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Summary: Background: It was recently demonstrated that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. Studies have shown that physicians not trained as psychiatrists underdiagnose depression. This has not been explored among dermatologists. Objectives: To estimate the concordance between clinical assessment of depression and anxiety by a dermatologist and assessment with the Hospital Anxiety and Depression Scale (HADS). Methods: The study was an observational cross‐sectional multicentre study of prevalent cases of skin diseases in 13 countries in Europe. Consecutive patients were recruited in outpatient clinics and filled in questionnaires prior to clinical examination by a dermatologist who reported any diagnosis of skin disease and signs of mood disorders. Results: Analysis of the 3635 consultations showed that the agreement between dermatologist and HADS was poor to fair (lower than 0·4) for all diagnosis categories. The true‐positive rate (represented by the percentage of dermatologists recognizing signs of depression or anxiety in patients with depression or anxiety as defined by a HADS value ≥ 11) was 44·0% for depression and 35·6% for anxiety. The true negative rate (represented by the percentage of dermatologists not detecting signs of depression or anxiety in non‐depressed or non‐anxious patients defined by HADS‐value < 11) was 88.8% for depression and 85.7% for anxiety. Conclusions: Dermatologists in Europe tend to underestimate mood disorders. The results suggest that further training for dermatologists to improve their skills in diagnosing depression and anxiety might be appropriate. When present, the psychological suffering of patients with dermatological conditions needs to be addressed. [ABSTRACT FROM AUTHOR]

Objectives:To compare the intake of total sugars, foods and drinks rich in added sugar, and energy in children on weekdays (Monday-Thursday), Fridays and weekends.Methods:Dietary intake (g, kJ, energy %) was assessed using a computerized 24-h recall method in a sample of 2- to 9-year-old children from Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain and Sweden who were participating in the IDEFICS baseline study (2007-2008). Analyses were performed in 9497 children by selecting one 24-h recall per child (for comparison of weekdays vs weekends, and Fridays vs weekdays and weekends). Selected stratified analyses were performed by country and age group.Results:Intake of total sugars exceeded 20 energy % in all countries but one. In the non-stratified analyses, the intakes of total sugars and foods and drinks rich in added sugar were found to be higher on weekends compared with weekdays (both P<0.001), and intakes on Fridays were a mix between intakes on weekdays and weekends. Energy intake did not differ between weekdays and weekends. Results were somewhat heterogeneous, both across countries and age groups.Conclusions:High intake of sugar remains an important nutritional problem in children of many European countries. Interventions aiming to prevent this diet pattern may optimize their impact by targeting dietary habits on Fridays and weekends. Furthermore, when conducting dietary assessment in children, data from weekends and Fridays in combination with a selection of Mondays to Thursdays are needed to capture habitual sugar intake. Age and dietary cultures should also be considered in dietary intervention and assessment as effect modifications were seen for both age and country. [ABSTRACT FROM AUTHOR]

Background: Allergic contact dermatitis can negatively impact an individual's daily life in terms of work and interpersonal relationships. Patch‐tested individuals show an improved quality of life (QoL). Objectives: We aimed to assess the impact on QoL after patch testing and what value an intervention would have on QoL. Methods: Dermatology Quality of Life Index (DLQI) were assessed in participants with positive patch test reaction. The participants were randomized, in parallel design, into two groups that received either standard information (controls, n = 70) or a reminder letter in addition to standard information (intervention group, n = 66), ClinicalTrials.gov NCT01953380. Results: The response rate was 74% (n = 136). The DLQI score was significantly lower 1 year after patch testing in comparison with baseline in the entire group (mean DLQI 6.3 and 4.5 respectively, 95% CI 0.93–2.72, P < 0.001). However, linear regression analyses showed no significant differences in DLQI score at follow‐up between the intervention and control groups. Neither age nor gender had impact on DLQI score. Conclusion: There was an improvement of QoL at follow‐up in the entire group. However, the intervention performed did not show any significantly greater improvement concerning QoL. Further research is needed to understand what factors apart from patch testing and medical care may affect QoL in patients with contact dermatitis, and what interventions are needed to improve QoL. [ABSTRACT FROM AUTHOR]

Background Atopic dermatitis (AD) affects health and quality of life (QoL) and also has great impact on both healthcare costs and costs to society. Objectives The aim of the study was to analyse the cost-effectiveness of treatment with tacrolimus ointment vs. standard treatment in patients with moderate to severe AD. Methods A Markov simulation model was constructed capturing several key features of AD and its treatment: disease severity, treatment alternatives, and QoL. The model was populated with data from three sources: (i) efficacy data from a randomized controlled trial including patients with moderate to severe AD treated with either tacrolimus ointment or standard treatment (corticosteroids), (ii) resource utilization and QoL data from a patient survey including 161 Swedish patients with AD, and (iii) official price lists. Costs were calculated according to disease severity for the two treatment alternatives using the perspective of the Swedish healthcare sector. Two analyses were performed, one based on the quantity of medication used in the trial and one based on the survey data. The relationship between effectiveness of tacrolimus ointment and the amount of medication used was tested in sensitivity analyses. Results In the model simulations patients with severe AD treated with tacrolimus ointment experienced on average 4·6 more AD-free weeks per year than patients given standard treatment. The corresponding figure for patients with moderate AD was 6·5 more AD-free weeks per year. The cost-effectiveness ratios [cost per Quality Adjusted Life Year (QALY) gained] for treatment with tacrolimus ointment vs. standard treatment were £2334 for moderate AD and £3875 for severe AD when treatment patterns from the survey were assumed, and £8269 for moderate AD and £12 304 for severe AD when treatment patterns from the clinical trial were assumed. The results of sensitivity analyses were all well within limits to be considered cost-effective. Conclusions Estimates of the incremental cost-effectiveness ratio are far below the currently discussed threshold in Sweden, corresponding to approximately £48 700 per QALY gained, and equivalent thresholds in other countries. Treatment with tacrolimus ointment in patients with moderate and severe AD can therefore be considered cost-effective. [ABSTRACT FROM AUTHOR]

Several studies among dermatological patients have shown a link between various chronic dermatological diseases and mental morbidity. To explore the association between self-reported skin morbidity and psychosocial factors in the general population. This population-based cross-sectional study is part of the Oslo Health Study conducted during 2000–2001. All individuals in Oslo County, Norway, born in 1924/25, 1940/41, 1955, 1960 and 1970 received a postal questionnaire, which 18 770 men and women answered. The questionnaire provided information on sociodemographic factors and self-reported health and psychosocial factors. Dichotomous variables for 10 self-reported skin complaints were used. These were previously validated and refer to the most common chronic skin diseases. Mental distress was measured with a validated 10-item instrument, the Hopkins Symptom Check List-10; social support with the number of confidants; and negative life events with a 12-item validated instrument. The odds ratio (OR) for mental distress was 1·70 [95% confidence interval (CI) 1·21–2·38] for having itch, 1·64 (95% CI 1·15–2·34) for pimples and 1·72 (95% CI 1·06–2·80) for face rash in an adjusted model. In an adjusted model the OR for skin disease was 1·60 (95% CI 1·39–1·84) when the individual had experienced more than two negative life events; and 2·52 (95% CI 2·12–3·00) for mental distress. Skin morbidity increased for both genders, with poor social support network. There was a significant interaction between social support network and negative life events in the logistic regression model for skin disease when adjusted for sociodemographic factors. The study quantifies the association between dermatological problems and psychosocial factors at a population level. It underlines the need to focus on these issues in research and needs assessment in dermatology. [ABSTRACT FROM AUTHOR]

