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Iwanaszko M, Waldeck N, Anafi R, Paller AS, Zee P, Fishbein A. Circadian Rhythms in Skin Barrier Function in Atopic Dermatitis: A Pilot Study. J Biol Rhythms 2024; 39:208-214. [PMID: 38305093 PMCID: PMC10994754 DOI: 10.1177/07487304231220695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Atopic dermatitis (AD) is symptomatically worse in the evening, but the mechanism driving nocturnal eczema remains elusive. Our objective was to determine the circadian rhythm of skin barrier function measured by transepidermal water loss (TEWL) in AD patients and explore the molecular underpinnings. A pilot study was performed on a diverse group of AD (n = 4) and control (n = 2) young patients. We used an inpatient tightly controlled, modified, constant routine protocol. TEWL was measured at least every 90 min in the antecubital fossa (lesional) and forearm, while whole blood samples were collected every 4 h. Results show a significant difference in the antecubital fossa TEWL in the AD group versus controls. TEWL in control skin decreases starting a few hours prior to bedtime, both in the antecubital fossa and in the forearm, while in the AD forearm skin, pre-bedtime TEWL increases. We identified 1576 differentially expressed genes using a time-dependent model. The top 20 upregulated gene ontology pathways included neuronal pathways, while the downregulated functional terms included innate immune signaling and viral response. Similar pathways positively correlated with forearm TEWL in controls and inversely with the AD group. Upregulation in sensory perception pathways correlated with increases in lesional (antecubital fossa) TEWL in the evening. Results show skin barrier function worsens in the evening in the AD group, at a time when barrier is normally rejuvenating in healthy skin. This timing and the detection of transcriptomic signatures of sensory perception and diminished viral response might correspond to the nocturnal itch. Larger studies are needed to evaluate these associations in the skin.
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Affiliation(s)
- Marta Iwanaszko
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611
| | - Nathan Waldeck
- Department of Medicine, Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 606112
| | - Ron Anafi
- Department of Medicine, Penn Institute for Bioinformatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104
| | - Amy S. Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611
| | - Phyllis Zee
- Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611
| | - Anna Fishbein
- Department of Pediatrics, Division of Allergy-Immunology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611
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Ratley G, Zeldin J, Chaudhary PP, Yadav M, Paller AS, Zee P, Myles IA, Fishbein A. The circadian metabolome of atopic dermatitis. J Allergy Clin Immunol 2024; 153:1148-1154. [PMID: 38262502 PMCID: PMC10999347 DOI: 10.1016/j.jaci.2023.11.926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/11/2023] [Accepted: 11/08/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by dry, pruritic skin. Several studies have described nocturnal increases in itching behavior, suggesting a role for the circadian rhythm in modulating symptom severity. However, the circadian rhythm of metabolites in the skin and serum of patients with AD is yet to be described. OBJECTIVE We sought to assess circadian patterns of skin and serum metabolism in patients with AD. METHODS Twelve patients with moderate to severe AD and 5 healthy volunteers were monitored for 28 hours in a controlled environment. Serum was collected every 2 hours and tape strips every 4 hours from both lesional and nonlesional skin in participants with AD and location-, sex-, and age-matched healthy skin of controls. We then performed an untargeted metabolomics analysis, examining the circadian peaks of metabolism in patients with AD. RESULTS Distinct metabolic profiles were observed in AD versus control samples. When accounting for time of collection, the greatest differences in serum metabolic pathways were observed in arachidonic acid, steroid biosynthesis, and terpenoid backbone biosynthesis. We identified 42 circadian peaks in AD or control serum and 17 in the skin. Pathway enrichment and serum-skin metabolite correlation varied throughout the day. Differences were most evident in the late morning and immediately after sleep onset. CONCLUSIONS Although limited by a small sample size and observational design, our findings suggest that accounting for sample collection time could improve biomarker detection studies in AD and highlight that metabolic changes may be associated with nocturnal differences in symptom severity.
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Affiliation(s)
- Grace Ratley
- Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Md
| | - Jordan Zeldin
- Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Md
| | - Prem Prashant Chaudhary
- Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Md
| | - Manoj Yadav
- Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Md
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Phyllis Zee
- Department of Neurology, Center for Sleep & Circadian Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Ian A Myles
- Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Md.
| | - Anna Fishbein
- Division of Allergy & Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Weins AB, Kerzel S, Schnopp C. Schwere atopische Dermatitis im frühen Kindesalter: Besonderheiten, Herausforderungen und neue Perspektiven in der Versorgung. J Dtsch Dermatol Ges 2024; 22:350-356. [PMID: 38451004 DOI: 10.1111/ddg.15344_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/22/2023] [Indexed: 03/08/2024]
Abstract
ZusammenfassungDie atopische Dermatitis ist die häufigste chronische Hauterkrankung im Kindesalter mit einer Prävalenz von 10% bei Kleinkindern unter 2 Jahren, wovon etwa 15% einen hohen Schweregrad aufweisen. „Kinder sind keine kleinen Erwachsenen“, dies trifft für die schwere frühkindliche atopische Dermatitis in besonderem Maße zu. Innerhalb dieser sensiblen Lebensphase zeigen sich alterstypische Facetten der Erkrankung (psychosozial, neurokognitiv, klinisch‐morphologisch), die Unterschiede im Management mit sich bringen.Besondere Bedeutung hat die Identifikation von Säuglingen und Kleinkindern mit früh‐persistierendem, schwerem Verlauf mit Blick auf eine erstmals für diese Altersgruppe zugelassene Systemtherapie: sowohl für die unmittelbare Versorgung der Hauterkrankung als auch unter dem Aspekt einer möglichen Prävention von Begleiterkrankungen. Da der „atopische Phänotyp“ klinische Überlappungen zum Spektrum der Immundefekte aufweist, ist die korrekte Einordnung des Hautbefundes bei therapierefraktärem Ekzem essenziell. In dieser Arbeit beschreiben wir eine alltagstaugliche Strategie, um anhand anamnestischer Warnhinweise, dermatologischer Leitbefunde und Labordiagnostik eine Abgrenzung von ekzematösen Hauterscheinungen bei primären Immundefekten vorzunehmen. Dazu geben wir aktuelle Empfehlungen zum Management des schweren frühkindlichen atopischen Ekzems, auch in Bezug auf die Indikation zur Systemtherapie.
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Affiliation(s)
- Andreas Benedikt Weins
- Klinik für Kinder- und Jugendmedizin, Universitätsklinik Augsburg
- KIDZ SKIN | Praxis für Kinder- und Jugenddermatologie, Ulm
| | - Sebastian Kerzel
- Krankenhaus Barmherzige Brüder, Klinik und Poliklinik für Kinder- und Jugendmedizin, Abteilung für Pädiatrische Pneumologie und Allergologie, Regensburg
| | - Christina Schnopp
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München
- Praxis Burgstraße, München
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Weins AB, Kerzel S, Schnopp C. Severe atopic dermatitis in early infancy: characteristics, challenges and new perspectives in clinical practice. J Dtsch Dermatol Ges 2024; 22:350-355. [PMID: 38450908 DOI: 10.1111/ddg.15344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/22/2023] [Indexed: 03/08/2024]
Abstract
Atopic dermatitis (AD) is the most common skin disease in infants and children with a prevalence of 10% in the first two years of life. In this age group up to 15% are severely affected. "Children are not little adults" - this applies in particular to infants with severe atopic dermatitis. Age-specific clinical aspects (psychosocial, neurocognitive, morphological) of the disease require an adjusted disease management. Considering recent approval of systemic treatment options, early identification of infants and children with severe and early persistent disease is of particular importance also in view of possible prevention of atopic comorbidity. As several inborn errors of immunity (IEI) share features of the atopic phenotype, it is essential for clinicians to distinguish signs of immunodeficiency from severe AD. Here, we describe a practical approach on the basis of clinical history and key dermatological and laboratory findings. Furthermore, this paper is aimed at providing an update on general management of severe AD in early infancy, including recommendations for systemic treatment.
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Affiliation(s)
- Andreas Benedikt Weins
- Department of Pediatrics, University Hospital Augsburg, Augsburg, Germany
- KIDZ SKIN | Practice for Pediatric Dermatology, Ulm, Germany
| | - Sebastian Kerzel
- Barmherzige Brüder Hospital, Department of Pediatrics, Section for Pediatric Pneumonology and Allergology, Regensburg, Germany
| | - Christina Schnopp
- Department of Dermatology and Allergology am Biederstein, Technical University Munich, Munich, Germany
- Practice Burgstraße, Munich, Germany
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Chu DK, Schneider L, Asiniwasis RN, Boguniewicz M, De Benedetto A, Ellison K, Frazier WT, Greenhawt M, Huynh J, Kim E, LeBovidge J, Lind ML, Lio P, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Wang J, Wheeler KE, Guyatt GH, Capozza K, Begolka WS, Chu AWL, Zhao IX, Chen L, Oykhman P, Bakaa L, Golden D, Shaker M, Bernstein JA, Greenhawt M, Horner CC, Lieberman J, Stukus D, Rank MA, Wang J, Ellis A, Abrams E, Ledford D, Chu DK. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol 2024; 132:274-312. [PMID: 38108679 DOI: 10.1016/j.anai.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Guidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology. OBJECTIVE To produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD. METHODS A multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group supported guideline development by performing systematic evidence reviews, facilitating guideline processes, and holding focus groups with patient and family partners. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed rating the certainty of evidence and strength of recommendations. Evidence-to-decision frameworks, subjected to public comment, translated evidence to recommendations using trustworthy guideline principles. RESULTS The panel agreed on 25 recommendations to gain and maintain control of AD for patients with mild, moderate, and severe AD. The eAppendix provides practical information and implementation considerations in 1-2 page patient-friendly handouts. CONCLUSION These evidence-based recommendations address optimal use of (1) topical treatments (barrier moisturization devices, corticosteroids, calcineurin inhibitors, PDE4 inhibitors [crisaborole], topical JAK inhibitors, occlusive [wet wrap] therapy, adjunctive antimicrobials, application frequency, maintenance therapy), (2) dilute bleach baths, (3) dietary avoidance/elimination, (4) allergen immunotherapy, and (5) systemic treatments (biologics/monoclonal antibodies, small molecule immunosuppressants [cyclosporine, methotrexate, azathioprine, mycophenolate, JAK inhibitors], and systemic corticosteroids) and UV phototherapy (light therapy).
