SCORAD Index Research Articles

JANUS KINASE INHIBITOR IN COMBINATION THERAPY IN ATOPIC DERMATITIS

BACKGROUND: Atopic dermatitis (AD) is a chronic recurrent immunoinflammatory skin disease that develops against the background of a genotypic defect in the skin barrier function and innate and adaptive autoimmunity. Currently, there is no specific therapy for AD, so there remains a need to constantly search for effective pathogenetic approaches to its treatment. Today, the Janus kinase type 1 inhibitor abrocitinib is recommended for the treatment of moderate to severe AD. AIMS: to conduct a comparative assessment of the effectiveness of the combination of UVB 311 nm with abrocitinib and UVB 311 nm phototherapy against the background of standard therapy according to indications in the treatment of patients with moderate and severe atopic dermatitis. MATERIALS AND METHODS: During the period from 2023 to 2024, the dermatological status and quality of life were assessed in 40 patients with moderate to severe atopic dermatitis who were prone to frequent relapses. The patients were treated at the clinic for skin and venereal diseases. Depending on the therapy, all patients were divided into two groups. The first group consisted of 20 patients receiving systemic, topical therapy in combination with UVB 311 phototherapy and additionally abrocitinib, at an induction dose of 200 mg followed by a dose of 100 mg. The second group included 20 patients who received systemic, local therapy in combination with UVB 311 phototherapy. Upon admission to the hospital and after two months of therapy, a comparative assessment of the DLQI index and an assessment of the prevalence and intensity of skin lesions in accordance with the SCORAD and IGA index were performed, an assessment of the level of IgE in the blood were performed RESULTS: after the course of therapy, the SCORAD index in patients of the first and second groups decreased statistically significantly (p=0.001) by 2.4 times and 1.6 times, respectively. The DLQI index in patients of the first and second groups after the course of therapy significantly (p=0.001) decreased by 3.2 times, 2.1 times, respectively. CONCLUSIONS: Our study revealed a more significant effectiveness of therapy with abrocitinib in combination with UVB 311 compared with UVB 311 monotherapy in patients with moderate and severe atopic dermatitis.

Evaluation of apoptosis markers in patients with atopic dermatitis

The purpose of the study was to analyze indicators of apoptosis in patients with atopic dermatitis (AD). Patients (N = 88) aged from 12 months to 3 years with varying degrees of disease severity were involved into trial. SCORAD indices were: 68.14±2.63 – in patients with severe AD; 32.03±1.43 – with moderate; and 12.12±1.43 – with mild AD, respectively. Determination of apoptosis markers (Caspase 8, Caspase 9, sCD153, sFas-L, Annexin 5) in blood serum was performed using an enzyme-linked immunosorbent assay (ELISA) using commercial kits from Bender MedSystems® (Austria). A study of apoptosis markers in the blood serum of children with AD revealed a significant decrease (p 0.05) in the concentration of Annexin 5 compared to standard values (by 20 times). A statistically significant decrease (p 0.05) in the concentration levels of Caspase 8 and Caspase 9 in the serum of AD patients was revealed. Thus, the concentrations of Caspase 8 were reduced on by 3 times, and Caspase 9 by 8 times compared to the norm. Also In addition, when determining sFas-L indicators, a statistically significant (p 0.05) decrease in concentration was noted compared to standard indicators. The content of sCD153 in the blood serum in AD patients was significantly higher (p 0.05) than the normative values by 5 times (not detected normally). The most pronounced disturbances in apoptosis indicators were observed in patients with severe atopic dermatitis, (p 0.05), highlighting the importance of studying apoptosis in the context of AD and the possible link between disruptions in this process and the severity of clinical manifestations in patients. The study demonstrates the peculiarities of apoptosis processes in children with AD. On the one hand, these patients have significantly increased activation of signaling systems, on the other hand, the elimination of altered immunocompetent cells does not occur properly, which contributes to the progression and chronicity of immune inflammation in the skin.

