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Park M, Yum HY, Bae JM, Lee S, Sung M, Yang SI, Lee J, Lee MH, Lee DH, Kim YH. Factors influencing the quality of life in children with atopic dermatitis in Korea: A multicenter cross-sectional study. Allergy Asthma Proc 2024; 45:112-119. [PMID: 38449009 DOI: 10.2500/aap.2024.45.230094] [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: 03/08/2024]
Abstract
Background: There is a lack of studies about which factors affect the quality of life (QoL) in children with atopic dermatitis (AD), although it is well known that AD has considerably negative effects on their QoL. Objective: This study aimed to measure the QoL in children with AD and identify the factors that affect their QoL. Methods: A questionnaire derived from the Children's Dermatology Life Quality Index (CDLQI) was used to measure QoL. Family history, allergic comorbidities, exacerbation-related factors, time of exacerbation, and previous and current treatment were also evaluated. The total immunoglobulin E (IgE) level and specific IgE sensitization were determined by the multiple allergen simultaneous test, allergy test, or skin-prick test. AD severity was categorized into mild, moderate, and severe based on treatments. Results: In total, 254 children (46.4 months, 53% boys) from seven hospitals completed the survey. The mean CDLQI score was 7.2 ± 5.5 (total score range of 0-30). The respondents were divided into three groups according to their QoL score distribution, with 0 - 4 points (n = 84), 5 - 9 points (n = 90), and ≥10 points (n = 80) representing good, fair, and poor QoL, respectively. The more severe AD showed the higher CDLQI score significantly (p = 0.001). Compared with other groups, children with poor QoL were more sensitized to inhalant allergens (odds ratio [OR] 1.29 [95% confidence interval {CI}], 1.03 - 1.62) and had more exacerbating factors (OR 1.26 [95% CI, 1.04 - 1.54]), which included inhalation allergen-related exacerbating factors (OR 2.54 [95% CI, 1.23 - 5.23), even after adjusting for age, total IgE, body mass index, severity, and use of moisturizer. The concordance between animal sensitization and an exacerbating factor, including dog and cat, was fair, with 0.39 κ and 0.85 accuracy. Conclusion: This study showed that impaired QoL in children with AD is associated with inhalant allergen sensitization and inhalant allergen-related exacerbation factors. Especially, dog and cat sensitization was a significant exacerbating factor. The inhalation-related exacerbation factors, including animal allergens, might be addressed to improve AD management in children.
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Affiliation(s)
- Mireu Park
- From the Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Yung Yum
- Department of Pediatrics, Seoul Medical Center, Seoul, Korea
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Sooyoung Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Myongsoon Sung
- Department of Pediatrics, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine, Gumi, Korea
| | - Song-I Yang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jeongmin Lee
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Mi Hee Lee
- Department of Pediatrics, Incheon Medical Center, Incheon, Korea
| | - Dong Hun Lee
- Department of Dermatology, Seoul National University Hospital, Seoul, Korea, and
| | - Yoon Hee Kim
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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El Achkar Mello ME, Simoni AG, Rupp ML, de Azevedo Simões PWT, de Souza Pires MM. Quality of life of pediatric patients with atopic dermatitis and their caregivers. Arch Dermatol Res 2023; 315:1571-1576. [PMID: 36723680 DOI: 10.1007/s00403-023-02544-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/02/2023]
Abstract
To compare the quality of life (QoL) of children with and without atopic dermatitis (AD) and that of their caregivers and to assess their QoL according to different degrees of AD. This is a cross-sectional, case-control study conducted with patients aged between 4 and 12 years with and without AD and their caregivers. Patients were treated at the Pediatric Dermatology Outpatient Center and the Childcare Center of the Joana de Gusmão Children's Hospital, respectively, from June 2021 to March 2022. The QoL Assessment Scale Autoquestionnaire Qualité de Vie Infant Imagé (AUQEI) was applied to children and adolescents with AD and the control group while the World Health Organization Quality of Life assessment instrument was administered to their caregivers. Fifty cases and fifty controls were included in this study. When assessing the QoL of the case and control groups, statistically significant differences were found in the domains of the AUQUEI instrument. Regarding QoL and AD severity, a statistically significant difference was seen (p = 0.027) when comparing moderate and severe SCORAD scores. When comparing the QoL of children with and without AD, a difference was seen between the two groups. The QoL of AD patients was worse and related to the severity of the disease. A better QoL was found among the caregivers in the control group. In the case group, the higher the SCORAD score, the worse the QoL. No relationship was found between AD severity and the QoL of the caregivers in the case group.
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Affiliation(s)
- Marice E El Achkar Mello
- Postgraduate Program in Medical Sciences, Universidade Federal de Santa Catarina, Rua Alves de Brito, 492/302, Florianópolis, Santa Catarina, CEP 88015-440, Brazil.
| | - Andrea Gisele Simoni
- Pediatric Dermatology Outpatient Clinic, Hospital Infantil Joana de Gusmão, Florianópolis, Santa Catarina, Brazil
| | - Maria Luiza Rupp
- Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Woo YR, Kim HS. Burden of Disease and Unmet Needs in the Diagnosis and Management of Atopic Dermatitis in Korea. J Clin Med 2023; 12:jcm12113744. [PMID: 37297937 DOI: 10.3390/jcm12113744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin condition associated with a significant disease burden in Korea. AD is highly prevalent among Korean children, adolescents, and adults, and can cause physical discomfort, psychological distress, and social isolation for those affected. Despite advances in our understanding of AD, there are still many unmet needs in diagnosing and managing the disease in Korea. One of the challenges in diagnosing AD is the lack of a definitive biomarker for AD in Korea, and there is a need for more effective, safe, and cost-effective treatments for AD. Therefore, finding out the current epidemiology, burden of AD, and how AD is currently being diagnosed in Korea and reviewing management options available in Korea will help resolve the unmet needs of AD patients in Korea. Addressing these and other unmet needs in AD management and diagnosis in Korea may improve outcomes for those affected by this challenging condition.
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Affiliation(s)
- Yu Ri Woo
- Department of Dermatology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Thyssen JP, Werfel T, Barbarot S, Hunter HJA, Pierce E, Sun L, Cirri L, Buchanan AS, Lu N, Wollenberg A. Maintained Improvement in Physician- and Patient-Reported Outcomes with Baricitinib in Adults with Moderate-to-Severe Atopic Dermatitis who were Treated for up to 104 Weeks in a Randomized Trial. J DERMATOL TREAT 2023; 34:2190430. [PMID: 36912484 DOI: 10.1080/09546634.2023.2190430] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Patients who completed the originating studies, BREEZE-AD1 (NCT03334396), BREEZE-AD2 (NCT03334422), and BREEZE-AD7 (NCT03733301), were eligible for enrolment in the multicentre, phase 3, long-term extension study BREEZE-AD3 (NCT03334435). At week 52, responders and partial responders to baricitinib 4 mg were re-randomized (1:1) into the sub-study to dose continuation (4 mg, N = 84), or dose down-titration (2 mg, N = 84).Maintenance of response was assessed from week 52 to 104 of BREEZE-AD3. Physician-rated outcomes included vIGA-AD (0,1), EASI75, and mean change from baseline in EASI. Patient-reported outcomes included DLQI, POEM total score, HADS, and from baseline: WPAI (presenteeism, absenteeism, overall work impairment, daily activity impairment) and change from baseline in SCORAD itch and sleep loss.With continuous treatment with baricitinib 4 mg, efficacy was maintained up to week 104 in vIGA-AD (0,1), EASI75, EASI mean change from baseline, SCORAD itch, SCORAD sleep loss, DLQI, POEM, HADS, and WPAI (all scores). Patients down-titrated to 2 mg maintained most of their improvements in each of these measures.The sub-study of BREEZE AD3 supports flexibility in baricitinib dosing regimens. Patients who continued treatment with baricitinib 4 mg and down-titrated to 2 mg maintained improvements in skin, itch, sleep, and quality of life for up to 104 weeks.
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Affiliation(s)
- Jacob P Thyssen
- Department of Dermatology and Venersology, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Sebastien Barbarot
- Department of Dermatology, Nantes Université, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Hamish J A Hunter
- Department of Dermatology, Salford Care Organisation, part of the Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford, UK
| | | | - Luna Sun
- Eli Lilly and Company, Indianapolis, USA
| | - Lisa Cirri
- Eli Lilly and Company, Indianapolis, USA
| | | | - Na Lu
- Precision Statistics Consulting, Woodbury, Minnesota, USA
| | - Andreas Wollenberg
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximillian University, Munich, Germany
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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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Manjunath J, Lei D, Ahmed A, Ayasse M, Chavda R, Gabriel S, Silverberg JI. Longitudinal Course of Sleep Disturbance and Relationship With Itch in Adult Atopic Dermatitis in Clinical Practice. Dermatitis 2023; 34:42-50. [PMID: 36705649 DOI: 10.1089/derm.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Sleep disturbance (SD) is common in atopic dermatitis (AD). We examined the longitudinal course of SD and relationship with itch in AD patients. Methods: A prospective, dermatology practice-based study was performed (N = 1295) where patients were assessed at baseline and follow-up visits. Results: At baseline, 16.9% of the patients had severe SD based on Patient-Reported Outcomes Information System (PROMIS) SD T scores, 19.1% had difficulty falling asleep, 22.9% had difficulty staying asleep, and 34.2% had SD from AD. A total of 31.4% of the patients with difficulty staying asleep at baseline experienced persistent difficulties (for 3 follow-ups or more). Only 17.7% with baseline difficulty falling asleep had persistent disturbance. Despite significant fluctuation in sleep scores, SD generally improved over time. Of the patients facing baseline SD from AD, 31.5% experienced SD at the first visit, and only 12.3% experienced persistent SD at the second follow-up visit. Predictors of increased PROMIS sleep-related impairment T scores over time included baseline PROMIS sleep-related impairment T scores (0.74 [0.68-0.80]), having 3 to 6 nights of itch (2.22 [0.85-3.59]), and severe/very severe AD (4.40 [2.60-6.20]). Conclusions: A significant proportion of adult AD patients, particularly those with moderate-severe AD and frequent itch, had baseline SD. Although sleep scores generally improved over time, many patients experienced a fluctuating or persistent course.
