Pattern of growth and adiposity from infancy to adulthood in atopic dermatitis

Atopic Dermatitis and Water: Is There an Optimum Water Intake Level for Improving Atopic Skin?

Water is a vital nutrient with innumerable functions for every living cell. The functions of human skin include protection against dehydration of the body. Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease that presents with dry skin, erythematous and eczematous lesions, and lichenification. This paper discusses the question of whether extra water intake in children with AD affects skin hydration and the skin barrier function. Among the methods used to treat dry skin, topical leave-on products are the first-line treatment, intended to improve hydration and the skin barrier function. The effectiveness of adequate water intake as a measure to treat dry skin is still under debate. Normal skin hydration increases with dietary water intake, particularly in those with prior lower water consumption. Skin dryness in AD is instrumental to the itch and inflammation cycle, contributing to barrier impairment and aggravating disease severity and flares. Certain emollients provide significant hydration to AD skin, with relief of dryness and reduction in barrier impairment, disease severity, and flares. Further investigations are needed to evaluate the optimum water intake levels in children with AD, as important questions remain unanswered, namely, does oral hydration provide relief of skin dryness and reduce barrier impairment, disease severity, and flares; is there any additional benefit from using mineral or thermal spring water; or is there a need to specifically study the fluid/water intake in children with AD and food allergy (FA) restrictions?

Association Between Atopic Dermatitis and Height, Body Mass Index, and Weight in Children

Importance

Atopic dermatitis may be associated with short stature and obesity in children, but most previous studies have been either small or cross-sectional.

Objective

To evaluate the association between atopic dermatitis and height, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and weight throughout childhood.

Design, Setting, and Participants

TARGet Kids! (The Applied Research Group for Kids) is an ongoing prospective longitudinal cohort study that collects data at routine physician visits throughout childhood. In this cohort, children aged 5 or younger were followed up into adolescence at regular physician visits at general pediatric and family practices in Toronto, Canada, from June 2008 to February 2021.

Exposure

Parental report of atopic dermatitis.

Main Outcomes and Measures

Primary outcomes were length-for-age and BMI-for-age z scores. The secondary outcome was weight-for-age z score. Linear mixed effects models were used to estimate associations between atopic dermatitis and each outcome. In secondary analyses, interaction terms were included between atopic dermatitis and age.

Results

A total of 10 611 children were included in the analysis, with mean (SD) baseline age of 23 (20) months; 5070 (47.8%) participants were female. Participants were followed for a median (range) of 28.5 (0.0-158.0) months. A total of 1834 (17.3%) children had atopic dermatitis during follow-up. Atopic dermatitis was associated with lower length-for-age z score (-0.13; 95% CI, -0.17 to -0.09; P < .001), higher BMI z score (0.05; 95% CI, 0.01 to 0.09; P = .008), and lower weight-for-age z score (-0.07; 95% CI, -0.10 to -0.04; P < .001) compared with children without atopic dermatitis. The associations between atopic dermatitis and height and BMI changed with age, diminishing by age 14 years and 5.5 years, respectively. Based on World Health Organization growth tables, children with atopic dermatitis were on average 0.5 cm shorter with 0.2 more BMI units at age 2 years and 0.6 cm shorter with no difference in BMI at age 5 years than children without atopic dermatitis after adjusting for covariates. There was no evidence of interaction between atopic dermatitis and age with respect to weight.

Conclusions and Relevance

In this cohort study, atopic dermatitis was associated with shorter stature, higher BMI, and lower weight in early childhood, but these associations were small and, for height and BMI, attenuated with age and resolved by adolescence.

Quality of Life and Disease Impact of Atopic Dermatitis and Psoriasis on Children and Their Families

Atopic dermatitis (AD) and psoriasis are common chronic skin diseases affecting children. These disorders negatively impact the quality of life (QoL) of patients in health-related aspects such as physical, psychosocial, and mental functioning. This health impact is more accurately represented when accounting for the numerous comorbidities associated with each disorder, and the impact the disorders have on patients’ families. A number of QoL tools have been developed and can be routinely implemented in the evaluation of QoL in pediatric patients and their caregivers. Ways to improve QoL include a multidisciplinary approach to care, education, and psychological support.

