until liberal regular use of keratolytic topical agents was introduced. Hereditary papulotranslucent acrokeratoderma, a differential diagnosis in this case, was considered; however, in this condition once papules and wrinkling appear, they typically remain and are further exacerbated by water exposure. For this patient, a diagnosis of atypical ASK was favoured due to the persisting sequelae, with probable mild atopic dermatitis reflected by palmar hyperlinearity. This case serves to highlight this rare dermatological phenomenon and its impact on a teenage swimmer.

Combining 16S Sequencing and qPCR Quantification Reveals Staphylococcus aureus Driven Bacterial Overgrowth in the Skin of Severe Atopic Dermatitis Patients.

Atopic dermatitis (AD) is an inflammatory skin disease with a microbiome dysbiosis towards a high relative abundance of Staphylococcus aureus. However, information is missing on the actual bacterial load on AD skin, which may affect the cell number driven release of pathogenic factors. Here, we combined the relative abundance results obtained by next-generation sequencing (NGS, 16S V1-V3) with bacterial quantification by targeted qPCR (total bacterial load = 16S, S. aureus = nuc gene). Skin swabs were sampled cross-sectionally (n = 135 AD patients; n = 20 healthy) and longitudinally (n = 6 AD patients; n = 6 healthy). NGS and qPCR yielded highly inter-correlated S. aureus relative abundances and S. aureus cell numbers. Additionally, intra-individual differences between body sides, skin status, and consecutive timepoints were also observed. Interestingly, a significantly higher total bacterial load, in addition to higher S. aureus relative abundance and cell numbers, was observed in AD patients in both lesional and non-lesional skin, as compared to healthy controls. Moreover, in the lesional skin of AD patients, higher S. aureus cell numbers significantly correlated with the higher total bacterial load. Furthermore, significantly more severe AD patients presented with higher S. aureus cell number and total bacterial load compared to patients with mild or moderate AD. Our results indicate that severe AD patients exhibit S. aureus driven increased bacterial skin colonization. Overall, bacterial quantification gives important insights in addition to microbiome composition by sequencing.

Topical Chinese herbal medicine in treating atopic dermatitis (eczema): A systematic review and meta-analysis with core herbs exploration

Ethnopharmacological relevanceTopical Chinese herbal medicine (CHM) is commonly used to relieve atopic dermatitis (AD); however, the up-to-date evidence concerning the effectiveness of topical CHM on treating AD is lacking. Moreover, the CHM prescriptions are often too complicated to realize the overall mechanisms of CHM, especially when compared to western medicines (WM). Aim of the studyTo evaluate the effectiveness of topical CHM for treating AD by conducting a meta-analysis on randomized clinical trials (RCTs). MethodsTwenty RCTs comparing topical CHM to active control/placebo were included in the final analysis. The primary outcome was the symptom scores changed from baseline and the effectiveness rate was the secondary outcome. Subgroup analysis on different initial symptom severity and the different interventions in control groups was performed. System pharmacology analysis was performed to explore core CHM and possible pharmacological mechanisms of CHM for AD. ResultsCompared with active/blank placebo, topical CHM seemed more effective (SMD: −0.35, 95 %CI: −0.59 to −0.10, p-value = 0.005, I2 = 60%). The effectiveness rate was higher (RR: 1.29, 95 %CI 1.15–1.44, p-value <0.00001, I2 = 71%). In subgroup analysis, mild and moderate AD patients with topical CHM were more effective than placebo (SMD: −0.28, 95 %CI -0.56 to −0.01, p-value = 0.04, I2 = 5%; −0.34, 95%CI -0.64 to −0.03, p-value = 0.03, I2 = 0%, separately). Topical CHM has 1.25 times more effective than the topical glucocorticoid (95 %CI 1.09–1.43, p-value = 0.001, I2 = 64%). Core CHMs, such as Phellodendron chinense C.K. Schneid., Sophora flavescens Ait., Cnidium monnieri (L.) Cusson, and Dictamnus dasycarpus Turcz., had effects on the pathways on immune and metabolism systems different from WM. ConclusionOur results exploit the potential role of CHM on treating AD, especially for mild and moderate AD.

