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Management of Atopic Dermatitis
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Management of Atopic Dermatitis

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

Deadline for manuscript submissions: closed (31 January 2021) | Viewed by 21062

Special Issue Editor

Prof. Luca Bianchi

E-Mail Website
Guest Editor
Dermatology Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
Interests: psoriasis; hidradenitis suppurativa; atopic dermatitis; immune-mediated skin diseases; pharmacogenetics; biotechnological therapies

Special Issue Information

Dear Colleagues,

Childhood and adult atopic dermatitis (AD) is a chronic inflammatory skin condition with variable clinical phenotypes, partly related to age, ethnicity, and disease severity, that causes a significant psychological and financial impact on patients, families and society. A combination of genetic and environmental factors, which induce skin barrier dysfunction; abnormal immune activation of Th2 and Th22; varying degrees of Th1 and Th17 axis dysregulation; and skin microbiota dysbiosis, together with a strong psychosomatic profile, may all influence therapeutic strategies. AD clinical and molecular heterogeneity highlights the unmet need for effective therapeutic options against more than one immune axis pathways. Published data, medical training, individual experience, and institutional norms mostly drive the published AD treatment guidelines. Therapeutic goals require a multistep approach to reduce pruritus and establish disease control primarily based on disease severity, patient’s age, comorbidities, compliance, and costs. Topical and systemic drugs in development are innumerable and schematically divided into intra or extracellular agents. Ongoing randomized clinical trials demonstrate the efficacy and safety of several antagonist new drugs acting on objective and subjective disease parameters and on quality of life. However, studies on real-life experience are expected to include more information since patients from clinical trials do not act typically. This Issue examines the pathophysiology, epidemiology, heterogeneous clinical presentation, burden, diagnosis, and new topical and systemic emerging treatments of AD.

Prof. Luca Bianchi
Guest Editor

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Keywords

  • atopic dermatitis
  • pathophysiology
  • emerging therapies
  • quality of life
  • comorbidities
  • management

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Published Papers (4 papers)

