Factors influencing the occurrence of hand eczema in adults with a history of atopic dermatitis in childhood

A series of 955 persons aged 24-44 years, with atopic dermatitis in childhood, were interviewed in order to identify factors which increase the risk of developing hand eczema in adult life, or aggravate already existing hand eczema. Endogenous (constitutional) factors were in general of greater importance than exogenous factors, viz. chemicals, water, soil and wear (friction). Eczematous involvement of the hands in childhood was of predominant importance. In individuals without such involvement, severe (widespread) dermatitis in childhood was a dominant factor. Other factors, each of them significantly more important than the exogenous ones, were persistent eczema on other parts of the body and dry/itchy skin. The factors female sex, family history of atopic dermatitis and simultaneous bronchial asthma/allergic rhinitis were associated with increased risk of developing hand eczema in adult life, but were of limited importance compared with the other endogenous and the exogenous factors.     

Sources of online information utilized by caregivers of pediatric patients with atopic dermatitis

There is limited information on the use of websites and social media platforms among dermatology patients. This survey study of 210 children with atopic dermatitis and their caretakers who attended dermatology clinic from 6/1/2020 through 5/1/2021 revealed that 83.8% had used online sources for information related to their condition. There was wide variation in the sources used and the participants' perceived trustworthiness of these. This study highlights the importance of physicians actively engaging with the online sources used by patients with atopic dermatitis and their caregivers during counseling in clinic.     

Economic evaluation of maintenance treatment with tacrolimus 0.1% ointment in adults with moderate to severe atopic dermatitis

Background Rational health care decision‐making based on outcomes and economic evidence is essential to provide the best possible care for individual patients with atopic dermatitis (AD). Objectives To describe treatment outcomes and to evaluate resource utilization and associated cost of maintenance use of tacrolimus ointment (MU) vs. standard use of tacrolimus ointment (SU) in adults with AD. Methods A pan‐European, phase III multicentre randomized clinical trial was conducted. Patients with mild to severe AD were randomized to tacrolimus 0·1% ointment (MU) or vehicle (SU) twice per week for 12 months. Disease exacerbations were treated by using open‐label tacrolimus 0·1% ointment twice daily. Resource utilization data were collected prospectively alongside the clinical trial. Costs of pooled resource data were determined using German unit cost data. Direct and indirect costs were considered from third party payer, patient and societal perspectives. Results All patients with moderate and severe AD were included in a subanalysis, 75 patients in the MU arm (57% moderately affected) and 59 patients in the SU arm (59% moderately affected). In patients with moderate AD, the number of disease exacerbations in the MU arm was 2·4 vs. 5·5 in the SU arm (P < 0·001); in patients with severe AD corresponding figures were 2·3 vs. 7·4 (P < 0·001), respectively. Mean ± SD total annual cost per patient was €1525 ± 1081 (MU) vs. €1729 ± 1209 (SU) in patients with moderate AD and €2045 ± 2013 (MU) vs. €2904 ± 1510 (SU) in patients with severe AD. Conclusions Maintenance treatment with 0·1% tacrolimus ointment is more effective and leads to cost savings and improved health‐related quality of life in comparison with standard use of 0·1% tacrolimus ointment, especially in patients with severe AD.     

213例儿童特应性皮炎临床及病理特点分析

本研究对213例AD儿童患者临床及组织病理学特点进行分析,患儿平均发病年龄为0.88±1.73岁,约85.9%的患者表现为慢性皮炎;约78.9%的患者有个人或家族遗传过敏史。组织病理学示角化过度、微水疱形成、棘层肥厚、海绵水肿、浅层血管周围炎症及嗜酸性粒细胞浸润。     

Clinical effectiveness of a silk fabric in the treatment of atopic dermatitis

BACKGROUND: In children with atopic dermatitis (AD), eczema is easily aggravated by contact with irritant factors (e.g. aggressive detergents, synthetic and woollen clothes, climatic factors). OBJECTIVES: To evaluate the effectiveness of a special silk fabric (MICROAIR DermaSilk) in the treatment of young children affected by AD with acute lesions at the time of examination. METHODS: Forty-six children (mean age 2 years) affected by AD in an acute phase were recruited: 31 received special silk clothes (group A) which they were instructed to wear for a week; the other 15 served as a control group (group B) and wore cotton clothing. Topical moisturizing creams or emulsions were the only topical treatment prescribed in both groups. The overall severity of the disease was evaluated using the SCORAD index. In addition, the local score of an area covered by the silk clothes was compared with the local score of an uncovered area in the same child. All patients were evaluated at baseline and 7 days after the initial examination. RESULTS: At the end of the study a significant decrease in AD severity was observed in the children of group A (mean SCORAD decrease from 43 to 30; P = 0.003). At the same time, the improvement in the mean local score of the covered area (from 32 to 18.6; P = 0.001) was significantly greater than that of the uncovered area (from 31 to 26; P = 0.112). CONCLUSIONS: The use of special silk clothes may be useful in the management of AD in children.     

