Search Results (198)

Background: Alopecia areata (AA), an autoimmune condition causing non-scarring hair loss, often coexists with atopic dermatitis (AD) due to shared T-helper cell type 2 (Th2)-mediated pathways. Dupilumab, a monoclonal antibody inhibiting IL-4 and IL-13 signaling, is a cornerstone treatment for AD but has conflicting reports regarding its impact on AA, with some suggesting therapeutic benefits and others indicating AA induction. Methods: This retrospective study, utilizing the TriNetX Research Network’s de-identified data from over 300 million patient records, investigates the association between dupilumab use and AA risk in AD patients. Results: After propensity score matching, 23,782 dupilumab users were compared with an equal number of controls. Results revealed a statistically significant increased AA risk in dupilumab users (odds ratio: 1.436, 95% CI: 1.066–1.935, p = 0.0167) after 16 weeks. Cases occurring within 16 weeks were excluded. Conclusions: Potential mechanisms include immune rebalancing, with Th2 suppression possibly upregulating Th1/Th17 pathways or unmasking latent AA in predisposed individuals. These findings challenge dupilumab’s potential as an AA treatment and highlight the need for vigilant monitoring, including routine scalp examinations and patient education. Future research should focus on mechanistic pathways, risk stratification, and comparative studies with other biologics to optimize personalized treatment strategies for AD and AA. Full article

Staphylococcus spp. skin colonization is involved in the pathogenesis of atopic dermatitis (AD). While coagulase-positive Staphylococcus aureus strains are known to worsen symptoms, the role of coagulase-negative staphylococci (CoNS) remains controversial. Further research is needed to clarify the pathogenicity of CoNS in AD patients. A study involving 329 children with AD (mean age: 4.89 years) assessed the frequency of staphylococcal colonization on affected skin, along with the toxin-producing properties and antibiotic resistance of isolated strains. Mild AD: Predominantly colonized by CoNS (especially S. epidermidis). Moderate/Severe AD: Showed a significant increase in S. aureus colonization. CoNS (including S. epidermidis) could produce enterotoxins (A, B, C) and toxic shock syndrome toxin-1 (TSST-1), though less frequently than S. aureus strains. In severe AD, the number of toxin-producing CoNS strains (especially enterotoxin A producers) was higher than in mild AD, and the number of non-toxin-producing strains was lower. CoNS exhibited higher resistance rates than S. aureus. Methicillin-resistant S. epidermidis (MRSE): 23.4%. Methicillin-resistant S. aureus (MRSA): 1.27%. CoNS may contribute to AD pathogenesis through toxin production (exacerbating inflammation) and antibiotic resistance (limiting treatment options). Severe AD may involve a synergistic effect between S. aureus and toxin-producing CoNS. Full article

Atopic dermatitis (AD) is a chronic, multifactorial inflammatory skin disease characterized by persistent pruritus, immune system dysregulation, and an increased expression of cyclooxygenase-2 (COX-2), an enzyme that plays a central role in the production of prostaglandins and the promotion of inflammatory responses. In this study, we employed a comprehensive computational pipeline to identify phytocompounds capable of inhibiting COX-2 activity, offering an alternative to traditional non-steroidal anti-inflammatory drugs. The African and Traditional Chinese Medicine natural product databases were subjected to molecular screening, which identified six top compounds, namely, Tophit1 (−16.528 kcal/mol), Tophit2 (−10.879 kcal/mol), Tophit3 (−9.760 kcal/mol), Tophit4 (−9.752 kcal/mol), Tophit5 (−8.742 kcal/mol), and Tophit6 (−8.098 kcal/mol), with stronger binding affinities to COX-2 than the control drug rofecoxib (−7.305 kcal/mol). Molecular dynamics simulations over 200 ns, combined with MM/GBSA binding free energy calculations, consistently identified Tophit1 and Tophit2 as the most stable complexes, exhibiting exceptional structural integrity and a strong binding affinity to the target protein. ADMET profiling via SwissADME and pkCSM validated the drug-likeness, oral bioavailability, and safety of the lead compounds, with no Lipinski rule violations and favorable pharmacokinetic and toxicity profiles. These findings underscore the therapeutic potential of the selected phytocompounds as novel COX-2 inhibitors for the management of atopic-prone skin and warrant further experimental validation. Full article

