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International Journal of Women's... Jun 2024Atopic dermatitis (AD) is one of the most common inflammatory dermatoses in adults. Women are disproportionately impacted by AD and report significant impacts on quality...
BACKGROUND
Atopic dermatitis (AD) is one of the most common inflammatory dermatoses in adults. Women are disproportionately impacted by AD and report significant impacts on quality of life compared to men.
OBJECTIVE
Given the absence of formal guidelines for the treatment of AD in women of childbearing age, we will review special considerations for treating women of childbearing age with AD to ensure consistent care and optimal outcomes for these patients.
METHODS
PubMed and Google Scholar databases were searched for relevant articles from database inception through May of 2023.
RESULTS
There are several treatments including topical therapies, systemic therapies, and phototherapy that are considered safe during preconception, pregnancy and breastfeeding. Given the negative consequences of uncontrolled AD for both the mother and the unborn baby, the risks and benefits of potential therapies should be reviewed with all women of childbearing age suffering from AD.
LIMITATIONS
The gold standard in recommending therapies is randomized controlled trials; however, pregnant and lactating women are often excluded from these trials.
CONCLUSION
Through shared decision-making between the dermatologist, obstetrician, and patient, the risks and benefits of any therapy should be thoroughly discussed and considered with all women of childbearing age, to optimize care and outcomes for this unique population.
PubMed: 38860232
DOI: 10.1097/JW9.0000000000000151 -
JID Innovations : Skin Science From... Jul 2024Loss-of-function variants in the gene have been identified as the strongest cause of susceptibility to atopic dermatitis (AD) in Europeans and Asians. However, very...
Loss-of-function variants in the gene have been identified as the strongest cause of susceptibility to atopic dermatitis (AD) in Europeans and Asians. However, very little is known about the genetic etiology behind AD in African populations, where the prevalence of AD is notably high. We sought to investigate the genetic origins of AD by performing whole-genome sequencing in an Ethiopian family with 12 individuals and several affected in different generations. We identified 2 variants within (p.D13Y) and (p.A918S) genes cosegregating with AD in the affected individuals. Further genotyping analyses in both Ethiopian and Swedish AD cases and controls revealed a significant association with the variant (p.D13Y, < .0013) only in the Ethiopian cohort. However, the variant (p.A918S) did not show any association in our Ethiopian cohort. Instead, 2 previously recognized variants (p.A849V, < .0085 and p.G908R, < .0036) were significantly associated with AD in our Ethiopian cohort. Our study indicates that the and genes might be important in the etiology of AD in Ethiopians. Additional genetic and functional studies are needed to confirm the role of these genes and the associated variants into the development of AD.
PubMed: 38859976
DOI: 10.1016/j.xjidi.2024.100284 -
Journal of the American Academy of... Jun 2024
Effectiveness of abrocitinib for the treatment of moderate-to-severe atopic dermatitis in patients switched from dupilumab and/or tralokinumab: A real-world retrospective study.
PubMed: 38857764
DOI: 10.1016/j.jaad.2024.05.081 -
Biomedical Optics Express May 2024The therapeutic application of blue light (380 - 500nm) has garnered considerable attention in recent years as it offers a non-invasive approach for the management of...