Patterns of care and referral in children with atopic dermatitis and concern for food allergy

Although many providers believe that up to 30% of atopic dermatitis (AD) is food induced, food challenge studies show that food-induced eczematous reactions are rare. When food allergy is suggested to cause AD, it often leads to allergy testing with a high false-positivity rate, in turn further focusing parents on food allergy. Study subjects were children less than 11 years old with AD and food allergy suspicion. Prior diagnoses, provider, and testing patterns were assessed by questionnaire given to the parents. Thirty-eight patients with AD were enrolled. Most subject's parents suspected food allergy induced AD. Initial skin diagnoses were made by pediatricians (79%) and family practitioners (18%) as eczema. Allergy was suggested by providers as cause for AD in 63% of the present study's patients. Seventy-nine percent had allergy testing. Greater than 90% of parents claimed their children had food allergy and food-induced AD. Sixty-six percent had positive food allergy tests and 37% had definite history of immediate IgE reactions to food. The majority of this population had allergy suggested as causative for eczema by their primary care provider and were subsequently evaluated by allergist and allergy testing. Consensus about the role of food allergy between the different providers of AD in children would result in more effective, efficient, and less costly health care.     

A prospective study of the prevalence and incidence of atopic dermatitis in children aged 0-42 months

BACKGROUND: There is strong evidence that the incidence and prevalence of atopic diseases is increasing. However, estimates of the prevalence of atopic dermatitis (AD) have varied greatly in the U.K. and most parts of the developed world. OBJECTIVES: The aim of the study was to estimate the prevalence and incidence of AD between the ages of 0 and 42 months in children born in the 1990s in a defined population in the U.K. DESIGN: We used data from the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC), a large population-based study in the U.K. that enrolled all pregnant mothers who were resident in Avon and had their delivery date falling between 1 April 1991 and 31 December 1992. Since then ALSPAC has collected a wide range of data from the newborns and their parents. Data reported here were collected at 6, 18, 30 and 42 months using parental reports in a postal questionnaire. Of the 14 009 children originally enrolled 8530 provided information on AD in each of the four follow-up questionnaires. We defined AD as a report of rash in at least two of the four questionnaires. Incidence risk was defined as the percentage of new cases of AD between follow-up questionnaires, out of the total number of children whose parents had not reported that they had AD by the time of the previous follow-up. RESULTS: Period prevalence of 21.0%, 25.6%, 23.2% and 19.9% were observed at ages 0-6, 6-18, 18-30 and 30-42 months, respectively. The corresponding incidence risks were 21.0%, 11.2% and 3.8%, at 0-6, 6-18 and 18-30 months, respectively. There were no gender differences in either the incidence or prevalence of the disease. CONCLUSIONS: Results from this large, prospective study are consistent with recent reports of increased incidence and prevalence of AD. Health planners can use our estimates of incidence and prevalence to project the number of children likely to suffer from AD during infancy and early childhood, and thus to determine the human and financial resources required.     

The millennium criteria for the diagnosis of atopic dermatitis

Abstract: Atopic dermatitis forms an active area of basic and clinical research, where important new knowledge about genetics and immunopathogenesis has surfaced over the past years, and where simultaneous development of new and innovative therapies is under way. However, the inclusion of any patient in an atopic dermatitis study, whether it is on its genetics, pathogenesis or therapy, requires a diagnosis which is irrefutable. Since there is no simple and also no complicated laboratory procedure to reach a diagnosis of atopic dermatitis, different sets of clinical criteria have been developed for the purpose of making the diagnosis uniformly in different studies as well as in different study centers. The most commonly used are Hanifin and Rajka's set of diagnostic features, which have major and minor clinical criteria to be fulfilled in order to establish a diagnosis of atopic dermatitis. Recent developments in the immunology of atopy have clearly established the major abnormality in this syndrome, the preferential production of allergen-specific IgE. In this contribution, it is suggested that the presence of such antibodies in a given patient should be a mandatory criterium for the diagnosis of atopic dermatitis. Such a diagnostic test however establishes a diagnosis of atopic syndrome, not atopic dermatitis. Thus, for atopic dermatitis we have to rely, for the time being, on additional clinical criteria. The clinical features described in the literature are critically evaluated, and it is suggested that in addition to the mandatory presence of allergen-specific IgE, 2 of 3 principal criteria (pruritus, typical morphology and distribution, chronic or chronically relapsing) should be present for such a diagnosis. Finally, the minor features originally described by Hanifin and Rajka and later evaluated by others are revised and divided over 4 subcategories; a) related to subclinical eczema; b) related to dry skin; c) extra skin folds; and d) ophthalmological pathology. They are suggested to be used as additional criteria only, needed when clinical suspicion is high but the new mandatory and principal diagnositic criteria described here are inconclusive. For study purposes, we suggest that the mandatory and principal criteria are sufficient. They are now evaluated and validated in ongoing atopic dermatitis treatment studies.     

