Community validation of the United Kingdom diagnostic criteria for atopic dermatitis in Romanian schoolchildren

Although the U.K. modification of Hanifin and Rajka's diagnostic criteria for atopic dermatitis (AD) for use in epidemiological studies has demonstrated good validity and repeatability when previously tested in a U.K. community setting, little is known about its performance in other countries where different cultural, educational and linguistic factors could impair validity. We used a questionnaire to test the validity of the U.K. criteria as a point prevalence measure of AD in 1114 Romanian schoolchildren aged 6–12 years against the clinical diagnosis of a dermatologist with an interest in AD, who was unaware of the questionnaire content and responses. The sensitivity and specificity of the U.K. criteria for AD in this setting was 74% and 99%, respectively, an improvement rather than a deterioration in validity when compared with the previous U.K. study. Test–retest repeatability for all of the questions pertaining to the U.K. criteria using the chance-corrected kappa statistic was high, with values of 0.72 and over. The positive predictive value of the criteria was lower than in the U.K. study (63% compared with 80%, respectively) due to the very low prevalence of AD in this study (2.4%). The validity of a parental report of 'eczema' was poor, with a sensitivity of 22%, specificity of 97% and positive predictive value of 18%. This study suggests that the U.K. criteria perform well in settings outside the U.K., although care has to be taken when using the criteria to ascertain cases in settings where the prevalence of AD is very low.     

Clinical comparison of human and canine atopic dermatitis using human diagnostic criteria (Japanese Dermatological Association, 2009): proposal of provisional diagnostic criteria for canine atopic dermatitis

Atopic dermatitis (AD) is a common skin disease encountered in both humans and dogs. Canine AD can be used in the analysis of naturally occurring AD; however, details of clinical comparison have been lacking. The purpose of this study is to compare those clinical features using the human diagnostic criteria (Japanese Dermatological Association, 2009). Fifty-one dogs with canine AD were evaluated by the human criteria. Prior to this study, canine AD was basically diagnosed by the fulfillment of two authentic canine AD criteria and a positive reaction against Dermatophagoides farinae in serum immunoglobulin E levels and/or in intradermal tests. Among the human AD criteria items, behavior corresponding to pruritus was observed in all 51 dogs. Skin lesions corresponding to eczematous dermatitis were seen in 50 dogs, and symmetrical distribution of skin lesions was noted in all 51 dogs. A chronic or chronically relapsing course was observed in 50 dogs. Based on these results, the concordance rate for the criteria was 96% (49/51). Differential diagnoses of AD were also investigated in the same manner. The concordance rate for the criteria was 0% (0/69) in scabies, 2% (1/50) in pyoderma, 0% (0/50) in demodicosis, 0% (0/9) in cutaneous lymphoma, 0% (0/2) in ichthyosis, 25% (2/7) in flea allergy, 48% (24/50) in seborrheic dermatitis and 75% (3/4) in food allergy. Canine AD is thus indicated as a valuable counterpart to human AD in clinical aspects. In addition, the human AD criteria could be applicable, with some modification, as provisional diagnostic criteria for canine AD.     

Comparative efficacy of Hanifin and Rajka''s criteria and the UK working party''s diagnostic criteria in diagnosis of atopic dermatitis in a hospital setting in North India

BACKGROUND: Diagnosis of atopic dermatitis (AD) depends on clinical features because no definitive diagnostic test exists. Criteria proposed by Hanifin and Rajka (Acta Derm Venereol (Stockh) 1980; Suppl 92: 44-47) were acceptable for hospital-based studies but were found not to be suitable for field studies. A UK working party formulated clinical diagnostic criteria that could be used in both hospital and epidemiological settings. Validation studies of the criteria showed widely variable results, probably due to different clinical settings and ethnicity. AIM AND OBJECTIVE: This study was undertaken to validate Hanifin and Rajka's criteria and to assess the comparative efficacy of their criteria and the UK working party's diagnostic criteria in the diagnosis of AD in a hospital setting in North India. SUBJECTS AND METHODS: This study serially included 101 patients with AD and 48 controls of paediatric age group. The study period was from July 2003 to December 2004. RESULTS: Hanifin and Rajka's criteria (sensitivity 96%, specificity 93.75%, positive predictive value 97% (PPV) and negative predictive value (NPV) 91.84%) had a statistical advantage over the UK working party's diagnostic criteria (sensitivity 86%, specificity 95.83%, PPV 97.75% and NPV 76.67%), with a P-value < 0.005.     

