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Background: Skin tape‐strips and biopsies are widely used methods for investigating the skin in atopic dermatitis (AD). Biopsies are more commonly used but can cause scarring and pain, whereas tape‐strips are noninvasive but sample less tissue. The study evaluated the performance of skin tape‐strips and biopsies for studying AD. Methods: Whole‐transcriptome RNA‐sequencing was performed on paired tape‐strips and biopsies collected from lesional and non‐lesional skin from AD patients (n = 7) and non‐AD controls (n = 5). RNA yield, mapping efficiency, and differentially expressed genes (DEGs) for the two methods (tape‐strip/biopsy) and presence of AD (AD/non‐AD) were compared. Results: Tape‐strips demonstrated a lower RNA yield (22 vs. 4596 ng) and mapping efficiency to known genes (28% vs. 93%) than biopsies. Gene‐expression profiles of paired tape‐strips and biopsies demonstrated a medium correlation (R2 = 0.431). Tape‐strips and biopsies demonstrated systematic differences in measured expression levels of 6483 genes across both AD and non‐AD samples. Tape‐strips preferentially detected many itch (CCL3/CCL4/OSM) and immune‐response (CXCL8/IL4/IL5/IL22) genes as well as markers of epidermal dendritic cells (CD1a/CD207), while certain cytokines (IL18/IL37), skin‐barrier genes (KRT2/FLG2), and dermal fibroblasts markers (COL1A/COL3A) were preferentially detected by biopsies. Tape‐strips identified more DEGs between AD and non‐AD (3157 DEGs) then biopsies (44 DEGs). Tape‐strips also detected higher levels of bacterial mRNA than biopsies. Conclusions: This study concludes that tape‐strips and biopsies each demonstrate respective advantages for measuring gene‐expression changes in AD. Thus, the specific skin layers and genes of interest should be considered before selecting either method. [ABSTRACT FROM AUTHOR]

Background: The international classification of diseases, 10th revision (ICD‐10) includes several unvalidated diagnostic codes for hand eczema (HE). Knowledge is sparse on HE patient characteristics. Objectives: To validate selected HE ICD‐10 codes in the Danish National Patient Registry (DNPR) and describe disease characteristics, lifestyle factors and medication use in adult HE patients. Methods: Nineteen HE ICD‐10 codes were selected and validated based on patient charts. Five cohorts were constructed based on the diagnostic code, DL30.8H (HE unspecified), in the DNPR: (i) patients with DL30.8H code (n = 8386), (ii) patients with DL30.8H code, but without atopic dermatitis (AD) (n = 7406), (iii) sex‐ and age‐matched general population (n = 8386) without HE. Two additional cohorts nested in the DNPR included participants from the Danish Skin Cohort, (iv) patients with DL30.8H code but without AD (n = 1340) and (v) general population cohort (n = 9876). Results: ICD‐10 codes revealed positive predictive values ≥90% except irritant contact dermatitis (unspecified) (79.7%) and hyperkeratotic hand and foot eczema (84.1%). HE patients were most often women, middle‐aged or older, of Danish ethnicity, had an atopic medical history and were smokers. Topical corticosteroid prescriptions were almost doubled in HE cohorts compared to general populations. Conclusion: We validated several HE ICD‐10 codes and identified important HE patient characteristics. [ABSTRACT FROM AUTHOR]

