Three Item Severity Research Articles

A case series evaluating the efficacy of herbal oil-based Bambusa vulgaris (Bamboo) leaf extracts as a topical treatment for atopic dermatitis

BackgroundAtopic dermatitis (AD) is a chronic, immune-mediated inflammatory skin disease and incurable that affects both children and adults. Up-to-now, there is no established animal model for AD that can be used in treatment experiments hence it challenges. This case series study aimed to describe the primary clinical treatment outcomes in volunteers with AD when using herbal oil-based bamboo leaf extracts. MethodsDerma gel's ingredients includes: (a) Total Bamboo leaf extracts (50%); (b) Mixed herbal oils (olive, curcumin, coconut, sweet gourd in equal volume, 10%); (c) Vaseline (40%) (d) Skin penetration enhancement additives. It was tested for safety and fast antimicrobial activity before using as a supportive AD treatment. From January to December 2022, 9 cases of AD (ranging from mild to severe) were recruited, including children and adult. The patients applied Derma gel with total bamboo leaf extracts three times a day for three months. The Three Item Severity (TIS) score was used to assess the severity of AD, which included evaluating erythema, edema, papulation, and excoriation at baseline and after 3 months of follow-up. ResultsAmong the 9 AD participants (2 mild, 3 moderate, and 4 severe), 8 out of 9 regardless of the severity of their condition or age, experience with corticosteroids became asymptomatic AD after 3 months of using Dermal gel. ConclusionThese primary results suggested that Bambusa vulgaris leaf extracts could potentially be effective in alleviating AD symptoms and promoting asymptomatic periods. To further validate these findings, additional investigation through randomized clinical trials is necessary. If confirmed, these results could contribute to the development of a novel topical herbal medicine for AD treatment.

Efficacy and Safety of a Skin Healing Cream in Mild-to-Moderate Eczema in a Mixed Population Including Infants: An Open-label, Single-arm Study

Abstract Introduction: Atopic dermatitis is an inflammatory skin condition that begins in infancy, characterized by extreme skin dryness, excoriations, and erythema. A completely natural product with plant extracts and vegetable oils was developed to manage eczema and associated conditions in a mixed population including infants. Materials and Methods: An open-label, single-arm, single-center study was conducted to evaluate the safety and efficacy of the test product on eczema severity. A total of 58 subjects, including infants, children, and adults aged 0 months to 60 years, diagnosed with mild-to-moderate eczema, were included. The subjects applied a small amount of product on the affected area twice daily for 14 days. Three-Item Severity (TIS) score, Eczema Area and Severity Index (EASI) change, and symptomatic relief were assessed at various time points. Results: The TIS score in children significantly reduced from baseline at 24 h (12.22%), day 7 (52.26%), and day 14 (79.74%), (all P <0.0001). Similarly, a statistically significant reduction in EASI was observed in adults at day 7 (13.68%) and day 14 (30.87%) (all P < 0.0001), which continued to offer relief throughout the study duration. Irritation significantly decreased from baseline throughout the study duration to day 14 (75.17%) (P < 0.0001). A significant reduction in other symptoms including dryness, itching, rashes, and edema was also seen from day 7 to day 14 (P < 0.0001). Conclusion: The test product was found to be safe and effective in reducing eczema severity and associated conditions in infants and adults. It promotes the development of healthy neonatal skin and hence can be considered as a skin-healing cream for infants.

Anti-inflammatory properties of raw honey and its clinical applications in daily practice

