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Background: Washing with water is not inferior to washing with soaps and detergents in children with atopic dermatitis (AD) in remission during the fall-winter seasons. We investigated whether this finding varies during summer based on the type of cleanser (soaps and detergents). Methods: This evaluator-blinded, pragmatic, randomized, and non-inferiority study enrolled patients with AD whose eczema was controlled following regular steroid ointment application 2 days/week. For 8 ± 4 weeks, participants washed their upper and lower limbs with a cleanser on one side and with water alone on the other. Each participant chose either a weakly alkaline soap or an acidic detergent. The primary outcome was the Eczema Area and Severity Index (EASI) score at week 8 ± 4. Results: The data of 43 of the 47 registered participants were analyzed. The median patient age was 44 (23–99) months; 28 and 15 participants chose weakly alkaline and acidic cleansers, respectively. At week 8 ± 4, EASI scores of the water and cleanser sides were 0.00 (0.00–0.40) and 0.15 (0.00–0.40), respectively (p = 0.74). The difference between both sides was 0.00 (−0.07 to 0.14); the limits of the 95 % confidence interval did not reach the pre-specified non-inferiority margin. No difference was observed in the median Patient-Oriented Eczema Measure score, number of additional steroid ointment applications, and occurrences of skin infections. There were no differences between the cleanser types in any of the results. Conclusions: We demonstrated that washing with water was not inferior to that with a cleanser in patients with AD in the maintenance phase during summer, regardless of the type of cleanser.

Background: Pediatric patients with moderate-to-severe atopic dermatitis (AD) often experience a high disease burden and have a high risk of persistent disease. Standard-of-care immunosuppressive systemic treatments have been used off-label for AD in pediatric patients despite concerns for suboptimal safety with continuous use and risk of relapse upon discontinuation. The biologic agent dupilumab is the first systemic treatment approved for moderate-to-severe AD in children as young as 6 months. Long-term safety and efficacy data in this patient population are needed to inform continuous AD management. Objectives: The purpose of this work was to determine the long-term safety and efficacy of dupilumab treatment up to 1 year in an open-label extension (OLE) study [LIBERTY AD PED-OLE (NCT02612454)] in children aged 6 months to 5 years with moderate-to-severe AD who previously participated in the 16-week, double-blind, phase 3 LIBERTY AD PRESCHOOL trial (NCT03346434 part B; parent study) and were subsequently enrolled in PED-OLE. Methods: In PED-OLE, patients received dupilumab every 4 weeks according to a weight-tiered regimen (body weight ≥ 5 kg to < 15 kg: 200 mg; ≥ 15 kg to < 30 kg: 300 mg). Results: Data for 142 patients were analyzed, 60 of whom had completed the 52-week visit at time of database lock. Mean age at baseline was 4.1 y [SD, 1.13; range, 1.0–5.9 years]. A majority (78.2%) of patients reported ≥ 1 treatment-emergent adverse event (TEAE), most of which were mild or moderate and transient. The most frequently reported TEAEs were nasopharyngitis (19.7%), cough (15.5%), and pyrexia (14.1%). One TEAE led to treatment discontinuation (severe urticaria, which resolved in 1 day). By week 52, 36.2% of patients had achieved an Investigator's Global Assessment score of 0/1 (clear/almost clear skin), and 96.6%, 79.3%, and 58.6% had at least 50%, 75%, or 90% improvement, respectively, in Eczema Area and Severity Index scores. Conclusions: Consistent with results seen in adults, adolescents, and older children (aged 6–11 years), treatment with dupilumab for up to 1 year in children aged 6 months to 5 years with inadequately controlled moderate-to-severe AD demonstrated an acceptable long-term safety profile and sustained efficacy. These results support the long-term continuous use of dupilumab in this patient population. Trial Registration: ClinicalTrials.gov Identifiers: NCT02612454 and NCT03346434 (part B). Plain Language Summary: Atopic dermatitis (AD) is a chronic inflammatory skin disease that often results in a high disease burden in young children and their families. Patients often need long-term treatment to control their disease symptoms, including itch and rash. Dupilumab treatment for 16 weeks has shown benefits in children aged 6 months to 5 years with moderate-to-severe AD, with an acceptable safety profile. As AD is likely to continue from childhood into adolescence and adulthood, there is a need for data supporting long-term use of dupilumab in young children. In this study, children who completed the 16-week study continued dupilumab treatment for up to 1 year, receiving 200 mg or 300 mg of dupilumab (depending on the child's bodyweight) every 4 weeks. Through the year of treatment, 78.2% of patients reported at least one side effect, most of which were mild or moderate. Only one patient interrupted treatment because of severe skin rash (hives), which was resolved in 1 day. At the end of the year, 36.2% of patients had clear or almost clear skin, and almost all (96.6%) achieved at least 50% improvement in their extent and severity of disease. Additionally, 79.3%, and 58.6% had at least 75% or 90% improvement in their extent and severity of disease. In summary, consistent with results seen in adults, adolescents, and older children, this study showed that 1-year dupilumab treatment provides continued benefits with an acceptable safety profile. These results support long-term continuous use of dupilumab in children aged 6 months to 5 years with moderate-to-severe AD. 5SqqskjZPmoHiNU8WnfbXp What is the long-term safety and efficacy profile in young children with moderate-to-severeatopic dermatitis treated with dupilumab? [ABSTRACT FROM AUTHOR]