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Affiliation(s)
- Derek K Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada.
| | - Lynda Schneider
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts.
| | | | - Mark Boguniewicz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Division of Pediatric Allergy and Clinical Immunology, National Jewish Health, Denver, Colorado
| | - Anna De Benedetto
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | | | - Winfred T Frazier
- Department of Family Medicine, UPMC St. Margaret, Pittsburgh, Pennsylvania
| | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colorado
| | - Joey Huynh
- Sepulveda VA Medical Center, North Hills, California
| | | | - Jennifer LeBovidge
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Mary Laura Lind
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona
| | - Peter Lio
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen A Martin
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Monica O'Brien
- Tufts University School of Medicine, Boston, Massachusetts
| | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics, USC Keck School of Medicine, Los Angeles, California
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jonathan M Spergel
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Kathryn E Wheeler
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Gordon H Guyatt
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, California
| | | | - Alexandro W L Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Irene X Zhao
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Lina Chen
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Paul Oykhman
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Layla Bakaa
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - David Golden
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marcus Shaker
- Dartmouth Geisel School of Medicine and Dartmouth Hitchcock Medical Center, Section of Allergy, Lebanon, New Hampshire
| | | | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colorado
| | - Caroline C Horner
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Jay Lieberman
- University of Tennessee Health Science Center and LeBonheur Children's Hospital, Memphis, Tennessee
| | - David Stukus
- Nationwide Children's Hospital and Ohio State University College of Medicine, Columbus, Ohio
| | - Matthew A Rank
- Mayo Clinic in Arizona and Phoenix Children's Hospital, Scottsdale and Phoenix, Arizona
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Anne Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Elissa Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dennis Ledford
- Morsani College of Medicine, University of South Florida and James A. Haley Veterans' Affairs Hospital, Tampa, Florida
| | - Derek K Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
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Arif MK, Zee PC, Paller AS, Crowley SJ, Roenneberg T, Fishbein AB. Severe atopic dermatitis, sleep disturbance, and low light exposure. Sleep 2024; 47:zsad276. [PMID: 37935914 DOI: 10.1093/sleep/zsad276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 08/01/2023] [Indexed: 11/09/2023] Open
Abstract
STUDY OBJECTIVES Atopic dermatitis (AD) is a chronic inflammatory skin disorder in children. AD worsens at night, particularly in severe disease. Low light exposure contributes to inflammation, poor sleep, and misalignment between circadian (24-hour) rhythms (biological clocks) and social clocks (weekday vs. weekend sleep timing), but has not been evaluated in AD. Our objective was to perform a cross-sectional study to determine whether there is an association between AD severity, recorded light exposure (RLE), and sleep measures in participants with AD and healthy controls. METHODS Secondary data analysis from two prospective observational studies of 74 participants ages 5-17 years old with severe AD compared to others (healthy controls and mild/moderate AD). Participants wore actigraphy watches for at least 1 weekday and one weekend. Rest/activity and RLE (lux) were obtained from the watches and were analyzed to estimate duration and quality of sleep/light exposure. RESULTS Participants (n = 74) were on average 10.9 ± 3.6 years old, with 45% female, 17% no AD, 27% mild, 32% moderate, and 24% severe AD. On weekends, severe AD participants versus others fell asleep at a similar time (23:52 ± 1:08 vs. 23:40 ± 1:29 mean clock-time hours ± SD; p = 0.23), had similar sleep-onset latency (8.2 ± 8.7 vs. 12.7 ± 16.9 minutes; p = 0.28), but woke later (09:12 ± 1:04 vs. 08:13 ± 1:14 minutes; p < 0.01) resulting in a later sleep-midpoint (04:32 ± 0:53 vs. 03:49 ± 1:08 minutes; p = 0.02). Severe AD participants had lower levels of daytime RLE than others (mean-over-all-days: 1948.4 ± 2130.0 vs. 10341.3 ± 13453.8 lux; p = 0.01) and throughout seasons, weekdays, or weekend, yet had similar nighttime RLE. CONCLUSION Severe AD is characterized by low RLE and sleep disturbance. Low RLE could potentially induce circadian misalignment, contributing to inflammation and worse disease in severe AD. Low RLE can also reflect altered lifestyle and behavior due to atopic disease impacts. Prospective studies are needed to test causality and the potential of bright light as an adjuvant therapy for severe AD.
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Affiliation(s)
- Mariam K Arif
- Division of Allergy-Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Phyllis C Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephanie J Crowley
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Till Roenneberg
- Institutes for Medical Psychology and for Occupational-, Social- and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Anna B Fishbein
- Division of Allergy-Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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7
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Blouchou A, Chamou V, Eleftheriades C, Poulimeneas D, Kontouli KM, Gkiouras K, Bargiota A, Gkouskou KK, Rigopoulou E, Bogdanos DP, Goulis DG, Grammatikopoulou MG. Beat the Clock: Assessment of Night Eating Syndrome and Circadian Rhythm in a Sample of Greek Adults. Nutrients 2024; 16:187. [PMID: 38257080 PMCID: PMC10818804 DOI: 10.3390/nu16020187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
The night eating syndrome (NES) is characterized by excessive food intake during the evening and night hours, with 25% of the daily intake being consumed post-dinner, paired with ep-isodes of nocturnal food intake, at a frequency of more than twice weekly. The NES has been associated with a misaligned circadian rhythm related to a delay in overall food intake, increased energy and fat consumption. The present cross-sectional study aimed to assess NES in a Greek population and evaluate possible links between NES and chronotype. NES was assessed using the Night Eating Questionnaire (NEQ), and circadian rhythm, sleep and mood were evaluated with the Sleep, Circadian Rhythms, and Mood (SCRAM) questionnaire. A total of 533 adults participated in the study. A relatively high prevalence of NES was revealed, with more than 8.1% (NEQ ≥ 30) of the participants reporting experiencing NES symptoms, depending on the NEQ threshold used. Most participants had the intermediate chronotype. NEQ score was positively associated with the morning chronotype, and SCRAM was negatively related to "Good Sleep". Each point increment in the depression score was associated with 6% higher odds of NES. The early identification of NES gains importance in clinical practice, in a collective effort aiming to reduce NES symptomatology and its detrimental health effects.
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Affiliation(s)
- Anastasia Blouchou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, Sindos, GR-57400 Thessaloniki, Greece; (A.B.); (V.C.); (C.E.)
| | - Vasiliki Chamou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, Sindos, GR-57400 Thessaloniki, Greece; (A.B.); (V.C.); (C.E.)
| | - Christos Eleftheriades
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, Sindos, GR-57400 Thessaloniki, Greece; (A.B.); (V.C.); (C.E.)
| | - Dimitrios Poulimeneas
- Department of Nutritional Science and Dietetics, School of Health Sciences, University of the Peloponnese, GR-24100 Kalamata, Greece
| | - Katerina-Maria Kontouli
- Department of Primary Education, School of Education, University of Ioannina, GR-45110 Ioannina, Greece
| | - Konstantinos Gkiouras
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41223 Larissa, Greece
| | - Alexandra Bargiota
- Department of Endocrinology and Metabolic Diseases, Faculty of Medicine, University of Thessaly, Biopolis, GR-41223 Larissa, Greece
| | - Kalliopi K. Gkouskou
- Laboratory of Biology, School of Medicine, National and Kapodistrian University of Athens, GR-11527 Athens, Greece;
- Genosophy, 1 Melissinon and Damvergidon Street, GR-71305 Heraklion, Crete, Greece
| | - Eirini Rigopoulou
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, Larissa University Hospital, Biopolis, GR-41334 Larissa, Greece
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Larissa University Hospital, Biopolis, GR-41334 Larissa, Greece
| | - Dimitrios P. Bogdanos
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41223 Larissa, Greece
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece
| | - Maria G. Grammatikopoulou
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41223 Larissa, Greece
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece
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8
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Yosipovitch G, Gooderham MJ, Ständer S, Fonacier L, Szepietowski JC, Deleuran M, Girolomoni G, Su JC, Bushmakin AG, Cappelleri JC, Feeney C, Chan G, Thorpe AJ, Valdez H, Biswas P, Rojo R, DiBonaventura M, Myers DE. Interpreting the Relationship Among Itch, Sleep, and Work Productivity in Patients with Moderate-to-Severe Atopic Dermatitis: A Post Hoc Analysis of JADE MONO-2. Am J Clin Dermatol 2024; 25:127-138. [PMID: 37624488 PMCID: PMC10796557 DOI: 10.1007/s40257-023-00810-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Abrocitinib, an oral, once-daily Janus kinase 1-selective inhibitor, improved itch severity, sleep, and work productivity versus placebo in patients with moderate-to-severe atopic dermatitis. OBJECTIVE The aim of this study was to investigate relationships among itch, sleep, and work productivity in the phase III JADE MONO-2 clinical trial. METHODS A repeated-measures longitudinal model was used to examine relationships between itch (using the Peak Pruritus Numerical Rating Scale [PP-NRS] or Nighttime Itch Scale [NTIS]) and sleep disturbance/loss (using the Patient-Oriented Eczema Measure sleep item and SCORing AD Sleep Loss Visual Analog Scale) and, separately, between itch and work productivity (using the Work Productivity and Activity Impairment-Atopic Dermatitis Version 2.0 questionnaire). Mediation modelling was used to investigate the effect of treatment (abrocitinib vs placebo) on work impairment via improvements in itch and sleep. RESULTS The relationships between itch/sleep and itch/work productivity were approximately linear. PP-NRS scores of 0, 4-6, and 10 were associated with 0 days, 3-4 days, and 7 days per week of disturbed sleep, respectively. PP-NRS or NTIS scores of 0-1, 4-5, and 10 were associated with 0-10%, 20-30%, and >50% overall work impairment, respectively. Seventy-five percent of the effect of abrocitinib on reducing work impairment was indirectly mediated by improvement in itch, followed by sleep. CONCLUSION These results quantitatively demonstrate that reducing itch severity is associated with improvements in sleep and work productivity. Empirical evidence for the mechanism of action of abrocitinib showed that itch severity is improved, which reduces sleep loss/sleep disruption and, in turn, improves work productivity. CLINICAL TRIAL REGISTRATION NCT03575871.
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Affiliation(s)
- Gil Yosipovitch
- Department of Dermatology, Miami Itch Center, Miami, FL, USA
| | | | - Sonja Ständer
- Department of Dermatology, Center for Chronic Pruritus, Münster University Hospital, Münster, Germany
| | - Luz Fonacier
- NYU Langone Hospital-Long Island Allergy and Immunology, Mineola, NY, USA
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Mette Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | | | - John C Su
- Department of Paediatrics, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Australia
- Department of Dermatology, Monash University, Eastern Health, Box Hill, VIC, Australia
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9
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Cameron S, Donnelly A, Broderick C, Arichi T, Bartsch U, Dazzan P, Elberling J, Godfrey E, Gringras P, Heathcote LC, Joseph D, Wood TC, Pariante C, Rubia K, Flohr C. Mind and skin: Exploring the links between inflammation, sleep disturbance and neurocognitive function in patients with atopic dermatitis. Allergy 2024; 79:26-36. [PMID: 37469218 DOI: 10.1111/all.15818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/06/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
Atopic dermatitis (AD) is a chronic, pruritic and inflammatory, dry skin condition with many known comorbidities. These include airway disease, food allergies, atopic eye disease and autoimmune conditions. Furthermore, there is often significant sleep disturbance as well as increased psychological distress and mental health problems. Severe AD therefore often has a significant impact on the quality of life of both patients and their families. In this review we discuss recent findings on the putative links between AD, its association with itch, sleep disturbance and neuropsychiatric morbidity, including the role of inflammation in these conditions. Itch was thought to predominantly drive sleep disruption in AD. We now understand changes in sleep influence immune cell distribution and the associated inflammatory cytokines, which suggests a bidirectional relationship between AD and sleep. We also increasingly recognize inflammation as a key driver in psychological symptoms and disorders. The link between cutaneous, systemic and possible brain inflammation could at least in part be driven by the sleep deprivation and itch-driven neuronal proliferation seen in AD.
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Affiliation(s)
- Shona Cameron
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ali Donnelly
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Conor Broderick
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ullrich Bartsch
- Surrey Sleep Research Centre, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London and University of Surrey, Guildford, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jesper Elberling
- Depart of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Emma Godfrey
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Gringras
- Paediatric Sleep Department, Evelina Children's Hospital, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Desaline Joseph
- Paediatric Sleep Department, Evelina Children's Hospital, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tobias C Wood
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carmine Pariante
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London and University of Surrey, Guildford, UK
| | - Katya Rubia
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London and University of Surrey, Guildford, UK
| | - Carsten Flohr
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
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10
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Samynathan A, Fishbein AB, Abbott SM, Booster GD, Zee PC, Sheldon SH, Yosipovitch G, Silverberg JI. Assessment and Management of Sleep Disturbances in Atopic Dermatitis: A Review. Dermatitis 2024; 35:S7-S12. [PMID: 37756222 DOI: 10.1089/derm.2023.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Atopic dermatitis (AD) is a chronic burdensome inflammatory skin disease with well-established cutaneous and systemic comorbidities and disease burden. AD particularly has profound impacts on sleep in individuals of all ages. Sleep disturbances (SDs) affect 6.2% of school-age children and 33-87.1% of adults with AD. This narrative review addresses the burden of SD in AD patients, as well as biological mechanisms of SD in AD, including biological clocks influencing sleep, inflammation, and behavior. Approaches for early detection, diagnosis, objective quantification, patient education, and management are reviewed. It is imperative to break the itch-scratch cycle to reduce SDs and improve quality of life in individuals with AD.