Management of patients with atopic dermatitis: the role of emollient therapy

Atopic dermatitis is a common inflammatory skin disorder that afflicts a growing number of young children. Genetic, immune, and environmental factors interact in a complex fashion to contribute to disease expression. The compromised stratum corneum found in atopic dermatitis leads to skin barrier dysfunction, which results in aggravation of symptoms by aeroallergens, microbes, and other insults. Infants—whose immune system and epidermal barrier are still developing—display a higher frequency of atopic dermatitis. Management of patients with atopic dermatitis includes maintaining optimal skin care, avoiding allergic triggers, and routinely using emollients to maintain a hydrated stratum corneum and to improve barrier function. Flares of atopic dermatitis are often managed with courses of topical corticosteroids or calcineurin inhibitors. This paper discusses the role of emollients in the management of atopic dermatitis, with particular emphasis on infants and young children.

Obesity and the skin

Obesity is a serious global health problem, perhaps the biggest public health issue of our times. Excess body weight may be a factor in carcinogenesis in general, as well as contributing to the pathogenesis of metabolic, cardiovascular and musculoskeletal disorders. Obesity also has many cutaneous features, which form the basis for this review article. Many of these clinical entities are common to the majority of obese patients, e.g. striae distensae, plantar hyperkeratosis and an increased risk of skin infections. However, it may also be associated with poor wound healing, malignant melanoma and an increased risk of inflammatory dermatoses, such as psoriasis, as well as some rarer disorders. Therapeutic interventions for obesity, whether over-the-counter, prescription medicines or surgical interventions, are increasingly commonplace. All of these treatment modalities potentially have dermatological side-effects too.

Comorbidity in Atopic Dermatitis

The negative impact of atopic dermatitis (AD) often extends beyond the skin. Children with AD experience increased rates of infectious, mental health, and allergic diseases compared to their non-atopic peers. The mechanisms underlying these associations remain elusive. New insights from genetic and epidermal research pinpoint the skin barrier as a primary initiator of AD. Epicutaneous sensitization represents an intriguing new model which links a disrupted skin barrier to the later development of IgE-mediated diseases in patients with AD. Recent epidemiological studies have identified new comorbidities linked to AD as well, including several mental health disorders and obesity. This manuscript reviews the recent literature regarding both classic and newly described AD comorbidities.

Associations of growth trajectories in infancy and early childhood with later childhood outcomes

BACKGROUND

Weight and length at birth (which represent fetal growth) and weight and length or height gain during childhood (which potentially represent catch-up growth) may be related to later health outcomes. However, methods for the assessment of such relations are complex and underdeveloped.

OBJECTIVES

We aimed to describe childhood weight and length or height trajectories and to relate these to later outcomes by using rash at age 6.5 y as an example.

DESIGN

The data came from a prospective cohort study in Belarus in 10,494 children born in 31 hospitals that participated in a cluster randomized trial of breastfeeding promotion. Weight and length or height were measured at birth, at scheduled clinic visits up to 1 y, and at 6.5 y; intermediate measures were obtained from routine child health records. Linear spline multilevel models for weight and length or height were used to estimate each child's deviance from average birth weight, birth length, weight, and length or height gain velocity in each time period. Logistic regression was used to relate the outcome (parental report of rash at 6.5 y) to these weight and length or height estimates.

RESULTS

The best-fitting splines for length or height and weight had knots at 3 and 12 mo, with another knot at 34 mo for height. The only relation between weight and length or height and reported rash was a positive association with weight gain velocity between 12 and 34 mo (odds ratio per SD increase in weight gain velocity: 1.11; 95% CI: 1.01, 1.22).

CONCLUSION

Advantages of multilevel models include no restriction to measures at arbitrary times or to individuals with complete data and allowance for measurement error. This trial was registered at isrctn.org as ISRCTN37687716.