Experience of abrocitinib in atopic dermatitis

Atopic dermatitis is an autoinflammatory, genetically determined, itchy disease characterized by a long, relapsing course and a sharp decrease in the patient’s quality of life. Atopic dermatitis is caused by a complex interaction of immune dysregulation, epidermal gene mutations, and multi-environmental factors that affect the skin, causing intense itchy rashes. The disease often occurs among young children and subsequently has age-related clinical features. Currently, the treatment of atopic dermatitis has a wide range of options, including drugs from the group of small molecules recently registered in the Russian Federation. The drugs are intended for patients with moderate to severe atopic dermatitis. Baricitinib, abrocitinib and upadacitinib as Janus kinase inhibitors from the small molecule group have already demonstrated good tolerability, safety and a pronounced clinical effect in the vast majority of patients with atopic dermatitis in available clinical trials. The first clinical experience with the use of abrocitinib in adult patients with atopic dermatitis is presented. The interest of the presented clinical cases lies in the demonstration of high clinical efficacy and safety of mono- and combination therapy with the Janus kinase inhibitor abrocitinib. Despite the short period of treatment and observation (4 weeks), objective severity of atopic dermatitis manifestations (SCORAD index 60 points) and sharp decrease in the patients' quality of life (DLQI index 20 points), a reduction of clinical parameters exceeding 60% was achieved at a dose of 200 mg daily. During the whole observation period no adverse clinical reactions or changes in laboratory parameters were registered against the background of abrocitinib administration. The pilot results of abrocitinib use are encouraging and provide grounds for conducting longer and larger-scale studies to investigate the efficacy of the drug for its inclusion in the combination therapy of patients with moderate to severe atopic dermatitis.

The role of epigenetic factors in childhood atopic dermatitis

Atopic dermatitis (AD) is a genetically determined chronic inflammatory skin disease characterized by itching, relapsing course, age-related features of the lesion morphology and localization. The etiological factors contributing to the development of AD are: allergic reactions, inflammatory reactions in the skin, leading to a barrier disfunction, the affect and interaction of genetic and environmental factors. Epigenetic mechanisms also play a key role in immune regulation. The aim of this work is to study the genome-wide methylation profile in the skin of children with AD in the acute stage, as well as to determine changes in the expression level of immune response genes associated with common signaling pathways during therapy. Whole-genome sequencing was conducted to examine methylation in the skin samples from AD patients and controls. The stages of bioinformatics data processing were carried out. Changes in the expression levels of the TLR2, TLR9, IL4, IL13, CAMP, and DEFB1 genes before and after treatment were carried out using RT-PCR-RT on samples of mononuclear blood cells. When comparing samples from patients with AD and healthy children, changes were shown in the methylation of 2364 regions of genomic DNA with their corresponding specific genes. Among the identified genes, those related to processes associated with the pathogenesis of AD were selected. At the next stage, changes in the expression of the described immunity factors (TLR2, TLR9, IL-4, IL-13, DEFB1, CAMP) were assessed over time according to the type of treatment. For this purpose, patients were divided into 2 groups depending on the prescription of systemic therapy. Three months after treatment, the level of expression for all studied immune factors decreased. However, a significant decrease in expression for almost all parameters (except for the DEFB1 gene) was recorded in the group in which systemic therapy (dupilumab) was used in addition to topical treatment. At the same time, the SCORAD index after treatment improved by an average of 63% and amounted to 17±6.0 points. Thus, systemic therapy aimed at suppressing signaling of IL-4 and IL-13 cytokines indirectly leads to normalization of the expression levels of innate immune factors. Studying the regulation of molecular genetic mechanisms of immunity involved in the processes of inflammation in AD helps to clarify the immunopathogenesis of this disease, determine diagnostic markers and targets for drug therapy.

Metabolomic biomarkers and altered phenylalanine metabolic pathway in preschool children with atopic dermatitis - A pilot study.

Background Atopic dermatitis (AD) has high prevalence in children. Current AD diagnosis and management focuses only on clinical phenotypes, but do not explore the endophenotypes, which are more important because they are a series of biomarkers linking clinical phenotype and genotype Aims Metabolomics can qualitatively and quantitatively capture real-time dynamic changes in a wide range of small molecule metabolites. This pilot study evaluated metabolomics biomarkers and altered metabolic pathways in preschool children with AD, aiming to explore the underlying molecular mechanisms and signalling pathways of the disease. Methods Blood samples of 23 preschool children with AD and 23 healthy children without AD or any other skin disease were collected. The untargeted metabolomic measurements were performed on a SCIEX-AD ultraperformance liquid chromatography system coupled with an AB SCIEX X500B QTOF system. Characteristics of small molecules in AD children were assessed and their associations with AD clinical index were evaluated. Altered metabolic pathways in AD children were also analysed using a comprehensive metabolomics platform. Results A total of 1,969 metabolites were identified, of which AD children exhibited 377 significantly altered metabolites. Multivariate statistical analysis demonstrated that the AD group and the control group could be clearly separated. Volcano plot analysis illustrated that 144 metabolites were up-regulated and 233 metabolites were down-regulated in AD children. The Severity Scoring of Atopic Dermatitis (SCORAD index) showed a moderate-to-strong association with estrogens, carotenes, leukotrienes, flavonols and keto acids in AD children (|r|=0.440-0.557). Several pathways, including the phenylalanine metabolism, were identified as altered in AD children. Limitations A small group of children was included in the study; the results need to be validated in larger sample sizes. Conclusion Results of this study illustrate potential alterations in metabolites and the phenylalanine metabolic pathway in preschool children with AD. Although this is a pilot study with a limited sample size, it may provide a new perspective for exploring the pathogenesis of AD, and for personalised treatment modalities.