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Affiliation(s)
- Archana Samynathan
- From the Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Anna B Fishbein
- Department of Allergy and Immunology, Robert and Anne Lurie Children's Hospital, Chicago, Illinois, USA
| | - Sabra M Abbott
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Genery D Booster
- Department of Pediatrics, National Jewish Hospital, Denver, Colorado, USA
| | - Phyllis C Zee
- Department of Sleep Medicine, Robert and Anne Lurie Children's Hospital, Chicago, Illinois, USA
| | - Stephen H Sheldon
- Sleep Medicine Center, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Gil Yosipovitch
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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11
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Sugiyama A, Murakami Y, Okamoto K, Nakano H, Wakatsuki M, Kawano T, Akamine Y, Iwata M, Motomura C, Kojima K, Oda M, Honjo S, Odajima H, Nakahara T, Furue M, Ikoma A. Nocturnal Scratching and Quality of Sleep in Children with Atopic Dermatitis. Acta Derm Venereol 2023; 103:adv12345. [PMID: 37870075 PMCID: PMC10622160 DOI: 10.2340/actadv.v103.12345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/22/2023] [Indexed: 10/24/2023] Open
Abstract
Itching due to atopic dermatitis causes sleep disorders in children, but its pathology is unknown. The aim of this study is to investigate nocturnal scratching as an indirect index of itching during sleep and its relationship with depth of sleep in children with atopic dermatitis. Nocturnal scratching was measured in a total of 20 children with atopic dermatitis, using a smartwatch installed with the application Itch Tracker. Depth of sleep was analysed using polysomnography. The severity of atopic dermatitis was scored using Eczema Area and Severity Index (EASI) and Patient-Oriented Eczema Measure (POEM). The number and time of nocturnal scratching measured by Itch Tracker had a significantly positive correlation with EASI scores, whereas POEM scores were not correlated with EASI scores. Mean sleep efficiency was 90.0% and scratching episodes (n = 67) started mainly during the awake stage or light sleep stages. In the scratching episodes that started during sleep stages (n = 34), the sleep stage changed to a lighter one or to the awake stage in 35.5% of episodes. Itch Tracker is applicable to measure nocturnal scratching in children. Nocturnal scratching can deteriorate quality of sleep by changing the sleep stage to a lighter one or to the awake stage.
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Affiliation(s)
- Akiko Sugiyama
- Department of Allergology and Dermatology, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
| | - Yoko Murakami
- Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan.
| | | | - Hiroshi Nakano
- Sleep Disorders Center, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
| | - Masatoshi Wakatsuki
- Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
| | - Toshiaki Kawano
- Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan Sleep Disorders Center, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
| | - Yuko Akamine
- Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
| | - Mihoko Iwata
- Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan Sleep Disorders Center, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
| | - Chikako Motomura
- Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan Sleep Disorders Center, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
| | - Kaoru Kojima
- Department of Clinical Research, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
| | - Makiko Oda
- Department of Clinical Research, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
| | - Satoshi Honjo
- Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan; Department of Clinical Research, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
| | - Hiroshi Odajima
- Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
| | | | - Masutaka Furue
- Department of Dermatology, Kyushu University, Fukuoka, Japan
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12
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Sun N, Dai D, Deng S, Cai X, Song P. Bioinformatics Integrative Analysis of Circadian Rhythms Effects on Atopic Dermatitis and Dendritic Cells. Clin Cosmet Investig Dermatol 2023; 16:2919-2930. [PMID: 37873510 PMCID: PMC10590565 DOI: 10.2147/ccid.s424343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023]
Abstract
Background Atopic dermatitis (AD) is an allergic inflammatory skin disease caused by aberrant and over-reactive immune response. Although circadian rhythm disruption is implicated in multiple immunoinflammatory conditions, including AD, the mechanisms at the molecular level underlying AD and circadian rhythms remain elusive. Methods Bulk and single-cell RNA-sequencing data of AD patients were acquired from the Gene Expression Omnibus, including GSE121212, GSE120721, and GSE153760 datasets. A single-sample gene set enrichment analysis was performed to estimate circadian rhythm gene expression levels. A differential expression analysis was utilized to identify the key candidate genes in AD. CIBERSORT was used to quantify the proportions of immune cells, and the R package "Seurat" was utilized to investigate single-cell RNA-sequencing data. Results Circadian rhythm gene expression levels were lower in AD skin samples than in normal skin samples. Dendritic cells were significantly upregulated and negatively correlated with circadian rhythm gene expression levels in AD patients. Compared with circadian rhythm-related genes in the control samples, ARNTL2, NOCT, and RORC were differentially expressed in AD; ARNTL2 and NOCT were significantly upregulated, whereas RORC was significantly downregulated in AD. ARNTL2, NOCT, and RORC also showed robust abilities to diagnose AD. We validated that the abundance of the dendritic cell was positively correlated with the ARNTL2 and NOCT expression levels using bulk RNA-sequencing data of the GSE121212 and single-cell RNA-sequencing data of the GSE153760. Moreover, the functional enrichment analysis showed that the IL-17 and NF-κB signaling pathways, Th1 and Th2 cell differentiations, and primary immunodeficiency, were enriched in AD patients. Conclusion The findings of this study suggested that the circadian rhythm is involved in the progression of AD, and RNTL2, NOCT, and RORC as well as dendritic cells are differentially expressed in AD. These findings could be used to introduce diagnostic and chronotherapeutic modalities for AD.
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Affiliation(s)
- Nan Sun
- Department of Dermatology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China
| | - Dan Dai
- Department of Dermatology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China
| | - Shihang Deng
- Department of Dermatology, Shenzhen Bao’an Authentic TCM Therapy Hospital, Shenzhen, 518126, People’s Republic of China
| | - Xun Cai
- Department of Dermatology, The Fifth People’s Hospital of Suzhou, Suzhou, 215131, People’s Republic of China
| | - Ping Song
- Department of Dermatology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China
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13
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Afzal UM, Ali FR. Sleep deprivation and the skin. Clin Exp Dermatol 2023; 48:1113-1116. [PMID: 37288611 DOI: 10.1093/ced/llad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
Sleep is an under-evaluated symptom when assessing patients with cutaneous disease. Consequently, the relationship between sleep deprivation and disease burden is often not considered. The focus of our review article is to explore the bidirectional relationship between sleep and cutaneous disease investigating the disruption in circadian rhythmicity and skin homeostasis. Management strategies should focus on optimizing disease control coupled with improving sleep hygiene.
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Affiliation(s)
| | - Faisal R Ali
- Mid Cheshire NHS Foundation Trust, Crewe, UK
- St John's Institute of Dermatology, London, UK
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14
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Pehlivan S. The circadian systems genes and their importance of human health. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2023; 137:1-15. [PMID: 37709372 DOI: 10.1016/bs.apcsb.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
The circadian rhythm is the timing mechanism that creates approximately 24-hour rhythms in cellular and bodily functions in almost all living species. These internal clock systems enable living organisms to predict and respond to daily changes in their environment, optimizing temporal physiology and behavior. Circadian rhythms are regulated by both genetic and environmental risk factors. Circadian rhythms play an important role in maintaining homeostasis at the systemic and tissue levels. Disruption of this rhythm lays the groundwork for human health and disease. Disruption in these rhythms increases the susceptibility to many diseases, such as cancer, psychiatric disorders, and neurodegenerative diseases. In this chapter, the characteristics of circadian rhythm and its relationship with diseases will be discussed.
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Affiliation(s)
- S Pehlivan
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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15
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Polaskey MT, Bendelow A, Mukherji J, Buranosky B, Silverberg JI, Fishbein A. Facial atopic dermatitis is associated with sensitization to cow's milk, egg whites, and peanuts in children under 36 months. Pediatr Dermatol 2023; 40:497-499. [PMID: 37037213 DOI: 10.1111/pde.15326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/13/2023] [Indexed: 04/12/2023]
Abstract
Atopic dermatitis (AD) in early childhood often precedes the development of food sensitization and allergy, but the role of treating AD to prevent food allergy remains poorly understood. Our objective was to assess the relationship between facial dermatitis and food sensitization to cow's milk, egg whites, and peanuts in early childhood, as aggressive treatment of facial dermatitis could serve as a potential opportunity for food sensitization prevention. By 3 years of age, food sensitization levels to cow's milk, egg whites, and peanuts were 48% greater in children with facial AD than in children with no facial involvement of their AD. Additional research is needed to determine if facial involvement of AD in infants and young children is associated with increased food allergy.
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Affiliation(s)
| | - Anne Bendelow
- Ann and Robert H. Lurie Children's Hospital of Chicago, Data Analytics and Reporting, Chicago, Illinois, USA
| | - Janak Mukherji
- Division of Allergy & Immunology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Brooke Buranosky
- Division of Allergy & Immunology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Anna Fishbein
- Division of Allergy & Immunology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Division of Allergy & Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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16
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Guo M, Su J, Zheng S, Chen B. Objective Sleep in Atopic Dermatitis: A Meta-Analysis. Dermatitis 2023; 34:145-150. [PMID: 36917527 DOI: 10.1089/derm.2022.29005.mgu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: The evidence regarding objective sleep especially for the sleep architecture in atopic dermatitis (AD) was limited and not well summarized. Objective: To determine the objective sleep in AD patients as well as its confounders. Methods: We searched PubMed/Medline, Embase, and PsycInfo up to May 2021. Case-control studies or cohort studies that recruited AD patients and healthy controls and reported objective sleep parameters assessed by polysomnography or actigraphy were included. Results: A total of 7 studies with 173 AD patients and 122 controls were analyzed. Specifically, AD patients have significantly decreased total sleep time (TST, -13.797 minutes) and sleep efficiency (SE, -5.589%) accompanied by prolonged wake time after sleep onset (WASO, 29.972 minutes) and rapid eye movement sleep latency (31.894 minutes, all P < 0.05). Furthermore, subgroup analyses showed more WASO in severe AD subgroup compared with nonsevere AD subgroup (51.323 minutes vs 20.966 minutes, P = 0.032), less SE in male-majority subgroup compared with female-majority subgroup (-9.443% vs -4.997%, P = 0.018), and less TST in adult subgroup compared with child subgroup (-41.045 vs -4.016 minutes, P = 0.037). Conclusion: Objective sleep was worse in AD patients, especially among patients with severe AD, males, and adults. AD appears to more predispose difficulty in sleep maintenance rather than falling asleep.
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Affiliation(s)
| | - Jing Su
- From the Department of Nursing
| | | | - Baixin Chen
- Department of Sleep Medicine, Shantou University Mental Health Center
- Sleep Medicine Center, Shantou University Medical College, Shantou, China
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17
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Fishbein AB, Lor J, Penedo FJ, Forrest CB, Griffith JW, Paller AS. Patient-reported outcomes for measuring sleep disturbance in pediatric atopic dermatitis: Cross-sectional study of the Patient Reported Outcomes Measurement Information System pediatric sleep measures and actigraphy. J Am Acad Dermatol 2023; 88:348-356. [PMID: 32504726 PMCID: PMC7710591 DOI: 10.1016/j.jaad.2020.05.138] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/09/2020] [Accepted: 05/07/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Most children with atopic dermatitis (AD) experience sleep disturbance, but reliable and valid assessment tools are lacking. OBJECTIVES To test the Patient-Reported Outcomes Measurement Information System (PROMIS) sleep measures in pediatric AD and to develop an algorithm to screen, assess, and intervene to reduce sleep disturbance. METHODS A cross-sectional study was conducted with children with AD ages 5 to 17 years and 1 parent (n = 61), who completed sleep, itch, and AD-specific questionnaires; clinicians assessed disease severity. All children wore actigraphy watches for a 1-week objective sleep assessment. RESULTS PROMIS sleep disturbance parent proxy reliability was high (Cronbach α = 0.90) and was differentiated among Patient-Oriented Eczema Measure (POEM)-determined disease severity groups (mean ± standard deviation in mild vs moderate vs severe was 55.7 ± 7.5 vs 59.8 ± 10.8 vs 67.1 ± 9.5; P < .01). Sleep disturbance correlated with itch (numeric rating scale, r = 0.48), PROMIS sleep-related impairment (r = 0.57), and worsened quality of life (Children's Dermatology Life Quality Index, r = 0.58), with all P values less than .01. Positive report on the POEM sleep disturbance question has high sensitivity (95%) for PROMIS parent proxy-reported sleep disturbance (T-score ≥ 60). An algorithm for screening and intervening on sleep disturbance was proposed. LIMITATIONS This was a local sample. CONCLUSIONS Sleep disturbance in pediatric AD should be screened using the POEM sleep question, with further assessment using the PROMIS sleep disturbance measure or objective sleep monitoring if needed.
