Search

Aim Methods Results Conclusions Atopic dermatitis is a popular allergy disease among children, adolescents and adults. The risk of depression in patients with atopic dermatitis can be evaluated using an updated systemic review and meta‐analysis of observational and cross‐sectional studies.The log odds ratio (OR) was transformed using the OR and 95% confidence interval (CI) to assess the risk of depression in patients with atopic dermatitis across the children, adolescent and adult groups. After a restricted selection, 39 studies of 234 306 patients with atopic dermatitis and 10 935 459 reference individuals were enrolled. The focused outcome was the OR and 95% CI of depression risk in each included study, assigned according to the age for the children, adolescent and adult groups.In adult patients with atopic dermatitis, a significantly higher risk of depression was observed. In addition, the similar significantly higher risk of depression was observed in children and adolescent patients with atopic dermatitis, respectively. However, the significantly high heterogeneity was observed across children, adolescent and adult groups.In the current meta‐analysis, the patients with atopic dermatitis had a higher risk of depression across the children, adolescent and adult groups, respectively. However, substantial heterogeneity should be considered during the interpretation of our meta‐analysis results. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a prevalent chronic inflammatory skin disease with a substantial global burden and negative impact on quality of life. While genetics and pathophysiology are key to understanding AD, emerging evidence indicates that social and structural determinants of health (SDOH and StDOH) strongly influence the condition's onset, severity, and outcomes. SDOH, such as economic stability, education quality and access, healthcare quality and access, neighborhood environment, and social/community context, shape individual risk and disease experience. StDOH, including government processes, economic policies, social/public policies, and cultural/societal values, further act as upstream forces that directly and indirectly influence AD outcomes. In this review, we synthesize current knowledge on the impacts of SDOH and StDOH on AD incidence, severity, and disparities. Embracing a biopsychosocial model is crucial to elucidate the etiology, epidemiology, and optimal management of AD. Future research should adopt a holistic approach, moving beyond a purely biological perspective to consider the intricate interplay of social and structural determinants in understanding and managing AD. [ABSTRACT FROM AUTHOR]

Several microbiome studies have recently demonstrated microbial dysbiosis in various chronic inflammatory skin diseases, and it is considered an important role in the pathogenesis. Although the role of skin dysbiosis in inflammatory skin diseases is debatable, the local microenvironment is considered essential concerning compositional changes and functional alterations of the skin microbiota. Indeed, various local nutrients (e.g., lipids), pH values, water, oxygen, and antimicrobial peptides may affect the level of skin dysbiosis in these skin diseases. In particular, in atopic dermatitis and hidradenitis suppurativa, significant changes in skin dysbiosis have been associated with local aberrant host immune changes. In this review, the potential pathogenic crosstalk between the host and the microbiota is reviewed in relation to the physical, chemical, and biological microenvironments of various chronic inflammatory skin diseases. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a genetically predisposed allergic inflammatory dermatosis with chronic, pruritic, and recurrent features. Patients with AD have dry and itchy skin, often accompanied by chronic eczematous lesions, allergic rhinitis, or asthma, which has a considerable impact on their daily lives. With advances in genome sequencing technology, it has been demonstrated that microorganisms are involved in this disease, and the microorganisms associated with AD are attracting considerable research attention. An increasing number of studies conducted in recent years have demonstrated that an imbalanced microbiome in AD patients has substantial impact on disease prognosis, and the causes are closely tied to various immune mechanisms. However, the involvement of microorganisms in the pathogenesis of AD remains poorly understood. In this paper, we review the advances in research on the immunological mechanisms of the skin microbiome, intestinal microbiome, and lung microbiome that are related to AD prognosis and immunotherapy protocols. It is hoped that this approach will lay the foundation for exploring the pathogenesis of and emerging treatments for AD. [ABSTRACT FROM AUTHOR]

Background Objectives Materials and Methods Results Conclusions Atopic dermatitis (AD) and hand eczema often co‐occur, particularly among adults.To examine the interplay between AD and hand eczema in the general population, by characterising prevalence, disease severity, contact sensitization, and comorbidities in individuals with one or both conditions.In this cross‐sectional study, 100 000 randomly selected adults in the Danish general population received a questionnaire via a secure, digital mailbox linked to their civil registration number. Participants answered questions regarding eczema, disease severity, patch testing, and comorbidities.A total of 40 007 individuals responded to the question on a lifetime prevalence of AD, and the prevalence among adult Danes was 9.0%. Nearly one third of individuals with AD reported moderate to severe disease. AD was associated with contact sensitization and increased hand eczema prevalence. Individuals with both AD and hand eczema reported worse disease severity. Furthermore, having both conditions was associated with an increased risk of psychiatric comorbidities.This study provided updated information about unselected adults with AD in Denmark. Individuals with both AD and hand eczema represent a vulnerable subgroup that physicians should be attentive to. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusions The validity of the self‐report questionnaire for hand eczema (HE) among Croatian hairdressers was not investigated previously, leading to uncertainty in the prevalence estimated from self‐reported data.To (1) investigate the validity of the self‐report questionnaire for HE in hairdressing apprentices and (2) examine the differences between apprentices who recognised their HE symptoms and those who did not.Clinical examination for HE signs on hands and wrists was performed by the Osnabrueck Hand Eczema Severity Index for 408 apprentices at four visits covering the entire schooling period. Self‐report HE was based on the Nordic Occupational Skin Questionnaire.Low sensitivity (7%–37%) with high specificity (≥95%) was observed, with both measures improving from baseline to last visit. The severity of HE signs was the only factor associated with the correct identification of HE signs in analyses adjusted for previous HE signs, health‐related quality of life, and atopic dermatitis (adjusted odds ratios of 1.58 with 95% confidence interval [1.06–2.35] and 1.74[1.38–2.19] at second and third follow‐up visit, respectively).Self‐report questionnaire for HE showed low sensitivity in hairdressing apprentices, especially at the beginning of training and in those with mild symptoms. Further validation studies following questionnaire modifications aimed at adolescent population are advised. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusions People with skin disease suffer due to disease‐related physical symptoms, as well as due to significant psychosocial burden. A major contributor of this burden is the experience of stigmatization. Research indicates that people with visible skin diseases deal with both social stigma and self‐stigma.This systematic literature review aimed to aggregate existing research on correlates and mechanisms that contribute to self‐stigmatization among people with atopic dermatitis, psoriasis, vitiligo, alopecia areata or hidradenitis suppurativa and to, ultimately, identify targets for psychosocial interventions.The review followed PRISMA guidelines. Four databases, PubMed, OVID, Web of Science and PsycINFO were searched for peer‐reviewed articles. Studies were identified by two independent researchers and were eligible if they (1) assessed adults with one of five chronic skin diseases—atopic dermatitis, psoriasis, vitiligo, alopecia areata or hidradenitis suppurativa, (2) measured self‐stigma or relevant synonyms, (3) evaluated psychosocial correlates, predictors or explanatory mechanisms of self‐stigma and (4) were published in German or English in a peer‐reviewed journal. The Johanna Briggs Institute Checklist for Analytical Cross Sectional Studies was used to evaluate the quality of studies.Twenty‐seven studies were included with a mean quality rating of 7.04 (out of 8). Social stigma, coping strategies (such as lack of acceptance) and lack of social support were identified as main predictors of self‐stigma. Although study quality was good, all but one study had a cross‐sectional design that does not allow examining causal relationships among the determinants of self‐stigma.Findings from the present review revealed several psychosocial variables that are malleable and potentially suitable as intervention targets. Those variables such as acceptance should be targeted in evidence‐based interventions specifically developed to reduce self‐stigma to, ultimately, improve mental health of people affected. [ABSTRACT FROM AUTHOR]

This document is a collection of summaries from a conference on contact dermatitis. The summaries cover a wide range of topics related to the prevention, diagnosis, and treatment of contact dermatitis. They discuss strategies for prevention, the role of allergens, the relationship between the skin barrier and immune responses, genetic factors, and new treatment options. The summaries highlight the importance of individualized treatment and preventive measures. The document also covers topics such as measuring outcomes in research, legal aspects of patch testing, labelling regulations, and occupational dermatitis. This information can be valuable for library patrons researching these specific topics. [Extracted from the article]