Prevalence of Isotretinoin Therapy in Adolescents and Young Adults With and Without Atopic Dermatitis: A Nationwide Prescription-based Population Study

Although isotretinoin has anti-inflammatory and immunomodulatory properties, it can exacerbate atopic dermatitis. National estimates of the extent to which patients with atopic dermatitis are affected by severe acne and isotretinoin tolerability are lacking. The aim of this study is to investigate isotretinoin therapy in patients with atopic dermatitis and to compare the nationwide prevalence with individuals without atopic dermatitis. All Norwegian residents were followed for 17 years until age 20–22 years in 2020. Approximately 28% of patients with atopic dermatitis had been treated for acne, and 8% had received isotretinoin before age 23 years. In those over 17 years old, significantly more patients with atopic dermatitis were treated with isotretinoin than those without. At age 22 years, 2.21% (95% confidence interval 1.92–2.49) of patients with atopic dermatitis were treated with isotretinoin, compared with 1.55% (95% confidence interval 1.44–1.65) of those without, representing 42.8% (1.43; 95% confidence interval 1.24–1.65) higher use in patients with atopic dermatitis. Patients who received long-term treatment (probable severe atopic dermatitis) tolerated isotretinoin similarly to patients who received short-term treatment (probable mild atopic dermatitis). There was significantly higher use of topical corticosteroids during isotretinoin therapy in patients with atopic dermatitis. Conclusively, severe acne (isotretinoin therapy) was associated with atopic dermatitis at the population level in young adults.

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.

A Retrospective Analysis of Risk Factors for Atopic Dermatitis Severity.

Background: Atopic dermatitis (AD) has the highest burden of any skin disease; however, the severity-associated factors remain unclear. Objective: To evaluate potential severity-associated factors of AD and to design and validate a severity prediction model to inform the management of AD patients. Methods: A cross-sectional study of 900 AD patients was conducted from December 2021 to October 2022 at our hospital. The primary outcome was disease severity, categorized as mild, moderate, or severe using the scoring atopic dermatitis index. Ordinal logistic regression and bootstrapped validation were used to derive and internally validate the model. Results: Increasing age, elevated eosinophil level, higher economic status, and urban residence were associated with severe AD. Breastfeeding, disinfectants and topical emollients use, and short duration of bathing were associated with mild AD. In the prediction model, predictors included age, eosinophil and economic status, residence, feeding, disinfectants and emollients use, and duration of bathing. Prediction models demonstrated good discrimination (bias-corrected concordance index [c-index] = 0.72) and good calibration. Conclusion: Risk factors for the severity of AD were identified that could aid the early prediction of AD progression. The predictive model included variables that are easily evaluated and could inform personalized prevention and therapy.

Impact of daily use of emollient ‘plus’ on corticosteroid consumption in patients with atopic dermatitis: An open, randomized controlled study

Emollients are the baseline treatment for mild or moderate atopic dermatitis (AD) to improve the epidermal barrier and provide anti-irritant and anti-pruritic effects. Emollient 'plus' can influence the skin microbiome of atopic eczema patients. To evaluate the benefits of using Emollient 'plus' to reduce corticosteroid consumption. In an open, single-centre, randomized, controlled study, patients with mild to moderate AD (Severity scoring of AD [SCORAD] score 20-30) were randomized 1:1 to apply the Emollient 'plus' twice daily for 28 days or to continue with their usual classical emollient (Control group). In addition, each patient received topical corticosteroids to use when necessary and according to the dermatologist's prescription. Assessments included SCORAD, PO-SCORAD, local SCORAD, quality of life questionnaires, and tolerability. A total of 119 patients were included in the PP population with a mean age of 26.50 ± 17.5 years old (min-max 3-71 years). Between baseline and day 28, the mean amount of corticosteroid used was lower for the Emollient 'plus' versus Control group (6.03 vs. 9.16 g; p=0.041) and corticosteroid was applied on fewer days (37.5% vs. 46.9% of days; p=0.0256) with fewer applications per day (0.55 vs. 0.71 applications per day; p=0.0203). Similar improvements were observed in both groups for SCORAD, PO-SCORAD, local SCORAD, skin sensation score, AD burden scale, patient benefit index >1, as well as subject and investigator efficacy and tolerability questionnaire assessments. Between baseline and day 28, there was significant corticosteroid-sparing in the Emollient 'plus' group compared to the Control group in quantity, number of applications per day and number of days of use, whilst efficacy was maintained with no significant differences between the two groups for all clinical evaluations, as well as for tolerability.

Circulating biomarkers are associated with disease severity of chronic hand eczema and atopic dermatitis.