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Affiliation(s)
- Anna B. Fishbein
- Department of Pediatrics, Division of Pediatric Allergy & Immunology, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago IL, USA
| | - Jennifer Lor
- Department of Pediatrics, Division of Pediatric Allergy & Immunology, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago IL, USA
| | - Frank J. Penedo
- Department of Psychology, University of Miami Sylvester Comprehensive Cancer Center, Miami FL, USA
| | - Christopher B. Forrest
- Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia PA, USA
| | - James W. Griffith
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago IL, USA
| | - Amy S. Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago IL, USA
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18
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Duan GY, Silverberg JI. Sleep impairment in patients with chronic inflammatory skin diseases: A review of mechanisms and management. J Am Acad Dermatol 2023; 88:421-427. [PMID: 35700930 DOI: 10.1016/j.jaad.2022.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/02/2022] [Accepted: 06/05/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Chronic inflammatory skin diseases (CISD), such as atopic dermatitis and psoriasis, are associated with nocturnal sleep disturbances, which may in turn exacerbate inflammation. OBJECTIVE To summarize the complex factors that underlie the relationship between CISD and sleep impairment. METHODS We conducted a focused review of the published literature, including retrospective, prospective, and interventional studies, clinical trials, reviews, and consensus guidelines. RESULTS The results of our literature review identified a complex interplay among various physiological, psychosocial, and behavioral factors mediating the relationship between sleep loss and CISD alongside targeted management strategies. We highlight treatment strategies that target these pathways, providing a practical framework for clinicians managing sleep loss in patients with CISD. Current guidelines by dermatology societies on the management of sleep disturbances in patients with CISD are limited and largely focus mostly on atopic dermatitis and psoriasis. CONCLUSIONS We recommend that sleep problems must be regularly assessed and managed in patients with CISD. Updated clinician guidelines are needed to better recognize and address the multifactorial nature of sleep loss in patients with CISD.
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Affiliation(s)
- Grace Y Duan
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
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19
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Gillow G, Jackson K, Mukherji J, Buranosky B, Palomo R, Sheldon S, Fishbein A. Timing of scratch and limb movements during sleep in children with atopic dermatitis. Pediatr Dermatol 2022; 40:305-307. [PMID: 36446757 DOI: 10.1111/pde.15212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/12/2022] [Indexed: 12/05/2022]
Abstract
In this retrospective analysis of children with atopic dermatitis (n = 6) who coincidentally had a video polysomnography, we found that most nocturnal limb movements in children with atopic dermatitis are non-scratch versus scratch, 109.0 ± 67.9 vs. 15.3 ± 5.4 (p = 0.01). Average scratch duration was 8.4 ± 2.7 s, which was not different by sleep stage. Scratch movements are distinct in timing, occurring most often during N2 sleep, in the first third of sleep, and peaking at 90 minutes after sleep onset, corresponding with completion of the first sleep cycle.
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Affiliation(s)
- Gabrielle Gillow
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kathryn Jackson
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Janak Mukherji
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Brooke Buranosky
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Regina Palomo
- Sleep Medicine Center, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Stephen Sheldon
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Pediatric Pulmonary and Sleep Medicine, Northwestern University, Chicago, Illinois, USA
| | - Anna Fishbein
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Pediatric Allergy and Immunology, Northwestern University, Chicago, Illinois, USA
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Magyari A, Ye M, Margolis DJ, McCulloch CE, Cummings SR, Yaffe K, Langan SM, Abuabara K. Adult atopic eczema and the risk of dementia: A population-based cohort study. J Am Acad Dermatol 2022; 87:314-322. [PMID: 35367295 DOI: 10.1016/j.jaad.2022.03.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Chronic inflammatory conditions have been linked to dementia, but little is known about the role of atopic eczema, an inflammatory condition recently recognized to be common among older adults. OBJECTIVE To determine whether active atopic eczema is associated with incident dementia. METHODS A longitudinal cohort study of 1,767,667 individuals aged 60 to 99 years registered with The Health Improvement Network, a primary care cohort in the United Kingdom. The diagnoses of atopic eczema and dementia were identified using medical record codes. RESULTS The incidence of dementia was 57 per 10,000 person-years among those with atopic eczema during follow-up (12.1% of the population) compared with 44 per 10,000 person-years in the control group. This translated to a 27% increased risk of dementia (hazard ratio, 1.27; 95% CI, 1.23-1.30) in adjusted Cox proportional hazard models. Similar associations were observed in subgroup analyses of vascular dementia and Alzheimer's disease. The association persisted after additionally adjusting for the use of systemic corticosteroids (hazard ratio, 1.29; 95% CI, 1.26-1.33) and potential mediators (hazard ratio, 1.19; 95% CI, 1.16-1.22). More severe eczema was associated with a higher risk of dementia. LIMITATIONS Lack of detailed data on severity. CONCLUSION Atopic eczema was associated with a small but increased risk of incident dementia. The association increased with the severity of atopic eczema.
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Affiliation(s)
- Alexa Magyari
- UC Berkeley School of Public Health, Berkeley, California
| | - Morgan Ye
- Department of Dermatology, University of California, San Francisco School of Medicine (UCSF), San Francisco, California
| | - David J Margolis
- Department of Dermatology and Center for Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Charles E McCulloch
- Division of Biostatistics, University of California, San Francisco School of Medicine (UCSF), San Francisco, California
| | - Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Kristine Yaffe
- Center for Population Brain Health, University of California, San Francisco School of Medicine (UCSF), San Francisco, California
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | - Katrina Abuabara
- UC Berkeley School of Public Health, Berkeley, California; Department of Dermatology, University of California, San Francisco School of Medicine (UCSF), San Francisco, California.
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21
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Nakao A, Nakamura Y. Time will tell about mast cells: Circadian control of mast cell activation. Allergol Int 2022; 71:425-431. [PMID: 35853794 DOI: 10.1016/j.alit.2022.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 12/27/2022] Open
Abstract
Mast cell activation is crucial to the development of allergic disease. New studies have shown that both IgE-dependent and -independent mast cell activation is temporally regulated by the circadian clock, a time-of-day-keeping system that consists of transcriptional-translational feedback loops of several clock genes. For instance, the core clock gene Clock controls the expression of the high-affinity IgE receptor (FcεRI) and interleukin-33 (IL-33) receptor ST2 on mast cells in a time-dependent manner. As a result, the threshold of IgE-dependent or IL-33-dependent mast cell activation differs between daytime and nighttime. This mechanism may underlie the observation that allergic disease shows a marked day-night change in symptom occurrence and severity. Consistent with this novel concept, environmental and lifestyle factors that disturb the normal rhythmicity of the circadian clock, such as irregular eating habits, can lead to the loss of circadian control of mast cell activation. Consequently, the degree of mast cell activation becomes equally strong at all times of day, which might clinically result in worsening allergic symptoms. Therefore, further understanding of the association between mast cell activation and the circadian clock is important to better manage patients with allergic disease in the real world, characterized by a "24/7 society" filled with environmental and lifestyle factors that disturb the circadian clock rhythmicity.
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Affiliation(s)
- Atsuhito Nakao
- Department of Immunology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan; Atopy Research Center, Juntendo University School of Medicine, Tokyo, Japan.
| | - Yuki Nakamura
- Department of Immunology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
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22
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O'Connor C, Irvine AD, Murray D, Murphy M, O'B Hourihane J, Boylan G. Study protocol: assessing SleeP IN infants with early-onset atopic Dermatitis by Longitudinal Evaluation (The SPINDLE study). BMC Pediatr 2022; 22:352. [PMID: 35717147 PMCID: PMC9206384 DOI: 10.1186/s12887-022-03382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is the most common chronic inflammatory skin condition in childhood. Most (50-60%) children with AD report sleep disturbance, which is secondary to itch, dry skin, inflammation, and abnormal circadian rhythm. Sleep is essential for brain development, learning, and growth. Sleep disruption in early life is associated with cognitive and psychological dysfunction in later life. The aim of this study is to describe in detail the sleep architecture of infants with early-onset atopic dermatitis (AD), compared to controls, by using EEG polysomnography, sleep actigraphy, and parental reporting. METHODS This observational study will recruit six- to eight-month old infants with moderate to severe AD and age-matched control infants who do not have AD. At six-eight months diurnal sleep electroencephalography and polysomnography will be performed in our research center. Nocturnal sleep actigraphy will be performed at home for five consecutive nights at six-eight months and 12 months. Between six and 12 months, monthly questionnaires will capture data on quantitative sleep and parental sleep. Skin barrier and immune profiles will be captured at six-eight and 12 months. AD will be assessed using standardized severity assessment tools and treated according to protocol. A neurodevelopmental assessment will be performed at 18 months to assess cognition and behaviour. An estimated sample size of 50 participants in each group is required to power the primary outcome of disturbed macrostructure of sleep and secondary outcomes of disturbed microstructure of sleep, and disturbed parental sleep, assuming an attrition rate of 60%. Potential confounding factors which will be controlled for in the data analysis will include parental educational level, parental depression, feeding practice, and number of siblings. DISCUSSION This study will provide a rich analysis of sleep in infants with AD in the first year of life using detailed electroencephalography, novel actigraphy techniques, and longitudinal parent-reported data. It may provide guidance on the optimal treatment of AD to prevent or reduce sleep disruption. TRIAL REGISTRATION clinicaltrials.gov NCT05031754 , retrospectively registered on September 2nd, 2021.
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Affiliation(s)
- Cathal O'Connor
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland. .,Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland. .,INFANT research centre, University College Cork, Cork, Ireland.
| | - Alan D Irvine
- INFANT research centre, University College Cork, Cork, Ireland.,Department of Dermatology, Children's Health Ireland at Crumlin, Dublin, Ireland.,Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Murray
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland.,INFANT research centre, University College Cork, Cork, Ireland
| | - Michelle Murphy
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - Jonathan O'B Hourihane
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland.,INFANT research centre, University College Cork, Cork, Ireland
| | - Geraldine Boylan
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland.,INFANT research centre, University College Cork, Cork, Ireland
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23
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Sherrey J, Biggs S, Dorrian J, Martin J, Gold M, Kennedy D, Lushington K. Allergic disease, sleep problems and psychological distress in children recruited from the general community. Ann Allergy Asthma Immunol 2022; 129:366-372. [PMID: 35598883 DOI: 10.1016/j.anai.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is unclear which allergic disease is most strongly related to which sleep problem and whether sleep problems may mediate the association between allergic disease and psychological distress. There is also a need for more community-based studies using non-referred samples. OBJECTIVE To examine the association between individual allergic diseases and sleep problems and test whether the association between allergic disease and psychological distress is mediated through sleep problems. METHODS Parents of 1449 Australian children aged 6-10y recruited from the general community completed measures of sleep problems (Pediatric Sleep Survey Instrument), psychological distress (Strengths and Difficulties Questionnaire), and frequency of allergic disease. RESULTS Sleep and psychological distress scores were in the normal range. After controlling for co-existing allergic diseases: allergic rhinitis was associated with sleep routine problems, morning tiredness, night arousals, sleep disordered breathing and restless sleep; asthma with sleep routine problems, sleep disordered breathing and restless sleep; and eczema with restless sleep. Path analyses revealed that sleep problems mediated the association between asthma and allergic rhinitis but not eczema with psychological distress. CONCLUSION In this non-referred community sample, the frequency of sleep problems and psychological distress was lower than that typically reported in children referred to specialized centres. However, allergic rhinitis was associated with a broad range of sleep problems and to a lesser extent in children with asthma and least in children with eczema. Path analysis revealed that the association between allergic disease and psychological distress was mediated through sleep problems highlighting the importance of assessing sleep health in children with allergic disease.
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Affiliation(s)
- Jade Sherrey
- University of South Australia, Justice and Society Unit, Adelaide, Australia
| | - Sarah Biggs
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Jillian Dorrian
- University of South Australia, Justice and Society Unit, Adelaide, Australia
| | | | | | | | - Kurt Lushington
- University of South Australia, Justice and Society Unit, Adelaide, Australia.
