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Background: Systematic reviews (SRs) could offer the best evidence supporting interventions, but methodological flaws limit their trustworthiness in decision-making. This cross-sectional study appraised the methodological quality of SRs on atopic dermatitis (AD) treatments. Methods: We searched MEDLINE, EMBASE, PsycINFO, and Cochrane Database for SRs on AD treatments published in 2019–2022. We extracted SRs’ bibliographical data and appraised SRs’ methodological quality with AMSTAR (A MeaSurement Tool to Assess systematic Reviews) 2. We explored associations between methodological quality and bibliographical characteristics. Results: Among the 52 appraised SRs, only one (1.9%) had high methodological quality, while 45 (86.5%) critically low. For critical domains, only five (9.6%) employed comprehensive search strategy, seven (13.5%) provided list of excluded studies, 17 (32.7%) considered risk of bias in primary studies, 21 (40.4%) contained registered protocol, and 24 (46.2%) investigated publication bias. Cochrane reviews, SR updates, SRs with European corresponding authors, and SRs funded by European institutions had better overall quality. Impact factor and author number positively associated with overall quality. Conclusions: Methodological quality of SRs on AD treatments is unsatisfactory. Future reviewers should improve the above critical methodological aspects. Resources should be devolved into upscaling evidence synthesis infrastructure and improving critical appraisal skills of evidence users. [ABSTRACT FROM AUTHOR]

Abstract Prurigo is a reactive, hyperplastic skin condition characterized by pruritic papules, plaques, and/or nodules. The temporal classification includes acute/subacute and chronic disease (≥ 6 weeks), with different clinical variants, synonymies, and underlying etiological factors. The immunology of chronic prurigo shows similarities with atopic dermatitis due to the involvement of IL-4 and IL-13, IL-22, and IL-31. Treatment includes antihistamines, topical steroids, dupilumab, and JAK inhibitors. Several conditions manifest clinically as prurigo-like lesions, and the correct clinical diagnosis must precede correct treatment. Furthermore, chronic prurigos represent a recalcitrant and distressing dermatosis, and at least 50% of these patients have atopic diathesis, the treatment of which may induce adverse effects, especially in the elderly. The quality of life is significantly compromised, and topical treatments are often unable to control symptoms and skin lesions. Systemic immunosuppressants, immunobiologicals, and JAK inhibitors, despite the cost and potential adverse effects, may be necessary to achieve clinical improvement and quality of life. This manuscript reviews the main types of prurigo, associated diseases, their immunological bases, diagnosis, and treatment.

Introduction. Reports regarding the correlation and effect size of change of the full spectrum of quality of life and disease severity measures applied in-person to patients with atopic dermatitis are scarce. Objectives. To assess quality-of-life with 3 different instruments and to evaluate disease severity indices and to determine their correlation and effect size of change between two measurements. Materials and methods. Patient-level data were obtained through two in-person visits. Sociodemographic information and data related to disease distribution, severity (through the BSA, EASI, SCORAD, POEM, and itching scales), and the impact of atopic dermatitis on quality of life using the DLQI and Skindex-29, and EQ-5D, were assessed. The correlation between change in quality-of-life scores and disease severity scores in addition to the standardized effect size were also evaluated. Results. Only 139 out of 212 patients completed the follow-up visit. BSA highly correlated with SCORAD and EASI, and the lowest correlation was found with POEM. The best correlation of pruritus VAS was found with sleep disturbance. The SCORAD score highly correlated with EASI, and the lowest correlation was found with POEM. The magnitude of the effect at initiation of the study vs follow-up was in average moderate to important. Conclusions. Patients with atopic dermatitis experience a substantial burden on quality of life. Disease activity correlates better with quality-of-life measurements when the disease is less severe after starting therapy. POEM and Skindex-29 seem to be optimal to determine disease severity and quality of life in adults with atopic dermatitis.

Abstract Background The treatment for atopic dermatitis (AD) has been the focus of clinical research, and behavioral intervention is considered an indispensable treatment method. To our knowledge, no relevant meta-analysis has evaluated the effects of behavioral interventions on atopic dermatitis. Objectives To evaluate the effects of behavioral interventions on atopic dermatitis. Methods The authors searched PubMed, EMBASE, and Cochrane CENTRAL to retrieve relevant RCTs (up to Feb 2022). The search strategy involved a combination of related keywords. The Cochrane Q and I2 statistics were used to assess heterogeneity. Results Six RCTs involving seven reports with 246 patients were included. The results suggested that behavioral interventions could relieve eczema severity (correlation coefficient [r = −0.39]; p < 0.001) and scratching severity significantly (r = −0.19; p = 0.017), while not affect itching intensity (r = −0.02; p = 0.840). A sensitivity analysis confirmed the robustness of the results. Study limitations An important limitation of this study was the insufficient number of RCTs and the limited sample size. In addition, the study lacked a control group receiving a type of intervention other than the experimental protocol. Another limitation was the short duration of follow-up. Conclusions This study suggests that behavioral interventions could be effective in treating atopic dermatitis by reducing eczema and scratching severity. Additionally, habit-reversal behavioral therapy may be more effective for treating atopic dermatitis.

Background/Objectives: 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. Methods: 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. Results: 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. Conclusion: 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]

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To construct a structural model of family management for children with atopic dermatitis. In this cross-sectional study, data were collected using a structured questionnaire. Participants included primary caregivers of children aged 2–12 years who had received a medical diagnosis of atopic dermatitis and had been experiencing the condition for over three months. We used SPSS/WIN 26.0 to analyze the variables and AMOS 23.0 for structural equation modeling. Family functioning resilience, social support, and family coping had significant direct effects on family management. Illness severity, illness duration, and family life difficulty indirectly influenced family management, demonstrating significant total effects. The severity and duration of atopic dermatitis, family life difficulty, family functioning resilience, social support, and family coping explained 78.9% of the model. The final model was suitable for predicting family management for children with atopic dermatitis. By confirming mediating effects, this study contributes to enhancing family management through nursing interventions. These findings offer valuable insights for developing family-centered nursing strategies to improve family management for children with atopic dermatitis. Nursing interventions targeting the alleviation of family management challenges and enhancement of family functioning resilience, social support, and family coping are pivotal for improving the well-being of children with atopic dermatitis. Furthermore, tailored intervention development must take into account not only the severity and illness duration of atopic dermatitis in children but also the characteristics of the family. Improving family nursing through such tailored interventions can help enhance children's health and quality of life. • Family management for children with atopic dermatitis is important. • Family management was explained by illness severity and duration. • Family management was explained by family life difficulty, resilience, and coping. • The findings help develop family-centered nursing children with atopic dermatitis. [ABSTRACT FROM AUTHOR]

AbstractBackground Systematic reviews (SRs) could offer the best evidence supporting interventions, but methodological flaws limit their trustworthiness in decision-making. This cross-sectional study appraised the methodological quality of SRs on atopic dermatitis (AD) treatments.Methods We searched MEDLINE, EMBASE, PsycINFO, and Cochrane Database for SRs on AD treatments published in 2019–2022. We extracted SRs’ bibliographical data and appraised SRs’ methodological quality with AMSTAR (A MeaSurement Tool to Assess systematic Reviews) 2. We explored associations between methodological quality and bibliographical characteristics.Results Among the 52 appraised SRs, only one (1.9%) had high methodological quality, while 45 (86.5%) critically low. For critical domains, only five (9.6%) employed comprehensive search strategy, seven (13.5%) provided list of excluded studies, 17 (32.7%) considered risk of bias in primary studies, 21 (40.4%) contained registered protocol, and 24 (46.2%) investigated publication bias. Cochrane reviews, SR updates, SRs with European corresponding authors, and SRs funded by European institutions had better overall quality. Impact factor and author number positively associated with overall quality.Conclusions Methodological quality of SRs on AD treatments is unsatisfactory. Future reviewers should improve the above critical methodological aspects. Resources should be devolved into upscaling evidence synthesis infrastructure and improving critical appraisal skills of evidence users.