Validation of the diagnostic criteria for atopic dermatitis.

OBJECTIVE: To validate the accuracy of newly proposed diagnostic criteria for atopic dermatitis (AD). DESIGN: Double-blind, cross-sectional study comparing the achievement of new criteria with the diagnosis of a dermatologist. SETTING: A private, general dermatology, outpatient clinic. PATIENTS: A sample of 416 consecutive patients attending the clinic within 2 months (146 males and 270 females), consisting of 60 patients with AD and 356 control patients with other skin diseases. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive values of proposed criteria in the diagnosis of AD. RESULTS: Sensitivity, specificity, and positive and negative predictive values of proposed diagnostic criteria for AD were 10.0% (95% confidence interval [CI], 4.1%-21.2%), 98.3% (95% CI, 96.2%-99.3%), 50.0% (95% CI, 22.3%-77.7%), and 86.6% (95% CI, 82.8%-89.7%), respectively. CONCLUSIONS: These diagnostic criteria for AD are highly specific and are suitable for clinical trials. However, they may not achieve enough sensitivity to be useful for large, population-based epidemiological studies or for routine clinical practice, at least in Iran.     

Validation of the U.K. diagnostic criteria for atopic dermatitis in a population setting

Summary One reason why so little is known about the epidemiology of atopic dermatitis (AD) is lack of suitable diagnostic criteria. A simple list of diagnostic criteria for AD for use in epidemiological studies has recently been developed by a U.K. working party. These have performed well in hospital validation studies of subjects with skin diseases. This study sought to validate the newly proposed criteria for AD in a population setting by conducting a cross-sectional survey of 695 schoolchildren aged 3–11 years in three randomly selected primary schools in West Lambeth, London. As a point prevalence measure, the U.K. criteria had a sensitivity of 70%, a specificity of 93%, and a positive predictive value of 47% when compared with a dermatologist's examination findings. Subsequent analysis suggested that most children classified as false positives had suffered from AD in the last year, but were inactive at the time of examination. When adjusted for these cases, the sensitivity and specificity increased to 80 and 97%, respectively, corresponding to positive and negative predictive values of 80 and 97%, respectively. The U.K. diagnostic criteria for AD appear to work well as a 1-year period prevalence measure in London schoolchildren. Further validation in adults and other countries are needed.     

A systematic review of diagnostic criteria for psoriasis in adults and children: evidence from studies with a primary aim to develop or validate diagnostic criteria

Psoriasis is a disease of the skin and joints. It can cause red, flaky patches of skin on any part of the body and swelling in the joints. Around the world psoriasis is known to occur in up to 8 in 100 adults and 2 in 100 children. The researchers of this review are based in Nottingham and Sheffield in the UK. The purpose of the review was to find all studies that had created diagnostic criteria for psoriasis and collect any results on how well the criteria worked at diagnosing psoriasis. The term diagnostic criteria was used to describe a list of items that, when present together, meant a diagnosis of psoriasis could be made. In order to complete the review the researchers searched online research databases, summarised the findings and checked the quality of the studies. Twenty‐three studies were found that developed diagnostic criteria. These criteria included genetic and laboratory criteria, criteria using skin imaging techniques, criteria based on microscopic changes seen on skin biopsy, criteria using computer‐based algorithms, a questionnaire‐based criteria and criteria to be used within traditional Chinese medicine. The criteria in these 23 studies mostly performed well at diagnosing psoriasis, but were often test‐based and would be used alongside a medical consultation. Test‐based criteria often required specific equipment or a skin/blood sample. None of the 23 diagnostic criteria involved looking at the skin in a physical examination, which would best mirror current medical practice and are available for other skin diseases. Such criteria would be useful to health professionals and researchers.     