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24
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Cheng BT, Patel MS, Xu M, Tilley CC, Zee PC, Paller AS, Fishbein AB. Timing of itch among children with atopic dermatitis. Ann Allergy Asthma Immunol 2022; 128:603-605. [PMID: 35131408 PMCID: PMC9058187 DOI: 10.1016/j.anai.2022.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Brian T Cheng
- Department of Allergy & Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mallika S Patel
- Department of Allergy & Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mindy Xu
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Caroline C Tilley
- Department of Allergy & Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Phyllis C Zee
- Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anna B Fishbein
- Division of Allergy-Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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25
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Psychological Interventions Are More Effective Than Educational Interventions at Improving Atopic Dermatitis Severity: A Systematic Review. Dermatitis 2022:01206501-990000000-00002. [PMID: 35481826 DOI: 10.1097/der.0000000000000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT We determined which educational and/or psychological interventions were most effective in atopic dermatitis (AD). A systematic review of published studies evaluated the effectiveness of educational and/or psychological interventions in MEDLINE, Embase, SCOPUS, LILACS, Cochrane, China National Knowledge Infrastructure, Taiwan Electronic Periodical Services, and CiNii. Two reviewers conducted title/abstract, full-text review, and data extraction. Twenty-four prospective studies were included, including 20 randomized controlled trials. Educational (4/7 studies) and combined educational and psychological (5/6 studies) interventions reduced AD severity; psychological (10/11 studies) interventions showed the greatest benefit. The most commonly studied psychological intervention was habit reversal training (8/11 studies), which was most frequently incorporated in studies that reduced AD severity (8/10 studies). The most commonly studied educational interventions were education on AD triggers (7/7 studies) and skin care (7/7 studies); they were incorporated in all studies that reduced AD severity. Different psychological and/or educational interventions successfully reduced AD severity, especially habit reversal training.
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26
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Yeo H, Ahn SS, Jung E, Lim Y, Lee YH, Shin SY. Transcription factor EGR1 regulates the expression of the clock gene PER2 under IL-4 stimulation in human keratinocytes. J Invest Dermatol 2022; 142:2677-2686.e9. [DOI: 10.1016/j.jid.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 11/24/2022]
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27
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Peng L, Wen L, Zhang J, Zhang X, Wei Q, Guo J, Zeng J. Circadian Pharmacological Effects of Paeoniflorin on Mice With Urticaria-like Lesions. Front Pharmacol 2022; 12:639580. [PMID: 35222003 PMCID: PMC8863972 DOI: 10.3389/fphar.2021.639580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/22/2021] [Indexed: 12/29/2022] Open
Abstract
Paeoniflorin (PF) is a monoterpene glucoside with various biological properties, and it suppresses allergic and inflammatory responses in a rat model of urticaria-like lesions (UL). In the present study, we treated OVA-induced mice presenting UL with PF at four circadian time points (ZT22, ZT04, ZT10, and ZT16) to determine the optimal administration time of PF. The pharmacological effects of PF were assessed by analyzing the scratching behavior; histopathological features; allergic responses such as immunoglobulin E (IgE), leukotriene B4 (LTB4), and histamine (HIS) release; inflammatory cell infiltration [mast cell tryptase (MCT) and eosinophil protein X (EPX)]; and mRNA levels of inflammatory cytokines such as interleukin (IL)-12, IL-6, interferon-γ (IFN-γ), and IL-4. It was demonstrated that PF significantly alleviated scratching behavior and histopathological features, and ZT10 dosing was the most effective time point in remission of the condition among the four circadian time points. Moreover, PF decreased the serum levels of IgE, LTB4, and HIS, and PF administration at ZT10 produced relatively superior effectiveness. PF treatment, especially dosing at ZT10, significantly reduced the number of mast cells and granules and diminished the infiltration of MCT and EPX in the skin tissues of mice with UL. Furthermore, the oral administration of PF effectively decreased the inflammatory cytokine levels of IL-12 mRNA. In conclusion, different administration times of PF affected its efficacy in mice with UL. ZT10 administration demonstrated relatively superior effectiveness, and it might be the optimal administration time for the treatment of urticaria.
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Affiliation(s)
- Li Peng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lijuan Wen
- Clinical Skills Center, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaotong Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qin Wei
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Guo
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Jing Guo, ; Jinhao Zeng,
| | - Jinhao Zeng
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Geriatric Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Jing Guo, ; Jinhao Zeng,
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28
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Zhou NY, Nili A, Blackwell CK, Ogbuefi N, Cummings P, Lai JS, Griffith JW, Paller AS, Wakschlag LS, Fishbein AB. Parent report of sleep health and attention regulation in a cross-sectional study of infants and preschool-aged children with atopic dermatitis. Pediatr Dermatol 2022; 39:61-68. [PMID: 34935180 PMCID: PMC9308997 DOI: 10.1111/pde.14889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Older children with atopic dermatitis (AD) suffer from poor sleep and attention problems. However, until recently, the dearth of developmentally sensitive assessment tools impeded characterization in younger children. We aimed to characterize sleep and attention problems in young children with AD and identify modifiable factors. METHODS A cross-sectional study of children with AD aged 1-4 years was stratified by disease severity (Patient-Oriented Eczema Measure), age, and racial/ethnic groups. Developmentally sensitive surveys assessed attention (Multidimensional Assessment Profile of Attention Regulation), sleep, and itch (Patient-Reported Outcomes Measurement Information System). Linear regression models identified predictors of sleep health and attention dysregulation. RESULTS Parents (n = 60) of children aged 2.78 ± 0.98 years with severe (n = 25), moderate (n = 25), or mild (n = 10) AD were recruited across the United States. Significantly reduced sleep health (T-score ≥ 60) was reported in 86% of children with moderate/severe disease (n = 43), and 50% had ≥5 nights of disturbed sleep per week. A suboptimal sleep environment was identified with 32% of children with too much light, noise, or electronic device usage. With regard to attention regulation, in children with severe AD, 80% had trouble sitting still and 72% of children had trouble paying attention no matter their surroundings. In fully adjusted models, AD severity was a significant predictor of poor sleep health (B = 0.79 [0.31-1.28], p < .01) and attention dysregulation (B = 1.22 [0.51-1.93], p < .01). CONCLUSIONS More severe AD correlates with poor sleep health and attention dysregulation. In addition to aggressive treatment of AD, clinicians should advise on modifiable sleep hygiene practices and consider screening for attention dysregulation in young children.
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Affiliation(s)
- Nina Y Zhou
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Amanda Nili
- Department of Medical Social Sciences and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, Illinois, USA
| | - Courtney K Blackwell
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nonye Ogbuefi
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Peter Cummings
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jin-Shei Lai
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, Illinois, USA
| | - James W Griffith
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy S Paller
- Department of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren S Wakschlag
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, Illinois, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anna B Fishbein
- Division of Pediatric Allergy & Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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29
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Huang Y, Jing D, Su J, Huang Z, Liu H, Tao J, He M, Chen X, Shen M, Xiao Y. Association of Night Shift Work With Chronic Spontaneous Urticaria and Effect Modification by Circadian Dysfunction Among Workers. Front Public Health 2021; 9:751579. [PMID: 34926376 PMCID: PMC8674304 DOI: 10.3389/fpubh.2021.751579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Night shift work is common in the current working environment and is a risk factor for many diseases. The study aimed to explore the relationship between night shift work with chronic spontaneous urticaria (CSU), and the modification effect of circadian dysfunction on it. Methods: A cross-sectional survey was conducted among Chinese workers. Exposure was measured by night work history and duration. Circadian dysfunction was characterized by excessive daytime sleepiness (EDS). The diagnosis of CSU was made by dermatologists who were investigating on the spot. The effect size was expressed as odds ratios (ORs). Results: A total of 8,057 participants were recruited, and 7,411 (92%) with complete information were included in the final analyses. The prevalence rates of CSU for workers without night shift and those with night shift history were 0.73 and 1.28%, respectively. Compared with workers who never worked night shifts, the risk of CSU increased with the length of night shift work: OR = 1.55 (95% confidence interval [CI]: 0.78-3.06) for duration <5 years and OR = 1.91 (95% CI: 1.12-3.26) for duration ≥5 years. EDS s EDS has been shown to modify this combination. Among workers without EDS, there was no association between night shift and CSU (OR = 0.94; 95% CI: 0.49-1.79). Whereas, in participants with EDS, the correlation was significant (OR = 3.58; 95% CI: 1.14-11.20). However, the effect modification by sleep disturbance was not observed. Conclusions: Night shift work is a risk factor for CSU, and there is a dose-response relationship between night shift work hours and the risk of CSU. This connection may be modified by circadian dysfunction.
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Affiliation(s)
- Yuzhou Huang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Danrong Jing
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Zhijun Huang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Han Liu
- Department of Dermatology, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, China
| | - Juan Tao
- Department of Dermatology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Meian He
- Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Changsha, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Changsha, China
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
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30
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Yang AF, Nguyen M, Li AW, Lee B, Chun KS, Wu E, Fishbein AB, Paller AS, Xu S. Use of technology for the objective evaluation of scratching behavior: A systematic review. JAAD Int 2021; 5:19-32. [PMID: 34816131 PMCID: PMC8593746 DOI: 10.1016/j.jdin.2021.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 10/30/2022] Open
Abstract
Introduction Pruritus is a common symptom across various dermatologic conditions, with a negative impact on quality of life. Devices to quantify itch objectively primarily use scratch as a proxy. This review compares and evaluates the performance of technologies aimed at objectively measuring scratch behavior. Methods Articles identified from literature searches performed in October 2020 were reviewed and those that did not report a primary statistical performance measure (eg, sensitivity, specificity) were excluded. The articles were independently reviewed by 2 authors. Results The literature search resulted in 6231 articles, of which 24 met eligibility criteria. Studies were categorized by technology, with actigraphy being the most studied (n = 21). Wrist actigraphy's performance is poorer in pruritic patients and inherently limited in finger-dominant scratch detection. It has moderate correlations with objective measures (Eczema and Area Severity Index/Investigator's Global Assessment: rs(ρ) = 0.70-0.76), but correlations with subjective measures are poor (r2 = 0.06, rs(ρ) = 0.18-0.40 for itch measured using a visual analog scale). This may be due to varied subjective perception of itch or actigraphy's underestimation of scratch. Conclusion Actigraphy's large variability in performance and limited understanding of its specificity for scratch merits larger studies looking at validation of data analysis algorithms and device performance, particularly within target patient populations.
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Affiliation(s)
- Albert F Yang
- University of Illinois at Chicago College of Medicine, Chicago, Illinois.,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Morgan Nguyen
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alvin W Li
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brad Lee
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Keum San Chun
- Electrical and Computer Engineering, The University of Texas at Austin, Austin, Texas
| | - Ellen Wu
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anna B Fishbein
- Department of Pediatrics (Allergy and Immunology), Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Pediatrics (Dermatology), Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.,Center for Bio-Integrated Electronics, Evanston, Illinois
| | - Shuai Xu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Center for Bio-Integrated Electronics, Evanston, Illinois.,Querrey Simpson Institute for Bioelectronics, Evanston, Illinois.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
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Abstract
Circadian disruption is pervasive and can occur at multiple organizational levels, contributing to poor health outcomes at individual and population levels. Evidence points to a bidirectional relationship, in that circadian disruption increases disease severity and many diseases can disrupt circadian rhythms. Importantly, circadian disruption can increase the risk for the expression and development of neurologic, psychiatric, cardiometabolic, and immune disorders. Thus, harnessing the rich findings from preclinical and translational research in circadian biology to enhance health via circadian-based approaches represents a unique opportunity for personalized/precision medicine and overall societal well-being. In this Review, we discuss the implications of circadian disruption for human health using a bench-to-bedside approach. Evidence from preclinical and translational science is applied to a clinical and population-based approach. Given the broad implications of circadian regulation for human health, this Review focuses its discussion on selected examples in neurologic, psychiatric, metabolic, cardiovascular, allergic, and immunologic disorders that highlight the interrelatedness between circadian disruption and human disease and the potential of circadian-based interventions, such as bright light therapy and exogenous melatonin, as well as chronotherapy to improve and/or modify disease outcomes.