Previous studies on prevalence of skin diseases in the population have been based on clinical examination of a sample of the population. A questionnaire on self-reported skin complaints has recently been developed and validated for use in population surveys, but has not been used until now. To quantify the skin morbidity in an adult urban population assessed by a newly developed self-measurement instrument, and to explore the associations between skin morbidity and sociodemographic factors in the community. The study was a population-based cross-sectional study carried out in the city of Oslo. Adult participants ( n = 18 770) aged 30–76 years answered a questionnaire giving information on self-reported skin complaints, and which included demographic, psychosocial and general health variables. Itch was the dominating skin complaint in all age groups. Adjusted odds ratios for itch, self-reported hand eczema and self-reported acne showed significant associations with female gender and reporting households of middle income. There was no association with employment categories. This study shows that skin complaints referring to the most common chronic skin diseases varied with age, gender and marital status, and worsened with middle-income household. It provides evidence that household income is associated with skin morbidity, bringing dermatological aspects to studies on health inequalities. [ABSTRACT FROM AUTHOR]

Estimation of skin diseases in the community is challenging because we do not easily have access to the nonhealthcare-seeking population. A potential tool is a questionnaire asking for self-reported skin complaints. Such an instrument has not yet been developed. To validate a simple instrument assessing skin morbidity in the general adult population, to predict clinical skin morbidity from self-reported skin complaints. A questionnaire was drawn up in Norwegian and validated against clinical signs in two samples of an urban population, 100 healthcare-seeking adults in a dermatological clinic, and 100 nonhealthcare-seeking adults. A total self-reported score was calculated and validated against severity of clinical signs (no sign, trivial, moderate or severe). The inter-rater agreement was assessed in a small study including 16 patients from a dermatological clinic. The participation rate was 98%. The sensitivity was 61%, the specificity 69% and the positive predictive value 82% when the caseness criterion was any clinical sign of skin disease. The agreement was good between the two observers for clinical skin morbidity, with κ = 0·67. This questionnaire is a simple tool to evaluate skin morbidity in an adult population. The use of self-reported complaints to predict clinical morbidity may be of value in quantifying and exploring skin diseases at the population level. Further studies are needed to improve the instrument. It is our intention to demonstrate the potential usefulness of this questionnaire in a forthcoming population survey in Norway. [ABSTRACT FROM AUTHOR]

In addition to proton-pumping complex I, plant mitochondria contain several type II NAD(P)H dehydrogenases in the electron transport chain. The extra enzymes allow the nonenergy-conserving electron transfer from cytoplasmic and matrix NAD(P)H to ubiquinone. We have investigated the type II NAD(P)H dehydrogenase gene families in Arabidopsis. This model plant contains two and four genes closely related to potato (Solanum tuberosum) genes nda1 and ndb1, respectively. A novel homolog, termed ndc1, with a lower but significant similarity to potato nda1 and ndb1, is also present. All genes are expressed in several organs of the plant. Among the nda genes, expression of nda1, but not nda2, is dependent on light and circadian regulation, suggesting separate roles in photosynthesis-associated and other respiratory NADH oxidation. Genes from all three gene families encode proteins exclusively targeted to mitochondria, as revealed by expression of green fluorescent fusion proteins and by western blotting of fractionated cells. Phylogenetic analysis indicates that ndc1 affiliates with cyanobacterial type II NADH dehydrogenase genes, suggesting that this gene entered the eukaryotic cell via the chloroplast progenitor. The ndc1 should then have been transferred to the nucleus and acquired a signal for mitochondrial targeting of the protein product. Although they are of different origin, the nda, ndb, and ndc genes carry an identical intron position. [ABSTRACT FROM AUTHOR]

Summary Background Hand eczema is a common skin disease that affects about 10% of the general population of working age in Sweden. The resulting long sick-leave periods and need for changes of work and re-training put an economic burden on society, and there is an interest indeveloping cost-effective epidemiological surveillance instruments such as a screening questionnaire. Objectives In a search for a simple screening questionnaire for hand eczema we compared the validity of a question about the presence of hand eczema with hand eczema diagnosis based on self-reported signs. Methods Consecutive patients (n = 95) referred for hand eczema and people in an ongoing epidemiological survey (n = 113) participated in the study. Before seeing an experienced dermatologist they had to: (1) answer a short questionnaire about current signs and symptoms from the hands; and (2) state whether they had hand eczema on the day of examination. The minimum criteria for hand eczema diagnosed by the dermatologist (‘gold standard’) were erythema and papules or vesicles, or erythema and scaling and fissures/lichenification. Results Of the 208 persons examined 93 fulfilled the criteria for hand eczema according to the ‘gold standard’. Hand eczema diagnosis based on clinical signs reported in the questionnaire by the participants gave a sensitivity of 0·62 and a specificity of 0·87 in comparison with the dermatologists' diagnoses. Regarding the question about current hand eczema, agreement was good between the participants' and the dermatologists' judgements, giving a sensitivity of 0·87 and a specificity of 0·79. Comparing clinical signs reported by the participants and the findings by the dermatologists, the best agreement was for fissures, with a κ -value of 0·65 (95% CI 0·55–0·75), and the poorest was for papules with 0·47 (95% CI 0·32–0·62). Conclusions It was difficult for the... [ABSTRACT FROM AUTHOR]

Cold stress effects on the expression of genes for respiratory chain enzymes were investigated in potato (Solanum tuberosum L., cv. Desiree) leaves. The nda1 and ndb1 genes, homologues to genes encoding the non-proton-pumping respiratory chain NADH dehydrogenases of Escherichia coli and yeast, were compared to genes encoding catalytic subunits of the proton-pumping NADH dehydrogenase (complex I). Using a real-time PCR system, we demonstrate a specific and gradual decrease of the NDA1 transcript after exposing the plants to 5°C. After 6 days of cold treatment the NDA1 transcript abundance is 10% of the original level. This decrease is accompanied by specific decreases of immunodetected NDA protein and internal rotenone-insensitive NADH oxidation in mitochondria isolated from cold-treated plants. The alternative oxidase is not cold-induced neither at the protein nor at the activity level. The results are discussed in relation to the recent finding that the nda1 gene expression is completely light-dependent. [Copyright &y& Elsevier]