Evaluation of diagnostic criteria for atopic dermatitis: validity of the criteria of Williams et al. in a hospital-based setting

BACKGROUND: Surveys of the prevalence of atopic dermatitis (AD) have been carried out world-wide, but the results vary widely. The differences probably result from the use of different diagnostic criteria. Williams et al. proposed minimum, simplified, diagnostic criteria that require no invasive test and are easy to use. Pilot studies in European countries showed their suitability for implementation both in hospitals and in the community, and their high sensitivity and specificity. OBJECTIVES: To evaluate the potential practical value of the criteria of Williams et al. in the Chinese population. METHODS: The criteria of Hanifin and Rajka (gold standard), Williams et al. and Kang and Tian were applied and compared in 111 patients with AD and 121 control subjects with other skin diseases in three out-patient centres in China. RESULTS: The criteria of Williams et al. showed a similar diagnostic efficiency to that of the gold standard, with the sensitivity, specificity and kappa value reaching 95.50%, 97.52% and 0.93, respectively. No significant difference was found between the criteria of Williams et al. and those of Kang and Tian (chi2 = 0.69, P > 0.05). 'Onset under the age of 2 years', a criterion of Williams et al. could be used in subjects of any age. CONCLUSIONS: The diagnostic efficiency of the criteria of Williams et al. was basically similar to those of Hanifin and Rajka and of Kang and Tian in our out-patient settings. However, those of Williams et al. were easier to apply and required no invasive tests.     

Diagnostic criteria for atopic dermatitis: a systematic review

BACKGROUND: Atopic dermatitis (AD) has a wide spectrum of dermatological manifestations and despite various validated sets of diagnostic criteria that have been developed over the past decades, there is disagreement about its definition. Nevertheless, clinical studies require valid diagnostic criteria for reliable and reproducible results. OBJECTIVE: To summarize the evidence concerning the validity of diagnostic criteria for AD. METHODS: All data sources were identified through searches on Medline, Embase and Cochrane databases. The Quality Assessment of Diagnostic Accuracy tool (QUADAS) was used. Results are presented in a receiver operating characteristic (ROC) plot. RESULTS: Out of the 20 articles that met the criteria, 27 validation studies were identified. In two studies concerning Hanifin and Rajka diagnostic criteria sensitivity and specificity ranged from 87.9% to 96.0% and from 77.6% to 93.8%, respectively. Nineteen validation studies of the U.K. diagnostic criteria showed sensitivity and specificity ranging from 10% to 100% and 89.3% to 99.1%, respectively. Three validation studies concerning the Schultz-Larsen criteria showed sensitivity from 88% to 94.4% and specificity from 77.6% to 95.9%. In one article concerning the criteria of Diepgen, the sensitivity ranged from 83.0% to 87.7% and the specificity from 83.9% to 87.0%. One article studied the Kang and Tian criteria and reported 95.5% sensitivity and 100% specificity. One article validating the International Study of Asthma and Allergies in Childhood (ISAAC) criteria showed a positive and negative predictive value of 48.8% and 91.1%, respectively. CONCLUSION: With this systematic review of the existing sets of diagnostic criteria for AD a varying number of validation studies with varying methodological quality was found. The U.K. diagnostic criteria are the most extensively validated. However, improvement of methodological design for validation studies and uniformity in well-validated and applicable diagnostic criteria are needed to improve future intervention studies and to compare study results.     

