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Journal of Cellular and Molecular... Jun 2020Atopic dermatitis (AD) is a chronic and recurrent inflammatory skin disease, affecting up to 10% to 20% of children and 3% of adults. Although allergen sensitization,...
Atopic dermatitis (AD) is a chronic and recurrent inflammatory skin disease, affecting up to 10% to 20% of children and 3% of adults. Although allergen sensitization, skin barrier abnormalities and type 2 immune responses are involved, the exact molecular pathogenesis of AD remains unclear. MicroRNAs (miRNAs) are short (19-25 nucleotides) single-stranded RNA molecules that regulate gene expression at post-transcriptional level and are implicated in the pathogenesis of many inflammatory and immunological skin disorders. This systematic review sought to summarize our current understanding regarding the role of miRNAs in AD development. We searched articles indexed in PubMed (MEDLINE) and Web of Science databases using Medical Subject Heading (MeSH) or Title/Abstract words ('microRNA/miRNA' and 'atopic dermatitis/eczema') from inception through January 2020. Observational studies revealed dysregulation of miRNAs, including miR-143, miR-146a, miR-151a, miR-155 and miR-223, in AD patients. Experimental studies confirmed their functions in regulating keratinocyte proliferation/apoptosis, cytokine signalling and nuclear factor-κB-dependent inflammatory responses, together with T helper 17 and regulatory T cell activities. Altogether, this systematic review brings together contemporary findings on how deregulation of miRNAs contributes to AD.
Topics: Dermatitis, Atopic; Gene Expression Regulation; Humans; MicroRNAs; Models, Biological
PubMed: 32351034
DOI: 10.1111/jcmm.15208 -
The Journal of Allergy and Clinical... Apr 2016The association between atopic dermatitis (AD) and food allergy (FA) is not fully understood, although a causal relationship has been suggested. This has important... (Review)
Review
BACKGROUND
The association between atopic dermatitis (AD) and food allergy (FA) is not fully understood, although a causal relationship has been suggested. This has important implications for prevention and treatment.
OBJECTIVE
We aimed to review the association between AD and FA, the effect of FA on AD severity, chronicity, and age of onset, and the temporal relationship between the two.
METHODS
Medline and Embase were systematically searched from inception to November 2014 for studies investigating both AD and FA.
RESULTS
Sixty-six studies were identified. Eighteen were population-based, 8 used high-risk cohorts, and the rest comprised patients with either established AD or FA. In population-based studies, the likelihood of food sensitization was up to 6 times higher in patients with AD versus healthy control subjects at 3 months of age (odds ratio, 6.18; 95% CI, 2.94-12.98; P < .001). Other population-based studies reported that up to 53% of subjects with AD were food sensitized, and up to 15% demonstrated signs of FA on challenge. Meanwhile, studies including only patients with established AD have reported food sensitization prevalences up to 66%, with challenge-proven FA prevalences reaching up to 81%. Sixteen studies suggested that FA is associated with a more severe AD phenotype. Six studies indicated that AD of earlier onset or increased persistence is particularly associated with FA. Finally, one study found that AD preceded the development of FA.
CONCLUSIONS
This systematic review confirms a strong and dose-dependent association between AD, food sensitization, and FA. AD of increased severity and chronicity is particularly associated with FA. There is also evidence that AD precedes the development of food sensitization and allergy, in keeping with a causal relationship.
Topics: Chronic Disease; Dermatitis, Atopic; Food Hypersensitivity; Humans; Risk Factors; Severity of Illness Index
PubMed: 26897122
DOI: 10.1016/j.jaci.2015.10.049 -
Italian Journal of Dermatology and... Jun 2023The human skin barrier is structurally and functionally immature at birth, with elevated skin surface pH, lower lipid content, and lower resistance to chemicals and...