SummaryExpression of genes for respiratory chain dehydrogenases was investigated in potato (Solanum tuberosum L. cv. Desiree) leaves. The recently characterized nda1 and ndb1 genes, homologues to genes encoding the non-proton pumping respiratory chain NADH-dehydrogenases of Escherichia coli and yeast, were compared to genes encoding catalytic subunits of the proton-pumping NADH dehydrogenase (complex I). As leaves develop from young to mature, the nda1 transcript level increases, accompanied by an elevation in immunodetected NDA protein and internal rotenone-insensitive NADH oxidation. The other investigated transcripts, proteins and NAD(P)H oxidation activities were essentially unchanged. A variation in transcript level, specific for nda1, is seen at different times of the day with highest expression in the morning. This variation also influences the apparent developmental induction. Further, the nda1 mRNA in leaves specifically and completely disappears during dark treatment, with a rapid re-induction when plants are returned to light. Corresponding immunodetected NDA protein is specifically decreased in mitochondria isolated from dark-treated plants, accompanied by a lower capacity for internal rotenone-insensitive NADH oxidation. Complete light dependence and diurnal changes in expression have previously not been reported for genes encoding respiratory chain proteins. Qualitatively similar to NDA, the alternative oxidase showed developmental induction and light dependence. In addition to the specific change in nda1, a general, slower down-regulation in darkness was seen for the other NAD(P)H dehydrogenase genes. The nda1 expression during development, and in response to light, indicates a specific role of the encoded enzyme in the photosynthetically associated mitochondrial metabolism. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the cumulative incidence, point prevalence, and severity of atopic dermatitis (AD) in a pediatric population. We also aimed to identify differential diagnoses relevant to AD in this population. Methods: Children scheduled for a health visit at 5.5 years of age were selected consecutively during the period October 1997–March 1998 from two cities in southern Sweden (Göteborg and Kristianstad). Schultz Larsen's questionnaire was used to evaluate the cumulative incidence of AD. Clinical examination was performed by dermatologists (A.B. and Å.S.) for those children with active eczema. The UK working party's criteria were used for the clinical diagnosis of AD. The SCORAD index was used to evaluate the severity of eczema. This index includes evaluation of extent, intensity, and subjective symptoms to a maximum score of 103 points. Results: In Göteborg 1219 and in Kristianstad 742 questionnaires were answered regarding 1961 children, 1004 boys and 957 girls. The response rate was 89%. According to the answers to Schultz Larsen's questionnaire, the cumulative incidence of AD in the whole material was 20.7% (406/1961) (CI 95% 18.9–22.5). In Göteborg, 104 of the examined children fulfilled the UK working party's criteria, equivalent to a point prevalence of 8.5% (CI 95% 7.0–10.1). In Kristianstad, the corresponding point prevalence was 11.5% (CI 95% 9.2–13.8). The severity of AD was evaluated in all children with visible eczema. SCORAD evaluation was performed in 155 of the 157 children with visible eczema. The majority of children had mild or moderate eczema; mean value 20.5 (CI 95% 18.7–22.3), median 19.6. Of the 96 children who did not fulfil the criteria of AD, other skin disorders were diagnosed in 51 at the clinical examination. Dry skin was by far the most common differential diagnosis. Conclusions: We have used validated protocols to evaluate the cumulative incidence,... [ABSTRACT FROM AUTHOR]

The purpose of this comparative study was to record the prevalence and to estimate the incidence of self-reported hand dermatosis in a cohort of upper secondary school pupils on two different occasions, in 1995 and 1997. A previously validated questionnaire was used. Of the 1273 pupils invited to participate, 1136 (89·2%) responded to the questionnaire. The 1-year prevalence increased, although not significantly, from 9·6% in 1995 to 10·5% in 1997. For girls, the 1-year prevalence increased significantly, from 12·4% to 15·7%, while for boys the 1-year prevalence decreased, but not significantly, from 6·7% to 5·1%. The cumulative incidence was significantly higher (P < 0·001) among the girls (10·5%) than among the boys (2·8%). Multiple logistic regressions showed that the highest risk factors for 1-year prevalence in 1995 were having self-reported childhood eczema, and a family history of atopic eczema or asthma. In 1997, the highest risk factors were self-reported childhood eczema, female gender and a family history of atopic eczema. This study has identified the point at which the genders diverge with regard to hand dermatosis, with boys tending to recover, while girls show a steady or even increasing prevalence. [ABSTRACT FROM AUTHOR]

AbstractPurpose: To evaluate and compare the diagnostic accuracy of duplex ultrasound (US) and MR angiography (MRA) at 1.0 T in aortoiliac arterial disease using digital subtraction angiography (DSA) as the reference standard. In addition, a comparison of the 2D time-of flight (TOF) and 3D contrast-enhanced MRA (CE MRA) techniques was performed. Material and Methods: Prospectively, 39 patients with symptoms of lower-extremity arterial occlusive disease were examined using US, TOF MRA, CE MRA and DSA. Significant lesions (stenosis >=50%) and occlusions were evaluated blindly for each method. Results: For all segments, the sensitivity for US, TOF MRA and CE MRA with regard to significant lesions was 0.72, 0.81 and 0.81, respectively, and the specificity for each was 0.97, 0.91 and 0.92, respectively. For significant lesions above the inguinal ligament the corresponding sensitivity was 0.84, 0.89 and 0.94 and the specificity 0.93, 0.82 and 0.73, respectively. The specificity was higher when the two MRA methods were combined. TOF MRA overgraded 7 segments as occluded. In most cases, the length of the occlusions was correctly determined on CE MRA, overestimated on TOF MRA and uncertain on US. Conclusion: Neither US nor MRA were sufficiently accurate to fully replace angiography. MRA was preferable to US as a non-invasive test when vascular intervention was contemplated. Although CE MRA was superior to TOF MRA, the most accurate results were achieved when the two methods were combined. [ABSTRACT FROM AUTHOR]

Summary: Two different cDNAs, homologous to genes for rotenone-insensitive NADH dehydrogenases of bacteria and yeast, were isolated from potato. The encoded proteins, called NDA and NDB, have calculated molecular masses of 55 and 65 kDa, respectively. The N-terminal parts show similarity to mitochondrial targeting peptides and the polypeptides are in vitro imported into potato mitochondria. Import processing to a smaller polypeptide is seen for the NDA but not the NDB protein. After import, NDA is intramitochondrially sorted to the matrix side of the inner membrane, whereas NDB becomes exposed to the intermembrane space. Imported proteins are associated to membranes upon digitonin permeabilization. On expression in Escherichia coli, NDB is released from the bacterial membrane in the absence of divalent cations whereas detergents are necessary for solubilization of NDA. Both deduced amino-acid sequences contain the dual motifs for nucleotide binding with the characteristics of the core criteria, similar to the bacterial homologues. Unique among NADH dehydro- genases, the NDB amino-acid sequence contains a non-conserved insert, which is similar to EF-hand motifs for calcium binding. Phylogenetic analyses group the rotenone-insensitive NADH dehydrogenases largely by species, but suggest ancient gene duplications. [ABSTRACT FROM AUTHOR]

The author comments on the article "Methotrexate and azathioprine for severe atopic dermatitis: a 5-year follow-up study of a randomized controlled trial," by L.A.A. Gerbens et al., published in this issue of the journal. Gerbens and colleagues studied the efficacy and safety of methotrexate and azathioprine drugs for long-term treatment of severe atopic dermatitis.

The article discusses the impact of migration on the structure of patient population, which increased the demand for health care and dermatological care, highlighting the need for translators and translations. Topics include the escalation of skin diseases due to migration, importance of ethnicity, and the lack of literature during migration.

Summary: Recent research has suggested that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. However, dermatologists are trained to diagnose skin diseases but are not necessarily trained in diagnosing and treating mental health concerns that might be triggered by their patients’ skin diseases. In this study, 3635 patients attending dermatology clinics in 13 European countries completed detailed questionnaires, using a scale called HADS, designed to assess depression and anxiety. Each patient was then examined by a dermatologist who recorded the skin diagnosis and also answered the following two questions: ‘Do you see depressive signs in the patient?’ and ‘Do you see anxiety signs in the patient?’. The possible answers were ‘yes’ or ‘no’. Comparing the results of the questionnaires completed by the patients with the responses to these two questions by the doctors, the dermatologists underestimated depression in 5.8% of the consultations and anxiety in 11.2% of the consultations. On the other hand, dermatologists overestimated depression and anxiety in 10% and 11.8% of the consultations, respectively. The authors conclude that overall the agreement between clinician and patient assessment of mood symptoms was poor, suggesting that mood symptoms are under‐recognized by dermatologists in a routine care setting. [ABSTRACT FROM AUTHOR]

This article discusses a case of a 14-year-old girl who was admitted to the Department of Dermatology, Central Hospital in Kristianstad, Sweden because of eczematous lesions on her cheeks. As a little child, she had eczematous lesions on her face, and since the age of 3 years, recurrent vesicular eczema localized to fingers, toes and soles. She had never had flexural dermatitis, allergic rhinitis or asthma and did not fulfil the criteria of atopic dermatitis. For 2 months, she had treated a mild acne vulgaris of her face with Clearasil stick and Clearasil ointment.