Eczema, or atopic dermatitis (AD), is a chronic inflammatory skin condition characterized by persistent itching and scratching, significantly impacting patients’ quality of life. Effective monitoring of scratching behaviour is crucial for assessing disease severity, treatment efficacy, and understanding the relationship between itch and sleep disturbances. This review explores current technological approaches for detecting and monitoring scratching and itching in AD patients, categorising them into contact-based and non-contact-based methods. Contact-based methods primarily involve wearable sensors, such as accelerometers, electromyography (EMG), and piezoelectric sensors, which track limb movements and muscle activity associated with scratching. Non-contact methods include video-based motion tracking, thermal imaging, and acoustic analysis, commonly employed in sleep clinics and controlled environments to assess nocturnal scratching. Furthermore, emerging artificial intelligence (AI)-driven approaches leveraging machine learning for automated scratch detection are discussed. The advantages, limitations, and validation challenges of these technologies, including accuracy, user comfort, data privacy, and real-world applicability, are critically analysed. Finally, we outline future research directions, emphasizing the integration of multimodal monitoring, real-time data analysis, and patient-centric wearable solutions to improve disease management. This review serves as a comprehensive resource for clinicians, researchers, and technology developers seeking to advance objective itch and scratch monitoring in AD patients. Full article

Background/Objectives: Atopic dermatitis (AD) is a chronic inflammatory skin condition with rising global prevalence. Increasing maternal antibiotic use during pregnancy has raised concerns about its potential link to childhood allergic diseases, including AD. However, existing meta-analyses have yielded inconsistent results. A systematic review and meta-analysis were conducted to investigate the association between prenatal antibiotic exposure, including intrapartum antibiotic prophylaxis (IAP), and the risk of AD developing in offspring. Methods: A systematic search protocol (PROSPERO ID: CRD42024577804) was conducted up to 29 August 2024, across the PubMed, Embase, and Cochrane databases. Cohort and case–control studies reporting associations between maternal antibiotic exposure during pregnancy or intrapartum and the risk of AD in offspring were included. Data were analyzed using RevMan Web and Comprehensive Meta-Analysis software. Results: Twenty studies involving 3,256,929 mother–child pairs were reviewed. The meta-analysis data demonstrated that prenatal antibiotic exposure was associated with AD in the main analysis (odds ratio [OR]: 1.12, 95% CI 1.03–1.21), but not in a separate analysis with a pooled hazard ratio (HR) (HR: 1.12, 95% CI 0.96–1.31). Trim-and-fill correction for significant publication bias (Egger’s test p = 0.003) in the main analysis resulted in a non-significant effect size (OR: 1.09, 95% CI 0.99–1.20). Subgroup analysis and meta-regression suggested that publication years and sample sizes contributed significant heterogeneity (p < 0.05). Regarding IAP and the risk of AD, no association was found (OR: 1.62, 95% CI 0.87–3.00). Conclusions: Current evidence in the existing literature does not support a positive relationship between antibiotic exposure, either during pregnancy or in the intrapartum period, and the risk of development of AD in offspring. However, substantial heterogeneity and the very low certainty of evidence limit the strength of our findings. Further studies that address confounders more thoroughly are needed to confirm these results. Full article

