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Augustin M, Misery L, von Kobyletzki L, Armario-Hita JC, Mealing S, Redding M. Unveiling the true costs and societal impacts of moderate-to-severe atopic dermatitis in Europe. J Eur Acad Dermatol Venereol 2022; 36 Suppl 7:3-16. [PMID: 35801296 DOI: 10.1111/jdv.18168] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/01/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022]
Abstract
Atopic dermatitis (AD) is a chronic, auto-immune condition that imposes a high burden on individuals, society, and the healthcare system. Approximately 4.4% of adults and up to 18.6% of children/adolescents have AD in Europe, with 20% of all cases accounting for moderate-to-severe forms. This form of the condition in adults results in annual societal costs across Europe of an estimated €30 billion; €15.2 billion related to missed workdays or reduced work productivity, €10.1 billion related to direct medical costs and €4.7 billion related to personal expenditure of patients/families. AD can also substantially impact physical, emotional, and social quality-of-life. Several studies have shown the debilitating itch-scratch cycle is the main cause of the multifaceted burden, as it causes substantial sleep deprivation and stigmatisation due to the physical appearance of the skin, and confidence issues. These factors lead to psychosocial issues and can cumulate over time and prohibit patients reaching their 'full life potential'. Despite this, many patients with the condition are undertreated, resulting in uncontrolled symptoms and a further strain placed on patients, society, and the economy. The authors of this White Paper comprise the European Atopic Dermatitis Working Group, which is a network of international specialists with expertise in dermatology and healthcare policy decisions. Their programme of action is focused on harnessing their expertise to build consensus, advance research, share knowledge, and ultimately seek to improve AD care outcomes through achieving long-term symptom control. This White Paper presents a systematic evaluation of the overall financial and humanistic burden of moderate-to-severe AD and the current challenges that exist with AD care. It introduces recommendations for how, collaboratively, key stakeholders and policy makers can support improvements in AD management to achieve better disease control, thus reducing the costs and associated burden placed on individuals, society, and the economy.
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Affiliation(s)
- M Augustin
- University Medical Center Hamburg, Hamburg, Germany
| | - L Misery
- University Hospital of Brest, Brest, France
| | | | | | - S Mealing
- York Health Economics Consortium (YHEC), York, UK
| | - M Redding
- Eczema Outreach Support, Linlithgow, UK
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2
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Howells LM, Chalmers JR, Gran S, Ahmed A, Apfelbacher C, Burton T, Howie L, Lawton S, Ridd MJ, Rogers NK, Sears AV, Spuls P, von Kobyletzki L, Thomas KS. Development and initial testing of a new instrument to measure the experience of eczema control in adults and children: Recap of atopic eczema (RECAP). Br J Dermatol 2020; 183:524-536. [PMID: 31794074 PMCID: PMC7496132 DOI: 10.1111/bjd.18780] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2019] [Indexed: 02/01/2023]
Abstract
Background Eczema control has been identified as an important outcome by key stakeholders in eczema research (including patients, carers, healthcare professionals and researchers) but no validated instruments for the domain have been identified. Objectives To develop a measurement instrument to capture a patient's perspective of eczema control that is suitable for use in eczema clinical trials. Methods Best practice for the development of a patient‐reported outcome was followed. A mixed‐methods approach was used to develop and refine a conceptual framework, generate, refine and select items and to test the distribution and construct validity of the final scale. The mixed‐methods approach involved expert panel meetings (including patient representatives, healthcare professionals and methodologists), and data collection using a focus group, cognitive interviews and an online survey with people with eczema and caregivers. Multivariable linear regression was used in the item selection process. Results Fourteen expert panel members co‐produced the instrument, with input from people with eczema and caregivers via a focus group (n = 6), cognitive interviews (n = 13) and an online survey (n = 330). The resulting instrument, Recap of atopic eczema (RECAP), is a seven‐item questionnaire that captures eczema control via self or caregiver report. The development process aimed to ensure good content validity and feasibility. Initial testing suggested no floor or ceiling effects and good construct validity. Hypothesized correlation with the Patient‐Oriented Eczema Measure was confirmed [r(258) = 0·83, P < 0·001]. Conclusions RECAP has the potential to improve reporting of eczema control in research and clinical practice. Further exploration of measurement properties is required. Linked Comment: Pattinson and Bundy. Br J Dermatol 2020; 183:418–419. What's already known about this topic? Eczema control has been identified as an important outcome by key stakeholders in eczema research (including patients, carers, healthcare professionals and researchers). Qualitative studies suggest eczema control is a multifaceted and individual experience and no instrument has been identified that captures eczema control in this way.
