Objective SCORAD Research Articles

Prediction of disease severity using serum biomarkers in patients with mild-moderate Atopic Dermatitis: A pilot study.

Atopic dermatitis (AD) is an inflammatory skin condition that relies largely on subjective evaluation of clinical signs and symptoms for diagnosis and severity assessment. Using multivariate data, we attempted to construct prediction models that can diagnose the disease and assess its severity. We combined data from 28 mild-moderate AD patients and 20 healthy controls (HC) to create random forest models for classification (AD vs. HC) and regression analysis to predict symptom severities. The classification model outperformed the random permutation model significantly (area under the curve: 0.85 ± 0.10 vs. 0.50 ± 0.15; balanced accuracy: 0.81 ± 0.15 vs. 0.50 ± 0.15). Correlation analysis revealed a significant positive correlation between measured and predicted total SCORing Atopic Dermatitis score (SCORAD; r = 0.43), objective SCORAD (r = 0.53), eczema area and severity index scores (r = 0.58, each p < 0.001), but not between measured and predicted itch ratings (r = 0.21, p = 0.18). We developed and tested multivariate prediction models and identified important features using a variety of serum biomarkers, implying that discovering the deep-branching relationships between clinical measurements and serum measurements in mild-moderate AD patients may be possible using a multivariate machine learning method. We also suggest future methods for utilizing machine learning algorithms to enhance drug target selection, diagnosis, prognosis, and customized treatment in AD.

PD05 Investigating the course of atopic eczema up to 1 year following completion of narrowband ultraviolet B phototherapy

Abstract Narrowband UVB (NBUVB) is a recommended second-line treatment for moderate-to-severe atopic eczema unresponsive to adequate topical therapy, and is known to induce good short-term improvement of eczema severity (Reynolds NJ, Franklin V, Gray JC et al. NBUVB and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial. Lancet 2001; 357:2012–16). However, it is unclear how adult patients fare with their eczema severity long after completion of a course of NBUVB. We aimed to investigate the severity of atopic eczema in adults, 1 year following the completion of NBUVB, using validated clinical activity measures. We hypothesized that, after 1 year, eczema severity would remain better than at baseline (prior to having NBUVB). We undertook a multicentre prospective observational study of adults with atopic eczema (as per Hanifin and Rajka criteria) prescribed NBUVB as part of their standard clinical care. Participants had moderate-to-severe disease, with a minimum objective SCORAD of 15 and minimum Investigator’s Global Assessment (IGA) of 3, and were resistant to at least one conventional treatment (e.g. potent topical steroid). Eczema severity was assessed by selected investigators using SCORAD and IGA. Assessments were made at baseline, at the end of NBUVB and at 4, 8 and 12 months after completion of NBUVB. We aimed to recruit 80 patients at the outset to provide us with about 25–30 patients for analysis at the 1 year post-NBUVB follow-up. Eighty patients (47 men, 33 women) with a mean age of 37 years (range 18–83) were recruited, with a baseline mean (SD) SCORAD of 39.2 (12.5). Forty-nine patients could not attend to complete NBUVB or the follow-up visits thereafter. Three patients had to stop NBUVB as their eczema flared. Mean baseline SCORAD of the 28 patients who completed the study was 41.3 (14.7), with the mean IGA being 3 (range 3–4; reflecting moderate to severe disease, respectively). Compared with baseline, mean SCORAD was significantly lower at the end of NBUVB [19.1 (13); P &amp;lt; 0.001] and at 4 months post-NBUVB [21.9 (11.9); P &amp;lt; 0.001]. Furthermore, compared with baseline, there was a sustained ongoing reduction of mean SCORAD at 8 months [22.6 (13.1); P &amp;lt; 0.001] and 12 months post-NBUVB [21.1 (14.8); P &amp;lt; 0.001]. Mean SCORAD at 1 year was not statistically significantly different to that on completion of NBUVB (P &amp;gt; 0.5). Change in IGA matched similar sustained improvement trends with SCORAD. These findings indicate that NBUVB may provide a long-lasting effect for patients who complete a course, helping to diminish their eczema severity to a more manageable level. These data can further inform consultations with patients, when outlining the approach of NBUVB for their care.