Early intervention and active management of infant atopic eczema may play a crucial role in limiting eczema severity and preventing the onset of immediate‐type food allergy. Eczema management involves education, skincare and medications targeting skin inflammation and barrier repair. Topical corticosteroids are the mainstay of anti‐inflammatory therapy, with nonsteroidal options available for some infants. Proactive therapy, addressing subclinical inflammation, is useful for preventing eczema flares, especially in infants with recurrent eczema flares despite reactive therapy. In clinical practice, holistic consideration of overall infant and family health is essential. Providing advice on maternal stress management, nutritional guidance and recommendations for proper sleep and lifestyle is crucial for the well‐being of children and their families, not limited to eczema treatment alone. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD), a complex and heterogeneous chronic inflammatory skin disorder, manifests in a spectrum of clinical subtypes. The application of genomics has elucidated the role of genetic variations in predisposing individuals to AD. Transcriptomics, analyzing gene expression alterations, sheds light on the molecular underpinnings of AD. Proteomics explores the involvement of proteins in AD pathophysiology, while epigenomics examines the impact of environmental factors on gene expression. Lipidomics, which investigates lipid profiles, enhances our understanding of skin barrier functionalities and their perturbations in AD. This review synthesizes insights from these omics approaches, highlighting their collective importance in unraveling the intricate pathogenesis of AD. The review culminates by projecting future trajectories in AD research, particularly the promise of multi‐omics in forging personalized medicine and novel therapeutic interventions. Such an integrated multi‐omics strategy is poised to transform AD comprehension and management, steering towards more precise and efficacious treatment modalities. [ABSTRACT FROM AUTHOR]

Background: Twin studies revealed that genetic effects play a role in hand eczema (HE), but the responsible genetic factors are unknown. Objectives: To identify and characterise genetic loci associated with HE and to provide insight into the genetic overlap between HE and atopic dermatitis (AD). Methods: We used questionnaire‐derived and genotype data from the European population‐based Lifelines cohort and biobank. We performed a discovery genome‐wide association study (GWAS) of HE (2879 cases and 16 249 controls) and of AD (1706 cases and 17 190 controls). We replicated our findings in an independent Lifelines sample for HE (1188 cases and 6431 controls) and AD (757 cases and 6747 controls). We conducted several post‐GWAS analyses and performed genetic correlation analyses between our HE results and independent AD data. Results: The two‐step GWAS of HE, regardless of adjusting for AD, identified one independent locus 20q13.33, likely driven by a number of causal single‐nucleotide polymorphisms. For the AD GWAS, we replicated a known stop‐gained rs61816761 at locus 1q21.3 (FLG, FLGAS1). We found a strong genetic correlation (p < 0.01) between HE and AD (rg = 0.65), regardless of adjusting for AD (rg = 0.63). Conclusions: Locus 20q13.33 is associated with HE, and there is a large genetic overlap between HE and AD. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is the most common paediatric inflammatory skin disease. There are currently no robust biomarkers that could reliably predict its manifestation, and on the molecular level, it is less well characterized than adult AD. Objectives: This study aimed to extend previous findings and provide evidence for distinct changes of the epidermal proteome and microbiome preceding the onset of AD as well as characterizing early AD. Methods: We longitudinally analysed epidermal biomarker levels and microbial profiles in a cohort of 50 neonates at high risk for AD, who had participated in a randomized controlled trial on early emollient use for AD prevention. Results: About 26% of the infants developed AD until month 24 with an average age of 10 month at disease onset. In children with later AD, IL‐1Ra, TNFβ, IL‐8, IL‐18, IL‐22, CCL2, TARC, TSLP and VEGFa showed increased levels prior to disease manifestation with levels of IL‐1Ra, TNFβ and VEGFa already increased shortly after birth. Further, children with later AD displayed a delayed maturation and differentially composed skin microbiome prior to AD onset. At manifestation, levels of multiple Th2, Th17/22 and Th1‐associated biomarkers as well as innate immunity markers were elevated, and abundances of commensal Streptococcus species were reduced in favour of Staphylococcus epidermidis. Conclusions: Our results indicate that elevations of proinflammatory stratum corneum biomarkers and alterations of the skin microbiome precede paediatric AD and characterize the disease at onset. [ABSTRACT FROM AUTHOR]

Background: Identification of biomarkers is required for a systems medicine approach and personalized treatment in atopic dermatitis (AD). These biomarkers may not only aid in diagnosing but also might be suitable to predict the effectiveness of targeted treatment. Objective: We aimed to identify proteomic, microbial and miRNA biomarkers in AD patients and investigated their course in relation to the clinical response upon anti‐IL‐4Rα therapy. Methods: Proteomic and miRNA screening was performed in AD patients in comparison to healthy controls. Differentially regulated serum proteins, miRNA and selected skin microbiota were measured consecutively in 50 AD patients before and upon systemic dupilumab treatment. A random forest classifier was used to predict the outcome of dupilumab therapy based on the initial biomarker patterns. Results: We identified 27 proteomic candidates, miRNA and three microbial strains to be dysregulated in AD. CCL17, CCL13, CCL22, E‐selectin and BDNF were differently regulated and significantly associated with treatment response. In contrast, neither the microbial composition nor the miRNA pattern was associated with treatment response upon dupilumab treatment. Conclusion: AD patients display defined dysregulations regarding their systemic proteomic serum profile, miRNA patterns and their skin microbiome. The proteomic profile and selected skin bacteria changed profoundly upon anti‐IL‐4Rα therapy which was associated with an overall clinical response. This was not seen in miRNA‐related biomarkers. Our findings support the hypothesis that biomarker profiles reflect treatment responses and may in the future be used to develop a personalized medicine approach for the treatment of AD patients. [ABSTRACT FROM AUTHOR]

Background and Purpose: Chitinase‐3‐like 1 (CHI3L1) causes skin inflammation in the progression of atopic dermatitis. We investigated if anti‐CHI3L1 antibody could prevent the development of atopic dermatitis and its mechanisms of action. Experimental Approach: The effect of CHI3L1 antibody on phthalic anhydride‐induced atopic dermatitis animal model and in vitro reconstructed human skin (RHS) model were investigated. Expression and release of atopic dermatitis‐related cytokines were determined using an enzyme‐linked immunosorbent assay, and RT‐qPCR, STAT3 and CXCL8 signalling were measured by western blotting. Key Results: Anti‐CHI3L1 antibody suppressed phthalic anhydride‐induced epidermal thickening, clinical score, IgE level and infiltration of inflammatory cells, and reduced phthalic anhydride‐induced inflammatory cytokines concentration. In addition, CHI3L1 antibody treatment inhibited the expression of STAT3 activity in phthalic anhydride‐treated skin. It was also confirmed that CHI3L1 antibody treatment alleviated atopic dermatitis‐related inflammation in the RHS model. The inhibitory effects of CHI3L1 antibody was similar or more effective compared with that of the IL‐4 antibody. We further found that CHI3L1 is associated with CXCL8 by protein‐association network analysis. siRNA of CHI3L1 blocked the mRNA levels of CHI3L1, IL‐1β, IL‐4, CXCL8, TSLP, and the expression of CHI3L1 and p‐STAT, and the level of CXCL8, whereas recombinant level of CXCL8 was elevated. Moreover, siRNA of STAT3 reduced the mRNA level of these cytokines. CHI3L1 and p‐STAT3 expression correlated with the reduced CXCL8 level in the RHS in vitro model. Conclusion and Implications: Our data demonstrated that CHI3L1 antibody could be a promising effective therapeutic drug for atopic dermatitis. [ABSTRACT FROM AUTHOR]