Effects of a pH-Regulating Emollient Cream in Mild Atopic Dermatitis Patients with Moderate Localized Lesions

Introduction: Increased skin pH values in patients with atopic dermatitis (AD) contribute to poor antimicrobial and permeability barrier functions of the skin. In practice, the majority of topical preparations available for dry skin conditions do not provide sufficient pH and buffering capacity for maintaining optimum skin surface conditions. To address this issue, we tested a novel zinc lactobionate preparation to determine whether the regular application would lower skin surface pH, and in doing so improve the condition of lesional skin. Methods: The assessment for local severity of AD was done with the Scoring Atopic Dermatitis Index (SCORAD) and skin dryness was assessed by capacitance measurement. Results: The results showed that the test product lowered skin pH and improved AD skin lesions from moderate to mild during 2 weeks of application. In the treated area a lowered pH of about 0.85 units was found. Together with the lowering of pH, the local SCORAD significantly improved from 8.3 on average down to 4.0, while in the untreated area, only a slight improvement (from 8.2 to 6.4) was found. Conclusion: Synergistic effects of the test product’s pH lowering and emollient properties might explain the observed improvements in clinical signs of AD and further research against a comparator would allow the specific contribution of pH modulation to these improvements to be unambiguously isolated.

Effect of Omega-3 Polyunsaturated Fatty Acid Supplementation on Clinical Outcome of Atopic Dermatitis in Children.

The use of omega-3 fatty acids (omega-3 FA) in the treatment of atopic dermatitis (AD) is an area of ongoing research. Some studies suggest that dietary supplementation with omega-3 FA can help manage symptoms of AD by reducing lesion severity, skin inflammation, dryness and itching, while others show no significant beneficial effect. The aim of this study was to evaluate the effect of omega-3 FA from fish oil in combination with gamma-linolenic acid (GLA) from blackcurrant seed oil in children with AD. This is a longitudinal, prospective, randomized, triple blind, placebo-controlled parallel clinical trial. The study was conducted during the 2-year period throughout autumn, winter, and spring, avoiding the summer when AD usually improves. Children were randomized to receive the active study product (Mega Kid®) containing a specific blend of omega-3 and omega-6 fatty acids or placebo. The primary outcomes were changes in severity of AD measured using SCORing Atopic Dermatitis (SCORAD), patient-oriented SCORAD (PO-SCORAD) and the difference in topical corticosteroid (TCS) use. The secondary outcomes were changes in itch intensity, sleep quality and Family Dermatology Life Quality Index (FDLQI). Data were analyzed for 52 children (26 in the intervention group and 26 in the placebo group). In children receiving the active product, intention-to-treat analysis showed that after 4 months of treatment, there was a significant decrease in the SCORAD index (from median 42 to 25, p < 0.001) and the use of topical corticosteroids (from median 30 to 10 mg/month, p < 0.001), but also significant improvements in itch, sleep quality, and overall quality of life. Omega-3 fatty acids in combination with GLA and vitamin D may decrease symptoms and were associated with an improvement clinical picture of AD in children. Therefore, we can conclude that supplementation with this specific combination could be considered a safe and effective intervention that may significantly reduce the severity of AD in pediatric patients.

Change of epidermal barrier parameters and biomechanical parameters of the skin in children with atopic dermatitis during the use of a lipid-restoring cream containing biotic complex