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Affiliation(s)
- Jaya Manjunath
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Donald Lei
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC.,Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL
| | - Adnan Ahmed
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL
| | - Marissa Ayasse
- Department of Dermatology, Renaissance School of Medicine at Stony Brook University, NY
| | - Rajeev Chavda
- Galderma SA
- Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - Sylvie Gabriel
- Galderma SA
- Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - Jonathan Ian Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC.,Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL
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Neri I, Galli E, Baiardini I, Picozza M, Rossi AB, Matruglio P, Moretti D, Cipriani F. Implications of Atopic Dermatitis on the Quality of Life of 6-11 Years Old Children and Caregivers (PEDI-BURDEN). J Asthma Allergy 2023; 16:383-396. [PMID: 37077900 PMCID: PMC10106808 DOI: 10.2147/jaa.s404350] [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: 01/10/2023] [Accepted: 03/20/2023] [Indexed: 04/21/2023] Open
Abstract
Purpose Atopic dermatitis (AD) is a chronic, relapsing and remitting inflammatory skin disease characterized by intense itch. The disease burden includes physical limitations, psychosocial discomfort, and a reduced quality of life (HRQoL). This study presents the results of a parent-reported survey on the psychosocial impact of AD on Italian pre-adolescent children (6-11 years old), with a specific focus on bullying, self-isolation, absenteeism, and presenteeism. Methods An online questionnaire was sent to 3067 random recipients and 160 matched the inclusion criteria for age, self-reported AD diagnosis, localizations (according to ISAAC), and disease severity (POEM ≥8). 100 children, with comparable ages, not matching the inclusion criteria for AD, were recruited as a control group. Results Children with AD and their caregivers had a significantly lower quality of sleep (QoS) compared to the control group. The presence of AD was directly responsible for many restless nights, both in children and caregivers (58.9 and 55.4 respectively). Children with AD and their parents also experienced significantly more daytime drowsiness (43.6 and 54.6 days, respectively). Children with AD were more frequently victims of bullying at school (20.0% vs 9.0%; p≤0.05) or in other social environments (16.9% vs 3.0%; p≤0.05). AD caused 17.7 days of absenteeism and 20.1 days of presenteeism per student over the previous 12 months, accounting for 37.8 days of study impairment overall. Severe/very severe AD had a significantly greater impact on presenteeism than moderate AD (25.1 vs 17.5 days; p≤0.05). Presenteeism, which was more pronounced among bullied students, was positively correlated with absenteeism only in the AD cohort. Conclusion AD has a detrimental impact on the HRQoL of pediatric patients, causing stigmatization and social isolation. Functional distress was also reported by caregivers. Our study might inform the public and policymakers about the disease burden of AD at a young age.
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Affiliation(s)
- Iria Neri
- Dermatology Unit, IRCCS Azienda Ospedaliero Universitaria Bologna, University of Bologna, Bologna, Italy
| | - Elena Galli
- UOS Immuno-Allergologia dell’Età evolutive, Ospedale S.Pietro-Fatebenefratelli, Rome, Italy
| | - Ilaria Baiardini
- Respiratory Unit for Continuity of Care, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
- Personalized Medicine Asthma, & Allergy Clinic, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Mario Picozza
- National Association of Atopic Dermatitis (ANDeA), Prato, Italy
- Neuroimmunology Unit, Santa Lucia Foundation IRCCS, Rome, Italy
| | | | | | | | - Filippo Cipriani
- Sanofi, Milan, Italy
- Correspondence: Filippo Cipriani, Sanofi, Viale Bodio 37b, Milan, Italy, Email
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Balato A, Zink A, Babino G, Buononato D, Kiani C, Eyerich K, Ziehfreund S, Scala E. The Impact of Psoriasis and Atopic Dermatitis on Quality of Life: A Literature Research on Biomarkers. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122026. [PMID: 36556392 PMCID: PMC9782020 DOI: 10.3390/life12122026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Psoriasis (PSO) and Atopic dermatitis (AD) are common inflammatory skin diseases that affect people of all ages globally. They negatively impact the quality of life (QoL) of patients in health-related aspects such as physical, psychological and mental functioning. Here, we conducted a review of studies relating to candidate biomarkers and indicators associated with QoL impairment in PSO and AD. Data research was performed using PUBMED and SCOPUS databases from inception to September 2022. Most of the included studies reported genomic or proteomic biomarkers associated with disease activity and QoL outcomes. Sociodemographic, clinical and therapeutic factors have also been implicated in deterioration of life quality in these patients. The inclusion of clinical characteristics, QoL impairment and co-diagnosis should be considered in drug development programs, since processing biomarkers based on an increased number of features in addition to drug class and disease will intensify the value of the biomarker itself, thereby maximizing the future clinical utility as a stratification tool.
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Affiliation(s)
- Anna Balato
- Dermatology Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Alexander Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, 80802 Munich, Germany
- Unit of Dermatology, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Graziella Babino
- Dermatology Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Dario Buononato
- Dermatology Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Charlotte Kiani
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, 80802 Munich, Germany
| | - Kilian Eyerich
- Unit of Dermatology, Karolinska University Hospital, 17176 Stockholm, Sweden
- Department of Dermatology and Venereology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
- Division of Dermatology and Venereology, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Stefanie Ziehfreund
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, 80802 Munich, Germany
| | - Emanuele Scala
- Department of Dermatology and Venereology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
- Division of Dermatology and Venereology, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, 17176 Stockholm, Sweden
- Correspondence:
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Navarrete-Rodríguez EM, Del-Río-Navarro BE, Reyes Noriega N, Berber A, Mérida Palacio V, García-Almaráz R, Ellwood P. Have the prevalence of eczema symptoms increased in the Mexican pediatric population? Prevalence and associated factors according to Global Asthma Network Phase I. World Allergy Organ J 2022; 15:100710. [PMID: 36267354 PMCID: PMC9578987 DOI: 10.1016/j.waojou.2022.100710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 10/31/2022] Open
Abstract
Background In children, atopic dermatitis or eczema is the most common inflammatory disease of the skin. According to the International Study of Asthma and Allergies in Childhood (ISAAC) Phase IIIB in Mexico, 5.8% of children and 4.9% of adolescents had eczema symptoms. In 2012, Global Asthma Network (GAN) was established to update the prevalence of eczema and estimate potential factors contributing to its development. Objective To estimate the prevalence and associated factors for atopic eczema symptoms and diagnosis in children and adolescents according to GAN Phase I and compare the results with ISAAC Phase IIIB in Mexico. Methods A cross-sectional, multicenter survey was conducted in 15 Mexican centers during the period of 2015-2017 using the GAN Phase I questionnaires in children (6-7-year-olds) and adolescents (13-14-year-olds). The prevalences obtained from the GAN Phase I study, were compared with ISAAC Phase IIIB results; a Spearman's correlation analysis was conducted between temperature, relative humidity, and altitude and eczema symptoms, and a logistic regression was performed to predict current eczema symptoms by age group. Results A total of 35 777 children and 41 399 adolescents were included. Since ISAAC Phase IIIB, the prevalence of itchy rash in the past 12 months significantly increased in the children's group [6.6% (95% CI 5.7-7.4) vs 7.8 (95% CI 7.5-8.1), p = 0.000] and adolescents' group [5.8% (95% CI 5.0-6.7) vs 6.7% (95% CI 6.5-7.0), p = 0.000].In the adolescents' group, the prevalence of nocturnal awakenings caused by rash symptoms on more than one night per week had a negative correlation between altitude (Spearman's Rho = -0.558, p value = 0.031), and a positive correlation with the average annual temperature (Spearman's Rho = 0.604, p value = 0.017) and annual relative humidity (Spearman's Rho = 0.742, p value = 0.002). The most significant associations in children were the presence of sneezing or runny or blocked nose in the past 12 months [(OR 3.13, 95% CI 2.60-3.77), p = 0.000], the use of paracetamol in the first year of life ([OR 1.52, 95% CI 1.15-2.01), p = 0.003] and the use of antibiotics in the first year of life [(OR 1.30, 95% CI 1.08-1.55) p = 0.004]. Moreover, altitude at 100-1000 m above sea level was associated with current eczema symptoms in adolescents (p = 0.001). Conclusions There has been a significant increase in eczema symptoms in both age groups since ISAAC Phase IIIB study. Additionally, eczema symptoms were associated with temperature, relative humidity, asthma, hay fever symptoms, the use of paracetamol and antibiotics.
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Affiliation(s)
| | - Blanca Estela Del-Río-Navarro
- Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico,Corresponding author. Hospital Infantil de México Federico Gómez, Dr. Márquez No. 162, Col. Doctores, Deleg. Cuauhtémoc, 06720, México, D.F., Mexico.