What does this study add? We have developed Recap of atopic eczema (RECAP), a seven‐item questionnaire to capture the experience of eczema control in all ages and eczema severities; there are two versions: a self‐reported version for adults and older children with eczema, and a caregiver‐reported version for younger children with eczema. Designed with input from people with eczema, caregivers and healthcare professionals to ensure good content validity. Initial testing of score distributions and construct validity suggests good measurement properties.
What are the clinical implications of the work? The RECAP instrument is appropriate and feasible for measuring eczema control in clinical trials and may also be useful in routine practice.
Linked Comment: Pattinson and Bundy. Br J Dermatol 2020; 183:418–419. Plain language summary available online
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Affiliation(s)
- L M Howells
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - J R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - S Gran
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - A Ahmed
- Patient representative, Nottingham, UK
| | - C Apfelbacher
- Department of Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.,Institute of Social Medicine and Health Economics, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - T Burton
- Patient representative, Nottingham, UK
| | - L Howie
- Patient representative, Brisbane, Australia
| | - S Lawton
- Rotherham NHS Foundation Trust, Rotherham, UK
| | - M J Ridd
- Department of Population Health Science, University of Bristol, Bristol, UK
| | - N K Rogers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - A V Sears
- St John's Institute of Dermatology and Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - P Spuls
- Department of Dermatology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
| | - L von Kobyletzki
- Centre for Clinical Research, Malmö, Lund University, Sweden.,Centre for Clinical Research, Örebro University, Sweden
| | - K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Vestergaard C, Wollenberg A, Barbarot S, Christen-Zaech S, Deleuran M, Spuls P, Flohr C, Trzeciak M, von Kobyletzki L, Seneschal J, Paul C, Bieber T, Werfel T, Fölster-Holst R, Darsow U, Gieler U, Svensson Å, Cork M, Stalder JF, De Raeve L, Kunz B, Simon D, Chernyshov P, Hijnen D, Gelmetti C, Ring J, Taieb A, de Bruin-Weller M, Thyssen JP. European task force on atopic dermatitis position paper: treatment of parental atopic dermatitis during preconception, pregnancy and lactation period. J Eur Acad Dermatol Venereol 2019; 33:1644-1659. [PMID: 31231864 DOI: 10.1111/jdv.15709] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/07/2019] [Indexed: 12/14/2022]
Abstract
Atopic dermatitis (AD) is a common inflammatory skin disease that affects both children and adults, including a large number of adults of reproductive age. Several guidelines for the treatment of AD exist, yet specific recommendations for the treatment of pregnant or lactating women and for adults planning to have a child are often lacking. This position paper from the European Task force on Atopic Dermatitis (ETFAD) is based on up-to-date scientific literature on treating pregnant and lactating women as wells as adults with AD planning to have a child. It is based on the expert opinions of members of the ETFAD and on existing safety data on the proposed treatments, many of which are derived from patients with other inflammatory diseases or from transplantation medicine. For treating future parents, as well as pregnant and lactating women with AD, the use of topical treatments including moisturizers, topical corticosteroids, tacrolimus, antiseptics such as chlorhexidine, octenidine, potassium permanganate and sodium hypochlorite (bleach) is deemed to be safe. Ultraviolet (UV) therapy may also be used. Systemic treatment should be prescribed only after careful consideration. According to the opinion of the ETFAD, treatment should be restricted to systemic corticosteroids and cyclosporine A, and, in selected cases, azathioprine.
