Diagnosis and Treatment of Atopic Dermatitis in Adults and Children

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Dermatology".

Deadline for manuscript submissions: closed (1 December 2024) | Viewed by 9031

Special Issue Editor


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Guest Editor
Department of Pediatrics, University Medical Centre Maribor, Maribor, Slovenia
Interests: children; atopic dermatitis; food allergy; peanut allergy; anaphylaxis; community-acquired pneumonia; lung ultrasound

Special Issue Information

Dear Colleagues,

The incidence of atopic dermatitis and associated comorbidities is increasing dramatically in both children and adults worldwide. The burden of the disease on the individual and on society is also increasing. Atopic dermatitis is a disease that causes not only health problems such as itching, insomnia and increased risk of allergic reactions. The inflammation of the skin often also affects the appearance of the individual, which is particularly burdensome for adolescents and young adults, and exacerbates the disease itself through emotional distress in a positive feedback loop.

In the last decade, tremendous progress has been made in both the understanding of the etiopathogenesis and the treatment of atopic dermatitis. The focus of understanding atopic dermatitis has shifted from atopy to the breakdown of the protective skin barrier and dysregulation of the immune response, and a breakthrough in treatment has been made with the use of biologics, first in adults and in recent years in children.

With this special issue of Medicina, we aim to contribute to the understanding of atopic dermatitis as a syndrome composed of multiple phenotypes based on endotypes that differ both in the role and mode of skin barrier impairment and in the type of excessive immune response and the associated cytokines and inflammatory cells involved. In this way, we aim to identify those biomarkers of the disease that can contribute most to the personalized treatment of atopic dermatitis, which is of utmost importance in the era of biologics.

This special issue welcomes both original and review scientific articles addressing the epidemiology, an etiopathogenesis, diagnosis and treatment of atopic dermatitis and related comorbidities in adults and children.

Dr. Vojko Berce
Guest Editor

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Keywords

  • atopic dermatitis
  • children
  • adults
  • etiopathogenesis
  • treatment
  • comorbidities
  • atopy
  • skin barrier
  • aberrant immune response
  • biologics

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Published Papers (4 papers)