Background: Rubber accelerators are used in the production of rubber gloves and may cause contact allergy. Objectives: To estimate long‐term trend and prevalence of contact allergy to rubber accelerators for a 30‐year period in Denmark, high‐risk occupations, and exposures. Methods: Data from all patients with contact dermatitis consecutively patch tested at the department of Skin and Allergy Gentofte hospital with the rubber accelerators from the European baseline series (EBS) from 1990 to 2019, were analysed. Further, patients under suspicion of rubber accelerator contact allergy were additionally patch‐tested with rubber accelerators from the specialised rubber series from 2005 to 2019 and these were additional extracted. Results: The overall prevalence of contact allergy to one or more of the rubber accelerators from the EBS series was 2.7% with a significant decline in the first 12‐years, followed by a stable frequency in the past 18‐years. Associations with occupational contact dermatitis, hand dermatitis, and leg/foot dermatitis were found. Wet‐work occupations were most often affected and gloves the most frequent exposure. Conclusions: Contact allergy to one or more of the rubber accelerators from the EBS is frequent and has been unchanged for several decades, which calls for prevention. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Diabetes devices that deliver insulin and measure blood glucose levels are cornerstones in modern treatment of type 1 diabetes. However, their use is frequently associated with the development of skin problems, particularly eczema and wounds. Proper skin care may prevent skin problems, yet evidence-based information from interventional studies is missing. Providing this information is the aim of this study. RESEARCH DESIGN AND METHODS: This cluster-controlled intervention study tested the efficacy of a basic skin care program (including use of lipid cream, removal, and avoidance of disinfection). A total of 170 children and adolescents with type 1 diabetes were included and assigned either to the intervention group (n = 112) or the control group (n = 58). Participants were seen quarterly the first year after device initiation, with clinical assessment and interview in an unblinded setting. RESULTS: Eczema or wounds were observed in 33.6% of the intervention group compared with 46.6% of control participants (absolute difference, 12.9% [95% CI −28.7%, 2.9%]; P = 0.10). The adjusted odds of wound development were decreased by 71% in the intervention compared with control group (for wounds, odds ratio 0.29 [95% CI 0.12, 0.68]; P = 0.005). In total, only eight infections were seen, without a higher frequency in the intervention group, despite advice to omit disinfection. CONCLUSIONS: These data indicate our basic skin care program partially prevented diabetes device–induced skin reactions. However, more preventive strategies with other adhesives, patches, and/or types of lotions are needed for optimized prevention. [ABSTRACT FROM AUTHOR]

Treatment of psoriasis with adalimumab has been associated with weight gain; however, data are sparse. We conducted a cohort study in Danish patients with psoriasis treated with adalimumab, secukinumab and ustekinumab. After 1 year of treatment, we found no significant weight gain and the three treatments were comparable with regards to change in bodyweight. Therefore, our study does not support that adalimumab results in weight gain. [ABSTRACT FROM AUTHOR]

Background mRNA-based COVID-19 vaccines have short- and long-term efficacy in healthy individuals, but their efficacy in patients with psoriasis receiving immunomodulatory therapy is less studied. Objectives To investigate long-term immunity after COVID-19 vaccination in patients with psoriasis receiving immunomodulatory therapy. Methods A prospective cohort study including patients (n = 123) with psoriasis receiving methotrexate (MTX) or biologics and controls (n = 226). Only mRNA-based COVID-19 vaccines administered with standard intervals between doses were investigated. Markers of immunity included SARS-CoV-2 spike glycoprotein-specific IgG and IgA, neutralizing capacity, and interferon-γ release from T cells stimulated with peptides of the SARS-CoV-2 spike glycoprotein. Results The proportion of IgG responders was lower 6 months after vaccination in patients receiving anti-tumour necrosis factor (TNF) treatment compared with controls. Anti-TNF treatment was associated with lower IgG levels (β = −0.82, 95% confidence interval −1.38 to −0.25; P = 0.001). The median neutralizing index was lower in the anti-TNF group [50% inhibition (interquartile range [IQR] 37–89)] compared with controls [98% inhibition (IQR 96–99)]; P < 0.001. Cellular responses were numerically lowest in the anti-TNF group. Conclusions Treatment with anti-TNF has an impact on the immunity elicited by mRNA-based COVID-19 vaccination in patients with psoriasis, resulting in a faster waning of humoral and cellular markers of immunity; however, the clinical implications are unknown. [ABSTRACT FROM AUTHOR]

After 6 and 12 months, the proportion of patients responding was higher for patients who were HLA-Cw6-negative compared with HLA-Cw6-positive patients when assessing response as PASI90. A proportion of patients treated with biologics for psoriasis do not respond to therapy.[[1]] Reason for lack of response includes among other clinical[3] and genetic factors[4] of which HLA-Cw6 is the most thoroughly investigated.[5] Several studies have shown an association between HLA-Cw6 and response to ustekinumab, but the magnitude of this association is unknown and smaller studies have shown conflicting results for interleukin-17 inhibitors and TNF- inhibitors. For each group, the number of studies, the number of patients, the number of HLA-Cw6-positive and HLA-Cw6-negative patients were recorded. [Extracted from the article]