The therapeutic application of blue light (380 - 500nm) has garnered considerable attention in recent years as it offers a non-invasive approach for the management of prevalent skin conditions including acne vulgaris and atopic dermatitis. These conditions are often characterised by an imbalance in the microbial communities that colonise our skin, termed the skin microbiome. In conditions including acne vulgaris, blue light is thought to address this imbalance through the selective photoexcitation of microbial species expressing wavelength-specific chromophores, differentially affecting skin commensals and thus altering the relative species composition. However, the abundance and diversity of these chromophores across the skin microbiota remains poorly understood. Similarly, devices utilised for studies are often bulky and poorly characterised which if translated to therapy could result in reduced patient compliance. Here, we present a clinically viable micro-LED illumination platform with peak emission 450 nm (17 nm FWHM) and adjustable irradiance output to a maximum 0.55 ± 0.01 W/cm, dependent upon the concentration of titanium dioxide nanoparticles applied to an accompanying flexible light extraction substrate. Utilising spectrometry approaches, we characterised the abundance of prospective blue light chromophores across skin commensal bacteria isolated from healthy volunteers. Of the strains surveyed 62.5% exhibited absorption peaks within the blue light spectrum, evidencing expression of carotenoid pigments (18.8%, 420-483 nm; , spp.), porphyrins (12.5%, 402-413 nm; spp.) and potential flavins (31.2%, 420-425 nm; and spp.). We also present evidence of the capacity of these species to diminish irradiance output when combined with the micro-LED platform and in turn how exposure to low-dose blue light causes shifts in observed absorbance spectra peaks. Collectively these findings highlight a crucial deficit in understanding how microbial chromophores might shape response to blue light and in turn evidence of a micro-LED illumination platform with potential for clinical applications.
PubMed: 38855662
DOI: 10.1364/BOE.522867 -
Archives of Dermatological Research Jun 2024The objective was to study a large, international, ethnically diverse population of patients with atopic dermatitis (AD) to support the creation of patient-centric...
The objective was to study a large, international, ethnically diverse population of patients with atopic dermatitis (AD) to support the creation of patient-centric recommendations for AD management. Qualitative data were generated from 45-min, 1:1 telephone interviews conducted across 15 countries in each patient's native language. Interviews explored the impact of AD on patients' lives, patients' most important symptoms, treatment expectations, and treatment decision-making. Participants were also questioned on their current knowledge of AD scoring systems and what was most important to include in these tools. In total, 88 adult patients (≥ 18 years old) receiving treatment for AD were recruited through a market research database, clinician referrals, and local advertising. All patients were screened to ensure a balanced and diverse sample in terms of age, gender, educational level, employment status, geographic location, and AD severity. Patients involved in market research or activities supporting advocacy groups within the previous 6 months or affiliated with or employed by pharmaceutical companies were excluded. AD had a substantial impact on patients' lives. Itch, skin redness, and dry/flaky skin were the most frequently reported symptoms, with > 75% of patients experiencing these symptoms every 1-3 days. Mental health issues were common and resulted in the greatest negative impact on patients' daily lives. Patients perceived clinicians to underestimate the burden of their AD. Patients had little awareness of AD scoring systems and indicated a preference for these to be more clearly incorporated in clinical practice. For an ideal scoring system, patients favored using a combination of patient-reported and clinician-reported outcomes to reflect disease burden and ensure consistency across all settings. This global study generated diverse patient perspectives on the disease burden of AD, their expectations of treatment, and their views on AD scoring methods. These data provide evidence to support the development of patient-centric recommendations for AD management.
Topics: Humans; Dermatitis, Atopic; Female; Male; Adult; Middle Aged; Qualitative Research; Patient Reported Outcome Measures; Severity of Illness Index; Cost of Illness; Young Adult; Quality of Life; Aged; Adolescent
PubMed: 38850461
DOI: 10.1007/s00403-024-03130-w -
Journal of Dermatological Science Mar 2024Lympho-epithelial Kazal-type-related inhibitor (LEKTI) is a serine protease inhibitor consisting of multiple domains. A loss of function mutation is described in...
BACKGROUND
Lympho-epithelial Kazal-type-related inhibitor (LEKTI) is a serine protease inhibitor consisting of multiple domains. A loss of function mutation is described in Netherton patients that show severe symptoms of atopic lesions and itch.
OBJECTIVES
LEKTI domain 6 (LD6) has shown strong serine protease-inhibitory action in in vitro assays and thus it was tested in vitro and in vivo for potential anti-inflammatory action in models of atopic skin disease.
