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Epidemiology and Treatment of Atopic Eczema

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dermatology".

Deadline for manuscript submissions: closed (30 November 2014) | Viewed by 180704

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Special Issue Editors

Dr. Sebastien Barbarot

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Guest Editor

Dermatology Department, Pediatric Dermatology Unit, CHU Hotel Dieu, 44093 Nantes, France
Interests: pediatric dermatology; patient reported outcoumes in eczema trials; adherence to topical treatments; topical steroid phobia in eczema; education programs in eczema; neurofibromatosis type 1; hemangioma; congenital nevi

Prof. Dr. Kim Thomas

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Guest Editor

Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Room A103, King’s Meadow Campus, Lenton Lane, Nottingham NG7 2NR, UK
Interests: the design and conduct of dermatology clinical trials for the treatment and prevention of skin disease; clinical trial methodologies of interest include outcomes research, efficient trial designs, consensus methodologies and patient and public involvement in research

Special Issue Information

Dear Colleagues,

Eczema (also known as atopic eczema or atopic dermatitis), is estimated to affect one in five school children, and is increasing worldwide. It is a condition that impacts on both the patient and their family, and has a large impact on healthcare resource use.

For such a common condition, it is perhaps surprising that there are still so many unanswered questions about its causes, possible strategies for its prevention, and the best and safest ways of treating the disease.

This Special Issue compiles articles that reflect current best practice from around the world in the management of eczema, along with new insights into the causes, mechanisms and strategies for prevention.

Prof. Dr. Kim Thomas
Dr. Sébastien Barbarot
Guest Editors

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Keywords

eczema
atopic dermatitis
atopic eczema
allergy
itch
skin disease
treatment
prevention
epidemiology

Published Papers (14 papers)

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Research

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119 KiB

Open AccessArticle

How Often Do Comparative Randomised Controlled Trials in the Field of Eczema Fail to Directly Compare the Treatments Being Tested?

by Sonia Ratib, Sally R. Wilkes, Helen Nankervis, Kim S. Thomas and Hywel C. Williams

J. Clin. Med. 2015, 4(6), 1312-1324; https://doi.org/10.3390/jcm4061312 - 17 Jun 2015

Cited by 2 | Viewed by 5245

Abstract

The objective of the study was to identify all parallel design randomised controlled trials (RCTs) comparing treatments for eczema in recent dermatology literature that have failed to report a between-group analysis. The GREAT database (www.greatdatabase.org.uk) was searched to identify parallel group RCTs comparing two or more interventions published in the English language in the last decade, 2004 to 2013. The primary outcome was the number of studies that had not reported a between-group analysis for any of the outcomes. Where possible we re-analysed the data to determine whether a between-group analysis would have given a different conclusion to that reported. Out of a total of 304 RCTs in the study period, 173 (56.9%) met the inclusion criteria. Of the 173 eligible studies, 12 (6.9%) had not conducted a between-group analysis for any of the reported outcomes. There was no clear improvement over time. Five of the eight studies that were re-analysed yielded non-significant between-group differences yet reported significant within-group comparisons. All but one of the 12 studies implied that the experimental intervention was successful despite not undertaking any between-group comparisons. Although the proportion of all RCTs that fail to report an appropriate between-group analysis is small, the fact that any scientist who purports to compare one treatment against another then chooses to omit the key comparison statistic is worrying. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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Open AccessArticle

Clinical Characteristics, Treatments, and Prognosis of Atopic Eczema in the Elderly