440 Prevalence and burden of rhinoconjunctivitis in atopic dermatitis patients: a cross-sectional study

Abstract Allergic rhinoconjuncitivitis can be highly symptomatic and burdensome and complicates the management of eyelid and facial dermatitis in persons with atopic dermatitis (AD). However, little is known about the prevalence, burden and predictors of allergic rhinoconjunctivitis symptoms in patients with AD, particularly among adults. This study aims to determine the prevalence and predictors of allergic rhinoconjunctivitis severity in patients with AD. A cross-sectional, dermatology practice-based study was performed at an urban academic medical center (n = 507). Atopic dermatitis severity was assessed by investigator-assessed Eczema Area and Severity Index (EASI), body surface area (BSA), investigator’s global assessment (IGA), objective-SCORing AD and patient-reported Global Assessment (PtGA). Impact of allergic rhinoconjunctivitis symptoms was assessed by Rhinoconjunctivitis Quality of Life Questionnaire. The cohort included children (&amp;lt;18 years; n = 36, 7.1%), young adults (18–49 years; n = 281, 55.4%) and older adults (≥50 years; n = 190, 37.5%), males (n = 219, 43.2%) and females (n = 288, 56.8%), Hispanics (n = 43, 8.5%), Blacks (n = 50, 9.9%), White non-Hispanics (n = 349, 68.8%), Asians (n = 51, 10.1%) and multiracial/other race (n = 14, 2.8%); 413 (81.5%) had private insurance. Overall, 246 (48.5%) reported a history of hay fever, and 15 (3.0%) and 416 (82.1%) of patients with AD reported having trouble with one or multiple rhinoconjunctivitis symptoms in the past 2 weeks; 30 (5.9%) and 365 (72.0%) of patients with AD had quite a bit or extreme trouble with one or multiple rhinoconjunctivitis symptoms, respectively. More severe AD overall (EASI, BSA, IGA and PtGA), as well as more severe facial dermatitis, flexural eczema and xerosis were associated with worse rhinoconjunctivitis symptoms, whereas, race, gender and presence of nummular dermatitis were generally not associated with rhinoconjunctivitis symptom severity. Quite a bit or extreme trouble from one or more rhinoconjunctivitis symptoms was reported in 39 (56.5%) patients with clear/almost clear, 85 (74.6%) mild, 135 (82.8%) moderate and 106 (84.8%) severe PtGA scores. In multivariable ordinal logistic regression models that controlled for demographics, AD severity was significantly associated with higher odds of a wide range of nasal and ocular symptoms, as well as rhinoconjunctivitis symptoms negatively impacting daily activities, causing sleep and practical problems, and negative emotions. Allergic rhinoconjunctivitis symptoms occurred in more than 4 out of 5 patients with AD overall, and almost 90% of patients with severe AD. Allergic rhinoconjunctivitis was more common in those with more severe AD, and particularly those with more severe facial dermatitis, flexural eczema and xerosis. Rhinconjunctivitis symptoms negatively impact the lives of patients with AD and warrant appropriate screening and management in clinical practice.

433 Outcome measures demographics and characteristics in predicting hand eczema severity in atopic dermatitis patients

433 Outcome measures demographics and characteristics in predicting hand eczema severity in atopic dermatitis patients

Skin microbiome in atopic dermatitis: New insights from clinical trials.