HaCaT keratinocytes in an in vitro atopic dermatitis (AD) model. Methods HaCaT cells were divided into the control group (no treatment) and the model group (0.05, 0.1 and 0.2 mmol/L). HaCaT cells in the model group were stimulated with 10 µg/L tumor necrosis factor-α (TNF-α)/interferon-γ (IFN-γ) for 24 h. Cells in the model group were pretreated with 0.05, 0.1 and 0.2 mmol/L matrine for 1 h and then stimulated with 10 µg/L TNF-α/IFN-γ for 24 h. MTT assay was used to assess the cytotoxicity of matrine. Enzyme-linked immunosorbent (ELISA) assay was performed to determine levels of cytokines (IL-6, IL-8 and IL-1β) and chemokines (TARC, MDC and RANTES). mRNA expression levels of antioxidant genes were detected by real-time quantitative PCR (RT-qPCR). Cell migration was analyzed by scratch closure assay. Immunohistochemistry was commended to analyze the nuclear translocation of NF-κB p65. Western blot assay was used to detect the phosphorylation levels of p38, ERK and p65 proteins. Results Compared with the model group, matrine 0.1 and 0.2 mmol/L significantly decreased the expression levels of IL-6, IL-1β, IL-8 and chemokines, and matrine significantly enhanced the expression levels of superoxide dismutase-1 (SOD1), SOD2, catalase (CAT) and glutathione peroxidase (GPx), and promoted scratch wound healing (P＜0.05). In addition, matrine 0.1 and 0.2 mmol/L inhibited the phosphorylation levels of p38, ERK and p65 proteins and the nuclear translocation of p65. Conclusion Matrine possesses anti-inflammatory and antioxidant properties, and stimulates wound closure in eratinocyte AD model, which may be related to the inhibition of the activation of MAPK and NF-κB pathways. [ABSTRACT FROM AUTHOR]

Background Autologous blood therapy (ABT) has been used to treat atopic dermatitis (AD) for over a century, even though evidence supporting its efficacy is lacking. We aimed to investigate the effectiveness and safety of autologous serum intramuscular injection (ASIM), which is a modified form of ABT, in treating mild-to-moderate AD. Methods This study was a 12-week, open-label, prospective, uncontrolled trial. Following a 4-week run-in period, 22 out of 25 screened patients received ASIM once a week for 4 weeks in conjunction with standard treatment. The primary outcome measure was the Eczema Area and Severity Index (EASI), while the secondary outcomes included the Scoring Atopic Dermatitis (SCORAD) score, Dermatologic Life Quality Index (DLQI), and patient ratings of pruritus, sleep difficulty, disease status, and treatment effectiveness. Safety parameters were also assessed. Results EASI scores showed a non-statistically significant trend toward improvement during ASIM intervention. Patients with at least a 50% improvement in the EASI score at 4 weeks were older and had lower peripheral eosinophil counts (p

Abstract Background: Methotrexate (MTX) is an alternative treatment for patients with moderate/severe atopic dermatitis (AD). Objective: The authors evaluated the effect of MTX on the cutaneous expression of cytokines and chemokines that are involved in the inflammatory response in adult AD patients who received treatment with methotrexate for 24 weeks. Methods: The authors conducted a prospective single-institution cohort study with 12 adults with moderate/severe AD who received oral MTX (15 mg/wk for 24 wks) and 10 non-atopic matched controls. The comparison was made of skin biopsies of lesional and non-lesional skin, pre- and post MTX treatment. The authors analyzed mean epidermal thickness and expression of IL-31, IL-31RA, OSMR, TSLP, Ki67, IL-4 mRNA, IL-6, IL-10, TNF-α, IFN-γ, TARC, and CCL-22. Results: There was a reduction in mean epidermal thickness (p = 0.021), an increase in IL-31RA expression (immunohistochemistry) in the epidermis (p = 0.016) and a decrease in IL-31 gene expression (p = 0.019) on lesional AD skin post-MTX treatment. No significant changes in the cutaneous expression of the other evaluated markers were identified. Study limitations: Small sample size and limited length of follow-up. Conclusions: Treatment with MTX in adults with moderate/severe AD reduced epidermal hyperplasia and changed the cutaneous expression of inflammatory cytokines and receptors that are mainly related to pruritus, including IL-31 and IL-31RA.

Background: Delgocitinib ointment, a topical Janus kinase inhibitor, is used as treatment of patients with atopic dermatitis (AD) aged ≥2 years in Japan. Although initiating appropriate and early treatment upon the onset of AD in childhood is important, the safety and efficacy of delgocitinib ointment in infants with AD have not been established. Methods: This phase 3 study was conducted from October 2020 to June 2022 (number JapicCTI-205412). Eligible Japanese infants with AD aged 6 to

Delgocitinib ointment, a topical Janus kinase inhibitor, is used as treatment of patients with atopic dermatitis (AD) aged ≥2 years in Japan. Although initiating appropriate and early treatment upon the onset of AD in childhood is important, the safety and efficacy of delgocitinib ointment in infants with AD have not been established. This phase 3 study was conducted from October 2020 to June 2022 (number JapicCTI-205412). Eligible Japanese infants with AD aged 6 to <24 months received 0.25% or 0.5% of delgocitinib ointment twice daily for 52 weeks in an open-label uncontrolled manner. Topical corticosteroids were allowed to apply for worsening AD during the treatment period at the investigators' discretion. A total of 22 infants were enrolled. Adverse events (AEs) were reported in 21 (95.5%) infants and were mostly mild. No treatment-related AEs were reported. The Modified Eczema Area and Severity Index (mEASI) score continuously decreased until week 4, and the score reduction was maintained until week 52. The mean percent changes in the mEASI score from baseline were −73.5% at week 4, −81.7% at week 28, and −81.9% at week 52. Delgocitinib was not detected in the plasma of most infants (68.2%–95.2%). Delgocitinib ointment is well tolerated and effective for up to 52 weeks when applied to Japanese infants with AD. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a chronic skin disease whose hallmark is a deficient skin barrier. Current treatment consists of restoring this barrier using emollients, reported corticosteroids, and systemic medications in severe cases. This study aimed to evaluate the subdermal hyaluronic acid (HA) injection to treat AD. We applied HA to plaques of atopic dermatitis, and there was a global improvement in the lesions and skin elasticity after two weeks. There was no complete regression of the plaques; however, HA can be proposed as an adjuvant treatment option for key areas.