Washing with water is not inferior to washing with soaps and detergents in children with atopic dermatitis (AD) in remission during the fall-winter seasons. We investigated whether this finding varies during summer based on the type of cleanser (soaps and detergents). This evaluator-blinded, pragmatic, randomized, and non-inferiority study enrolled patients with AD whose eczema was controlled following regular steroid ointment application 2 days/week. For 8 ± 4 weeks, participants washed their upper and lower limbs with a cleanser on one side and with water alone on the other. Each participant chose either a weakly alkaline soap or an acidic detergent. The primary outcome was the Eczema Area and Severity Index (EASI) score at week 8 ± 4. The data of 43 of the 47 registered participants were analyzed. The median patient age was 44 (23–99) months; 28 and 15 participants chose weakly alkaline and acidic cleansers, respectively. At week 8 ± 4, EASI scores of the water and cleanser sides were 0.00 (0.00–0.40) and 0.15 (0.00–0.40), respectively (p = 0.74). The difference between both sides was 0.00 (−0.07 to 0.14); the limits of the 95 % confidence interval did not reach the pre-specified non-inferiority margin. No difference was observed in the median Patient-Oriented Eczema Measure score, number of additional steroid ointment applications, and occurrences of skin infections. There were no differences between the cleanser types in any of the results. We demonstrated that washing with water was not inferior to that with a cleanser in patients with AD in the maintenance phase during summer, regardless of the type of cleanser. [ABSTRACT FROM AUTHOR]

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From dry skin in the newborn to atopic eczema in the infant and child, health professionals in primary care play a crucial role in supporting families in the care of skin, and the treatment and management of skin conditions in children. The evidence base can be conflicting and guidance changes frequently. With so much information to share with new parents, baby skincare is often seen as a lower priority when imparting health promotion advice than other areas such as safe sleep or infant feeding. It has been argued that, with the rising prevalence of atopic eczema in the UK population, advice to parents about what to be concerned about and when to seek medical advice is imperative. This article explores the evidence on general skincare from the newborn period to the treatment and management of common skin conditions, including atopic eczema and seborrheic dermatitis. [ABSTRACT FROM AUTHOR]