Abrocitinib is a selective Janus kinase 1 inhibitor approved for the treatment of atopic dermatitis. It is metabolized primarily by cytochrome P450 (CYP) 2C19 (approximately 53%) and CYP2C9 (approximately 30%), which form 2 active metabolites. The pharmacologic activity of abrocitinib is attributable to the unbound exposures of abrocitinib and those metabolites with active moiety area under the plasma concentration–time curve (AUC) considered the best measure of the total pharmacological effect. The effect of CYP2C19 and/or CYP2C9 genotypes on abrocitinib and active moiety exposures were evaluated using a meta‐analysis of the noncompartmental estimates of exposure pooled from 10 clinical studies. A linear mixed‐effects model was developed on the basis of the power model to evaluate the effect of CYP2C19 and/or CYP2C9 genotypes on exposure (i.e., abrocitinib AUC and peak plasma concentration, active moiety AUC and peak plasma concentration). The genotypes were evaluated individually and as a combined phenotype effect. When evaluating the poor metabolizers of CYP2C19 or CYP2C9 individually, the estimated increases were 44.9% and 42.0% in active moiety AUC, respectively. The combined phenotype models showed a 0.6% decrease, and 25.1% and 10.5% increases in the active moiety AUC for “elevated,” “mixed,” and “reduced” metabolizers, respectively. Overall, the active moiety exposures did not appear to be affected to a clinically meaningful extent by different genotypes of CYP2C19 and/or CYP2C9. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Studies of childhood diet diversity and allergic disease have not examined additional associations with an offspring allergy‐linked maternal diet index during pregnancy. We studied both associations in a pre‐birth cohort.Offspring allergic disease diagnoses were obtained from electronic medical records. Maternal and infant diet were self‐reported. Adjusted parametric Weibull time‐to‐event models assessed associations between maternal diet index, infant diet diversity and time to development of allergic rhinitis, atopic dermatitis, asthma, wheeze, IgE‐mediated food allergy, and a combined outcome of any allergic disease except for wheeze.Infant diet diversity at 1 year was associated with the risk of the combined outcome between 1 and 4 years of age (p = .002). While both maternal diet index and infant diet diversity at 1 year were associated with the risk of the combined outcome between 1 and 4 years of age (both p < .05), infant diet diversity at 1 year did not modify the association between maternal diet index and the risk of the combined outcome between 1 and 4 years of age (p = .5). The group with the lowest risk of the combined allergy outcome had higher maternal diet index and higher infant diet diversity.The novel finding that both maternal diet index during pregnancy and infant diet diversity at 12 months are associated with the risk of a combined allergic disease outcome points to two targets for preventive interventions: maternal diet index scores during pregnancy and offspring diet diversity during infancy. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Atopic dermatitis (AD) is a common chronic skin disorder in children. We aimed to investigate trends and regional disparities of burden in paediatric AD at global, regional and national levels, and to explore potential associated factors.Based on data from Global Burden of Disease study 2019, we assessed trends in burden of AD aged <19 years from 1990 to 2019, including prevalent and incident cases, age‐standardised prevalence and age‐standardised incidence. For potential associated factors, correlations of above trends and indexes of socio‐economic status (sociodemographic index, SDI) and health service coverage (universal health coverage index, UHCI) were evaluated. We conducted decomposition analysis to understand the net contribution of population‐level factors and their contribution proportions on changes of prevalent and incident cases, including age structure, population change and epidemiological change.Global prevalent and incident cases of paediatric AD increased by about 5.7 and 0.7 million between 1990 and 2019, respectively. Global age‐standardised prevalence and incidence decreased by −0.17% (−0.19% to −0.16%) and −0.12% (−0.13% to −0.11%) per year from 1990 to 2019, respectively. Regionally, the highest increase of prevalent and incident cases was in low SDI region (by 96.77% and 84.85%); the highest decrease of age‐standardised prevalence and incidence was in high SDI regions (by −0.20% and −0.27% per year). The correlation analyses identified significant negative correlations between trends and SDI and UHCI. Population change was a major driver of case rise; epidemiological change and age structure showed negative impact of case rise. Regional disparities in contribution of three population‐level factors were seen, including net contribution direction (positive or negative) and contribution proportion levels.Global paediatric AD case numbers increased, primarily due to population growth. Prevalence and incidence decreased slightly. Geographic inequalities were seen. Developing region‐specific strategies targeting potential factors is essential to reduce paediatric AD burden. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease worldwide. AD is a highly complex disease with different subtypes. Many elements of AD pathophysiology have been described, but if/how they interact with each other or which mechanisms are important in which patients is still unclear. Langerhans cells (LCs) are antigen‐presenting cells (APCs) in the epidermis. Depending on the context, they can act either pro‐ or anti‐inflammatory. Many different studies have investigated LCs in the context of AD and found them to be connected to all major mechanisms of AD pathophysiology. As APCs, LCs recruit other immune cells and shape the immune response, especially adaptive immunity via polarization of T cells. As sentinel cells, LCs are primary sensors of the skin microbiome and are important for the decision of immunity versus tolerance. LCs are also involved with the integrity of the skin barrier by influencing tight junctions. Finally, LCs are important cells in the neuro‐immune crosstalk in the skin. In this review, we provide an overview about the many different roles of LCs in AD. Understanding LCs might bring us closer to a more complete understanding of this highly complex disease. Potentially, modulating LCs might offer new options for targeted therapies for AD patients. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusions Eczema and psoriasis are common diseases. Despite both showing active epidermal contribution to the inflammatory process, their molecular aetiology and pathological mechanisms are different.Further molecular insight into these differences is therefore needed to enable effective future diagnostic and treatment strategies. The majority of our mechanistic and clinical understanding of psoriasis and eczema is derived from RNA, immunohistology and whole skin biopsy data.In this study, non‐invasive epidermal sampling of lesional, perilesional and non‐lesional skin from diseased and healthy skin was used to perform an in depth proteomic analysis of epidermal proteins.Our findings confirmed the psoriasis‐associated cytokine IL‐36γ as an excellent protein biomarker for lesional psoriasis. However, ELISA and ROC curve analysis of 53 psoriasis and 42 eczema derived samples showed that the sensitivity and specificity were outperformed by elastase‐specific protease inhibitor, elafin. Of note, elafin was also found upregulated in non‐lesional psoriatic skin at non‐predilection sites demonstrating inherent differences between the non‐involved skin of healthy and psoriatic individuals. Mass spectrometry and ELISA analysis also demonstrated the upregulation of the anti‐inflammatory molecule IL‐37 in psoriatic perilesional but not lesional skin. The high expression of IL‐37 surrounding psoriatic plaque may contribute to the sharp demarcation of inflammatory morphology changes observed in psoriasis. This finding was also specific for psoriasis and not seen in atopic dermatitis or autoimmune blistering perilesional skin. Our results confirm IL‐36γ and add elafin as robust, hallmark molecules distinguishing psoriasis and eczema‐associated inflammation even in patients under systemic treatment.Overall, these findings highlight the potential of epidermal non‐invasive sampling and proteomic analysis to increase our diagnostic and pathophysiologic understanding of skin diseases. Moreover, the identification of molecular differences in healthy‐looking skin between patients and healthy controls highlights potential disease susceptibility markers and proteins involved in the initial stages of disease. [ABSTRACT FROM AUTHOR]

The Eczema Area and Severity Index is an investigator‐assessed instrument reporting clinical signs of atopic dermatitis. The instrument is extensively validated in both adult and paediatric populations and recommended as a core outcome measure to assess clinical signs by the Harmonising Outcome Measures for Eczema initiative in clinical trials and was recently recommended as an option to measure signs in clinical practice. Here, we review the validation of the instrument using standard assessment criteria, explore controversies and challenges to its universal applicability and highlight future electronic adaptations. We find that the instrument demonstrates adequate performance in the measurement properties recommended by the COnsensus‐based Standards for the selection of health Measurement INstruments initiative for instruments reporting clinical signs, is clinically interpretable, and is suitable for all atopic dermatitis severities. Some validation gaps remain. Information reporting on its performance in diverse populations, with emphasis on deeply pigmented skin, is promising though limited. Technological adaptations are demonstrating promising initial validation results and may facilitate remote and/or automated assessments assisting clinical care and decentralized clinical trials in the future. We find no strong evidence limiting its use in trials or clinical practice although questions pertaining to the effect of investigator training remain. We recommend that the Eczema Area and Severity Index be used in all interventional atopic dermatitis trials and be considered alongside other recommended clinical practice severity instruments. [ABSTRACT FROM AUTHOR]

