Family burden of hospital-managed pediatric atopic dermatitis: A nationwide registry-based study

Impact of Atopic Dermatitis® on Quality of Life of Caregivers: A Systematic Review and Meta-Analysis

Abstracts: Background: Atopic Dermatitis® (AD) is a chronic dermatological condition that affects both patients and their caregivers. Aims: To summarize evidence on the impact of AD on the quality of life (QoL) of caregiver. Methods: Observational studies were searched for in Medline, Embase, Cochrane Library, SCOPUS, and CINAHL databases up till March 1, 2023. Results: Seventy studies with a total of 33,291 study participants were identified. The Dermatitis® Family Index (DFI) questionnaire featured in 29 studies and was chosen for further meta-analysis. The pooled DFI for all studies was 9.35 (95% confidence interval [CI] 6.94-11.76). For individual components, the highest component scores were for 1.24 for expenditure (95% CI 0.80-1.69), followed by 1.14 for emotions (95% CI 0.77-1.50), as well as sleep 1.12 (95% CI 0.71-1.54) and exhaustion 1.12 (95% CI 0.76-1.48). Meta-analysis on the effect of patient QoL on family QoL was conducted on 15 studies, with a pooled Spearman's rank coefficient using Infants' Dermatitis® Quality of Life Index (IDQoL) was 0.632 (95% CI 0.558-0.707), whereas that using Children's Dermatology Life Quality Index (CDLQI) was 0.624 (95% CI 0.507-0.741). For the 17 studies correlating AD severity with family QoL, a pooled Spearman's rank coefficient of 0.425 (95% CI 0.330-0.521) was obtained. Conclusions: AD is associated with significant negative impacts on caregiver QoL, particularly in family finance, caregiver burnout, and sleep impairment. This was consistently affected by AD severity and patient QoL in all studies examining this association.

A Review of Atomic-Force Microscopy in Skin Barrier Function Assessment

Skin barrier function (SBF) disorders are a class of pathologies that affect a significant portion of the world population. These disorders cause skin lesions with intense itch, impacting patients' physical and psychological well-being as well as their social functioning. It is in the interest of patients that their disorder be monitored closely while under treatment to evaluate the effectiveness of the ongoing therapy and any potential adverse reactions. Symptom-based assessment techniques are widely used by clinicians; however, they carry some limitations. Techniques to assess skin barrier impairment are critical for understanding the nature of the disease and for helping personalize treatment. This review recalls the anatomy of the skin barrier and describes an atomic-force microscopy approach to quantitatively monitor its disorders and their response to treatment. We review a panel of studies that show that this technique is highly relevant for SBF disorder research, and we aim to motivate its adoption into clinical settings.

Short-term effects of meteorological factors on childhood atopic dermatitis in Lanzhou, China

Atopic dermatitis (AD) is one of the leading burdens of skin disease in children globally. Meteorological factors are involved in the onset and development of AD. Several studies have examined the effects of meteorological factors on AD, but their results are inconsistent, and the understanding of the link between AD and meteorological factors remains inadequate. In this study, a total of 19,702 children aged 0 to 14 visited the outpatient clinic for AD from 2015 to 2019 in Lanzhou, China. A distributed lag nonlinear model (DLNM) applies to evaluate effects of meteorological factors on childhood AD in Lanzhou, China, and further explored age and gender differences. It was found that extremely high or low temperatures, extremely high diurnal temperature range (DTR), extremely low relative humidity (RH), and extremely high wind speed (WS) increased the risk of outpatient visits for childhood AD. Effects of extremely high DTR and extremely high WS were more intense, with maximum cumulative risks of 2.248 (95% CI 1.798, 2.811) and 3.834 (95% CI 3.086, 4.759) at lag 0-21, respectively. Furthermore, the combination of low temperature and low RH can also contribute to the higher risk of childhood AD. For extreme temperatures, children aged 7-14 years were more vulnerable. For extremely low RH, extremely high DTR and WS, boys and children aged 0-3 years were more vulnerable. Public health departments should strengthen publicity and education about how meteorological factors affect childhood AD and develop sex- and age-specific preventative measures.

Systemic treatment of children and adolescents with atopic dermatitis aged ≥2 years: a Delphi consensus project mapping expert opinion in Northern Europe

BACKGROUND

Paediatric atopic dermatitis (AD) can be burdensome, affecting mental health and impairing quality of life for children and caregivers. Comprehensive guidelines exist for managing paediatric AD, but practical guidance on using systemic therapy is limited, particularly for new therapies including biologics and Janus kinase (JAK) inhibitors, recently approved for various ages in this indication.

OBJECTIVES

This expert consensus aimed to provide practical recommendations within this advancing field to enhance clinical decision-making on the use of these and other systemics for children and adolescents aged ≥2 years with moderate-to-severe AD.

METHODS

Nineteen physicians from Northern Europe were selected for their expertise in managing childhood AD. Using a two-round Delphi process, they reached full or partial consensus on 37 statements.

RESULTS

Systemic therapy is recommended for children aged ≥2 years with a clear clinical diagnosis of severe AD and persistent disease uncontrolled after optimizing non-systemic therapy. Systemic therapy should achieve long-term disease control and reduce short-term interventions. Recommended are cyclosporine A for short-term use (all ages) and dupilumab or methotrexate for long-term use (ages ≥6 years). Consensus was not reached on the best long-term systemics for children aged 2-6 years, although new systemic therapies will likely become favourable: New biologics and JAK inhibitors will soon be approved for this age group, and more trial and real-world data will become available.

CONCLUSIONS

This article makes practical recommendations on the use of systemic AD treatments for children and adolescents, to supplement international and regional guidelines. It considers the systemic medication that was available for children and adolescents with moderate-to-severe AD at the time this consensus project was done: azathioprine, cyclosporine A, dupilumab, methotrexate, mycophenolate mofetil and oral glucocorticosteroids. We focus on the geographically similar Northern European countries, whose healthcare systems, local preferences for AD management and reimbursement structures nonetheless differ significantly.