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Background Atopic dermatitis (AD) may affect cognitive function, but studies are limited and inconsistent. The effect of AD severity on cognition remains underexplored and few previous studies have examined clinically validated or repeated measures of cognition throughout childhood. Objectives To evaluate the relationship of AD activity and severity with validated measures of general cognition in a longitudinal birth cohort. Methods We conducted cross-sectional analyses using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK cohort of 14 975 individuals followed prospectively since their birth in 1991–92. AD was assessed 11 times between the age of 6 and 166 months. Mothers were asked if their child had an 'itchy, dry skin rash in the joints and creases', and AD status was time-updated accordingly as 'never', 'maybe', 'inactive', 'active/mild' or 'active/moderate–severe'. General cognition [i.e. intelligence quotient (IQ)] was measured at 18, 49, 103 and 186 months of age using the Griffiths Mental Development Scales (GMDS), Wechsler Preschool and Primary Scale of Intelligence (WPPSI), Wechsler Intelligence Scale for Children (WISC) and Wechsler Abbreviated Scale of Intelligence (WASI), respectively. Multivariable linear regression was used to compare IQ with respect to nearest time-updated AD status. Secondary analyses were stratified by the presence or absence of psychiatric or learning disorders. An exploratory longitudinal analysis of IQ across all four outcome assessments was conducted using generalized estimating equations. Results No significant associations between AD status and full-scale IQ scores on the GMDS, WPPSI, WISC and WASI were observed after adjustment for sociodemographic factors, atopic comorbidities and sleep characteristics. However, at 8 years of age, WISC Performance IQ was slightly, although statistically significantly, lower among children with active/moderate–severe AD [β coefficient –2.16, 95% confidence interval (CI) –4.12 to –0.19] and Verbal IQ was slightly, but statistically significantly, higher among those with inactive AD (β coefficient 1.31, 95% CI 0.28–2.34) compared with those without AD. Analyses stratified by psychiatric or learning disorders, and exploratory longitudinal analyses of cognition revealed similar findings. Conclusions We did not find any clinically meaningful associations between AD activity and severity and general cognitive function during early childhood and adolescence. Future studies should incorporate objective measures of AD severity and investigate outcomes beyond IQ. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) may be associated with an increased burden of neuropsychiatric outcomes such as anxiety and depression, but longitudinal data on the impact of AD severity is lacking, and a comprehensive assessment of neuropsychiatric disease in adults with AD is needed. Objectives: Determine risk of incident neuropsychiatric disease among adults with AD by severity. Methods: A cohort study using electronic health records data from UK general practices from 1994 to 2015. Adults (≥18 years) with AD were matched on age, practice and index date to patients without AD. AD severity was categorized using treatments and dermatology referrals. Outcomes were incident anxiety, depression, bipolar disorder, schizophrenia, attention‐deficit/hyperactivity disorder (ADHD), autism, obsessive‐compulsive disorder (OCD), suicidality and completed suicide. Results: Comparing 625,083 adults with AD to 2,678,888 adults without AD, AD was associated with higher risk of anxiety [HR 1.14 (1.13–1.15)], depression [1.14 (1.13–1.15)] and OCD [1.48 (1.38–1.58)] across all severities. Mild or moderate AD was also associated with higher risk of autism, ADHD, bipolar disorder and suicidality. Conclusions: Atopic dermatitis is associated with a higher risk of multiple neuropsychiatric conditions, but these risks differ by specific condition and AD severity. Clinicians should inquire about mental health in patients with AD. [ABSTRACT FROM AUTHOR]

Background Atopic dermatitis (AD) is a common chronic inflammatory skin condition. While other chronic inflammatory conditions are associated with increased risk of venous thromboembolism (VTE), associations between AD and VTE have not been established. Objectives We examined whether AD is associated with an increased risk of VTE in a population-based study. Methods Electronic health records were extracted from UK general practices contributing to the Optimum Patient Care Research Database (1 January 2010 to 1 January 2020). All adults with AD were identified (n = 150 975) and age- and sex-matched with unaffected controls (n = 603 770). The risk of VTE, consisting of pulmonary embolism (PE) or deep-vein thrombosis (DVT), was compared in people with AD vs. controls using Cox proportional hazard models. PE and DVT were examined separately as secondary outcomes. Results We identified 150 975 adults with active AD and matched them with 603 770 unaffected controls. During the study, 2576 of those with active AD and 7563 of the matched controls developed VTE. Individuals with AD had a higher risk of VTE than controls [adjusted hazard ratio (aHR) 1.17, 95% confidence interval (CI) 1.12–1.22]. When assessing VTE components, AD was associated with a higher risk of DVT (aHR 1.30, 95% CI 1.23–1.37) but not PE (aHR 0.94, 95% CI 0.87–1.02). The VTE risk was greater in older people with AD (≥ 65 years: aHR 1.22, 95% CI 1.15–1.29; 45–65 years: aHR 1.15, 95% CI 1.05–1.26; < 45 years: aHR 1.07, 95% CI 0.97–1.19) and those with obesity [body mass index (BMI) ≥ 30: aHR 1.25, 95% CI 1.12–1.39; BMI < 30: aHR 1.08, 95% CI 1.01–1.15). Risk was broadly consistent across mild, moderate or severe AD. Conclusions AD is associated with a small increase in risk of VTE and DVT, with no increase in risk of PE. The magnitude of this risk increase is modest in younger people, and those without obesity. [ABSTRACT FROM AUTHOR]