角质形成细胞与特应性皮炎相关研究进展

角质形成细胞（keratinocytes,KCs）的异常导致角蛋白的表达出现异常,从而导致表皮屏障功能失调。在特应性皮炎(Atopic Dermatitis,AD)皮损中,KC大量表达胸腺淋巴基质生成素、肿瘤坏死因子α以及一些白细胞介素如IL-1α、IL-1β和IL-18等介导皮肤的炎症反应。在AD中KC还可表达模式识别受体,通过先天免疫系统,产生和维持炎症反应。另外,AD皮损中KC损伤导致抗菌肽的表达缺乏可能有助于增加AD患者皮肤对感染病毒、细菌和真菌的易感性。本文对角质形成细胞与特应性皮炎相关研究进展进行综述。     

Prevalence and risk factors for atopic dermatitis in preschool children

BACKGROUND: Atopic dermatitis (AD) is a common condition in infancy which usually disappears by 3 years of age in a significant proportion of children. The prognosis is mostly determined by severity and presence of atopic sensitization. OBJECTIVES: To investigate prevalence of AD, comorbidities and risk factors in a population of preschool children aged 3-5 years. METHODS: Children in kindergartens were evaluated. The International Study of Asthma and Allergies in Childhood written questionnaire (WQ) was used, with additional questions on risk factors. Atopy was investigated by skin prick tests. RESULTS: One thousand, four hundred and two valid WQs (92% response rate) were returned for evaluation. The prevalence of AD symptoms in the last 12 months in the whole population was 18.1% (254 cases). Seventy-two per cent of these children presented AD-specific localizations. The prevalence of eczema as a doctor's diagnosis in the total population was 15.4%. Positive atopic sensitization was present in 18.6% of the total and in 32.2% of the AD study population, respectively. Multiple sensitivities were observed in 58.2% of sensitized children. The prevalence of sensitization demonstrated that the most common sensitizing allergens in children with AD were mites and grass pollen. Rhinitis symptoms and wheezing were present in 32.2% and 24.2%, respectively, of children with AD. Allergic sensitization to egg, cat, grass pollen and mites, as well as the presence of symptoms of rhinitis, and a positive family history of atopy were all significant risk factors for AD. CONCLUSIONS: The study demonstrates a high prevalence of AD and a close relationship with rhinitis symptoms. Significant risk factors for AD were sensitization to food or inhalant allergens as well as parental history of atopy.     

The disease burden of pediatric patients with atopic dermatitis in Japan

Background

Atopic dermatitis (AD) is a chronic skin condition that is associated with significant patient burden and decreased health-related quality of life (HRQoL). We report results of the real-world Epidemiology of Children with Atopic Dermatitis Reporting on their Experience study in Japanese pediatric patients, focusing on the impact of AD severity on disease burden.

Methods

Children and adolescents aged 6 months to 17 years (or their caregivers/parents) completed an online survey between September 26, 2018, and March 5, 2019. Patients with diagnosed AD (i.e., met International Study of Asthma and Allergies in Childhood criteria and had a self-reported AD diagnosis) were evaluated for disease severity using the Patient-Oriented Eczema Measure (POEM). Impact of AD severity on AD symptoms (itching, pain, and sleep disturbance), disease flares, atopic comorbidities, healthcare resource utilization, school days missed, and HRQoL were assessed.

Results

Of 5702 Japanese pediatric patients, 547 had diagnosed AD and were included in this analysis. Based on POEM scores, AD severity was clear/mild in 346 patients (63.3%), moderate in 177 (32.5%), and severe in 24 (4.4%). Across all age groups (i.e., less than 6, 6–11, and 12–17 years), increased AD severity was associated with increased AD symptom severity, number of flares, atopic comorbidities, healthcare resource utilization, and school absences, as well as worsened HRQoL.

Conclusions

This population-based study of Japanese children and adolescents showed that greater AD severity had a high impact on disease burden.     

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

Background

Therapeutic patient education is a continuous, systematic, patient‐centered learning process to help patients and their families acquire and maintain the skills they need to manage their lives with a chronic disease. It has been proven effective in increasing treatment adherence and improving quality of life for patients with atopic dermatitis (AD) in Western countries. We introduce the first multicenter, randomized controlled clinical trial of therapeutic patient education in Chinese children with AD.

Objectives

To evaluate the effects of therapeutic patient education on the severity of AD, quality of life, and understanding and successful use of emollients in Chinese children with eczema.

Methods

We recruited 580 children, ages 2‐14 years, with moderate to severe AD from six hospitals in China. Participants were randomized (1:1) to an intervention (n = 293) or control (n = 249) group. In addition to the severity of AD, data on quality of life and a questionnaire on family and patient knowledge of emollients were evaluated at the 6‐month follow‐up.

Results

On study completion, we found that the intervention group showed a significantly greater reduction in mean SCORing Atopic Dermatitis (P < .001) and Infant's Dermatology Life Quality Index (P = .030) scores than the control group. In addition, knowledge about the use of emollients improved significantly in the intervention group. There was no significant difference between groups in Children's Dermatology Life Quality Index scores.

Conclusions

The first randomized controlled trial of a therapeutic patient education program in China had positive long‐term effects on decreasing eczema severity and improvement of quality of life in children 2‐4 years of age with AD, as well as in promoting greater understanding of the use of emollients.