Background: Honey is a natural product; and in terms of phytochemical composition, it contains a high number of flavonoids and polyphenols such as quercetin, kaempferol, chrysin, and apigenin. Flavonoids found in honey mitigate the inflammatory processes, thereby exhibiting the anti-inflammatory potential of honey. Besides their anti-oxidant activities, flavonoids have the ability to inhibit pro-inflammatory enzymes such as LOX, COX, iNOS, and pro-inflammatory mediators, including cytokines, nitric oxide, and chemokines. Furthermore, flavonoids modulate transcriptional factors such as NF-?B, thereby controlling the expression of several inflammatory mediators.Methods: Clinical uses of natural raw honey have been studied at our Umm Ghuwailina Health Center, Doha, Qatar, with daily application under occlusion with promising results, in various patients with multiple conditions, including eczema, seborrheic dermatitis, and psoriasis. A layer of honey was applied to the lesion site, covered with a transparent securement dressing, and washed off for 7 consecutive days for patients with atopic dermatitis and psoriasis. The Three Item Severity (TIS) score, which includes erythema, edema/papulation, and excoriation on a scale from 0 to 3, was used for atopic dermatitis. For psoriasis, the primary outcome measure was the intensity component of the validated Psoriasis Area and Severity Index (PASI) and the Visual Analogue Score (VAS). Participants who were allergic to honey or receiving any corticosteroid within the last one month were excluded.Results: Twelve patients with atopic dermatitis had a significant improvement from a TIS score of 6 to 1 noticed in the honey-treated lesion 1 week later. With regard to psoriatic lesions, 6 patients were studied. There was a significant overall improvement in their psoriatic lesions, reaching a PASI score of 80 even one month after stopping the topical honey application. The vast majority of patients showed a significant improvement and no side effects.Conclusion: Raw natural honey might be a promising efficacious and cost-effective alternative to advanced anti-inflammatory products. However, well-designed double-blind placebo-controlled clinical trials are needed to confirm the benefits of honey from different botanical sources.

Impact of atopic dermatitis on the quality of life of children and their families.

Background Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, with a significant effect on the quality of life (QoL). This study aims to evaluate the impact of AD on the QoL of children and their parents and to identify predictors affecting their QoL. Methods The cross-sectional study was conducted in Montenegro. It included 200 children with AD aged 5-16 years and their parents. The severity of disease was measured by the Three Item Severity (TIS) score, while QoL was assessed with the Children's Dermatology Life Quality Index (CDLQI) and the Dermatitis Family Impact (DFI) questionnaire. Results The mean CDLQI score of the children affected by AD was 17.11 and the mean DFI score of their parents 19.86. There was a significant correlation between AD severity score assessed by a doctor (TIS) and both CDLQI and DFI scores (r=0.53 and r=0.27, respectively). A moderate positive correlation was observed between the QoL of children with AD and QoL of their parents (r=0.53). According to multiple linear regression, more impaired QoL of affected children was associated with more severe AD, younger parent's age and their lower educational level. Poorer QoL of parents was associated with female sex, younger age of children, more severe AD, lower educational level of parents and absence of a family history of atopic disease. Conclusions The present study confirmed that AD has a large negative impact on QoL of both patients with AD and their families. More impaired QoL was associated with more severe AD.

Real-life efficiency and safety comparison study of emollient ointment based on glycerophosphoinositol (GPI) salt of choline and other emollient products in patients with atopic dermatitis

Introduction The aim of this study was to investigate the effectiveness and safety of emollient preparations in comparison with the emollient ointment containing glycerophosphoinositol salt of choline in patients with atopic dermatitis (AD). Methods In a ‘real–life’ study, 300 patients with moderate AD were age-stratified and divided into two groups: patients applying GPI emollient and the comparator. We evaluated the effectiveness of AD treatment using: Eczema Area and Severity Index (EASI), Three Item Severity (TIS), Visual Analogue Scale (VAS) and Four-Item Itch Questionnaire. Results The GPI emollient was superior in reduction AD symptoms in children: VAS (−2.58 ± 0.25), TIS (−2.22 ± 0.22), EASI (−15.27 ± 1.77), and adults: VAS (−2.42 ± 0.19), TIS (−2.22 ± 0.17), EASI (−13.22 ± 1.53), as compared to the other emollient in children: VAS (−0.67 ± 0.19), TIS (0.47 ± 0.19), EASI (−3.71 ± 1.01) and adults: VAS (−0.86 ± 0.09), TIS (0.77 ± 0.09), EASI (−2.95 ± 0.46), p < .001. Similar results were observed in Four Item Itch Questionnaire. Conclusion Both emollients showed good safety and tolerance profile and reduced AD symptoms. The GPI emollient seems to be more slightly effective in reducing AD symptoms as compared to the other commercially available emollient.