However, markers of systemic inflammation were numerically lower in patients treated with biologics and these biologics may hold the potential to reduce the risk of CVD in patients with psoriasis. The mean SII (492.7 ± 363.0 vs. 696.2 ± 246.3 [ I p i = 0.017]) and NLR (1.95 ± 1.11 vs. 2.77 ± 0.86 [ I p i = 0.002]) were lower in the patients receiving biologic treatment compared to the untreated patients. Psoriasis is a systemic inflammatory disease that is associated with a disease severity-dependent increased risk of atherosclerotic cardiovascular disease (CVD).[1] Increased burden of systemic inflammation and traditional cardiovascular risk factors are thought to increase the risk of CVD in psoriasis, and shared inflammatory pathways represent a possible link between the two diseases.[1] Biomarkers of systemic inflammation such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and high-sensitivity C-reactive protein (hs-CRP) are increased in patients with psoriasis compared to healthy controls.[[2]] Furthermore, increased NLR is associated with CVD in patients with psoriasis.[[4]] Recently, the systemic immune-inflammation index (SII), which is calculated by the following formula: neutrophils × platelets/lymphocytes and thus combines NLR and PLR in one index, was also shown to be increased in patients with psoriasis.[[6]] It is unknown which biomarker of systemic inflammation best captures both disease activity measured by psoriasis area and severity index (PASI)[[2], [8]] and risk of CVD in patients with psoriasis. [Extracted from the article]

Background: Allergic contact dermatitis (ACD) in the eye region caused by topical eye medications is difficult to diagnose and may be overlooked. Objective: To study the characteristics and causative agents in patients with ACD caused by topical eye medications in a Danish tertiary dermatology department. Methods: A retrospective study of 318 patients, patch tested between 2013 and 2021 due to suspected ACD to topical eye medications. All patients were tested with a locally developed eye medication series, some were additionally tested with suspected eye medications. Medical records were studied in patch test positive patients. Results: Contact allergy to a topical eye allergen/medication was found in 12.9% (n = 41) of 318 patients, and culprit allergens were phenylephrine (6.9%), timolol (2.5%) and ketotifen (1.6%). Patch test positive patients were often previously diagnosed with cataract (29.3%) or glaucoma (24.4%), and the majority reported more than one previous reaction. Initial symptoms were oedema (56.0%), erythema (48.8%) and dermatitis (31.7%) in the eye region, and facial dermatitis was also seen. Conclusions: Patients with symptoms from the eye region who have been using topical eye medications should be patch tested with ingredients from commonly used eye medications supplemented by the products tested 'as is'. [ABSTRACT FROM AUTHOR]

For people with psoriasis, biomarkers aiding in the personalization of treatment with biologics are needed. We examined the usefulness of several biomarkers of inflammation in this respect. The neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the systemic immune–inflammation index (SII) were measured in patients with psoriasis initiating TNF-α inhibitors (n = 131), IL-17/IL-17R inhibitors (n = 65), or IL-23/IL-12/23 inhibitors (n = 50). The blood levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, interferon (IFN)-γ, IL-17A, IL-6, soluble IL-6 receptor (sIL-6R), and soluble IL-6 signal transducer (sIL-6ST) were measured in patients initiating adalimumab (n = 62) or IL-17/IL-17R inhibitors (n = 24). Treatment response was defined by a psoriasis area and severity index (PASI) ≤ 2 three months after treatment initiation. Responders to TNF-α inhibitors had a lower NLR at baseline than non-responders (median and interquartile range (IQR) 2.15 (1.67–2.86) vs. 2.54 (1.88–3.55); p = 0.04). Responders to treatment with adalimumab had lower IL-6 levels at baseline than non-responders (0.99 (0.42–1.4) vs. 1.62 (0.96–2.41) pg/mL; p = 0.02). For the majority of patients, the IL-17A, IL-1β, and IFN-γ levels were below quantification limits. NLR and IL-6 may serve as predictive biomarkers of treatment response to TNF-α inhibitor therapy in patients with psoriasis. [ABSTRACT FROM AUTHOR]