Propolis is a natural resinous substance made by bees through mixing various plant sources. Propolis has been widely recognized as a functional food due to its diverse range of beneficial bioactivities. However, the therapeutic effects of consuming propolis against atopic dermatitis (AD) remain largely unknown. The current study aimed to investigate the potential efficacy of propolis against AD and explore the active compound as well as the direct molecular target. In HaCaT keratinocytes, propolis inhibited TNF‐α‐induced interleukin (IL)‐6 and IL‐8 secretion. It also led to a reduction in chemokines such as monocyte chemoattractant protein‐1 (MCP‐1) and macrophage‐derived chemokine (MDC), while restoring the levels of barrier proteins, filaggrin and involucrin. Propolis exhibited similar effects in AD‐like human skin, leading to the suppression of AD markers and the restoration of barrier proteins. In DNCB‐induced mice, oral administration of propolis attenuated AD symptoms, improved barrier function, and reduced scratching frequency and transepidermal water loss (TEWL). In addition, propolis reversed the mRNA levels of AD‐related markers in mouse dorsal skin. These effects were attributed to caffeic acid phenethyl ester (CAPE), the active compound identified by comparing major components of propolis. Mechanistic studies revealed that CAPE as well as propolis could directly and selectively target MKK4. Collectively, these findings demonstrate that propolis may be used as a functional food agent for the treatment of AD. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Infantile colic is a common condition with limited knowledge about later clinical manifestations. We evaluated the role of the early life gut microbiome in infantile colic and later development of atopic and gastrointestinal disorders.Copenhagen Prospective Studies on Asthma in Childhood2010 cohort was followed with 6 years of extensive clinical phenotyping. The 1‐month gut microbiome was analyzed by 16S rRNA sequencing. Infantile colic was evaluated at age 3 months by interviews. Clinical endpoints included constipation to age 3 years and prospectively diagnosed asthma and atopic dermatitis in the first 6 years of life, and allergic sensitization from skin prick tests, specific Immunoglobulin E, and component analyses.Of 695 children, 55 children (7.9%) had infantile colic. Several factors were associated with colic including race, breastfeeding, and pets. The 1‐month gut microbiome composition and taxa abundances were not associated with colic, however a sparse Partial Least Squares model including combined abundances of nine species was moderately predictive of colic: median, cross‐validated AUC = 0.627, p = .003. Children with infantile colic had an increased risk of developing constipation (aOR, 2.88 [1.51–5.35], p = .001) later in life, but also asthma (aHR, 1.69 [1.02–2.79], p = .040), atopic dermatitis (aHR, 1.84 [1.20–2.81], p = .005) and had a higher number of positive allergic components (adjusted difference, 116% [14%–280%], p = .012) in the first 6 years. These associations were not mediated by gut microbiome differences.We link infantile colic with risk of developing constipation and atopic disorders in the first 6 years of life, which was not mediated through an altered gut microbiome at age 1‐month. These results suggest infantile colic to involve gastrointestinal and/or atopic mechanisms. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Dupilumab is the first and only biologic agent approved for the treatment of atopic dermatitis (AD) in pediatric patients aged from 6 months to 17 years. The study aimed to evaluate the impact of dupilumab on the occurrence of comorbidities in pediatric patients with AD.In this population‐based cohort study, we utilized electronic health records from multiple healthcare organizations across the United States. Pediatric patients (<18 years of age) with a diagnosis of AD initiating dupilumab were propensity‐score matched 1:1 to those initiating other systemic agents (azathioprine, cyclosporine, methotrexate, mycophenolate mofetil, or systemic corticosteroids). The primary outcomes were new‐onset comorbidities emerging during the study period measured by the risk ratio (RR) and its confidence interval (CI). Subgroup analyses were stratified by age (0–5 years, 6–11 years, and 12–17 years), sex, and race.A total of 3575 pediatric patients with AD treated with dupilumab were matched to 3575 patients treated with other systemic agents. The dupilumab cohort was associated with a lowered risk of new‐onset atopic comorbidities (including asthma [RR, 0.72; 95% CI, 0.59–0.89] and allergic rhinitis [RR, 0.62; 95% CI, 0.52–0.74]), infections (e.g., skin and soft tissue infection [RR, 0.70; 95% CI, 0.63–0.76] and respiratory tract infection [RR = 0.56; 95% CI, 0.51–0.61]), psychiatric disorders (e.g., mood disorder [RR, 0.52; 95% CI, 0.39–0.70] and anxiety [RR, 0.57; 95% CI, 0.46–0.70], sleep disturbance [RR, 0.60; 95% CI, 0.47–0.77]), neurologic and developmental disorders (e.g., attention deficit hyperactivity disorder [RR, 0.54; 95% CI, 0.38–0.75]). Furthermore, the positive effects are found to be more pronounced in younger children (aged 0–5 years) with AD.Treatment with dupilumab compared to systemic agents resulted in reductions in AD‐related comorbidities in pediatric patients. [ABSTRACT FROM AUTHOR]

Background Objectives Animals Materials and Methods Results Conclusion and Clinical Relevance Lokivetmab, a caninised monoclonal antibody against interleukin (IL)‐31, is an effective treatment for the pruritus associated with canine atopic dermatitis (cAD).To investigate the efficacy and safety of lokivetmab during long‐term treatment defined as at least three consecutive lokivetmab injections in atopic dogs under field conditions. To assess individual factors influencing treatment outcome and adverse events.150 dogs with cAD.Medical records of dogs treated with lokivetmab were reviewed, and owners and/or veterinarians were contacted as needed for follow‐up. A decrease of the pruritus Visual Analog Scale (PVAS) score by ≥2 or a PVAS score ≤2 after treatment was considered as treatment success. Logistic regression was used to investigate the influence of a variety of factors on outcome: type of cAD (food versus environment), age at first lokivetmab administration, disease chronicity, dosage and/or secondary infection. Any adverse event that occurred during the study period was recorded.Lokivetmab reduced the PVAS score with long‐term use (p < 0.01); the success rate was 53 of 69 total dogs (77%). The probability of treatment failure decreased with increasing treatment duration. None of the factors investigated influenced the treatment outcome. Twelve dogs of 150 (8%) showed adverse events such as gastrointestinal signs or lethargy.Lokivetmab appears to be an effective and safe long‐term anti‐itch therapy for dogs with cAD. [ABSTRACT FROM AUTHOR]

TAVO101 is a humanized anti‐human thymic stromal lymphopoietin (TSLP) monoclonal antibody under clinical development for the treatment of atopic dermatitis (AD) and other allergic inflammatory conditions. The crystallizable fragment region of the antibody was engineered for half‐life extension and attenuated effector functions. This Phase 1, double‐blinded, randomized, placebo‐controlled study assessed the safety, tolerability, pharmacokinetics, and immunogenicity of TAVO101 in healthy adult subjects in seven ascending dose cohorts. Subjects received a single intravenous administration of TAVO101 or placebo with a 195‐day follow‐up. TAVO101 was safe and well tolerated. The incidences and severities of treatment‐emergent adverse events were mostly mild and comparable between the active and placebo groups, with no trends of dose relationship. There were no severe adverse events, deaths, or treatment‐related withdrawals. TAVO101 exhibited a linear pharmacokinetic profile, low clearance, and a median elimination half‐life of 67 days in healthy subjects. All TAVO101‐treated subjects tested negative for anti‐drug antibodies. To support development in AD, TAVO101 was studied in an oxazolone‐induced AD model in hTSLP transgenic mice and demonstrated efficacy. This long‐acting anti‐TSLP antibody has the potential for stronger and sustained allergic inflammatory disease control. The results from this study warranted further clinical development of TAVO101 in patients. [ABSTRACT FROM AUTHOR]

Background Objective Animals Materials and Methods Results Conclusions and Clinical Relevance Mycophenolate is an immunomodulating agent successfully used for the treatment of moderate‐to‐severe atopic dermatitis (AD) in people. Mycophenolate is an effective steroid‐sparing treatment option for use in dogs with inflammatory skin diseases.To evaluate whether once‐daily modified‐release mycophenolate (OKV‐1001) is safe and effective for treating moderate‐to‐severe canine AD.Client‐owned atopic dogs (n = 9) were enrolled.In an open‐label multicentre pilot study, OKV‐1001 (30 mg/kg every 24 h) was given orally for ≤84 days. Concomitant tapering doses of glucocorticoids were administered up to Day (D)28. Clinicians assessed Canine Atopic Dermatitis Extent and Severity Index, 4th iteration (CADESI‐04) on D0, D14, D28, D56 and D84. Body weight and clinical pathological parameters were measured at baseline and at the end of the study.Treatment with OKV‐1001 combined with glucocorticoids significantly reduced the severity of AD within two weeks in seven of nine (77.8%) dogs. The mean percentage change from baseline in the CADESI‐04 score was 29% (p = 0.009) at D14 (n = 9), 39% (p = 0.008) at D28 (n = 9) and 49% (p = 0.03) at D56 (n = 7) at which point glucocorticoids had been withdrawn. In two dogs the improvement in CADESI‐04 was 62% and 23% (respectively) on D84. No significant adverse events including clinical pathological findings were reported.Modified‐release mycophenolate (OKV‐1001) may represent a promising alternative treatment option for dogs with moderate‐to‐severe AD. The safety and efficacy profile of OKV‐1001 will need to be established in larger, placebo‐controlled clinical trials. [ABSTRACT FROM AUTHOR]