| | - Nayely Reyes Noriega
- Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Arturo Berber
- Asesor Externo del Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | | | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, 1023, New Zealand
| | - GAN Phase I Study groupRamos-GarcíaBeatriz Del CarmenMDfEscalante-DomínguezAlberto JoséMDgLinares-ZapiénFrancisco JavierMDhGardea-MorenoHéctor LeonardoMDiOchoa-LópezGeorginaMDjHernández-MondragónLuis OctavioMDkLozano-SáenzJosé SantosMDlSacre-HazouriJosé AntonioMDmJuan-PinedaMa de los ÁngelesMDnSánchez-CoronelMaría GuadalupeMDoRodríguez-PérezNoelMDpAmbriz-MorenoMaría de JesúsMDpDel-Río-ChivardiJaime MarianoqSaucedo-RamírezOmar JosueMDqInstituto Mexicano del Seguro Social San Luis Potosí, San Luis Potosí, MexicoHospital General Tijuana, Baja California, MexicoCentro de Investigación, Diagnóstico y Tratamiento de Asma y Alergias, Toluca, Estado de México, MexicoHospital Ángeles Chihuahua, Chihuahua, MexicoHospital Ángeles Ciudad Juárez, Chihuahua, MexicoCRIT Michoacán, Morelia, Michoacán, MexicoHospital Ángeles Xalapa, Veracruz, MexicoUniversidad Veracruzana, Córdoba, Veracruz, MexicoPrivate Practice, Puerto Vallarta, Jalisco, MexicoBenemérita Universidad Autónoma de Aguascalientes, Aguascalientes, MexicoHospital General de Matamoros, Tamaulipas, MexicoServicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
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Huang J, Choo YJ, Smith HE, Apfelbacher C. Quality of life in atopic dermatitis in Asian countries: a systematic review. Arch Dermatol Res 2022; 314:445-462. [PMID: 34086064 PMCID: PMC9162971 DOI: 10.1007/s00403-021-02246-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin condition which impacts psychological wellbeing and social relationships. There have been studies of AD's impact on quality of life (QoL) in Western countries, but these findings cannot be directly extrapolated to Asian populations with genetic, environmental and cultural differences. Therefore, we aimed to systematically review the literature pertaining to QoL impairment in AD in East and Southeast Asia to characterize the impact of AD on patients and their families, and to identify the factors affecting the degree of QoL impairment. A search of English language papers was conducted on MEDLINE, EMBASE, PSYCInfo, Global Health and Web of Science. Observational studies measuring QoL using single or multi-item instruments in people with self-reported or physician diagnosed atopic dermatitis were included. 27 studies from 29 articles were included and synthesized. There is data documenting QoL impairment in AD sufferers and their families, across a wide range of Asian countries, healthcare settings and ages. Aspects of QoL impacted to a greater extent included symptoms of itch, feelings of embarrassment, and sleep disturbance. Severity of disease affects the degree of impairment of QoL, but there is no apparent link between QoL impairment and patient demographic factors, or other medical factors such as age at diagnosis or duration of illness. Our findings also highlighted the need for clinicians to actively explore the impact of patient's symptoms, especially in an Asian context where healthcare communications are traditionally doctor-centric.
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Affiliation(s)
- Jinghui Huang
- Department of Family Medicine and Primary Care, Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Yue Jia Choo
- Department of Family Medicine and Primary Care, Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Helen Elizabeth Smith
- Department of Family Medicine and Primary Care, Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Christian Apfelbacher
- Department of Family Medicine and Primary Care, Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore.
- Institute of Social Medicine and Health Systems Research, Otto Von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
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11
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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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12
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Kaundinya T, Rakita U, Guraya A, Abboud DM, Croce E, Thyssen JP, Alexis A, Silverberg JI. Differences in Psychometric Properties of Clinician- and Patient-Reported Outcome Measures for Atopic Dermatitis by Race and Skin Tone: A Systematic Review. J Invest Dermatol 2022; 142:364-381. [PMID: 34352262 PMCID: PMC8792149 DOI: 10.1016/j.jid.2021.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 02/03/2023]
Abstract
The psychometric validity and reliability of widely used atopic dermatitis (AD) outcome measures across different races and ethnicities are unclear. We describe the rates of reporting race, ethnicity, and skin tone in studies testing the psychometric properties of AD outcome measures and compare the psychometric analyses across race, ethnicity, and skin tone. We systematically reviewed MEDLINE and EMBASE for studies reporting psychometric properties of clinician-reported or patient-reported outcome measures in AD (International Prospective Register of Systematic Reviews: CRD42021239614). Overall, 16,100 nonduplicate articles were screened; 165 met inclusion criteria. Race and/or ethnicity were reported in 55 (33.3%) studies; of those, race was assessed by self-report in 10 studies (6.1%) or was unspecified in 45 (27.3%). A total of 16 studies (9.7%) evaluated psychometric property differences by race, and only five (4.4%) of those did not recognize it as a limitation. Properties assessed across race, ethnicity, or skin tone were differential item functioning, convergent validity feasibility, inter-rater reliability, intrarater reliability, test‒retest reliability, and known-groups validity. Multiple instruments demonstrated performance differences across ethnoracial groups. This review highlights the paucity of race/ethnicity consideration for psychometric property testing in AD outcome measurement instruments. More AD outcomes instruments should be validated in diverse populations.
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Affiliation(s)
- Trisha Kaundinya
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Uros Rakita
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Armaan Guraya
- Chicago College of Osteopathic Medicine, Midwestern University, Chicago, Illinois, USA
| | | | - Emily Croce
- School of Nursing, The University of Texas at Austin, Austin, Texas, USA; Pediatric and Adolescent Dermatology, Dell Children's Medical Group, Austin, Texas, USA
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrew Alexis
- Dermatology, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Jonathan I Silverberg
- Department of Dermatology, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA.
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13
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Murota H, Koike Y, Morisaki H, Matsumoto M, Takenaka M. Exacerbating factors and disease burden in patients with atopic dermatitis. Allergol Int 2022; 71:25-30. [PMID: 34764038 DOI: 10.1016/j.alit.2021.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Indexed: 11/01/2022] Open
Abstract
The number of patients with atopic dermatitis is on the rise worldwide, and Japan is no exception. According to recent estimates of the percentage of patients with atopic dermatitis in Japan by age, the majority of patients are between 20 and 44 years old. Because the peak age of onset of atopic dermatitis is during infancy, many patients may experience prolonged symptoms from infancy to adulthood. A prolonged clinical course also increases the burden of atopic dermatitis on affected patients. Decreased productivity due to work disruptions, reduced daily activity, higher direct medical costs, fatigue, and daytime sleepiness due to sleep disturbances are typical burdens on patients with atopic dermatitis. In order to reduce these burdens, it is necessary to shorten its clinical course and achieve long-term control without relying on medications, possibly by using avoidance or coping measures of aggravating factors. Typical aggravating factors of atopic dermatitis include irritant dermatitis, food allergy in children, sweating, and psychological stress in adults. Food allergy places a heavy burden on the quality of life of affected patients and their families. The effectiveness of educational interventions for sweating and psychological stress is unclear. We must also evaluate the economic burden and cost-effectiveness of interventions on the patient as aggravating factors to be addressed.
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14
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Stingeni L, Belloni Fortina A, Baiardini I, Hansel K, Moretti D, Cipriani F. Atopic Dermatitis and Patient Perspectives: Insights of Bullying at School and Career Discrimination at Work. J Asthma Allergy 2021; 14:919-928. [PMID: 34321892 PMCID: PMC8312319 DOI: 10.2147/jaa.s317009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by recurrent eczematous lesions and intense pruritus. AD patients are known to face a considerable disease burden, including physical and emotional limitations. There is still limited knowledge about daily implications in education and occupation. We describe disease social stigmatization by measuring bullying and self-isolation in students and professional discrimination in workers. Overall loss of productivity, either at school and at the workplace, was quantified as the sum of absenteeism (number of days AD sick leave) and presenteeism (number of days with decreased focus and functionality). Methods An on-line web survey was sent to 3235 random recipients and 401 met the inclusion criteria (self-reporting AD and ≥12 yo). The survey domains included daily limitations, QoL, feelings and relationships, together with specific questions about bullying, discrimination and loss of productivity. Results AD negatively affected QoL in 51.6% of respondents, whereas 68.8% considered AD as a real limit to daily routine. More in detail, 39.3% of students were victims of bullying and 33.9% of workers felt discriminated because of AD. On average, absenteeism in students was for 17.1 days/year (presenteeism: 19.5 days/year), whereas in workers, the estimate was 10.9 days/year (presenteeism: 13.1 days/year). Absenteeism and presenteeism were more pronounced in bullied/discriminated subjects. Conclusion AD multidimensional implications deeply affect and undermine personal and professional fulfillments. Our results contribute to a better understanding of what living with AD means.
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Affiliation(s)
- Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Anna Belloni Fortina
- Unit of Dermatology, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Ilaria Baiardini
- Respiratory Unit for Continuity of Care, IRCCS, Ospedale Policlinico San Martino, Genova, Italy.,Personalized Medicine Asthma, & Allergy Clinic, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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15
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A Qualitative Analysis of Provider Notes of Atopic Dermatitis-Related Visits Using Natural Language Processing Methods. Dermatol Ther (Heidelb) 2021; 11:1305-1318. [PMID: 34056694 PMCID: PMC8322369 DOI: 10.1007/s13555-021-00553-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Real-world disease management of atopic dermatitis (AD) is hampered by a lack of consistency between providers that treat AD regarding assessment of severity, disease activity, and quality of life. Variability and inconsistency in documentation makes it difficult to understand the impact of AD. This study summarizes AD-related symptoms and concerns captured in unstructured qualitative provider notes by healthcare providers during visits with patients with AD. Methods Provider notes were obtained for patients with AD (n = 133,025) from a USA-based ambulatory electronic health records system. The sample included both children (n = 69,551) and adults at least 18 years of age (n = 63,474) receiving treatment from a variety of specialties including primary care, dermatology, and allergy/immunology. Key skin-related words were identified from a review of a sample of notes and natural language processing (NLP) was applied to determine the frequency of the keywords and bigram patterns. Results Provider notes largely focused on symptoms (primarily itch) and symptom relief rather than the impact of AD on work or lifestyle. Despite the known relationship between itch and skin pain, neuralgia was not widely documented. Compared to primary care providers, dermatologists’ and allergist/immunologists’ notes had more documentation of symptom-related issues. Personal and work/life burden issues were not widely documented regardless of specialty. Conclusion The topics documented in case notes by healthcare providers about their patients with AD focus largely on symptoms and, to a lesser extent, treatment, but do not reflect the burden of AD on patients’ lives. This finding highlights a potential care gap that warrants further investigation.
