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Background The epidemiology of atopic dermatitis ( AD) in the U.S.A. has been described largely via US population-based questionnaire studies. However, the validity of the questions used for self- and caregiver-reported eczema has not been previously demonstrated. Objectives To validate the assessment of self- and caregiver-reported eczema. Methods We performed a prospective multicentre dermatology-practice-based study (three sites) to determine the validity of caregiver- and self-reported ever having eczema and 1-year history of eczema. Questionnaires were administered to unselected patients prior to their encounter. Patients ( n = 782) were then evaluated by expert dermatologists trained in utilizing the Hanifin and Rajka criteria for AD. Sensitivity, specificity, positive predictive value ( PPV) and negative predictive value were determined. Results Caregiver-reported 1-year history of childhood eczema was found to have a sensitivity (95% confidence interval) of 0·70 (0·59-0·80), specificity of 0·96 (0·93-0·99) and PPV of 0·87 (0·78-0·96) when compared with a physician's diagnosis of AD at that visit. Similarly, self-reported 1-year history of adult eczema was found to have a sensitivity of 0·70 (0·59-0·80), specificity of 0·95 (0·93-0·97) and PPV of 0·76 (0·64-0·85). The specificities and PPVs of a history of ever having caregiver- (0·89, 0·82-0·96 and 0·81, 0·70-0·93) and self-reported eczema (0·97, 0·95-0·99 and 0·91, 0·85-0·97) were high, with a high sensitivity in children (0·83, 0·72-0·95) but not in adults (0·43, 0·37-0·51). Conclusions Self- and caregiver-reported diagnosis of eczema ever or in the past year based on a single question demonstrates sufficient validity for the epidemiological study of AD. [ABSTRACT FROM AUTHOR]

The article describes the case of a severe pemphigus vulgaris (PV) in a patient with history of human immunodeficiency virus (HIV) infection who attained complete remission after two courses of rituximab therapy. It suggests the use of rituximab in HIV-positive patients with PV to avoid the various side-effects potentially related to conventional immunosuppressive therapies.

Summary: Background: Children aged ≥ 6 to < 12 years with severe atopic dermatitis (AD) have limited treatment options. In a 16‐week, randomized, placebo‐controlled, phase III trial in children, dupilumab, a monoclonal antibody inhibiting interleukin (IL)‐4/IL‐13 signalling, significantly improved signs and symptoms with acceptable safety; longer‐term safety and efficacy data are lacking. Objectives: To report the pharmacokinetic profile and long‐term safety and efficacy of dupilumab in children (aged ≥ 6 to < 12 years) with severe AD. Methods: Children (aged ≥ 6 to < 12 years) with severe AD were enrolled in a global, multicentre, phase IIa, open‐label, ascending‐dose, sequential cohort study and subsequent open‐label extension (OLE) study. Patients received single‐dose dupilumab 2 or 4 mg kg−1 followed by 8‐week pharmacokinetic sampling, then 2 or 4 mg kg−1 weekly for 4 weeks (phase IIa), followed by the same weekly regimen (OLE). Primary endpoints were dupilumab concentration–time profile and treatment‐emergent adverse events (TEAEs); secondary assessments included Eczema Area and Severity Index (EASI) and Peak Pruritus Numeric Rating Scale (PP‐NRS) score. Results: Of 38 children enrolled, 37 completed phase IIa and 33 continued to the OLE. Nonlinear, target‐mediated pharmacokinetics characterized dupilumab concentrations (week 24–48 mean serum concentrations: 2 mg kg−1, 61–77 mg L−1; 4 mg kg−1, 143–181 mg L−1). TEAEs were mostly mild to moderate and transient; none led to treatment discontinuation. The most commonly reported TEAEs were nasopharyngitis (2 mg kg−1, 47%; 4 mg kg−1, 56%) and AD exacerbation (29% and 13%, respectively). Single‐dose dupilumab rapidly improved AD with further improvements through week 52. Mean EASI and PP‐NRS improved by −37%/−33% and −17%/−20% at week 2 (phase IIa) and −92%/−84% and −70%/−58% at week 52 (OLE), respectively. Conclusions: These safety and efficacy results support the use of dupilumab as a continuous long‐term treatment for children aged ≥ 6 to < 12 years with severe AD. What is already known about this topic?Severe atopic dermatitis (AD) has a marked negative impact on patient quality of life and can cause financial burden owing to a lack of effective treatments.Dupilumab significantly improved signs and symptoms of AD with an acceptable safety profile in a 16‐week randomized, double‐blind, placebo‐controlled phase III study in children aged ≥ 6 to < 12 years with severe AD. What does this study add?This study extends information on the safety, efficacy and pharmacokinetic profile of dupilumab treatment for up to 52 weeks in children aged ≥ 6 to < 12 years with severe AD.The results support the use of dupilumab as a continuous long‐term treatment for children aged ≥ 6 to < 12 years with severe AD. Linked Comment: Sibbald. Br J Dermatol 2021; 184:792–793. [ABSTRACT FROM AUTHOR]