Studies self-reported skin morbidity in an adult urban population in Great Britain. Aim of the study; Significance of the study for further research.

The article presents the case study of a 6-year-old boy, who was referred to hospital due to a red plaque on his left shoulder since birth. The examination of the patient revealed erythematous plaque on the anterior surface of the left shoulder. Other topics include skin biopsy showing irregular acanthosis of epidermis with patchy basal hyperpigmentation and histopathological presentation of pseudoangiomatous xanthelasmoid mastocytosis.

Background Onset of psoriasis may occur at any age. Early negative experiences often influence personality development, and may lead to physical disease, anxiety and depression in adulthood. Knowledge about onset of psoriasis and psychopathology is limited. Objectives To examine whether patients with early-onset psoriasis differ psychologically from patients with late-onset psoriasis, regarding personality traits, anxiety and depression. Methods A descriptive cross-sectional study was conducted among 101 consecutively recruited outpatients with psoriasis. A psychosocial interview was performed followed by self-assessment of validated questionnaires: Swedish Universities Scales of Personality ( SSP), Spielberger State- Trait Anxiety Inventory and Beck Depression Inventory. Psoriasis severity was assessed by the Psoriasis Area and Severity Index. Results Patients with early-onset psoriasis (age < 20 years) were significantly more anxious and depressed than patients with late-onset psoriasis. In multiple linear regression models, younger age at onset of psoriasis was a significant determinant of higher scores of four personality traits: SSP-embitterment, -trait irritability, -mistrust and -verbal trait aggression. Conclusions Our results indicate that early detection of psychological vulnerability when treating children and adolescents with psoriasis seems to be of great importance. Traits of psychological vulnerability and pessimistic personality traits were found to be significantly associated with the early onset of psoriasis, but not with disease duration in this study. These traits may be seen as a consequence of psoriasis, and/or as individual traits modulating and impairing clinical course and efforts to cope with psoriasis. [ABSTRACT FROM AUTHOR]

Long-term low-level topical anti-inflammatory therapy has been suggested as a new paradigm in the treatment of atopic eczema (AE). To determine the efficacy and tolerability of topical corticosteroids and calcineurin inhibitors for flare prevention in AE. Systematic review of randomized controlled trials reporting efficacy of topical corticosteroids and/or topical calcineurin inhibitors for flare prevention in AE. Identification of relevant articles by systematic electronic searches (Cochrane Library, Medline) supplemented by hand search. Primary efficacy endpoint: proportion of participants experiencing at least one flare during proactive anti-inflammatory treatment. Relative risks (RRs) and corresponding 95% confidence intervals (CIs) were calculated and pooled by pharmaceutical agent using random-effects meta-analysis. Sensitivity analysis included meta-regression to explore the influence of study-specific covariates. Nine articles reporting on eight vehicle-controlled trials were included. Three, four and one trial(s) evaluated proactive therapy with topical tacrolimus, fluticasone propionate and methylprednisolone aceponate, respectively. Each agent under study was more efficacious to prevent flares than vehicle. Meta-analysis suggested that topical fluticasone propionate (RR 0·46, 95% CI 0·38-0·55) may be more efficacious to prevent disease flares than topical tacrolimus (RR 0·78, 95% CI 0·60-1·00). Meta-regression indicated robustness of these findings. Proactive anti-inflammatory therapy was generally well tolerated. The trials identified, however, do not allow firm conclusions about long-term safety. Vehicle-controlled trials indicate efficacy of proactive treatment with tacrolimus, fluticasone propionate and methylprednisolone aceponate to prevent AE flares. Indirect evidence from vehicle-controlled trials suggests that twice weekly application of the potent topical corticosteroid fluticasone propionate may be more efficacious to prevent AE flares than tacrolimus ointment. Head to head trials should be conducted to confirm these results. Future studies are also needed to evaluate the long-term safety of proactive treatment of AE. [ABSTRACT FROM AUTHOR]

AIMS: The aim was to establish a baseline prevalence of skin conditions of public health importance in the general population and taking the validity of the questions into account. Our model is intended for future surveillance of skin conditions. METHODS: The suggested questions have for the first time been used in Swedish population surveys. A random sample was taken from the general population aged 16 to 84 years of the participating areas. RESULTS: During the past 12 months, hand eczema was reported by 9.4%, childhood eczema by 15.7% and nickel allergy by 13.7% of the population. Hand and childhood eczema questions have previously been validated. Taking the validity into account, the actual population prevalence of hand eczema (11.7%) is underestimated, and the prevalence of atopic childhood eczema (10.0%) is overestimated based on the results of the questionnaire. In addition to presenting prevalence, population survey results can be used for risk analyses. A 10-fold risk of hand eczema in individuals with childhood eczema and self-reported nickel sensitivity is shown in our study. CONCLUSIONS: Questionnaires can be used for epidemiologic surveillance so long as the questions are validated and that the validity is taken into account when estimating the occurrence of the conditions. Public health surveys such as this one lay the basis for future epidemiological surveillance of skin conditions that can be subject to interventions. We propose that these, or similar, questions should be used regularly in population surveys and supplemented by questions on skin exposure. [ABSTRACT FROM AUTHOR]

Background When this study was initiated, no previous studies comparing methotrexate and ciclosporin for moderate to severe plaque psoriasis had been performed. Objectives To compare the effectiveness, quality of life and side-effects of methotrexate and ciclosporin treatments in a context reflecting normal clinical practice. Methods Eighty-four patients with moderate to severe plaque psoriasis were randomized to treatment with methotrexate or ciclosporin for 12 weeks. The primary outcome was the Psoriasis Area and Severity Index (PASI). The secondary outcome was quality of life, measured by the Dermatology Life Quality Index (DLQI) and the 36-item Short Form Health Survey (SF-36). A visual analogue scale (VAS) was used for patients’ assessment. Results Sixty-eight patients started treatment and were included in the analysis. Dropout before initiation of treatment was higher in the ciclosporin group. Mean PASI change from baseline at 12 weeks was 58% in the methotrexate group and 72% in the ciclosporin group, showing ciclosporin to be more effective than methotrexate. Improvement of the VAS score was higher in the ciclosporin group. The methotrexate group showed a greater improvement in the subscale Physical Functioning of the SF-36. No significant difference between the groups was found for DLQI. Conclusions Treatment with methotrexate or ciclosporin for chronic plaque psoriasis brings satisfactory disease control, improved quality of life and tolerable side-effects. A statistically significant difference in effectiveness between treatment groups was recorded, showing ciclosporin to be more effective than methotrexate in a short-term perspective. [ABSTRACT FROM AUTHOR]

Background: The plant respiratory chain contains several energy-dissipating enzymes, these being type II NAD(P)H dehydrogenases and the alternative oxidase, not present in mammals. The physiological functions of type II NAD(P)H dehydrogenases are largely unclear and little is known about their responses to stress. In this investigation, potato plants (Solanum tuberosum L., cv. Desiree) were sprayed with antimycin A, an inhibitor of the cytochrome pathway. Enzyme capacities of NAD(P)H dehydrogenases (EC 1.6.5.3) and the alternative oxidase were then analysed in isolated leaf mitochondria. Results: We report a specific decrease in internal rotenone-insensitive NADH dehydrogenase capacity in mitochondria from antimycin A-treated leaves. External NADPH dehydrogenase and alternative oxidase capacities remained unaffected by the treatment. Western blotting revealed no change in protein abundance for two characterised NAD(P)H dehydrogenase homologues, NDA1 and NDB1, nor for two subunits of complex I. The alternative oxidase was at most only slightly increased. Transcript levels of nda1, as well as an expressed sequence tag derived from a previously uninvestigated closely related potato homologue, remained unchanged by the treatment. As compared to the daily rhythm-regulated nda1, the novel homologue displayed steady transcript levels over the time investigated. Conclusions: The internal rotenone-insensitive NADH oxidation decreases after antimycin A treatment of potato leaves. However, the decrease is not due to changes in expression of known nda genes. One consequence of the lower NADH dehydrogenase capacity may be a stabilisation of the respiratory chain reduction level, should the overall capacity of the cytochrome and the alternative pathway be restricted. [ABSTRACT FROM AUTHOR]