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Affiliation(s)
- Anna B Fishbein
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Ann & Robert H. Lurie Children's Hospital, and
| | - Kristen L Knutson
- Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Phyllis C Zee
- Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Yousaf M, Ayasse M, Ahmed A, Gwillim E, Janmohamed SR, Yousaf A, Patel KR, Thyssen JP, Silverberg JI. Association between Atopic Dermatitis and Hypertension: A Systematic Review and Meta-Analysis. Br J Dermatol 2021; 186:227-235. [PMID: 34319589 DOI: 10.1111/bjd.20661] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies found conflicting results about the association of atopic dermatitis (AD) with hypertension. OBJECTIVES Determine whether AD and AD severity are associated with hypertension. METHODS A systematic review was performed of published studies in MEDLINE, EMBASE, Scopus, Web of Science, and GREAT databases. At least 2 reviewers conducted title/abstract, full-text review, and data extraction. Quality of evidence was assessed using the Newcastle-Ottawa Scale. RESULTS Fifty-one studies met inclusion criteria; 19 had sufficient data for meta-analysis. AD was associated with higher odds of hypertension compared to healthy controls (increased in 9 of 16 studies; pooled prevalence: 16.4% vs 13.8%; random-effects regression, pooled unadjusted odds ratio [OR][95% confidence interval <CI95>]: 1.16 [1.04-1.30]), but lower odds of hypertension compared to psoriasis (decreased in 5 of 8 studies; 15.4% vs 24.8%; 0.53 [0.37-0.76]). In particular, moderate-severe AD were associated with hypertension compared to healthy controls (increased in 4 of 6 studies; 24.9% vs 14.7%; 2.33 [1.10-4.94]). Hypertension was commonly reported as an adverse-event secondary to AD treatments, particularly systemic cyclosporine A. Limitations include lack of longitudinal studies or individual-level data and potential confounding. CONCLUSIONS AD, particularly moderate-to-severe disease, was associated with increased hypertension compared to healthy controls, but lower odds than psoriasis.
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Affiliation(s)
- M Yousaf
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M Ayasse
- Department of Dermatology, George Washington University School of Medicine, Washington, DC, USA
| | - A Ahmed
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - E Gwillim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S R Janmohamed
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - A Yousaf
- Department of Dermatology, West Virginia University School of Medicine, Morgantown
| | - K R Patel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J P Thyssen
- Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
| | - J I Silverberg
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Association of Childhood Atopic Dermatitis With a Higher Risk of Health Care Utilization and Drug Use for Asthma: A Nationwide Cohort Study. Dermatitis 2021; 33:257-263. [PMID: 34238820 DOI: 10.1097/der.0000000000000724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Overwhelming evidence supports a causal relationship between occurrence of asthma and atopic dermatitis (AD). OBJECTIVE The aims of the study were to determine the incidence of asthma in children with AD and to examine the health care utilization and drug use for asthma in children with AD. METHODS Children with hospital-diagnosed AD (cases) were matched with individuals from the background population (controls) in a 1:4 ratio. RESULTS In the final cohort (18,625 cases and 74,500 controls), the incident cases of asthma were 4203 among AD cases and 5298 in controls, corresponding to incidence rates of 34 and 9 in cases and controls per 1000 person-years, respectively (hazard ratio [HR] = 3.82, 95% confidence interval [CI] = 3.65-4.00). During the 1-year follow-up period from asthma diagnosis, children with concomitant AD had a significantly higher risk of hospital admission (HR = 1.97, 95% CI = 1.63-2.37), emergency department visits (HR = 1.62, 95% CI = 1.22-2.14), outpatient visits (HR = 1.97, 95% CI = 1.74-2.23), asthma medication (HR = 1.31, 95% CI = 1.27-1.35), and rescue course corticosteroids (HR = 1.74, 95% CI = 1.13-2.69) compared with children with asthma only. CONCLUSIONS The risk of being diagnosed with asthma was higher in children with AD. Risk of health care utilization and drug use for asthma was higher in children with both AD and asthma compared with asthma only.
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Manjunath J, Silverberg JI. Association between atopic dermatitis and headaches throughout childhood and adolescence-A longitudinal birth cohort study. Pediatr Dermatol 2021; 38:780-786. [PMID: 33931896 DOI: 10.1111/pde.14607] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND/OBJECTIVES Atopic dermatitis (AD) is associated with sleep disturbance, psychosocial distress, anxiety, depression, and atopic comorbidities, which may be associated with increased headaches. Our objective was to understand the association of AD and comorbid asthma, sleep and mental health disturbances with headaches throughout childhood and adolescence. METHODS Data were analyzed from The Fragile Families and Child Wellbeing Study, a longitudinal birth cohort study of 4898 urban children born in 1998-2000. RESULTS AD was associated with headaches at age 5 (adjusted odds ratio [95% confidence interval]: 2.14 [1.27-3.59]), 9 (1.69 [1.27-2.27]) and 15 years (1.71 [1.37-2.14]). AD at age 9 was associated with higher odds of subsequent headaches at age 15 (1.36 [1.05-1.76]). Children with AD at two (1.60 [1.12-2.29]) or all three (1.79 [1.16-2.75]) study-waves had higher odds of headaches at age 15 years. In multivariable repeated measures logistic regression models, significant two-way interactions were found for AD with sleep disturbance (4.59 [3.15-6.69]), attention deficit (hyperactivity) disorder (2.85 [1.87-4.35]), asthma (2.87 [2.18-3.76]), anxiety (2.47 [1.76-3.48]) or depression (2.86 [1.89-4.34]) as predictors of headaches. CONCLUSION Children and adolescents with AD, particularly those with sleep disturbances, atopic and mental health comorbidities, had increased headaches. Persistent childhood AD was associated with headaches in adolescence.
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Affiliation(s)
- Jaya Manjunath
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Fishbein AB, Cheng BT, Tilley CC, Begolka WS, Carle AC, Forrest CB, Zee PC, Paller AS, Griffith JW. Sleep Disturbance in School-Aged Children with Atopic Dermatitis: Prevalence and Severity in a Cross-Sectional Sample. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3120-3129.e3. [PMID: 33991704 DOI: 10.1016/j.jaip.2021.04.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) causes sleep disturbance but the epidemiology is not known. OBJECTIVE To estimate the US prevalence of sleep disturbance and its impact on psychological and neurocognitive function. METHODS We conducted a cross-sectional survey of 180 parent-child dyads with AD using stratified sampling based on disease severity (Patient Oriented Eczema Measure: mild [n = 30), moderate (n = 75) or severe (n = 75]), age, and race (White or Black or African American or other). Symptoms of sleep and psychologic health were assessed using the Patient-Reported Outcome Measurement Information System. To estimate the prevalence of sleep disturbance, we calculated weights using poststratification adjustment making marginal frequencies of AD severity, race, and age similar to marginal frequencies in the 2007 National Survey of Children's Health. Unweighted regression models examined associations with sleep disturbance. RESULTS In children age 5 to 17 years with AD, we estimated that sleep disturbance occurred in 66.9% (95% confidence interval, 53.3% to 80.5%; 3,116,305 children). The odds of severe sleep disturbance (worse than 95% of US children) were highest in moderate to severe versus mild AD (2.03 [1.00-4.10]; P = .0495; compared with 8.68 [1.82-41.49]; P = .0068). Predictors of parent proxy-reported sleep disturbance were itch intensity (adjusted β [95% confidence interval] 1.33 [0.62-2.04]) and low income (<$50,000: 6.64 [2.05-11.23]; and $50,000 to less than 100,000: 4.75 [0.35-9.14]). Controlling for disease severity, itch intensity, and significant sociodemographics-parent-proxy, reported sleep disturbance was associated with increased severity of sleep-related impairment, depression, fatigue, and anxiety, in addition to worse inattention and impulsivity. In fully adjusted models, children who self-reported sleep disturbance (T-score ≥60) had increased odds of sleep-related impairment (1.20 [1.11-1.29]), depression (1.13 [1.03, 1.24]), fatigue (1.28 [1.06-1.54]), and anxiety (1.16 [1.02-1.31]). CONCLUSIONS Sleep disturbance is a common symptom of AD. It affects about 3 million US children and is associated with neuropsychiatric impairment, including depression, anxiety, and inattention. Clinicians should screen for these symptoms in school-aged children, particularly those with moderate to severe AD.
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Affiliation(s)
- Anna B Fishbein
- Division of Allergy-Immunology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Brian T Cheng
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Caroline C Tilley
- Division of Allergy-Immunology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | - Adam C Carle
- Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Psychology, University of Cincinnati College of Arts and Sciences, Cincinnati, Ohio
| | - Christopher B Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Phillis C Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - James W Griffith
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Chun KS, Kang YJ, Lee JY, Nguyen M, Lee B, Lee R, Jo HH, Allen E, Chen H, Kim J, Yu L, Ni X, Lee K, Jeong H, Lee J, Park Y, Chung HU, Li AW, Lio PA, Yang AF, Fishbein AB, Paller AS, Rogers JA, Xu S. A skin-conformable wireless sensor to objectively quantify symptoms of pruritus. SCIENCE ADVANCES 2021; 7:7/18/eabf9405. [PMID: 33931455 PMCID: PMC8087407 DOI: 10.1126/sciadv.abf9405] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/15/2021] [Indexed: 05/27/2023]
Abstract
Itch is a common clinical symptom and major driver of disease-related morbidity across a wide range of medical conditions. A substantial unmet need is for objective, accurate measurements of itch. In this article, we present a noninvasive technology to objectively quantify scratching behavior via a soft, flexible, and wireless sensor that captures the acousto-mechanic signatures of scratching from the dorsum of the hand. A machine learning algorithm validated on data collected from healthy subjects (n = 10) indicates excellent performance relative to smartwatch-based approaches. Clinical validation in a cohort of predominately pediatric patients (n = 11) with moderate to severe atopic dermatitis included 46 sleep-nights totaling 378.4 hours. The data indicate an accuracy of 99.0% (84.3% sensitivity, 99.3% specificity) against visual observation. This work suggests broad capabilities relevant to applications ranging from assessing the efficacy of drugs for conditions that cause itch to monitoring disease severity and treatment response.
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Affiliation(s)
- Keum San Chun
- Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX 78712, USA
| | - Youn J Kang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Jong Yoon Lee
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Sibel Health, Niles, IL 60714, USA
| | - Morgan Nguyen
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Brad Lee
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | | | - Emily Allen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Hope Chen
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | | | - Lian Yu
- Electrical and Computer Engineering, University of Illinois at Champaign-Urbana, Champaign, IL 61801, USA
| | - Xiaoyue Ni
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA
| | - KunHyuck Lee
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Hyoyoung Jeong
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | | | - Yoonseok Park
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Ha Uk Chung
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Sibel Health, Niles, IL 60714, USA
| | - Alvin W Li
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Peter A Lio
- Chicago Eczema Center, Chicago, IL 60654, USA
| | - Albert F Yang
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Anna B Fishbein
- Department of Pediatrics (Allergy and Immunology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL 60611, USA
| | - Amy S Paller
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Pediatrics (Dermatology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL 60611, USA
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA.
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA.
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Pediatrics (Allergy and Immunology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL 60611, USA
- Department of Pediatrics (Dermatology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL 60611, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
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Bragazzi NL, Trabelsi K, Garbarino S, Ammar A, Chtourou H, Pacifico A, Malagoli P, Kocic H, Conic RRZ, Kridin K, Pigatto PDM, Damiani G. Can intermittent, time-restricted circadian fasting modulate cutaneous severity of dermatological disorders? Insights from a multicenter, observational, prospective study. Dermatol Ther 2021; 34:e14912. [PMID: 33629451 DOI: 10.1111/dth.14912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/07/2021] [Accepted: 02/19/2021] [Indexed: 12/19/2022]
Abstract
The impact of intermittent circadian fasting (ICF) on skin disorders is far to be plenty deciphered. However, the circadian rhythm seems to exert a modulation on dermatoses severity, drug-response, and drug-related side effects. We aimed to evaluate ICF effect in the daily management of dermatological diseases. In this multicenter, prospective observational study we enrolled patients willing to undergo the 2018 ICF (from May 16 to June 14). Dermatoses severity were evaluated at the beginning of ICF (T0) and at the end of ICF (T1) by two independent board-certified dermatologists. Seventy-two patients suffering from different dermatoses volunteered to take part into the study. They displayed a mean age of 40.38 ± 12.46 years (median 41.0 years), 25 subjects were males (34.7% of the entire sample). The median weight change was 0 kg. The overall ICF effect size was -0.58 ([95% CI -0.83 to -0.33], P < .0001, medium effect size). Since in the present investigation no weight loss occurred, we could speculate that the impact of fasting in terms of improvements in the clinical symptoms could be rather due to the perturbation of the human biological clock. Despite our data remain preliminary, a chronobiological approach should be incorporated in the dermatological armamentarium.