Background Atopic dermatitis (AD) is associated with immunological dysfunction, which may influence cancer development. Previous studies of AD and cancer demonstrate inconsistent results and few of these studies examined children or AD severity and treatment. Objectives To determine malignancy risk among children and adults with AD. Methods We conducted a cohort study using electronic health records data from UK general practices in The Health Improvement Network between 1994 and 2015. Children (< 18 years old) and adults (≥ 18 years old) with AD were matched on age, practice and index date to patients without AD. AD was categorized as mild, moderate or severe using treatments and dermatology referrals as proxies. The primary outcome was any incident malignancy, including in situ malignancy, identified using diagnosis codes and categorized into haematological, skin and solid organ malignancies. Secondary outcomes included specific malignancies: leukaemia, lymphoma, melanoma, nonmelanoma skin cancer (NMSC) and common solid-organ cancers. Results Among 409 431 children with AD (93.2% mild, 5.5% moderate, 1.3% severe) and 1 809 029 children without AD who had median follow-up of 5–7 years, the incidence rates of malignancy were 1.9–3.4 and 2.0 per 10 000 person-years (PY), respectively. The adjusted risk of malignancy overall did not differ with respect to AD [hazard ratio (HR) 1.02 (95% confidence interval 0.92–1.12)]. Severe AD was associated with increased lymphoma risk [HR 3.18 (1.41–7.16), excluding cutaneous T-cell lymphoma (CTCL)], and mild AD was associated with increased NMSC risk [1.55 (1.06–2.27)]. Among 625 083 adults with AD (65.7% mild, 31.4% moderate, 2.9% severe) and 2 678 888 adults without AD who had median follow-up of 5 years, incidence rates of malignancy were 97.4–125.3 per 10 000 PY and 103.7 per 10 000 PY, respectively. The adjusted risk of any malignancy did not differ with respect to AD [HR 1.00 (0.99–1.02)]. However, adults with severe AD had a twofold higher risk of non-CTCL lymphoma. AD was also associated with slightly higher skin cancer risk [HR 1.06 (1.04–1.08)] and slightly lower solid cancer risk [0.97 (0.96–0.98)] but results varied by specific cancers and AD severity. Conclusions Epidemiological evidence does not support a strong overall malignancy risk in AD but lymphoma risk may be increased with severe AD. [ABSTRACT FROM AUTHOR]

Dupilumab is prescribed in one dosage across adult atopic dermatitis patients. Differences in drug exposure may explain variation in treatment response. Investigating the clinical relevance of dupilumab serum concentration in atopic dermatitis in real-world practice. In two centers (Netherlands, UK), adults treated with dupilumab for atopic dermatitis were evaluated for effectiveness and safety pretreatment and at 2, 12, 24, and 48 weeks; trough serum samples were analyzed for dupilumab concentration at corresponding time points. In 149 patients, median dupilumab levels during follow-up ranged from 57.4 to 72.4 μg/mL. Levels showed high inter-patient and low intra-patient variability. No correlation was found between levels and ΔEASI. At 2 weeks, levels of ≥64.1 μg/mL predict EASI ≤7 at 24 weeks (specificity:100%, sensitivity:60%; p =.022). At 12 weeks, ≤32.7 μg/mL predicts EASI >7 at 24 weeks (sensitivity:95%, specificity:26%; p =.011). Inverse correlations were found between baseline EASI and levels at 2, 12, and 24 weeks (r = −0.25 to 0.36; p ≤.023). Low levels were particularly observed in patients with adverse events, treatment interval deviation, and discontinuation. At the on-label dosage, the measured range of dupilumab levels does not seem to yield differences in treatment effectiveness. However, disease activity does seem to influence dupilumab levels - higher baseline disease activity results in lower levels at follow-up. [ABSTRACT FROM AUTHOR]