Emollients are an integral part of the therapy for patients with atopic dermatitis. The most effective will be the new generation of emollients – emollients plus, which normalize the skin microbiome. Their effectiveness can be assessed by determining the parameters of the epidermal barrier (hydratation, sebum level, pH) and skin elasticity.Objectives. To evaluate the effectiveness and safety of a lipid-restoring cream containing a biotic complex LE SANTI in children with atopic dermatitis.Material and methods. From August to December, 25 children (9 girls, 36 % and 16 boys, 64 %) aged from 3 to 17 years (average age 9.2 years) with atopic dermatitis participated in an observational program to evaluate the effectiveness and safety of a lipid-restoring cream LE SANTI. For 21 days, patients applied the cream twice a day, they had 6 visits, during which was collected their medical history, adverse events, physical examination, determined indicators of the epidermal barrier (hydratation, sebum content, pH), biomechanical characteristics (skin elasticity), and also severity of disease (SCORAD) and quality of life (CDLQI). At visit 6, patients were assessed for satisfaction with the use of the cream.Results. All participants of the observation program completed their participation on time. As part of the observational program, there was an increase in skin hydration and sebum level by 3 and 3.5 times, respectively, pH level turned to the acidic values by 18%, an increase in elasticity by 30%, a decrease in SCORAD and CDLQI indices by 1.9 times or more 3 times respectively. The patients did not experience any adverse events; the satisfaction rating from the use of the cream was 4.78/5.Conclusions. Lipid-restoring cream LE SANTI can be recommended for inclusion in the treatment regimen for atopic dermatitis as a basic external agent that meets all the requirements for effectiveness and safety for children with atopic dermatitis, as well as basic care during remission.

Atopic dermatitis in Ethiopian children: a multicenter study of clinical severity, characteristics, and sociodemographic factors.

Atopic dermatitis (AD) is a chronic relapsing, pruritic, inflammatory skin disease. Assessing the characteristics and risk factors of severe AD is central to healthcare workers' understanding and subsequent education of patients for the most optimal outcomes. The clinical characteristics are known to vary depending on populations and regions. AD has been well-documented in the global North in mainly Caucasian populations, while very few studies have been conducted on African patients residing in Africa. This study assessed the clinical characteristics, severity, and sociodemographic factors of children with AD in Southern Ethiopia. A hospital-based cross-sectional study was conducted among 461 children and their caregivers in four randomly selected hospitals in Southern Ethiopia from October 2022 to September 2023. A systematic sampling technique was used to enroll study participants. Clinical profile and sociodemographic data were collected by trained data collectors. The Scoring Atopic Dermatitis (SCORAD) index tool was used. The descriptive analysis was performed to characterize study participants. Univariate and ordinary logistic regression were used to identify factors associated with the SCORAD index score. The OR with 95% was used to show the strength of association, and a p-value of <0.05 was used to declare the level of significance. Out of 461 AD-diagnosed children, 212 (46%) were girls and 249 (54%) were boys. In the sample of pediatric patients, 149 (32.3%) exhibited mild AD, 231 (46.2%) presented with moderate, and 99 (21.5%) showed signs and symptoms of severe AD. All patients had itching. Dryness of skin, excoriation, and erythema, followed by lichenification, were the most observed signs. In the ordinary logistic regression model, age onset of the disease [AOR 95% CI 1.95 (1.3-2.94)], sex of caregiver or family [AOR 95% CI 0.61 (0.41-0.90)], family atopy history [AOR 95% CI 0.64 (0.44-0.93)], mother education status [95% CI 2.45 (1.1-5.47)], and use of herbal medication [AOR 95% CI 0.50 (0.33-0.79)] were significantly associated with the severity of AD. In this study, 68% of children were found to have moderate-to-severe AD. Early onset, maternal education, familial atopy history, sex of caregiver, and use of herbal medication were independent predictors of severe AD in children. We recommend further investigation into these variables for their potential to serve as markers to assess the severity of AD and improve the care and management of children with AD in Ethiopia.

Serum Concentration of IL-5 Receptor (IL-5R) and Associations with Disease Severity in Patients with Chronic Spontaneous Urticaria (CSU) and Atopic Dermatitis (AD).

The immunological pathogenesis of atopic dermatitis (AD) and chronic spontaneous urticaria (CSU) has not been fully elucidated yet. The aim of our research was to assess the serum concentration of interleukin-5 receptor (IL-5R) in relation to the disease activity and pruritus intensity in adult patients with AD and CSU. This pilot study included 45 participants (15 patients with AD, 15 patients with CSU, and 15 healthy controls). Blood samples were taken to examine the serum levels of IL-5R using the enzyme-linked immunosorbent assay (ELISA) test. The Scoring Atopic Dermatitis (SCORAD) index, the Urticaria Activity Score (UAS7), and the Visual Analogue Scale (VAS) were used to assess the disease activity and the pruritus intensity, respectively. Obtained results revealed that the IL-5R concentration was significantly higher in patients with CSU than in patients with AD and in the controls (p = 0.038). There was a positive correlation between the IL-5R level and the SCORAD index in patients with AD (r = -0.9, p = 0.047), which was not found for the CSU activity by UAS7 and with the pruritus severity by VAS in both examined groups of patients. Our findings underscore higher serum levels of IL-5R among CSU and AD patients, which may highlight its functional role in the pathogenesis of these diseases. In contrast, IL-5R might not be fully useful in reflecting the severity of symptoms. Although our results are promising, this study should be conducted on a larger cohort of patients.