Impact of atopic dermatitis on the quality of life of children and their families.

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, with a significant effect on the quality of life (QoL). This study aims to evaluate the impact of AD on the QoL of children and their parents and to identify predictors affecting their QoL. The cross-sectional study was conducted in Montenegro. It included 200 children with AD aged 5-16 years and their parents. The severity of disease was measured by the Three Item Severity (TIS) score, while QoL was assessed with the Children's Dermatology Life Quality Index (CDLQI) and the Dermatitis Family Impact (DFI) questionnaire. The mean CDLQI score of the children affected by AD was 17.11 and the mean DFI score of their parents 19.86. There was a significant correlation between AD severity score assessed by a doctor (TIS) and both CDLQI and DFI scores (r=0.53 and r=0.27, respectively). A moderate positive correlation was observed between the QoL of children with AD and QoL of their parents (r=0.53). According to multiple linear regression, more impaired QoL of affected children was associated with more severe AD, younger parent's age and their lower educational level. Poorer QoL of parents was associated with female sex, younger age of children, more severe AD, lower educational level of parents and absence of a family history of atopic disease. The present study confirmed that AD has a large negative impact on QoL of both patients with AD and their families. More impaired QoL was associated with more severe AD.

Quality of life in infants with atopic dermatitis and their families.

IntroductionAtopic dermatitis (AD) is the most common chronic inflammatory skin disease, with a significant effect on quality of life (QoL).AimTo evaluate the impact of AD on QoL of Montenegrin infants and their parents and to identify predictors affecting their QoL.Material and methodsThe cross-sectional study was conducted between August 2017 and July 2018 and included 186 infants with AD aged 0–4 years and their parents. The severity of disease was measured by the Three-Item Severity (TIS) score, while QoL was assessed with the Infants’ Dermatitis Quality of Life Index (IDQOL) and the Dermatitis Family Impact (DFI) questionnaire.ResultsThe mean overall scores were 14.72 for IDQOL and 17.78 for DFI. The positive correlation was observed between AD severity and both the IDQOL and DFI scores (r = 0.61, p < 0.001 and r = 0.67, p < 0.001, respectively). The highest-scoring IDQOL items were “itching and scratching”, and “child’s mood”. Poorer infants’ QoL was associated with more serious AD (B = 2.56; 95% confidence interval (CI): 2.08–3.04), concomitant atopic disease (B = 3.86; 95% CI: 1.78–5.94), family history of atopic disease (B = 3.80; 95% CI: 1.84–5.77), older age of the child (B = 1.14; 95% CI: 0.20–2.07) and older age of the parent (B = 0.28; 95% CI: 0.04–0.53). Similarly, parents had poorer QoL if their infants had more severe AD (B = 2.56; 95% CI: 2.14–2.87), another atopic disease (B = 2.91; 95% CI: 0.99–4.84) or family history of atopic disease (B = 4.33; 95% CI: 2.57–6.09).ConclusionsOur results demonstrate that AD has a significant negative impact on infants’ QoL as well as on QoL of their parents.

Does gender influence quality of life in children with atopic dermatitis?

Introduction: Atopic dermatitis (AD) is a chronic skin disease that has a significant impact on quality of life (QoL). The aim of this paper was to evaluate if gender affects some aspects of QoL in children with AD. Materials and methods: The cross-sectional study was conducted at the Clinic of Dermatology and Venereology, Clinical Center of Montenegro, between August 2017 and July 2018 and included 200 children aged 5-16 years with AD diagnosis. The severity of disease was measured by the Three Item Severity (TIS) score, while QoL was assessed with the Children's Dermatology Life Quality Index (CDLQI). Socio-demographic data on children with AD were collected by a short questionnaire. Results: The difference in overall CDLQI between boys and girls was not statistically significant. The domains that were most affected by AD were school/holidays (mean score 2.27 ± 0.65), and symptoms (mean score 2.22 ± 0.70). Swimming/ sports activities, school/holidays, teasing/bullying and sleep disturbance were more affected in girls. Overall CDLQI score and CDLQI subscale scores (except school/holidays and sleep in boys) significantly correlated with TIS. According to multivariate logistic regression analyses statistically significant differences between two genders were not found for age, AD severity, concomitant atopic disease, and family history of atopic disease. Conclusion: Although we did not find differences between the two genders in the overall health related QoL, this study confirmed the tendency for AD to have a more severe impact on girls' lives. These results may influence treatment and counselling of children affected with AD.