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16
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Hon KLE, Chan VPY, Leung AKC. Experimental Drugs with the Potential to Treat Atopic Eczema. J Exp Pharmacol 2021; 13:487-498. [PMID: 34012301 PMCID: PMC8126870 DOI: 10.2147/jep.s259299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/23/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction Eczema or atopic dermatitis (AD) is a chronically relapsing dermatosis characterized by pruritus and a significant impact on the quality of life. Methods The authors undertook a structured search of peer-reviewed research articles from PubMed and Google Scholar. Recent and up-to-date studies relevant to the topic were included. Results This report overviews current treatment and experimental drug for AD. Topical agents including topical phosphodiesterase E4 (PDE4) inhibitors such as crisaborole are efficacious in the treatment of AD with few side effects. Monoclonal antibodies such as dupilumab given subcutaneously are efficacious for more severe disease. Systemic treatment can ameliorate symptoms in severe and recalcitrant AD. New systemic treatment includes several traditional herbal formulations that have undergone clinical trials using modern research methodology to determine their efficacy and safety. AD is associated with many complicating psychosocial issues. Often suboptimal efficacy is due to unrealistic expectations and poor compliance making treatment difficult in spite of effective treatment and efforts in drug discovery. Randomized trials have shown that novel topical and subcutaneous medications are safe and efficacious. Regarding herbs, a methodology for the investigation of herbal medications is often flawed and scientific evidence is lacking. Experimental drugs include various biologics, PDE4 and JAK inhibitors in topical, oral, subcutaneous or intravenous forms are in various phases of trials. Conclusion Many novel medications demonstrate efficacy for AD. Experimental drugs include various biologics, PDE4 and JAK inhibitors are in various phases of trials.
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Affiliation(s)
- Kam Lun Ellis Hon
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong, People's Republic of China
| | - Vivian P Y Chan
- Pharmacy Department, The Hong Kong Children's Hospital, Hong Kong, People's Republic of China
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary, and the Alberta Children's Hospital, Calgary, Alberta, Canada
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17
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Muzzolon M, Imoto RR, Canato M, Abagge KT, de Carvalho VO. Educational intervention and atopic dermatitis: impact on quality of life and treatment. Asia Pac Allergy 2021; 11:e21. [PMID: 34007831 PMCID: PMC8103006 DOI: 10.5415/apallergy.2021.11.e21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/26/2021] [Indexed: 01/02/2023] Open
Abstract
Background Educational intervention (EI) could improve understanding of atopic dermatitis (AD) and adherence to treatment, decreasing severity, and improving quality of life (QoL). Objective This study aims to evaluate the influence of an EI on the severity of the disease and on the QoL in children with AD. Methods A controlled clinical trial was performed, including children up to 14 years of age with AD. Patients were allocated into control group (CG), which received usual guidelines on AD during the outpatient visit, and a study group (SG) that, in addition to the usual guidelines, participated in the EI. The severity of AD was assessed by Scoring Atopic Dermatitis (SCORAD) and Eczema Area and Severity Index (EASI). QoL was assessed by the Children's Dermatology Life Quality Index and the Dermatitis Family Impact Questionnaire. Results Twenty-seven participants were included in the CG and 21 in the SG. There was a decrease in the median value for the QoL of children in the SG after the intervention (p = 0.04), as well as in the caregiver's (p = 0.04). In the CG, the median QoL of children and caregivers remained unaltered, for caregivers the median value for the QoL was equal throughout first and second evaluation (p = 0.32). In the SG, EASI values decreased after the intervention (p = 0.04), as well as SCORAD (p = 0.04). The CG did not show any decrease in the values of EASI (p = 0.88) scores nor of SCORAD scores (p = 0.82). Conclusion The EI rendered a decrease in severity of the disease and improvement in the QoL of patients and their caregivers.
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18
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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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19
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Cheng BT, Silverberg JI. Association of pediatric atopic dermatitis and psoriasis with school absenteeism and parental work absenteeism: A cross-sectional United States population-based study. J Am Acad Dermatol 2021; 85:885-892. [PMID: 33667540 DOI: 10.1016/j.jaad.2021.02.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 02/07/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The impact of childhood atopic dermatitis (AD) and psoriasis on school absenteeism is not fully elucidated. OBJECTIVE To determine the burden and predictors of chronic school absenteeism in children with AD and psoriasis. METHODS Data were analyzed from the 1999-2015 Medical Expenditure Panel Surveys, cross-sectional, population-based studies of health status and function in the United States. RESULTS Among 3132 and 200 children with AD and psoriasis, respectively, 1544 (67.7%) and 97 (62.5%) missed ≥1 day, and 120 (3.9%) and 5 (3.6%) missed ≥15 days (chronically absent) per year due to illness. AD was associated with chronic absenteeism overall (logistic regression; adjusted odds ratio 1.42, 95% CI [1.13-1.78]) and with more severe disease (mild-moderate: 1.33 [1.04-1.70], severe: 2.00 [1.21-3.32]). No statistical difference in chronic absenteeism was found for children with versus those without psoriasis (1.26 [0.51-3.12]). Parents of children with AD were more likely to miss work for caregiving versus those of children without AD, whereas parents of children with psoriasis had similar rates of work absenteeism versus those of children without psoriasis. LIMITATIONS The severity of AD and psoriasis was assessed by treatment pattern. CONCLUSION Children in the United States with AD had increased chronic school absenteeism. Further interventions are warranted to prevent school absenteeism in childhood AD.
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Affiliation(s)
- Brian T Cheng
- Department of Allergy & Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC.
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20
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Bawany F, Northcott CA, Beck LA, Pigeon WR. Sleep Disturbances and Atopic Dermatitis: Relationships, Methods for Assessment, and Therapies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1488-1500. [PMID: 33321263 DOI: 10.1016/j.jaip.2020.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022]
Abstract
Atopic dermatitis is one of the most common chronic inflammatory skin conditions and is associated with sleep disturbances in 47% to 80% of children and 33% to 90% of adults. Herein, we review the literature on sleep disturbances experienced by patients with atopic dermatitis, as well as the mechanisms that may underlie this. We present subjective and objective methods for measuring sleep quantity and quality and discuss strategies for management. Unfortunately, the literature on this topic remains sparse, with most studies evaluating sleep as a secondary outcome using subjective measures. The development of portable, at-home methods for more objective measures offers new opportunities to better evaluate sleep disturbances in atopic dermatitis research studies and in clinical practice.
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Affiliation(s)
- Fatima Bawany
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY
| | - Carrie A Northcott
- Early Clinical Development, Digital Medicine and Translational Imaging, Pfizer, Inc, Cambridge, Mass
| | - Lisa A Beck
- Department of Dermatology, Medicine and Pathology, University of Rochester Medical Center, Rochester, NY
| | - Wilfred R Pigeon
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY.
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21
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Abstract
BACKGROUND The impact of childhood atopic dermatitis (AD) on social and behavioral issues is not well understood. OBJECTIVE This study sought to determine the prevalence and predictors of social and behavioral symptoms and functional impairment among US children with AD. METHODS The 1996 to 2015 Medical Expenditure Panel Surveys were analyzed, including a representative, cross-sectional study of 2553 US children with AD. Behavioral and functional issues were examined using Columbia Impairment Scale (CIS) scores. RESULTS Childhood AD was associated with behavioral and functional problems, particularly nervousness (odds ratio [OR], 1.18; 95% confidence interval [95% CI], 1.06-1.31), home behavior (OR, 1.18; 95% CI, 1.06-1.32), staying out of trouble (OR, 1.18; 95% confidence interval, 1.06-1.31), and relationships with other kids (OR, 1.17; 95% CI, 1.05-1.31) and with siblings (OR, 1.14; 95% CI, 1.02-1.28). Higher CIS scores were present in children with AD versus without AD (adjusted β, 0.62; 95% CI, 0.22-1.02) and with psoriasis (adjusted β, 0.86; 95% CI, 0.22-1.49). Among children with AD, higher CIS scores were notably associated with male sex, older age, lower household income, public insurance, and comorbid depression and anxiety. CONCLUSIONS AD was associated with behavioral and functional impairment, similar to psoriasis and other common chronic conditions. There are significant sociodemographic differences in CIS scores.
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Urban K, Chu S, Giesey RL, Mehrmal S, Uppal P, Nedley N, Delost GR. The global, regional, and national burden of atopic dermatitis in 195 countries and territories: An ecological study from the Global Burden of Disease Study 2017. JAAD Int 2020; 2:12-18. [PMID: 34409347 PMCID: PMC8362298 DOI: 10.1016/j.jdin.2020.10.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction Numerous population-based studies have focused on the global prevalence of atopic dermatitis (AD), but there are few studies on the global trends of the burden associated with AD. Methods We analyzed the global AD trends in 2017 in 195 countries worldwide using the Global Burden of Disease (GBD) Study database, including prevalence rates, age and sex patterns, and AD burden, using disability-adjusted life years (DALYs). Age-standardized DALYs were also compared to the sociodemographic index values of all the countries in 2017. Results The age-specific DALYs in 2017 showed a right-skewed distribution, with the highest DALYs between 1 and 5 years of age. Females had a higher burden of AD throughout all age groups and geographic regions. The GBD super region with the greatest burden of DALYs caused by AD was high income (178.63 DALYs per 100,000 males, 231.8 for females), and the country with the highest DALYs was Sweden (326.91). The GBD super region with the lowest age-standardized DALY burden caused by AD was south Asia (84.51 DALYs per 100,000 males, 100.54 for females). Conclusion There is a large GBD caused by AD. The observed burden is the greatest in resource-rich countries, females, and young children.