Children and adolescents suffering from moderate‐to‐severe atopic dermatitis (AD) face a significant disease burden that greatly impacts their quality of life. Treatment options for AD are currently limited. To assess the safety and efficacy of biologic drugs, dupilumab, lebrikizumab, or tralokinumab, in improving outcomes in patients with moderate to severe inadequately controlled AD. We searched PubMed, Embase and Cochrane databases for randomized controlled trials (RCTs) comparing dupilumab, lebrikizumab or tralokinumab to placebo in patients with AD. We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs), random effects model was used and a p‐value <0.05 was considered as statistically significant. We analysed data into Review Manager 5.4. A total of five RCTs and 973 patients were included, of whom 592 were prescribed a biologic drug. Compared with placebo, patients receiving a biologic drug had a greater improvement, achieved an Investigator Global Assessment (IGA) score of 0 or 1 (OR 5.05; 95% CI 3.08–8.29), Eczema Area and Severity Index (EASI) 75 (OR 6.87; 95% CI 4.71–10.02), EASI 50 (OR 8.89; 95% CI 6.18–12.78) and EASI 90 (8.30; 95% CI 4.81–14.31). The proportion of patients with 3 points or more (OR 6.56; 95% CI 4.34–9.90) or 4 points or more (OR 8.09; 95% CI 5.19–12.59) improvement from baseline in peak pruritus NRS was significantly higher with biologic drugs than placebo. There were no significant differences between groups regarding adverse events (OR 0.79; 95% CI 0.58–1.07), and conjunctivitis (OR 2.08; 95% CI 1.00–4.33). In this meta‐analysis, dupilumab, lebrikizumab, and tralokinumab have shown significant improvements in signs, symptoms and quality of life in children or adolescents with moderate to severe AD. Larger studies may be needed to continue evaluating the safety and efficacy of these biologic drugs in this patient population. [ABSTRACT FROM AUTHOR]

The 4th Davos Declaration was developed during the Global Allergy Forum in Davos which aimed to elevate the care of patients with atopic dermatitis (AD) by uniting experts and stakeholders. The forum addressed the high prevalence of AD, with a strategic focus on advancing research, treatment, and management to meet the evolving challenges in the field. This multidisciplinary forum brought together top leaders from research, clinical practice, policy, and patient advocacy to discuss the critical aspects of AD, including neuroimmunology, environmental factors, comorbidities, and breakthroughs in prevention, diagnosis, and treatment. The discussions were geared towards fostering a collaborative approach to integrate these advancements into practical, patient‐centric care. The forum underlined the mounting burden of AD, attributing it to significant environmental and lifestyle changes. It acknowledged the progress in understanding AD and in developing targeted therapies but recognized a gap in translating these innovations into clinical practice. Emphasis was placed on the need for enhanced awareness, education, and stakeholder engagement to address this gap effectively and to consider environmental and lifestyle factors in a comprehensive disease management strategy. The 4th Davos Declaration marks a significant milestone in the journey to improve care for people with AD. By promoting a holistic approach that combines research, education, and clinical application, the Forum sets a roadmap for stakeholders to collaborate to improve patient outcomes in AD, reflecting a commitment to adapt and respond to the dynamic challenges of AD in a changing world. [ABSTRACT FROM AUTHOR]

We present a case of a 47‐year‐old male with severe atopic dermatitis and metastatic renal cell carcinoma managed successfully with dupilumab. This case further supports the safety of dupilumab in patients with active malignancy, an area currently with limited data. [ABSTRACT FROM AUTHOR]

Background: Dupilumab has been shown to be an effective treatment in moderate‐to‐severe atopic dermatitis (AD) and severe asthma (SA). However, comparative real‐world analyses of adverse events (AE), particularly dupilumab‐associated ocular surface disease (DAOSD), are lacking. Objective: This is the first real‐world study to provide insight into the prevalence of AEs associated with dupilumab in AD compared with SA. Secondary objectives were to assess the prevalence, onset and therapeutic strategies of DAOSD and evaluate dupilumab discontinuation rates. Methods: Data from two daily practice registries including AD and SA patients receiving dupilumab treatment were analyzed. Adverse events, including DAOSD, were evaluated. Results: In total, 322 AD and 148 SA patients were included. Headaches (23.6%), injection site reactions (10.1%), and influenza‐like symptoms (13.5%) were more prevalent in SA patients. Interestingly, ocular AEs were significantly more prevalent in AD patients (62.1%, p < 0.001), including conjunctivitis (17.1%, p = 0.004). 88% AD and 47% SA patients with ocular AEs received one or more ophthalmic treatment(s). Additionally, 20% of AD and 17.6% of SA patients discontinued dupilumab treatment due to ocular AEs, while only 65% of these AD and none of these SA patients were referred to an ophthalmologist. Conclusion: The higher incidence of DAOSD in AD patients compared with SA patients in this real‐world study highlights the importance of physician awareness, especially when prescribing dupilumab to AD patients. Conversely, the findings of this study help alleviate potential concerns about ocular AEs in patients with SA who do not have comorbid AD. Furthermore, the effective management of most ocular AEs with ophthalmic treatments suggests favorable tolerability of dupilumab in daily practice, and multidisciplinary collaboration is essential to proactively manage ocular AEs before discontinuing dupilumab. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of canine adverse food reactions (AFRs) is based on vague criteria, such as '>50% improvement' during elimination diet trial (EDT) followed by 'deterioration' during provocation test (PT). Objective: The objective of the study was to use predefined criteria to evaluate response during EDT [i.e., Owner Global Assessment of Treatment Efficacy (OGATE) = good‐to‐excellent] and relapse during PT [i.e., Owner Global Assessment of Challenge Deterioration (OGACD) = moderate‐to‐severe and/or >100% increase of lesional (Canine Atopic Dermatitis Extent and Severity Index, 4th iteration, CADESI‐04) and/or of pruritus (pruritus Visual Analog Scale, PVAS) scores]. Animals: Twenty‐nine dogs with atopic dermatitis. Materials and Methods: An extensively hydrolysed diet was fed to all dogs followed, in seven of 11 nonresponders, by a second home‐made novel‐protein EDT. Dogs responding to either EDT were challenged with their previous diet. Results: Thirteen (44.8%) dogs were diagnosed with AFRs: at the end of EDT, their OGATE was good (9 of 13; 69.2%) or excellent (four of 13; 30.8%), and both CADESI‐04 (46.7%) and PVAS (71.1%) had decreased significantly; at the end of PT, OGACD was moderate or severe in 12 of 13 (92.3%) dogs, and both CADESI‐04 (127.9%) and PVAS (181.8%) had increased significantly. Of the 16 dogs without AFRs, 6 (37.5%) responded to the commercial (n = 5) or home‐made (n = 1) diet [OGATE = good (three of six) or excellent (three of six)], with significant concurrent reduction of CADESI‐04 and nonsignificant reduction of PVAS, yet they did not relapse during PT. Conclusions and Clinical Relevance: The proposed (predefined) criteria for the evaluation of response during EDT and deterioration during PT seem reliable and are easily applicable in clinical practice and research. [ABSTRACT FROM AUTHOR]

Background: Fine bubble (FB) bathing has shown benefits on a mouse model of atopic dermatitis (AD). However, its efficacy in dogs with AD remains to be evaluated. Objective: This study aimed to assess the clinical effectiveness of FB bathing in dogs with AD. Animals: Seventeen dogs with AD whose clinical presentation showed a Canine Atopic Dermatitis Extent and Severity Index, 4th iteration (CADESI‐04) score of <40. Materials and Methods: The dogs were randomly assigned to either the FB bathing group or the shampoo group. The treatments were administered once a week as per the instructions, in a trial totalling 4 weeks. Evaluations were conducted on Day (D)0 and D28 to assess the outcomes of the trial. The severity of AD was measured using the CADESI‐04 and the pruritus Visual Analog Scale (PVAS). The skin barrier function parameters, transepidermal water loss (TEWL) and stratum corneum hydration were measured before and after the treatment. Results: Both treatment groups demonstrated a decreasing trend in CADESI‐04 scores, yet the FB group exhibited significant improvement in comparison to the shampoo group after 1 month of trial. There were no significant changes in PVAS scores in either group. No significant difference was found in skin barrier function parameters between the two treatments, although TEWL slightly decreased in the FB group and slightly increased in the shampoo group after treatment. Conclusions and Clinical Relevance: These results suggested that FB treatment provides benefits for dogs with AD and offers an alternative topical treatment option with a lesser impact on skin barrier function compared to frequent shampooing. [ABSTRACT FROM AUTHOR]