Therapeutic Effect of Tzu-Yun Ointment on Patients with Atopic Dermatitis: A Preliminary, Randomized, Controlled, Open-Label Study.

Atopic dermatitis comprises a group of chronic, relapsing inflammatory conditions. Topical steroids (TS) can ameliorate atopic dermatitis but induce skin atrophy and secondary infection. Tzu-Yun ointment (TYO) was used widely for skin ulcers and pus discharges. This study sought to determine whether TYO can replace TS therapy for atopic dermatitis. This preliminary, randomized, controlled, open-label design compared the therapeutic effects of TS and TYO in patients with atopic dermatitis; 33 patients were randomly assigned to the TS group (17 patients) and the TYO group (16 patients). All patients received an 8-week TS or TYO treatment. Primary outcome measures were assessed by using the Eczema Area and Severity Index (EASI) and Three Item Severity (TIS) before the treatment (baseline, week 0) and 1 week (week 1), 2 weeks (week 2), 4 weeks (week 4), and 8 weeks (week 8) after initiation of the treatment. Of the 33 enrolled patients, 31 (16 in the TS group and 15 in the TYO group) completed the study. Patients in both groups showed decreased EASI and TIS scores, with no significant difference at weeks 0, 1, 2, 4, and 8. TYO may be as effective as TS therapy for atopic dermatitis and has potential as an alternative treatment for this condition.

Serum IgE levels and severity of atopic dermatitis

INTRODUCTION: Atopic dermatitis is an itchy, chronic relapsing, inflammatory skin condition with typical flexural distribution. The eruption is frequently associated with other atopic conditions in the individual or other family members . It is associated with increased production of serum IgE levels. The objective of this study is to evaluate whether serum IgE levels correlate with the severity of atopic dermatitis (AD) based on Three Item Severity (TIS) Score of AD.&#x0D; MATERIAL AND METHODS: This is a hospital based observational study carried out from June 2014 to January 2015. Eighty two atopic dermatitis patients aged ≤ 20 years were recruited from the OPD of Dermatology Department of Gandaki Medical College, and the AD severity was evaluated using TIS score (Three Item Severity score). Concentrations of serum total IgE were measured and compared with controls.&#x0D; RESULTS: The mean age of our study group comprising of 82 patients was 9.03±5.6 years. The overall TIS score was 5.74±2.02.To find out the correlation between the disease severity and IgE level, one way ANOVA test was used. There was no statistical difference between the IgE levels of controls and the patients with mild disease but there was a significant correlation between severity of disease (between mild, moderate and severe AD) and the levels of serum IgE. (P&lt;0.05)&#x0D; CONCLUSION: Serum IgE is an useful indicator for predicting severity of atopic dermatitis in young patients.

Correlation between Objective SCORAD and Three-Item Severity Score Used by Physicians and Objective PO-SCORAD Used by Parents/Patients in Children with Atopic Dermatitis

Background: A self-assessment rating scale (SAS) is a good tool to assess the fluctuating disease severity and quality of life (QoL) in children with atopic dermatitis (AD). The European Task Force on Atopic Dermatitis created an SAS based on the Scoring Atopic Dermatitis (SCORAD) index, called the Patient-Oriented SCORAD (PO-SCORAD). Objective: The aim of our study was to measure the correlation between alternative systems such as the Objective SCORAD, the Three-Item Severity (TIS) score and the Objective PO-SCORAD. We also investigated the correlations between the objective severity assessments and QoL. Methods: In a specialized outpatient clinic, an observational prospective study was performed with children ≤16 years with AD. Results: Seventy-five children were included. A good and significant correlation was shown between Objective SCORAD and Objective PO-SCORAD: Spearman's ρ correlation (r_s) = 0.63 (p < 0.001). The correlation with QoL was moderate, but still significant (r_s = 0.41-0.61, p < 0.001). Conclusion: The Objective PO-SCORAD can be used for the evaluation of fluctuating AD and correlates significantly with the Objective SCORAD and the less time-consuming TIS score.