by Ryoji Tanei

J. Clin. Med. 2015, 4(5), 979-997; https://doi.org/10.3390/jcm4050979 - 18 May 2015

Cited by 27 | Viewed by 11998

Abstract

Atopic eczema (AE) in the elderly is gradually increasing and has been added to the classification of AE in recent years. This investigation retrospectively analyzed 60 patients with elderly AE. Among the clinical characteristics, a male predominance, existence of several patterns of onset and clinical course, and associations with immunoglobulin (Ig)E-allergic-status and asthmatic complication were observed. The highest positive-rate and positive-score for serum-specific IgE against Dermatophagoides farinae were 83.8% and 2.65 in patients with IgE-allergic AE, and a lower incidence of lichenified eczema in the elbow and knee folds were observed. In terms of treatments and outcomes, clinical improvement and clinical remission were observed in 80.8% and 36.5% of cases, respectively, using standard treatments and combined therapy with oral corticosteroid in severe cases. As for complications and final prognosis, most elderly AE patients reached the end of life with AE, but patients with IgE-allergic AE showed significantly lower incidences of complications of malignancy and death from malignancy. These results indicate that AE in the elderly represents a new subgroup of AE with specific features. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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49 KiB

Open AccessArticle

The Importance of Acidification in Atopic Eczema: An Underexplored Avenue for Treatment

by David J. Panther and Sharon E. Jacob

J. Clin. Med. 2015, 4(5), 970-978; https://doi.org/10.3390/jcm4050970 - 18 May 2015

Cited by 65 | Viewed by 9464

Abstract

Atopic dermatitis is a form of dermatitis commonly seen in children and adults. Its pathophysiology is complex and is centered on the barrier function of the epidermis. An important aspect of the skin’s barrier is pH, which in turn affects a number of parameters such as the skin flora, protease function, and mediators of inflammation and pruritus. Normal pH for non-neonatal skin is acidic and ranges from 4 to 6. Skin pH in atopic dermatitis patients is often increased into the neutral to basic range, and the resulting cascade of changes contributes to the phenotype of atopic dermatitis. Therefore, the maintenance of normal skin pH remains an important topic in understanding and treating atopic dermatitis. This article will review skin pH and its impact on normal barrier function, pathological pH changes in atopic dermatitis, and the therapeutic considerations related to restoring and maintaining pH balance. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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Open AccessArticle

Sick Leave and Factors Influencing Sick Leave in Adult Patients with Atopic Dermatitis: A Cross-Sectional Study

by Harmieke Van Os-Medendorp, Simone Appelman-Noordermeer, Carla Bruijnzeel-Koomen and Marjolein De Bruin-Weller

J. Clin. Med. 2015, 4(4), 535-547; https://doi.org/10.3390/jcm4040535 - 27 Mar 2015

Cited by 11 | Viewed by 6199

Abstract

Background: Little is known about the prevalence of sick leave due to atopic dermatitis (AD). The current literature on factors influencing sick leave is mostly derived from other chronic inflammatory diseases. This study aimed to determine the prevalence of sick leave due to AD and to identify influencing factors. Methods: A cross-sectional study was carried out in adult patients with AD. Outcome measures: sick leave during the two-week and one-year periods, socio-demographic characteristics, disease severity, quality of life and socio-occupational factors. Logistic regression analyses were used to determine influencing factors on sick leave over the two-week period. Results: In total, 253 patients were included; 12% of the patients had to take sick leave in the last two weeks due to AD and 42% in the past year. A higher level of symptom interference (OR 1.26; 95% CI 1.13–1.40) or perfectionism/diligence (OR 0.90; 95% CI 0.83–0.96) may respectively increase or decrease the number of sick leave days. Conclusion: Sick leave in patients with AD is a common problem and symptom interference and perfectionism/diligence appeared to influence it. Novel approaches are needed to deal with symptoms at work or school to reduce the amount of sick leave due to AD. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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Open AccessCommunication

New Developments in Biomarkers for Atopic Dermatitis

by Judith L. Thijs, Wouter Van Seggelen, Carla Bruijnzeel-Koomen, Marjolein De Bruin-Weller and DirkJan Hijnen