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Research

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10 pages, 443 KiB  
Article
Linguistic Validation and Reliability of the Croatian Version of the TOPICOP Questionnaire
by Adela Markota Čagalj, Josko Markic, Dubravka Vuković, Zdenka Šitum Čeprnja, Tina Gogić Salapić, Ivan Buljan and Shelly Melissa Pranić
Medicina 2024, 60(6), 968; https://doi.org/10.3390/medicina60060968 - 12 Jun 2024
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Abstract
Background and Objectives: This study demonstrates the factor structure and reliability of the Croatian version of the TOPICOP (Topical Corticosteroid Phobia) questionnaire, thereby contributing to further validation and standardization of the measurement of topical corticophobia with dermatological patients or their parents, which [...] Read more.
Background and Objectives: This study demonstrates the factor structure and reliability of the Croatian version of the TOPICOP (Topical Corticosteroid Phobia) questionnaire, thereby contributing to further validation and standardization of the measurement of topical corticophobia with dermatological patients or their parents, which directly affects patient or parent compliance, as well as the final therapeutic effect. Materials and Methods: The cross-sectional, observational study was conducted at the University Hospital Centre Split, Department of Dermatovenerology. The research involved inviting 120 participants (age 12–68) who attended the University Hospital Centre Split’s Atopy School, patients examined in the Dermatology Outpatient Clinic of the University Hospital Centre Split and diagnosed with atopic dermatitis (AD) or allergic contact dermatitis (ACD), and parents or legal representatives of patients younger than 12 years old. The TOPICOP questionnaire consists of 12 items assessing the three different components of topical corticophobia (worries, beliefs, and behaviour). Respondents evaluated their perception of the correctness of each statement within 10 min of filling out the questionnaire on a four-point Likert scale. Results: The response rate was 94%, resulting in a sample of 113 respondents (109 adults and 4 children). Factor analysis yielded one common factor of relatively high reliability (Cronbach α = 0.85, 95% CI 0.81 to 0.89). No differences were found in questionnaire scores between male and female participants, nor between the parents/legal representatives of dermatological patients and other patients. Conclusions: This research contributes to further development of the appropriate measuring instrument, its practical application, and thus, the better recognition, resolution, and prevention of topical corticophobia as part of the better overall healthcare and treatment of chronic dermatological patients. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Atopic Dermatitis in Adults and Children)
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12 pages, 1812 KiB  
Article
Patients’ and Caregivers’ Experiences Navigating the Burden of Atopic Dermatitis in Argentina
by Korey Capozza, Michelle Tu, Alan Schwartz, Jodi L. Johnson and Mónica Ladner
Medicina 2024, 60(4), 584; https://doi.org/10.3390/medicina60040584 - 31 Mar 2024
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Abstract
Background and Objectives: Little is known about patients’ and caregivers’ experiences with atopic dermatitis (AD) in Argentina, so a survey was administered to learn more. Materials and Methods: A 53-item anonymous survey was administered in Spanish to adult AD patients ( [...] Read more.
Background and Objectives: Little is known about patients’ and caregivers’ experiences with atopic dermatitis (AD) in Argentina, so a survey was administered to learn more. Materials and Methods: A 53-item anonymous survey was administered in Spanish to adult AD patients (n = 334) and caregivers (n = 339) of pediatric AD patients in Argentina (total n = 673). Demographics, healthcare provider information, financial burden, disease severity, disease burden, level of disease-specific education, and experience with shared physician/patient decision making were collected. Linear and logistic regression models were used for statistical comparisons. Results: Survey respondents were overwhelmingly female (90.8%), as was the overall patient population (72.8%). Patients were seen mostly by healthcare specialists (66.8% dermatologists, 13.5% pediatricians, 7.7% allergists, and 7.2% general practitioners). Only 2.8% of respondents reported no symptoms, while 33.3%, 52.4%, and 11.5% reported mild, moderate, and severe AD disease, respectively. Anxiety/depression and pain/discomfort were the most impactful on respondents’ quality of life. Caregivers of children with moderate to severe AD and adult patients with severe AD reported a significant financial burden, including using savings or not purchasing food or other essentials to afford medical care. Few people reported receiving disease-specific education or having their own treatment priorities taken into consideration. For adult patients, receiving disease education and being asked about treatment priorities were associated with higher treatment satisfaction and AD control. Discussion: Mental health, pain/discomfort, and financial worries are the most important burdens for adult AD patients and caregivers of children with AD in Argentina. We recommend prioritizing disease-specific education and shared decision making to improve AD care in Argentina. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Atopic Dermatitis in Adults and Children)
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13 pages, 303 KiB  
Article
Associations between Atopic Dermatitis and Behavior Difficulties in Children
by Inga Kisieliene, Beatrice Aukstuolyte, Antanas Mainelis, Odilija Rudzevicienė, Matilda Bylaite-Bucinskiene and Andreas Wolenberg
Medicina 2024, 60(3), 492; https://doi.org/10.3390/medicina60030492 - 17 Mar 2024
Cited by 1 | Viewed by 1967
Abstract
Background and Objectives: There has been increasing evidence that atopic dermatitis (AD) is associated with behavioral difficulties (BDs). There is currently a lack of evidence of how the severity of the disease determines BDs and what additional factors may contribute to their [...] Read more.
Background and Objectives: There has been increasing evidence that atopic dermatitis (AD) is associated with behavioral difficulties (BDs). There is currently a lack of evidence of how the severity of the disease determines BDs and what additional factors may contribute to their manifestation. The aim is to determine what kind of BDs occur in children with AD compared to healthy children and to find out what additional factors may contribute to the development of BDs in AD patients. Materials and Methods: This is a cross-sectional, prospective study with the application of a risk assessment instrument for behavior difficulties (Child Behavior Checklist, CBCL 6/18) in pediatric patients with AD and healthy controls (6–17 years) between 1 January 2020 and 31 December 2022. For statistical comparison, mainly Wilcoxon–Mann–Whitney and Student’s t-test were used, considering a significance level of 5%. Results: This study included a total of 101 children: 48% with AD, 52% non-AD. The mean age was 10 ± 2.7 years for AD, and10.5 ± 3.1 years for the control patients. AD patients had higher internal behavior scale scores and T-scores (6.6 ± 6.4 vs. 9.6 ± 6.9 and 47.9 ± 9.5 vs. 52.3 ± 10.2, p = 0.01), anxiety/depression scale score and T-score (2.8 ± 2.7 vs. 4.3 ± 3.5 and 47.7 ± 8.4 vs. 52.5 ± 11, p = 0.02), and somatic problems scale score and T-score (2.1 ± 2.3 vs. 3.5 ± 3 and 47.6 ± 8.5 vs. 52.7 ± 10.9, p = 0.005). Patients with severe AD had sleep disturbance and itching scores higher than those with mild–moderate AD (5.4 ± 2.6 vs. 2.4 ± 2.2, p = 0.000 and 6.6 ± 2.4 vs. 4 ± 2.8, p = 0.001). The mean morning serum cortisol concentration was lower in AD patients compared to controls (252.91 ± 304.34 vs. 351.55 ± 126.09 nmol/L, p = 0.047). Conclusions: Children with AD present a higher risk of BDs than healthy controls. Patients with severe AD experience more sleep disturbances and a greater intensity of itching compared to mild–moderate AD. The occurrence of BDs was not related to serum cortisol levels. The cortisol level, severity, age, gender, duration of illness, intensity of pruritus, and sleep disturbance did not affect the development of BDs. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Atopic Dermatitis in Adults and Children)