A comparison between criteria for diagnosing atopic eczema in infants

BACKGROUND: Epidemiological studies have shown different estimates of the frequency of atopic eczema (AE) in children. This may be explained by several factors including variations in the definition of AE, study design, age of study group, and the possibility of a changed perception of atopic diseases. The role of IgE sensitization in AE is a matter of debate. OBJECTIVES: To determine the prevalence and cumulative incidence of AE in a group of unselected infants followed prospectively from birth to 18 months of age using different diagnostic criteria; to evaluate the agreement between criteria; and to describe the association between atopic heredity and postnatal sensitization, respectively, and the development of AE according to the different diagnostic criteria. METHODS: During a 1-year period a consecutive series of 1095 newborns and their parents were approached at the maternity ward at the Odense University Hospital, Denmark and a cohort of 562 newborns was established. Infants were examined and followed prospectively from birth and at 3, 6, 9, 12 and 18 months of age. AE was diagnosed using four different criteria, the Hanifin and Rajka criteria, the Schultz-Larsen criteria, the Danish Allergy Research Centre (DARC) criteria developed for this study and doctor-diagnosed visible eczema with typical morphology and atopic distribution. Additionally, the U.K. diagnostic criteria based on a questionnaire were used at 1 year of age. Agreement between the four criteria was analysed at each time point and over time, and agreement between the four criteria and the U.K. questionnaire criteria was analysed. RESULTS: The cumulative 1-year prevalence of AE using the Hanifin and Rajka criteria was 9.8% (95% confidence interval, CI 7-13%), for the Schultz-Larsen criteria it was 7.5% (95% CI 5-10%), for the DARC criteria 8.2% (95% CI 6-11%), for visible eczema 12.2% (95% CI 9-16%) and for the U.K. criteria 7.5% (95% CI 5-10%). The pairwise agreement between criteria showed good agreement, with rates varying between 93% and 97% and kappa scores between 0.6 and 0.8. Agreement analysis of diagnoses between the four criteria demonstrated that cumulative incidences showed better agreement than point prevalence values. CONCLUSIONS: Agreement between different criteria for diagnosing AE was acceptable, but the mild cases constituted a diagnostic problem, although they were in the minority. Repeated examinations gave better agreement between diagnostic criteria than just one examination. Atopic heredity was less predictive for AE than sensitization to common food and inhalant allergens in early childhood.     

Remembering childhood atopic dermatitis as an adult: factors that influence recollection

BACKGROUND: Atopic dermatitis (AD) is common in the population, and studies have shown that the disease is on the increase. Studies based on hospital records reflect selected populations and may miss less severe cases of AD, and the use of self-reported questionnaires has the drawback of recall bias. OBJECTIVES: To investigate some possible factors influencing recall bias when questionnaires are used to establish the prevalence of childhood eczema in an adult population. METHODS: A questionnaire regarding past and present eczema was sent to 557 cases (with signs suggesting the diagnosis AD) and 554 matched controls (subjects lacking signs of AD) born during 1960-1969 and identified in school health medical records. Cases and controls were aged 31-42 years at the time of the study and 70.5% returned the questionnaire. RESULTS: Of 403 cases, 29% did not report childhood eczema in the questionnaire. There was a difference between those who did recall their childhood AD (remembering group, RG), and those who did not (forgetful group, FG) in who had documented the diagnostic signs in the school health records. In the RG the signs were reported by both parents and school health personnel in 51% of cases, and in the FG this was true of only 16%. The RG had a higher prevalence of eczema after 15 years of age and of hand eczema. The RG also reported more visits to physicians after the age of 15 years and more time taken as sick leave due to eczema. CONCLUSIONS: Several factors influence how well people remember their AD in childhood. These factors include disease activity in adult life, disease severity, and who noticed the eczema in childhood.     