J. Clin. Med. 2015, 4(3), 479-487; https://doi.org/10.3390/jcm4030479 - 16 Mar 2015

Cited by 25 | Viewed by 6990

Abstract

The application of biomarkers in medicine is evolving. Biomarkers do not only give us a better understanding of pathogenesis, but also increase treatment efficacy and safety, further enabling more precise clinical care. This paper focuses on the current use of biomarkers in atopic dermatitis, new developments and future perspectives. Biomarkers can be used for many different purposes, including the objective determination of disease severity, confirmation of clinical diagnosis, and to predict response to treatment. In atopic dermatitis, many biomarkers have been investigated as a marker for disease severity. Currently serum thymus and activation-regulated chemokine (TARC) is the superior biomarker for assessing disease severity. However, we have recently shown that the use of a panel of serum biomarkers is more suitable for assessing disease severity than an individual biomarker. In this overview, we will discuss alternative sources for biomarkers, such as saliva and capillary blood, which can increase the user friendliness of biomarkers in atopic dermatitis (AD). Both methods offer simple, non-invasive and cost effective alternatives to venous blood. This provides great translational and clinical potential. Biomarkers will play an increasingly important role in AD research and personalized medicine. The use of biomarkers will enhance the efficacy of AD treatment by facilitating the individualization of therapy targeting the patients’ specific biological signature and also by providing tools for predicting and monitoring of therapeutic response. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

64 KiB

Open AccessArticle

What Should General Practice Trainees Learn about Atopic Eczema?

by Deepani Munidasa, Antonia Lloyd-Lavery, Susan Burge and Tess McPherson

J. Clin. Med. 2015, 4(2), 360-368; https://doi.org/10.3390/jcm4020360 - 12 Feb 2015

Cited by 8 | Viewed by 5593

Abstract

Effective atopic eczema (AE) control not only improves quality of life but may also prevent the atopic march. The Royal College of General Practitioners’ (RCGP) curriculum does not currently provide specific learning outcomes on AE management. We aimed to gain consensus on learning outcomes to inform curriculum development. A modified Delphi method was used with questionnaires distributed to gather the views of a range of health care professionals (HCPs) including general practitioners (GPs), dermatologists, dermatology nurses and parents of children with AE attending a dedicated paediatric dermatology clinic. Ninety-one questionnaires were distributed to 61 HCPs and 30 parents; 81 were returned. All agreed that learning should focus on the common clinical features, complications and management of AE and the need to appreciate its psychosocial impact. Areas of divergence included knowledge of alternative therapies. Parents felt GPs should better understand how to identify, manage and refer severe AD and recognized the value of the specialist eczema nurse. Dermatologists and parents highlighted inconsistencies in advice regarding topical steroids. This study identifies important areas for inclusion as learning outcomes on AE management in the RCGP curriculum and highlights the importance of patients and parents as a valuable resource in the development of medical education. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

Review

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238 KiB

Open AccessReview

The Role of Malassezia spp. in Atopic Dermatitis

by Martin Glatz, Philipp P. Bosshard, Wolfram Hoetzenecker and Peter Schmid-Grendelmeier

J. Clin. Med. 2015, 4(6), 1217-1228; https://doi.org/10.3390/jcm4061217 - 29 May 2015

Cited by 103 | Viewed by 20700

Abstract

Malassezia spp. is a genus of lipophilic yeasts and comprises the most common fungi on healthy human skin. Despite its role as a commensal on healthy human skin, Malassezia spp. is attributed a pathogenic role in atopic dermatitis. The mechanisms by which Malassezia spp. may contribute to the pathogenesis of atopic dermatitis are not fully understood. Here, we review the latest findings on the pathogenetic role of Malassezia spp. in atopic dermatitis (AD). For example, Malassezia spp. produces a variety of immunogenic proteins that elicit the production of specific IgE antibodies and may induce the release of pro-inflammatory cytokines. In addition, Malassezia spp. induces auto-reactive T cells that cross-react between fungal proteins and their human counterparts. These mechanisms contribute to skin inflammation in atopic dermatitis and therefore influence the course of this disorder. Finally, we discuss the possible benefit of an anti-Malassezia spp. treatment in patients with atopic dermatitis. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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Open AccessReview

A Review of Multidisciplinary Interventions in Atopic Dermatitis

by Sara C. Spielman, Jennifer S. LeBovidge, Karol G. Timmons and Lynda C. Schneider