Purpose: The favorable clinical efficacies of intramuscular injection of autologous blood in patients with atopic dermatitis (AD) and intramuscular injection of autologous serum in patients with chronic urticaria have been demonstrated by randomized clinical trials. In this study, we assessed the clinical effectiveness and safety of the intramuscular injection of autologous serum in patients with AD. Materials and Methods: In this randomized, placebo-controlled, and double-blind trial, 23 adolescent and adult patients with moderate-to-severe AD were enrolled. The patients were randomized to receive eight intramuscular injections of 5 mL of autologous serum (n=11) or saline (n=12) over 4 weeks, and were followed up until week 8. Changes in the clinical severity scores of AD assessed by SCORing Atopic Dermatitis (SCORAD), patient-reported Dermatology Life Quality Index (DLQI) score, and incidence of adverse events were assessed from baseline to week 8. Results: One patient in the treatment group and two patients in the placebo group were lost to follow-up before week 8. The intramuscular administration of autologous serum, compared with saline, decreased the SCORAD clinical severity score (-14.8% vs. 10.7%, p=0.006) and improved the DLQI score (-32.6% vs. 19.5%, p=0.01) from baseline to week 8. Serious adverse events were not observed. Conclusion: Intramuscular injection of autologous serum may be effective in treating AD. Further studies are needed to evaluate the clinical usefulness of this intervention for AD (KCT0001969). [ABSTRACT FROM AUTHOR]

Objective: The study aimed to conduct a systematic review of the literature to verify the association between exposure to pesticides and allergic diseases (asthma, allergic rhinitis, and atopic dermatitis) in children and adolescents. Method: A systematic review and meta-analysis were performed using the PRISMA method with the question “What is the association between exposure to pesticides and allergic diseases in children (asthma, allergic rhinitis, and atopic dermatitis)?” MEDLINE, EMBASE, SciELO, and Cochrane electronic databases were searched throughout the period in the literature up to September 2020. A total of 1296 studies were found, and 24 were selected. Results: Exposure to pesticides showed a two-fold greater risk of developing or exacerbating asthma in children and adolescents (odds ratio [OR] = 2.14 95% confidence interval [CI] 1.26-3.64, p < 0.01). There was no association between exposure to pesticides and the development of allergic rhinitis (OR = 2.73, 95% CI 0.13-57.8, p = 0.52) and atopic dermatitis (OR = 2.19, 95% CI 0.51-9.36, p = 0.29). Conclusions: Exposure to pesticides increases the risk of developing or exacerbating asthma in children and adolescents. There was no evidence of an association between exposure to pesticides and the development of allergic rhinitis and atopic dermatitis in children and adolescents, possibly due to the low number of studies found in this review.

Despite the need for improved eczema therapies and a rapid increase in available eczema clinical trials, participation remains low. The aim of this study was to identify factors associated with clinical trial awareness, interest, and barriers to enrolment and participation. An online survey, administered 1 May to 6 June 2020 to adults (≥ 18 years) with eczema in the USA, was analysed. Among 800 patients included, mean age was 49.4 years, most respondents were female (78.1%), White (75.4%), non-Hispanic (91.4%), and geographically living in an urban/suburban area (Rural-Urban Continuum Codes (RUCC) 1–3, 90.8%). Only 9.7% of respondents reported previous participation in clinical trials, while 57.1% had considered participation and 33.2% never considered participation. Higher satisfaction with current eczema therapy, clinical trial literacy, and confidence in finding eczema trial information were all associated with clinical trial awareness, interest, and successful participation. Younger age and having atopic dermatitis were associated with increased awareness, while female gender was a barrier to interest and successful participation.

Although isotretinoin has anti-inflammatory and immunomodulatory properties, it can exacerbate atopic dermatitis. National estimates of the extent to which patients with atopic dermatitis are affected by severe acne and isotretinoin tolerability are lacking. The aim of this study is to investigate isotretinoin therapy in patients with atopic dermatitis and to compare the nationwide prevalence with individuals without atopic dermatitis. All Norwegian residents were followed for 17 years until age 20–22 years in 2020. Approximately 28% of patients with atopic dermatitis had been treated for acne, and 8% had received isotretinoin before age 23 years. In those over 17 years old, significantly more patients with atopic dermatitis were treated with isotretinoin than those without. At age 22 years, 2.21% (95% confidence interval 1.92–2.49) of patients with atopic dermatitis were treated with isotretinoin, compared with 1.55% (95% confidence interval 1.44–1.65) of those without, representing 42.8% (1.43; 95% confidence interval 1.24–1.65) higher use in patients with atopic dermatitis. Patients who received long-term treatment (probable severe atopic dermatitis) tolerated isotretinoin similarly to patients who received short-term treatment (probable mild atopic dermatitis). There was significantly higher use of topical corticosteroids during isotretinoin therapy in patients with atopic dermatitis. Conclusively, severe acne (isotretinoin therapy) was associated with atopic dermatitis at the population level in young adults.

[Display omitted] Atopic march refers to the sequential development of allergic diseases from infancy through adolescence, typically beginning with atopic dermatitis (AD), followed by food allergy and then airway diseases, later evolving to broader or worsened spectrum of allergic diatheses. No intervention has shown to alter its course. We sought to determine the rate of acquisition of new or worsened allergic events for dupilumab versus placebo in patients with AD. Allergy-associated events from 12 clinical trials were grouped into 17 allergy categories, and IgE changes from baseline were defined. A new/worsened event was considered one step of atopic march. Treatment effect was assessed by incidence rate ratios (IRRs), dupilumab versus placebo, by meta-analysis. The duration of pooled AD studies was 4 to 52 weeks (1359 patient-years; n = 2296 dupilumab, n = 1229 placebo, median age 35 years). The median age at AD onset was 2 years. Baseline allergic disease burden was comparable between groups. Dupilumab reduced the risk of new/worsening allergies by 34% (IRR 0.66; 95% confidence interval [CI], 0.52-0.84) and new allergies by 37% (IRR 0.63; 95% CI, 0.48-0.83) versus placebo. Including IgE category shift, the IRR for combined new/worsening allergies was reduced by 54% (IRR 0.46; 95% CI, 0.36-0.57). These treatment benefits did not reverse on treatment discontinuation in off-treatment follow-up. The acquisition/worsening of allergic conditions suggestive of atopic march was observed in a pooled adult/adolescent AD study population with inadequately controlled AD. Treatment with dupilumab reduced new/worsened allergy events versus placebo; inclusion of IgE category change increased the apparent benefit. [ABSTRACT FROM AUTHOR]

Parental exposures prior to conception might influence asthma and allergy risk in offspring. As occupational exposures are established risk factors for asthma and allergies, we investigated if parental occupational exposures prior to conception cause wheeze and eczema in offspring during the first year of life. We analysed data of 436 families from an offspring cohort based on a follow-up study of German participants of the International Study of Asthma and Allergies in Childhood (ISAAC). Offspring cohort data was collected between 2009 and 2019. Occupational exposures were based on participants' work histories and measured by a Job-Exposure-Matrix. We used Bayesian logistic regression models for analysis. Inference and confounder selection were based on directed acyclic graphs. In mothers, for both allergic and irritative occupational exposures prior to conception suggestive effects on offspring eczema during the first year of life were found (allergens: odds ratio (OR) 1.22, 95% compatibility interval (CI) 0.92–1.57; irritants: OR 1.36, 95% CI 0.99–1.77), while no relation with wheeze was suggested. Our results suggest that reduction of asthma-related occupational exposures might not only reduce the burden of disease for occupationally induced or aggravated asthma and allergies in employees but also in their children. [ABSTRACT FROM AUTHOR]

Abstract Immunobiologicals are a reality in current clinical practice and have increasingly gained space in the inflammatory disease scenario, especially in dermatology, with approved drugs for psoriasis, atopic dermatitis, and hidradenitis suppurativa, in addition to many others undergoing study. It is important for dermatologists to have knowledge of the medications approved in Brazil, for the best management of dermatoses, in addition to the fact that they represent hope for improvement in patients with chronic diseases.

