Dermatitis®

Extracorporeal photopheresis (ECP) is a safe treatment modality with immunomodulatory effects. The latter may also explain efficacy of ECP in patients with atopic dermatitis (AD).

We aimed to assess various blood parameters of AD patients who underwent ECP over a maximum 1-year treatment period.

We performed a retrospective single-center chart review (clinical data, laboratory data) of adult patients with AD who had received for at least 3 ECP cycles, in part combined with other treatment modalities.

We studied 60 patients with AD (85% extrinsic type, 15% intrinsic type) who had median number of 14 (4–23) ECP cycles within a maximum 1-year treatment. When compared with baseline, leukocytes and lymphocytes remained significantly decreased after 3-, 6-, 9-, and 12-month ECP (P = 0.014 and P = 0.0012, respectively). A significant decline of eosinophils, as well as eosinophilic cationic protein levels, was observed after 3-, 6-, 9-, and 12-month ECPs (P = 0.011 and P = 0.0017, respectively). Total serum immunoglobulin E (IgE), as well as lactate dehydrogenase, were significantly decreased at 3-, 6-, 9-, and 12-month evaluation compared with baseline (P < 0.00001 and P = 0.00007, respectively). Patients with slight or marked improvement of AD after their ECP treatment period had significantly higher median baseline serum IgE levels than patients who did not respond to ECP (P = 0.0023).

Several laboratory parameters, including eosinophils, eosinophilic cationic protein, total serum IgE, and lactate dehydrogenase, which declined under ECP, are well-known disease biomarkers for AD patients. With normalization of the abovementioned laboratory parameters, a clinical response to ECP treatment was observed in almost two thirds of patients, confirming that ECP may be an effective combination treatment modality for AD.

Atopic dermatitis (AD) is associated with substantial financial cost, including increased out-of-pocket (OOP) expenses. Associations and impact of OOP costs are poorly understood.

The aim of the study was to characterize the impact and associations of OOP health care expenses for AD.

A 25-question online survey was administered to National Eczema Association members (N = 113,502). Inclusion criteria (US residents aged ≥18 years; self-reported AD or primary caregiver of individual with AD) were met by 77.3% (1118 of 1447).

Respondents with monthly OOP expenses greater than $200 were more likely to have increased AD severity, flares, health care provider visits, prescription polypharmacy, use of step-up therapy, frequent skin infections, and poorer disease control (P < 0.005 for all). Respondents with OOP yearly expenditures greater than $1000 had similar associations and additionally increased rates of comorbid asthma, allergic rhinitis, and anxiety/depression (P < 0.005 for all). A total of 64.6% (n = 624) reported harmful household financial impact of OOP expenses. Predictors of harmful impact included severe AD (adjusted odds ratio [95% confidence interval], 2.62 [1.11–6.19], P = 0.04), comorbid asthma (1.42 [1.07–1.87], P = 0.03), 5 health care provider visits or more in a year (2.80 [1.62–4.82], P = 0.0007), greater than $200 OOP monthly expenditures (2.16 [1.45–3.22], 0.0006), and $1000 annual OOP expenditures or more (4.56 [3.31–6.27], P < 0.0001).

Out-of-pocket expenses for AD significantly impact household finances. Clinical interventions are needed to minimize OOP expenses while optimizing care outcomes.

Capsule Summary:

• Atopic dermatitis (AD) is associated with significant financial cost, including increased out-of-pocket (OOP) expenses, although the impact and associations of OOP health care expenses for AD management are not well understood.

• The OOP health care expenses related to AD are associated with increased disease severity and health care utilization and significantly impact the household finances of patients and caregivers.

• Health care providers should be mindful of the OOP financial burden related to AD management and engage in shared decision making to create a treatment plan that is practical and effective and minimizes household financial impact.

Atopic dermatitis (AD) is a chronic, inflammatory skin disease associated with itch, sleep disturbance, psychosocial distress, anxiety, and depression.