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Affiliation(s)
- C Vestergaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - A Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany.,Hautklinik Thalkirchner Straße, Staedtisches Klinikum Muenchen, Muenchen, Germany
| | - S Barbarot
- Department of Dermatology, CHU Nantes, Nantes, France
| | - S Christen-Zaech
- Pediatric Dermatology Unit, Departments of Dermatology and Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - M Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - P Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C Flohr
- St. Johns Institute of Dermatology, Kings College and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Trzeciak
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | | | - J Seneschal
- Department of dermatology, INSERM, University of Bordeaux, Bordeaux, France
| | - C Paul
- Department of Dermatology, Larrey Hospital, Toulouse University, Toulouse, France
| | - T Bieber
- Department of Dermatology and Allergology, and Christine Kühne-Center for Allergy Research and Education, University of Bonn, Bonn, Germany
| | - T Werfel
- Department of Dermatology and Allergology, Hannover Medical School, Hannover, Germany
| | - R Fölster-Holst
- Department of Dermatology, Venerology and Allergology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - U Darsow
- Department of Dermatology and Allergology Biederstein, Technical University of Munich, Munich, Germany
| | - U Gieler
- Department of Dermatology, Justus-Liebig-University, Giessen, Germany
| | - Å Svensson
- Department of Dermatology, Lund University, Malmoe, Sweden
| | - M Cork
- Sheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - J-F Stalder
- Department of Dermatology, CHU Nantes, Nantes, France
| | - L De Raeve
- Department of Dermatology, UZ Brussel, Free University of Brussels (VUB), Brussels, Belgium
| | - B Kunz
- Dermatologikum, Hamburg, Germany
| | - D Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - P Chernyshov
- Department of Dermatology, National Medical University, Kiev, Ukraine
| | - D Hijnen
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - C Gelmetti
- Department of Pediatric Dermatology, Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - J Ring
- Department of Dermatology and Allergology Biederstein, Technical University of Munich, Munich, Germany.,Christiane-Kühne Center for Allergy Research and Education (CK-Care), Davos, Switzerland
| | - A Taieb
- Department of dermatology, INSERM, University of Bordeaux, Bordeaux, France
| | - M de Bruin-Weller
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Chalmers JR, Thomas KS, Apfelbacher C, Williams HC, Prinsen CA, Spuls PI, Simpson E, Gerbens LAA, Boers M, Barbarot S, Stalder JF, Abuabara K, Aoki V, Ardeleanu M, Armstrong J, Bang B, Berents TL, Burton T, Butler L, Chubachi T, Cresswell-Melville A, DeLozier A, Eckert L, Eichenfield L, Flohr C, Futamura M, Gadkari A, Gjerde ES, van Halewijn KF, Hawkes C, Howells L, Howie L, Humphreys R, Ishii HA, Kataoka Y, Katayama I, Kouwenhoven W, Langan SM, Leshem YA, Merhand S, Mina-Osorio P, Murota H, Nakahara T, Nunes FP, Nygaard U, Nygårdas M, Ohya Y, Ono E, Rehbinder E, Rogers NK, Romeijn GLE, Schuttelaar MLA, Sears AV, Simpson MA, Singh JA, Srour J, Stuart B, Svensson Å, Talmo G, Talmo H, Teixeira HD, Thyssen JP, Todd G, Torchet F, Volke A, von Kobyletzki L, Weisshaar E, Wollenberg A, Zaniboni M. Report from the fifth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative). Br J Dermatol 2018; 178:e332-e341. [PMID: 29672835 DOI: 10.1111/bjd.16543] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2018] [Indexed: 12/11/2022]
Abstract
This is the report from the fifth meeting of the Harmonising Outcome Measures for Eczema initiative (HOME V). The meeting was held on 12-14 June 2017 in Nantes, France, with 81 participants. The main aims of the meeting were (i) to achieve consensus over the definition of the core domain of long-term control and how to measure it and (ii) to prioritize future areas of research for the measurement of the core domain of quality of life (QoL) in children. Moderated whole-group and small-group consensus discussions were informed by presentations of qualitative studies, systematic reviews and validation studies. Small-group allocations were performed a priori to ensure that each group included different stakeholders from a variety of geographical regions. Anonymous whole-group voting was carried out using handheld electronic voting pads according to predefined consensus rules. It was agreed by consensus that the long-term control domain should include signs, symptoms, quality of life and a patient global instrument. The group agreed that itch intensity should be measured when assessing long-term control of eczema in addition to the frequency of itch captured by the symptoms domain. There was no recommendation of an instrument for the core outcome domain of quality of life in children, but existing instruments were assessed for face validity and feasibility, and future work that will facilitate the recommendation of an instrument was agreed upon.
