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Lichen sclerosus is one of the dermatoses that specifically affects the anogenital skin. It has peaks of incidence in prepubertal girls and postmenopausal women. The objective of this critical appraisal was to review systematically the evidence for efficacy and safety of different treatments. There are no randomized controlled studies of treatment in prepubertal girls and most studies are small case series or case reports. There is little focus on quality of life. [ABSTRACT FROM AUTHOR]

Skin diseases are the fourth most common cause of all human disease, affecting almost one-third of the world's population, yet their burden is often underestimated, despite their visibility.1,2 Burden of disease is a concept that was first developed in the 1990s by the Harvard School of Public Health, the World Bank and the World Health Organization (WHO) to describe death and loss of health due to diseases, injuries and risk factors for all regions of the world. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. [Extracted from the article]

Filaggrin loss-of-function ( FLG) mutations are associated with eczema and skin barrier impairment, but it is unclear whether skin barrier impairment precedes phenotypic eczema in FLG mutation carriers. To study the association between FLG mutations, skin barrier impairment and clinical eczema at 3 months of age. A total of 88 infants were examined for eczema. Disease severity was determined by the SCORAD eczema severity score. Transepidermal water loss (TEWL) was measured on unaffected forearm skin. Venous blood samples were screened for the four most common FLG mutations found in the U.K. white population (R501X, 2282del4, R2447X and S3247X). Median SCORAD and TEWL measurements in children with and without eczema and FLG mutations were compared. Thirty-three per cent (29/88) of children had clinical eczema. Median SCORAD was 10·6 (range 3·5-31·0). TEWL (g m h) was higher in children with eczema compared with unaffected infants (median TEWL 14·24 vs. 11·24, P < 0·001). Higher TEWL was associated with more severe disease ( r = 0·59, P < 0·001, median TEWL, SCORAD < 15, 13·1 vs. 29·6, SCORAD ≥ 15, P = 0·029). Clinically dry skin was associated with higher TEWL, even in the absence of eczema (median TEWL 17·55 vs. 11·08, P = 0·008). Seventeen per cent (15/88) of children carried at least one FLG mutation. FLG mutation carriers were significantly more likely to have clinically dry skin, even in the absence of eczema [odds ratio (OR) 8·50, 95% confidence interval (CI) 1·09-66·58, P = 0·042]. FLG mutation carriers were also more likely to have eczema by 3 months of age (OR 4·26, 95% CI 1·34-13·57, P = 0·014). FLG mutations were significantly associated with higher median TEWL (all children, FLG'yes' 21·59 vs. FLG'no' 11·24, P < 0·001), even without clinical eczema ( FLG'yes' 15·99 vs. FLG'no' 10·82, P = 0·01). By the age of 3 months, FLG mutations are associated with an eczema phenotype, dry skin and TEWL. The observation that TEWL is elevated in unaffected FLG mutation carriers suggests that skin barrier impairment precedes clinical eczema. [ABSTRACT FROM AUTHOR]