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Affiliation(s)
- Nicola Luigi Bragazzi
- Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy.,Department of Mathematics and Statistics, Laboratory for Industrial and Applied Mathematics, York University, Toronto, Ontario, Canada.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genoa, Polyclinic Hospital San Martino IRCCS, Genoa, Italy
| | - Khaled Trabelsi
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genoa, Polyclinic Hospital San Martino IRCCS, Genoa, Italy
| | - Achraf Ammar
- Institute of Sport Science, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Hamdi Chtourou
- Institut Supérieur du Sport et de l'Education Physique de Sfax, Université de Sfax, Sfax, Tunisia.,Activité Physique, Sport et Santé, UR18JS01, Observatoire National du Sport, Tunis, Tunisia
| | - Alessia Pacifico
- Clinical Dermatology Department, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | | | - Hristina Kocic
- Department of Dermatology, University of Nis, Nis, Serbia
| | - Rosalynn R Z Conic
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Khalaf Kridin
- Department of Experimental Dermatology, Lubeck Institute, University of Lübeck, Lübeck, Germany
| | - Paolo Daniele Maria Pigatto
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Mizutani H, Tamagawa-Mineoka R, Yasuike R, Minami Y, Yagita K, Katoh N. Effects of constant light exposure on allergic and irritant contact dermatitis in mice reared under constant light conditions. Exp Dermatol 2021; 30:739-744. [PMID: 33629775 DOI: 10.1111/exd.14308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/08/2021] [Accepted: 02/14/2021] [Indexed: 01/28/2023]
Abstract
Environmental light levels can affect physiological functions, such as general activity, body temperature and metabolism. Irregular lifestyles, such as those involving exposure to light during the night, can exacerbate the clinical symptoms of several inflammatory skin diseases. However, the effects of constant light exposure on immune responses are not fully understood. This study aimed to elucidate the effects of constant light exposure on two major types of skin reactions, allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD). BALB/c mice were kept under constant light conditions or a normal light and dark cycle, and their ACD and ICD responses were assessed after the topical application of 2,4,6-trinitro-1-chlorobenzene and croton oil, respectively, to the ear skin. Interestingly, in both ACD and ICD, the ear-swelling response and local leukocyte infiltration were aggravated by constant exposure to light, which has previously been shown to severely disturb the behavioural rhythms of mice. In ACD, these findings were accompanied by increases in the numbers of degranulated mast cells and eosinophils. These results suggest that constant light exposure intensifies allergic and non-allergic skin inflammation.
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Affiliation(s)
| | | | | | - Yoichi Minami
- Departments of Physiology and Systems Bioscience, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhiro Yagita
- Departments of Physiology and Systems Bioscience, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Silverberg JI. Validity and reliability of a novel numeric rating scale to measure skin-pain in adults with atopic dermatitis. Arch Dermatol Res 2021; 313:855-861. [PMID: 33547939 DOI: 10.1007/s00403-021-02185-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/08/2021] [Indexed: 12/31/2022]
Abstract
Little is known about the measurement properties of numeric rating scales (NRS) for pain in AD. We evaluated a novel NRS for skin-pain and existing NRS for average overall-pain in adults with AD. Self-administered questionnaires and skin-examination were performed in 463 AD patients (age 18-97 years) in a dermatology practice setting. Numeric rating scales skin-pain and average overall-pain had moderate correlations with each other, and multiple clinician-reported and patient-reported AD severity outcomes (Spearman correlations, P < 0.0001). There were significant and stepwise increases of NRS skin-pain and average overall-pain scores with patient-reported global severity (Wilcoxon rank-sum test, P < 0.0001). Floor-effects were observed for NRS skin-pain and average overall-pain. Changes from baseline in NRS skin-pain and average overall-pain showed weak-moderate correlations with changes of POEM, vIGA-AD*BSA, SCORAD, and DLQI. Using an anchoring approach, the optimal interpretability band for NRS skin-pain was clear = 0, mild = 1-3, moderate = 5-6, severe = 7-9, and very severe = 10 (weighted kappa = 0.4923). The thresholds for minimally clinically important difference for NRS skin-pain ranged from 2.2 to 2.9. NRS skin-pain and average overall-pain showed moderate-good reliability. Numeric rating scales skin-pain and average overall-pain had sufficient validity, reliability, responsiveness, and interpretability in adults with AD, and were inherently feasible as single-items for use in clinical trials and practice.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Suite 2B-425, Washington, DC, USA. .,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Yang S, Chew H, Jiang Y, Cheng L, Guo X, Che H, Sun N. Lentinan Inhibited the Activation of Th2 Cells in Allergic Mice by Reducing the Amplitude of Changes in Biological Rhythm. Int Arch Allergy Immunol 2020; 182:167-181. [PMID: 33378763 DOI: 10.1159/000509437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Biological rhythm is inextricably linked to the physiological mechanisms of allergic diseases, but the exact mechanisms are still poorly understood. Clinical studies have reported rhythmic fluctuations in allergic diseases. The search for natural and harmless active ingredients based on biological rhythm with which to regulate allergic diseases is essential for the control of food allergy. METHODS In this study, mice were treated at different time points to determine the link between the severity of allergic reactions and the circadian clock genes. The mice were treated with lentinan, either continuously or discontinuously, to assess their clinical symptoms, vascular permeability, immune cells, cytokines, and clock genes. Specifically, rat basophilic leukemia (RBL-2H3) cells were treated with lentinan and the rhythmic changes of cell degranulation were measured. RESULTS The results in different models showed that the allergic reactions in mice treated at different time points were significantly different and thus related to fluctuations in biological rhythm. Treatment with lentinan was found to reduce the amplitude of changes in the clock genes, such as the activation of Per and Cry proteins in allergic mice, as well as to regulate biological rhythm in cells, inhibit the activation of Th2 cells, and alleviate allergic reactions. Furthermore, lentinan changed the rhythm of degranulation in RBL-2H3 cells. CONCLUSION Lentinan was, therefore, determined to successfully alleviate allergic reactions by reducing the amplitude of changes in the body's biological rhythm, inhibiting the activation of Th2 cells, and affecting the immune microenvironment.
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Affiliation(s)
- Shuai Yang
- Key Laboratory of Precision Nutrition and Food Quality, Key Laboratory of Functional Dairy, Ministry of Education, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Huifang Chew
- Key Laboratory of Precision Nutrition and Food Quality, Key Laboratory of Functional Dairy, Ministry of Education, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Yuchi Jiang
- Key Laboratory of Precision Nutrition and Food Quality, Key Laboratory of Functional Dairy, Ministry of Education, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Lei Cheng
- Key Laboratory of Precision Nutrition and Food Quality, Key Laboratory of Functional Dairy, Ministry of Education, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Xiaoya Guo
- Key Laboratory of Precision Nutrition and Food Quality, Key Laboratory of Functional Dairy, Ministry of Education, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Huilian Che
- Key Laboratory of Precision Nutrition and Food Quality, Key Laboratory of Functional Dairy, Ministry of Education, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China,
| | - Na Sun
- School of Food Science and Technology, Dalian Polytechnic University, National Engineering Research Center of Seafood, Dalian, China
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Kage P, Simon JC, Treudler R. Atopic dermatitis and psychosocial comorbidities. J Dtsch Dermatol Ges 2020; 18:93-102. [PMID: 32026645 DOI: 10.1111/ddg.14029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/03/2019] [Indexed: 01/04/2023]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease that may be associated with a number of comorbidities including psychosocial disorders, which are the primary focus of this article. The data presented is based on a literature search in PubMed and subsequent screening of relevant review articles and guidelines. There is a greater prevalence of depression, anxiety, sleep disorders and suicidal ideation among individuals with AD. The disease negatively impacts patients' quality of life. Children with AD have been shown to more commonly exhibit signs of attention-deficit/hyperactivity disorder. Only little data exists on the association of AD with schizophrenia, eating disorders or obsessive-compulsive disorder. There is a great need for research in the field of AD-related comorbidities, especially with respect to the question as to whether and how novel treatment options may potentially affect these comorbidities.
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Affiliation(s)
- Paula Kage
- Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Center for Allergology - LICA-CAC, University of Leipzig, Germany
| | - Jan-Christoph Simon
- Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Center for Allergology - LICA-CAC, University of Leipzig, Germany
| | - Regina Treudler
- Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Center for Allergology - LICA-CAC, University of Leipzig, Germany
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Measurement Properties of Patient Health Questionnaire 9 and Patient Health Questionnaire 2 in Adult Patients With Atopic Dermatitis. Dermatitis 2020; 32:225-231. [DOI: 10.1097/der.0000000000000653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Walton JC, Walker WH, Bumgarner JR, Meléndez-Fernández OH, Liu JA, Hughes HL, Kaper AL, Nelson RJ. Circadian Variation in Efficacy of Medications. Clin Pharmacol Ther 2020; 109:1457-1488. [PMID: 33025623 DOI: 10.1002/cpt.2073] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/13/2020] [Indexed: 12/22/2022]
Abstract
Although much has been learned about circadian clocks and rhythms over the past few decades, translation of this foundational science underlying the temporal regulation of physiology and behavior to clinical applications has been slow. Indeed, acceptance of the modern study of circadian rhythms has been blunted because the phenomenology of cyclic changes had to counteract the 20th century dogma of homeostasis in the biological sciences and medicine. We are providing this review of clinical data to highlight the emerging awareness of circadian variation in efficacy of medications for physicians, clinicians, and pharmacists. We are suggesting that gold-standard double-blind clinical studies should be conducted to determine the best time of day for optimal effectiveness of medications; also, we suggest that time of day should be tracked and reported as an important biological variable in ongoing clinical studies hereafter. Furthermore, we emphasize that time of day is, and should be considered, a key biological variable in research design similar to sex. In common with biomedical research data that have been historically strongly skewed toward the male sex, most pharmaceutical data have been skewed toward morning dosing without strong evidence that this is the optimal time of efficacy.
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Affiliation(s)
- James C Walton
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - William H Walker
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Jacob R Bumgarner
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - O Hecmarie Meléndez-Fernández
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Jennifer A Liu
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Heather L Hughes
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Alexis L Kaper
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Randy J Nelson
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
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Does daily bathing or showering worsen atopic dermatitis severity? A systematic review and meta-analysis. Arch Dermatol Res 2020; 313:729-735. [PMID: 33196889 DOI: 10.1007/s00403-020-02164-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 12/26/2022]
Abstract
The optimal frequency of water bathing/showering in atopic dermatitis (AD) is unknown. We sought to determine the efficacy of different bathing/showering frequencies at improving AD severity. A systematic review and meta-analysis was performed of studies evaluating the clinical efficacy of bathing/showering regimen in AD. MEDLINE, EMBASE, SCOPUS, LILACS, Cochrane, China National Knowledge Infrastructure, Taiwan electronic periodical services and CiNii were searched. Two authors independently performed title/abstract and full-text review and data extraction. All 13 included studies were prospective and demonstrated numerically reduced AD severity in patients treated with a water bathing/showering regimen in ≥ 1 time-point compared with baseline. In random-effects regression models, baths/showers ≥ 7 vs. < 7 times per week were not associated with significant differences of Cohen's D scores for eczema area and severity index (n = 5 studies; least-square means: 1.34 vs. 0.90; P = 0.45; I2 = 91.8), Scoring AD (n = 5 studies; 0.73 vs. 0.41; P = 0.13; I2 = 97.4) or body surface area (n = 4 studies; 0.45 vs. 0.28; P = 0.17; I2 = 93.4). Similar results were observed in sensitivity analyses by study design, quality, use of emollients, and use of topical corticosteroids. No publication bias was detected by Egger regression (P ≥ 0.26) or Begg rank (P ≥ 0.19) tests. Three studies were included in the qualitative analysis, which found that bathing/showering ≥ 7 resulted in significant improvement of Investigator Global Assessments, extent of skin lesions and itch caused by AD. In conclusion, the optimal frequency of water bathing/showering in AD remains unclear. Daily showers/baths were not associated with worse severity, and should be permitted in AD. Larger scale, well-designed RCT are still needed to determine the optimal bathing parameters.