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Affiliation(s)
- Katelyn Urban
- Lake Erie College of Osteopathic Medicine, Greensburg, Pennsylvania
| | - Sherman Chu
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Northwest, Lebanon, Oregon
| | - Rachel L Giesey
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sino Mehrmal
- Department of Internal Medicine, Alameda Health System - Highland Hospital, Oakland, California
| | - Prabhdeep Uppal
- Department of Emergency Medicine and Department of Family Medicine, Christiana Care Health System, Newark, Delaware
| | - Natalie Nedley
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
| | - Gregory R Delost
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania.,Apex Dermatology and Skin Surgery Center, Mayfield Heights, Ohio
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23
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Żychowska M, Reich A, Maj J, Jankowska-Konsur A, Szepietowski JC. Comparison of the impact of childhood psoriasis on mothers' and fathers' quality of life - does gender of a caregiver play a role? J Eur Acad Dermatol Venereol 2020; 35:685-692. [PMID: 32915485 DOI: 10.1111/jdv.16930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psoriasis is a chronic skin condition that in one third of cases starts in the first two decades of life. The disease might impact the quality of life (QoL) of the affected children and their caregivers. The issue of gender differences in the assessment of psychological burden of dermatological conditions has been the subject of few studies with contradictory results. OBJECTIVES The aim of this study was to investigate the differences in the impact of childhood psoriasis on mothers' and fathers' well-being using Family Dermatology Life Quality Index (FDLQI). METHODS Forty-five children with psoriasis (31 girls and 14 boys; mean age ± standard deviation (SD) 10.53 ± 3.44 years) and their parents (45 mothers and 45 fathers) were included in the study. Both parents of each child were asked to separately fill in the validated Polish version of the FDLQI questionnaire. RESULTS Comparing the FDLQI scores, the QoL of mothers was significantly more impaired than the QoL of fathers (13.44 ± 6.46 versus 9.53 ± 6.12 points; P < 0.0001). In mothers, childhood psoriasis had a significantly greater impact in the areas of emotional distress (P = 0.007), dealing with other people's reactions (P < 0.0001), social life (P = 0.02), amount of time spent caring for the child's skin (P = 0.0001) and extra housework (P = 0.0005), compared to fathers. The FDLQI scores of both mothers and fathers were independent of the impairment of children's QoL or the severity of psoriasis, except for positive correlation between mothers' FDLQI scores and children's BSA (R = 0.31; P = 0.03). CONCLUSIONS Differences in the impact of childhood skin diseases on mothers' and fathers' well-being should be taken into consideration while developing educational programmes for patients and their families. There is a need for further, multi-centre research that would take into account geographical and cultural differences, in order to reliably assess the impact of childhood psoriasis on various aspects of caregivers' QoL.
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Affiliation(s)
- M Żychowska
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland.,Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - A Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - J Maj
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - A Jankowska-Konsur
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
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24
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Abstract
BACKGROUND Little is known about the impact of multimorbidity in childhood atopic dermatitis (AD). OBJECTIVE We sought to determine the likelihood and predictors of chronic disease multimorbidity in childhood AD. METHODS Data were examined for children (<18 years) in the 1996-2015 Medical Expenditure Panel Survey, an annual, representative sample of United States households. Multimorbidity was assessed using Charlson Comorbidity Index (CCI), Healthcare Utilization Project Chronic Comorbidity Indicator (HCUP-CCI) and frequency of atopic comorbidities. RESULTS Young children with mild-moderate and severe AD, and adolescents with mild-moderate AD had higher CCI scores. Similarly, young children and adolescents with mild-moderate and severe AD had increased HCUP-CCI scores. Children with AD and atopic disease had higher CCI and HCUP-CCI scores than children with either alone. Young children and adolescents with mild-moderate and severe AD had more atopic comorbidities. CONCLUSIONS Pediatric AD is associated with increased atopic and non-atopic multimorbidity. Comorbid atopic disease may identify a subset of children with AD who particularly benefit from enhanced screening and management of multimorbidity.
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25
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Torun EG, Ertugrul A, Tekguc DC, Bostanci I. Sleep Patterns and Development of Children with Atopic Dermatitis. Int Arch Allergy Immunol 2020; 181:871-878. [PMID: 32772024 DOI: 10.1159/000509402] [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] [Received: 05/12/2020] [Accepted: 06/14/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic inflammatory disease that begins in early childhood. Sleep problems have increased in children with AD. The aim of this study was to evaluate sleep patterns and the development of children with AD at an early age. METHODS This is a cross-sectional study consisting of a total of 80 children aged 0-36 months with AD. Patients were evaluated by the Brief Infant Sleep Questionnaire and International Guide for Monitoring Child Development. RESULTS The median age (IQR) of the patients was 6 (4.25-9) months, 63.7% of them were male and 50% of them had sleep problems. Male sex (OR: 3.78, p = 0.024, 95% CI, 0.083-0.837), patients with AD who were in the first 3 months after diagnosis (OR: 3.56; 95% CI, 1.220-10.43, p = 0.020), and moderate-severe AD (OR: 5.09; 95% CI, 1.649-15.748, p = 0.005) were determined as risk factors for sleep problems. In all, 12.5% of the patients needed support for one or more developmental areas (gross motor skills, expressive language and communication, receptive language, fine motor skills, relationship, and play). Developmental delay was higher in patients with sleep problems (p = 0.037). Multiple siblings (OR: 14.381; 95% CI, 1.557-132.871, p = 0.019) and the presence of sleep problems (OR: 8.011; 95% CI, 1.764-36.387, p = 0.024) were found to be risk factors for developmental delay. CONCLUSION Boys with moderate-severe AD within the first 3 months of diagnosis were at increased risk for sleep problems. Children with AD who have multiple siblings and sleep problems should be evaluated for developmental delay and monitored closely.
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Affiliation(s)
- Emine Gulsah Torun
- Department of Pediatrics, Health Sciences University Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
| | - Aysegul Ertugrul
- Pediatric Allergy and Immunology Department, Health Sciences University Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey,
| | - Doga Ceren Tekguc
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Health Sciences University Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
| | - Ilknur Bostanci
- Pediatric Allergy and Immunology Department, Health Sciences University Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
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26
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Hon KL, Loo S, Leung AKC, Li JTS, Lee VWY. An overview of drug discovery efforts for eczema: why is this itch so difficult to scratch? Expert Opin Drug Discov 2020; 15:487-498. [PMID: 32050818 DOI: 10.1080/17460441.2020.1722639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: Atopic dermatitis (AD) is a type of allergic/inflammatory dermatitis characterized by itch and an impairment in quality of life.Areas covered: Herein, the authors review drug discovery efforts for AD, highlighting the clinical efficacy of novel drugs, with a particular focus on the relief of pruritus. Topical agents include emollients, topical antihistamines, corticosteroids, calcineurin inhibitors and herbs. Recently, topical phosphodiesterase E4 (PDE4) inhibitors like crisaborole have become available and are efficacious for mild to moderate AD with few side effects. For more severe AD, monoclonal antibodies like dupilumab are considered as efficacious subcutaneous treatment options. In severe and recalcitrant AD, systemic treatment can ameliorate AD symptoms.Expert opinion: Many topical and systemic medications have demonstrated therapeutic benefits for AD. Indeed, randomized trials have shown that topical PDE4 inhibitors and subcutaneous dupilumab are safe and efficacious. Objective tools to evaluate itch and gauge treatment efficacy is important, but current methodology relies primarily on clinical scores. AD is a systemic atopic disease with a lot of complicated psychosocial issues. Suboptimal efficacy is often due to poor compliance and unrealistic expectation of curative treatment, rendering treatment difficult despite the existence of effective medications.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.,The Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Steven Loo
- The Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joyce T S Li
- Centre for Learning Enhancement And Research, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vivian W Y Lee
- Centre for Learning Enhancement And Research, The Chinese University of Hong Kong, Shatin, Hong Kong
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27
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Birdi G, Cooke R, Knibb RC. Impact of atopic dermatitis on quality of life in adults: a systematic review and meta-analysis. Int J Dermatol 2020; 59:e75-e91. [PMID: 31930494 DOI: 10.1111/ijd.14763] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 11/26/2019] [Accepted: 12/06/2019] [Indexed: 11/28/2022]
Abstract
Atopic dermatitis (AD) can affect quality of life (QoL) of adult patients in whom the condition can be severe and persistent. There are currently no systematic reviews of the impact of AD on adults. This paper provides the first systematic literature review and meta-analysis of the impact of AD on QoL in adults. A systematic search was conducted using MEDLINE, Scopus, and Web of Science for articles published until October 2018. Inclusion criteria were a clinical diagnosis of AD, adult patients, and QoL as an outcome measure. Interventions were excluded. A total of 32 studies were included. While QoL was assessed using Dermatology Life Quality Index (DLQI) in 25 studies, there was heterogeneity in the tools used to measure disease severity across studies. Meta-analysis of the seven studies that used the SCORAD to measure disease severity showed severity to be significantly related to poorer QoL. The remaining 18 studies also showed increased disease severity significantly related to poorer QoL. When compared to healthy controls, AD patients demonstrated significantly lower QoL, but findings were mixed in studies that compared QoL in AD to other skin conditions. The findings highlight the significant impact that AD has on QoL in adults and the need for validated and relevant QoL measures to be implemented in clinical assessments for AD. Areas that require further research include an exploration of gender differences in QoL and the use of longitudinal study designs to explore factors that may cause differences in QoL ratings.
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Affiliation(s)
- Gurkiran Birdi
- Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Richard Cooke
- Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Rebecca C Knibb
- Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK
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28
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Meltzer LJ, Flewelling KD, Jump S, Gyorkos E, White M, Hauk PJ. Impact of atopic dermatitis treatment on child and parent sleep, daytime functioning, and quality of life. Ann Allergy Asthma Immunol 2020; 124:385-392. [PMID: 31923547 DOI: 10.1016/j.anai.2019.12.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a common childhood disorder that is associated with a variety of negative health outcomes in children and parents, including poor sleep and daytime functioning. Despite this, few studies have examined the impact of treatment for AD on sleep, and even fewer have included validated sleep questionnaires, child report of sleep disturbance, or objective measures of sleep. OBJECTIVE To address limitations in the literature by examining objective and subjective reports of sleep, as well as measures of daytime functioning before and after admission to an intensive treatment program for AD. METHODS Twenty-nine parent-child dyads who presented to an intensive day treatment program participated in this study. Sleep was objectively measured with 1 week of actigraphy both 1 week before admission and 1 month after discharge. Subjective questionnaires of sleep, daytime functioning, and quality of life were completed by children and parents at admission, discharge, 1 month after discharge, and 3 months after discharge. RESULTS Study results highlight the benefit of the treatment program on reducing AD severity, as well as improvements in objectively measured sleep duration and efficiency, self-reported measures of sleep, daytime functioning, and quality of life in children and parents up to 3 months after discharge. CONCLUSION This study highlights the importance of treatment for child AD on both child and parent health outcomes.
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Affiliation(s)
- Lisa J Meltzer
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
| | | | - Stephanie Jump
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | | | - Michael White
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Pia J Hauk
- Department of Pediatrics, National Jewish Health, Denver, Colorado
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29
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Abstract
Atopic dermatitis (AD) was once thought to be a benign childhood disease that remitted with increasing age. However, recent studies have transformed the understanding of AD, particularly in adult patients. AD is common in adults and can lead to substantial disability by negatively affecting sleep, mental health, and quality of life. There seem to be different genetic, immunologic, and epidemiologic risk factors for AD in adults than in children. This article examines the pathophysiology, epidemiology, heterogeneous clinical presentation, burden, diagnosis, and treatment of adult AD.