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Affiliation(s)
- J R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - C Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - C A Prinsen
- Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - P I Spuls
- Department of Dermatology, Academic Medical Center, Amsterdam, the Netherlands
| | - E Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, U.S.A
| | - L A A Gerbens
- Department of Dermatology, Academic Medical Center, Amsterdam, the Netherlands
| | - M Boers
- VU University Medical Center, Amsterdam, the Netherlands
| | - S Barbarot
- Department of Dermatology, Nantes University Hospital (CHU de Nantes), France
| | - J F Stalder
- Department of Dermatology, Nantes University Hospital (CHU de Nantes), France
| | - K Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A
| | - V Aoki
- University of São Paulo Medical School, São Paulo, Brazil
| | - M Ardeleanu
- Regeneron Pharmaceuticals, Tarrytown, NY, U.S.A
| | | | - B Bang
- LEO Pharma, Ballerup, Denmark
| | | | | | - L Butler
- National Eczema Association, San Rafael, CA, U.S.A
| | - T Chubachi
- GlaxoSmithKline, Research Triangle Park, NC, U.S.A
| | | | - A DeLozier
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | | | - L Eichenfield
- Rady Children's Hospital, University of California San Francisco, San Diego, CA, U.S.A
| | - C Flohr
- St John's Institute of Dermatology, St Thomas' Hospital, London, U.K
| | | | - A Gadkari
- Regeneron Pharmaceuticals, Tarrytown, NY, U.S.A
| | - E S Gjerde
- The Psoriasis and Eczema Association of Norway, Oslo, Norway
| | - K F van Halewijn
- Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | | | - L Howells
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - L Howie
- Global Parents for Eczema Research, Brisbane, Australia
| | | | - H A Ishii
- Brazilian Atopic Dermatitis Association (AADA), São Paulo, Brazil
| | - Y Kataoka
- Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
| | | | - W Kouwenhoven
- Dutch Association for People with Atopic Dermatitis, Nijkerk, the Netherlands
| | - S M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, U.K
| | - Y A Leshem
- Beilinson Hospital and Tel Aviv University, Petah Tikva and Tel Aviv, Israel
| | - S Merhand
- Association Française de l'Eczéma, Redon, France
| | | | - H Murota
- Department of Dermatology, Osaka University, Suita, Japan
| | - T Nakahara
- Department of Dermatology, Kyushu University, Fukuoka, Japan
| | - F P Nunes
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - U Nygaard
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | | | - Y Ohya
- National Centre for Child Health and Development, Tokyo, Japan
| | - E Ono
- Osaka University, Osaka, Japan
| | - E Rehbinder
- Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - N K Rogers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - G L E Romeijn
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M L A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A V Sears
- St John's Institute of Dermatology, St Thomas' Hospital, London, U.K
| | | | - J A Singh
- Department of Medicine, University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, AL, U.S.A
| | - J Srour
- Klinik und Poliklinik für Dermatologie und Allergologie der LMU - München, Munich, Germany
| | - B Stuart
- Primary Care and Population Sciences Division, University of Southampton, Southampton, U.K
| | - Å Svensson
- Department of Dermatology and Venereology, Lund University, Malmö, Sweden
| | - G Talmo
- The Psoriasis and Eczema Association of Norway, Haugesund, Norway
| | - H Talmo
- The Psoriasis and Eczema Association of Norway, Haugesund, Norway
| | | | - J P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - G Todd
- University of Cape Town, Cape Town, South Africa
| | - F Torchet
- Association Française de l'Eczéma, Redon, France
| | - A Volke
- Department of Dermatology, University of Tartu, Tartu, Estonia
| | - L von Kobyletzki
- Department of Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Public Health Sciences, Karlstad University, Karlstad, Sweden.,CF Wahlgren, Dermatology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden.,Department of Dermatology, Venereology and Allergy University Hospital Schleswig-Holstein, Kiel, Germany
| | - E Weisshaar
- Department of Social Medicine, Occupational and Environmental Dermatology, Ruprecht Karls University, Heidelberg, Germany
| | | | - M Zaniboni
- University of São Paulo, Campinas, Brazil