Although chronic hand eczema (CHE) is a highly prevalent and disabling skin disease, it is currently unknown if CHE is associated with systemic inflammation. To characterize the plasma inflammatory signature of CHE. Using Proximity Extension Assay technology, we assessed 266 inflammatory and cardiovascular disease risk proteins in the plasma of 40 healthy controls, 57 patients with atopic dermatitis (AD) with active lesions, 11 with CHE and a history of AD (CHEPREVIOUS_AD), and 40 with CHE and no history of AD (CHENO_AD). Filaggrin gene mutation status was also assessed. Protein expression was compared between groups and according to disease severity. Correlation analyses for biomarkers, and clinical- and self-reported variables, were performed. Very severe CHENO_AD was associated with systemic inflammation when compared with controls. Levels of T helper (Th)2- and Th1-, general inflammation and eosinophil activation markers increased with severity of CHENO_AD, primarily being significantly increased in very severe disease. Significant, positive correlations were found between markers from these pathways and severity of CHENO_AD. Moderate-to-severe but not mild AD displayed systemic inflammation. The Th2 markers C-C motif chemokine (CCL)17 and CCL13 (also known as monocyte chemotactic protein 4) were the top differentially expressed proteins in both very severe CHENO_AD and moderate-to-severe AD, showing a higher fold change and significance in AD. CCL17 and CCL13 levels further correlated positively with disease severity in both CHENO_AD and AD. Systemic Th2-driven inflammation is shared between very severe CHE with no history of AD, and moderate-to-severe AD, suggesting that Th2 cell targeting could be effective in several CHE subtypes.

Burden of adult atopic dermatitis and unmet needs with existing therapies

ObjectivePatients with atopic dermatitis (AD) have low treatment satisfaction. In this study, we evaluated the humanistic burden, treatment satisfaction, and treatment expectations in patients with AD in the United States.MethodsAdults with AD recruited through the National Eczema Association and clinical sites completed a web-based survey comprising the Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD), Dermatology Life Quality Index; Work Productivity and Activity Impairment Questionnaire-Atopic Dermatitis; Treatment Satisfaction Questionnaire for Medication (TSQM); and answered questions on healthcare provider (HCP) visits, treatment history, and treatment goals. Descriptive analyses were performed to compare participants by severity.ResultsAmong 186 participants (mean [standard deviation] age 39.7 [15.3] years, 79.6% female), 26.9%, 44.6%, and 26.3% of the participants had mild, moderate, or severe AD, respectively, based on PO-SCORAD. Greater disease severity was associated with a greater impact on work and daily life, decreased TSQM scores, and increased HCP visits. Corticosteroid topical cream or ointment (53.8%) and oral antihistamines (31.2%) were most commonly used for the treatment of AD. Participants reported declining/stopping/changing AD treatment due to the potential for side effects or lack of efficacy. ‘Leading normal lives’ (28.0%) and ‘being itch-free’ (33.9%) were important treatment goals.ConclusionsIndividuals with AD, especially severe disease, face a considerable humanistic burden even while using treatment.

Influence of the cream with filaggrin activity modulator for dry and sensitive skin in children with mild to moderate severity atopic dermatitis on objective indicators of skin barrier function and disease severity indices

BACKGROUND: Atopic dermatitis is a chronic, relapsing and severely itchy dermatitis that usually occurs in childhood and has a characteristic age-related distribution. Atopic dermatitis is relatively frequent, affecting 1020% of children in developed countries. Atopic dermatitis in children associated with poor school performance, low self-esteem and family problems. Recent studies show importance in atopic dermatitis pathogenesis of protein filaggrin and modulation of its activity may be a promising direction in the pathogenic therapy of atopic dermatitis.&#x0D; AIM: to study the effect of a cream for dry, sensitive and atopic skin with a modulator of filaggrin activity on the course of mild and moderate atopic dermatitis.&#x0D; MATERIAL AND METHODS: An open, prospective, multicentre, non-comparative, single-group clinical trial was organized to test the effectiveness of a cream with a filaggrin activity modulator. The study was on outpatients in the participated centers and included 5 visits with a screening visit 1, and 5th visit ― therapy completion. Cream was used for 12 weeks. In total, the study involved 60 children aged 3 to 18 years with diagnoses of atopic dermatitis of mild and moderate severity. The severity of atopic dermatitis was measured with the SCORAD, EASI, IGA scales, also measured was skin pH and transepidermal water loss (TEWL), as well as the severity of xerosis according to visual analogue scale.&#x0D; RESULTS: The severity of atopic dermatitis in children whose therapy regimens included Admera cream decreased by 19.6 points according to the SCORAD index, including in children who did not receive mometasone furoate in the therapy schemes, the SCORAD index decreased statistically significantly compared to the baseline data (p 0.001). The overall decline in the EASI index ― by 3.0 points, the IGA global assessment index ― by 2.0 points, the severity of xerosis decreased by 3 points (in all cases, p 0.001). Transepidermal water loss decreased (by 4.5 g/m2 per hour, p 0.001); Skin pH did not change (difference 0.02, p=0.34). The smell was rated as "excellent" by 86.7% (95% CI 75.494.1), the consistency ― by 83.3% (95% CI 71.591.7) of the respondents, and overall satisfaction was noted by ― 88.3% (95% CI 77.495.2) of the respondents.&#x0D; CONCLUSION: Сream for dry and sensitive skin with a modulator of filaggrin activity during the study showed good efficacy and tolerability and can be used in atopic dermatitis treatment regimens as a basic care product, both during exacerbation and remission.

