What's new in atopic dermatitis?

Departmentof Pharmacology, University of Bern, Bern, SwitzerlandKey words: atopic dermatitis; clinical features;constitutional dermatitis; epidemiology; extrinsictype; immunopathology; intrinsic type.Prof. Dr B. Wu¨thrichAllergy Unit, Department of DermatologyUniversity Hospital8091 ZurichSwitzerlandAccepted for publication 22 March 2001

Bidirectional relationship between atopic dermatitis and inflammatory bowel disease: A systematic review and meta-analysis

Background/Objective: Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by diverse clinical manifestations. However, variations in its clinical presentations across different ages, genders, anatomical sites, and seasons remain incompletely understood. The objective was to explore the clinical heterogeneities of AD using data from the Chinese non-selective registration system. Methods: A prospective analysis was conducted on 3829 AD patients enrolled in the Chinese Non-selective Registry for AD (CNRAD) at hospital settings from 2020 to 2022. Demographic profiles; distribution, type, and severity of the skin lesion; laboratory findings; allergic comorbidities; family history; and exacerbating factors were analyzed. Results: The male-to-female ratio was 0.92 among adolescent and adult AD patients but increased to 2.11 in elderly AD patients, highlighting an age-dependent gender difference in AD prevalence. Age groups displayed distinct anatomical preferences for lesion distribution, with reduced involvement of the cubital and popliteal fossae in adult and elderly patients. Based on skin lesion characteristics, ten clinical subtypes of AD were proposed. Elderly AD patients exhibited higher severity, compared to adolescence and adult AD patients, with male patients being more severe than females. Elderly AD patients showed a lower proportion of extrinsic type, compared to childhood AD patients. Seasonal change emerged as the most important factor triggering AD flares. Conclusions: This study provides new insights into the heterogeneities of AD clinical manifestations in the Chinese population, demonstrating their significant dependence on temporal factors, including age and season.

Atopic dermatitis is a chronic inflammatory skin disease that affects the growth and development of children. The prevalence of atopic dermatitis has been continually increasing, and this has also been accompanied by rising socioeconomic costs. Interest has been growing in alternative medicine as a means of alleviating the burden of atopic dermatitis. This was a single-center, double-blinded, randomized, placebo-controlled investigator-led clinical trial including 60 atopic dermatitis patients. The participants were classified into an experimental group (30 persons) and a control group (30 persons), who were administered, respectively, socheongryong-tang or a placebo for 4 weeks. After 4 weeks of treatment, the participants visited the trial center again and assess their efficacy and safety. The researchers performed statistical comparisons of the changes in the SCORAD Index, amount and frequency of ointment use, and height and weight to assess the efficacy. To assess the safety, diagnostic tests and vital sign checks were performed at each visit, and the presence or absence of adverse events was observed. As a result, the frequency and the amount of steroid ointment application in both groups increased, but the experimental group showed less tendency (p = 0.081). Results of analyzing the children in the experimental group in relation to growth showed a significantly greater height growth than the control group (p < 0.05). In addition, all study participants did not show any remarkable abnormal signs in the safety evaluation. In conclusion, compared to the control group, the experimental group, who took socheongryong-tang showed a tendency to be less dependent on steroid ointment and statistically significant increase in height.

BackgroundAtopic dermatitis (AD) is a common inflammatory and chronically relapsing disorder with increasing prevalence. However, little is known about its prevalence in Shanghai, the top metropolitan of China. This study will estimate and compare the prevalence of AD in urban and rural areas in representative samples of 3 to 6-year-old children in Shanghai.Methodology/Principal FindingsA descriptive cross-sectional study was performed. Pre-school children were obtained by cluster sampling from 8 communities in different districts in Shanghai. The main instrument was the core questionnaire module for AD used in the U.K. Working Party's study. All the data were statistically analyzed by EpiData 3.1 and SPSS16.0. A total of 10436 children completed the study satisfactorily, with a response rate of 95.8%. The prevalence of AD in 3 to 6-year-old children was 8.3% (Male: 8.5%, Female: 8.2%). The prevalence in urban areas of Shanghai was gradiently and significantly higher than that in rural areas. The highest prevalence was in the core urban area (10.2% in Xuhui Tianping) vs. the lowest far from the urban areas (4.6% in Chongming Baozhen).Conclusions/SignificanceThe prevalence of AD was 8.3% (95%CI: 7.6%–9.1%) in children aged 3 to 6 in Shanghai. The prevalence of AD decreased from the center to the rural areas in Shanghai.