We aimed to understand the association between AD and aberrant childhood behaviors.

We used data from the Fragile Families and Child Wellbeing Study, a longitudinal birth cohort study of 4898 urban children.

Atopic dermatitis was associated with the 75th or greater percentile of mean behavioral scores at 5 years (multivariable logistic regression; adjusted odds ratio [aOR] [95% confidence interval {95% CI}] = 1.51 [1.18–1.93]), 9 years (1.62 [1.32–1.99]), and 15 years (1.44 [1.17–1.76]). There were significantly increased behavioral problems at age of 15 years when AD persisted at ages of 5, 9, and 15 years (Poisson regression; adjusted risk ratio [95% CI] = 1.17 [1.01–1.35]). Atopic dermatitis was associated with 12 aberrant behaviors, particularly fighting (repeated-measures logistic regression; aOR [95% CI] = 1.40 [1.15–1.70]), physically attacking people (1.38 [1.09–1.76]), being sullen (1.31 [1.15–1.49]), worrying (1.41 [1.23–1.61]), and threatening others (1.35 [1.08–1.70]). Significant 2-way interactions were present between AD and sleep as predictors of underactivity (4.31 [3.06–6.08]), being threatening (aOR [95% CI] = 3.42 [2.20–5.34]), being sullen (3.86 [2.74–5.43]), and nervousness (4.56 [3.29–6.32]).

Childhood AD, particularly persistent disease with sleep disturbances, was associated with a wide range of behavioral problems in childhood and adolescence.

Patients with atopic dermatitis (AD) are susceptible to infectious and inflammatory cutaneous comorbidities.

The aim of the study was to describe the prevalence of cutaneous comorbidities associated with AD, including their relationship with AD severity.

A retrospective cross-sectional analysis was performed using the Israeli Maccabi Healthcare Services database. Prevalent AD cases on December 31, 2017, were diagnosed with AD at any time since 1998 and had 1 or more recent (2013–2017) AD diagnoses. Dispensed AD treatments within 5 or fewer years served as a surrogate for AD severity. Cutaneous comorbidities in AD cases were compared with non-AD controls matched 1:1 on age, sex, and residential area. Among adults, comorbidities were compared across AD severity using multinomial logistic regression.

The eligible population included 94,483 patients with mild (57.7%), moderate (36.2%), or severe (6.1%) AD, and 94,483 matched non-AD controls. Skin infections, inflammatory skin conditions, cutaneous manifestations of AD, and sweat gland disorders were more prevalent (P < 0.001) in patients with AD than in controls. Most cutaneous comorbidities that were more prevalent in adult patients with AD were also significantly (P < 0.001) associated with AD severity.

This study suggests that AD is associated with many infectious and inflammatory cutaneous comorbidities and highlights the relationship between AD severity and comorbidity prevalence.

There are differing results in the literature regarding the relationship between atopic dermatitis (AD) and peripheral blood leukocyte profiles.

The aim of the study was to investigate the relationship between AD, blood immune cell profiles, and disease severity.

One hundred AD patients aged 1 month to 18 years without any history of infection or systemic disease were enrolled as the study group. Serum concentration levels of total immunoglobulin E, calculated blood leukocyte profiles, and AD index severity scoring were calculated for statistical comparison.

The differences between the groups for neutrophil-lymphocyte ratio and eosinophil-lymphocyte ratio were statistically different. However, there was no statistically significant correlation between the investigated parameters and AD index severity scoring.

Although significant differences were found in some of the parameters between the groups, unfortunately, the lack of correlation between the parameters investigated and the disease severity index restricts their use in clinical practice.

Dupilumab-associated conjunctivitis in patients with atopic dermatitis (AD) is not fully characterized.

The aim of the study was to characterize the incidence of bacterial and nonbacterial conjunctivitis among patients with AD who initiated dupilumab.