Background: In a European study on contact allergy in the general population, it has been hypothesized that the combination of contact allergy to a fragrance together with a history indicating dermatitis at exposure and thereafter subsequent avoidance of scented products implied a diagnosis of allergic contact dermatitis. Objectives: The primary aim of this study was to validate this hypothesis/algorithm. The secondary aim was to investigate whether there was any association between the outcome of the recent repeated open application test (ROAT) and the patch test reactivity. Methods: One hundred nine subjects with and without contact allergy to fragrance mix II (FM II) were recruited. Volunteers from six European dermatology clinics participated in the study including a patch test and a ROAT. Results: Twenty‐four positive ROAT reactions were noted in total including 20 of those 32 with contact allergy to FM II. None of the volunteers reacted to the vehicle (P < 0.001). More individuals with a positive algorithm had positive ROATs when compared with those with a negative algorithm. However, the difference was not statistically significant (P = 0.12). The lower the patch test concentration eliciting a positive test reaction, the more likely was a positive ROAT and the more likely that the positive ROAT appeared early during the investigative period. Conclusions: The algorithm used in this study was not validated but it was indicated in this ROAT setup. The stronger the patch test reactivity the more likely was a positive ROAT and the more likely it was that the positive ROAT appeared early during the application period. [ABSTRACT FROM AUTHOR]

Summary: Background: In contact dermatitis, it is crucial to understand and remember the outcome of patch testing. Unfortunately, many patients do not remember the results of their patch tests. Objectives: Our aim was to evaluate the effects of an intervention programme in which extensive information on specific contact allergy was provided, in individuals with positive patch test reactions. Methods: The study was designed as a randomized, investigator‐blinded clinical trial. Participants with positive test reactions were randomized into two groups that received either standard information according to clinical routine or standard information and a reminder letter. Knowledge of contact allergies was evaluated using questionnaires 12 months after inclusion. Results: There were 184 adults included in the trial and the response rate at 1‐year follow‐up was 78% (143 of 184). Sixty‐five per cent (45 of 69) in the intervention group and 54% (40 of 74) in the control group reported the correct name of the allergen (P = 0·23). Participants with several – as opposed to few – positive patch test reactions had difficulty in remembering the correct names of the allergens (P = 0·001). Moreover, the type of allergy had an influence on their ability to remember the name of the allergen correctly and their ability to make changes in lifestyle. Conclusions: The intervention performed did not significantly affect the participants' ability to remember their contact allergy. To achieve better knowledge and changes in lifestyle, efforts to inform should concentrate on individuals with several positive patch test reactions, those with particular allergens, individuals over 60 years of age, and – concerning changes in lifestyle – males. What is already known about this topic? Patch testing is crucial for patients with contact dermatitis.The ability to remember and understand the outcome of the patch testing is fundamental.Unfortunately, many patients do not remember or have misunderstood the results of their patch tests. Patients who require more information should be identified. What does this study add? This study suggests that participants' ability to remember and understand their patch test results, and also to make changes in lifestyle, are dependent on factors such as the number of contact allergies, which allergy they have, age and sex.The results highlight the importance of making further efforts to gain higher efficacy in the information and education given. It is therefore valuable to take special care with these patients and to cautiously educate and inform them about the results of patch tests. Linked Comment:Korkmaz and Boyvat. Br J Dermatol 2021; 184:2. Plain language summary available online [ABSTRACT FROM AUTHOR]

Summary: Background: A long‐term prospective observational safety study is essential to characterize fully the safety profile of systemic immunomodulating therapies for patients with atopic eczema. The TREatment of ATopic eczema (TREAT) Registry Taskforce offers a large platform to conduct such research using national registries that collect the same data using a predefined core dataset. Objectives: To present a protocol for a safety study comparing dupilumab with other systemic immunomodulating therapies in children and adults with moderate‐to‐severe atopic eczema, to assess the long‐term safety risk of these therapies in a routine clinical care setting. Methods: We describe a registry‐embedded international observational prospective cohort study. Adult and paediatric patients who start treatment with dupilumab or another systemic immunomodulating agent for their atopic eczema will be included. The primary end point is the incidence of malignancies (excluding nonmelanoma skin cancer) compared between the treatment groups. Secondary end points include other serious adverse events and adverse events of special interest, such as eye disorders and eosinophilia. Conclusions: This protocol delineates a safety study for dupilumab in adult and paediatric patients with atopic eczema, using a standardized methodological approach across several national registries. The protocol could also be used for other novel systemic immunomodulating therapies, and could provide licensing and reimbursement authorities, pharmaceutical companies and clinicians with safety evidence from a routine clinical care setting. What's already known about this topic? There is a need for long‐term data on the safety of systemic immunomodulating therapies in patients with atopic eczema.Regulatory bodies, such as the European Medicines Agency, increasingly stipulate the collection of such data as part of the licensing agreement for new treatments, to assess the new agent's long‐term safety profile against established therapies.Large numbers of patients with a long duration of follow‐up are necessary in order to detect rare events like malignancies. What does this study add? The TREAT Registry Taskforce offers a platform to conduct such research with a network of multiple national atopic eczema research registries.We present a protocol for an investigator‐initiated multicentre safety study comparing dupilumab with other systemic immunomodulating therapies in adults and subsequently adolescents and children with moderate‐to‐severe atopic eczema.This protocol can be used as a framework for similar studies for other novel systemic immunomodulating therapies across both adult and paediatric populations. Plain language summary available online [ABSTRACT FROM AUTHOR]

Summary: Background: In a European study on contact allergy in the general population, it was hypothesized that the combination of contact allergy to a fragrance together with a history indicating dermatitis at exposure, and thereafter subsequent avoidance of scented products, implied a diagnosis of allergic contact dermatitis. Objectives: The primary aim of this study was to validate this hypothesis and algorithm. The secondary aim was to investigate whether there was any association between the outcome of the repeated open application test (ROAT) and the patch test reactivity. Methods: In total, 109 patients with and without contact allergy to fragrance mix (FM) I were recruited. Volunteers from six European dermatology clinics participated in the study including a patch test and a ROAT. Results: Positive ROAT reactions were noted in 26 of the 44 volunteers with contact allergy to FM I. None of the volunteers reacted to the vehicle (P < 0·001). More individuals with a positive algorithm had positive ROATs than those with a negative algorithm. However, the difference was not statistically significant. The lower the patch test concentration eliciting a positive test reaction, the more likely a positive ROAT and the more likely that the positive ROAT appeared early during the investigative period. Conclusions: The algorithm used in this study was not substantiated in this ROAT set‐up. The stronger the patch test reactivity the more likely was a positive ROAT and the more likely it was that the positive ROAT appeared early during the application period. What's already known about this topic? To the best of our knowledge, a scientifically designed and conducted repeated open application test (ROAT) has never been performed before to validate a diagnosis of allergic contact dermatitis partly based on a questionnaire. What does this study add? This is the largest controlled, randomized and blinded ROAT performed to date.Higher patch test reactivity to fragrance mix I indicated a greater likelihood of a positive ROAT. What are the clinical implications of this work? Further refinement of the questions is required in order to diagnose allergic contact dermatitis from fragrances based on a questionnaire. Linked Comment:Uter. Br J Dermatol 2020; 182:831–832. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a common inflammatory skin disease that affects both children and adults, including a large number of adults of reproductive age. Several guidelines for the treatment of AD exist, yet specific recommendations for the treatment of pregnant or lactating women and for adults planning to have a child are often lacking. This position paper from the European Task force on Atopic Dermatitis (ETFAD) is based on up‐to‐date scientific literature on treating pregnant and lactating women as wells as adults with AD planning to have a child. It is based on the expert opinions of members of the ETFAD and on existing safety data on the proposed treatments, many of which are derived from patients with other inflammatory diseases or from transplantation medicine. For treating future parents, as well as pregnant and lactating women with AD, the use of topical treatments including moisturizers, topical corticosteroids, tacrolimus, antiseptics such as chlorhexidine, octenidine, potassium permanganate and sodium hypochlorite (bleach) is deemed to be safe. Ultraviolet (UV) therapy may also be used. Systemic treatment should be prescribed only after careful consideration. According to the opinion of the ETFAD, treatment should be restricted to systemic corticosteroids and cyclosporine A, and, in selected cases, azathioprine. [ABSTRACT FROM AUTHOR]