Atopic dermatitis (AD) is a chronic skin inflammatory disorder, with extensive burden among both children and adults.1 Recent advances in mechanistic understanding of underlying inflammatory pathways associated with AD phenotypes have resulted in improved options for topical and systemic treatment,2 with efficacy of monotherapies (e.g. abrocitinib, baricitinib, dupilumab, lebrikizumab, nemolizumab, tralokinumab, upadacitinib) ranging from 56.7% to 83.6%.3 Progression of AD is influenced by a combination of genetic, environmental and microbial covariates, and several studies have demonstrated the potential role of skin resident microbial flora (especially the bacterium Staphylococcus aureus) in AD,4 which may also impact response to therapy. Pertinent to this topic, Rauer et al.5 present their results from microbiome analysis of skin samples collected from patients with AD in the current issue of The Journal of the European Academy of Dermatology and Venereology. The authors analyzed baseline demographic and microbiome data from 60 moderate-to-severe AD patients from a previously reported cohort in New York, USA, to investigate correlation between disease severity and composition of the skin microbiome. Skin microbiome was sampled by swabbing lesional and adjacent non-lesional skin, and characterized by sequencing hypervariable regions V1–V3 of the 16S rRNA gene. Severity of AD was determined using SCORAD (SCORing Atopic Dermatitis), the validated clinical tool used to assess the extent and severity of eczema. Rauer et al. used objective SCORAD (oSCORAD, which considers only extent and intensity of AD) to determine correlation of AD severity with microbiome. These authors reported the skin microbiome of AD patients was dominated by S. aureus, which was detected in 79% of samples and was the most abundant species in 49% of lesional and 28% of non-lesional samples. Interestingly, diversity of skin microbiome correlated with oSCORAD, with lower diversity in lesional skin compared to non-lesional skin. High AD severity was associated with low evenness (a key determinant of microbiome composition), independent of skin sampling location. These results indicate dysbiosis in the microbiome population in lesional skin. Moreover, these authors identified S. aureus as a major contributor to association of microbiome diversity with AD severity and AD-affected skin sites. Among clinical variables, ethnicity was found to be an important covariate in the association between AD severity and skin microbiome. However, given the small sample size for sub-group analysis in the study, the contribution of ethnicity to skin microbiome and AD severity warrants further investigation. While elevated levels of S. aureus in the skin microbiome of AD patients have previously been reported,4 the study by Rauer et al.5 underscores the clinical relevance of this association as the samples were collected from patients at baseline of a well-designed clinical trial. Further analysis of skin microbiome during the progression of disease is likely to shed important insight into the interplay between changes in microbial composition and response to therapy. Given these interesting findings, a reasonable next step could be inclusion of skin microbiome sampling into clinical trials as exploratory endpoints in future clinical trials of AD. This would allow assessment if the identified microbial changes are linked with patient outcomes or medication response in a controlled setting. Ultimately this may then allow patient stratification based on microbial composition. Expanding those findings beyond the microbiome, such as targeting skin fungal mycobiome or virome may also reveal new insights into the contribution of microbial populations in AD. An important clinical implication of these results is that abundance of S. aureus may be used as a surrogate for skin microbial dysbiosis, especially since this organism may be more easily measured in a clinical setting using quantitative PCR rather than complete or complex microbiome analysis. Sequencing results can subsequently be obtained to analyze the microbiome, and used as a validation tool. The current study by Rauer et al.5 highlights key relationships between the skin microbiome and severity of AD, and will greatly inform ongoing efforts to develop new personalized therapeutic options for this disease. The authors have no conflicts of interest to declare. Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Itching in Atopic Dermatitis: Patient- and Physician-reported Outcomes in the German Atopic Dermatitis Registry TREATgermany.

TREATgermany is an investigator-initiated prospective disease registry. It investigates physician- and patient-reported disease severity (Eczema Area and Severity Index (EASI), objective Scoring Atopic Dermatitis (oSCORAD), Investigator Global Assessment, Patient-Oriented Eczema Measure (POEM), Patient Global Assessment (PGA)), patient-reported symptoms (itch, sleep loss, depressive symptoms), therapy courses and dermatological quality of life (DLQI) in moderate-to-severe atopic dermatitis with SCORAD > 20. 1,134 atopic dermatitis patients (mean age 41.0 ± 14.7 years, 42.5% females) were enrolled by 40 German recruiting sites (dermatological clinics and practices) between June 2016 and April 2021. The current analysis focuses on itch scores obtained with a numerical rating scale (NRS)) documented for the previous 3 days prior to baseline visit. The results show that 97.2% (1,090 of 1,121) patients experienced itch. Itch severity correlated moderately with severity of atopic dermatitis oSCORAD (rho = 0.44 (0.39-0.48)) and EASI score (rho = 0.41 (0.36-0.46)). A strong correlation was found with self-reported disease severity as PGA (rho = 0.68 (0.65-0.71)), POEM sum score (rho = 0.66 (0.63-0.69)) and dermatological quality of life impairment DLQI (rho = 0.61 (0.57-0.65)). Itch as a subjective complaint is more closely correlated with patient-reported outcomes than with objective assessments by the physician.

Enterotoxin Gene Cluster and selX Are Associated with Atopic Dermatitis Severity—A Cross-Sectional Molecular Study of Staphylococcus aureus Superantigens

Staphylococcus aureus superantigens (SAgs) have been reported to aggravate atopic dermatitis. However, comprehensive analyses of these molecules in multiple microniches are lacking. The present study involved 50 adult patients with active atopic dermatitis. S. aureus was isolated from the lesional skin, nonlesional skin, and anterior nares. Multiplex-PCR was performed to identify genes encoding (1) selX (core genome); (2) seg, selI, selM, selN, selO, selU (enterotoxin gene cluster, EGC); and (3) sea, seb, sec, sed, see, tstH (classic SAgs encoded on other mobile genetic elements). The results were correlated to clinical parameters of the study group. selx and EGC were the most prevalent in all microniches. The number of SAg-encoding genes correlated between the anterior nares and nonlesional skin, and between the nonlesional and lesional skin. On lesional skin, the total number of SAg genes correlated with disease severity (total and objective SCORAD, intensity, erythema, edema/papulation, lichenification and dryness). Linear regression revealed that AD severity was predicted only by selx and EGC. This study revealed that selX and EGC are associated with atopic dermatitis severity. Anterior nares and nonlesional skin could be reservoirs of SAg-positive S. aureus. Restoring the physiological microbiome could reduce the SAg burden and alleviate syndromes of atopic dermatitis.