Effectiveness of a nurse-led one-to-one education programme in addition to standard care in children with atopic dermatitis: a multicentre randomized control trial.

Therapeutic patient education (TPE) is recommended for children with atopic dermatitis (AD), but no consensus has been reached on the optimal tailoring of delivery. While repeated multidisciplinary group education sessions have shown effectiveness, the benefits of one-on-one educational interventions led by nurses for children with AD have not yet been assessed. To assess the benefits of additional, well-structured, 1-h nurse-led individual TPE interventions in children with AD and their families compared with standard care alone. Children with moderate-to-severe AD and their parents were randomized to receive a 1-h nurse-led education session in addition to standard care vs. standard care alone. The primary outcome was the area under the curve (AUC) of the SCORing of Atopic Dermatitis index (SCORAD) from baseline to week 24 (lower AUC values represent better long-term control of the disease). In our study, 176 patients were randomized across 11 centres, and 153 were included in the full analysis set. The mean (SD) age was 4.47 (4.57) years. By week 24, there were no significant differences in the AUCs of the SCORAD between the two groups (P = 0.3). Secondary outcomes including patient-reported severity and quality of life [AUCs of the patient-oriented SCORAD (PO-SCORAD) and Infants' Dermatitis Quality of Life Index (IDLQI), Children's Dermatitis Quality of Life Index (CDLQI) and Family Dermatitis Quality of Life Index (FDLQI)] were not significantly different between the two groups. The only significant change observed in the intervention group, when compared with the one receiving standard care, was a decrease in topical steroid phobia, as assessed by the topical corticosteroid phobia (TOPICOP) score. Prespecified subgroup analyses showed that disease severity in the intervention group was significantly lower throughout the study, compared with the standard-care group when participants had moderate AD at baseline (n = 47); while participants with severe AD at baseline (n = 106) did not show benefit from the intervention. Participants showed no additional benefit from the intervention regardless of age group. This study did not show any additional effectiveness, in long-term severity control, of a 1-h nurse-led TPE intervention in children with AD treated with standard care, compared with those treated with standard care alone. However, it should be noted that the intervention reduced the fear of using topical steroids and may be beneficial for patients in the subgroup with moderate AD.

Long-term, observational, real-world study of dupilumab for the treatment of moderate-to-severe atopic dermatitis: a 52-week single-center retrospective analysis in China.

For dupilumab, real-world long-term follow-up data remain scarce, and studies on optimized treatment modes as well as drug survival rate and its predictors are lacking. To explore the effectiveness of different treatment modes of dupilumab and to understand the drug survival rates of dupilumab in China and its predictive factors. This retrospective study included patients with moderate-to-severe AD who received dupilumab treatment. Their clinical data were collected and analyzed. Compared with baseline, the SCORing Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), numerical rating scale (NRS), and Atopic Dermatitis Control Tool (ADCT) scores significantly decreased at 12, 24, and 52 weeks (p < 0.0001),and the continuous medication group had more significant improvements in SCORAD, EASI, NRS, and ADCT scores at 52 weeks than the noncontinuous medication group (p < 0.05). The 6-month and 1-year drug survival rates of dupilumab were 59.7% and 51.9%, respectively. The most common reason for treatment discontinuation was the satisfactory control of AD. Patients with adult-onset AD (adjusted odds ratio [OR]: 0.15, 95% confidence interval [CI]: 0.03-0.73) ,not complicated by other systemic diseases (adjusted OR: 0.17, 95% CI: 0.04-0.84) and eosinophilia at baseline (adjusted OR: 3.71, 95% CI: 1.12-12.26) had a higher probability of drug discontinuation. In real-world practice in China, dupilumab has exhibited good long-term effectiveness and safety for the treatment of moderate-to-severe AD, and continuous administration can benefit patients in the long term.

Association Between Increased Body Mass Index (BMI) and Atopic Dermatitis in Children Attending a Tertiary Referral Center: A Case-Control Study.