METHODS
Human skin equivalents were treated with LD6 and an inflammatory reaction was challenged by kallikrein-related endopeptidase 5 (KLK5). Furthermore, LD6 was tested on dorsal root ganglia cells stimulated with KLK5, SLIGRL and histamine by calcium imaging. The effect of topically administered LD6 (0.4-0.8%) in lipoderm was compared to a topical formulation of betamethasone-diproprionate (0.1%) in a therapeutic setting on atopic dermatitis-like lesions in NC/Nga mice sensitized to house dust mite antigen. Endpoints were clinical scoring of the mice as well as determination of scratching behaviour.
RESULTS
KLK5 induced an upregulation of CXCL-8, CCL20 and IL-6 in skin equivalents. This upregulation was reduced by pre-incubation with LD6. KLK5 as well as histamine induced calcium influx in a population of neurons. LD6 significantly reduced the calcium response to both stimuli. When administered onto lesional skin of NC/Nga mice, both LD6 and betamethasone-dipropionate significantly reduced the inflammatory reaction. The effect on itch behaviour was less pronounced.
CONCLUSION
Topical administration of LD6 might be a new therapeutic option for treatment of lesional atopic skin.
PubMed: 38849289
DOI: 10.1016/j.jdermsci.2024.03.004 -
Journal of Cutaneous Medicine and... Jun 2024There has been a call to action to enhance representation of non-white individuals in dermatology clinical trials. Investigations in differential response to treatment... (Review)
Review
There has been a call to action to enhance representation of non-white individuals in dermatology clinical trials. Investigations in differential response to treatment across populations are limited, particularly in conditions of commonality, impact, distinct presentation, and diagnosis in non-white participants, such as atopic dermatitis and psoriasis. This systematic review summarized and identified if biologic treatment outcomes in moderate-to-severe atopic dermatitis and psoriasis varied in skin of colour (SOC) participants in phase 3 trials. MEDLINE, COCHRANE, and EMBASE databases were used to conduct the search following PROSPERO registration. Following screening of 3209 articles, 11 studies were collected with 1781 SOC participants with a mean age of 40.99 ± 6.3 years (range: 30.6-51.6 years). Male participants accounted for 76.9% (n = 1370/1781) of the sample, and Chinese, Japanese, Taiwanese, and Korean participants accounted for 64.3%, 24.2%, 4.5%, and 3.4% of participants, respectively. Participants with atopic dermatitis were treated with dupilumab (n = 216/388) and participants with psoriasis were treated with adalimumab (n = 313/1393), bimekizumab (n = 62/1393), ixekizumab (n = 13/1393), secukinumab (n = 117/1393), and ustekinumab (n = 289/1393). No significant SOC population-based outcomes were found across treatment groups. However, differences in baseline characteristics or comorbidities were found, suggesting race or ethnic background should be considered when treatment is prescribed in psoriasis or atopic dermatitis. Although no significant SOC participant differential response to treatment were found, large-scale randomized controlled trials investigating comparable treatment outcomes and stratifying results by SOC population in atopic dermatitis and psoriasis are warranted to confirm these findings.
PubMed: 38847375
DOI: 10.1177/12034754241260023 -
Skin Health and Disease Jun 2024Excoriated pruritus can be an intolerable symptom in patients with cancer where Type 2 inflammation and its associated cytokines IL-4 and IL-13 play major roles in the...
Excoriated pruritus can be an intolerable symptom in patients with cancer where Type 2 inflammation and its associated cytokines IL-4 and IL-13 play major roles in the pruritus. Dupilumab, an antibody blocking IL-4 and IL-13, is approved for treating moderate to severe atopic dermatitis (AD) where itching is a significant symptom. We present a case report of intractable malignancy-associated AD and pruritus with eosinophilia in a patient with stage IV malignant melanoma who was treated with dupilumab. Biweekly treatment with dupilumab led to an immediate improvement in itching and resolution of the AD, which subsided after a few doses and without significant adverse effects. Routine radiologic monitoring of the malignant melanoma showed concomitant resolution of secondary nodules in the lung, liver, and pleura. It was concluded that dupilumab may be a safe and effective treatment for intractable malignancy-associated AD with pruritus and may have potential for moderating metastatic malignant melanoma.
PubMed: 38846700
DOI: 10.1002/ski2.362