The human skin barrier is structurally and functionally immature at birth, with elevated skin surface pH, lower lipid content, and lower resistance to chemicals and pathogens. Infants at risk for atopic dermatitis (AD) may present with xerosis almost immediately after birth. The current algorithm on skincare for newborns and infants aims to promote a healthy skin barrier and potential mitigation of AD. The project used a modified Delphi hybrid process comprising face-to-face discussions followed by an online follow-up replacing a questionnaire. During the meeting, a panel of eight clinicians who treat newborns and infants discussed the systematic literature review results and a draft algorithm addressing non-prescription skincare for neonates and infants. Online the panel reviewed and adopted the algorithm using evidence coupled with the panel's expert opinion and clinical experience. The algorithm provides clinical information for pediatric dermatologists, dermatologists, and pediatric healthcare providers treating neonates and infants. The advisors adopted a scale based on clinical signs for the algorithm: 1) scaling/xerosis; 2) erythema; and 3) erosion/oozing. Skincare for newborns and infants includes: aim for a cool environment and soft cotton clothing, give lukewarm baths (~5 min, 2-3 x week) with consideration of a gentle cleanser (pH 4-6) and the application of a full-body moisturizing after bath, while avoiding products with toxic and irritating ingredients. A growing body of evidence recognizes the benefits of ongoing daily use of non-alkaline cleansers and moisturizers. Gentle cleansers and moisturizers containing barrier lipids help maintain the protective skin barrier when applied from birth onwards.
Topics: Humans; Infant; Infant, Newborn; Child; Dermatitis, Atopic; Skin; Skin Care; Erythema; Health Status; Autonomic Nervous System Diseases
PubMed: 37278500
DOI: 10.23736/S2784-8671.23.07336-X -
Journal of the American Academy of... Oct 2016Previous studies found conflicting results about whether childhood atopic dermatitis (AD) persists into adulthood. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Previous studies found conflicting results about whether childhood atopic dermatitis (AD) persists into adulthood.
OBJECTIVE
We sought to determine persistence rates and clinical factors associated with prolonged AD.
METHODS
A systematic review was performed in MEDLINE, EMBASE, Scopus, GREAT, LILACS, Web of Science, Academic Search Complete, and Cochrane Library. Meta-analysis was performed using Kaplan-Meier plots and random-effects proportional hazards regression.
RESULTS
In total, 45 studies including 110,651 subjects spanning 434,992 patient-years from 15 countries were included. In pooled analysis, 80% of childhood AD did not persist by 8 years and less than 5% persisted by 20 years after diagnosis (mean ± SE: 6.1 ± 0.02 years). Children with AD that persisted already for more than 10 years (8.3 ± 0.08 years) had longer persistence than those with 3 (3.2 ± 0.02 years) or 5 (6.8 ± 0.06 years) years of persistence. Children who developed AD by age 2 years had less persistent disease (P < .0001). Persistence was greater in studies using patient-/caregiver-assessed versus physician-assessed outcomes, female versus male patients (P ≤ .0006), but not in those with sensitivity to allergens (P = .90). Three studies found prolonged persistence with more severe AD.
LIMITATIONS
Some studies did not capture recurrences later in life.
CONCLUSIONS
Most childhood AD remitted by adulthood. However, children with already persistent disease, later onset, and/or more severe disease have increased persistence.
Topics: Adolescent; Adult; Age Factors; Age of Onset; Allergens; Child; Child, Preschool; Dermatitis, Atopic; Female; Humans; Kaplan-Meier Estimate; Male; Patch Tests; Prognosis; Proportional Hazards Models; Recurrence; Risk Assessment; Severity of Illness Index; Sex Factors; Young Adult
PubMed: 27544489
DOI: 10.1016/j.jaad.2016.05.028 -
Cureus Sep 2023A significant portion of the pediatric population is affected by allergy diseases, which have become a worldwide public health concern. Could maternal diet during... (Review)
Review
A significant portion of the pediatric population is affected by allergy diseases, which have become a worldwide public health concern. Could maternal diet during pregnancy or breastfeeding influence allergy outcomes in offspring? If this cause-and-effect relationship exists, it will be simpler to design prevention strategies to reduce the incidence of allergic disorders in children, reduce costs to the public health system and to parents, and improve the quality of life of allergic children and their parents. In this systematic review, we will visit the literature from January 2019 to December 2022 to see if any relationship was found between maternal nutrition and its consequences on children's allergy occurrence. We will focus only on food allergy and eczema outcomes in the offspring. Also, we will summarize what was found to be protective or nonprotective to better control the outcomes if applied in the future.