Background: Supplementation of polyunsaturated fatty acids (PUFA) enables dose reduction of prednisolone and ciclosporin in canine atopic dermatitis (cAD). Objective: To determine if oral administration of PUFA reduces the dose of oclacitinib in cAD. Animals: Twenty‐two client‐owned dogs with cAD receiving oclacitinib. Materials and Methods: Dogs received a fish oil product (PUFA) or paraffin oil (placebo) for 16 weeks. Owners adjusted the oclacitinib dose according to daily pruritus assessments. On Day (D)0, D56 and D112, Canine Atopic Dermatitis Extent and Severity Index, fourth iteration (CADESI‐04), pruritus Visual Analog Scale (PVAS), quality‐of‐life score (QoL), Global Assessment (GA), quality‐of‐coat (QoC) and adverse events were recorded. Results: Mean daily oclacitinib dose was significantly reduced in the PUFA group from 0.51 ± 0.20 mg/kg/24 h (D0) to 0.19 ± 0.14 mg/kg/24 h (D85–112; p < 0.00001) and not in the placebo group (D0: 0.70 ± 0.33 mg/kg/24 h; D85–112: 0.53 ± 0.35 mg/kg/24 h, p = 0.5422). CADESI‐04 did not change over time or differ between groups. PVAS was significantly lower in the PUFA group (2.8 ± 1.5) compared to placebo (4.2 ± 1.6) at D112 (p = 0.0375). QoL and QoC improved only in the PUFA group (QoL: D0: 20 ± 7, D112: 12 ± 5, p = 0.0057; QoC: D0: 0 ± 0.5, D112: 1 ± 0.5, p = 0.0410). GA on D112 was higher in the PUFA group (p = 0.008). No adverse events were observed. Conclusion: Oral supplementation of PUFA allowed dose reduction of oclacitinib and improved PVAS, QoL, QoC and GA. The use of PUFA is recommended and was safe in the atopic study dogs receiving oclacitinib. [ABSTRACT FROM AUTHOR]

Objective: Atopic dermatitis (AD) is characterized by compositional and structural changes to the skin at lesional sites. Alteration to the levels and organization of both protein and lipid components are associated with disease status and lead to impaired barrier and hydration. Corneodesmosin (CDSN) and the arrangement and length of the intercellular lipid lamellae (ICLL) are altered in disrupted skin states. The aim of this research was to profile the distribution of CDSN and the ICLL in the stratum corneum (SC) at lesional and non‐lesional sites in AD‐prone skin and to investigate the impact of an eczema calming lotion containing petroleum jelly, fatty acids, and colloidal oatmeal. Methods: An IRB‐approved study was conducted with participants with active AD. From a small subset of participants, tape strips were collected from lesional and non‐lesional sites on the arm, prior to and after twice daily application, over 4 weeks of an eczema calming lotion containing petroleum jelly, fatty acids, and colloidal oatmeal. Fluorescent antibody staining was used to investigate the distribution of CDSN. Transmission electron microscopy (TEM) was used to characterize the ICLL. Results: The distribution/coverage of CDSN was similar between lesional and non‐lesional sites at baseline; application of the lotion resulted in a more defined honeycomb/peripheral distribution. Normalized ICLL (nICLL) was lower in baseline samples from lesional sites relative to non‐lesional sites. Application of the lotion increased this parameter by the end of the study at all sites. Conclusion: The eczema calming lotion containing petroleum jelly, fatty acids and colloidal oatmeal provided changes in corneodesmosomal proteins distribution and ICLL, consistent with improvements in corneocyte maturation and improved barrier function in the skin of individuals with atopic dermatitis. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease resulting in decreased quality of life. Histamine and specifically the H4 receptor play a key role in the inflammatory process in AD and serve as targets for novel therapeutic approaches. Objective: In the present study we aimed to elucidate the immunopathological mechanisms with which the H4 receptor impacts TH2 cells and contributes to AD pathophysiology. Methods: Total CD4+ T cells obtained from healthy or AD individuals and in vitro differentiated TH2 cells were cultured under different conditions and the mRNA expression or protein production of target molecules were determined using quantitative real‐time PCR and ELISA. Results: H4 receptor mRNA expression was upregulated concentration dependent upon IL‐4 stimulation in in vitro differentiated TH2 cells progressively during the differentiation. Transcriptomic analysis of in vitro differentiated TH2 versus TH1 cells revealed that the H4 receptor among other genes represents one of the highly upregulated genes in TH2 cells. Most importantly, increased amounts of IL‐5 and IL‐13 mRNA expression were detected in in vitro differentiated TH2 cells as well as protein secretion in the presence of histamine or of the H4 receptor‐selective‐agonist when compared to the untreated control. Conclusion: We show for the first time an H4 receptor dependent upregulation of the pro‐inflammatory cytokines IL‐5 and IL‐13 in human TH2 cells by histamine. This suggests that the blockade of the H4 receptor may lead to downregulation of these cytokines and amelioration of AD symptoms as reported in first clinical studies. [ABSTRACT FROM AUTHOR]

This article discusses the use of dupilumab, a biologic medication, for the treatment of atopic dermatitis (AD) in pediatric and young adult patients with inborn errors of immunity (IEIs). The medication has been approved for use in children with moderate to severe AD who have inadequate control with topical therapies. The article presents case studies of patients with IEIs and AD who were treated with dupilumab, showing significant clinical improvement as early as week 4 of treatment. However, further studies are needed to evaluate the long-term safety and efficacy of dupilumab in this patient population. [Extracted from the article]

Background: The complexity, high prevalence, and substantial personal and socioeconomic burden collectively render atopic dermatitis (AD) a major public health concern. Using crowdsourced Internet data has the potential to provide unique insights into this concern, as demonstrated by several previous studies. However, a comprehensive comparison across European countries remains lacking. Objectives: The study aimed to investigate AD‐related web searches across Europe to assess spatiotemporal variations and associations between disease‐related and external factors. Methods: AD‐related web search data were extracted for 21 European countries between February 2019 and January 2023. Descriptive analysis and autocorrelation functions were performed to examine spatiotemporal patterns. Correlations (r) were used to evaluate the associations between web searches and disease‐related, socioeconomic and meteorological data. Results: Over 241 million AD‐related web searches were identified, with search volume varying substantially among European countries (p < 0.001) and correlating with AD prevalence and disease burden (both r = 0.51, p = 0.019). Search volume increased between 2019 and 2023 in all countries and seasonally peaked in January and March. Negative correlations with median population age (r = −0.46, p = 0.039), number of general practitioners (r = −0.29, p = 0.226) and specialists (r = −0.27, p = 0.270) were observed. Moderate to strong correlations were found between search volume and cold, humid and windy weather with fewer sunshine hours, while higher online interest typically occurred 1–3 months after such weather conditions. Conclusion: The study highlights the great potential of online crowdsourced data analysis, for example, to investigate the impact of climate change or to identify unmet needs at a population level. Furthermore, the growing online interest in AD and the corresponding seasonal peaks emphasize the necessity of adapting treatment plans, intensifying public health campaigns, and disseminating reliable online information by governments and healthcare providers, especially during these periods. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusions Despite the widespread off‐label use of methotrexate (MTX) for the treatment of atopic dermatitis (AD), there is limited high‐quality evidence on dosing regimens and existing guidelines do not provide clear recommendations regarding dosing strategies.The aim of this study was to achieve international consensus among AD experts to standardize the dosing regimen for MTX treatment in adults and children with AD.An electronic Delphi (eDelphi) study was conducted from October 2021 to September 2022. Recruitment was conducted through dermatology societies and AD interest groups. Participation was open to dermatologists and dermatology residents experienced in treating AD patients with MTX. The study consisted of three online rounds. The first round was informed by a systematic review of relevant literature, and subsequent rounds were adjusted based on the results of the previous round. Participants voted on 19 proposals using a 9‐point scale (1–3 disagree, 4–6 neither agree nor disagree, 7–9 agree). Consensus was achieved when at least 70% of participants agreed, and less than 15% disagreed. Proposals that did not reach consensus in the first three rounds were discussed in a consensus meeting, where consensus was defined as less than 30% disagreement.In total, 152 participants completed Round 1, 104 (68%) completed all survey rounds, and 43 (28%) joined the consensus meeting. Consensus was achieved on 7 proposals in Round 1, 4 in Round 2 and 6 in Round 3. The final 2 proposals reached consensus during the consensus meeting. Consensus topics include test dose, start dose, maximum dose, administration route, dosing schedule, management of stopping treatment, treatment duration and folic acid supplementation.This eDelphi study achieved consensus on 19 proposals related to MTX dosing for adults and children with AD. These results aim to guide prescribing decisions and encourage a standardized global approach to MTX use in AD. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusion Atopic dermatitis (AD), which can significantly impact quality of life, is a complex, heterogeneous skin disease affecting all ages and therefore can lead to very different patient journeys. Understanding the patient journey within the healthcare system is essential for improving care outcomes.To explore the patient journey of individuals with AD in Germany, with a specific focus on the utilization of Internet resources throughout this process.A cross‐sectional study using a self‐administered questionnaire was conducted from June 2021 to February 2022. Participants were recruited from dermatology private practices, a university hospital and online platforms.The study included 276 participants (62.3% female; mean age: 46.3 ± 18.4 years; mean disease duration: 26.9 ± 17.5 years; mean DLQ Index: 10.0 ± 5.6). Around 191 participants were currently receiving medical treatment, with 9.1% receiving biologic therapy. Most of the people initially contacted a GP (42.4%) and were diagnosed by a dermatologist first (57.6%). Around 47.1% were currently in treatment by a dermatologist, seeking dermatological care on average 4.5 times a year. Almost all individuals (86.2%) have already consulted more than one physician during their patient journey. Overall, participants consulted a median of five physicians, while those with severe AD consulted a median of six physicians. Initial symptoms to diagnosis and between consulting two different physicians both had a median duration of 6 months. Dissatisfaction with treatment outcomes emerged as a common reason for changing physicians. Approximately 76.4% of participants used the Internet for disease‐related information, primarily relying on Google. Overall, 63% found the information quality unsatisfactory.The study underlines the widespread utilization of medical treatment and the proactive healthcare‐seeking behaviour during a long patient journey. Dissatisfaction with treatment outcomes, alternative medicine and the quality of the Internet sources emphasize the potential for improving the comprehensive disease management to improve care outcomes. [ABSTRACT FROM AUTHOR]