Clinical Efficacy and Tolerability of a Novel Selective Corticosteroid in Atopic Dermatitis - Two Randomised Controlled Trials

Topical corticosteroids remain the first-line therapy for atopic dermatitis (AD). Hence, we investigated the efficacy and safety profile of a novel selective corticosteroid, GW870086. We performed 2 randomised, double-blind, controlled studies with 25 AD patients and 20 healthy subjects. The changes in the Three-Item Severity (TIS) score and the skin thickness were the primary end points, respectively. The adjusted TIS score (day 22) shows that the novel corticosteroid resulted in a non-significant, but dose-dependent reduction compared to placebo (GW870086 0.2% vs. placebo = -0.38, GW870086 2% vs. placebo = -0.89). Significant skin thinning was observed in the second study on days 14 and 21 when patients were treated with the comparator but not with the novel corticosteroid compared to placebo. The clinical efficacy of the new selective corticosteroid was not superior to placebo, although a dose-dependent improvement upon treatment was noticed without the onset of skin thinning.

The effect of topical corticosteroids on bone mineral density in adults with atopic dermatitis

The effect of topical corticosteroids on bone mineral density in adults with atopic dermatitis

Prevalence and Severity of Atopic Dermatitis in Jeju Island: A Cross-sectional Study of 4,028 Korean Elementary Schoolchildren by Physical Examination Utilizing the Three-item Severity Score

The objective of this study was to evaluate the precise prevalence of atopic dermatitis (AD) in schoolchildren in Jeju Island in South Korea examined in 2009. Nine elementary schools were randomly selected from Jeju Island and a total of 4,028 schoolchildren were examined by a dermatologist. AD was diagnosed based on the Korean Atopic Dermatitis Research Group criteria for the disease. The severity of AD was measured with the three-item severity score (TIS). The point prevalence of AD was 9.5% overall. The prevalence among higher graders (age 9-12 years) was significantly lower than that in lower graders (age 6-9 years) (7.5% vs. 11.9%, < 0.00001). AD prevalence in girls (11.1%) was higher than that in boys (8.1%) (<0.005). In each grade, more than 50% of those affected had the mild form (TIS score 1 or 2). There were no apparent differences in severity of AD between grades or genders. This is the first Asian study of prevalence in schoolchildren using TIS score for evaluating AD severity.

Quality of Life Measurement and its Relationship to Disease Severity in Children with Atopic Dermatitis in General Practice

Atopic dermatitis (AD) has a big impact on quality of life. The usefulness of health-related quality of life questionnaires for children with AD in general practice, and the relationship of quality of life to disease severity, as assessed by parents and by investigators, however, is not known. This study used the Infants' Dermatitis Quality of Life Index (IDQoL) to assess quality of life in children with AD selected from general practice. Severity of AD was determined by investigators and parents using the objective SCORAD (SCORing Atopic Dermatitis), the TIS (three-item severity scale), or by an additional question on the IDQoL. A total of 66 patients (41% boys, mean age 31 months) were included. Correlations between disease severity assessed by parents and by investigators were low (Rs 0.29-0.51). Correlations between IDQoL and severity assessed by investigators were also low (Rs 0.08-0.36). However, correlations between IDQoL and severity according to parents were high (Rs 0.67-0.73). In conclusion, disease severity and disease-related quality of life are different aspects of AD and must be taken into consideration when evaluating treatment or investigating new dermatological therapies in trials.