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Beckman L, Janson S, von Kobyletzki L. Corrigendum to “Associations between neurodevelopmental disorders and factors related to school, health, and social interaction in schoolchildren: Results from a Swedish population-based survey” [Disabil Health J 9(4) (2016) 663–672]. Disabil Health J 2018; 11:330. [DOI: 10.1016/j.dhjo.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wollenberg A, Oranje A, Deleuran M, Simon D, Szalai Z, Kunz B, Svensson A, Barbarot S, von Kobyletzki L, Taieb A, de Bruin-Weller M, Werfel T, Trzeciak M, Vestergard C, Ring J, Darsow U. ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients. J Eur Acad Dermatol Venereol 2016; 30:729-47. [DOI: 10.1111/jdv.13599] [Citation(s) in RCA: 267] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/10/2015] [Indexed: 12/27/2022]
Affiliation(s)
- A. Wollenberg
- Department of Dermatology and Allergy; Ludwig-Maximilian-University; Munich Germany
| | - A. Oranje
- Department of Dermatology (Pediatric Dermatology and Hair); Dermicis Skin clinic; Alkmaar and Rotterdam The Netherlands
| | - M. Deleuran
- Department of Dermatology; Aarhus University Hospital; Aarhus Denmark
| | - D. Simon
- Department of Dermatology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - Z. Szalai
- Heim Pal Childrens Hospital; Budapest Hungary
| | - B. Kunz
- Dermatologikum; Hamburg Germany
| | - A. Svensson
- Department of Dermatology; University Hospital UMAS; Malmö Sweden
| | - S. Barbarot
- Department of Dermatology; University of Nantes; Nantes France
| | | | - A. Taieb
- Service de Dermatologie et Dermatologie Pédiatrique; Centre de référence pour les maladies rares de la peau; INSERM 1035; Université de Bordeaux; Talence France
| | - M. de Bruin-Weller
- Department of Dermatology; University of Utrecht; Utrecht The Netherlands
| | - T. Werfel
- Department of Dermatology; Hautklinik Linden; MHH; Hannover Germany
| | - M. Trzeciak
- Department of Dermatology, Venereology and Allergology; Medical University of Gdansk; Gdansk Poland
| | - C. Vestergard
- Department of Dermatology; Aarhus University Hospital; Aarhus Denmark
| | - J. Ring
- Department of Dermatology and Allergy Biederstein; Technische Universität München; Munich Germany
- Christine Kühne Center for Allergy Research and Education (CK-CARE); Davos Switzerland
| | - U. Darsow
- Department of Dermatology and Allergy Biederstein; Technische Universität München; Munich Germany
- ZAUM - Center of Allergy & Environment; Munich Germany
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von Kobyletzki L, Apfelbacher C, Schmitt J, Svensson Å. Factors that predict remission of infant eczema. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chalmers JR, Schmitt J, Apfelbacher C, Dohil M, Eichenfield LF, Simpson EL, Singh J, Spuls P, Thomas KS, Admani S, Aoki V, Ardeleanu M, Barbarot S, Berger T, Bergman JN, Block J, Borok N, Burton T, Chamlin SL, Deckert S, DeKlotz CC, Graff LB, Hanifin JM, Hebert AA, Humphreys R, Katoh N, Kisa RM, Margolis DJ, Merhand S, Minnillo R, Mizutani H, Nankervis H, Ohya Y, Rodgers P, Schram ME, Stalder JF, Svensson A, Takaoka R, Teper A, Tom WL, von Kobyletzki L, Weisshaar E, Zelt S, Williams HC. Report from the third international consensus meeting to harmonise core outcome measures for atopic eczema/dermatitis clinical trials (HOME). Br J Dermatol 2014; 171:1318-25. [PMID: 24980543 PMCID: PMC4298247 DOI: 10.1111/bjd.13237] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 01/25/2023]
Abstract
This report provides a summary of the third meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in San Diego, CA, U.S.A., 6-7 April 2013 (HOME III). The meeting addressed the four domains that had previously been agreed should be measured in every eczema clinical trial: clinical signs, patient-reported symptoms, long-term control and quality of life. Formal presentations and nominal group techniques were used at this working meeting, attended by 56 voting participants (31 of whom were dermatologists). Significant progress was made on the domain of clinical signs. Without reference to any named scales, it was agreed that the intensity and extent of erythema, excoriation, oedema/papulation and lichenification should be included in the core outcome measure for the scale to have content validity. The group then discussed a systematic review of all scales measuring the clinical signs of eczema and their measurement properties, followed by a consensus vote on which scale to recommend for inclusion in the core outcome set. Research into the remaining three domains was presented, followed by discussions. The symptoms group and quality of life groups need to systematically identify all available tools and rate the quality of the tools. A definition of long-term control is needed before progress can be made towards recommending a core outcome measure.