077 The thirteen bacterial species inversely correlated with disease activities of atopic dermatitis in human showed a biotherapeutic potential based on their suppressive effects in mice

Skin commensals have been suggested to have a role in the pathogenesis of atopic dermatitis (AD), and bacteriotherapy has attracted attention. Here, we investigated the bacterial dynamics of AD patients treated by bleach baths and identified 13 bacterial species as candidates for biotherapy. Skin swab samples were collected monthly from AD patients for 6 months before and after 3-month bleach baths and analyzed using 16S rRNA gene sequencing. Multiple regression analysis using objective SCORing AD (o-SCORAD) and 34 representative bacterial species revealed that two bacterial species, Staphylococcus aureus and Staphylococcus hominis, were positively correlated with o-SCORAD, while 13 species of bacteria were inversely correlated.

Association of Adult Atopic Dermatitis Severity With Decreased Physical Activity: A Cross-sectional Study.

Background: Atopic dermatitis (AD) is associated with chronic pruritus, skin pain, sleep deprivation, depression, and anxiety, which may lead to decreased physical activity (PA). Objective: The aim of the study is to elucidate the impact of disease and itch severity on PA in adult AD. Methods: This is a prospective dermatology practice-based study of 955 AD patients (ages 18-97 years). Results: In multivariable logistic regression models controlling for age, sex, race/ethnicity, and asthma history, patient-reported global AD severity (PtGA), Patient-Oriented Eczema Measure, Eczema Area and Severity Index (EASI), and Investigator's Global Assessment (IGA) were associated with itch impairing light PA, moderate PA, and vigorous PA, as well as higher Patient-Reported Outcomes Measurement Information System Itch Questionnaire PA T-scores. Higher objective Scoring AD (O-SCORAD) was associated with itch impairing moderate PA. In bivariable analyses, performing greater than or equal to 30 minutes of light PA greater than or equal to 1 day a week was decreased with higher PtGA, Patient-Oriented Eczema Measure, and EASI; greater than or equal to 30 minutes of moderate PA greater than or equal to 1 day a week was decreased with PtGA, EASI, O-SCORAD, and IGA; and greater than equal to 30 minutes of vigorous PA was decreased with patient-reported AD severity, EASI, O-SCORAD, and IGA. In multivariable logistic regression models, the impact of itch on PA was inversely associated with light PA, moderate PA, and vigorous PA. Conclusion: Adult AD patients with more severe disease have decreased levels of PA secondary to itch.