Review

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10 pages, 475 KiB  
Review
Restoration of Skin Barrier Abnormalities with IL4/13 Inhibitors and Jak Inhibitors in Atopic Dermatitis: A Systematic Review
by Isidora Chatzigeorgiou, Dimitra Koumaki, Efstratios Vakirlis, Ilias Papadimitriou and Stamatios Gregoriou
Medicina 2024, 60(8), 1376; https://doi.org/10.3390/medicina60081376 - 22 Aug 2024
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Abstract
Background and Objectives: Atopic dermatitis is a chronic inflammatory skin disorder with a significant burden on patients’ quality of life. This systematic review aims to evaluate the restoration of skin barrier abnormalities with interleukin-4/interleukin-13 (IL-4/IL-13) inhibitors and Janus kinase (JAK) inhibitors in [...] Read more.
Background and Objectives: Atopic dermatitis is a chronic inflammatory skin disorder with a significant burden on patients’ quality of life. This systematic review aims to evaluate the restoration of skin barrier abnormalities with interleukin-4/interleukin-13 (IL-4/IL-13) inhibitors and Janus kinase (JAK) inhibitors in atopic dermatitis. Materials and Methods: A comprehensive review of the literature was conducted, focusing on studies that assess the use of IL-4/IL-13 inhibitors and JAK inhibitors for atopic dermatitis. We identified eligible studies by searching Medline via PubMed with a special focus on their effect on the restoration of the epidermal barrier. Included studies evaluated the transepidermal water loss (TEWL), the reduction in epidermal thickness (ET), the improvement in ceramide synthesis, and the increase in stratum corneum hydration (SCH) with IL-4/IL-13 inhibitors and JAK inhibitors. The quality of included studies was assessed using the ROBINS-I and the RoB 2.0 tool for assessing the risk of bias. Results: Ten of the included studies concern dupilumab, while two concern JAK inhibitors. Ten were observational studies and two were randomized controlled trials (RCTs). The total number of included participants was 378 concerning dupilumab and 38 concerning JAK inhibitors. Five studies did not include any comparison group, three included healthy volunteers, two were conducted versus placebo, and two compared dupilumab with other treatments. The follow-up period ranged between 29 days and 32 weeks. The results demonstrated a significant decrease in transepidermal water loss (TEWL) and an increase in SCH on eczematous lesions for patients with sustained response to dupilumab treatment and observed improvements in ET and filaggrin (FLG) staining, which further support the efficacy of JAK inhibitors in enhancing skin barrier function. Conclusions: This review underscores the efficacy of IL-4/IL-13 inhibitors in improving skin barrier function. However, the limited number of studies focusing on JAK inhibitors and the overall lack of RCTs highlight the need for further research to establish the definitive role of IL-4/IL-13 inhibitors and JAK inhibitors in the restoration of the skin barrier. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Atopic Dermatitis in Adults and Children)
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