Background. Cow’s milk allergy (CMA) is one of the most common food allergies in infancy, with prevalence estimates of 0.5–7.5% in high-income countries. Data from low- and middle-income regions remain limited, and the predominant immune mechanism (IgE or non-IgE mediated) may vary across populations. Objective. We aimed to determine the prevalence and clinical characteristics of CMA in infants from an urban, low-income Chilean population. Methods. A prospective cohort study was conducted at Padre Hurtado Hospital in Santiago, Chile. Healthy term newborns were recruited and followed for up to 12 months. Sociodemographic, perinatal data and parental atopy were recorded. Parents were contacted monthly to screen for CMA symptoms. Infants with ≥two symptoms underwent clinical evaluation, a 4-week cow’s milk protein exclusion diet, and an open oral food challenge (OFC). Diagnosis followed international consensus guidelines. Results. Of 552 enrolled infants (48% male), 27 were diagnosed with CMA, yielding a prevalence of 4.9% (95% CI 3.1–7.0%). All cases exhibited non-IgE-mediated symptoms, including vomiting, dermatitis, colic, and perianal erythema. CMA was diagnosed before 6 months of age in 74% of cases. At 12 months, 40% had developed oral tolerance. Sociodemographic and perinatal characteristics were similar between groups, but some self-reported parental atopic traits were more frequent in CMA cases. Conclusions. CMA prevalence in this Chilean cohort was comparable to that reported in high-income countries, with a predominance of non-IgE-mediated forms. These findings support the need for standardized diagnostic protocols, including OFC, in diverse populations. Future studies should explore long-term outcomes and risk factors in non-IgE-mediated CMA. Full article

Purpose: This study evaluated the effectiveness of a school-based experiential self-management program for children with atopic dermatitis (AD) based on Roy’s adaptation theory. Design and Methods: Data were collected from June to August 2021, with 33 children in the experimental group and 32 in the control group. Participants were 10- to 11-year-old elementary school children who reported having AD symptoms within the past year and were able to complete self-report questionnaires. The program consisted of seven weekly school-based sessions that included disease education, symptom management techniques, skin care practices, nutritional guidance, and self-esteem enhancement activities. Outcomes, including AD severity, disease-related knowledge, adaptive behavior, self-esteem, and quality of life, were measured at baseline, post-intervention, and four weeks post-intervention using Generalized Estimating Equation analysis. Results: The experimental group showed significant improvements in AD severity (SCORAD: 22.80 ± 3.18 to 17.75 ± 2.24), disease-related knowledge (10.64 ± 2.00 to 13.64 ± 1.39), adaptive behavior (3.55 ± 1.70 to 10.58 ± 2.45), self-esteem (26.18 ± 4.76 to 31.55 ± 3.46), and quality of life (90.24 ± 11.07 to 100.27 ± 9.76), while the control group remained unchanged. Improvements were sustained four weeks post-intervention. Conclusions: This program effectively reduced AD severity and enhanced knowledge, adaptive behavior, self-esteem, and quality of life in children with AD. Practice Implications: School-based self-management programs effectively enhance disease knowledge, adaptive behaviors, and quality of life in children with AD. Full article

Background/Objectives: Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by recurrent rashes and itching, which seriously affects the quality of life of patients and brings a heavy economic burden to society. The treat-to-target (T2T) strategy was proposed to guide optimal use of systemic therapies in patients with moderate to severe AD, and patients’ adherence is emphasized along with combined evaluation from both health providers and patients. While effective treatments for AD are available, non-adherence of treatment is common in clinical practice due to the patients’ unawareness of self-evaluation and lack of concern about the specific follow-up time points in clinics, which leads to the treatment failure and repeated relapse of AD. Methods: This project consists of three parts. First, an artificial intelligence (AI) model for diagnosis and severity grading of AD based on deep learning will be trained. Second, an AI assistant decision-making system (AIADMS) in the form of an app will be developed. Third, we design a prospective, randomized controlled trial to test the hypothesis that the AIADMS with implementation of the T2T could help control the disease progression and improve the clinical outcomes. Results: A total of 232 participants diagnosed with moderate to severe AD will be included and allocated into the app group or the control group. In the app group, participants will be assisted in using the app during the process of management and follow-up at the scheduled time points, including 2 weeks, 4 weeks, 8 weeks, 12 weeks, 6 months, and 12 months after treatment. In the control group, the diagnosis, treatment, and follow-up of participants will be carried out according to the current routine on a face-to-face basis. The primary outcome is the overall efficiency rate of treating objectives including PP-NRS, EASI, SCORAD, POEM, and DLQI at 12 weeks after treatment, which is calculated as the “Total number of participants with effective treatment of 5 treating objectives/total number of participants *100%”. Spss20.0 software will be used to analyze the data according to the principle of intent to treat. Trial Registration: The protocol was registered at the National Institutes of Health Clinical Trials Registry with the trial registration number NCT06362629 on 11 April 2024. Conclusions: This study aims to improve AD management by integrating advanced technology, patient engagement, and clinician oversight through AIADMS app to achieve treat-to-target (T2T) goals for effective and safe long-term control. Full article