Summary: Background: Atopic dermatitis (AD) might adversely affect academic performance, possibly through influences on psychological functioning such as stress resilience. Objectives: To investigate the association of atopic dermatitis with stress resilience, cognitive function and educational attainment. Methods: We used data from a national cohort of men who underwent a military conscription examination at ages 17–20 years in Sweden between 1969 and 1976. All potential conscripts met a physician who assessed current or previous history of AD. Stress resilience was measured by a psychologist using a semistructured interview. The conscription assessment included a written cognitive function test. The highest level of education achieved was identified through record linkage. Results: The study population included 234 715 men, 1673 (0·7%) of whom had a diagnosis of AD. AD was associated with a greater risk of low stress resilience [adjusted relative risk ratio (RRR) 1·60, 95% confidence interval (CI) 1·38–1·86]. AD was associated with higher cognitive function (β‐coefficient 0·15, 95% CI 0·05–0·24) and higher educational level (RRR 1·29, 95% CI 1·13–1·47). However, adjustment for socioeconomic characteristics of the family of origin attenuated the magnitude of the associations and eliminated the statistical significance (β‐coefficient 0·06, 95% CI −0·03 to 0·15; RRR 1·16, 95% CI 1·00–1·35). Conclusions: Swedish men with AD had lower stress resilience in late adolescence but did not have lower cognitive function or poorer educational attainment. The lower stress resilience associated with AD is consistent with an increased risk of possible long‐term adverse health outcomes. What's already known about this topic? Atopic dermatitis can influence quality of life, but little is known about its possible impact on educational attainment. What does this study add? Atopic dermatitis was not associated with lower cognitive function or poorer academic attainment in this large general‐population‐based cohort study of men in Sweden.Men with atopic dermatitis had lower stress resilience in late adolescence, which has potential adverse implications for mental and physical health in subsequent adulthood. Respond to this article Linked Comment:Vittrup and Thyssen. Br J Dermatol 2019; 180: 452–453. Plain language summary available online [ABSTRACT FROM AUTHOR]

Background Adherence to topical corticosteroids ( TCS) is essential for the effective treatment of atopic dermatitis but can be limited by concerns about their use. This study examined the feasibility of applying the validated TOPICOP score for assessing TCS phobia across different countries. Methods This was a prospective multicentre feasibility study conducted in 21 hospitals in 17 countries. Patients >3 months of age with atopic dermatitis or their parents or legal representatives completed a validated translation of the TOPICOP questionnaire in the country's native language. Respondents also completed questionnaires collecting opinions about the feasibility and acceptability of the TOPICOP questionnaire. Results A total of 1564 participants in 15 countries were included in the analysis. 81% of respondents considered the questions clear or very clear, and 79% reported that it took less than 5 minutes to complete. Each of the individual items in the TOPICOP questionnaire was considered to be not at all difficult to answer by 49% to 74% of participants. The mean global TOPICOP score was 44.7%±20.5. Mean TOPICOP subscores were 37.0±22.8% for knowledge and beliefs, 54.7±27.8% for fears and 50.1±29.1% for behaviours. Global scores and subscores differed between countries, although the subscores did not always vary in parallel, suggesting different levels of TCS phobia and different drivers for each country. Conclusions The TOPICOP score can be feasibly applied across countries and may therefore be useful for obtaining qualitative and quantitative data from international studies and for adapting patient education and treatment. [ABSTRACT FROM AUTHOR]

The patient is the centre of a web of relationships, and the impact of his/her disease on family members and caregivers must be taken into account. The aim of this study was to identify the specific instruments that measure the impact of a dermatological disease on the quality of life (QoL) of family members, by performing a systematic search of the literature. Fifteen papers were identified, describing the creation and validation of nine instruments. Four of them concerned atopic dermatitis (Dermatitis Family Index, DFI; Parents' Index QoL Atopic Dermatitis, PiQoL- AD; QoL in primary caregivers of children with atopic dermatitis, QPCAD; Childhood Atopic Dermatitis Impact Scale, CADIS), two measured the impact of psoriasis in family members (Psoriasis Family Index, PFI; FamilyPso), one the impact of epidermolysis bullosa (Epidermolysis Bullosa Burden of Disease, EB-BoD), one of ichthyosis (Family Burden Ichthyosis, FBI), and one was generic for dermatological conditions (Family Dermatology Life Quality Index, FDLQI). The European Academy of Dermatology and Venereology quality of life taskforce recommends that the impact of a skin disease on family and caregivers should be measured as part of any thorough evaluation of the burden of a disease. Guidelines are given to choose the most appropriate instruments. [ABSTRACT FROM AUTHOR]

Background Symptoms have been identified as a core outcome domain for atopic eczema (AE) trials. Various instruments exist to measure symptoms in AE, but they vary in quality and there is a lack of standardization between clinical trials. Our objective was to systematically evaluate the quality of the evidence on the measurement properties of AE symptom instruments, thereby informing consensus discussions within the Harmonising Outcome Measures for Eczema (HOME) initiative regarding the most appropriate instruments for the core outcome domain symptoms. Methods Using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist and predefined criteria for good measurement properties on identified development and validation studies of AE symptom instruments, a best evidence synthesis was performed to draw an overall conclusion on quality of the instruments and to provide recommendations. Results Eighteen instruments were identified and evaluated. When the quality and results of the studies were considered, only five of these instruments had sufficient validation data to consider them for the core outcome set for the core outcome domain symptoms. These were the paediatric Itch Severity Scale (ISS), Patient-Oriented Eczema Measure (POEM), Patient-Oriented SCOring Atopic Dermatitis (PO-SCORAD), Self-Administered Eczema Area and Severity Index (SA-EASI) and adapted SA-EASI. Conclusions ISS (paediatric version), POEM, PO-SCORAD, SA-EASI and adapted SA-EASI are currently the most appropriate instruments and therefore have the potential to be recommended as core symptom instrument in future clinical trials. These findings will be utilized for the development of a core outcome set for AE. [ABSTRACT FROM AUTHOR]