Omalizumab for severe atopic dermatitis in 4- to 19-year-olds: the ADAPT RCT

BackgroundEvidence for systemic treatments for severe childhood eczema is limited. Systemic immunosuppressants are unlicensed for use in children and are associated with unwanted side effects.ObjectiveTo examine the role of anti-immunoglobulin E (IgE) [omalizumab (Xolair®, Novartis Pharmaceuticals UK Ltd, Frimley, UK)] in children and young people with severe eczema.DesignA double-blind, placebo-controlled, parallel-arm randomised (1 : 1) trial.SettingA single specialist centre – Guy’s and St Thomas’ NHS Foundation Trust, London.ParticipantsAtopic children and young people (aged 4–19 years) with severe eczema.InterventionsTreatment with omalizumab or placebo for 24 weeks.Main outcome measuresThe primary outcome was eczema severity, measured using the objective SCORing Atopic Dermatitis (SCORAD) at 24 weeks. Secondary outcomes included validated measures of eczema severity, quality of life (QoL) and potent topical steroid use.ResultsSixty-two participants, with a median baseline total IgE level of 8373 kU/l, received treatment with omalizumab (n = 30) or placebo (n = 32). The unadjusted mean objective SCORAD score at week 24 was 43.1 [standard deviation (SD) 12.5] for participants in the omalizumab arm and 49.2 (SD 11.3) for participants in the placebo arm. After adjustment for baseline objective SCORAD score, age and IgE level, the mean difference between arms at 24 weeks was –6.9 [95% confidence interval (CI) –12.2 to –1.5;p = 0.013], in favour of omalizumab. The mean objective SCORAD scores improved by –12.4 and –5.1 in the omalizumab and placebo arms, respectively, by 24 weeks. Secondary outcome measure estimates were also in favour of omalizumab for eczema severity at 24 weeks: the adjusted mean treatment arm difference was –8.3 (95% CI –15.1 to –1.1;p = 0.024) for total combined objective and subjective SCORAD and –6.7 (95% CI –13.2 to –0.1;p = 0.046) for the Eczema Area and Severity Index, with less effect on the Patient-Oriented Eczema Measure (POEM; –1.1, 95% CI –4.6 to 2.4;p = 0.527). Treatment estimate precision was limited by the sample size. The QoL measures favoured omalizumab, with an improvement (reduction) in both (Children’s) Dermatology Life Quality Index [(C)DLQI] score (mean –3.5, 95% CI –6.4 to –0.5;p = 0.022) and Paediatric Allergic Disease Quality of Life Questionnaire score (mean –0.5, 95% CI –0.9 to 0.0;p = 0.050). The mean (C)DLQI score improved by 50%, from 17.0 (SD 5.6) at baseline to 8.5 (SD 5.9) at week 24, for patients treated with omalizumab. Improvements were seen despite lower potent topical steroid use in the omalizumab arm, with 48% more days of use than (109 days in the placebo arm vs. 161 days in the omalizumab arm) and twice the body surface area coverage of (15.5% in the placebo arm vs. 31.3% in the omalizumab arm) the placebo arm. There were fewer treatment failures and new systemic immunosuppression initiations in the omalizumab arm. There was no difference in the numbers of cases of infective eczema and eczema exacerbation. There was one suspected severe adverse reaction in the omalizumab arm. In each arm, six participants reported a total of seven severe adverse events that were unrelated to treatment. Non-serious respiratory and dermatological adverse event rates were higher in the placebo arm (incidence rate ratio 0.69, 95% CI 0.49 to 0.96).ConclusionsOmalizumab, in a highly atopic paediatric population with severe eczema, reduced eczema severity and improved QoL despite a reduction in potent steroid use and highly elevated total IgE levels. Omalizumab, with its favourable side effect profile, warrants further study as a treatment option for this difficult-to-manage population. Further studies are needed to clarify the role of omalizumab. Treatment benefit became more apparent towards 24 weeks and persisted after treatment stopped. The optimal duration of treatment needs to be determined.Trial registrationThis trial is registered as ISRCTN15090567, EudraCT 2010-020841-29 and ClinicalTrials.gov NCT02300701.FundingThis project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health and Care Research (NIHR) partnership. This will be published in full inEfficacy and Mechanism Evaluation; Vol. 9, No. 5. See the NIHR Journals Library website for further project information. A grant from the Guy’s and St Thomas’ Charity supported the Atopic Dermatitis Anti-IgE Paediatric Trial (ADAPT). Omalizumab and the placebo were supplied by Novartis Pharmaceuticals UK Ltd.

Effectiveness of Cimetidine as Adjuvant Therapy in the Treatment of Acute-Extrinsic Atopic Dermatitis: A Double-Blind Randomized Controlled Trial.

IntroductionAcute extrinsic atopic dermatitis (AD) requires long-term treatment. Cimetidine could be used as an adjuvant therapy for acute-extrinsic AD due to immunomodulatory effects. This study aims to assess the effectiveness of cimetidine as an adjuvant to standard treatment in acute extrinsic AD.MethodsThis is a double-blind randomized controlled trial involving 26 AD patients aged 12–60 years from 2017 to 2020. Effectiveness of cimetidine was assessed by comparing SCORing Atopic Dermatitis (SCORAD) and objective SCORAD changes in both groups at week 2, 4, 6, and 8. Serum levels of immunoglobulin E (IgE), interferon (IFN)-γ, interleukin (IL)-12, and IL-4 were also documented.ResultsSignificant differences were observed in SCORAD changes at week 2, 4, 6, and 8 (p = 0.004; p = 0.001; p < 0.001; and p < 0.001 respectively), objective SCORAD changes at week 2, 4, 6, and 8 (p = 0.004, p = 0.001, p < 0.001, and p < 0.001 respectively), and IgE level changes at week 8 (p = 0.002) between the two groups. However, there were no significant changes in IFN-γ, IL-12, and IL-4 levels between the two groups.ConclusionCimetidine is a safe and effective adjuvant therapy for acute-extrinsic AD.Trial RegistrationNCT04018131.

Lower caprylate and acetate levels in the breast milk is associated with atopic dermatitis in infancy.