Economic and Humanistic Burden in Paediatric Patients with Atopic Dermatitis.

Data concerning the economic and humanistic burden in patients with paediatric atopic dermatitis (AD) and their families are scarce. This retrospective study investigated these burdens in paediatric patients with AD using maintenance treatment with topical corticosteroids and/or conventional systemic immunosuppressants. Patient-reported outcomes regarding quality of life, AD severity, and parental work-related impairment were completed at inclusion. Data on healthcare resource utilization and medication prescription were collected retrospectively over the previous 12 months. Patients were categorized into mild, moderate or severe AD, based on Eczema Area and Severity Index score and medication use. Costs per patient per year per AD severity category were calculated. A total of 101 patients (median age 11.0 years (interquartile range 7.5-14.0), 47.5% men) were included, of whom 38 had mild AD, 37 moderate AD, and 26 severe AD. Mean ± standard deviation (SD) total costs patient per year for mild, moderate and severe AD were €1,812 ± €1,280, €2,680 ± €3,127, and €5,861 ± €3,993, respectively. Highest total direct and indirect costs were found in patients with severe AD, mainly due to higher healthcare and medication costs. Highest humanistic burden was found in patients with moderate AD. For example, the median (interquartile range) Patient-Oriented Eczema Measure score was significantly higher in these patients compared with mild and severe AD (19.0 (15.0-24.0) vs 12.0 (8.8-15.0) and 17.0 (9.5-22.0), respectively). AD in paediatric patients incurs considerable direct and indirect costs, especially in patients with severe AD. The high humanistic burden in patients with moderate AD underlines the need for effective and safe new treatment options for children with AD.

Effect of Disease Severity on Comorbid Conditions in Atopic Dermatitis: Nationwide Registry-Based Investigation in Finnish Adults

The majority of registry studies on atopic dermatitis include only patients and diagnoses from specialized healthcare. The aim of this retrospective, real-world cohort study was to evaluate the effect of atopic dermatitis severity on comorbidities and total morbidity, with comprehensive data from both primary and specialty healthcare registries covering the entire Finnish adult population. In total, 124,038 patients were identified (median age 46 years; 68% female) and stratified by disease severity. All regression analyses (median follow-up 7.0 years) were adjusted at a minimum for age, sex, obesity, and educational level. Compared with mild atopic dermatitis, severe atopic dermatitis was significantly associated with multiple morbidities, including neurotic, stress-related and somatoform disorders, abscesses, erysipelas/cellulitis, impetigo, herpes zoster, extragenital herpes, bacterial conjunctivitis, septicaemia, lymphomas, alopecia areata, urticaria, other dermatitis, contact allergy, osteoporosis, and intervertebral disc disorders (p < 0.001). In addition, there were significant associations with alcohol dependence, depression, condylomas, rosacea, migraine, sleep apnoea, hypertension, enthesopathies, atherosclerosis, and drug-induced cataract (p < 0.05). Odds ratios were modest and mostly were between 1.10 and 2.75. Furthermore, patients with severe atopic dermatitis had lower incidences of prostate cancer, cystitis, and anogenital herpes than patients with mild atopic dermatitis (p < 0.05). These results suggest that severe atopic dermatitis results in significant overall morbidity.

Prevalence and risk factors of atopic dermatitis in Chinese adults: a nationwide population-based cross-sectional study.