This article is a report of the fourth meeting of the Harmonising Outcome Measures for Eczema ( HOME) initiative held in Malmö, Sweden on 23-24 April 2015 ( HOME IV). The aim of the meeting was to achieve consensus over the preferred outcome instruments for measuring patient-reported symptoms and quality of life for the HOME core outcome set for atopic eczema ( AE). Following presentations, which included data from systematic reviews, consensus discussions were held in a mixture of whole group and small group discussions. Small groups were allocated a priori to ensure representation of different stakeholders and countries. Decisions were voted on using electronic keypads. For the patient-reported symptoms, the group agreed by vote that itch, sleep loss, dryness, redness/inflamed skin and irritated skin were all considered essential aspects of AE symptoms. Many instruments for capturing patient-reported symptoms were discussed [including the Patient-Oriented SCOring Atopic Dermatitis index, Patient-Oriented Eczema Measure ( POEM), Self-Administered Eczema Area and Severity Index, Itch Severity Scale, Atopic Dermatitis Quickscore and the Nottingham Eczema Severity Score] and, by consensus, POEM was selected as the preferred instrument to measure patient-reported symptoms. Further work is needed to determine the reliability and measurement error of POEM. Further work is also required to establish the importance of pain/soreness and the importance of collecting information regarding the intensity of symptoms in addition to their frequency. Much of the discussion on quality of life concerned the Dermatology Life Quality Index and Quality of Life Index for Atopic Dermatitis; however, consensus on a preferred instrument for measuring this domain could not be reached. In summary, POEM is recommended as the HOME core outcome instrument for measuring AE symptoms. [ABSTRACT FROM AUTHOR]

Background Population-based studies about contact allergy are scarce. Objectives To obtain reliable estimates of the prevalence of contact allergy in the general population in Europe. Methods A cross-sectional study of a random sample from the general population, aged 18-74 years, in five different European countries (Sweden, the Netherlands, Germany, Italy and Portugal). In total, 12 377 subjects were interviewed and a random sample ( n = 3119) patch tested to TRUE Test panels 1-3 and Fragrance Mix ( FM) II, hydroxyisohexyl 3-cyclohexene carboxaldehyde ( HICC) and sesquiterpene lactone mix. A positive patch test reaction is considered as contact allergy. Results In total, 27·0% [95% confidence interval (CI) 25·5-28·5] had at least one positive reaction to an allergen of the European baseline series, with a significantly higher prevalence in women than in men. The highest age-standardized prevalences (≥ 1%) were found for nickel (14·5%, 95% CI 13·2-15·8), thiomersal (5·0%, 95% CI 4·2-5·8), cobalt (2·2%, 95% CI 1·7-2·7), FM II (1·9%, 95% CI 1·5-2·5), FM I (1·8%, 95% CI 1·4-2·3), HICC (1·4%, 95% CI 1·0-1·9), p- tert-butylphenol formaldehyde resin (1·3%, 95% CI 0·9-1·7) and para-phenylenediamine (1·0%, 95% CI 0·6-1·3). Only nickel and thiomersal showed a statistically significantly different prevalence for contact allergy among the different European populations. Subjects reporting contact dermatitis in their lifetime (age-standardized prevalence 15·1%, 95% CI 13·8-16·3) had an increased risk for contact allergy (odds ratio 1·9, 95% CI 1·5-2·5). The risk of having a contact allergy was not increased in those with atopic dermatitis (prevalence 7·6%, 95% CI 6·7-8·6; odds ratio 1·0, 95% CI 0·7-1·4). Conclusions Contact allergy to at least one allergen of the European baseline series was diagnosed in more than one-quarter of the general European population. Therefore measures to improve the primary prevention of contact allergy have to be enforced. [ABSTRACT FROM AUTHOR]

Background Contact allergy to fragrances is assessed mostly in clinical populations of patients. Studies in the general population are scarce and vary in their methodology across countries. Objectives To determine the prevalence of fragrance contact allergy in the European general population and to assess the clinical relevance of positive patch test reactions to different fragrances. Methods In five European countries (Germany, Italy, the Netherlands, Portugal and Sweden) a random sample from the general population aged 18-74 years was drawn. In total, 12 377 subjects were interviewed in this cross-sectional study and a random sample ( n = 3119) was patch tested using the TRUE Test and Finn Chamber techniques. Patch test procedures were harmonized by mandatory training before the study and monitoring during the study. Results The highest prevalence for contact allergy of 2·6% [95% confidence interval ( CI) 2·1-3·2] was found for fragrance mix ( FM) I in petrolatum, with a high content of atranol and chloratranol, followed by 1·9% (95% CI 1·5-2·4) for FM II in petrolatum. The conservatively estimated prevalence of fragrance contact allergy was 1·9% (95% CI 1·5-2·5). This is defined as the existence of a positive patch test to FM I or FM II; any of their individual materials; Myroxylon pereirae; sesquiterpene lactones or 3- and 4-hydroxyisohexyl 3-cyclohexene carboxaldehyde that show clinical relevance, defined conservatively as lifetime avoidance of scented products and an itchy skin rash lasting > 3 days in a lifetime. Using the reported lifetime prevalence of any contact dermatitis instead of the lifetime prevalence of any itchy skin rash, the prevalence is 0·8% (95% CI 0·5-1·2). The prevalence rates of contact allergy to fragrances in women are about twice those in men. Conclusions This study helps to identify targets for prevention of fragrance allergy. [ABSTRACT FROM AUTHOR]

In this article, the author discusses studies related to methodological aspects for assessment of hand eczema. Topics discussed include the Hand Eczema Severity Index (HECSI) as a measure of severity applied by E. Held and others which compares the extent and morphology of hand eczema, the Hand Eczema Extent Score (HEES) used by B. Meding and others for evaluation and high correlation between HEES and HECSI between dermatologists and nurses.

Background There is a paucity of evidence for the use of systemic agents in children with atopic eczema refractory to conventional therapy, resulting in considerable variation in patient management. Objectives The European TREatment of severe Atopic eczema in children Taskforce ( TREAT) survey was established to collect data on current prescribing practice, to identify factors influencing the use of specific systemic agents, and to inform the design of a clinically relevant intervention study. Methods Consultant physician members of the paediatric dermatology societies and interest groups of eight European countries were invited to participate in a web-based survey. The multiple-response format questionnaire collated data on clinical practice in general, as well as detailed information on the use of systemic agents in refractory paediatric atopic eczema. Results In total, 343/765 members (44·8%) responded to the invitational emails; 89·2% were dermatologists and 71% initiate systemic immunosuppression for children with severe atopic eczema. The first-line drugs of choice were ciclosporin (43·0%), oral corticosteroids (30·7%) and azathioprine (21·7%). Ciclosporin was also the most commonly used second-line medication (33·6%), with methotrexate ranked as most popular third choice (26·2%). Around half of the respondents (53·7%) replied that they routinely test and treat reservoirs of cutaneous infection prior to starting systemic treatment. Across the eight countries, penicillins were the first-line antibiotic of choice (78·3%). Conclusions In the absence of a clear evidence base, the European TREAT survey confirms the wide variation in prescribing practice of systemic immunosuppression in refractory paediatric atopic eczema. The results will be used to inform the design of a randomized controlled trial relevant to patient management across Europe. [ABSTRACT FROM AUTHOR]

Summary [ABSTRACT FROM AUTHOR]

European Task Force on Atopic Dermatitis statement on severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection and atopic dermatitis Atopic dermatitis (AD) is a complex disease with elevated risk of respiratory comorbidities.[[1]] Severely affected patients are often treated with immune-modulating systemic drugs.[[3]] On 11 March 2020, the World Health Organization declared the 2019 novel coronavirus severe acute respiratory syndrome (SARS-Cov-2) epidemic to be a pandemic. If systemic treatment of AD needs to be paused, patients should be supplied with ample topical therapy and guidance on the amount needed to prevent flares until systemic therapy can be reinstated. [Extracted from the article]