Abstract Atopic dermatitis predisposes to skin infections, and on the other hand, some therapies used for atopic dermatitis may worsen viral infections whose lesions may be more diffuse and resistant to treatment. The authors present a patient with severe atopic dermatitis and disseminated molluscum contagiosum infection. The molluscum contagiosum did not clear with topical treatment, and it worsened her atopic dermatitis even more, so the authors started treatment with dupilumab. After two months, the patient's dermatitis went into clinical remission and there was resolution of the infection with no recurrence at the 12-month follow-up. Dupilumab is nowadays a promising treatment for severe atopic dermatitis. To our knowledge, only four reports of molluscum contagiosum during dupilumab therapy have been reported in the literature, with contrasting effects. According to the authors’ experience, treatment with dupilumab appears to be a safe alternative for patients with severe atopic dermatitis who are also infected with molluscum contagiosum, as opposed to other treatments such as systemic corticosteroids or cyclosporine.

Abstract Background Atopic dermatitis is the most common inflammatory skin disease in childhood and has an important impact on quality of life, especially severe cases or those that are recalcitrant to treatments. Sensitization to allergens with the potential for allergic contact dermatitis is a factor associated with cases of recalcitrant atopic dermatitis. Understanding the relationship between atopic dermatitis, allergens, and allergic contact dermatitis is essential. In Brazil, there are no studies on sensitization to allergens found in patch tests with pediatric batteries in patients with atopic dermatitis. Objectives To verify the main sensitizing agents, the prevalence of allergic contact dermatitis and the epidemiological and clinical profile of children and adolescents with atopic dermatitis. Methods Cross-sectional, prospective study in patients between 4 and 18 years of age, with recalcitrant atopic dermatitis, treated at the Sanitary Dermatology Outpatient Clinic (RS). All patients underwent patch tests with a battery of pediatric allergens. Results The prevalence of sensitization and allergic contact dermatitis in the evaluated patients was 37.07% (20/54) and 27.7% (15/54), respectively. The most frequent allergens were: nickel sulfate (16.7%), disperse blue (5.6%), and fragrance mix I (5.6%). Nickel was associated with the female sex (p = 0.019). Study limitations Sample size and selection, absence of a control group. Conclusions A proportion of patients with recalcitrant atopic dermatitis may be sensitized to different allergens and may even have developed allergic contact dermatitis. Recognizing this context is important in the prevention strategy and management of the disease.

Objective: The study aimed to conduct a systematic review of the literature to verify the association between exposure to pesticides and allergic diseases (asthma, allergic rhinitis, and atopic dermatitis) in children and adolescents. Method: A systematic review and meta-analysis were performed using the PRISMA method with the question "What is the association between exposure to pesticides and allergic diseases in children (asthma, allergic rhinitis, and atopic dermatitis)?" MEDLINE, EMBASE, SciELO, and Cochrane electronic databases were searched throughout the period in the literature up to September 2020. A total of 1296 studies were found, and 24 were selected. Results: Exposure to pesticides showed a two-fold greater risk of developing or exacerbating asthma in children and adolescents (odds ratio [OR] = 2.14 95% confidence interval [CI] 1.26-3.64, p < 0.01). There was no association between exposure to pesticides and the development of allergic rhinitis (OR = 2.73, 95% CI 0.13-57.8, p = 0.52) and atopic dermatitis (OR = 2.19, 95% CI 0.51-9.36, p = 0.29). Conclusions: Exposure to pesticides increases the risk of developing or exacerbating asthma in children and adolescents. There was no evidence of an association between exposure to pesticides and the development of allergic rhinitis and atopic dermatitis in children and adolescents, possibly due to the low number of studies found in this review. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is a chronic, recurrent, inflammatory skin condition that is associated with detrimental effects on the lives of patients and their families, including an impact on quality of life (QOL). Studies about QOL on Latin American AD patients are scarce and have generally included few patients. Objective: describing AD impact on the QOL in a large cohort in Argentina. Methods: a structured web-based survey including 1,650 AD pediatric and adult patients was performed. Results: according to retrieved data, AD symptoms onset started during childhood in most patients, but 20 % of participants reported that manifestations of AD were initially perceived during late adolescence and adulthood. Important differences were observed among country regions, with a shorter time-to-diagnosis in most populated and richer districts. Main affected domains included frustration, anger, mood alterations, stress, sleep alterations, routine alterations, pain and economic impact of AD. Limitations: biases inherent to survey design. Conclusions: we consider that our study contributes to a better understanding of AD in Argentina, as well as its physical, social and financial impact on affected patients.

Background: Eczema affects one in five children in the UK. Regular application of emollients is routinely recommended for children with eczema. There are four main emollient types, but no clear evidence of which is best. The current 'trial and error' approach to find suitable emollients can be frustrating for parents, children, and clinicians.Aim: To identify how parents and children experience and evaluate emollients.Design and Setting: Qualitative interview study, nested within a primary care trial of emollients (Best Emollients for Eczema [BEE] trial).Method: Semi-structured interviews with children with eczema and their parents were conducted. Participants were purposively sampled on emollient type (lotion, cream, gel, or ointment), age, and eczema severity.Results: Forty-four parents were interviewed, with children participating in 24 of those interviews. There was no clear preference for any one emollient type. The strongest theme was the variation of experience in each of the four types. Participants focused on thickness and absorbency, both positively and negatively, to frame their evaluations. Effectiveness and acceptability were both considered when evaluating an emollient but effectiveness was the primary driver for continued use. For some, participating in the trial had changed their knowledge and behaviour of emollients, resulting in use that was more regular and for a longer duration.Conclusion: There is no one emollient that is suitable for everyone, and parents/children prioritise different aspects of emollients. Future research could evaluate decision aids and/or tester pots of different types, which could enable clinicians and parents/children to work collaboratively to identify the best emollient for them. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is a chronic inflammatory disease of the skin and its prevalence is continuously on the rise. This study aimed to evaluate the prevalence of AD in adults living in Southwestern part of Iran and its association with respiratory allergic disorders. Methods: In this population-based cross-sectional stratified, using multistage cluster random sampling method, a total of 5420 individuals aged 15-65 years were selected from Bushehr City, Iran, from which, 5201 completed the Global Allergy and Asthma Network of Excellence (GA2LEN) questionnaire (Response rate = 96.1%). The total prevalence of AD and its prevalence in allergic diseases was calculated, and the association of AD and these diseases was evaluated using multiple logistic regression model. Findings: The overall prevalence of AD was 29% (32% women vs 25.9% men; P < 0.001). The highest prevalence was seen among participants in the age group of 25-34 and 35-44 years (P < 0.001). The prevalence of AD among the patients with asthma, chronic rhinosinusitis (CRS), and allergic rhinitis (AR) was 50.5%, 48.4%, and 47.1%, respectively, that it was significantly related only with AR (P < 0.001). Conclusion: The prevalence of allergic diseases in Bushehr City was high. The comorbidities of the other allergic diseases such as asthma, chronic rhinosinusitis (CRS), and allergic rhinitis (AR) leads to a higher prevalence of AD.