Atopic dermatitis (AD) occurs in exclusively breastfed infants. As fatty acids have some immunomodulatory effect, we aimed to investigate the influence of fatty acid compositions in breast milk (BM) on the development of AD in exclusively breastfed infants. We enrolled two- to four-month-old exclusively breastfed infants. The objective SCORing Atopic Dermatitis (objSCORAD) was evaluated. The lipid layer of BM was analyzed by gas chromatography for fatty acid levels. Medical charts were reviewed. Forty-seven AD infants and 47healthy controls were enrolled. The objSCORAD was 20.5±1.7 (shown as mean±SEM) in the AD group. The age, sex, parental atopy history, and nutrient intake of mothers were not significantly different between two groups. The palmitate and monounsaturated fatty acid (MUFA) levels in BM positively correlated with objSCORAD, while caprylate, acetate, and short-chain fatty acid (SCFA) levels negatively correlated with objSCORAD (p=.031, .019, .039, .013, .022, respectively). However, the butyrate levels in BM were not significantly different. The caprylate and acetate levels in BM were significantly associated with the presence of infantile AD (p=.021 and .015, respectively) after adjusting for age, sex, parental allergy history, MUFA, palmitate, and SCFA levels in BM. ObjSCORAD in infancy was significantly associated with persistent AD (p=.026) after adjusting for age, sex, parental atopy history, caprylate, palmitate, MUFA, acetate, and SCFA levels in BM. Caprylate and acetate levels in BM for exclusively breastfed infants were negatively associated with objSCORAD. Lower caprylate and acetate in BM might be the risk factors for infantile AD, while butyrate in BM was not associated with infantile AD.

Longitudinal course and phenotypes of health-related quality of life in adults with atopic dermatitis.

The real-world course of health-related quality of life (HRQoL) in atopic dermatitis (AD) is not well established. To examine predictors, longitudinal course and phenotypes of HRQoL in adult patients with AD. This was a prospective dermatology-practice based study of 955 patients with AD (age 18-97 years). Patients were assessed at baseline and approximately 6, 12, 18 and 24 months. HRQoL was assessed using the 10-item short-form Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health (PGH). AD severity and impact was assessed by patient-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Eczema Area and Severity Index (EASI), Objective SCORing Atopic Dermatitis (O-SCORAD), Investigator's Global Assessment (IGA), Numerical Rating Scale (NRS) average and worst itch, PROMIS sleep-related impairment (SRI), and nine-item Patient Health Questionnaire (PHQ)-9. Repeated-measures regression models were constructed to examine itch over time. In multivariable linear regression models controlling for age, race/ethnicity, history of asthma, hay fever and food allergy, baseline PGH-physical (PGH-P4) T scores were inversely associated with patient-reported global AD severity, POEM, EASI, objective SCORAD, IGA, NRS average and worst itch, PROMIS SRI and PHQ-9, with stepwise decreases of physical health with worsening severity. PGH-mental health (PGH-M4) T scores were associated with all aforementioned severity measures aside from POEM. In multivariable repeated measures linear regression models, decreased PGH-P4 and PGH-M4 T scores and mapped five-dimension EuroQoL over time were associated with self-reported global AD severity, NRS worst and mean itch, POEM, PROMIS sleep disturbance and SRI, EASI, objective SCORAD, IGA and PHQ-9. Latent class analysis identified six classes of HRQoL, which were associated with measures of AD severity, nonwhite race, Hispanic ethnicity and having only public health insurance, but not age or sex. Patients with AD have a heterogeneous longitudinal course and distinct patterns of HRQoL. Many patients had fluctuating HRQoL over time. Most patients with moderate to severe disease at baseline had persistent HRQoL impairment over time.

Efficacy of House Dust Mite Sublingual Immunotherapy in Patients with Atopic Dermatitis: A Randomized, Double-Blind, Placebo-Controlled Trial

Sensitization to house dust mites (HDMs) is frequent in patients with atopic dermatitis. To investigate the efficacy of sublingual immunotherapy (SLIT) with Dermatophagoides pteronyssinus extract in patients with atopic dermatitis sensitized to HDM. In this randomized, double-blind, placebo-controlled trial, we enrolled 91 patients 3 years or older, with SCORing Atopic Dermatitis (SCORAD) score greater than or equal to 15 and positive skin test result and/or IgE to D pteronyssinus. Patients were stratified according to age (<12 and ≥12 years) to receive HDM SLIT or placebo for 18 months. Primary outcome was a greater than or equal to 15-point decrease in SCORAD score. Secondary outcomes were decreases in SCORAD and objective SCORAD, Eczema Area and Severity Index, visual analog scale for symptoms, and pruritus scale scores; Investigator's Global Assessment 0/1; and decrease greater than or equal to 4 points in Dermatology Life Quality Index. Background therapy was maintained. A total of 66 patients completed the study (35 HDM SLIT, 31 placebo). After 18 months, 74.2% and 58% of patients in the HDM SLIT group and the placebo group, respectively, showed greater than or equal to 15-point decrease in SCORAD score (relative risk, 1.28; 95% CI, 0.89-1.83). Significant SCORAD score decreases from baseline of 55.6% and 34.5% in HDM SLIT and placebo groups (mean difference, 20.4; 95% CI, 3.89-37.3), significant objective SCORAD score decreases of 56.8% and 34.9% in HDM SLIT and placebo groups (mean difference, 21.3; 95% CI, 0.66-41.81), and more patients with Investigator's Global Assessment 0/1 in the HDM SLIT group as compared with the placebo group (14 of 35 vs 5 of 31; relative risk, 2.63; 95% CI, 1.09-6.39) were observed at 18 months. Our results suggest that HDM SLIT may be effective in HDM-sensitized patients as an add-on treatment for atopic dermatitis.