Background Atopic dermatitis (AD) and obesity represent chronic diseases, with growing worldwideprevalence, that rely on a common pathophysiological background: perpetual inflammation. Moreover, AD is considered more and more to be a beyond-the-skin disease with various associated comorbidities. This study aimed to investigate a potential link between overweight/obese status and AD in children. Methods A case-control study was performed on 130 AD patients and 130 exact age and sex match controls that attended the Pediatric Dermatology Department of Colentina Clinical Hospital. Based on the weight (in kilograms) and height (in centimeters), the body mass index (BMI), and the corresponding age and gender percentiles were assessed in both groups; study participants were divided as normal-weight, underweight, overweight, or obese. AD severity was evaluated using the Scoring Atopic Dermatitis Index (SCORAD), and quality of life impairment was assessed with the Dermatology Life Quality Index (DLQI).Descriptive statistics, t-tests, and logistic regression with odds ratios (OR) and associated 95% confidence intervals (CI) were used for data analysis. Results A statistically significantly higher BMI was identified in the AD group compared to controls (p=0.027). The relative risk for overweight/obese status in the AD group compared to controls was three times more frequent (OR 3.61, 95% CI 1.45-10.3, p<0.01). Additionally, the increased BMI in the AD group correlated significantly with disease severity as determined by SCORAD (p<0.05), with a relative risk for overweight/obese status in the moderate-severe AD subgroup being 20 times more frequent as compared to mild AD (OR 20.4, 95% CI 6.53-90.7, p<0.001). Conclusions To our knowledge, this is the first study to evaluate the correlation between AD and BMI in Romanian children. Statistically significant correlations between increased BMI, AD development, and AD severity in children were identified in our study population. This study's small sample size and single-center study design represent possible limitations. Additional, larger, multicentric studies are required to establish a more precise correlation between AD and obesity. Physicians should be aware of this potential association in order to perform obesity screening in AD children for more appropriate multidisciplinary management of such patients.

Retrospective evaluation of the effectiveness and safety of UVB-311 in atopic dermatitis

BACKGROUND: Atopic dermatitis is a widespread skin disease based on immune and genetic mechanisms of chronic inflammation formation. The disease most often develops in early childhood, has a frequent recurrent course, age-related clinical features. In this regard, the disease is characterized by a wide variety of treatment methods, the effectiveness of which varies and is a highly debated topic at the present time. AIM: to retrospectively evaluate the efficacy and safety of standard local and systemic therapy of atopic dermatitis in combination with UVB 311 nm. MATERIALS AND METHODS: 100 case histories of patients with atopic dermatitis of varying severity who were in the clinic of skin and venereal diseases in the period from 2022 to 2023 were analyzed. Of these, 50 patients received combined systemic and topical therapy with UVB 311 nm (the first group), and 50 patients received only standard topical and systemic therapy (the second group). Systemic and topical therapy of atopic dermatitis included, according to clinical recommendations, corticosteroids, calcineurin inhibitors, antihistamines. RESULTS: As a result of combined therapy with UVB 311 nm, patients showed a decrease in the SCORAD index by 1.7 times after 1 month of therapy, by 8 times after 2 months, and by 30 times after 6 months. In the second group, the SCORAD index decreased 1.2 times after 1 month from the start of therapy (p=0.0004), 3 times after 2 months (p=0.0001), 20 times after 6 months (p=0.003). Side effects in the first group were detected only in 5 (10%) patients: 2 (4%) patients had skin burning, 2 (4%) had skin itching, 1 (2%) patient had photodermatitis in the form of erythema of the skin. These adverse reactions were of a short-term nature and quickly passed if the recommendations were followed without canceling the procedures. CONCLUSION: UVB 311 nm therapy for atopic dermatitis has a higher therapeutic effect, is well tolerated, has minimal early side effects, and leads to clinical remission faster than standard systemic and local therapy.

New Topical Treatment for Atopic Dermatitis

The primary approach for managing atopic dermatitis (AD) involves the use of topical corticosteroids as the first-line treatment.While high-potency topical corticosteroids have shown to be effective, they come with an increased risk of local and, rarely, systemic adverse effects. Additionally, patients often experience a relapsing and remitting course. A revolutionary topical treatment for psoriasis and AD has recently received patent approval from the Spanish Ministry of Industry, Trade, and Tourism. This innovative treatment, presented in the form of a lotion, includes a combination of clobetasol, papaverine hydrochloride, spironolactone, a milk-peptide complex, and propylene glycol. An 18-year-old female presented with AD on the back of her neck and scalp. The patient had no significant past medical history and primarily complained of intense pruritus in the AD lesions. The patient received guidance to apply our recently patented lotion, Psorisbye, once a day for 5 days. In total, 50 ml of Psorisbye was utilized over 4 days. On the fifth day, the patient underwent an examination at the outpatient clinic. The patient reported a significant improvement in pruritus sensations and observed a reduction in scaled lesions. Upon evaluating our patient, a comparison of the lesions before and after applying the topical treatment for 4 days revealed a notable improvement in the SCORAD index, decreasing from 49.95 to 0. While the results of Psorisbye in this case show promise, it is crucial to conduct further studies with larger sample sizes and extended follow-up periods to validate the findings presented in our case report.