PubMed: 37842462
DOI: 10.7759/cureus.45114 -
Indian Journal of Dermatology 2023Atopic dermatitis (AD) is a common chronic dermatological condition affecting ~10% of adults and ~20% of the paediatric population in high-income countries. There is a... (Review)
Review
Atopic dermatitis (AD) is a common chronic dermatological condition affecting ~10% of adults and ~20% of the paediatric population in high-income countries. There is a lack of comprehensive understanding of the disease burden of AD in India. In this systematic review, the primary objective was to review epidemiological data on AD in India based on articles published between 2011 and 2021. The secondary objective was to assess the disease burden from economic and quality of life (QoL) perspectives. A literature search was conducted using the PubMed and Google Scholar databases using predefined search strings. Relevant studies published in English on AD between 2011 and 2021 were included. This review included 11 articles, of which nine reported demographic and clinical characteristics. The reported prevalence ranged from 3.1% to 7.21% among the paediatric population, up to 16 years of age. The prevalence of AD ranged from 0.98% to 9.2% in studies including paediatric and adult patients. The cost of medications was reported to be the major contributor to the economic burden associated with AD. Mental illnesses such as depression and anxiety were frequently reported in association with AD. Although AD is a common disorder affecting all age groups, there is a lack of substantial epidemiological data. None of the current studies covers the entire country. Hence, studies with a wider geographic scope covering all aspects of disease burden are required to help clinicians and policymakers to understand the disease burden and devise appropriate preventive and management strategies.
PubMed: 37822382
DOI: 10.4103/ijd.ijd_181_23 -
Frontiers in Immunology 2022Several clinical trials have evaluated the efficacy and safety of interleukin-13 (IL-13) with lebrikizumab and tralokinumab in patients with moderate to severe atopic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several clinical trials have evaluated the efficacy and safety of interleukin-13 (IL-13) with lebrikizumab and tralokinumab in patients with moderate to severe atopic dermatitis (AD). However, the safety and efficacy of IL-13 inhibitors as a potent biologic for AD remain elusive.
OBJECTIVE
To assess the efficacy and safety of IL-13 inhibitors in moderate to severe AD.
METHOD
Randomized clinical trials (RCTs), comparing IL-13 inhibitors vs placebo treatment in patients with moderate to severe AD, were identified from public database from its inception to November 9, 2021. The study was registered in PROSPERO (CRD42021254920).
RESULTS
Six studies reporting 7 RCTs involving 2946 patients with moderate-to-severe AD were included for the pooled analysis. Compared with placebo, antagonizing IL-13 with lebrikizumab and tralokinumab showed a greater improvement in percentage change of EASI (MD -20.37, 95%CI -32.28, -8.47), and a larger proportion of patients achieving numerical rating scale (NRS) with more than 4-points improvement (RR 1.59, 95%CI 1.23, 2.05). Additionally, IL-13 inhibitors also improved impaired dermatology life quality index (DLQI) (MD -14.49, 95%CI -19.23, -9.75). In terms of safety, both lebrikizumab and tralokinumab were well tolerated, with the except that they were linked to an increased risk of conjunctivitis compared to placebo treatment.
CONCLUSION
Antagonizing IL-13 with lebrikizumab and tralokinumab have demonstrated encouraging clinical efficacy against moderate-to-severe AD with excellent safety profile, albeit they did come with a higher risk of conjunctivitis than placebo treatment.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier ID=CRD42021254920.
Topics: Conjunctivitis; Dermatitis, Atopic; Humans; Interleukin Inhibitors; Interleukin-13; Treatment Outcome
PubMed: 35967348
DOI: 10.3389/fimmu.2022.923362 -
The Journal of Investigative Dermatology May 2024Cardiovascular guidelines recommend early screening and preventative treatment for children with chronic inflammatory diseases. Atopic dermatitis (AD) is associated with... (Meta-Analysis)
Meta-Analysis
Cardiovascular guidelines recommend early screening and preventative treatment for children with chronic inflammatory diseases. Atopic dermatitis (AD) is associated with cardiovascular risk in adults, but data in children are limited. We systematically searched for studies that examined the association between childhood AD and cardiovascular risk factors and outcomes. Data from 10 publications, including 577,148 individuals, revealed an association between AD and ischemic heart disease (n = 3, OR = 1.68, 95% confidence interval [CI] = 1.29-2.19) and diabetes (n = 4, OR = 1.31, 95% CI = 1.12-1.53), but this did not persist among studies that adjusted for potential confounders (n = 2, OR = 0.98, 95% CI = 0.35-2.75). Similarly, there was an association with lipid disorders but not across the entire population distribution (n = 7, OR = 1.24, 95% CI = 1.13-1.36, 95% prediction interval = 0.95-1.61). AD was not associated with hypertension (n = 5, OR = 1.15, 95% CI = 0.98-1.34, 95% prediction interval = 0.81-1.62) or stroke (n = 2, OR = 1.24, 95% CI = 0.94-1.62). Studies lacked detail on AD severity and important confounders such as body mass index, and the certainty of evidence was very low to low on the basis of GRADE (Grading of Recommendations, Assessment, Development and Evaluation) assessments. Currently, data do not support a clinically meaningful increase in cardiovascular risk for children with AD.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Cardiovascular Diseases; Dermatitis, Atopic; Heart Disease Risk Factors; Risk Factors