Emollients are used as soap substitutes, bath additives, and leave-on treatments for dry skin conditions like eczema. However, there are many different types of emollients available. This article reviews what guidelines and formularies advise and what the research evidence is regarding their effectiveness and acceptability. It also summarises the findings from the recently published Best Emollients for Eczema (BEE) study, which was the first head-to-head comparison of commonly used lotions, creams, gels and ointments for childhood eczema in the world, and which recommends a decision aid to help parents and older children find a product that suits them. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis, a chronic inflammatory skin disease can significantly reduce patients' quality of life. It is commonly observed in infants or young children but can also occur in adults. Patients with atopic dermatitis are at risk of developing food allergies, allergic rhinitis, and asthma. Current Concepts: Treatment of atopic dermatitis should commence with moisturization of epidermal skin and avoidance of environmental factors that may trigger exacerbation of atopic dermatitis. Topical corticosteroid application remains the gold standard for medical management of atopic dermatitis; however, topical corticosteroids are often avoided owing to concerns regarding the adverse effects of these drugs. Recently, several systemic immunosuppressants and biological agents have been introduced for the treatment of atopic dermatitis. These medications are associated with fewer adverse effects than those observed with previous treatments and have therefore shown positive results for successful management of atopic dermatitis. Discussion and Conclusion: It is expected that new drugs tailored to the disease level of each patient will revolutionize the treatment of atopic dermatitis more effectively in future. [ABSTRACT FROM AUTHOR]

Background: During the first wave of the COVID‐19 pandemic of Spring 2020, Denmark was one of the first countries to introduce lockdown measures, including closing of all daycare centers. Following the reopening of daycare centers, Danish Health Authorities implemented a mandatory intensive hand hygiene regimen. Objectives: To examine the occurrence and point prevalence of hand eczema as a consequence of more intensive hand hygiene among Danish children attending daycare. Methods: The heads of 1667 daycare centers in Denmark were contacted and asked to forward a link to a questionnaire to parents of the children attending the daycare center. Results: Among 6858 children, 12.1% had hand eczema before reopening of daycare centers, whereas 38.3% reported hand eczema after the children returned to daycare. Of the children who never had hand eczema, 28.6% developed hand eczema after returning to daycare. The risk of hand eczema was significantly associated with atopic dermatitis, female gender, higher age, and frequency of handwashing. Conclusion: Following the implemented hygiene regimen, a high proportion of young children rapidly developed hand eczema. Well‐established prophylactic skin care might have spared a proportion of the children from developing hand eczema. [ABSTRACT FROM AUTHOR]

Keywords: algorithm; atopic dermatitis; children; eczema; therapy EN algorithm atopic dermatitis children eczema therapy 407 410 4 01/09/21 20210101 NES 210101 The diagnostic work-up of atopic dermatitis (AD, atopic eczema) was discussed in part I.1 This part of the medical algorithm focuses on the therapy of AD in early childhood and is based on recent literature and international guidelines.2-4 The management of AD is mainly based on disease severity, which has already been discussed in part I. Basic therapy of the disturbed skin barrier is always necessary, that is, also for children that do not suffer from active lesions. Climate therapy at high altitude is beneficial for atopic dermatitis, probably due to UV exposure, avoidance of allergen exposure, and decreased stress.7 For severe AD, or for cases that do not respond well to topical therapy, wet wrap therapy can be initiated in inpatient or outpatient settings.8 Ultraviolet (UV) therapy is used reluctantly in early childhood due to the cumulative UV dosage, time necessary, and anxiety in the UV cabin. Given the special pace of innovation in AD treatment, the future is bright for young children with severe atopic dermatitis!. [Extracted from the article]