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Affiliation(s)
- Jonathan I Silverberg
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, USA.
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30
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Ražnatović Đurović M, Janković J, Tomić Spirić V, Relić M, Sojević Timotijević Z, Ćirković A, Đurić S, Janković S. Does age influence the quality of life in children with atopic dermatitis? PLoS One 2019; 14:e0224618. [PMID: 31725802 PMCID: PMC6855426 DOI: 10.1371/journal.pone.0224618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/17/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is one of the most common childhood skin diseases that can affect the quality of life (QoL) of children. The QoL of Montenegrin children with AD has not been sufficiently explored. The aim of this study was to assess their QoL with special emphasize on age differences. METHODS This cross-sectional study included children with AD seen at the Clinic of Dermatology and Venereology, Clinical Center of Montenegro (CCM) in Podgorica between August 2017 and July 2018. The QoL was assessed with the Infants' Dermatitis Quality of Life Index (IDQOL) and the Children's Dermatology Life Quality Index (CDLQI). Disease severity was measured by the Three Item Severity (TIS) score. RESULTS A total of 386 children with AD aged from newborn to 16 years took part in this study. The mean total score of the QoL was 14.7 in infants (0-4 years old), 19.4 in younger children (5-9 years old), and 16.6 in older children (10-16 years old). Age was in negative correlation with the CDLQI score, leisure domain of the CDLQI and CDLQI sleep, and in positive correlation with the IDQOL child mood. TIS score was in positive correlation with both the IDQOL and CDLQI score. CONCLUSIONS The QoL measured by CDLQI was more impaired in younger children, whilst IDQOL child mood was more impaired in older infants. The most impaired QoL was seen in children in the age group 5-9 years. Regardless of disease severity, treatment and counseling of children suffering from AD should be tailored specifically to their age.
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Affiliation(s)
- Milena Ražnatović Đurović
- Clinic of Dermatology and Venereology, Clinical Center of Montenegro, Faculty of Medicine University of Montenegro, Podgorica, Montenegro
| | - Janko Janković
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- * E-mail:
| | - Vesna Tomić Spirić
- Department of Internal Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Allergology and Immunology, Clinical Center of Serbia, Belgrade, Serbia
| | - Milijana Relić
- Department of Dermatology, Faculty of Medicine, University of Priština, Kosovska Mitrovica, Serbia
| | | | - Anđa Ćirković
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slađana Đurić
- Department for Preventive Medicine, Faculty of Medicine, University of Priština, Kosovska Mitrovica, Serbia
| | - Slavenka Janković
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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31
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Hon KL, Ng WGG, Kung JSC, Cheng NS, Ng DKK, Leung TF. Utility of the Pediatric Allergic Disease Quality of Life Questionnaire for childhood eczema. Br J Dermatol 2019; 181:290-295. [PMID: 30706447 DOI: 10.1111/bjd.17710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Childhood atopic dermatitis (AD) is a chronic inflammatory disease associated with pruritus and sleep loss. It is important to evaluate quality-of-life (QoL) impairment objectively in atopic diseases in children. OBJECTIVES To investigate the utility of the Pediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) in children with eczema. METHODS PADQLQ, Patient-Oriented Eczema Measure (POEM, a short-term subjective symptom score), Nottingham Eczema Severity Score (NESS, a long-term subjective symptom score) and Children's Dermatology Life Quality Index (CDLQI, a short-term subjective symptom score) were compared and correlations evaluated. RESULTS PADQLQ, POEM, NESS and CDLQI correlated well with each other (n = 132 sets; Spearman correlations: rho = 0·48-0·70, P < 0·001). A Bland-Altman plot showed a reasonably good agreement between CDLQI and PADQLQ. PADQLQ showed that symptoms of asthma, allergic conjunctivitis and allergic rhinitis were present in 20-30%, 45-71% and 58-67% of children with AD, respectively. Nevertheless, there was no association of eczema symptomatology by POEM or NESS with the severity of other allergic diseases. CONCLUSIONS PADQLQ correlates well with AD-specific severity and QoL scores and reflects all allergic symptoms that holistically influence QoL in children with AD. PADQLQ is hence a composite severity score in terms of clinical symptomatology and QoL impairment for AD.
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Affiliation(s)
- K L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - W G G Ng
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - J S C Kung
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - N S Cheng
- Nethersole School of Nursing, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - D K K Ng
- Hong Kong Sanatorium & Hospital, Hong Kong
| | - T F Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
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32
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Silverberg JI. Comorbidities and the impact of atopic dermatitis. Ann Allergy Asthma Immunol 2019; 123:144-151. [PMID: 31034875 DOI: 10.1016/j.anai.2019.04.020] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 04/22/2019] [Accepted: 04/22/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease with substantial patient and population burdens. A number of comorbid health problems occur in patients with AD, aside from the cutaneous signs and symptoms. This review summarizes recent developments in the burden and comorbidities of AD. DATA SOURCES Literature review. STUDY SELECTIONS Nonsystematic. RESULTS Different aspects of AD, such as chronic pruritus, psychosocial distress, and inflammation, can lead to anxiety, depression, or suicidality. Atopic dermatitis is associated with and may predispose to higher risk of other atopic disorders, including asthma, hay fever, food allergy, and eosinophilic esophagitis. Persons with AD appear to be at higher risk for infectious and cardiovascular risk. CONCLUSION Atopic dermatitis is associated with substantial burden and comorbidities. Identifying AD comorbidities is essential for proper disease management and improving overall patient outcomes.
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Affiliation(s)
- Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University, Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois.
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33
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Hon KL, Ng WGG, Kung JSC, Leung PC, Leung TF. Pilot Studies on Two Complementary Bath Products for Atopic Dermatitis Children: Pine-Tar and Tea. MEDICINES 2019; 6:medicines6010008. [PMID: 30626074 PMCID: PMC6473907 DOI: 10.3390/medicines6010008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/24/2018] [Accepted: 12/28/2018] [Indexed: 11/16/2022]
Abstract
Background: Few standardized bath product clinical trials were performed for atopic dermatitis patients. Pine-tar and green tea extracts are plant-derived products that have been described as having anti-allergic effects which may reduce AD disease severity. Methods: The efficacy of two complementary bath products was studied and compared. Efficacy and acceptability of the bath products were measured by patient general acceptability of treatment (GAT: very good, good, fair or poor), disease severity (SCORAD: SCoring Atopic Dermatitis), quality of life (CDLQI: Children Dermatology Life Quality Index), and pertinent clinical parameters were measured before and after four weeks of treatment. Sample size calculations for further clinical trials were performed. In one group, nine AD patients were subjected to bathing with a pine-tar bath oil for 10–15 min daily for four weeks. In another group, 20 AD subjects bathed with a teabag containing green tea extracts for four weeks. Results: Significant improvements in clinical- and patient-orientated parameters were found in the pine-tar bathing group, but not the tea-bag bathing group. Both groups reported very good/good GAT on the studied products. Teabag bathing was considered not efficacious for further clinical trials. Conclusions: The pilot studies provided preliminary data on the efficacy of pine tar bath oil. We do not document a significant efficacy for bathing with tea extracts. Bathing with pine-tar is potentially a complementary topical treatment with good patient acceptance and adherence, but further evidence-based research for its recommendations is needed.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong 00852, China.
| | - Wing Gi Gigi Ng
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong 00852, China.
| | - Jeng Sum C Kung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong 00852, China.
| | - Ping Chung Leung
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong 00852, China.
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong 00852, China.
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34
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Janković S, Ražnatović-Đurović M, Ćirković A, Janković J. Does gender influence quality of life in children with atopic dermatitis? SCRIPTA MEDICA 2019. [DOI: 10.5937/scriptamed50-20944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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35
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Hon KL, Leong KF, Leung TN, Leung AK. Dismissing the fallacies of childhood eczema management: case scenarios and an overview of best practices. Drugs Context 2018; 7:212547. [PMID: 30532792 PMCID: PMC6281040 DOI: 10.7573/dic.212547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Eczema or atopic dermatitis (AD) is a common relapsing childhood dermatologic illness. Treatment of AD is primarily topical with emollients and corticosteroid/calcineurin inhibitor, which is efficacious for the majority of patients. However, AD is often complicated and difficult to manage in many Asian cities. Effective therapy is impeded by fallacies in the following aspects: (1) mistrust and unrealistic expectations about Western medicine, (2) skin care and allergy treatment, (3) ambiguity about optimal bathing and moisturizing, (4) hesitation and phobias about the usage of adequate topical corticosteroid and immunomodulatory therapies, (5) food and aeroallergen avoidance and dietary supplementation, and (6) complementary and alternative therapies. METHODS AND RESULTS Eleven anonymized case scenarios are described to illustrate issues associated with these fallacies. A literature review is performed and possible solutions to handle or dismiss these fallacies are discussed. CONCLUSIONS The first step in patient care is to accurately assess the patient and the family to evaluate possible concerns, anxiety, and phobias that could impede therapeutic efficacy. Education about the disease should be individualized. Conflicting recommendations on the usage of topical steroid have a detrimental effect on management outcomes, which must be avoided.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
| | - Kin Fon Leong
- Institut Pediatrik, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - Theresa Nh Leung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Alexander Kc Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
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Bao Q, Chen L, Lu Z, Ma Y, Guo L, Zhang S, Huang X, Xu S, Ruan L. Association between eczema and risk of depression: A systematic review and meta-analysis of 188,495 participants. J Affect Disord 2018; 238:458-464. [PMID: 29929155 DOI: 10.1016/j.jad.2018.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 03/30/2018] [Accepted: 05/11/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Several studies were conducted to investigate the association between eczema and risk of depression. This was important because the care of patients with eczema might be inadequate if their psychological problems were not also recognized and treated. However, these studies had some inherent limitations such as small sample sizes or lack of controlling for potential confounders. Further, little was known about psychological co-morbidity of eczema from a global perspective. METHODS We conducted a systematic literature search in PubMed (1966 through January 26th 2017), Cochrane Library (the Cochrane central register of controlled trials, up to January 26th 2017), Scopus (up to December 31st 2016) and Embase (1980 through January 26th 2017) supplemented by manual searches of bibliographies and conference proceedings. The relative risk (RR) with 95% confidence interval (CI) was estimated. RESULTS Ten studies with a total of 188,495 patients were included. Overall, the random effects model summarizing all comparisons suggested a positive association between eczema and risk of depression, the pooled RR was 2.02 (95% confidence interval 1.76 to 2.31, I² = 33.7%). Similar results were observed in subgroup analysis by region. LIMITATIONS Methodological limitations such as selection biases, sample sizes, severity of other diseases, treatment strategy, age and other factors might have influenced the results. CONCLUSIONS Our study showed that patients with eczema were associated with an increased risk of depression. These findings implicated that clinical doctors should continue to be more aware of the association between eczema and the risk of depression.