Clinical features of atopic dermatitis in a hospital‐based setting in China

Background Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease. There have been few detailed reports of the clinical evaluation of Chinese patients with AD. Objectives To give a profile of the clinical features of Chinese AD patients in a university hospital setting. Methods A total of 1008 cases met Hanifin and Rajka diagnostic criteria of AD were recruited at Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China. Results In our survey, 22.7% patients were mild, 66.6% were moderate and 10.7% were severe according to the SCORAD index. Both the frequency and severity of the male patients were slightly higher. The frequency of asthma among the AD patients was 16.7% and it was increased with the age (χ² = 205.20, P = 0.000). The frequencies of objective minor signs were demonstrated with age‐related changes. Besides, three localized variants including eyelid eczema (49.8%), scalp dermatitis (49.7%), infra‐auricular and retroauricular fissuring (44.8%) were commonly observed, especially in the infantile phase (P < 0.01). It was showed significant differences in serum total immunoglobulin E (IgE) and eosinophil cationic protein (ECP) levels of different age groups. The positive rate of Phadiatop was raised after 3 years old and that of the common food allergens were decreased after 6 years old. Conclusions More males than females had ongoing AD in our survey. Most AD debuted in the first year of the cases. High incidence of the three clinical signs: eyelid eczema, scalp dermatitis and infra‐auricular and retroauricular fissuring among the patients suggests it can be a potential valuable diagnostic clue to AD.     

Community validation of the U.K. diagnostic criteria for atopic dermatitis in Japanese elementary schoolchildren

BACKGROUND: A simple list of diagnostic criteria for atopic dermatitis for use in epidemiological studies was developed by a U.K. working party. This list served well for both hospital patients with skin diseases and in general population within the U.K. OBJECTIVES: To validate the U.K. diagnostic criteria in Japanese elementary schoolchildren, we collected the questionnaires on regular health checkups, which had been completed by parents of schoolchildren in 2001/2002 and 2004/2005. METHODS: Elementary schoolchildren were examined by dermatologists in eight areas (16,152 children) in 2001/2002 and in three areas (3849 children) in 2004/2005. The questionnaire was distributed to the parents 2 weeks before the skin examination, completed by the parents and collected after the survey. RESULTS: In 2002/2002 comparing the U.K. diagnostic criteria with the findings on clinical examination used as the reference standard, the U.K. criteria (1-year prevalence measure) showed a sensitivity of 71.8%, specificity of 89.3% and positive predictive value of 44.7%. In 2004/2005 we confirmed that the U.K. criteria for a point prevalence measure showed a higher positive predictive value (59.9%) compared with that for 1-year prevalence measure (49.3%). CONCLUSION: Now that we know the sensitivity and specificity of the U.K. criteria in the population examined in this study, we will be able in the near future to estimate the prevalence of atopic dermatitis in a similar population with reverse operation by questionnaires alone using these criteria without examination by dermatologists. Therefore, the validation study of U.K. criteria could be useful for future epidemiologic surveys.     

History of the establishment and revision of diagnostic criteria,severity index and therapeutic guidelines for pemphigus in Japan

We summarize the process of establishing and revising the diagnostic criteria, severity index and therapeutic guidelines for pemphigus in Japan (including the results of a nationwide survey regarding these guidelines). We also summarize the content and present an evaluation of the utility of these guidelines. Due to the publication of these documents throughout the Japanese medical community, it appears that patients with pemphigus have recently begun to receive appropriate treatment, dramatically improving their quality of life and prognosis. Continuous examination of these criteria by means of follow-up studies of patients treated according to the guidelines is necessary to determine the long-term efficacy of treatment. To this end, it is hoped that these guidelines will be more extensively disseminated among the medical community.     

The descriptive epidemiology of atopic dermatitis in the community

Atopic dermatitis (AD) is a common condition in the community, particularly amongst children. Although comparison of prevalence data between surveys is made difficult by differences in methodology, the available data suggest that there has been a substantial rise in the prevalence of AD, and that social, geographical and racial variation in disease frequency exists. There is a lack of quality data relating to the prognosis of AD. Recently a reliable set of diagnostic criteria has been developed and a number of severity scoring systems have been proposed for use in epidemiological studies.     