Summary: Background: Standardized quality‐of‐life (QoL) assessments can provide important and clinically relevant information. There is currently a lack of standardization in QoL assessments used in atopic dermatitis (AD). Objectives: To determine the content validity, construct validity, internal consistency, differential reporting, responsiveness, floor or ceiling effects and feasibility of the Dermatology Life Quality Index (DLQI), Itchy Quality of Life (ItchyQoL) and 5‐dimensions (5‐D) itch scales for assessing burden of AD in adults and to compare their performance. Methods: Self‐administered questionnaires and skin examination were performed in 340 adults with AD in a dermatology practice setting. Results: DLQI, ItchyQoL and 5‐D all had good content validity. DLQI, mean ItchyQoL and 5‐D itch all had strong correlations with frequency of AD symptoms (Patient‐Oriented Eczema Measure) and intensity of itch (numerical rating scale for itch), and moderate correlations with AD severity (Eczema Area and Severity Index and Scoring Atopic Dermatitis) (Spearman correlations, P < 0·001 for all). DLQI and 5‐D itch showed good internal consistency (Cronbach's alpha = 0·89 and 0·84), although ItchyQoL appeared to have several redundant items (alpha = 0·96). Uniform and nonuniform differential item functioning by age, sex and/or race/ethnicity was found for multiple items in DLQI, ItchyQoL and 5‐D itch. DLQI, ItchyQoL and 5‐D itch scores all demonstrated responsiveness, although ItchyQoL demonstrated the greatest responsiveness. There were no floor or ceiling effects for total scores. The median times for completion of DLQI, ItchyQoL and 5‐D itch were 2 min. Conclusions: The DLQI, ItchyQoL and 5‐D itch scales all showed good content and construct validity, and responsiveness in the assessment of AD in adults, and were feasible for use in clinical trials and practice. What's already known about this topic? Dermatology Life Quality Index (DLQI), 5‐dimensions (5‐D) itch and ItchyQoL are quality‐of‐life assessments that have been used to assess the burden of inflammatory and/or pruritic skin disorders.Conflicting and/or limited results have been demonstrated about their validity, reliability and feasibility, particularly in atopic dermatitis. What does this study add? This study demonstrates that DLQI, ItchyQoL and 5‐D itch had good construct validity and responsiveness, and similar amounts of time for completion in the assessment of adult atopic dermatitis, with no observed floor or ceiling effects. What are the clinical implications of this work? DLQI, ItchyQoL and 5‐D itch all appear to have sufficient validity and feasibility to be used as assessments of burden in adults with atopic dermatitis in clinical practice. Linked Comment: Apfelbacher and Ofenloch. Br J Dermatol 2019; 180:979–980. Respond to this article [ABSTRACT FROM AUTHOR]

Summary: Background: Several patient‐reported outcomes have been used to assess the burden of atopic dermatitis (AD). Some are disease specific, such as the Patient‐Oriented Eczema Measure (POEM), while others pertain to itch, for example the numerical rating scale (NRS)‐itch, ItchyQoL and 5‐D itch, or dermatological disease in general, for example the Dermatology Life Quality Index (DLQI). Development of severity strata is essential for proper interpretability of these assessments. Objectives: To confirm previously developed strata for POEM, DLQI and raw ItchyQoL, and develop strata for the NRS‐itch, mean ItchyQoL and 5‐D itch scale for use in adults with AD. Methods: Self‐administered questionnaires were completed by 210 adults with AD in a dermatology practice setting. Strata were selected using an anchoring approach based on patient‐reported disease severity. Results: We confirmed the existing strata for POEM (mild 0–7, moderate 8–16, severe 17–28; κ = 0·440), DLQI (mild 0–5, moderate 6–10, severe 11–30; κ = 0·398) and NRS‐itch (mild 0–3, moderate 4–6, severe 7–10; κ = 0·499). However, the preferred band for raw ItchyQoL was mild 22–58, moderate 59–74 and severe 75–110 (κ = 0·379) and for mean ItchyQoL, mild 1–2·9, moderate 3·0–3·9, severe 4·0–5·0 (κ = 0·374). The preferred band for 5‐D itch scale was mild 0–11, moderate 12–17 and severe 18–25 (κ = 0·331). Conclusions: Existing strata for POEM and DLQI performed well in adult AD. Previously reported strata for visual analogue scale‐itch performed best for NRS‐itch. We identified banding for the raw ItchyQoL for our AD population that varies slightly from the banding published for a more heterogeneous population. Finally, we proposed strata for mean ItchyQoL and 5‐D itch scale in adult AD. [ABSTRACT FROM AUTHOR]