Infantile atopic dermatitis: Serum vitamin D, zinc and TARC levels and their relationship with disease phenotype and severity.

Several markers that influence the clinical course of atopic dermatitis (AD) have been investigated so far. Thymus and activation regulated chemokine (TARC) - a Th2-related cytokine - increase in various atopic diseases. It has been shown that vitamin D affects Treg cells and immune responses. Zinc as an essential trace element for cell-cell interactions, cellular differentiation, and proliferation. However, the effect of these markers on infantile AD and disease severity are mostly unknown. The aim of this study was to investigate the relationship between TARC, vitamin D, zinc levels, and the disease severity in infants with AD. AD patients (n = 160) with age and sex that matched healthy controls (n = 79) were included in the study. The diagnosis of AD was made based on the Hanifin-Rajka criteria. The objective SCORAD index was used for the assessment of disease severity. A total of 160 patients (male 71.9%) with AD were included in the study. The median age of onset of symptoms was 2 (1.0-3.5) months. The lesions initially started on face 76.9%, neck 6.9%, extremities 7.5%, and body 8.8%. Nearly 40% of the patients were found to be atopic. Food allergy was found in 39.4%. The median of objective SCORAD index was 27.5 (17.5-40) in the study group. The TARC levels of AD patients were higher than control group [1803 pg/ml (1006- 3123) vs 709 pg/ml (504-1147), p < 0.001] There was a significant correlation between objective SCORAD scores and TARC values in subjects with AD (r = 0.363, p < 0.001). As the severity of AD increased, vitamin D levels decreased (p for trend 0.015) and TARC values increased (p for trend < 0.001). Serum zinc levels did not change with the severity of the disease. The presence of atopy did not have an influence on serum TARC, zinc, and vitamin D levels. In infants with AD, disease severity is positively related with TARC levels; and inversely proportional to vitamin D levels. TARC levels differ between patients and healthy controls. The presence of atopy has not been shown to affect these markers. © 2021 Codon Publications. Published by Codon Publications.

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.

Effects of Hyperbaric Oxygen Therapy in Children with Severe Atopic Dermatitis.

In the course of atopic dermatitis (AD), the overactivity of the immune system, associated with predominant Th2 lymphocyte responses, is observed, which leads to an increased inflammatory reaction. Cases of a severe course of atopic dermatitis lead to the search for new therapeutic options. The aim of this study was to assess the effects of hyperbaric oxygen therapy (HBOT) treatment for severe cases of AD in children. A total of 15 children with severe AD underwent therapy. The influence of HBOT on the clinical course of AD and immunomodulatory effect of the therapy was analyzed by the SCORAD and objective SCORAD (oSCORAD) scales and by determining the serum concentration of immunological parameters (blood: nTreg lymphocytes, CD4+CD25highCD127-FOXP3+, NKT lymphocytes CD3+, CD16/56+, and serum: total IgE, cytokines IL-4, IL-6, and IL-10, before and after the 30-day treatment cycle). The study showed a significant effect of the therapy on the improvement of the skin condition. In all children, a reduction in the extent and intensity of skin lesions, reduction of redness, swelling, oozing/crusting, scratch marks and skin lichenification after HBOT was observed. Patients also reported a reduction in the intensity of pruritus and an improvement in sleep quality after therapy. In all children, a statistically significant decrease in the serum level of IgE was observed. However, no statistically significant changes in the blood levels of IL-4, IL-6 and IL-10, as well as the percentage of CD4+CD25highCD127−FOXP3+ Treg and NKT lymphocytes, were found. In conclusion, the use of hyperbaric therapy has a positive impact on treatment results in children with a severe course of atopic dermatitis.