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Research

9 pages, 248 KiB  
Article
Quality of Life and Psychological Impact in Patients with Atopic Dermatitis
by Marina Talamonti, Marco Galluzzo, Dionisio Silvaggio, Paolo Lombardo, Chiara Tartaglia and Luca Bianchi
J. Clin. Med. 2021, 10(6), 1298; https://doi.org/10.3390/jcm10061298 - 21 Mar 2021
Cited by 28 | Viewed by 4155
Abstract
Atopic dermatitis (AD) is a dermatological disorder that affects patients’ mental health and psychological state in complex ways. The importance of understanding the entire scope of this burden is well recognized, but there is limited comprehensive information about the resulting stress on adult [...] Read more.
Atopic dermatitis (AD) is a dermatological disorder that affects patients’ mental health and psychological state in complex ways. The importance of understanding the entire scope of this burden is well recognized, but there is limited comprehensive information about the resulting stress on adult patients with AD. This study aimed to determine the degree of psychological stress in patients with AD compared to healthy participants. A total of 352 adult patients participated in this cross-sectional study—174 with AD and 178 healthy participants. Demographic and clinical data were collected. Itch and sleep disturbance were assessed using a numeric rating scale and a visual analogue scale. The 20-item Toronto Alexithymia Scale (TAS-20) and Beck Depression Inventory (BDI) questionnaires were administered to assess the symptoms of alexithymia and depression. Quality of life (QOL) was assessed in AD patients using the Dermatology Quality Index. In our study, we found high TAS-20 and BDI scores among patients with AD. The prevalence of alexithymic personality features was 56.3% in patients with AD versus 21.3% in healthy controls (p < 0.001). Based on BDI scoring (BDI-21 > 13), depression was suspected in a significantly higher number of patients with AD than in the control group (56.9% (99/174) vs. 15.7% (28/178); p < 0.0001). Eczema Area and Severity Index (EASI) score did not show any significant correlations with psychological parameters. Among clinical parameters, only sleep disturbance was positively correlated with depression (R = 0.307, p < 0.005). Our data show that the severity index score as a representative factor of skin involvement has a limited role in predicting the effect of skin diseases on mental status. Screening and assessment for psychiatric disorders, QOL, and sleep disturbance in patients with atopic dermatitis cannot be neglected by physicians and they should be treated in clinical practice with the consideration of psychosomatic approaches. Full article
(This article belongs to the Special Issue Management of Atopic Dermatitis)
12 pages, 520 KiB  
Article
Retrospective Study of Dupilumab Treatment for Moderate to Severe Atopic Dermatitis in Korea: Efficacy and Safety of Dupilumab in Real-World Practice
by Dong Hyek Jang, Seok Jae Heo, Hye Jung Jung, Mi Yeon Park, Seong Jun Seo and Jiyoung Ahn
J. Clin. Med. 2020, 9(6), 1982; https://doi.org/10.3390/jcm9061982 - 24 Jun 2020
Cited by 41 | Viewed by 5315
Abstract
Among biological agents for the treatment of atopic dermatitis (AD), dupilumab is a front-runner. Although many studies have been conducted on the real-world use of dupilumab, the sample size is often small and data is primarily on Western people. Therefore, we investigated the [...] Read more.
Among biological agents for the treatment of atopic dermatitis (AD), dupilumab is a front-runner. Although many studies have been conducted on the real-world use of dupilumab, the sample size is often small and data is primarily on Western people. Therefore, we investigated the efficacy and safety of dupilumab in patients with moderate-to-severe AD in Korea. All patients with moderate-to-severe AD treated with dupilumab from September 2018 to June 2019 in this institution were included and analyzed by medical records. They were evaluated using the Eczema Area and Severity Index (EASI), Numerical Rating Scale (NRS), Patient Oriented Eczema Measure (POEM), and Dermatology Quality of Life Index (DLQI), respectively on admission, after two weeks (only EASI and NRS) and after 16 weeks. Laboratory tests were measured before and 16 weeks after treatment. A total of 101 patients were included. All efficacy tools showed a significant decrease after 16 weeks; EASI 77.4%, NRS 70.0%, POEM 60.7%, and DLQI 65.0%. EASI was characterized by a marked improvement of 51.5% in just two weeks. The treatment response was not significantly different according to the interval of treatment. Elevated Lactate Dehydrogenase (LDH) at 16 weeks was associated with poor treatment response. Moreover, a high eosinophil count was related to a lower change in EASI and POEM. In the correlation analysis, EASI was not correlated to DLQI before treatment. For changes after 16 weeks, POEM showed the highest correlation with DLQI. (R = 0.66, p < 0.001) In the additional analysis for factors affecting treatment response, the female gender was associated with good treatment response. (odds ratio = 5.4, p = 0.04) Adverse events from treatment included facial erythema (9.9%) and conjunctivitis (5.0%). Overall, it was confirmed that the efficacy of dupilumab in the real-world is similar to that of the existing clinical trials. We suggest that POEM is a useful tool for identifying the quality of life. The female gender was associated with a good treatment response. Both an elevated LDH and a high eosinophil count could be a therapeutic biomarker. Further research will be needed for a long-term period. Full article
(This article belongs to the Special Issue Management of Atopic Dermatitis)
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12 pages, 297 KiB  
Article
Prevalence and Comorbidity of Atopic Dermatitis in Children: A Large-Scale Population Study Based on Real-World Data
by Yolanda Gilaberte, Juan Blas Pérez-Gilaberte, Beatriz Poblador-Plou, Kevin Bliek-Bueno, Antonio Gimeno-Miguel and Alexandra Prados-Torres
J. Clin. Med. 2020, 9(6), 1632; https://doi.org/10.3390/jcm9061632 - 28 May 2020
Cited by 43 | Viewed by 5158
Abstract
This study aimed at exploring atopic dermatitis (AD) prevalence in children and exhaustively analyzing their comorbidity. We conducted a descriptive analysis of their socio-demographic and comorbidity characteristics in the EpiChron Cohort (Aragón, Spain). Adjusted odds ratios (OR) were calculated for each comorbidity using [...] Read more.
This study aimed at exploring atopic dermatitis (AD) prevalence in children and exhaustively analyzing their comorbidity. We conducted a descriptive analysis of their socio-demographic and comorbidity characteristics in the EpiChron Cohort (Aragón, Spain). Adjusted odds ratios (OR) were calculated for each comorbidity using logistic regression models. In total, 33,591 children had a diagnosis of AD, resulting in an overall prevalence of 15.5%. AD prevalence was higher in girls compared to boys, in 3–9-year-olds compared to children of other ages, and in Spanish children compared to those of other nationalities. Multimorbidity was present in 43% of children, with the most frequent chronic comorbidities being asthma (13.1%), psychosocial disorders (7.9%), and visual impairment (7.8%). Many diseases were, regardless of their prevalence, statistically associated with AD. The strongest associations (odds ratio (OR) (95% confidence interval (CI))) were found in asthma (2.10 (2.02–2.17)), allergic rhinitis (2.00 (1.91–2.10)), and irritable bowel syndrome (1.90 (1.56–2.31)). A better understanding of the array of comorbidities associated with AD in children might help improve their clinical management. Future longitudinal studies are encouraged to shed light on the potential underlying pathophysiological mechanisms involved in the identified associations. Full article
(This article belongs to the Special Issue Management of Atopic Dermatitis)
11 pages, 1745 KiB  
Article
Dupilumab for the Treatment of Atopic Dermatitis in an Austrian Cohort-Real-Life Data Shows Rosacea-Like Folliculitis
by Tamara Quint, Patrick M. Brunner, Christoph Sinz, Irene Steiner, Robin Ristl, Kornelia Vigl, Susanne Kimeswenger, Katharina Neubauer, Detlev Pirkhammer, Martin Zikeli, Wolfram Hoetzenecker, Norbert Reider and Christine Bangert
J. Clin. Med. 2020, 9(4), 1241; https://doi.org/10.3390/jcm9041241 - 24 Apr 2020
Cited by 27 | Viewed by 5734
Abstract
Dupilumab is the first biological treatment approved for moderate-to-severe atopic dermatitis (AD). Efficacy and safety have been demonstrated in clinical trials, but real-life data is still limited. The objective of this study was to retrospectively evaluate Dupilumab treatment in AD patients in a [...] Read more.
Dupilumab is the first biological treatment approved for moderate-to-severe atopic dermatitis (AD). Efficacy and safety have been demonstrated in clinical trials, but real-life data is still limited. The objective of this study was to retrospectively evaluate Dupilumab treatment in AD patients in a real-life clinical setting. Effectiveness and safety outcomes were collected at baseline and after 2, 6, 10, 24, 39, and 52 weeks by using clinical scores for disease activity, as well as serological markers. Ninety-four patients from five dermatological hospitals were included. After 24 weeks of treatment, the median Investigator Global Assessment (IGA) and Eczema Area and Severity Index (EASI) showed a significant reduction compared to baseline (3.9 ± 0.7 vs. 1.4 ± 0.8 and 26.5 ± 12.5 vs. 6.4 ± 6.5). Interestingly, we observed rosacea-like folliculitis as an unexpected side effect in 6.4% of patients. Dupilumab proves to be an effective and well-tolerated treatment under real-life conditions. The occurrence of rosacea-like folliculitis warrants further mechanistic investigation. Full article
(This article belongs to the Special Issue Management of Atopic Dermatitis)
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