Studies on the prevalence of atopic dermatitis (AD) in adults in general populations are scarce worldwide. We performed a retrospective population-based observational cohort study of 537 098 adult patients diagnosed with AD in Catalonia, Spain, a larger population than in previous studies. Objectives: To study the prevalence of AD by age, sex, disease severity, multimorbidity, serum total immunoglobin E (tIgE), and appropriate medical treatment (AMT) for the population of Catalonia. The study population comprised adult individuals (≥18 years) diagnosed with AD according to medical records at different health care levels (primary, hospital, emergency) in the Catalan Health System. Statistical analyses were conducted to evaluate sociodemographic characteristics, prevalence, multimorbidity, serum tIgE, and AMT. The prevalence of AD in the adult Catalan population was 8.7%, being higher for nonsevere disease (8.5%) than for severe disease (0.2%) and in females (10.1%) than in males (7.3%). Topical corticosteroids were the most prescribed drug (66.5%), and treatment was prescribed more frequently in severe AD patients, especially systemic corticosteroids (63.8%) and immunosuppressants (60.7%). More than half of severe AD patients (52.2%) had serum tIgE ≥100 kU/L, and higher values were observed for those with multimorbidity. The most frequent comorbid respiratory diseases were acute bronchitis (13.7%), allergic rhinitis (12.1%), and asthma (8.6%). We provide new and robust evidence of the prevalence of AD and related characteristics in adults using a large-scale population-based study and a more significant cohort of individuals.

Background: Early-life sensitization to house dust mites (HDMs) is a recognized risk factor for adverse respiratory allergic outcomes. Methods: We investigated the clinical characteristics of infants under two years of age who visited our allergy clinic for evaluation with detectable HDM-specific IgE (sIgE) and compared them to HDM-sIgE–negative infants. Results: Among 1793 infants tested for HDM sIgE, 96 (5.4%) demonstrated sensitization. In the HDM-positive cohort, the prevalence of atopic dermatitis was 74.0% (90.9% among those <12 months), food allergy was 57.3% (100% among those <12 months), egg white sensitization was 71.9% (90.9% among those <12 months), and cow’s milk sensitization was 56.3% (81.8% among those <12 months). Atopic dermatitis, food allergy, ≥4 wheezing episodes, physician-diagnosed asthma, allergic rhinitis, egg white sensitization, cow’s milk sensitization, and sensitization to three or more food allergens were significantly more common in the HDM-positive group compared with the HDM-negative group. Significant correlations were observed between HDM sIgE and total IgE levels, as well as between HDM sIgE and egg white sIgE levels. Overall, HDM sensitization in infants was most frequently accompanied by atopic dermatitis and egg white sensitization. Conclusions: These findings suggest that early HDM sensitization should be closely monitored, particularly in infants with atopic dermatitis and food allergies who exhibit elevated total IgE and egg white sIgE levels.

Prevalence of common sensitizing aeroallergens in patients with atopic dermatitis.

The global epidemiology of atopic dermatitis (AD) in the current decade (2009–2019) has not been extensively reported. Epidemiological studies play an important role in presenting the risk factors of AD, as detailed prevalence and incidence data could demonstrate the burden of disease in the population of adults, adolescents, and children in different geographical regions. Thus, the primary objective of this review was to assess and summarize the epidemiological studies of the prevalence and incidence of AD in different age groups, focusing on data from studies published for 2009 to 2019. After a thorough literature search, six countries were identified from African, Asian, and European regions respectively, who published studies on AD. In contrast, only two studies were identified from Australia and New Zealand, three countries from North America and two from South America published AD studies, respectively. The highest prevalence of AD from included studies was noted among Swedish children with 34%, while the lowest prevalence was in Tunisian children with 0.65%; studies reporting incidence data were far less numerous. A common trend in the prevalence of AD was that children would have a higher prevalence as compared to adolescents and adults. The severity and morbidity of the disease showed variance with age, sex, socioeconomic characteristics, geographical location, and ethnicity. Environmental factors played an important role as causative agents in AD. The risk factors that were proven to cause and induce AD were skin barrier impairments due to FLG mutation, changes in the environment, and diet. FLG mutation may impair the skin barrier function by disruption of pH and hydration maintenance of the skin. Lastly, there were only a few studies on the incidence of AD in the 21st century. Therefore, epidemiological studies on childhood and adulthood AD in different continents are still needed, especially on the incidence of AD during adulthood.