Acute and recurrent pustulosis (ARP), previously known as actinic folliculitis, superficial actinic folliculitis, or even acne aestivalis, is a rare, underdiagnosed dermatological condition characterized by the sudden onset of monomorphic pustular eruptions on an erythematous background localized predominantly on the upper body. While typically associated with sun exposure, ARP can also be triggered by other factors, such as heat or sweating, underscoring its multifactorial etiology. We report the case of a 40-year-old woman with ARP, presenting diagnostic challenges due to overlapping clinical features and the coexistence of atopic dermatitis (AD), an association not previously documented in the literature. The patient exhibited recurrent pustular episodes localized on sun-exposed and non-exposed areas, unresponsive to conventional therapies. Comprehensive microbiological, histopathological, and clinical assessments excluded infectious, drug-induced, and other inflammatory pustular dermatoses, confirming the diagnosis of ARP. Importantly, treatment with Baricitinib, a Janus kinase (JAK) inhibitor primarily prescribed for AD, resulted in marked improvement in both conditions, suggesting shared inflammatory pathways. This therapeutic response highlights the potential role of JAK inhibitors in ARP management, particularly in cases resistant to standard interventions. This report also proposes the inclusion of heat- and sweat-induced ARP as a distinct subtype, expanding the understanding of its diverse triggers beyond UV radiation. Furthermore, it underscores the need for standardized diagnostic criteria and a structured approach to differential diagnosis, given the condition’s underdiagnosed and often misinterpreted nature. By shedding light on the clinical and therapeutic aspects of ARP, this case contributes to a more nuanced understanding of this rare entity and its potential interplay with inflammatory skin disorders such as AD. Full article

Background: Few reports exist regarding the incidence and factors associated with allergic reactions to COVID-19 vaccines during post-marketing surveillance, especially for inactivated whole virus or viral vector vaccines. We aimed to determine the incidence and factors associated with self-reported allergic reactions to COVID-19 vaccines in the Thai population. Methods: A cross-sectional case-control study was conducted via telephone-based interviews. Cases were defined as physician-confirmed, self-reported vaccine recipients diagnosed with non-severe immediate allergic reactions, anaphylaxis, or delayed allergic reactions. Controls were randomly sampled from vaccinated individuals who reported no adverse events and were matched by the type of vaccine (1 case:2 controls). Demographic information and the history of atopic diseases were collected in both groups. Conditional logistic regression analysis was used to explore associated factors. Results: Among 215,079 vaccine doses administered, the incidence of self-reported skin symptoms of allergic reactions was 1821 events (0.85%). The risk factors for allergic reactions included age < 60 years (aOR 3.53; 95% CI:1.43–8.70; p = 0.006), female sex (aOR 8.33; 95% CI: 4.35–15.94; p < 0.001), a personal history of allergic rhinitis (aOR 4.32; 95% CI: 2.43–7.69; p < 0.001), atopic dermatitis (aOR 4.27; 95% CI: 1.74–10.47; p = 0.002), food allergies (aOR 6.53; 95% CI: 2.42–17.61; p < 0.001), and a family history of allergic disease (aOR 2.14; 95% CI: 1.12–4.08; p = 0.021). Conclusions: COVID-19 vaccines showed a low incidence of self-reported allergic reactions, which were more likely to occur in younger individuals, females, and those with a history of atopic diseases. Full article