PubMed: 37972725
DOI: 10.1016/j.jid.2023.09.285 -
Archives of Dermatological Research Apr 2024Patient education in atopic dermatitis (AD) has worked in parallel to the gold standard of pharmacological treatment as a foundational component of therapeutic regimens.... (Meta-Analysis)
Meta-Analysis Review
Patient education in atopic dermatitis (AD) has worked in parallel to the gold standard of pharmacological treatment as a foundational component of therapeutic regimens. In addition to improving patient education, past investigations of educational interventions have demonstrated profound reductions in disease severity for patients living with AD. However, prior meta-analytical work has focused mostly on comparing in-person interventions, and thus the need to determine the effectiveness of virtual methodologies in the current post-COVID era remains. In this study, we conducted a systematic review of the literature to determine the effectiveness of online programming in AD education compared to in-person interventions. A comprehensive search was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions 2019. Studies were retrieved based on articles published up to 04 April 2023. Adherence to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement guided the reportage process for this systematic review and meta-analysis. The primary outcome of our meta-analysis was the effect of various educational modalities on atopic dermatitis severity as measured by multiple scales across the studies, the most common including SCORAD, Dermatology Life Quality Index (DLQI), Patient Oriented Eczema Measure (POEM), and Eczema Area and Severity Index (EASI). Most studies were randomized controlled trials, primarily from North America and Western Europe and focused on patient and/or caregiver education about disease management, self-care techniques, avoidance of triggers, and comprehensive understanding of the disease process. Our pooled analyses showed that targeted educational programs in understudied adult populations can be as impactful as those in pediatric groups. Moreover, virtual interventions can be employed as constructive tools for reducing barriers of access to patient education. Future research on educational interventions should utilize various methodologies to encourage individual learning preferences with a focus on adult cohorts.
Topics: Dermatitis, Atopic; Humans; Patient Education as Topic; Quality of Life; Severity of Illness Index; COVID-19
PubMed: 38662127
DOI: 10.1007/s00403-024-02871-y -
Complementary Therapies in Medicine Jun 2023Although skin disorders in children and adolescents are increasingly treated with phytotherapies in practice, there are very few studies investigating this topic, and no... (Review)
Review
OBJECTIVES
Although skin disorders in children and adolescents are increasingly treated with phytotherapies in practice, there are very few studies investigating this topic, and no systematic review exists that summarizes the current state of research. This review examines which herbal medicines show to be effective to treat atopic dermatitis, diaper dermatitis, and skin lesions or wounds.
METHODS
Clinical studies were searched according to PRISMA-guidelines in the medical databases of PubMed, EMBASE, and CINAHL and summarised in a systematic review.
RESULTS
Among the 429 articles screened, 17 studies with a total of 2358 participants were identified that suited our inclusion criteria. Thereof seven studies each on the treatment of atopic dermatitis and skin lesions or wounds and three on diaper dermatitis. The phytotherapeutics investigated were based on the following herbs: Evening primrose, blackcurrant, polypodium leucotomos, calendula, aloe vera, chamomile, comfrey, hamamelis, olive, hypericum, neem, white oak, and myrrh. They have mainly been analysed in randomized controlled trials, but also in (long-term) observational studies, prospective trials and case series.
CONCLUSIONS
Based on the application of the Jadad score, eight out of 17 of the studies examined were of low quality. Yet we found some indication that evening primrose oil may be effective for treating atopic dermatitis in children, while comfrey appears to have a positive effect on wound healing. Interestingly, none of the studies found positive effects for treating skin disorders with aloe vera or chamomile.
Topics: Adolescent; Humans; Child; Dermatitis, Atopic; Prospective Studies; Phytotherapy; Plants, Medicinal; Wound Healing
PubMed: 36958415
DOI: 10.1016/j.ctim.2023.102942