Occupational hand eczema is frequent in metalworkers. The contribution of metal allergies is poorly elucidated even though such exposures are common at the workplace. To estimate the prevalence of metal allergy to cobalt (Co), chromium (Cr) and nickel (Ni) in metalworkers and compare these to estimates from the European Surveillance System on Contact Allergies (ESSCA). Two authors independently searched PubMed for studies reporting on the prevalence of metal allergy in metalworkers. Proportion meta‐analyses were performed to calculate the pooled proportions of metal allergy in metalworkers. In total, 29 studies (22 from Europe) were included yielding 5691 subjects for quantitative analysis. The pooled proportion (95% confidence interval) of Co, Cr and Ni in European metalworkers with dermatitis referred to patch test clinics was 8.2% (5.3%–11.7%), 8.0% (5.1%–11.4%), and 11.0% (7.3%–15.4%), respectively. The corresponding estimates for unselected metalworkers from workplace studies were 4.9% (2.4%–8.1%), 5.2% (1.0%–12.6%), and 7.6% (3.8%–12.6%), respectively. In comparison, the prevalence of metal allergy in 13 382 consecutive European males with dermatitis was 3.9% (3.6%–4.2%), 4.4% (4.1%–4.8%) and 6.7% (6.3%–7.0%) for Co, Cr and Ni, respectively. Data on sex, age, body piercings and atopic dermatitis in metalworkers with metal allergy was mostly lacking. Metal allergy to all three metals was significantly more common in European metalworkers with dermatitis attending patch test clinics as compared to ESSCA data, indicating a relationship to occupational exposures, however, confounders could not be accounted for. [ABSTRACT FROM AUTHOR]

Background: Compliance with glove use and safe work practices are important factors in primary prevention of occupational hand eczema (OHE) in hairdressers. Objective: To assess the risk OHE and compliance with skin protective measures in hairdressers trained before and after implementation of a nationwide skin protection program in Danish hairdressing vocational schools in 2011. Methods: A repeated cross‐sectional study was performed. A questionnaire was sent in 2009 and 2020. The Danish Labour Market Supplementary Pension Scheme provided information on yearly payments from the hairdressing profession. Results: A response rate of 66.6% (305/460) was obtained in the 2009 survey and of 29.9% (363/1215) in the 2020 survey. The career time prevalence of OHE decreased from 42.8% to 29.0% (adjusted odds ratio 0.55 95% confidence interval [CI] 0.40‐0.77) and the incidence rate of OHE decreased from 57.5 (95%CI 48.4‐68.4) to 42.0 (95%CI 34.6‐50.9) per 1000 person years (incidence rate ratio 0.73 [95%CI 0.56‐0.95] between the two surveys). A statistically significant (P <.05) increase in glove use when doing wet‐work and when handling hair dyes, permanent wave solutions and bleaching products was observed in the 2020 compared to the 2009 survey. Conclusion: Our data suggest that skin protection training during apprenticeship reduces the risk of OHE in hairdressers. The lack of primary prevention of OHE in hairdressing vocational schools may be a missed opportunity in the prevention of the disease. [ABSTRACT FROM AUTHOR]

Background: Occupational hand eczema (OHE) is common in hairdressers, and many leave the trade because of the disease. However, the exact impact of OHE on career length is unknown.Objective: To assess the effect of OHE on career length and risk factors associated with leaving the trade because of OHE in hairdressers followed-up for up to 35 years.Methods: A prospective cohort study of Danish hairdressers graduating between 1985 and 2007 (n=5219) was performed. A questionnaire was sent in 2009 and 2020. The Danish Labor Marked Supplementary Pension Scheme provided information on affiliation to the hairdressing profession. Career length was assessed by Kaplan-Meier analyses.Results: The median survival time was 12.0 (95% CI 11.0 to 13.0) years in graduates with OHE and 14.0 (95% CI 12.6 to 15.4) years in graduates without OHE (p<0.001). Graduates with a frequency of hand eczema (HE) of 'once', 'several times' and 'almost all the time' had a median survival time of 20.0 (95% CI 14.6 to 25.4), 12.0 (95% CI 10.7 to 13.3) and 7.0 (95% CI 5.6 to 8.4) years, respectively. Graduates with OHE that left the trade (partly) because of HE constituted 11.7% of the study population. Factors associated with leaving the trade because of HE included a history of atopic dermatitis (adjusted OR (aOR) 2.2 (95% CI 1.2 to 4.0), a history of a positive patch test (aOR 5.1 (95% CI 2.3 to 11.0) and allergy to hair dyes (aOR 9.4 (95% CI 3.4 to 25.6).Conclusion: Career length is reduced in hairdressers with OHE, especially if frequently relapsing or caused by contact allergy, for example, to hair dyes. [ABSTRACT FROM AUTHOR]