Background: Observational evidence suggests that infection with helminths protects against allergic disease and allergen skin sensitization. It is postulated that such effects are mediated by helminth-induced cytokine responses, in particular IL-10. Objective: We tested this hypothesis in a rural area of central Vietnam where hookworm infection is endemic. Methods: One thousand five hundred and sixty-six schoolchildren aged 6–17 were randomly allocated to receive either anti-helminthic therapy or a placebo at 0, 3, 6, and 9 months. We compared changes in the prevalence of exercise-induced bronchoconstriction, allergen skin sensitization, flexural eczema on skin examination, questionnaire-reported allergic disease (wheeze and rhinitis symptoms), and immunological parameters (hookworm-induced IFN-γ, IL-5, IL-10) between 0 and 12 months. Results: One thousand four hundred and eighty-seven children (95% of these randomized) completed the study. The most common helminth infections were hookworm (65%) and Ascaris lumbricoides (7%). There was no effect of the therapy on the primary outcome, exercise-induced bronchoconstriction (within-participant mean percent fall in peak flow from baseline after anti-helminthic treatment 2.25 (SD 7.3) vs. placebo 2.19 (SD 7.8, P=0.9), or on the prevalence of questionnaire-reported wheeze [adjusted odds ratio (OR)=1.16, 95% confidence interval (CI) 0.35–3.82, P=0.8] and rhinitis (adjusted OR=1.39, 0.89–2.15, P=0.1), or flexural dermatitis on skin examination (adjusted OR=1.15, 0.39–3.45, P=0.8). However, anti-helminthic therapy was associated with a significantly higher allergen skin sensitization risk (adjusted OR=1.31, 1.02–1.67, P=0.03). This effect was particularly strong for children infected with A. lumbricoides at baseline (adjusted OR=4.90, 1.48–16.19, P=0.009). Allergen skin sensitization was inversely related to hookworm-specific IL-10 at baseline (adjusted OR=0.76, 0.59–0.99, P=0.04). No cytokine tested, including IL-10, changed significantly after the anti-helminthic therapy compared with the placebo. Conclusion: A significant reduction in worm burden over a 12-month period in helminth-infected children increases the risk of allergen skin sensitization but not of clinical allergic disease. The effect on skin sensitization could not be fully explained by any of the immunological parameters tested. Cite this as: C. Flohr, L. N. Tuyen, R. J. Quinnell, S. Lewis, T. T. Minh, J. Campbell, C. Simmons, G. Telford, A. Brown, T. T. Hien, J. Farrar, H. Williams, D. I. Pritchard and J. Britton, Clinical & Experimental Allergy, 2010 (40) 131–152. [ABSTRACT FROM AUTHOR]

The so-called‘hygiene hypothesis’ postulates an inverse relationship between atopic dermatitis (AD) and an environment that leads to increased pathogen exposure.We sought to systematically identify, summarize and critically appraise: (i) the epidemiological evidence to suggest that environmental exposures that lead to an increase in microbial burden reduce the risk of AD; (ii) whether any specific infections have been shown to reduce AD risk; (iii) whether there is a link between immunizations, use of antibiotics and AD risk; and (iv) to comment on the new therapeutic approaches in AD that have evolved out of the‘hygiene hypothesis’.We searched Medline from 1966 until August 2004 to identify relevant studies for inclusion. Differences in study design and populations did not allow formal meta-analysis. Studies were therefore described qualitatively.We identified 64 studies that were relevant to our review, 27 (42%) of which were of prospective design. There was prospective evidence to support an inverse relationship between AD and endotoxins, early day care and animal exposure. Two well-designed cohort studies have found a positive association between infections in early life and AD, and measles vaccination and AD. Antibiotic use was consistently associated with an increase in AD risk even into the antenatal period, although a few studies did not reach conventional statistical significance. A few small randomized controlled trials have suggested that probiotics can reduce AD severity and that probiotics may also be able to prevent AD to some degree.Although population-based studies have suggested a consistent inverse relationship between AD and increasing family size, this does not seem to be explained by a straightforward increased exposure to a single environmental pathogen. The effect seen with early day care, endotoxin and animal exposure may be due to a nonpathogenic microbial stimulus of a chronic or recurrent nature. This would also explain the risk increase associated with antibiotic use. Caution should prevail in the prescribing of antibiotics early in life, especially in children with a family history of AD. Larger well-designed pragmatic trials on probiotics and the prevention and treatment of AD are now needed to inform whether such interventions should be used in routine clinical practice. [ABSTRACT FROM AUTHOR]

Summary: Case reports and case series remain an important part of journals and are often first to document medical breakthroughs. This article reviews their characteristics, aims and limitations. It provides information on how to increase the validity of the bedside decision‐making process that these studies report, using tools such as validated outcomes and split‐body or n‐of‐1 trials. A section describing tools to improve writing of case reports and case series provides suggestions for detailed reporting and good evaluation of novelty, validity and relevance. It includes general and British Journal of Dermatology‐specific guidance. [ABSTRACT FROM AUTHOR]

How to integrate atopic dermatitis in the management of skin neglected tropical diseases in Sub-Saharan Africa? However, NTDs represent only 2%-4% of all skin diseases in SSA.[1] Geographical and financial hurdles make skin NTDs in SSA diseases of poverty affecting underserved people. Itch is a common denominator between skin NTDs, such as scabies and skin non NTDs such as AD. [Extracted from the article]