J. Clin. Med. 2015, 4(5), 1156-1170; https://doi.org/10.3390/jcm4051156 - 21 May 2015

Cited by 25 | Viewed by 6024

Abstract

Multidisciplinary interventions have been developed for patients with atopic dermatitis (AD) and their families, with the aim of improving outcomes such as disease control, adherence, and quality of life. We reviewed the content of different multidisciplinary approaches to intervention for AD and evidence for their impact on key outcome measures. We also provided data from our multidisciplinary outpatient program for pediatric AD. Studies included in the review suggest benefits of multidisciplinary interventions as models of treatment or adjuncts to standard medical care, with a positive impact on outcomes including disease severity and itching/scratching. There were limitations to existing studies, including heterogeneous methods used to assess quality of life outcomes across studies and lack of controlled studies assessing the outcome of clinical care programs. Further research will be useful in assessing the impact of multidisciplinary interventions on important outcomes such as treatment adherence and sleep, identifying the elements of multidisciplinary interventions that are most critical for improved outcomes, and identifying the best candidates for multidisciplinary intervention approaches. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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Open AccessReview

Vitamin D and the Development of Atopic Eczema

by Debra J. Palmer

J. Clin. Med. 2015, 4(5), 1036-1050; https://doi.org/10.3390/jcm4051036 - 20 May 2015

Cited by 17 | Viewed by 12844

Abstract

A “vitamin D hypothesis” has been proposed to explain the increased prevalence of eczema in regions with higher latitude. This review focuses on the current available evidence with regard to the possible effect of vitamin D on the development of atopic eczema. Observational studies have indicated a link between vitamin D status and eczema outcomes, including lower serum vitamin D levels associated with increased incidence and severity of eczema symptoms. Vitamin D is known to have a regulatory influence on both the immune system and skin barrier function, both critical in the pathogenesis of eczema. However heterogeneous results have been found in studies to date investigating the effect of vitamin D status during pregnancy and infancy on the prevention of eczema outcomes. Well-designed, adequately powered, randomised controlled trials are needed. The study design of any new intervention trials should measure vitamin D levels at multiple time points during the intervention, ultraviolet (UV) radiation exposure via the use of individual UV dosimeters, and investigate the role of individual genetic polymorphisms. In conclusion, the current available evidence does not allow firm conclusions to be made on whether vitamin D status affects the development of atopic eczema. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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Open AccessReview

Diagnosis of Atopic Dermatitis: Mimics, Overlaps, and Complications

by Elaine C. Siegfried and Adelaide A. Hebert

J. Clin. Med. 2015, 4(5), 884-917; https://doi.org/10.3390/jcm4050884 - 06 May 2015

Cited by 75 | Viewed by 50059

Abstract

Atopic dermatitis (AD) is one of the most common skin diseases affecting infants and children. A smaller subset of adults has persistent or new-onset AD. AD is characterized by pruritus, erythema, induration, and scale, but these features are also typical of several other conditions that can mimic, coexist with, or complicate AD. These include inflammatory skin conditions, infections, infestations, malignancies, genetic disorders, immunodeficiency disorders, nutritional disorders, graft-versus-host disease, and drug eruptions. Familiarity of the spectrum of these diseases and their distinguishing features is critical for correct and timely diagnosis and optimal treatment. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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Open AccessReview

Immune Pathways in Atopic Dermatitis, and Definition of Biomarkers through Broad and Targeted Therapeutics

by Yasaman Mansouri and Emma Guttman-Yassky

J. Clin. Med. 2015, 4(5), 858-873; https://doi.org/10.3390/jcm4050858 - 29 Apr 2015

Cited by 105 | Viewed by 10645

Abstract

Atopic dermatitis (AD) is the most common inflammatory skin disease. Recent research findings have provided an insight into the complex pathogenic mechanisms involved in this disease. Despite a rising prevalence, effective and safe therapeutics for patients with moderate-to-severe AD are still lacking. Biomarkers of lesional, nonlesional skin, and blood have been developed for baseline as well as after treatment with broad and specific treatments (i.e., cyclosporine A and dupilumab). These biomarkers will help with the development of novel targeted therapeutics and assessment of disease reversal, with the promise of a more personalized treatment approach. Since AD involves more than one subtype (i.e., intrinsic/extrinsic, pediatric/adult, etc.), these molecular fingerprints needs to be validated in all subpopulations with AD. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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Open AccessReview