Season of birth and subsequent body size: the potential role of prenatal vitamin D

OBJECTIVES

The relationship between season of birth and various physical and psychological outcomes was reported in many studies, although the underlying mechanism still remains unrecognized. The aim of this study was to explore the season-of-birth effect on body size in the sample of 1,148 eight-year-old Polish urban children and propose the mechanism responsible for this effect.

METHODS

The children were examined three times at their birthdays and at two cross-sectional surveys. Effects of the season of birth were checked by fitting the cosine function to empirical values and by comparison between two groups born in different periods of the year.

RESULTS

Data gathered at three examinations led to the same results: season-of-birth effect occurred only in boys and only in those relatively shortly breastfed and/or descended from the families of low-socioeconomic status. Specifically, the individuals born in October-April were taller (by 2-3 cm), heavier (by 2-3 kg), and fatter than those born in May-September.

CONCLUSIONS

The following explanatory mechanism has been formulated: insolation in Poland is minimal in November-February (winter period), and so ultraviolet absorption and vitamin D production is then the lowest. Vitamin D regulates embryo's cellular differentiation, and its deficiency triggers permanent developmental changes. Therefore, individuals conceived in autumn (i) are at the greatest risk of early vitamin D deficiency, (ii) are born in summer, and (iii) are relatively small in their further lives. The contribution of low-socioeconomic status, short breastfeeding, and being a male to the occurrence of the season-of-birth effect is also discussed.

Bone mineral density in children with moderate to severe atopic dermatitis

BACKGROUND

Low bone mineral density (BMD) has been reported in 30.4% of adult patients with atopic dermatitis (AD).

OBJECTIVE

The aim of this study was to determine the prevalence of low BMD in children with moderate to severe AD and to investigate the relation between BMD and corticosteroid and cyclosporine therapy.

METHODS

Lumbar spine BMD was measured by dual-energy X-ray absorptiometry in 60 children (age 5-16 years) with moderate to severe AD. BMD (in g/cm(2)) was expressed in Z-scores, the number of SD above or below the mean value of an age- and sex-matched reference population. In children, low BMD was defined as a Z-score less than -2. Information on lifestyle parameters and bone fractures were collected by use of a standardized questionnaire. The cumulative dose of corticosteroids and cyclosporine therapy was calculated for the previous 5-year period.

RESULTS

Three patients (5%) had low BMD; one patient (1.7%) had osteoporosis. The observed prevalence of low BMD in this study (6.7%; 95% confidence interval 1.8%-16.2%) does not differ from the expected prevalence of low BMD in the general population (P = .06). Overall, use of topical corticosteroids in the previous 5 years was not associated with a decrease in BMD (Z-score). When children received additional systemic treatment (oral corticosteroids and/or cyclosporine) in the previous 5 years, BMD decreased, although the decrease was not statistically significant. Correction for lifestyle parameters did not change these associations.

LIMITATIONS

The number of patients studied was limited. The cumulative dose of corticosteroids and cyclosporine therapy was only registered for the previous 5 years, and relatively low amounts of topical corticosteroids were used. The definition of low BMD differs between adults (Z-score < -1) and children (Z-score < -2). Because there is no Dutch BMD reference population for children, normative BMD references were obtained from a different population (US children).

CONCLUSIONS

Low BMD did not occur more frequently in this population of children with moderate to severe AD compared with the general population. Use of topical corticosteroids in the previous 5 years was not associated with a decrease in BMD.

Asthma and obesity: common early-life influences in the inception of disease

The respective prevalences of both asthma and obesity have seen a significant rise in the past few decades. Although the association between these 2 conditions has been found in many studies from different areas around the world, the exact mechanisms for how this association arises remains unresolved. Because both asthma and obesity appear to have their beginnings in early childhood, common exposures that predispose individuals to both these conditions may explain how they are associated. These exposures include common genetic predictors, prenatal exposure to specific nutrients and overall maternal nutrition, patterns of colonization of the neonatal and infant gut, birth weight and infant weight gain, sedentary behaviors, and levels of adipokines in early life.