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Affiliation(s)
- Qinyi Bao
- Department of Mental Health, Ningbo First Hospital, 59 Liuting Road, Ningbo 315010, China; Ningbo University School of Medicine, 818 Fenghua Road, Ningbo 315211, China
| | - Lina Chen
- Department of Respiratory Medicine, Ningbo First Hospital, 59 Liuting Road, Ningbo 315010, China
| | - Zhiyu Lu
- Ningbo University School of Medicine, 818 Fenghua Road, Ningbo 315211, China
| | - Yongyan Ma
- Department of Mental Health, Ningbo First Hospital, 59 Liuting Road, Ningbo 315010, China
| | - Lili Guo
- Department of Mental Health, Ningbo First Hospital, 59 Liuting Road, Ningbo 315010, China
| | - Shuaishuai Zhang
- Department of Mental Health, Ningbo First Hospital, 59 Liuting Road, Ningbo 315010, China
| | - Xiaoping Huang
- Department of Respiratory Medicine, Ningbo First Hospital, 59 Liuting Road, Ningbo 315010, China
| | - Suling Xu
- Department of Dermatology, Affiliated Hospital of Medical College, Ningbo University, Ningbo 315020, China.
| | - Liemin Ruan
- Department of Mental Health, Ningbo First Hospital, 59 Liuting Road, Ningbo 315010, China.
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Sleep disorders and atopic dermatitis: A 2-way street? J Allergy Clin Immunol 2018; 142:1033-1040. [PMID: 30144472 DOI: 10.1016/j.jaci.2018.08.005] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022]
Abstract
Sleep disturbance is very common in patients with atopic dermatitis (AD) and is a major factor leading to impaired quality of life. Sleep disturbance is often viewed as one of the symptoms of AD and one of the measures of disease severity. In this review we describe a variety of sleep disorders associated with AD and a wide range of effect that sleep disorders have on patients with AD. We also discuss our current understanding of the mechanism of sleep disturbance in patients with AD. The relationship between sleep disorders and AD might be bidirectional and could form a vicious cycle. Therefore we suggest viewing sleep disorders as a comorbidity of AD for which regular screening and bidirectional management strategies are indicated, with equal focus on maintaining disease control and implementing specific strategies to improve sleep.
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Mitchell AE. Bidirectional relationships between psychological health and dermatological conditions in children. Psychol Res Behav Manag 2018; 11:289-298. [PMID: 30104911 PMCID: PMC6074762 DOI: 10.2147/prbm.s117583] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Dermatological conditions are common among children. They are a frequent cause of presentation to health care services and a leading contributor to burden of disease. Evidence supports the notion that bidirectional relationships exist between children’s physical and psychological health, whereby the child’s dermatological condition can impact their psychological health and well-being, while, in the reverse direction, psychological factors (eg, stress) can impact the severity and course of the child’s skin disease. The psychological impact of dermatological conditions in childhood needs to be taken into account during the assessment, planning, and treatment phases of management. Likewise, the potential effect of children’s emotional and behavioral difficulties on management, particularly in terms of the impact on parents’ ability to implement their child’s treatment plan, should be considered. This literature review summarizes the current evidence for the relationships between three common chronic dermatological conditions of childhood – atopic dermatitis, psoriasis, and urticaria – and psychological adjustment and quality of life in childhood. Overall, a general paucity of research in the pediatric context – combined with limitations in terms of study design, variability in operationalization of constructs, and heterogeneity in measurement of outcomes – makes it difficult to draw firm conclusions in this area. Based on the available research, implications for successful long-term management of these conditions are discussed in terms of integrating psychological and parenting support with medical management to improve adherence, reduce disease severity, and improve quality of life for children and their families.
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Affiliation(s)
- Amy E Mitchell
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, QLD, Australia,
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Hon KL, Leung AKC, Leung TNH, Lee VWY. Investigational drugs for atopic dermatitis. Expert Opin Investig Drugs 2018; 27:637-647. [PMID: 30058384 DOI: 10.1080/13543784.2018.1494723] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Many novel medications and herbal medicines have claimed efficacy on atopic dermatitis (AD). AREAS COVERED This review covers evidence on efficacy of topical and oral forms of novel and investigational drugs. Topical agents include emollients, phosphodiesterase E4 (PDE4) inhibitors, and topical herbs. There is little evidence that ceramides or natural moisturizing factors provide relief in AD. PDE4 inhibitors have shown promise as an effective topical treatment for mild-to-moderate AD with minimal adverse events, and dupilumab as an effective subcutaneous agent for the treatment of moderate-to-severe AD in adult patients with little adverse effects. However, only preliminary data are available for dupilumab in children with AD. The long-term effects of dupilumab are also not known. Potential new systemic treatments include a number of herbal concoctions. EXPERT OPINION Randomized, double-blind placebo-controlled trials (RCTs) have demonstrated topical PDE4 inhibitors are effective and safe in the treatment of both children and adults with AD but further evaluations are needed. RCTs have also shown that subcutaneous dupilumab is an effective and safe agent for the treatment of AD in adults. Long-term effects of these topical and systemic investigational drugs are currently unavailable. Regarding herbal medications, scientific methods are often flawed and objective evidence is lacking.
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Affiliation(s)
- Kam Lun Hon
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin , Hong Kong
| | - Alexander K C Leung
- b Department of Pediatrics, The University of Calgary , Alberta Children's Hospital , Calgary , Canada
| | - Theresa N H Leung
- c Department of Paediatrics and Adolescent Medicine , The University of Hong Kong , Hong Kong
| | - Vivian W Y Lee
- d School of Pharmacy , The Chinese University of Hong Kong , Hong Kong
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Abstract
Atopic dermatitis is a heterogeneous, chronic, and inflammatory skin disease that is associated with a profound symptom burden. Recent studies have demonstrated associations between atopic dermatitis and a number of multi-organ and systemic disorders. The origin of these comorbid conditions is likely multifactorial, with combined effects of skin-barrier disruption, immune dysregulation, intense symptoms, and iatrogenic complications. Some of these comorbid conditions appear to be related to the underlying severity of atopic dermatitis and inadequate disease control. This review will summarize recent developments in the understanding of the comorbid health disorders associated with atopic dermatitis, particularly infections, sleep disturbances, and cardiovascular disease.
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Affiliation(s)
- Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Arkes building, 676 N Saint Clair St, Suite 1600, Chicago, IL, 60611, USA
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Fishbein AB, Mueller K, Kruse L, Boor P, Sheldon S, Zee P, Paller AS. Sleep disturbance in children with moderate/severe atopic dermatitis: A case-control study. J Am Acad Dermatol 2017; 78:336-341. [PMID: 29089179 DOI: 10.1016/j.jaad.2017.08.043] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/22/2017] [Accepted: 08/25/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sleep is disturbed in 60% of children with atopic dermatitis (AD). OBJECTIVE To characterize sleep in a cohort of children with moderate-to-severe AD and determine methods for assessment of sleep disturbance. METHODS A case-control study compared children age 6 to 17 years who have moderate-to-severe AD with age- and sex-matched healthy controls. Participants wore actigraphy watches and completed sleep- and disease-specific questionnaires. RESULTS Nineteen patients with AD and 19 controls completed the study. The patients with AD experienced wake after sleep onset (WASO) for 103 plus or minus 55 minutes as compared with 50 plus or minus 27 minutes in the controls (P < .01). They had a higher frequency of restless sleep, daytime sleepiness, difficulty falling back to sleep at night, and teacher-reported daytime sleepiness. Disease severity correlated well with WASO (total SCORing Atopic Dermatitis score: r = 0.61, P < .01; objective SCORing Atopic Dermatitis score: r = 0.58, P = .01; and Eczema Area and Severity Index: r = 0.68, P < .01). The Children's Dermatology Life Quality Index sleep question correlated with WASO (r = 0.52, P = .03), but self-reported itch severity did not (r = 0.28, P = .30). LIMITATIONS The study cohort was small. CONCLUSION Children with moderate-to-severe AD experience more WASO and lower sleep efficiency than healthy controls but similar bedtime and wake time, sleep duration, and sleep onset latency.
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Affiliation(s)
- Anna B Fishbein
- Division of Allergy & Immunology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.
| | - Kelly Mueller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lacey Kruse
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Peter Boor
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Stephen Sheldon
- Division of Pulmonology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Phyllis Zee
- Center for Circadian and Sleep Medicine, Northwestern University, Chicago, Illinois
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Silverberg NB, Durán-McKinster C. Special Considerations for Therapy of Pediatric Atopic Dermatitis. Dermatol Clin 2017; 35:351-363. [DOI: 10.1016/j.det.2017.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Fong AT, Katelaris CH, Wainstein B. Bullying and quality of life in children and adolescents with food allergy. J Paediatr Child Health 2017; 53:630-635. [PMID: 28608485 DOI: 10.1111/jpc.13570] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/26/2017] [Accepted: 02/14/2017] [Indexed: 12/01/2022]
Abstract
Food allergy is an increasing phenomenon in Australia, with most recent reports of food allergy occurring in 1 in 12 children. A number of studies have demonstrated that children and adolescents with food allergies experience a decreased quality of life across a number of domains. More recent evidence suggests that this population also experiences an increased occurrence of bullying compared to similar school-aged children. Some individuals have reported being bullied because of their allergies, whilst others have reported specific allergy-related-bullying, such as being touched with foods that they are allergic to or having their food being intentionally contaminated with an allergen. Where there may be a risk of severe anaphylaxis, this is of great concern. This article reviews the current literature on bullying in populations of children and adolescents with food allergies. Several papers worldwide have investigated this, providing evidence of its occurrence in North America, Canada, Italy and Japan.