Summary: Background: Clinical practice guidelines (CPGs) play a critical role in standardizing and improving treatment outcomes based on the available evidence. It is unclear how many CPGs are available globally to assist clinicians in the management of patients with skin disease. Objectives: To search for and identify CPGs for dermatological conditions with the highest burden globally. Methods: We adapted a list of 12 dermatological conditions with the highest burden from the Global Burden of Disease (GBD) study 2019. A systematic literature search was done to identify CPGs published between October 2014 to October 2019. The scoping review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) framework. Results: A total of 226 CPGs were included. Melanoma had the greatest representation in the CPGs, followed by dermatitis and psoriasis. Skin cancers had a relatively high CPG representation but with lower GBD disease burden ranking. There was an uneven distribution by geographical region, with resource‐poor settings being under‐represented. The skin disease categories of the CPGs correlated weakly with the GBD disability‐adjusted life‐years metrics. Eighty‐nine CPGs did not have funding disclosures and 34 CPGs were behind a paywall. Conclusions: The global production of dermatology CPGs showed wide variation in geographical representation, article accessibility and reporting of funding. The number of skin disease CPGs were not commensurate with its disease burden. Future work will critically appraise the methodology and quality of dermatology CPGs and lead to the production of an accessible online resource summarizing these findings. What is already known about this topic? Skin‐related diseases are leading causes of disability and disease burden globally.Clinical practice guidelines (CPGs) are important to ensure appropriate standards of care for skin conditions.The number, distribution, accessibility and quality of dermatological CPGs available globally is unknown. What does this study add? This is the first scoping review to describe the distribution of CPGs for common dermatological conditions of highest burden available internationally.Inflammatory skin conditions and skin cancers represent a higher proportion of the number of CPGs produced, largely driven by high‐income countries.Further studies to evaluate the quality of CPGs in dermatology, and the development of CPGs in skin diseases predominantly affecting resource‐poor countries, are needed. Linked Comment: T.E. Sivesind and R.P. Dellavalle. Br J Dermatol 2021; 185:690–691. Plain language summary available online [ABSTRACT FROM AUTHOR]

Dr. Seneschal has been an investigator, speaker, or consultant for Novartis, Abbvie, Sanofi, LeoPharma and Eli Lilly. Dr. De Raeve is a consultant, member of scientific advisory boards and/ or received personal fees and non-financial support from LEO Pharma, Pierre Fabre, Sanofi-Genzyme and Bioderma. Dr. Vestergaard has been investigator, speaker, or consultant for Novartis, Abbvie, Sanofi, LeoPharma and Eli Lilly. [Extracted from the article]

Summary: Atopic eczema is a skin disease affecting around 20% of UK children, 16% of whom have moderate to severe disease. Severe atopic eczema can cause sleep disturbance, poor school attendance and social withdrawal, as well as attention‐deficit hyperactivity disorder, anxiety and clinical depression. Skin can become infected and this can be a reason for hospital admission. Although most cases of atopic eczema can be treated with emollients, topical anti‐inflammatory treatments and/or ultraviolet (UV) therapy, around 2% of children require oral (taken by mouth) immuno‐suppressive treatment. The main treatment options of this type (called systemic agents) are Ciclosporin (CyA) and Methotrexate (MTX) and there is concern about their potential short‐ and long‐term side effects. This article explains an upcoming clinical trial called "The TREatment of severe Atopic eczema Trial" (TREAT). TREAT addresses key clinical questions for the management of children with severe atopic eczema using systemic medication, in particular whether there is a difference in speed of onset (how long the drug takes to start working), effectiveness, side‐effect profile and reduction in flares post‐treatment between CyA and MTX, and the cost‐effectiveness of the drugs. Furthermore, TREAT examines how both drugs go about reducing inflammation in the body and on the skin. The study will involve 102 children aged 2 to 16 years. Linked Article: Irvine et al. Br J Dermatol 2018; 179:1297–1306 [ABSTRACT FROM AUTHOR]