Staphylococcus aureus is an opportunistic pathogen and variable component of the human microbiota. A characteristic of atopic eczema (AE) is colonization by S. aureus, with exacerbations associated with an increased bacterial burden of the organism. Despite this, the origins and genetic diversity of S. aureus colonizing individual patients during AE disease flares is poorly understood. To examine the microevolution of S. aureus colonization, we deep sequenced S. aureus populations from nine children with moderate to severe AE and 18 non-atopic children asymptomatically carrying S. aureus nasally. Colonization by clonal S. aureus populations was observed in both AE patients and control participants, with all but one of the individuals carrying colonies belonging to a single sequence type. Phylogenetic analysis showed that disease flares were associated with the clonal expansion of the S. aureus population, occurring over a period of weeks to months. There was a significant difference in the genetic backgrounds of S. aureus colonizing AE cases versus controls (Fisher exact test, P = 0.03). Examination of intra-host genetic heterogeneity of the colonizing S. aureus populations identified evidence of within-host selection in the AE patients, with AE variants being potentially selectively advantageous for intracellular persistence and treatment resistance.

Prevalence of asthma, rhinoconjunctivitis and atopic eczema among Brazilian adolescents. Comparison between ISAAC phases I and III

Epidemiological study on childhood dermatoses performed by direct inspection of dermatologists is limited. To investigate the prevalence of selective childhood dermatoses in Taiwan. In a cross-sectional study carried out in June 2004, 4067 of 7851 children aged between 6 and 11 years living in the Kaohsiung County in south Taiwan were clinically surveyed and examined by two board-certified dermatologists (response rate 52%), regarding the point prevalence of acne, ephelides, warts, atopic dermatitis (AD), psoriasis, alopecia areata (AA) and keloid. Acne vulgaris was found in girls and boys from the age of 6 and 7, respectively, with comedones being the earliest presentation. Ephelides were not infrequently observed in our children (prevalence rate 8.4%, 95% confidence interval, CI 7.9-9.3%). The prevalence of warts on hands was 2.4% (95% CI 1.9-2.9%). The prevalence of AD was 1.7% (95% CI 1.3-2.1%), without gender difference. There were only four cases of AA but no psoriasis was found. Keloid was identified in 13 boys and 10 girls, accounting for 0.6% (95% CI 0.598-0.602%) of the children. Acne vulgaris is as common in Taiwan as in Western countries. Ephelides are not uncommon in our population with the main skin types III-IV. A clustered distribution of the wart infection was noted. The low prevalence of AD in Taiwan seems unaltered over the past decade. AA and psoriasis are rare in our series. Most keloids in our children are caused by BCG vaccination.

Prevalencia de dermatitis atópica en lactantes y preescolares de Santiago, Chile, 2007

Atopic dermatitis (AD) is a common multifactorial skin disease occurring primarily in young children. AD has increased in prevalence over the past decades, but little knowledge exists on the prevalence of AD in adults. Herein, published estimates of the point-prevalence and one-year prevalence of AD in adults are reviewed in the context of various study characteristics such as the age and gender distribution of the populations, sampling methods, study design, and geographical area of origin. In total, 14 different population studies reporting the prevalence of AD in adults in 17 countries were identified. There was a substantial between-country variation in both the point-prevalence (1.6 to 11.5%) and one-year prevalence (2.2 to 17.6%) of AD with heterogeneity explained partly by gender, age, geography, study design, and diagnostic criteria.

OBJECTIVES: Atopic dermatitis (AD) is an increasingly common, chronic, relapsing, inflammatory skin disease characterized by impaired epidermal barrier function and cutaneous inflammation. The prevalence of AD has steadily increased during the past few decades. The aim of this study was to comparatively investigate cytokine gene expression in the skin and peripheral blood of atopic dermatitis patients and healthy individuals. RESULTS: In the skin of patients with AD, a significant increase of the level of gene expression was observed for interleukin (IL)-2r (p < 0.0023), IL-5 (p = 0.002), IL-6 (p < 0.0023), IL-8 (p = 0.01), IL-12B (p < 0.0023), IL-10 (p < 0.0023), IL-23 (p = 0.002), IL-29 (p < 0.0023), and transforming growth factor beta (tGFbeta) (p < 0.0023) as compared to healthy individuals. In contrast, no difference between AD patients and healthy donors was detected with respect to cytokine gene expression in the peripheral blood. METHODS: Samples of skin and peripheral blood from 48 severe AD patients (SCORAD = 78.5 [57;89], IGA = 4.2 [3,9;4,7]) at the age of 17 to 45 years and 20 healthy donors aged from 19 to 32 years were analyzed for gene expression of cytokines using real-time reverse transcription polymerase chain reaction (RT-PCR). CONCLUSIONS: Activity of markers of chronic inflammation and Th1 immune response in severe AD, namely IL-2r, IL-8, IL-12B, IL-23, IL-29 and TGFbeta, as well as activity of anti-inflammatory IL-5 were predominant in the skin but not in the blood of AD patients.