This article discusses the impact of environmental exposures on chronic inflammatory dermatoses, such as contact dermatitis and eczema. These conditions are aggravated by factors such as allergens, irritants, pollutants, and climatic conditions. The article examines preventive and therapeutic strategies, evaluates epidemiological data and prevalence, and emphasizes the need for improved patient care and reduction of the overall burden of these dermatoses. The strategies include allergen identification and avoidance, use of protective gear, reduction of indoor and outdoor pollutants, adaptation of skincare routines based on climate, and the use of pharmacological and non-pharmacological approaches for treatment. The article also highlights the challenges of healthcare access and affordability, and the need for further research to understand the underlying molecular mechanisms. [Extracted from the article]

Objective: To investigate the causal relationship between inflammatory skin diseases (atopic dermatitis, and psoriasis) and IgA nephropathy using Mendelian randomization and enrichment analysis. Methods: The instrumental variables (IVs) in the European Bioinformatics Institute (EBI) database were used for two‐sample MR analysis. The results of inverse variance weighting (IVW) were used as the main method, the MR−Egger method was used for pleiotropy analysis and the leave‐one‐out method was used for sensitivity analysis to verify the reliability of the data. Combined with the human genome database GeneCards database and Metascape enrichment analysis. Results: People with AD had an increased risk of IgA nephropathy (IVW: OR = 1.06, 95% CI [1.0002–1.1248], p = 0.0491). Psoriasis and IgA nephropathy (IVW: OR = 0.97, 95% CI [0.9394–1.0055], p = 0.1002) no statistical significance, therefore cannot prove cause‐and‐effect relationship between. Conclusions: This study provides evidence that atopic dermatitis is associated with an increased risk of IgA nephropathy, but does not provide evidence that psoriasis is causologically associated with IgA nephropathy. Enrichment analysis suggested a causal relationship between inflammatory skin diseases and IgA nephropathy at the genetic level. [ABSTRACT FROM AUTHOR]

Objective: Oxidative stress is strongly associated with atopic dermatitis (AD), and increased antioxidant intake could potentially reduce the risk of or alleviate its symptoms. However, the argument is disputed. Therefore, we conducted a Mendelian randomization (MR) analysis to explore the causal relationship between dietary antioxidant vitamin intake and AD. Methods: We applied MR analysis to examine the causative association between dietary antioxidant vitamin intake (vitamin C, vitamin E, carotene, and retinol) and AD. The genome‐wide association study (GWAS) summary data for antioxidant vitamins intake and AD were obtained from the IEU OpenGWAS database and the UK biobank. Our study consisted of two major parts, MR analysis to detect the causal relationship between exposure and outcome, and sensitivity analysis as supplemental evidence to verify the robustness of the results. Result: The results revealed a suggestive causal relationship between vitamin E intake and AD (p = 0.038, OR 95% CI = 0.745–0.992). However, there was no causal relationship between the other three vitamins (vitamin C, carotene, and retinol) and AD (p = 0.507, OR 95% CI = 0.826–1.099) (p = 0.890, OR 95% CI = 0.864–1.184) (p = 0.492, OR 95% CI = 0.893–1.264). None of the single nucleotide polymorphisms (SNPs) were detected as heterogeneous and pleiotropy in the sensitivity analysis (p > 0.05). Conclusion: The analysis suggested that dietary intake of vitamin E may potentially lower the risk of AD. Conversely, intake of vitamin C, retinol, and carotene is not causally related to AD. Although vitamin E intake could be protective against AD, intake of dietary antioxidant vitamins to prevent or treat AD is not necessary. [ABSTRACT FROM AUTHOR]

Background: Recent studies increasingly suggest that microbial infections and the immune responses they elicit play significant roles in the pathogenesis of chronic inflammatory skin diseases. This study uses Mendelian randomization (MR) and Bayesian weighted Mendelian randomization (BWMR) to explore the causal relationships between immune antibody responses and four common skin diseases: psoriasis, atopic dermatitis (AD), rosacea, and vitiligo. Methods: We utilized summary statistics from genome‐wide association studies (GWAS) for antibody responses to 13 infectious pathogens and four skin diseases. Single nucleotide polymorphisms (SNPs) were selected as instrumental variables (IVs) to assess causal relationships using multiple MR methods, including inverse variance weighted (IVW), MR Egger, and weighted median. BWMR was also employed to confirm findings and address potential pleiotropy. Results: The IVW analysis identified significant associations between specific antibody responses and the skin diseases studied. Key findings include protective associations of anti‐Epstein–Barr virus (EBV) IgG seropositivity and Helicobacter pylori UREA antibody levels with psoriasis and AD. anti‐chlamydia trachomatis IgG seropositivity, anti‐polyomavirus 2 IgG seropositivity, and varicella zoster virus glycoprotein E and I antibody levels were negatively associated with rosacea, while EBV Elevated levels of the early antigen (EA‐D) antibody levels and HHV‐6 IE1B antibody levels were positively associated with rosacea. H. pylori Catalase antibody levels were protectively associated with vitiligo, whereas anti‐herpes simplex virus 2 (HSV‐2) IgG seropositivity was positively associated with vitiligo. The BWMR analysis confirmed these associations. Conclusion: This study underscores the significant role of H. pylori and other pathogens in these skin diseases, suggesting both protective and exacerbating effects depending on the specific condition. Understanding these pathogen‐immune interactions can lead to the development of more effective, personalized treatments and preventative strategies, ultimately improving patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is a refractory disease that occurs in clinical practice. One of the most common inflammatory skin diseases, its occurrence and development are related to inflammation. Nevertheless, the precise nature of the relationship between circulating inflammatory proteins and AD remains uncertain. Methods: A two‐sample MR analysis was performed to determine the causal relationship between the expression of 91 circulating inflammatory proteins and AD by using genome‐wide association study (GWAS) summary statistics data from the FinnGen consortia. The robustness of the MR results was assessed by means of sensitivity analysis. Results: The causal relationship between the expression of nine specific circulating inflammatory proteins and AD was corroborated by the inverse variance weighted (IVW) method. The findings indicated that three circulating inflammatory proteins, namely, interleukin‐18 receptor 1 [OR (CI) = 1.08 (1.05–1.11); p = 0.000001)], interleukin‐8 [OR (CI) = 1.07 (1.00–1.14); p = 0.036244)], and tumor necrosis factor ligand superfamily member 14 [OR (CI) = 1.05 (1.00–1.10); p = 0.036842)], were positively correlated with AD. Additionally, six circulating inflammatory proteins were negatively correlated with AD: the T‐cell surface glycoprotein CD5 [OR (CI) = 0.89 (0.84–0.95); p = 0.000191)], macrophage colony‐stimulating factor 1 [OR (CI) = 0.93 (0.88–0.99); p = 0.031422)], fractalkine [OR (CI) = 0.91 (0.85–0.97); p = 0.003067)], interleukin‐24 [OR (CI) = 0.91 (0.83–0.99); p = 0.031673)], signaling lymphocytic activation molecule [OR(CI) = 0.94 (0.89–1.00); p = 0.039818)], and urokinase‐type plasminogen activator [OR(CI) = 0.95 (0.90–1.00); p = 0.037037)]. Conclusion: This study confirms the potential causal relationship between circulating inflammatory proteins and AD and provides guidance for the clinical diagnosis and treatment of AD. [ABSTRACT FROM AUTHOR]