Abstract Background: Higher skin pH in atopic dermatitis contributes to impaired epidermal barrier. A moisturizer compatible with physiological pH could improve atopic dermatitis. Objective: To determine the effect of a physiologically compatible pH moisturizer in atopic dermatitis. Methods: A randomized half body, double blind, controlled trial involving patients with stable atopic dermatitis was performed. pH-modified moisturizer and standard moisturizer were applied to half body for 6 weeks. Results: A total of 6 (16.7%) males and 30 (83.3%) females participated. Skin pH reductions from week 0, week 2 and 6 were significant at the forearms (5.315 [0.98] to 4.85 [0.54] to 5.04 [0.78], p = 0.02) and abdomen (5.25 [1.01], 4.82 [0.64], 5.01 [0.59], p = 0.00) but not at the shins (5.01 [0.80], 4.76 [0.49], 4.85 [0.79], p = 0.09) with pH-modified moisturizer. Transepidermal water loss (TEWL) at the forearms decreased (4.60 [2.55] to 3.70 [3.10] to 3.00 [3.55], p = 0.00), abdomen (3.90 [2.90] to 2.40 [3.45] to 2.70 [2.25], p = 0.046). SCORAD improved from 14.1 ± 12.75 to 10.5 ± 13.25 to 7 ± 12.25, p = 0.00. In standard moisturizer group, pH reductions were significant at the forearms (5.29 [0.94] to 4.84 [0.55] to 5.02 [0.70], p = 0.00) and abdomen (5.25 [1.09], 4.91 [0.63], 5.12 [0.66], p = 0.00). TEWL at the forearm were (4.80 [2.95], 4.10 [2.15], 4.60 [3.40], p = 0.67), shins (3.80 [1.40], 3.50 [2.35], 4.00 [2.50], p = 0.91) and abdomen (3.70 [2.45], 4.10 [3.60], 3.40 [2.95], p = 0.80). SCORAD improved from 14.2 ± 9.1 to 10.9 ± 10.65 to 10.5 ± 11, p = 0.00. Reduction in pH was observed with both moisturizers while TEWL significantly improved with pH-modified moisturizer. pH-modified moisturizer resulted in greater pH, TEWL and SCORAD improvements however the differences were not significant from standard moisturizer. Study limitation: Skin hydration was not evaluated. Conclusion: Moisturization is beneficial for atopic dermatitis; use of physiologically compatible pH moisturizer is promising.

Abstract Background: Polymorphisms of the filaggrin 2 gene (rs 12568784 and rs 16899374) are associated with persistent atopic dermatitis in African American patients. Filaggrin 2 is a protein with a function similar to filaggrin and also encoded in the epidermal differentiation complex on chromosome 1q21. Objective: To evaluate the polymorphisms in the filaggrin 2 gene (rs 12568784 and rs 16899374) in children and adults with atopic dermatitis and to verify the association of these with the severity of the clinical picture, presence of other allergic diseases, and socio-demographic factors. Method: The study was carried out with patients and control group. Questionnaires were used to evaluate ethnicity, sex, age, family history, scoring, atopic dermatitis (SCORAD), among other parameters. Genotyping of the filaggrin 2 gene was performed by real-time polymerase chain reaction. Results: Forty-eight patients and 83 controls were evaluated. No correlation was found between the variables studied in patients with atopic dermatitis and polymorphisms, no significant difference between the prevalence of polymorphisms in the patients and in the control group p > 0.05. Study limits: The exclusive use of self-reported ethnicity information and the sample size. Results: The results of this work can be an incentive for the study of the polymorphisms in atopic dermaititis, considering the characteristic of the Brazilian multi ethnic population. Conclusion: This is an unpublished work in Brazil and the first study in the world to have a control group to evaluate alterations in the gene of filaggrin 2.

Objective: To compare expression levels of eotaxin in the serum and CCR3 on the peripheral blood monocytes (PBMC) prior to and after the treatment with NB-UVB plus pimecrolimus cream, in order to elucidate the pathogenesis of atopic dermatitis(AD). Methods: Serum level of eotaxin was detected by enzym-linked immunosorbent assay (ELISA) in 30 adult patients with AD prior to and after the treatment. CCR3 expression on the peripheral blood monocytes was analyzed by flow cytometry. Results: Treatment of AD with NB-UVB plus pimecrolimus cream markedly lowered the serum levels of eotaxin [(133.86±42.23) pg/mL vs. (101.54±35.63) pg/mL, P

Impaired skin barrier is one of the hallmarks of atopic dermatitis (AD), with abnormalities in the cornified envelope, lipid lamellae, tight junctions and cutaneous microbiome. These findings are also present in nonlesional skin of AD individuals, suggesting that epidermal barrier defects may be the initial step towards the development of AD and eventually other atopic diseases (atopic march). It is currently known that pathophysiology of AD involves an interplay between this dysfunctional skin barrier and a predominantly type 2 skewed innate and adaptive immune responses, which further disrupt the skin barrier through type 2 cytokines. In this setting, there is enhanced penetration of environmental and food allergens through a deficient barrier, leading to an increased susceptibility to sensitization. During the sensitization process, thymic stromal lymphopoietin (TSLP) polarizes skin dendritic cells to a T-helper 2 response, and TSLP seems to be a key cytokine in the sensitization of food allergy, allergic asthma and rhinitis. In this review, the authors describe the current knowledge of the pathophysiology of the epidermal barrier, its disruption in AD and how it may be involved in the development of atopic comorbidities and the role of barrier repair therapy on the prevention of the atopic march progression.