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Treister AD, Stefek H, Grimaldi D, Rupani N, Zee P, Yob J, Sheldon S, Fishbein AB. Sleep and Limb Movement Characteristics of Children With Atopic Dermatitis Coincidentally Undergoing Clinical Polysomnography. J Clin Sleep Med 2020; 15:1107-1113. [PMID: 31482832 DOI: 10.5664/jcsm.7800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Atopic dermatitis (AD) is a prevalent, chronic, itchy skin condition. Children undergoing polysomnography (PSG) may coincidentally have AD. Many children with AD have sleep disturbances. Our study aimed to characterize limb movements in children with AD and their effect on sleep. METHODS A retrospective chart review was conducted for children who underwent comprehensive attended PSG and had AD. PSG sleep parameters were compared to published normative data. A subset of patients with markedly elevated total limb movements was further compared to a matched group of patients with a diagnosis of periodic limb movement disorder (PLMD) and no history of AD. RESULTS There were 34 children with AD 6.36 ± 3.21 years (mean ± standard deviation), 50% female and with mild to moderate AD. There was increased wake after sleep onset (WASO = 46.0 ± 37.8 minutes), sleep onset latency (46.5 ± 53.0 minutes) and total limb movement index (13.9 ± 7.5 events/h) compared to normative values. Although our cohort was mostly mild AD, 7 of the 34 children with AD (20%) had a total limb movement index during sleep > 15 events/h. Increased total limb movements in PLMD versus patients with AD was most notable during stage N2 sleep (38 ± 17 versus 22 ± 7, P = .01, respectively). CONCLUSIONS We found altered PSG parameters in children with AD, suggesting that clinicians should consider the diagnosis when affected children undergo PSG. Although our AD cohort was mild, we still determined a need to consider AD when diagnosing PLMD given the presence of elevated total limb movements in children with AD. CITATION Treister AD, Stefek H, Grimaldi D, Rupani N, Zee P, Yob J, Sheldon S, Fishbein AB. Sleep and limb movement characteristics of children with atopic dermatitis coincidentally undergoing clinical polysomnography. J Clin Sleep Med. 2019;15(8):1107-1113.
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Affiliation(s)
- Alison D Treister
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Allergy, Division of Pediatric Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Heather Stefek
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Allergy, Division of Pediatric Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Daniela Grimaldi
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center for Circadian and Sleep Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Neil Rupani
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Allergy, Division of Pediatric Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Phyllis Zee
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center for Circadian and Sleep Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jeremy Yob
- Department of Pediatrics, Division of Pulmonology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois; Co-first author, contributed equally
| | - Stephen Sheldon
- Department of Pediatrics, Division of Pulmonology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois; Co-first author, contributed equally
| | - Anna B Fishbein
- Department of Allergy, Division of Pediatric Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
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Measurement Properties of 4 Patient-Reported Outcome Measures to Assess Sleep Disturbance in Adults With Atopic Dermatitis. Dermatitis 2020; 31:321-327. [PMID: 32947460 DOI: 10.1097/der.0000000000000625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The ideal patient-reported outcome measure to assess sleep disturbance in atopic dermatitis (AD) has not been determined. OBJECTIVE We sought to determine the measurement properties of the Patient-Reported Outcomes Measurement Information System (PROMIS) Itch Questionnaire Mood and Sleep (PIQ-MS), Sleep Disturbance (SD), Sleep-Related Impairment (SRI), and Epworth Sleepiness Scale (ESS) in adults with AD. METHODS A prospective dermatology practice-based study was performed using questionnaires and evaluation by a dermatologist (n=611). RESULTS PIQ-MS, PROMIS SD, SRI, and ESS had good convergent validity with intensity and frequency of sleep disturbance, Patient-Oriented Eczema Measure, Eczema Area and Severity Index, total and objective-Scoring AD, Numerical Rating Scale of worst-itch and average-itch, and Dermatology Life Quality Index. PIQ-MS had significantly better correlations with other severity measures than the other sleep measures (Fisher z-scores, P≤0.007). PIQ-MS, and to lesser extent PROMIS SD, PROMIS SRI and ESS had good discriminant validity. All four sleep assessments showed fair responsiveness to change of severity of sleep-disturbance, AD and itch. PIQ-MS had the best reliability. PIQ-MS, PROMIS SD, SRI and ESS showed good internal consistency and were feasible for use in clinical practice. CONCLUSIONS PIQ-MS, followed by PROMIS SD, had the best construct validity and reliability in adult AD.
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Abstract
Purpose of the Review Skin disease is associated with obstructive sleep apnea (OSA) both epidemiologically and mechanistically. In this review we highlight conditions which have a well-established link to obstructive sleep apnea, such as psoriasis and atopic dermatitis. Recent findings We describe putative mechanistic links between OSA and skin disease involving inflammatory pathways, obesity, mechanical upper airways obstruction, and hypoxia. In the context of these mechanisms we describe specific skin conditions, and other conditions which are associated with both skin manifestations (including hair/nail findings) and OSA. The risks/ benefits of CPAP in the context of skin disease are also reviewed. Summary We conclude that further research is needed to understand the mechanisms behind the associations between OSA and skin disease. Given the frequent co-occurrence of OSA and skin conditions, there would be great benefit for OSA clinical trials to consider improvement in skin disease as an outcome measure.
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Affiliation(s)
- Vinaya Soundararajan
- University of Illinois at Chicago, Department of Internal Medicine, Chicago, IL USA
| | - Jennifer Lor
- University of Illinois at Chicago, Department of Internal Medicine, Chicago, IL USA
- Ann & Robert H. Lurie Children's Hospital Department of Allergy, Division of Pediatric Allergy & Immunology, Chicago IL, USA
| | - Anna B Fishbein
- Ann & Robert H. Lurie Children's Hospital Department of Allergy, Division of Pediatric Allergy & Immunology, Chicago IL, USA
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Silverberg JI, Lei D, Yousaf M, Janmohamed SR, Vakharia PP, Chopra R, Chavda R, Gabriel S, Patel KR, Singam V, Kantor R, Hsu DY. Measurement properties of the Rajka-Langeland severity score in children and adults with atopic dermatitis. Br J Dermatol 2020; 184:87-95. [PMID: 32348552 DOI: 10.1111/bjd.19159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Multiple atopic dermatitis (AD) severity scales exist, with no gold standard for use in clinical practice. OBJECTIVES To determine the measurement properties of the Rajka-Langeland score and compare it with other clinician-reported outcomes in adults and children with AD. METHODS We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 427). RESULTS Rajka-Langeland had good concurrent validity with the Eczema Area and Severity Index (Spearman rho = 0·63), SCORing AD (SCORAD) (rho = 0·61), objective-SCORAD (rho = 0·52) and body surface area (rho = 0·51); good convergent validity with the numeric rating scale average-itch (rho = 0·60) and worst-itch (rho = 0·59), Patient-Oriented Eczema Measure (rho = 0·57), Dermatology Life Quality Index (rho = 0·53), Patient-Reported Outcomes Measurement Information System Itch Questionnaire (rho = 0·35-0·55) in adults and/or children; fair discriminant validity for patient- and physician-reported global AD severity; good responsiveness to change of severity of AD and itch; good reliability; internal consistency; with no floor or ceiling effects. Interpretability bands (3, clear/almost clear; 4-5, mild; 6-7, moderate; 8-9, severe) and minimal clinically important difference (1 point) were established. CONCLUSIONS The Rajka-Langeland score showed good construct validity, reliability, internal consistency and responsiveness in adults and children with AD.
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Affiliation(s)
- J I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Suite 2B-425, 2150 Pennsylvania Avenue, Washington, DC, 20037, USA.,Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - D Lei
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - M Yousaf
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - S R Janmohamed
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - P P Vakharia
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - R Chopra
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - R Chavda
- Galderma SA
- Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - S Gabriel
- Galderma SA
- Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - K R Patel
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - V Singam
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA
| | - R Kantor
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Derek Y Hsu
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
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Arganbright JM, Tracy M, Hughes SS, Ingram DG. Sleep patterns and problems among children with 22q11 deletion syndrome. Mol Genet Genomic Med 2020; 8:e1153. [PMID: 32222065 PMCID: PMC7284043 DOI: 10.1002/mgg3.1153] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 01/08/2020] [Accepted: 01/11/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To delineate sleep habits and problems in children with 22q11.2 deletion syndrome (22q11DS). METHODS Thirty children, age 1-15 (mean 6.8) years, participated in the study, which was an internet-based anonymous survey of parents of children with 22q11DS administered via the 22q11.2 Foundation. The main outcome was the Childhood Sleep Habits Questionnaire (CSHQ). RESULTS Scores on the CSHQ demonstrated clinically significant sleep problems in 29 of the 30 children. When compared with previously reported normative values for typically developing children of the same age, children with 22q11DS had significantly greater sleep problems. Only 30% of children had previously undergone sleep study. While about half of children had tried a medication for sleep, it usually was not felt to be helpful. In contrast, parents reported that behavioral interventions, such as consistent bedtime routine and appropriate sleep environment, were helpful. This is one of the first studies to specifically address sleep problems other than obstructive sleep apnea in children with 22q11DS. CONCLUSIONS The findings suggest children with 22q11DS may have a higher risk of experiencing clinical sleep problems, compared to typically developing children. Consideration of additional screening and treatment of sleep disorders in children with 22q11DS is warranted.
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Affiliation(s)
- Jill M Arganbright
- Division of Otolaryngology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Meghan Tracy
- Division of Otolaryngology, Children's Mercy Hospital, Kansas City, MO, USA
| | | | - David G Ingram
- Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, Kansas City, MO, USA
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Comparison of Patient-Oriented Eczema Measure and Patient-Oriented Scoring Atopic Dermatitis vs Eczema Area and Severity Index and other measures of atopic dermatitis: A validation study. Ann Allergy Asthma Immunol 2020; 125:78-83. [PMID: 32199977 DOI: 10.1016/j.anai.2020.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Little is known about the measurement properties of Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD) in adults with atopic dermatitis (AD). Even less is known about how PO-SCORAD performs compared with the Patient-Oriented Eczema Measure (POEM). OBJECTIVE To examine the measurement properties of PO-SCORAD and compare them with those of POEM. METHODS A prospective dermatology practice-based study of 291 patients with AD (age range, 18-72 years). RESULTS PO-SCORAD and POEM were moderately correlated with each other (Spearman ρ = 0.56) and had weak-moderate correlations with the Numeric Rating Scale (NRS) worst itch and average itch, Dermatology Life Quality Index (DLQI), ItchyQOL, Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (SD) and Sleep-Related Impairment (SRI), Patient Health Questionnaire-9 (PHQ-9), and Eczema Area and Severity Index (EASI) (P < .001). POEM had significantly stronger correlations with DLQI, ItchyQOL, and EASI than did PO-SCORAD. PO-SCORAD and POEM had fair discriminant validity. Changes from baseline in PO-SCORAD and POEM were moderately correlated with each other; were weakly to strongly correlated with NRS worst itch and average itch, DLQI, ItchyQOL, PROMIS SD, PROMIS SRI, PHQ-9, and EASI; and had good test-retest reliability. There was no differential item functioning of items or floor or ceiling effects for PO-SCORAD or POEM. The thresholds for meaningful change for PO-SCORAD and POEM were -15.5 and -5.0, respectively. Median completion times for PO-SCORAD and POEM were 3 minutes and 1 minute, respectively. CONCLUSION PO-SCORAD and POEM had good construct and cross-cultural validity, reliability, and responsiveness in adults with AD and were feasible for use in clinical trials and practice. However, POEM had better measurement properties than PO-SCORAD.
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