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Affiliation(s)
- J R Chalmers
- Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, U.K
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Schmitt J, von Kobyletzki L, Svensson A, Apfelbacher C. Efficacy and tolerability of proactive treatment with topical corticosteroids and calcineurin inhibitors for atopic eczema: systematic review and meta-analysis of randomized controlled trials. Br J Dermatol 2010; 164:415-28. [PMID: 20819086 DOI: 10.1111/j.1365-2133.2010.10030.x] [Citation(s) in RCA: 184] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term low-level topical anti-inflammatory therapy has been suggested as a new paradigm in the treatment of atopic eczema (AE). OBJECTIVES To determine the efficacy and tolerability of topical corticosteroids and calcineurin inhibitors for flare prevention in AE. METHODS Systematic review of randomized controlled trials reporting efficacy of topical corticosteroids and/or topical calcineurin inhibitors for flare prevention in AE. Identification of relevant articles by systematic electronic searches (Cochrane Library, Medline) supplemented by hand search. Primary efficacy endpoint: proportion of participants experiencing at least one flare during proactive anti-inflammatory treatment. Relative risks (RRs) and corresponding 95% confidence intervals (CIs) were calculated and pooled by pharmaceutical agent using random-effects meta-analysis. Sensitivity analysis included meta-regression to explore the influence of study-specific covariates. RESULTS Nine articles reporting on eight vehicle-controlled trials were included. Three, four and one trial(s) evaluated proactive therapy with topical tacrolimus, fluticasone propionate and methylprednisolone aceponate, respectively. Each agent under study was more efficacious to prevent flares than vehicle. Meta-analysis suggested that topical fluticasone propionate (RR 0·46, 95% CI 0·38-0·55) may be more efficacious to prevent disease flares than topical tacrolimus (RR 0·78, 95% CI 0·60-1·00). Meta-regression indicated robustness of these findings. Proactive anti-inflammatory therapy was generally well tolerated. The trials identified, however, do not allow firm conclusions about long-term safety. CONCLUSIONS Vehicle-controlled trials indicate efficacy of proactive treatment with tacrolimus, fluticasone propionate and methylprednisolone aceponate to prevent AE flares. Indirect evidence from vehicle-controlled trials suggests that twice weekly application of the potent topical corticosteroid fluticasone propionate may be more efficacious to prevent AE flares than tacrolimus ointment. Head to head trials should be conducted to confirm these results. Future studies are also needed to evaluate the long-term safety of proactive treatment of AE.
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Affiliation(s)
- J Schmitt
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, D-01307 Dresden, Germany.
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Jansen T, Gambichler T, von Kobyletzki L, Altmeyer P. Lichen planus actinicus treated with acitretin and topical corticosteroids. J Eur Acad Dermatol Venereol 2002; 16:174-5. [PMID: 12046829 DOI: 10.1046/j.1468-3083.2002.00392_3.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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