Background Atopic dermatitis (AD) is common in the population, and studies have shown that the disease is on the increase. Studies based on hospital records reflect selected populations and may miss less severe cases of AD, and the use of self-reported questionnaires has the drawback of recall bias. Objectives To investigate some possible factors influencing recall bias when questionnaires are used to establish the prevalence of childhood eczema in an adult population. Methods A questionnaire regarding past and present eczema was sent to 557 cases (with signs suggesting the diagnosis AD) and 554 matched controls (subjects lacking signs of AD) born during 1960-1969 and identified in school health medical records. Cases and controls were aged 31-42 years at the time of the study and 70.5% returned the questionnaire. Results Of 403 cases, 29% did not report childhood eczema in the questionnaire. There was a difference between those who did recall their childhood AD (remembering group, RG), and those who did not (forgetful group, FG) in who had documented the diagnostic signs in the school health records. In the RG the signs were reported by both parents and school health personnel in 51% of cases, and in the FG this was true of only 16%. The RG had a higher prevalence of eczema after 15 years of age and of hand eczema. The RG also reported more visits to physicians after the age of 15 years and more time taken as sick leave due to eczema. Conclusions Several factors influence how well people remember their AD in childhood. These factors include disease activity in adult life, disease severity, and who noticed the eczema in childhood. [ABSTRACT FROM AUTHOR]

Background The calcipotriol/betamethasone dipropionate two-compound product Dovobet®/Daivobet®/Taclonex®(LEO Pharma A/S, Ballerup, Denmark) has been shown to be safe and effective in the treatment of psoriasis for up to 8 weeks. As psoriasis is a chronic disease, long-term treatment may be required, so there is a need to investigate the safety of its use over a longer period of time. Objectives To investigate the safety of two treatment regimens involving use of the two-compound product over 52 weeks in the treatment of patients with psoriasis. Methods Patients ( n = 634) were randomized double-blind to treatment with: (i) 52 weeks of the two-compound product (two-compound group); (ii) 52 weeks of alternating 4-week periods of the two-compound product and calcipotriol (alternating group); or (iii) 4 weeks of the two-compound product followed by 48 weeks of calcipotriol (calcipotriol group). Treatments in all groups were used once daily when required. Results Adverse drug reactions (ADRs) occurred in 45 (21·7%) patients in the two-compound group, 63 (29·6%) in the alternating group and 78 (37·9%) in the calcipotriol group. The odds ratio for an ADR in the two-compound group relative to the calcipotriol group was 0·46 (95% confidence interval 0·30–0·70; P < 0·001). ADRs of concern associated with long-term topical corticosteroid use occurred in 10 (4·8%) patients in the two-compound group, six (2·8%) in the alternating group and six (2·9%) in the calcipotriol group; those with the highest incidence were skin atrophy, occurring in four (1·9%), one (0·5%) and two (1·0%) patients, respectively, and folliculitis, in three (1·4%), one (0·5%) and no patients, respectively. Conclusions Treatment with the two-compound product for up to 52 weeks appears to be safe and well tolerated whether used on its own or alternating every 4 weeks with calcipotriol treatment. [ABSTRACT FROM AUTHOR]

Summary: 特应性湿疹(也称为"特应性皮炎"或简称"湿疹")是一种常见的皮肤病。大多数患有特应性湿疹的人可以通过局部治疗(直接涂抹在皮肤上)来控制湿疹,比如润肤剂和局部皮质类固醇。 然而,一些患有中度至重度疾病的患者,不能用这些疗法很好地治疗疾病。这些人需要使用片剂或注射剂进行全身药物治疗(作用于全身的治疗),以有效减轻他们的症状。 Dupilumab 是一种新的全身性药物 (自 2018 年以来), 用于治疗中度至重度湿疹患者。它已经在美国和欧盟获批用于治疗 12 岁或以上的患者。 为了比较 Dupilumab 与其他全身药物治疗的安全性,研究人员需要所有这些药物在实际应用中的安全性数据。TREAT 登记工作组的登记处收集了所有全身药物治疗特应性湿疹的有效性和安全性的数据。英国、爱尔兰、美国、德国、荷兰、丹麦、瑞典、法国、意大利、西班牙和葡萄牙等国家都参与了 TREAT。所有这些国家都以相同的方式收集数据,因此数据具有可比性。 这篇文章描述了如何使用所有这些国际数据来比较 Dupilumab 与其他全身药物治疗安全性的研究方案。这对医生和患者都很重要,这可以让他们在知情的情况下决定哪种治疗对他们来说是最好的。 本摘要涉及研究: 特应性湿疹的治疗 (TREAT) 登记工作组: 一项针对特应性湿疹患者中 Dupilumab 和其他全身药物疗法的欧洲安全性研究的研究方案 Linked Article: Bosma et al. Br J Dermatol 2020; 182:1423–1429 [ABSTRACT FROM AUTHOR]

Summary: Atopic eczema (also called 'atopic dermatitis' or just 'eczema') is a common skin disease. Most people with atopic eczema can control their eczema with topical therapies (applied directly to the skin) such as emollients and topical corticosteroids. Some people, however, have moderate‐to‐severe disease that cannot be well managed with those therapies. Systemic therapy (acting on the whole body), with tablets or injections, is needed in these people to improve their symptoms effectively. Dupilumab is a new systemic medication (since 2018) for treating people with moderate‐to‐severe eczema. It has been approved both in the U.S.A. and the E.U. for people who are 12 years or older. In order to compare the safety of dupilumab with other systemic therapies, researchers need data on the safety of all those medications in real practice. The registries of the TREAT Registry Taskforce collect data on both the effectiveness and safety of all systemic therapies for atopic eczema. Countries such as the U.K., Ireland, the U.S.A., Germany, the Netherlands, Denmark, Sweden, France, Italy, Spain and Portugal are participating in TREAT. All those countries collect data the same way, so that the data are comparable. This article describes a protocol on how to use all these international data to compare the safety of dupilumab with other systemic treatments. This is important both for physicians and patients, to allow them to make informed decisions on which treatment is best for them. This is a summary of the study: TREatment of ATopic eczema (TREAT) Registry Taskforce: protocol for a European safety study of dupilumab and other systemic therapies in patients with atopic eczema Linked Article: Bosma et al. Br J Dermatol 2020; 182:1423–1429 [ABSTRACT FROM AUTHOR]

Linked Article: Smirnova et al. Br J Dermatol 2019; 180:559–564 [ABSTRACT FROM AUTHOR]

Summary: Atopic dermatitis (AD, often known as eczema) is a common skin disorder affecting up to 20% of children. However, our knowledge is incomplete for some long‐term effects of this condition such as educational attainment, meaning the level of education a person reaches at school, university or college. AD is usually visible, causes itching and sometimes sleeplessness, which may therefore impact on a person's education. In this study the level of education among adolescent males with and without AD was compared, as was cognitive function (brain processes that allow us to carry out tasks) and stress resilience (ability to cope with stress), using Swedish register data. The study included 234,715 men who underwent military conscription assessments aged 17‐20 years between 1969 and 1976: these assessments involved extensive physical and psychological examinations including a written cognitive function test. In total 1,673 (0.7%) had an AD diagnosis. Surprisingly, AD was not associated with reduced levels of academic attainment or cognitive function. In fact, slightly higher levels of education and cognitive function were observed and appear to be explained by men with AD having parents with a more advantaged socioeconomic position, resulting in improved educational performance. However, those with AD tended to have a lower ability to cope with stress, which has been linked with adverse mental and physical health outcomes in later adulthood. Linked Article: Smirnova et al. Br J Dermatol 2019; 180:559–564 [ABSTRACT FROM AUTHOR]