Objective To investigate the effects of shikonin on thymic stromal lymphopoietin (TSLP)/OX40 ligand (OX40L) pathway and balance of helper T cell 1 (Th1)/helper T cell 2 (Th2) in mice with atopic dermatitis (AD). Methods AD mouse model was established by topical application of 2,4-dinitrofluorobenzene (DNFB).Model mice were randomly divided into model group, low shikonin group (10 mg/kg), medium shikonin group (20 mg/kg), high shikonin group (30 mg/kg), and the positive control group (prednisolone,10 mg/kg) by random number table method, with 15 mice in each group. Another 15 mice were used as the normal control group. The drug groups were given the corresponding drugs by gavage, with the volume of 10 mL/kg. The model group and the normal control group were given the same volume of solvent by gavage, once a day for 15 days. The scratch behavior of mice was observed on the 5th, 10th and 15th day after administration. The condition of skin lesions was evaluated on the 7th and 15th days after administration. At the end of the last administration, hematoxylin eosin (HE) staining was used to observe the histopathological changes of skin lesions. The ratio of Th1/Th2 cells in peripheral blood of mice was detected by flow cytometry. Levels of TSLP, tumor necrosis factor (TNF)-α, interleukin (IL)-4 and γ-interferon (IFN-γ) were detected by enzyme linked immunosorbent assay (ELISA). Western blot assay was used to detect the protein expression levels of TSLP and OX40L. Results Compared with the normal control group, the scratching behavior increased and the skin inflammatory injury aggravated in model group. There were dense infiltration of inflammatory cells in the epidermis and dermis in the model group, and the epidermis was thickened. The blood levels of Th2 cells, TSLP, TNF-α and IL-4, and the protein expression levels of TSLP and OX40L in skin lesions were significantly higher (P＜0.05), and the levels of Th1 cells, IFN-γ and Th1/Th2 ratio were significantly lower (P＜0.05). Compared with the model group, the scratching behavior were decreased on the 5th, the 10th and the 15th day, and the skin inflammatory injury decreased on the 7th and the 15th day in turn in low, middle and high dose shikonin groups (P＜0.05). After the last administration, the inflammatory cell infiltration and epidermal thickening in the epidermis and dermis of mice decreased in turn in low, medium and high dose shikonin groups. The scratching behavior, the degree of skin inflammatory injury, the levels of Th2 cells, TSLP, TNF-α and IL-4, and the protein expression levels of TSLP and OX40L decreased in turn (P＜ 0.05), and the levels of Th1 cells, IFN-γ and Th1/Th2 ratio increased in turn (P＜0.05). Conclusion Shikonin may maintain the balance of Th1/Th2 cells in peripheral blood and improve skin inflammatory injury of AD mice by inhibiting TSLP/OX40L pathway. [ABSTRACT FROM AUTHOR]

Impaired skin barrier is one of the hallmarks of atopic dermatitis (AD), with abnormalities in the cornified envelope, lipid lamellae, tight junctions and cutaneous microbiome. These findings are also present in nonlesional skin of AD individuals, suggesting that epidermal barrier defects may be the initial step towards the development of AD and eventually other atopic diseases (atopic march). It is currently known that pathophysiology of AD involves an interplay between this dysfunctional skin barrier and a predominantly type 2 skewed innate and adaptive immune responses, which further disrupt the skin barrier through type 2 cytokines. In this setting, there is enhanced penetration of environmental and food allergens through a deficient barrier, leading to an increased susceptibility to sensitization. During the sensitization process, thymic stromal lymphopoietin (TSLP) polarizes skin dendritic cells to a T-helper 2 response, and TSLP seems to be a key cytokine in the sensitization of food allergy, allergic asthma and rhinitis. In this review, the authors describe the current knowledge of the pathophysiology of the epidermal barrier, its disruption in AD and how it may be involved in the development of atopic comorbidities and the role of barrier repair therapy on the prevention of the atopic march progression. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is a disease with an impact on the patient's quality of life (QoL). Several tools have been designed to assess the clinical severity of the disease, such as the Eczema Area and Severity Index (EASI), while specific instruments have been created to assess QoL, such as the Dermatology Life Quality Index (DLQI) and the Quality of Life Index for Atopic Dermatitis (QoLIAD). Objective: To define which tool is the best to assess the QoL condition of adult patients with AD in relation to the EASI. Material and methods: Patients with AD (> 18 years old) were selected who agreed to complete the DLQI and QoLIAD questionnaires, as well as to have a dermatologic examination reported according to the EASI. Three simple linear regression models were fitted in order to quantify the association between EASI with DLQI and QoLIAD. A value of p < 0.05 was considered statistically significant. The CV condition model with the highest pseudo R² value was considered to have the strongest association with EASI. Results: A total of 72 patients were included. Simple quantile regression models revealed a regression coefficient of 0.243 for DLQI (p = 0.002) and 0.252 for QoLIAD (p = 0.003). The pseudo R² values were 0.15 for DLQI and 0.10 for QoLIAD, so DLQI had a higher correlation with EASI. Conclusions: DLQI proved to be the best instrument to assess CV impairment in adult patients with AD. [ABSTRACT FROM AUTHOR]

Abstract Background This study examined whether infants aged 0–3 months exhibited long-term effects of using a moisturizer skincare intervention and whether a short-term skin problem resulted in the subsequent development of food allergies or atopic dermatitis (AD) until the age of 2 years. Methods This study was a follow-up of a completed randomized control trial (RCT) of moisturizer skincare for infants aged 0–3 months. A self-reported questionnaire was mailed to the parents of children aged 1–2 years who had participated in the RCT. Data were analyzed using a Chi square test, by intention to treat analysis, and by multiple logistic regression. Results Of 155 infants, 22 (14.2%) and 28 (18.1%) had food allergies and AD/eczema until 2 years of age, respectively. No significant difference was seen in food allergies or AD between the group that received moisturizer skincare intervention and the control group. On the contrary, food allergies until 2 years of age were significantly associated with short-term (4–7 days) and long-term (more than 7 days) body skin problems occurring in the first 3 months of life, a family history of AD, and the time of starting complementary food. High value of face transepidermal water loss at 3 months of age was also associated with food allergies. Moreover, a short duration of severe diaper dermatitis during the first 3 months, a family history of AD, and being male were significantly associated with AD/eczema until the age of 2 years. Conclusions After adjusting for family history of AD, a short-term skin problem in the first 3 months of life was significantly associated with the development of food allergies or AD/eczema until the age of 2 years. Prevention or prompt treatment of skin problems in newborns is essential for preventing future allergic diseases. Trial registration This was a follow-up study conducted 2 years after the completed RCT of a moisturizer skincare intervention for early infants, which was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000013260)

Introduction: Atopic dermatitis (AD) is a chronic inflammatory disease that affects both children and adults. The main symptom is pruritus, which has an important impact on quality of life (QoL). The objective of our study was to assess the impact of AD on the quality of life of children through the CDLQI score. Population and Methods: We performed a cross-sectional survey, with descriptive and analytical aims, carried out on the basis of prospective recruitment, carried out over a period of 7 months from December 2017 to June 2018. The study included children (5-16 years) with AD selected during dermatology consultations at the Centre Hospitalier Universitaire of Treichville. Data collected included the socio-demographic characteristics of patients and their AD and the results of a questionnaire on the severity score (SCORAD) and the quality of life index in these children (CDLQI). Results: We included 60 children, mainly within the group from 05 to 09 years (57%). CDLQI average score was 9.9 and mean SCORAD 24. Pruritus, insomnia and sadness had more impact on QoL. We found a strong association between the severity of AD objectified by SCORAD and the CDLQI. Conclusion: The study reveals a high impact of AD on the QoL of children in Abidjan mainly through pruritus, insomnia and sadness. It opens up reflection on the need for education for AD management and the prospect of creating an atopy school in Côte d’Ivoire.