Pooling longitudinal claims data from 2 US databases, we identified AD patients who newly filled either dupilumab or methotrexate, mycophenolate or cyclosporine, between March 2017 and January 2020. Outcomes were conjunctivitis and its subtypes, bacterial, allergic, and keratoconjunctivitis. Patient follow-up lasted 6 months and 1:1 propensity score (PS) matching-controlled confounding.

Within 6 months of treatment initiation, the incidence of conjunctivitis was 6.6% in 3744 dupilumab initiators; bacterial conjunctivitis, 1.5%; allergic conjunctivitis, 2.2%; keratoconjunctivitis, 0.8%; and conjunctivitis requiring ophthalmic medication, 2.7%. After PS matching, dupilumab doubled the risk of conjunctivitis compared with methotrexate (relative risk [RR] 2.12; 1.56–2.91), mycophenolate (RR = 2.43; 1.32–4.47), or cyclosporine (RR = 1.83; 1.05–3.20). Risk of bacterial conjunctivitis was 1.6- to 4.0-fold increased with wide confidence intervals, and allergic conjunctivitis was increased 2.7- to 7-fold. There was no increased risk of keratoconjunctivitis. Patients with comorbid asthma had a further increased risk of conjunctivitis.

One in 15 patients treated with dupilumab developed conjunctivitis driven by bacterial and allergic conjunctivitis and not keratoconjunctivitis. This risk was further increased with comorbid asthma.

Atopic dermatitis (AD) is a systemic, multifactorial disease that causes significant morbidity and health care burden in Latin America (LA). Data on AD are scarce in LA. Lack of disease registries and non-standardized study methodologies, coupled with region-specific genetic, immunological, and environmental factors, hamper data collection. A panel of LA experts in AD was given a series of relevant questions to address before a conference. Each narrative was discussed and edited through numerous rounds of deliberation until achieving consensus. Identified knowledge gaps in AD research were updated prevalence, adult-disease epidemiology, local phenotypes and endotypes, severe-disease prevalence, specialist distribution, and AD public health policy. Underlying reasons for these gaps include limited funding for AD research, from epidemiology and public policy to clinical and translational studies. Regional heterogeneity requires that complex interactions between race, ethnicity, and environmental factors be further studied. Informed awareness, education, and decision making should be encouraged.

Few studies have investigated health-related quality of life (HRQoL) in patients with atopic dermatitis (AD) during the COVID-19 pandemic.

The objectives of this study were to compare HRQoL in adult AD patients before and during the pandemic and to assess measurement performance of 4 HRQoL measures.

Between 2018 and 2021, a multicenter, cross-sectional survey was conducted, involving 218 adult AD patients. Health-related quality of life outcomes included the EQ-5D-5L, Skindex-16, Dermatology Life Quality Index (DLQI), and DLQI-Relevant (DLQI-R). Severity was measured using objective SCORing Atopic Dermatitis, Eczema Area and Severity Index, and Investigator Global Assessment.

The mean ± SD EQ-5D-5L utility, Skindex-16, DLQI, and DLQI-R scores were 0.82 ± 0.22, 56.84 ± 27.46, 13.44 ± 8.46, and 13.76 ± 8.60, respectively. The patients reported more problems during the pandemic (P < 0.05) regarding pain/discomfort (odds ratio [OR], 1.78), worrying (OR, 1.89), concerns about persistence/reoccurrence of disease (OR, 1.88), and social relationships (OR, 1.69). The HRQoL outcomes showed strong correlations with each other (range of r_s, |0.69| to |0.99|). The Skindex-16, DLQI, and DLQI-R were able to discriminate between severity groups with large (η² = 0.20–0.23), whereas the EQ-5D-5L with moderate effect sizes (η² = 0.08–0.11).

Atopic dermatitis patients experienced significantly more problems in some areas of HRQoL during the pandemic. The EQ-5D-5L, Skindex-16, DLQI, and DLQI-R demonstrated good convergent and known-group validity and can be suitable instruments for HRQoL assessment in clinical and research settings.