High-affinity IgE receptors (FcεRI) are expressed on human blood eosinophils and may be upregulated on eosinophils at sites of allergic inflammation including atopic dermatitis and allergic asthma. FcεRI engagement, however, fails to elicit “effector” responses from eosinophils. Thus, a functional role for FcεRI on eosinophils has been uncertain. We evaluated the role of FcεRI in enhancing eosinophil antigen presentation in vivo by using humanized FcεRI α chain (hFcεRIα) transgenic mice. Eosinophils from hFcεRIα transgenic mice expressed humanized FcεRIα, with higher levels of eosinophils from the bronchoalveolar lavage of experimental asthma than those from polymyxin-elicited peritoneal lavage. The hFcεRIα-bearing eosinophils instilled intratracheally (i.t.) into recipient wild-type mice migrated from airways into paratracheal lymph nodes (pLNs) and spleens. Eosinophils, pretreated in vitro with nitrophenyl-ovalbumin ((NP)-OVA) and anti-NP human IgE complexes and instilled i.t., presented NP antigen via hFcεRIα to T cells more effectively than those pretreated with NP-OVA only, as assessed by pLN cell proliferation. IgE/FcεRIα-facilitated eosinophil antigen presentation resulted in increased IL-4 but not INF-γ production by pLN cells, with a bias towards Th2 cytokine production. Furthermore, cross-linking hFcεRIα on eosinophils increased eosinophil expressions of T cell costimulatory proteins CD40, CD80, and CD86. Humanized FcεRIα on murine eosinophils functions to enhance eosinophil antigen presentation capacities by mediating IgE-facilitated antigen presentation and upregulating expression of requisite T cell costimulatory proteins. Thus, a functional, non-“effector” role for FcεRI on eosinophils is revealed through identifying a means by which IgE may act on eosinophils to mediate their immunomodulatory, enhanced antigen presentation capabilities. Full article

For some years, blue light at a wavelength of 400–500 nm has emerged as a non-invasive and innovative treatment in dermatology. This narrative review provides a comprehensive exploration of the mechanisms by which blue light exerts therapeutic effects on various skin disorders including treatment of acne vulgaris, psoriasis, atopic dermatitis, vitiligo, androgenetic alopecia, ulcers and photoaging. We delve into the antimicrobial properties of blue light, highlighting its ability to generate reactive oxygen species that target and destroy pathogenic microorganisms such as Cutibacterium acnes. Additionally, we examine its anti-inflammatory effects, which involve the modulation of cytokine production and reduction in inflammatory cell infiltration, contributing to symptom relief in chronic inflammatory conditions. Blue light, through interaction with some photoreceptors, belonging to the Opsin family, is able to stimulate and prolong the anagen phase in the hair’s life cycle and stimulate repigmentation in vitiligoid patches. The photobiomodulation properties of blue light are also discussed, emphasizing how it influences cellular activities like proliferation and differentiation, thereby aiding in skin rejuvenation and healing processes. By assessing the clinical efficacy, safety profiles, and potential adverse effects reported in the current literature, we aim to present a balanced perspective on the utility of blue light therapy. The review also discusses advancements in light-emitting diode (LED) technology that have enhanced treatment delivery and patient outcomes. Furthermore, we outline future directions for research and clinical applications, emphasizing the need for standardized treatment protocols and long-term safety studies to fully integrate blue light therapy into dermatological practice. Full article