Introduction. Grover’s disease is characterized by pruriginous polymorphic rash with a variable course and duration. Although the etiology is still unknown, the disease is often associated with other dermatoses, malignant diseases, use of certain medications, as well as immunosuppression. Case Report. We report a case of a 70-year-old male patient who was referred for examination to the Clinic of Dermatovenereology Diseases, Clinical Center of Vojvodina, due to a rash that lasted for nine months. The first lesions on the skin appeared around the nipples as exudative eczematous plaques. A few months later, identical lesions appeared on the lower legs. During treatment with systemic anti-histamines and topical corticosteroids, there were episodes of transient improvements and re-exacerbations. In the meantime, erythematous brownish, round and oval papules appeared on the abdomen and the back, accompanied by intense itch. Laboratory findings revealed eosinophilia and elevated serum immunoglobulin E levels. A skin biopsy of the back lesion was performed and the histopathological examination confirmed the diagnosis of Grover’s disease. After the systemic treatment using corticosteroids and antihistamines, with gradual dose reduction and application of topical corticosteroids and emollients, complete regression of the skin lesions was achieved. Conclusion. Since the clinical manifestations of the disease may be nonspecific and discrete, dermatopathological analysis is of crucial importance in making the correct diagnosis. In patients with atopy, the treatment with systemic corticosteroids, antihistamines and topical agents may lead to regression of skin lesions with a significant improvement in the quality of life. [ABSTRACT FROM AUTHOR]

Abstract: Background: Current data regarding the associated factors of prurigo nodularis are still uncertain, except for atopic predisposition. Objectives: The purposes of this study were to (1) determine the frequencies of xerosis and other accompanying diseases of female patients with prurigo nodularis; (2) compare the demographic, clinical and accompanying disease characteristics by grouping these patients according to whether they have associated xerosis (who were subsequently subgrouped as atopic or non-atopic) or not. Methods: In this retrospective descriptive study, 80 females with PN were categorized according to the accompanying diseases (dermatological, systemic, neurological, psychogenic, mixed, or undetermined origin). Results: A total of 45 associated co-factors including dermatological in 63 (78.8%), systemic in 57 (71.3%), psychological in 33 (41.3%) and neurological co-factors in 14 (17.5%) of all patients with prurigo nodularis were detected. Xerosis was observed in 48 (60%) patients (non-atopic co-factors in 66.7% of them). The ratio of patients with mixed co-factors, dermatological+systemic co-factors and dermatological+systemic+psychological co-factors were found to be significantly higher in patients with xerosis compared to those without xerosis. Study limitations: Our study has certain limitations such as the absence of an age-matched control group, absence of follow-up data and the fact that the diagnosis of xerosis has not been based on objective methods. Conclusions: Xerosis has been identified in more than half of the patients with PN and it has been determined that in most patients xerosis is associated especially with diabetes mellitus and other conditions related to prurigo nodularis.

Abstract: Atopic dermatitis is a common inflammatory skin disease. New understanding in disease pathogenesis has led to a considerable number of promising new drugs in development. New topical agents can be especially helpful for children, providing an alternative to the need for chronic topical corticosteroid use. While many patients with mild or moderate disease can be managed with topical treatments, there are unmet needs for recalcitrant and severe cases. New and developing therapies hold promise for real advances in management of this complex disease.

A cross-sectional study was carried out in Brod-Posavina County, Croatia, to assess the prevalence of allergic diseases and atopy, as well as to investigate the possible etiologic factors for asthma, allergic rhinitis and eczema in childhood. The study included 1687 schoolchildren aged 10-11 years. Data were collected using standardized International Study of Asthma and Allergies in Childhood (ISAAC) Phase II written questionnaire. Skin prick tests were performed to provide an objective measure of atopy, defined as skin reactivity to one or more allergens. Lifetime prevalence of wheezing was 22.7%, rhinitis symptoms 22.5%, and eczema symptoms 17.9%. Period prevalence in the past 12 months was 7.9% for attacks of wheezing, 9.9% for rhinoconjunctivitis symptoms, and 10.1% for eczema symptoms. Of the children in which skin prick test was performed, 20.2% were positive for at least one of the allergens used, with house dust mite sensitization being the most frequent one. Risk factors for allergic disease include allergic disease in family, atopy, sensitization to indoor and outdoor allergens, and environmental tobacco smoke exposure at home. International comparison with the results of other ISAAC Phase II studies showed the Brod-Posavina County to be an area with moderate prevalence of atopy and current asthma symptoms.

OBJECTIVES: To identify the standard of care in atopic dermatitis from the expert perspective and to determine its costs for the Colombian health care system. MATERIAL AND METHOD: A panel of experts was performed, followed by a simulation of expected costs for the Colombian population. Five experts following the nominal group technique defined flow of patients with atopic dermatitis, their potential impact on quality of life, effectiveness of current therapies according to severity and frequency of consumption of medical resources, these frequencies were used to perform a cost analysis by level of severity using public databases. RESULTS: In Colombia the diagnosis of atopic dermatitis is mainly defined by clinical criteria, the most used standardized criteria are Hanifin and Rajka (60%). Four lines of management with off-label medications after the 3rd line were described and the results showed that 22% with moderate atopic dermatitis and 26% severe continued without control, conditioning that 3% (in severe atopic dermatitis) reported suicidal ideation. The cost of treatment and monitoring of adverse effects were the main source of costs. CONCLUSIONS: Atopic dermatitis is a disease involving significant morbidity and economic burden. With the therapeutic options used and after several lines of treatment a significant per centage of patients remained out of control. [ABSTRACT FROM AUTHOR]

Abstract: Background: Narrow-band UVB is the most innovative steroid sparing treatment in atopic dermatitis. There are studies showing efficacy of Narrow-band UVB in childhood atopic dermatitis, but there is lack of clinical trials in the literature determining the length of remission. Therefore, we sought to highlight its efficacy, safety and its post-treatment efficacy in childhood atopic dermatitis. Objective: To assess the clinical efficacy, safety of Narrow-band UVB in the treatment of paediatric atopic dermatitis and length of remission during 2 years of post-treatment follow-up. Methods: Thirty children (4-14 years) having moderate to severe AD (SCORAD index > 25) were enrolled for 12 weeks. Narrow-band UVB phototherapy was administered twice a week on non-consecutive days for three months. SCORAD index was calculated by the same dermatologist at baseline, 6th, 12th, 18th and 24th treatment session. Secondary outcomes were measured using visual analog scale for pruritus and sleep loss. Patients were also followed-up for 2 years to know the length of remission after end of therapy. Results: There was a significant reduction in SCORAD index at 6th, 12th, 18th and 24th treatment session in comparison to baseline. This improvement in SCORAD was also maintained during the 2 years of post-treatment follow-up period. Consequently, pruritus and sleep loss improved significantly from baseline to end of therapy and even during the 1st and 2nd year of follow-up. Study limitation: Open-label trial without control group. Conclusions: Narrow-band UVB is an efficacious and safe modality of treatment in childhood atopic dermatitis with good therapeutic index and minimal side effects.