Characteristics of infectious complications in moderate and severe forms of atopic dermatitis

Atopic dermatitis (AD) is a multifactorial, genetically determined disease with a chronic relapsing course and a predisposition to hyperimmunoglobulinemia E. Abnormal colonization of Staphylococcus aureus, Malassezia furfur, and Herpes Simplex plays a significant role in maintaining inflammation in AD. Objective — to determine the frequency of bacterial, mycotic and viral complications in a group of patients with moderate and severe AD. Materials and methods. From 2018 to 2023, 80 patients with AD (moderate and severe forms) aged from 1 year to 53 years (average age 14.6 years) were under our observation. Patients with a SCORAD index ≥ 25 were included in the study. To confirm the nature of the infectious complication, additional examination methods were used: microscopy, bacteriological culture, amplification methods of research, dermatoscopy, immunoenzyme analysis. Results and discussion. An analysis of the total number of relapses of AD during the year was carried out, depending on the age and gender of the patients. The largest number of relapses was observed in the age group from 6 to 10 years — 9.4 ± 0.6. The frequency of AD relapses had a certain correlation with the severity of the course of dermatosis — the SCORAD index increased to 31.2 ± 0.4 in the group of patients with the highest frequency of disease relapses (9.4 ± 0.6) per year and, as a result, increase in the frequency of infectious complications. The conducted analysis showed that each age group of AD patients had its own characteristic spectrum of bacterial, mycotic and viral complications. The most frequent infectious complications of AD observed in the examined patients were streptostaphyloderma (18.8 %), molluscum contagiosum (11.3 %), mycotic lesions (10.0 %), herpes infection (6.3 %), Coxsackie virus (3.8 %), EBV ­infection (2.5 %). Conclusions. As a result of the clinical study, it was established that infectious complications in AD have age, gender, and topographic features that can change the course and prognosis of dermatosis. Against the background of reduced immunoreactivity, the risk of disseminated, life­threatening forms of infections increases in patients with atopic dermatitis.

Atopic dermatitis in children: a cross-sectional study of its impact on quality of life

Background: Atopic dermatitis, characterized by chronic inflammation of the skin, manifests with symptoms such as itching, skin discomfort, and sleep disturbances, significantly impacting the physical health and daily functioning of affected children. We embarked on this study to assess the Quality of Life of children with AD, identify factors that influence their QoL, and determine the specific domains of QoL most affected by the condition. Methods: Children up to 16 years of age, who met the Hanifin and Rajka’s diagnostic criteria for AD, were identified. The severity of AD was assessed using the severity scoring of atopic dermatitis index, and QoL was assessed using validated questionnaires: the infants dermatitis quality of life index for children under 4 years and the children’s dermatology life quality index for children 4 years and above. Results: A total of 70 children with AD were enrolled in the study. The mean QoL (IDQOL/CDLQI) score for children with AD was 6.7±5.05 and QoL was significantly impaired in children with more severe disease. The domains of QoL most affected by AD were related to pruritus, sleep disturbances, mood changes and treatment related issues. The duration of illness and the presence of other atopic comorbidities showed a significant correlation with QoL impairment, whereas age, gender and socioeconomic status demonstrated no such correlation. Conclusions: This study highlights the substantial impact of AD on the QoL of affected children, especially due to symptoms like itching and sleep disturbances.

Ursodeoxycholic acid alleviates atopic dermatitis-associated inflammatory responses in HaCaT and RBL-2H3 cells and DNCB/DFE-treated mice