Atopic dermatitis: correlation between non-damaged skin barrier function and disease activity

Background Atopic dermatitis (AD) is a chronic dermatosis, predominant in childhood, characterized by pruritus and eczematous‐type lesions with xerosis as the prominent clinical sign. Objectives To analyze the correlation between biophysical measurements of skin barrier function and other assessment criteria of clinical severity according to Rajka and Langeland’s criteria. Methods Biophysical measurements [transepidermal water loss (TEWL) and corneometry] were obtained from 120 patients with the diagnosis of AD. Serum levels of IgE were also evaluated. Results A significant correlation between corneometry, TEWL, and clinical severity of AD was found. Data showed an inverse correlation between corneometry, TEWL, and AD severity, and a significant difference (P < 0.001) between mean of corneometry and TEWL and AD severity (mild, moderate, and severe). As for IgE levels, corneometry had significant negative correlation, in contrast with TEWL, which showed a significant positive correlation (P < 0.001). Conclusion Biophysical measurements of skin barrier in non‐lesional skin of AD may work as an evaluation factor for AD severity.     

Patient education programs for childhood atopic dermatitis: who is interested?

Background: Atopic dermatitis (AD) is a skin disease which causes psychological distress to patients and their families. Patient education programs for childhood AD have positive effects on the severity of the skin disease as well as on psychological variables. So far it has not been determined whether particular patient characteristics lead to being interested in patient education programs. The aim of this cross‐sectional study was to identify exploratory predictors of being interested in patient education programs in parents of children with atopic dermatitis. Patients and methods: A severity index (SCORAD) as well as questionnaire data were collected from 73 parents of children with AD to measure satisfaction with medical care, quality of life, coping strategies, and the subjective benefit of former treatments as possible predictors. Results: A regression analysis revealed that besides dissatisfaction with medical care, low social support and high active problem‐solving behavior were significant predictors of interest in patient education programs (R²= 0.244). Conclusions: Our study gives a preliminary indication that participation in a patient education program for childhood AD should be offered to parents without sufficient social support, but who would like to gather more information on coping with AD. This could also enhance satisfaction with the medical care provided.     

Oral administration of β‐carotene or lycopene prevents atopic dermatitis‐like dermatitis in HR‐1 mice

Atopic dermatitis (AD) is a chronic relapsing eczematous skin disease. Certain populations of patients are resistant to standard therapies with topical steroids and/or calcineurin inhibitors, and require systemic medication, such as immunosuppressants. Recently, several reports have shed light on the anti‐allergic effects of carotenoids. Therefore, we investigated the effect of p.o. administration of β‐carotene or lycopene on AD‐like symptoms of HR‐1 hairless mice fed with a low zinc/magnesium diet. Mice were divided into four groups: (i) fed with a standard diet (Co group); (ii) low zinc/magnesium diet (HR group); (iii) low zinc/magnesium and β‐carotene diet (HR‐C group); and (iv) low zinc/magnesium and lycopene diet (HR‐L group). They were then fed these diets for 8 weeks. Severities of dermatitis were assessed by their appearance, and histopathological and hematological observations. Mice in the HR group developed AD‐like dermatitis both clinically and histologically. HR‐C and HR‐L group mice also developed xerosis and wrinkle‐like skin changes, but they were milder than those of HR group mice. Histological analysis revealed that epidermis thickening and inflammatory cell infiltration in the skin of the HR‐C and HR‐L groups were both statistically less than those of the HR group. The concentration of thymus and activation regulated chemokine in the skin of the HR‐L group and the concentration of CCL27 in the skin of the HR‐C group were significantly lower than those of the HR group, respectively. In conclusion, p.o. administration of β‐carotene or lycopene prevents AD‐like symptoms in association with a suppression of T‐helper 2 chemokines in a murine model. Ingestion of carotenoids may be beneficial for patients with AD.     