The relationship between atopic dermatitis (AD) severity, sleep disturbance (SD), and health-related outcomes is not fully elucidated.

The aim of the study was to determine the prevalence of SD in adult AD and its relationship with AD severity and health outcomes among the US population.

A cross-sectional, US population–based survey study of 2893 adults was performed.

Among adults meeting the UK Diagnostic Criteria for AD, 255 (40.7%) reported 1 or more, 67 (11.1%) reported 3 to 4, and 57 (9.5%) reported 5 to 7 nights of SD in the past week; 475 (79.7%) reported at least some trouble sleeping in the past 3 days. Moderate and severe Patient-Oriented Scoring AD, Patient-Oriented Eczema Measure, and Numeric Rating Scale–itch and Numeric Rating Scale–skin pain scores were associated with more severe SD compared with those without AD. More frequent and severe SDs were associated with higher Dermatology Life Quality Index, lower 12-item Short-Form Health Survey, and higher Hospital Anxiety and Depression Scale (HADS) scores. Significant mediation by SD severity was observed between Patient-Oriented Eczema Measure and Numeric Rating Scale–itch with Dermatology Life Quality Index, 12-item Short-Form Health Survey physical and mental component scores, HADS-anxiety and HADS-depression scores, diagnosed anxiety, and heart disease.

Atopic dermatitis and AD severity are associated with SDs. Sleep disturbances considerably impact quality of life and other health outcomes in adults with AD.

This study aimed to evaluate the frequency of allergic contact dermatitis among children with atopic dermatitis (AD), the most common sensitizer, and the associated risk factors.

This retrospective study included children with AD who underwent patch testing at our dermatology department between 2005 and 2021.

Eighty patients were included. The average age was 77.6 months (4 months–17 years), divided as follows: children (76.3%), infants (11.3%), and teenagers (10%). The sex ratio (M/F) was 1.35. Thirty-two patients (40%) had positive patch test results. Allergic contact dermatitis was significantly more frequent among patients with severe AD (40.6%) than among those with moderate or mild AD (16.7%, P = 0.017). The most frequent allergens were nickel sulfate (23.7%), cobalt chloride (12.5%), potassium dichromate (8.7%), textile dyes (6.2%), and lanolin (5%).

Contact allergies are a common problem in children with AD. They seem to be at risk of sensitization to certain allergens mainly metals and components of skincare products. Patch testing should be performed whenever allergic contact dermatitis is suspected and in cases of severe AD.

For many years, the United Kingdom (UK) Working Party diagnostic criteria for atopic dermatitis (AD) have represented the criteria of choice for epidemiological studies. A recent study has reported a low sensitivity of these criteria among Tunisian patients, probably because of some epidemiologic characteristics of AD in our country.

Our objective was to validate a modified version of the UK Working Party criteria for AD in Tunisia by establishing their sensitivity, specificity, and positive predictive value and negative predictive value.

This case-control study was performed over a period of 18 months in our dermatology department in Tunisia. The diagnosis of AD was established clinically by 2 dermatologists who specialized in dermatoallergology. Based on the UK Working Party diagnostic criteria and respecting the epidemiological peculiarities of AD in Tunisia, we proposed a modified version of diagnostic criteria adapted to Tunisian AD. The modifications concerned the first, fourth, and fifth minor criteria of the UK Working Party diagnostic criteria list.

We collected 156 patients and 156 controls. The mean age of AD onset was 7 years and 9 months. The inverted topography of lesions was found in 67.9% of cases. The sensitivity, specificity, positive predictive, value and negative predictive value were, respectively, 56.4%, 97.4%, 95.65%, and 69.09% for the UK Working Party diagnostic criteria and 89.1%, 95.5%, 95.1%, and 89.7% for the modified version.

This modified version of the UK criteria seems to be a practical diagnosis tool for AD in Tunisia.