Background: While treatment is a definitive therapeutic component in the management of inflammatory skin conditions, adjunctive skin care comprising of appropriate cleansing, moisturization, and photoprotection are just as important. Cleansing, treatment, moisturization, and photoprotection (CTMP) constitute the four major components of holistic skincare routine for dermatological conditions. However, inadequate patient understanding of the condition, limited resources for physicians, and insufficient time for patient education during busy dermatological consultations are the main obstacles to establishing a holistic skincare routine in the real world. Aims: This study aimed to identify key challenges in the implementation of a holistic skincare routine, and offer practical guidance to physicians to improve adoption in the management of acne, atopic dermatitis, rosacea, and sensitive skin syndrome. Methods: An expert panel comprising of nine dermatologists from Australia, China, Hong Kong, Taiwan, India, Philippines, Singapore, South Korea, and Thailand convened to develop consensus statements to stimulate real‐world adoption of holistic skincare routine in acne, rosacea, atopic dermatitis, and sensitive skin syndrome using the Delphi approach. Results: Consensus was defined as ≥80% of panel rating statement as ≥8 or median rating of ≥8. The final statements were collated to develop consensus recommendations to encourage adoption of holistic skincare routine. Conclusion: Promoting patient education on the skin condition, training support staff in patient counseling, and offering physician training opportunities are the key strategies to encourage real‐world adoption of CTMP as a holistic skincare routine. The consensus recommendations presented here should be considered in all dermatology patients to accomplish the ultimate goals of improved treatment outcomes and patient satisfaction. [ABSTRACT FROM AUTHOR]

Allergic disease prevalence has increased globally with the subset of type 2 inflammatory diseases playing a substantial role. Type 2 inflammatory diseases may differ in clinical presentation, but they exhibit shared pathophysiology that is targeted by the unique pharmacology of dupilumab. Dupilumab binds to the interleukin (IL)‐4 receptor alpha subunit (IL‐4Rα) that blocks IL‐4 and IL‐13 signaling, two key drivers of type 2 inflammation. Herein, we review the mechanism of action and pharmacology of dupilumab, and the clinical evidence that led to the regulatory approvals of dupilumab for the treatment of numerous type 2 inflammatory diseases: atopic dermatitis, asthma, chronic rhinosinusitis with nasal polyposis, eosinophilic esophagitis, and prurigo nodularis. [ABSTRACT FROM AUTHOR]

Interleukin‐33 (IL‐33) is a proinflammatory alarmin cytokine released by damaged epithelial tissue cells that initiates and amplifies both type 1 and type 2 inflammatory cascades. A role for IL‐33 in atopic dermatitis (AD; a chronic, relapsing type 2 inflammatory disease of the skin) has been proposed. Itepekimab is a novel human IgG4P monoclonal antibody against IL‐33, currently in clinical development for chronic obstructive pulmonary disease (COPD). Two global phase II studies—a dose‐ranging itepekimab monotherapy study (NCT03738423) and a proof‐of‐concept study of itepekimab alone and in combination with dupilumab (NCT03736967)—were conducted in patients with moderate‐to‐severe AD to assess safety, tolerability, pharmacokinetics, pharmacodynamics, and efficacy; both studies were terminated following an interim analysis of the proof‐of‐concept study, which failed to demonstrate the efficacy of itepekimab. In these two studies, itepekimab exhibited linear and dose‐proportional pharmacokinetics. Pharmacodynamics of total IL‐33 indicated that itepekimab saturated binding to the target in serum at 300 mg q2w and q4w doses, and decreased blood eosinophil counts. Concentration–time profiles of itepekimab and total IL‐33 were similar for itepekimab with or without dupilumab, and between East Asian and non‐East Asian subgroups. Itepekimab was generally well tolerated, both alone and in combination with dupilumab. The lack of clinical efficacy for itepekimab observed in these studies suggests that IL‐33 may not be a key pathogenic driver in moderate‐to‐severe AD. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusion Atopic dermatitis (AD) is mainly driven by type 2 inflammation and often treated with topical agents. Studies comparing differences in biomarkers between these treatments are lacking.The aim of this study was to evaluate the effects of topical betamethasone 17‐valerate 0.1% and tacrolimus 0.1% ointment on skin barrier function and inflammatory biomarkers in skin and blood in adults with AD.In this randomized parallel‐group double‐blind double‐dummy active‐comparator study design, 36 adults with AD were treated with either whole‐body topical corticosteroid (betamethasone ointment 0.1% plus placebo once daily, n = 18) or calcineurin inhibitor (tacrolimus ointment 0.1% twice daily, n = 18). At baseline, after 2 weeks of daily treatment and after further 4 weeks of twice‐weekly maintenance treatment, we evaluated AD severity, levels of natural moisturizing factor (NMF) and cytokines in the skin and blood and characterized circulating T cells.Mean AD severity at baseline corresponded to moderate disease and decreased significantly in both groups. Levels of NMF increased significantly in the tacrolimus group after 2 weeks of treatment (p = 0.002) and tended to increase more than betamethasone at week 6 (p = 0.06). Most skin cytokines decreased with both treatments. However, IL‐8, IL‐18, IL‐22, IP‐10, MDC, MMP‐9 and TARC were significantly more decreased with betamethasone than tacrolimus after 2 weeks, while after 6 weeks this was only the case for IL‐8 and MMP‐9. Approximate half of the systemic cytokines decreased significantly with both treatments, but betamethasone decreased MDC significantly more after 2 weeks of treatment. T‐cell characterization analyses indicated slight differences in the expression and activation of T cells between groups.Topical treatment of AD with betamethasone and tacrolimus ointment effectively reduced disease severity, cutaneous and systemic inflammatory markers. Betamethasone was more effective in decreasing inflammation, but tacrolimus improved skin hydration (NMF levels) more than betamethasone. [ABSTRACT FROM AUTHOR]

Introduction Materials and methods Results Conclusions Atopic dermatitis (AD) is a chronic inflammatory dermatosis that affects all age groups. The impact of AD on patients' lives could differ across generations. Understanding the differences in objective and subjective severity of AD between generations may support more personalized care for the AD patients. Thus, this study aimed to compare the clinical severity and subjective impact of AD between generation Z (GZ) and the millennial generation (MG).We carried out a cross‐sectional observational study in patients diagnosed with moderate to severe AD born between 1993–2001 (GZ) and 1978–1992 (MG) who attended an AD specialist care unit for the first time. We collected severity indices evaluated by the dermatologist, such as the Eczema Area and Severity Index (EASI) or the Investigator Global Assessment (IGA), and severity scales that included patient assessment, such as the SCORing Atopic Dermatitis (SCORAD) or the Patient‐Oriented Eczema Measure (POEM).A total of 73 patients were included, of which 56.2% (41/73) were women. 52.86% (37/73) of the patients belonged to the MG, and 43.8% (33/73) belonged to GZ. Patients belonging to GZ presented lower severity of their AD compared to the MG (EASI: 9.75 ± 11.68 vs. 16.63 ± 14.66; P < 0.05). However, their perception of disease severity was similar to the MG (SCORAD: 43.54 ± 28.99 vs. 32.98 ± 21.91; P = 0.96; POEM: 13.21 ± 8.98 vs. 15.48 ± 6.69; P = 0.14).GZ presents a higher subjective perception of severity than millennials. Understanding these generational disparities contributes to creating more effective treatment strategies and provides a more targeted approach to care that addresses each generational group's unique needs and expectations. [ABSTRACT FROM AUTHOR]

Background/Objectives Methods Results Conclusion Atopic dermatitis (AD) is a common chronic skin disease in the pediatric population; however, rates of admissions for flares in patients established with dermatology compared to those that are not established have not been fully assessed in prior studies.We reviewed electronic medical records of patients hospitalized (billing codes 99221–99223, 99217) with diagnoses encompassing AD, eczema, and dermatitis (ICD‐10 codes L20.8‐L20.9, L30.8‐L30.9) between January 1, 2011, and December 31, 2021, at University Hospitals (UH) in Cleveland, Ohio. Patients were considered established with dermatology if they had been seen by a dermatology provider within 6 months prior to admission. Statistical analysis was performed using chi‐square goodness of fit.A total of 95 patient encounters met criteria for inclusion. Fifteen (15.8%) patients were established with dermatology at the time of admission and 80 (84.2%) were not. The chi‐square value (x2 = 44.74) was greater than the critical value of 10.828 at one degree of freedom (p < .001). There were 8 patients who had more than one admission for atopic dermatitis flares; 2 of these patients were established with dermatology prior to their first admission, and 4 were established at the time of the second admission.The majority of patients admitted with AD flare were not established with dermatology. Many of these patients lived in a low socioeconomic area and missed follow‐up appointments. Increasing access to dermatologic care for patients with atopic dermatitis, especially in lower‐income areas, could aid in decreasing atopic dermatitis‐related hospitalizations. [ABSTRACT FROM AUTHOR]