Abstract: Background: Atopic dermatitis is a prevalent health problem in the world. Allergic sensitization is an important risk factor, but the roles of other factors, inherent in tropic region, are unknown. Objective: A cohort study was designed in a tropical city to investigate molecular and environmental risk factors for eczema, considering as particular features perennial exposure to mites, poor living conditions and others tropical characteristics. Methods: 433 patients were included at baseline and biological samples were collected during 24 months of follow-up. Clinical information was collected using questionnaires (SCORAD, DLQI and a subjective scale) during each clinical assessment. Results: The prevalence of atopic eczema was 93%, with similar frequency between children and adults; parents history of eczema and polysensitization to mites, dogs, cats, cockroaches and birds, were risk factors for severe and persistent eczema and allergic comorbidities. Food sensitization was present in 16% of patients but food-induced allergies were scarce. Psychiatric, dental and ocular disorders were the most frequent non-allergic comorbidities. Study limitations: selection bias. Conclusion: We presented a tropical cohort of patients with eczema and we identified some risk factors for severe and persistent dermatitis. Some patterns of sensitization were associated with severe eczema and respiratory symptoms, and the natural history of "atopic march" is different to that described in some industrialized countries. The collection of biological samples will contribute to the understanding of the gene/environment interactions leading to allergy inception and evolution.

Children with atopic dermatitis (AD) usually develop symptoms when they reach the age of 6-7 years, but the risk of developing respiratory allergies, asthma and allergic rhinitis (AR) remains high. In most children with AD, the development of asthma and AR is associated with sensitization to food allergens and/or aeroallergens, while only a small percentage missed atopic diathesis. In about 35% of children with AD, food allergy is the provoking cause, and 60% of infants who had AD in the first 3 months of life were sensitized against aeroallergens by the age of 5. The aim of the study was to follow development of asthma and AR and to assess the most significant risk factors for developing respiratory allergy. A total of 114 children with AD were followed up for five years. At annual visits, the severity of disease, total immunoglobulin E (IgE) antibody values, skin prick tests, specific IgE antibodies to food allergens and aeroallergens, and absolute eosinophil count were assessed. Information on the family history of atopy and AD, feeding patterns during infancy, data on sensitivity to food allergens and/or aeroallergens, and on the occurrence of bronchial obstruction and nose symptoms were obtained. Asthma developed in 36 children, median age 7.7 years; 33 children had symptoms of AR, and 13 children with AD had both diseases associated; 38 children had sensitivity to food, of which 24 developed asthma and 13 AR; asthma developed in 18/23 children with sensitivity to aeroallergens, and almost an equal number of children developed AR. The increased absolute eosinophil count and specific IgE to aeroallergens and food allergens were the best asthma predictors, while AR predictors were family history and early onset of AD. In conclusion, children with AD are at a significant risk of developing respiratory allergies, and those with the increased absolute eosinophil count, positive specific IgE to aeroallergens and food allergens, heredity of AD, and early onset of AD are at the highest risk. Identification of risk factors will enable us to improve the treatments of AD in order to reduce the severity of disease and prevent manifestation of respiratory allergy.

Although atopic dermatitis (AD) is known to be a representative skin disorder, it also affects the systemic immune response. In a recent study, myoblasts were shown to be involved in the immune regulation, but the roles of muscle cells in AD are poorly understood. We aimed to identify the relationship between mitochondria and atopy by genome-wide analysis of skeletal muscles in mice. We induced AD-like symptoms using house dust mite (HDM) extract in NC/Nga mice. The transcriptional profiles of the untreated group and HDM-induced AD-like group were analyzed and compared using microarray, differentially expressed gene and functional pathway analyses, and protein interaction network construction. Our microarray analysis demonstrated that immune response-, calcium handling-, and mitochondrial metabolism-related genes were differentially expressed. In the Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology pathway analyses, immune response pathways involved in cytokine interaction, nuclear factor-kappa B, and T-cell receptor signaling, calcium handling pathways, and mitochondria metabolism pathways involved in the citrate cycle were significantly upregulated. In protein interaction network analysis, chemokine family-, muscle contraction process-, and immune response-related genes were identified as hub genes with many interactions. In addition, mitochondrial pathways involved in calcium signaling, cardiac muscle contraction, tricarboxylic acid cycle, oxidation-reduction process, and calcium-mediated signaling were significantly stimulated in KEGG and Gene Ontology analyses. Our results provide a comprehensive understanding of the genome-wide transcriptional changes of HDM-induced AD-like symptoms and the indicated genes that could be used as AD clinical biomarkers. [ABSTRACT FROM AUTHOR]

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Abstract: Background: Topical antimicrobial drugs are indicated for limited superficial pyodermitis treatment, although they are largely used as self-prescribed medication for a variety of inflammatory dermatoses, including atopic dermatitis. Monitoring bacterial susceptibility to these drugs is difficult, given the paucity of laboratory standardization. Objective: To evaluate the prevalence of Staphylococcus aureus topical antimicrobial drug resistance in atopic dermatitis patients. Methods: We conducted a cross-sectional study of children and adults diagnosed with atopic dermatitis and S. aureus colonization. We used miscellaneous literature reported breakpoints to define S. aureus resistance to mupirocin, fusidic acid, gentamicin, neomycin and bacitracin. Results: A total of 91 patients were included and 100 S. aureus isolates were analyzed. All strains were methicillin-susceptible S. aureus. We found a low prevalence of mupirocin and fusidic acid resistance (1.1% and 5.9%, respectively), but high levels of neomycin and bacitracin resistance (42.6% and 100%, respectively). Fusidic acid resistance was associated with more severe atopic dermatitis, demonstrated by higher EASI scores (median 17.8 vs 5.7, p=.009). Our results also corroborate the literature on the absence of cross-resistance between the aminoglycosides neomycin and gentamicin. Conclusions: Our data, in a southern Brazilian sample of AD patients, revealed a low prevalence of mupirocin and fusidic acid resistance of S. aureus atopic eczema colonizer strains. However, for neomycin and bacitracin, which are commonly used topical antimicrobial drugs in Brazil, high levels of resistance were identified. Further restrictions on the use of these antimicrobials seem necessary to keep resistance as low as possible.

Abstract: Advances in knowledge of neurocellulars relations have provided new directions in the understanding and treatment of numerous conditions, including atopic dermatitis. It is known that emotional, physical, chemical or biological stimuli can generate more accentuated responses in atopic patients than in non-atopic individuals; however, the complex network of control covered by these influences, especially by neuropeptides and neurotrophins, and their genetic relations, still keep secrets to be revealed. Itching and airway hyperresponsiveness, the main aspects of atopy, are associated with disruption of the neurosensory network activity. Increased epidermal innervation and production of neurotrophins, neuropeptides, cytokines and proteases, in addition to their relations with the sensory receptors in an epidermis with poor lipid mantle, are the aspects currently covered for understanding atopic dermatitis.

Abstract: Atopic dermatitis is a chronic inflammatory skin disease with a complex pathogenesis, where changes in skin barrier and imbalance of the immune system are relevant factors. The skin forms a mechanic and immune barrier, regulating water loss from the internal to the external environment, and protecting the individual from external aggressions, such as microorganisms, ultraviolet radiation and physical trauma. Main components of the skin barrier are located in the outer layers of the epidermis (such as filaggrin), the proteins that form the tight junction (TJ) and components of the innate immune system. Recent data involving skin barrier reveal new information regarding its structure and its role in the mechanic-immunological defense; atopic dermatitis (AD) is an example of a disease related to dysfunctions associated with this complex.