Background Scoring systems for assessing the signs of atopic dermatitis ( AD) are complex and difficult to interpret. Severity strata are helpful to interpret these assessments properly. Objectives To confirm previously reported strata for the Eczema Area and Severity Index ( EASI), Scoring Atopic Dermatitis ( SCORAD) and the objective component of SCORAD ( oSCORAD), and to develop strata for the modified EASI ( mEASI), Atopic Dermatitis Severity Index ( ADSI) and body surface area ( BSA) for use in adults with AD. Methods Skin examination was performed in 673 adolescents and adults (age ≥ 13 years) with diagnosed AD, in a dermatology practice setting. Strata were selected using an anchoring approach based on a four-point Investigator's Global Assessment of severity (clear of active skin lesions, mild, moderate or severe disease). Results We determined potential severity strata for EASI (0 clear, 0·1-5·9 mild, 6·0-22·9 moderate, 23·0-72 severe; κ = 0·69), mEASI (0-0·9 clear, 1-8·9 mild, 9·0-29·9 moderate, 30·0-90 severe; κ = 0·71), oSCORAD (0-7·9 clear, 8·0-23·9 mild, 24·0-37·9 moderate, 38·0-83 severe; κ = 0·70), SCORAD (0-9·9 clear, 10·0-28·9 mild, 29·0-48·9 moderate, 49·0-103 severe; κ = 0·68), ADSI (0-1·9 clear, 2-5·9 mild, 6·0-8·9 moderate, 9·0-15 severe; κ = 0·55) and BSA (0 clear, 0·1-15·9 mild, 16·0-39·9 moderate, 40·0-100 severe; κ = 0·66). oSCORAD values > 0 were found in clear skin due to the presence of xerosis, which is scored in oSCORAD. Similarly, SCORAD values > 0 were found in clear skin due to the scoring of xerosis, pruritus and sleeplessness. Similarly, mEASI and ADSI scores > 0 occurred in patients with clear skin due to scoring of pruritus. Conclusions We recommend using these strata for interpretation of their respective measures in clinical trials of AD. There are important differences between the five assessments, which profoundly impact the interpretation of their scores. [ABSTRACT FROM AUTHOR]

Summary: 异位性皮炎是一种皮肤病(AD,通常简称为湿疹),可能导致发痒(瘙痒)、睡眠障碍和生活质量(QoL)受损,通常会影响学习和工作等日常活动,进而影响心理健康。在研究湿疹或治疗患者期间,医生通常会使用各种系统来记录患者的湿疹严重程度。一些系统注重于患者的体征,例如皮肤损害的严重程度(受影响皮肤的面积)如何。然而,如上所述,这种疾病的许多症状是无法通过观察皮肤来衡量的,因此需要使用“患者报告结果”(PRO)的不同衡量方法,在这些方法中,患者会回答有关生活质量、情绪或瘙痒严重程度等问题。这些衡量方法并不专门用于湿疹,也可用于一系列皮肤疾病。每种PRO都对应着一系列不同的问题、反应选项和打分系统,因此难以针对不同的PRO来说明结果。业界针对一些PRO制定了严重性等级,用结果的分数来表示严重性级别,例如,在一项称为POEM的PRO中,0至7分表示轻度、8至16分表示中度,而17至28分则表示重度。本研究旨在确认针对先前报告的称为POEM和DLQI的PRO的等级对成年AD患者来说是否确实准确。此外,研究人员还针对一些其他的PRO制定了严重性等级:NRS‐瘙痒,平均ItchyQOL和5‐D瘙痒程度。作者们确认,POEM和DLQI的现有等级对成年AD患者来说运用得当,并建议修正某些其他PRO的等级并制定新等级。 [ABSTRACT FROM AUTHOR]

Summary: Atopic dermatitis (AD, also known simply as eczema) is a skin disease that can cause itching (pruritus), sleep disturbance and impaired quality of life (QoL), often affecting everyday activities such as school and work, resulting in impaired mental health. During studies into eczema or when treating patients, doctors use a variety of systems that record how severe the person's eczema is. Some of these look at the physical symptoms, such as how severe the skin lesions (areas of affected skin) are. However, as mentioned above, many of the symptoms of the disease can't be measured by looking at the skin, and for these, different measurements of ‘Patient Reported Outcomes’ (PRO) are used, in which the patient answers questions about, for example, their quality of life, mood or itch severity. These measures are not always specific to eczema, and can be used across a range of skin disorders. Each PRO has a different numbers of questions, response options, and scoring systems, which can make it difficult to interpret the results across different PROs. Severity strata have been developed for some PROs, which attribute levels of severity to the results of the scores, so for example, in a PRO called POEM, a score of 0 to 7 is mild, 8 to 16 is moderate and 17 to 28 is severe. This study sought to confirm whether previously reported strata for the PRO's called POEM and DLQI are indeed accurate for adults with AD. They also sought to develop severity strata for PRO's that don't already have them: NRS‐itch, mean ItchyQOL and 5‐D itch scale. The authors confirm that existing strata for POEM and DLQI perform well in adult AD and suggested amendments and new strata for certain other PRO's. [ABSTRACT FROM AUTHOR]