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Affiliation(s)
- Andrew T Fong
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Constance H Katelaris
- Immunology/Allergy Unit, Department of Medicine, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Brynn Wainstein
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia
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Sleep patterns of young children with newly diagnosed atopic dermatitis. Postepy Dermatol Alergol 2017; 34:143-147. [PMID: 28507494 PMCID: PMC5420607 DOI: 10.5114/ada.2017.67080] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/14/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction Even though atopic dermatitis (AD) most often begins in the first year of life, it is not well known whether sleep disturbances occur following the onset of the disease or whether they develop later. Aim To determine the sleep patterns of young children already diagnosed with AD in comparison to a control group by using a validated questionnaire, the Brief Infant Sleep Questionnaire (BISQ). Material and methods Forty-six children with a new diagnosis of AD and 60 healthy children, aged 3–36 months, participated in the study. Their sleep behaviors were assessed using the BISQ along with a structured sociodemographic data form. Results It was found that when compared with healthy children, children with AD did not have decreased daily total sleep duration (p = 0.1); however, it was found that they woke up more frequently at night (52.2% vs. 40%, p = 0.4) and they stayed awake significantly longer than 60 min when they woke up (41.3% vs. 11.7%, p < 0.05). In addition, mothers of children with AD reported that their children had three times as many sleep problems compared to the reports of mothers of healthy children. Conclusions The findings of this study showed that sleep disturbance was more common in young children with already diagnosed AD, and the BISQ provided a practical way to assess the sleep patterns. The use of a screening tool to enable early identification and treatment of childhood sleep problems among patients with AD should be encouraged.
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Silverberg JI. Selected comorbidities of atopic dermatitis: Atopy, neuropsychiatric, and musculoskeletal disorders. Clin Dermatol 2017; 35:360-366. [PMID: 28709566 DOI: 10.1016/j.clindermatol.2017.03.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease with substantial morbidity and quality of life impairment. There are a number of comorbid health problems that occur in patients with AD, aside from the cutaneous signs and symptoms. Chronic pruritus and inflammation can lead to sleep disturbances and mental health symptoms, which are not mutually exclusive. AD is associated with and may predispose to higher risk of other atopic disorders, including asthma and hay fever. Persons with AD appear to be at higher risk for multiple neuropsychiatric disorders, including depression, attention-deficit/hyperactivity disorder, speech disorders in childhood, headaches, and seizures. There is also a multifactorial association of AD with osteoporosis, injuries, and fractures. Elucidating the comorbidities of AD is important for disease management and improving overall clinical outcomes. This review summarizes recent developments in the atopic and neuropsychiatric comorbidities of AD.
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Affiliation(s)
- Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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Fishbein AB, Vitaterna O, Haugh IM, Bavishi AA, Zee PC, Turek FW, Sheldon SH, Silverberg JI, Paller AS. Nocturnal eczema: Review of sleep and circadian rhythms in children with atopic dermatitis and future research directions. J Allergy Clin Immunol 2015; 136:1170-7. [DOI: 10.1016/j.jaci.2015.08.028] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 08/07/2015] [Accepted: 08/11/2015] [Indexed: 01/25/2023]
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Association between childhood eczema and headaches: An analysis of 19 US population-based studies. J Allergy Clin Immunol 2015; 137:492-499.e5. [PMID: 26329510 DOI: 10.1016/j.jaci.2015.07.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 06/15/2015] [Accepted: 07/01/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Atopic dermatitis (or eczema) is a chronic inflammatory disorder associated with sleep disturbances and quality-of-life impairment. Sleep disturbances have been shown to cause headaches in childhood. However, an association between eczema and headaches is not well established. OBJECTIVES We sought to determine whether childhood eczema is associated with increased headaches and whether such association is related to fatigue or sleep disturbance. METHODS We analyzed data from 401,002 children and adolescents in 19 US population-based cross-sectional studies from the National Survey of Children's Health 2003/2004 and 2007/2008 and the National Health Interview Survey 1997-2013. RESULTS In multivariate models controlling for age, sex, race/ethnicity, household income, highest level of education in the family, insurance coverage, number of persons in the household, birthplace in the United States, ever history of asthma, hay fever, and food allergy, eczema was found to be associated with headaches in 14 of 19 studies. In a pooled analysis of all 19 studies, children with eczema compared with those without eczema had a significantly higher prevalence (10.7% [95% CI, 10.3% to 11.0%] vs 5.4% [95% CI, 5.3% to 5.5%]) and odds (1.52 [95% CI, 1.45-1.59]) of headaches. Mild (1.79 [95% CI, 1.07-2.98]) and severe (2.72 [95% CI, 1.33-5.57]) eczema were associated with significantly higher odds of headaches. In particular, eczema associated with atopy, fatigue, excessive daytime sleepiness, insomnia, and only 0 to 3 nights of sufficient sleep had even higher odds of headache than eczema alone. CONCLUSIONS Eczema is associated with increased headaches in childhood, particularly in patients with severe disease accompanied by atopy, fatigue, and sleep disturbances.
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Hon KL, Tsang YCK, Lee VWY, Pong NH, Ha G, Lee ST, Chow CM, Leung TF. Efficacy of sodium hypochlorite (bleach) baths to reduceStaphylococcus aureuscolonization in childhood onset moderate-to-severe eczema: A randomized, placebo-controlled cross-over trial. J DERMATOL TREAT 2015; 27:156-62. [DOI: 10.3109/09546634.2015.1067669] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Teyhan A, Galobardes B, Henderson J. Child Allergic Symptoms and Well-Being at School: Findings from ALSPAC, a UK Cohort Study. PLoS One 2015; 10:e0135271. [PMID: 26266935 PMCID: PMC4534318 DOI: 10.1371/journal.pone.0135271] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/20/2015] [Indexed: 11/19/2022] Open
Abstract
Background Eczema and asthma are common conditions in childhood that can influence children’s mental health. Despite this, little is known about how these conditions affect the well-being of children in school. This study examines whether symptoms of eczema or asthma are associated with poorer social and mental well-being in school as reported by children and their teachers at age 8 years. Methods Participants were from the Avon Longitudinal Study of Parents and Children. Measures of child well-being in school were child-reported (n = 6626) and teacher reported (n = 4366): children reported on their enjoyment of school and relationships with peers via a self-complete questionnaire; teachers reported child mental well-being using the Strengths and Difficulties Questionnaire [binary outcomes were high ‘internalizing’ (anxious/depressive) and ‘externalizing’ (oppositional/hyperactive) problems (high was >90th percentile)]. Child rash and wheeze status were maternally reported and symptoms categorised as: ‘none’; ‘early onset transient’ (infancy/preschool only); ‘persistent’ (infancy/preschool and at school age); and ‘late onset’ (school age only). Results Children with persistent (OR 1.29, 95% CI 1.02 to 1.63) and late onset (OR 1.48, 95% CI 1.02 to 2.14) rash were more likely to report being bullied, and children with persistent wheeze to feel left out (OR 1.42, 95% CI 1.10 to 1.84). Late onset rash was associated with high teacher-reported internalising behaviours (OR 1.61, 95% CI 1.02 to 2.54), and persistent rash with high externalising behaviours (OR 1.37, 95% CI 1.02 to 1.84). Child sleep and maternal mental health explained some of the associations with teacher-reported mental well-being. Conclusion Symptoms of eczema or asthma can adversely affect a child’s social and mental well-being at primary school. This suggests interventions, such as additional support or education of peers, should begin at early stages in schooling.
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Affiliation(s)
- Alison Teyhan
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Bruna Galobardes
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - John Henderson
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Silverberg JI, Garg NK, Paller AS, Fishbein AB, Zee PC. Sleep disturbances in adults with eczema are associated with impaired overall health: a US population-based study. J Invest Dermatol 2014; 135:56-66. [PMID: 25078665 DOI: 10.1038/jid.2014.325] [Citation(s) in RCA: 231] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/14/2014] [Accepted: 05/05/2014] [Indexed: 11/09/2022]
Abstract
Sleep disturbances are associated with poor health outcomes in adults. However, little is known about the sleep disturbances that occur in adult eczema. We studied the association between adult eczema and sleep disturbance and their impact on overall health and health care utilization. We used the 2012 National Health Interview Survey, a cross-sectional questionnaire of 34,613 adults. Eczema was associated with higher odds of fatigue (odds ratio (95% confidence interval): 2.97 (2.65-3.34)), regular daytime sleepiness (2.66 (2.34-3.01)), and regular insomnia (2.36 (2.11-2.64)), even after controlling for sleep duration, history of allergic disease, sociodemographics, and body mass index. There were significant interactions between eczema and fatigue, sleepiness, and insomnia as predictors of poorer overall health status, number of sick days, and doctor visits, such that eczema and each of the sleep symptoms were associated with higher odds of poorer outcomes than either eczema or sleep symptoms alone. Latent class analysis was used and identified five classes of fatigue, sleep disturbances, and allergic disorders. Two classes had high probabilities of eczema: one with high probabilities of asthma, hay fever, food allergy, and multiple sleep symptoms and the other with intermediate probability of insomnia alone. Future studies are warranted to better characterize sleep loss in eczema and develop strategies for treatment and prevention.
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Affiliation(s)
- Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University, Chicago, Illinois USA.
| | - Nitin K Garg
- Department of Dermatology, Northwestern University, Chicago, Illinois USA
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University, Chicago, Illinois USA
| | - Anna B Fishbein
- Departments of Allergy and Immunology and Pediatrics, Northwestern University, Chicago, Illinois, USA
| | - Phyllis C Zee
- Department of Neurology, Sleep Medicine, Northwestern University, Chicago, Illinois, USA
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