AimsUrsodeoxycholic acid (UDCA) is a hydrophilic dihydroxy bile acid used for cholestatic liver disease and exhibits antioxidant, antitumor, and anti-inflammatory effects. However, its potential effects on atopic dermatitis (AD) have not been elucidated. This study aimed to evaluate the efficacy of UDCA in inhibiting the inflammatory response and alleviating lesions in AD-like mice. Main methodsTo investigate the efficacy of UDCA in AD-like inflammatory responses, tumor necrosis factor-alpha (TNF-α)- and interferon-gamma (IFN-γ)-stimulated HaCaT cells and anti-dinitrophenyl immunoglobulin E (DNP-IgE)- and human serum albumin (HSA)-stimulated RBL-2H3 cells were used to investigate the levels of inflammatory factors and their mechanisms. AD-like lesions were induced by applying DNCB/DFE to mice. The effect of UDCA administration in AD-like mice was analyzed by assessing organ weight, serum IgE and inflammatory cytokine levels, and histopathological changes using immunohistochemical and immunofluorescent staining. Key findingsIn HaCaT cells, UDCA significantly diminished TARC, MDC, MCP-1, and IL-6 expression by inhibiting the phosphorylation of nuclear NF-κB and cytoplasmic IκB, and also increased the levels of skin barrier protein. In RBL-2H3 cells, UDCA reduced β-hexosaminidase and IL-4 levels. In AD-like mice, UDCA suppressed organ hypertrophy, ear edema, SCORAD index, DFE-specific IgE levels, inflammatory cytokine levels, skin hypertrophy, mast cell invasion, skin barrier loss, and thymic stromal lymphopoietin-positive areas. SignificanceUDCA suppressed the expression of pro-inflammatory cytokines by keratinocytes and mast cells. It also alleviated atopy by suppressing symptoms without organ toxicity in AD-like mice. UDCA may be an effective and safe treatment for AD.

Studying the role of cortisol in the pathogenesis of atopic dermatitis during pregnancy

Introduction. Atopic dermatitis (AD) is one of the most common dermatitis, characterized by complex pathogenetic mechanisms. Psychological stress is recognized as one of the triggers of AD. Stress causes a high release of cortisol and epinephrine or norepinephrine, stimulating the immune system, primarily T helper cells type 1 (Th1 cells), to produce pro-inflammatory cytokines, leading to a cellular immune response and inflammation. In recent years, there has been an increase in incidence among pregnant women, however, the specific mechanisms of the development of AD during pregnancy still remain poorly understood. Aim. To study the role of cortisol in AD during pregnancy.Materials and methods. The study included 76 pregnant women during an exacerbation of AD, 20 non-pregnant women during an exacerbation of AD, 20 non-pregnant women without AD, 20 pregnant women without AD. The severity of AD was determined using the SCORAD index. Cortisol levels were determined in blood serum using enzyme-linked immunosorbent assay (ELISA). Anxiety level was determined using the Beck Anxiety Inventory. The level of itching was determined using a 5D itching scale.Results. Cortisol levels in pregnant women with AD (629.8 pg/ml) were significantly higher than in non-pregnant women with AD (386.15 pg/ml) (p &lt; 0.05). Cortisol levels were correlated with the severity level (Spearman coefficient = 0.203, p = 0.018), anxiety level (Spearman coefficient = 0.411, p = 0.001), and level of itching (Spearman coefficient = 0.352, p = 0.001).Conclusions. Cortisol is important in the pathogenesis of AD during pregnancy. During pregnancy with exacerbation of AD, higher values were observed than outside pregnancy.

Alterations in gut microbiome associated with severity of atopic dermatitis in infants.

Atopic dermatitis (AD) often arises in infancy, and gut microbial dysbiosis is associated with the development of AD. However, less is known about specific changes in early-life gut microbiome associated with AD and AD severity. This study aims to reveal the gut microbial composition and function profiles associated with the severity of AD in infants. Sixty-two infants (mean [SD] age, 4.7[1.9] months) with different severities of AD were enrolled and divided into three groups (mild, moderate and severe) according to the Scoring Atopic Dermatitis (SCORAD) index. The profiles of gut microbial composition and function were analysed by sequencing 16S ribosomal RNA amplicons. Quality of life on children and the family was evaluated using published questionnaires. Decreased levels of Clostridium sensu stricto, Collinsella and increased level of Parabacteroides presented in the severe AD group compared with the mild AD group after adjusting potential confounders (p < 0.05). There were strong positive correlations between the Scoring Atopic Dermatitis (SCORAD) index and the relative abundance (RA) of Bacteroides and functional pathways for metabolism of sphingolipids and glycosphingolipids (p < 0.05). The SCORAD index was negatively correlated with the RA of Clostridium sensu stricto (p < 0.05), and was also positively correlated with the index of quality of life on children and the family (p < 0.05). Discrepancies in gut microbial composition and functional pathways were observed in infants with mild-to-severe AD. Alterations in butyrate-producing bacteria (Clostridium sensu stricto), sphingolipid-producing bacteria (Parabacteroides, Bacteroides), and related functional pathways were associated with the severity of AD infants.