Histamine and Skin Barrier: Are Histamine Antagonists Useful for the Prevention or Treatment of Atopic Dermatitis?

by Anna De Benedetto, Takeshi Yoshida, Sade Fridy, Joo-Eun S. Park, I.-Hsin Kuo and Lisa A. Beck

J. Clin. Med. 2015, 4(4), 741-755; https://doi.org/10.3390/jcm4040741 - 21 Apr 2015

Cited by 29 | Viewed by 10451

Abstract

Atopic Dermatitis (AD), the most common chronic inflammatory skin disease, is characterized by an overactive immune response to a host of environmental allergens and dry, itchy skin. Over the past decade important discoveries have demonstrated that AD develops in part from genetic and/or acquired defects in the skin barrier. Histamine is an aminergic neurotransmitter involved in physiologic and pathologic processes such as pruritus, inflammation, and vascular leak. Enhanced histamine release has been observed in the skin of patients with AD and antihistamines are often prescribed for their sedating and anti-itch properties. Recent evidence suggests that histamine also inhibits the terminal differentiation of keratinocytes and impairs the skin barrier, raising the question whether histamine might play a role in AD barrier impairment. This, coupled with the notion that histamine’s effects mediated through the recently identified histamine receptor H4R, may be important in allergic inflammation, has renewed interest in this mediator in allergic diseases. In this paper we summarize the current knowledge on histamine and histamine receptor antagonists in AD and skin barrier function. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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Open AccessReview

Biological Treatments in Atopic Dermatitis

by Andrea Montes-Torres, Mar Llamas-Velasco, Alejandra Pérez-Plaza, Guillermo Solano-López and Javier Sánchez-Pérez

J. Clin. Med. 2015, 4(4), 593-613; https://doi.org/10.3390/jcm4040593 - 03 Apr 2015

Cited by 53 | Viewed by 11377

Abstract

Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases that affect both children and adults with a prevalence of 30% and 10%, respectively. Even though most of patients respond satisfactory to topical anti-inflammatory drugs, about 10% require one or more systemic treatments to achieve good control of their illness. The progressive and increasingly detailed knowledge in the immunopathogenesis of AD has allowed research on new therapeutic targets with very promising results in the field of biological therapy. In this article, we will review the different biological treatments with a focus on novel drugs. Their mechanism of action, current status and results from clinical trials and observational studies will be specified. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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Open AccessReview

Interventions to Increase Treatment Adherence in Pediatric Atopic Dermatitis: A Systematic Review

by Alexandria M. Bass, Kathryn L. Anderson and Steven R. Feldman

J. Clin. Med. 2015, 4(2), 231-242; https://doi.org/10.3390/jcm4020231 - 27 Jan 2015

Cited by 53 | Viewed by 9641

Abstract

Poor adherence to treatment is a major factor limiting treatment outcomes in patients with atopic dermatitis. The purpose of our systematic review is to identify techniques that have been tested to increase treatment adherence in atopic dermatitis. A MEDLINE search was performed for clinical trials focusing on interventions used to increase adherence in atopic dermatitis. Four articles were retrieved. References of these studies were analyzed yielding three more trials. The seven results were evaluated by comparing the intervention used to improve adherence, how adherence was assessed, and the outcome of the intervention tested. Different approaches to increase adherence such as written eczema action plans, educational workshops, extra office visits, and use of an atopic dermatitis educator were evaluated. All interventions increased adherence rates or decreased severity in patients, except for two. The MEDLINE search yielded limited results due to a lack of studies conducted specifically for atopic dermatitis and adherence was measured using different methods making the studies difficult to compare. Interventions including patient education, eczema action plans, and a quick return for a follow-up visit improve adherence, but based on the lack of clinical trials, developing new techniques to improve adherence could be as valuable as developing new treatments. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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