Background: Emollients play a key role in the treatment of eczematous lesions and xerosis such as in atopic dermatitis. However, studies that show the actual benefits of cleansers are few and far between. Aims: This study aims to evaluate the tolerance and efficacy of a high‐emollient liquid cleanser (HELC) designed for very dry and atopic‐prone skin, in the absence of any additional skin care. The product is a soap‐free and fragrance‐free liquid cleanser, containing mild surfactants and a ternary system of selected emollients: glycerin, vaseline, and paraffin. Methods: In‐use study was conducted under dermatological, pediatric, and ophthalmological supervision in 50 subjects (infants, children, and adults) with "dry to very dry and atopic‐prone" skin. The primary objective of this monocentric, open, and intra‐individual study was to assess the dermatological and ophthalmological tolerance of HELC after 21 days of using it at least once a day on the face and body. The secondary objectives were to evaluate its efficacy based on a clinical score (SCORAD), assess its short‐ and long‐term moisturizing effect by measuring hydration rates (Corneometer®), and ascertain its cosmetic acceptability through a subjective evaluation questionnaire. Results: The study validates the good dermatological and ophthalmological tolerance of HELC. Its efficacy was demonstrated by improvements in the SCORAD and moisturizing scores. Furthermore, the product was very well accepted by the subjects. Conclusion: The fragrance‐free HELC tested in this study for 21 days on "dry to very dry and atopic‐prone skin" improves skin dryness and pruritus while ensuring good tolerance. [ABSTRACT FROM AUTHOR]

Parental concern over infant dry skin is a common challenge that midwives and other maternity professionals frequently address in the early postnatal period. Although infant dry skin is a normal process of adaptation to extra-uterine life, parents often wish to treat it, and there is uncertainty among health professionals about what is safe and best practice. For decades, health professionals have recommended the use of topical natural oils to prevent or treat infant dry skin, but more recently, there has been increasing concern that use of these oils on the skin may be a contributory factor in the rising prevalence of childhood atopic eczema. This article will consider how infant skin may be affected by topical products, the role of the health professional giving infant skin care advice and current evidence to support clinical practice. [ABSTRACT FROM AUTHOR]

Atopic eczema is a common childhood condition. This article gives guidance on patient assessment; developing a patient-centred plan of care; the topical products most effective for managing the condition; how optimal adherence to the treatment may be achieved; and when referral to services in secondary care is appropriate. [ABSTRACT FROM AUTHOR]

Olive oil is commonly recommended by health professionals to new parents for use in the prevention and treatment of the term baby's dry skin, and for baby massage. There is no evidence to support this practice. The use of olive oil may be harmful to skin, affecting skin barrier function. This effect may be a contributory factor in the prevalence of childhood conditions such as atopic eczema. This paper discusses a national online audit of UK maternity hospitals (n = 67) and neonatal units (n = 33) performed between November 2010 and January 2011. Our findings confirm that oil use on babies' skin is common practice. As the direct cost to the NHS for treatment of atopic eczema is high, it is imperative that further research in this area is performed, preferably in the form of a randomized controlled trial. Health professionals will then be in a position to provide accurate information to parents with regard to oil in baby skin care regimens. [ABSTRACT FROM AUTHOR]

Abstract: Developing countries such as India can offer unique perspectives on and contributions to knowledge of and the literature on atopic dermatitis, including information on epidemiology, the role of environmental factors, clinical features, and treatment strategies in resource‐poor settings using indigenous methodologies. This report will help in understanding atopic dermatitis in the Indian diaspora as well. [ABSTRACT FROM AUTHOR]

In childhood, atopic dermatitis typically begins around 2--6 months of age. It is thought that the skin barrier dysfunction as well as allergic disease is important in the mechanism of atopic dermatitis. However, there are few reports of the skin barrier function in childhood. So we examined the relationship between the longitudinal surveys of the skin barrier function through the average projected area of corneocytes (APAc) and clinical findings in children from 1 to 12 months. As a result of examinations, APAc of cheek and upper arm in 1-month-old children is the same as those in adults, and APAc of cheek and upper arm decreases by 6 months of age. These results suggest that the skin barrier function decreases before or after the onset age of atopic dermatitis during childhood. Moreover, we examined APAc of children aged 0–5 for 1 year in the same nursery. APAc of upper arm in atopic dermatitis or atopic disposition has a significant difference compared with that of the other subjects in December. Furthermore, it was shown that change of APAc in the children under medical treatment was correlated with clinical findings. In conclusion, it was thought that the APAc shown as the index of skin barrier dysfunction is associated with the onset age of atopic dermatitis in childhood. [ABSTRACT FROM AUTHOR]