Prevalence and risk factors of atopic dermatitis in Chinese adults: a nationwide population-based cross-sectional study.

Effect of Paediatric Atopic Dermatitis on Parental Sleep Quality.

Data on the impact of paediatric atopic dermatitis on parental sleep are scarce. The aim of this study was to examine the effects of paediatric atopic dermatitis on the quality of parents' sleep. This cross-sectional study included parents of patients with atopic dermatitis and parents of healthy children who completed validated Pittsburgh Sleep Quality Index questionnaires. The study and control groups were compared, as were results for mild and moderate atopic dermatitis with severe atopic dermatitis, mothers and fathers, and different ethnic groups. A total of 200 parents were enrolled. Sleep latency was significantly longer in the study group compared with the control group. Sleep duration was shorter in the parents of the mild AD group compared with the moderate-severe and control groups. Parents in the control group reported more daytime dysfunction than parents in the AD group. Fathers of children with AD reported more sleep disturbance than mothers.

Alopecia Universalis in an Adolescent Successfully Treated with Upadacitinib-A Case Report and Review of the Literature on the Use of JAK Inhibitors in Pediatric Alopecia Areata.

Alopecia areata (AA) is a cell-mediated autoimmune disease in which a cytotoxic T-cell response against hair follicles occurs. AA has been demonstrated to frequently co-exist with atopic dermatitis (AD), and the coincidence of atopy predisposes to a more severe course of the disease. To date, therapeutic options in AA, especially in the pediatric population, are mainly limited to corticosteroids, irritants, sensitizers, and immunosuppressive agents. Recently, innovative therapies have emerged, among which Janus kinase (JAK) inhibitors, effective in both AD and AA, appear to be the most promising. Here, a 14-year-old girl with alopecia universalis (AU) and mild AD is demonstrated, who was successfully treated with a selective JAK1 inhibitor, upadacitinib, which has been approved for the treatment of AD in adults and children aged 12years and older. Resolution of eczema and complete hair regrowth was achieved after 3months of therapy. Apart from transient mild leukopenia at weeks 4 and 8, no adverse events were noted. Data in the literature on the efficacy and safety of JAK inhibitors in the treatment of AA in the pediatric population is based on single case reports and case series. So far, topical tofacitinib and ruxolitinib, as well as systemic tofacitinib, ruxolitinib, and baricitinib have been used off-label in this indication in children. Upadacitinib is another effective treatment option with a good benefit-risk ratio for patients with AA, including cases coexisting with AD.

Clinical experience of using the Children’s Dermatology Life Quality Index in children with atopic dermatitis

Background. Atopic dermatitis is a common pruritic skin disease that causes a significant burden on patients, their families, and society. The purpose of this work was to evaluate the quality of life of children with atopic dermatitis and to study the correlation between the severity of atopic dermatitis and the quality of life according to the Children’s Dermatology Life Quality Index (CDLQI). Materials and methods. Patients with atopic dermatitis (n = 71) aged 4–17 years from the allergy department of the Kyiv City Children’s Clinical Hospital No. 2 were included in the study. The severity of atopic dermatitis was assessed by the SCORing Atopic Dermatitis (SCORAD) tool, and the quality of life — by the CDLQI. Spearman’s rank correlation coefficient was used for correlation analysis of the CDLQI and the SCORAD indicators. Correlation was considered probable at p &lt; 0.05. Results. Atopic dermatitis had a small effect on the quality of life in 25.4 % patients, a moderate effect — in 40.8 %, a very large effect — in 19.7 %, and in 12.7 % of patients, atopic dermatitis caused an extremely large effect on the quality of life. Spearman’s correlation coefficient of severity indicators on the SCORAD and the CDLQI was Ro = 0.932; a correlation was found at the significance level of p &lt; 0.01. When evaluating correlation indicators in subgroups of children by degree of severity, a difference was found: in patients with mild atopic dermatitis, there was no correlation (Ro = 0, p &gt; 0.05), in contrast to the group with moderate to severe (Ro = 0.625, p &lt; 0.01) and severe atopic dermatitis (Ro = 0.688, p = 0.01). The quality of life indicator had a positive correlation with the age of patients and duration of the disease, which may be related to a more severe course and a greater social and psychological burden for older children. Conclusions. The Ukrainian version of CDLQI is a reliable tool for assessing the quality of life of paediatric patients with atopic dermatitis.