Italian guidelines for therapy of atopic dermatitis—Adapted from consensus‐based European guidelines for treatment of atopic eczema (atopic dermatitis)

Atopic dermatitis (AD) therapeutic approach calls for a long‐term treatment. Treatment options for AD have recently undergone a revolutionary change by the introduction of the first biologic drug. Availability in daily practice of the last version of international AD guidelines, taking peculiarities of the country into account, can contribute to good clinical practice in Italy. To adapt European Dermatology Forum (EDF) guidelines for AD to the Italian medical–legal context, the EDF guidelines were assessed independently by two independent Italian renowned experts in the field and further integrated with articles published and systematically reviewed before May 2019. The first draft was collegially corrected and updated by the members of the SIDEMAST, ADOI, and SIDAPA. Recommendation levels (A; B; C; D) were graded based on the evidence levels (1–4). The adapted guidelines presented here focus on topical and systemic therapies in AD patients, both children and adults. As opposed to previous Italian guidelines, they include indications about biologics. New relevant evidence available from very recent literature and peculiarities of the Italian medical and legal context have been integrated in the revision process. If compared to general guidelines for AD not adapted to a specific national and cultural context, a revision for specific Italian needs is now available: It comprises the option of implementing the new biologic treatments and is likely to provide an important contribution to the improvement of clinical practice in Italy. Cooperation between patients, dermatologists, allergologists, and pediatricians remains mandatory in AD management. The authors of the present revision recommend an update of the Italian guidelines to be performed at least every second year.     

Sensory processing patterns of adults with atopic dermatitis

Background Atopic dermatitis (AD) has been associated with sensory hypersensitivity in children. Objective To examine the sensory profile of adults with AD using a standardized questionnaire that measures sensory processing and related behaviours in daily living. Methods Thirty‐two patients aged 18–53 years with AD and 32 healthy, sex‐ and age‐matched control subjects completed the Adolescent/Adult Sensory Profile (AASP). Severity of AD was assessed by the Severity Scoring of Atopic Dermatitis (SCORAD). Results Patients with AD showed higher sensory sensitivity and avoidance than the controls, mainly in the tactile, vestibular, visual and auditory modalities. Conclusions Adults with AD may suffer from sensory hypersensitivity. Additional studies should examine the influence of the peripheral and the central nervous system on sensory hypersensitivity. Better understanding of the sensory impairment of patients with AD may help improving treatment strategies for the disease.     

Long‐term management of moderate‐to‐severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a critical appraisal

Atopic dermatitis (AD) is a common, chronic inflammatory skin disorder. The mainstay of treatment is daily moisturiser and anti‐inflammatory cream, usually topical corticosteroid (TCS). Immune‐suppressive medicines, used in severe cases, can cause adverse effects (unwanted side effects). Last year a trial of a new immune‐suppressive treatment for AD called dupilumab was published in The Lancet. Here, dermatologists from Nottingham in the UK critically review that study. The industry‐sponsored research examined the long‐term efficacy and safety of dupilumab, a “biologic” medicine that selectively suppresses immune cells involved in AD. The randomised, double‐blinded, placebo‐controlled trial was carried out across 161 clinics internationally. Dupilumab 300mg was injected in adults with moderate to severe AD, weekly (319 patients) or fortnightly (106 patients), for 52 weeks All patients, including 315 given placebo, continued to use TCS as required. The researchers found that dupilumab + TCS was well tolerated (meaning patients were able to stay on the treatment) and improved AD more than TCS alone but was associated with more adverse effects (particularly conjunctivitis). No difference in efficacy was reported between weekly and fortnightly injections. This was generally a well‐conducted study, but the reviewers had some reservations. More participants were recruited than could be justified statistically: this suggests “seeding”, that is widespread testing to promote familiarity and confidence in the drug. The reviewers’ re‐analysis showed that fortnightly dosing was more effective than weekly, at half the cost. Most participants had moderate AD, but biologics are usually reserved for patients with severe disease. The comparison could have been with another systemic immune‐suppressant rather than placebo. These factors may bias conclusions in favour of the drug.