Validity and reliability of Patient-Reported Outcomes Measurement Information System Global Health scale in adults with atopic dermatitis

Patient-Reported Outcomes Measurement Information System Global Health (PGH) was validated to assess health-related quality of life in several diseases. Little is known about its measurement properties in adult atopic dermatitis. Examine the measurement properties of PGH in adult atopic dermatitis. A prospective dermatology practice-based study of 994 atopic dermatitis patients (18-97years). PGH physical and mental health 4-item and abridged 2-item T scores, as well as mapped EuroQol-5D score, showed strong to very strong correlation with one another and moderate to strong Spearman correlations with Patient-Oriented Scoring Atopic Dermatitis, Patient-Health Questionnaire-9, Patient-Reported Outcomes Measurement Information System sleep disturbance and related impairment, Eczema Area and Severity Index, objective Scoring Atopic Dermatitis; and weak to moderate correlations with Patient Oriented Eczema Measure, numeric rating scale worst itch and average itch, and Scoring Atopic Dermatitis. The Dermatology Life Quality Index (DLQI) had stronger correlations with Patient Oriented Eczema Measure, Patient-Oriented Scoring Atopic Dermatitis, numeric rating scale worst itch and average itch, Eczema Area and Severity Index, and Scoring Atopic Dermatitis, but weaker correlations with Patient-Health Questionnaire-9 and Patient-Reported Outcomes Measurement Information System sleep disturbance and related impairment (convergent/divergent validity). PGH and DLQI scores had similarly poor ability to differentiate between levels of self-reported global atopic dermatitis severity (known-groups validity). No floor or ceiling effects were observed. No PGH or DLQI items had differential item functioning by demographics. PGH and DLQI scores showed fair to good responsiveness. Finally, PGH and DLQI showed similarly good test-retest reliability. Single-center study. PGH scores had sufficient validity and reliability to assess health-related quality of life in atopic dermatitis.

Treatment Effect of Omalizumab on Severe Pediatric Atopic Dermatitis (the ADAPT Randomized Clinical Trial)

S Chan, V Cornelius, S Cro, JI Harper, G Lack. JAMA Pediatr. 2020;174(1):29–37 Currently, systemic treatments for severe childhood atopic dermatitis have limited evidence and/or are unlicensed. The use of anti-IgE medication (omalizumab) has been employed for multiple forms of atopic diseases such as severe asthma and in conjunction with oral immunotherapy during trials to treat food allergy. However, no large randomized studies in childhood atopic dermatitis have been published. The objective of this study was to determine the effectiveness of omalizumab in treating severe atopic dermatitis in children. Eligible participants were children and adolescents aged 4 to 19 years of age who had severe eczema (with objective Scoring Atopic Dermatitis [SCORAD] index >40) that was unresponsive to optimum topical or systemic therapy and were living in the London, UK area. The Atopic Dermatitis Anti-IgE Pediatric Trial (ADAPT) was a single-center, double-blind, …

The Propensity to Form Biofilm in vitro by Staphylococcus aureus Strains Isolated from the Anterior Nares of Patients with Atopic Dermatitis: Clinical Associations

Background: Atopic dermatitis is a chronic inflammatory dermatosis with complex pathogenesis. The skin microbiome in atopic dermatitis is dominated by Staphylococcus aureus which shows the ability to produce biofilm. Objectives: The aim of this work was to assess the influence of S. aureus biofilm on the course of atopic dermatitis. Methods: Disease severity was evaluated based on the SCORAD index in 56 adult patients with atopic dermatitis. Microtiter plate assay of the propensity to form biofilm was performed on S. aureus strains isolated from the anterior nares, lesional skin, and nonlesional skin. Microbiological results were correlated to the clinical parameters and total IgE concentration. Results: Biofilm-producing strains of S. aureus were identified in 76.3% (29/38) and 79.1% (34/43) of samples from the anterior nares and lesional skin, respectively (p > 0.05), and in 48.5% (16/33) of samples from nonlesional skin (p < 0.03). Patients colonized by biofilm-producing strains of S. aureus within the anterior nares showed statistically higher mean values of total and objective SCORAD and its components (extent, dryness), and of the largest extent of skin lesions during the flares in the last year when compared to patients colonized by non-biofilm-producing strains. Carriage of biofilm-producing S. aureus on lesional skin was associated with higher mean values of the extent of skin lesions during stable periods of the disease. Conclusions: The results of this study may suggest a relationship between the production of biofilm by S. aureus strains colonizing the anterior nares and the course of atopic dermatitis. Biofilm seems crucial for dispersal and persistent colonization of large areas of the skin by this pathogen. Destruction of S. aureus biofilm could positively affect the course of atopic dermatitis.