Background: Accumulating evidence supports the findings of an altered gut microbiota in patients with autoimmune disease. However, existing studies on the role of the gut microbiota in patients with psoriasis have demonstrated conflicting results and have mainly been based on 16s rRNA gene sequencing analysis. Objectives: To examine whether the gut microbiota of patients with psoriasis was altered in composition and functional potentials compared with healthy controls, and as a second approach compared with healthy cohabitant partners. A further aim was to investigate relationships to disease severity, and seasonal impact on the gut microbiota. Methods: In a case–control study, 126 faecal samples were collected from a sample of 53 systemically untreated patients with plaque psoriasis; 52 healthy controls matched for age, sex and body mass index; and 21 cohabitant partners. A subpopulation of 18 patients with psoriasis and 19 healthy controls continued in a longitudinal study, where four to six faecal samples were collected over 9–12 months. The gut microbiota was characterized using shotgun metagenomic sequencing analysis. Results: A significantly lower richness (P = 0·007) and difference in community composition (P = 0·01) of metagenomic species was seen in patients with psoriasis compared with healthy controls, and patients with psoriasis had a lower microbial diversity than their partners (P = 0·04). Additionally, the functional richness was decreased in patients with psoriasis compared with healthy controls (P = 0·01) and partners (P = 0·05). Increased disease severity was correlated with alterations in taxonomy and function, with a slight tendency towards a lower richness of metagenomic species, albeit not significant (P = 0·08). The seasonal analysis showed no shifts in community composition in healthy controls or in patients with psoriasis. Conclusions: The findings of a different gut microbiota in composition and functional potentials between patients with psoriasis and healthy controls support a linkage between the gut microbiota and psoriasis. These findings need to be validated in larger studies, and a potential causal relationship between the gut microbiota and psoriasis still needs to be shown. [ABSTRACT FROM AUTHOR]

Objective To investigate and compare clinical features and US signs of inflammation in joints and entheses in patients with psoriasis with and without musculoskeletal pain, and the additional value of US in classification of PsA. Furthermore, to explore the association between such findings and patient-reported outcomes (PROs) and the performance of screening-questionnaires for identifying patients with PsA. Methods Patients with psoriasis (n  = 126) recruited from a nationwide survey were evaluated at one of four rheumatology departments. The evaluation included clinical examination, laboratory tests, radiography, greyscale and colour Doppler US of 48 joints and 12 entheses, PROs, and four screening questionnaires for PsA. Patients were classified with Classification for PsA (CASPAR), US-modified CASPAR, and US-only criteria. Results When subgroups of self-reported pain (63%), no pain (29%) and diagnosed PsA (9%) were compared, patients with pain had higher tenderness-related clinical scores (tender joints, entheses and FM points) and US greyscale sum-scores, compared with 'no pain' patients. PROs were negligibly moderately correlated with pain-related clinical scores (Spearman's rho = 0.11–0.59, all patients), and negligibly weakly with US sum-scores (rho = 0.01–0.34). More patients could be classified as PsA when US synovitis/enthesitis was included as an entry criterion (US-modified CASPAR, 66% of all patients) compared with conventional CASPAR (35%) or US-only criteria (52%). Sensitivities of screening questionnaires were low for fulfilment of CASPAR (0.23–0.66), US-modified CASPAR (0.17–0.57), and US-only (0.20–0.57) criteria. Conclusion Self-reported pain in psoriasis is related to US inflammation. US-modified CASPAR criteria identified almost twice as many patients as conventional CASPAR criteria. Screening questionnaires showed limited value. [ABSTRACT FROM AUTHOR]