Long‐term reduction in local inflammation by a lipid raft molecule in atopic dermatitis

The complex pathogenesis of atopic dermatitis (AD) is guided by cell surface receptor-mediated signal transduction regulated in lipid rafts. Miltefosine is a raft-modulating molecule targeting cell membranes. With this controlled clinical study, the clinical and immunomodulatory efficacy of miltefosine was investigated in patients with AD in comparison with a topical corticosteroid treatment. Sixteen patients with AD were treated topically with miltefosine and hydrocortisone localized on representative AD target lesions for 3 weeks. To assess the clinical efficacy, the three item severity (TIS) score was evaluated before, during and after treatment as well as after 4-week-follow-up period. To study the anti-inflammatory effect of miltefosine on the cellular T cell pattern, skin biopsies were analysed before and after treatment. The TIS score dropped in both groups significantly after treatment. A carry-over effect was exclusively seen for miltefosine after discontinuing the treatment. These findings were substantiated by thermographic imaging with a significant decrease in the maximum temperature (T(max)) after miltefosine application (P = 0.034, DeltaT(max) = 1.7 degrees C [2.1-3.9]). Immunohistochemically, a reduction in lesional CD4(+)-infiltrating T cells was observed in both treatments. Moreover, increased FoxP3(+) cells were present in the skin after miltefosine treatment (before 5.4% [1.9-9.8], after 6.2% [3.5-9.5]). We demonstrate that miltefosine is locally active in patients with AD and led to a sustained clinical improvement in local skin inflammation. Moreover, the increased frequency of FoxP3(+) cells in the skin of patients with AD suggests its immunomodulatory properties.

Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score

It is important to determine the severity of atopic dermatitis (AD) for evaluation of disease improvement after and during therapy. Scoring of the severity of AD is demanded in clinical trials. The European Task Force on Atopic Dermatitis (ETFAD) has developed the SCORAD (SCORing AD) index to create a consensus on assessment methods for AD, so that study results of different trials can be compared. However, modification of the SCORAD index has led on several occasions to wrong and incorrect use of the system. To measure the extent of AD, the rule of nines is applied on a front/back drawing of the patient's inflammatory lesions. The extent can be graded 0-100. The intensity part of the SCORAD index consists of six items: erythema, oedema/papulation, excoriations, lichenification, oozing/crusts and dryness. Each item can be graded on a scale 0-3. The subjective items include daily pruritus and sleeplessness. Both subjective items can be graded on a 10-cm visual analogue scale. The maximum subjective score is 20. All items should be filled out in the SCORAD evaluation form. The SCORAD index formula is: A/5 + 7B/2 + C. In this formula A is defined as the extent (0-100), B is defined as the intensity (0-18) and C is defined as the subjective symptoms (0-20). The maximum SCORAD score is 103. Based on training sessions by the ETFAD, the SCORAD index was modified by excluding the subjective symptoms (objective SCORAD). The objective SCORAD consists of just the extent and intensity items, the formula being A/5 + 7B/2. The maximum objective SCORAD score is 83 (plus an additional 10 bonus points). Bonus points are given for severe disfiguring eczema (on face and hands). The three-item severity (TIS) score involves the scoring of erythema (redness), oedema and excoriations (scratches) in one representative lesion, marked as R-O-S. The TIS score corresponds well with the more detailed objective SCORAD and can be used as a prescreening system or as a quick system in studies and is excellent for epidemiological studies.

The value of SCORAD and beyond. Towards a standardized evaluation of severity?

The clinical scoring systems of atopic dermatitis were analysed and compared. Some biological parameters that can correlate with the clinical score were also reviewed. After the definition of the disease based on validated clinical criteria, the second necessity was the availability of reliable severity scores to allow clinicians to verify the course of the disease and the efficacy of treatments. After many proposals, the SCORAD (SCORing Atopic Dermatitis), that required more than three years of work, was the first one that was validated. SCORAD is freely available from an internet site and can be easily calculated using dedicated software. EASI (Eczema Area and Severity Index) score has also been validated but it has been modified twice. Simpler systems include SASSAD (Six Area, Six Sign Atopic Dermatitis) and TIS score (Three-Item Severity score). In parallel, biological parameters were investigated. Eosinophil cationic protein, circulating basophils, major basic protein, soluble E-selectin, antistaphylococcal enterotoxin B, immunoglobulin E titres and macrophage-derived chemokine, can correlate significantly with the clinical score. The clinicians will not benefit directly from laboratory techniques and will employ clinical scores.