Background: Paediatric atopic dermatitis (AD) has been linked to neuropsychiatric comorbidities such as depression, anxiety and attention‐deficit/hyperactivity disorder (ADHD). However, longitudinal data are limited, and the effect of AD severity on neuropsychiatric outcomes requires further characterization. Objectives: To determine the risk of several major neuropsychiatric conditions in children with AD. Methods: We analysed UK health records data in a population‐based cohort study. Each patient <18 years old with AD was matched to up to five unaffected patients on age, practice and index date. Treatments served as proxies for AD severity, which was analysed in a time‐updated manner. Outcomes were incident anxiety, depression, bipolar disorder, schizophrenia, ADHD, autism, obsessive–compulsive disorder (OCD), suicidal ideation or attempt, and completed suicide. Results: A total of 409,431 children with AD (93.2% mild, 5.5% moderate, 1.3% severe) were compared to 1,809,029 children without AD. In Cox regression models adjusted for age, sex, socioeconomic status and other atopic comorbidities, no statistically significant relationships were observed between AD and incident anxiety (HR 1.01, 95% CI 0.99–1.03), ADHD (1.02, 0.97–1.06), autism (1.02, 0.98–1.06), bipolar disorder (1.08, 0.85–1.36), suicidal ideation/attempt (0.98, 0.95–1.01) or completed suicide (0.85, 0.64–1.14). Children with AD were less likely to develop depression (0.93, 0.91–0.95) or schizophrenia (0.72, 0.54–0.95) but more likely to develop OCD (1.26, 1.16–1.37). However, there was substantial variation by AD severity and age in both the direction and magnitude of effect for many of the neuropsychiatric conditions examined. Conclusions: The was no substantial impact of AD on the overall risk of many neuropsychiatric conditions in children, but disease severity and age may be important modifying factors. Additional research is needed to further dissect the complex relationship between paediatric AD and neuropsychiatric comorbidities. [ABSTRACT FROM AUTHOR]

Linked Article: Nakamura et al. Br J Dermatol 2022; 186:274–284. Atopic dermatitis (AD, also known as eczema) is the most common chronic inflammatory skin disease affecting infants and children. Skin symptoms vary between individuals and within individuals in severity and location, as well as over time. AD usually starts in early infancy, with a proportion of affected individuals recovering in later childhood. Although the variability of AD is now widely accepted, there is no general agreement on what the different subtypes are. In a UK population‐based birth cohort, we explored what happened with children's AD over their childhood (from 0 to 11 years) using data from different sources (validated questionnaires and healthcare records). We also investigated if it was possible to identify which children would have persistent AD and which children would recover. We analysed a lot of data and our results suggest that caution should be used when comparing results from different studies, as AD definitions based on different data sources may lead to inconsistent findings. We found that in children with persistent AD there were associations with other health conditions including a striking increase in the risk of peanut allergy. We also found that having moderate or severe AD at the age of 3 years increased the risk of persistent AD. Linked Article: Nakamura et al. Br J Dermatol 2022; 186:274–284. [ABSTRACT FROM AUTHOR]

Stress is commonly quoted as a risk factor for psoriasis and eczema, but there is very little evidence. The aim of this study was to investigate the association between partner death (an extremely stressful life event) and psoriasis or eczema. We conducted cohort studies (which follow research participants over a period of time) using data from the UK Clinical Practice Research Datalink (1997‐2017) and Danish nationwide registries (1997‐2016) comparing risk of psoriasis and eczema in people whose partners died to people without partner death. The comparison group were matched to each person with partner death by age, sex, county of residence (Denmark), and general practice (UK). We assessed how strong the evidence was that partner death was associated with psoriasis and eczema in the UK and Denmark and then combined findings in both settings. In two cohort studies in general populations in the UK and Denmark, there was no evidence of an increased risk of psoriasis associated with partner bereavement. There was a short‐term increased risk of eczema in three years following partner death, which peaked during the first three months. However, there was no evidence of an increased long‐term risk of eczema. Acute stress may play a role in triggering the onset of new eczema or relapse of eczema previously in remission. We observed no evidence for increased long‐term risk of psoriasis and eczema following bereavement. Linked Article: Wong et al. Br J Dermatol 2020; 183:321–331. [ABSTRACT FROM AUTHOR]