Background: Systemic advanced therapies, including biologic drugs and Janus kinase (JAK) inhibitors, have revolutionized atopic dermatitis management. The increasing number of available options for such complex diseases demands careful treatment selection for each patient, considering numerous variables. Comparative analyses of these treatment modalities in the real world are still limited. Only a faithful basal characterization would enable posterior meaningful and accurate comparisons of the efficacy and safety profiles of these groups of drugs. This communication focuses on describing and comparing the baseline demographics and comorbidities of patients with atopic dermatitis currently treated with biologic therapies versus JAK inhibitors in our setting. Methods: We conducted an observational, descriptive, and ambispective study across three hospitals covering a population of over 500,000 inhabitants from January 2019 to December 2024. Baseline demographic data, anthropometric measures, lifestyle factors, cardiovascular risk factors, and comorbidities were analyzed using descriptive and inferential statistics. Additionally, basal severity and effectivity over time have also been compared. Results: A total of 150 patients were analyzed. A total of 102 had received biological therapies (dupilumab or tralokinumab), whereas 48 patients had received JAK inhibitors (upadacitinib, baricitinib, or abrocitinib). Ages ranged from 11 to 76 years. The overall cohort had a mean age of 35.87 ± 14.37 years and a male predominance (male-to-female ratio 1.63:1). Hypertension was more prevalent in the JAK inhibitors group (p = 0.0175), yet other cardiovascular risk factors, body measurements, atopic and non-atopic comorbidities, and disease severity were comparable across both groups. Conclusions: This study helped to characterize the baseline characteristics of patients treated with advanced systemic therapies in a real-world clinical setting. It pointed to just slight differences between the profiles of patients treated with biologics versus JAK inhibitors. This homogeneity in baseline characteristics sets the ground for further future comparisons of treatment outcomes in this cohort as potential confounding factors related to group imbalances are minimized. Full article

The discovery of effective cysteine protease inhibitors with crude protein kiwi extracts (CPKEs) has created novel challenges and prospects for pharmaceutical development. Despite extensive research on CPKEs, limited research has been conducted on treating atopic dermatitis (AD). Therefore, the objective of this work was to investigate the anti-inflammatory effects of CPKEs on TNF-α activation in a HaCaT cell model and in a DNCB (1-chloro-2, 4-dinitrochlorobenzene)-induced atopic dermatitis animal model. The molecular weight of the CPKE was determined using SDS-PAGE under non-reducing (17 kDa and 22 kDa) and reducing conditions (25 kDa, 22 kDa, and 15 kDa), whereas gelatin zymography was performed to examine the CPKE’s inhibitory impact on cysteine protease (actinidin and papain) activity. Moreover, the CPKE remains stable at 60 °C, with pH levels varying from 4 to 11, as determined by the azocasein assay. CPKE treatment decreased the phosphorylation of mitogen-activated protein kinase (MAPK) and Akt, along with the activation of nuclear factor-kappa B (NF-κB)-p65 in tumor necrosis factor-α (TNF-α)-stimulated HaCaT cells. Five-week-old BALB/c mice were treated with DNCB to act as an AD-like animal model. The topical application of CPKE to DNCB-treated mice for three weeks substantially decreased clinical dermatitis severity and epidermal thickness and reduced eosinophil infiltration and mast cells into ear and skin tissues. These findings imply that CPKE derived from kiwifruit might be a promising therapy option for inflammatory skin diseases such as AD. Full article

Background: The complementary food introduction and consumption guidelines for atopic dermatitis and food allergy prevention have evolved; however, their impact on infant feeding practices remains unclear. This study aimed to analyze complementary food diversity trends in infants, identify vulnerable infants with limited food diversity, and examine the trends in infants with or without vulnerable factors over time. Methods: This study analyzed infants aged 9–12 months who participated in the food diversity survey, conducted as part of the National Health Screening Program in Korea from 2009 to 2020. The complementary food items included grains, vegetables, fruits, eggs, fish, and meats. Infants consuming “six” and “less than six” complementary food items were categorized into high- and low-food-diversity groups, respectively. The study employed logistic regression models to examine the trends in food diversity and vulnerable factors with an assessment of the interaction effects. Results: This study included 3,425,301 participants (51.5% male) aged 11.3 months (standard deviation, 0.8). The high-food-diversity prevalence significantly increased over time, from 30.8% in 2009 to 52.9% in 2020 (p < 0.001). Vulnerable infants included those with preterm birth, low birth weight, non-breastfeeding status, high socioeconomic status, non-Seoul residence at birth, any perinatal conditions, hospitalization due to wheezing, atopic dermatitis and food allergies. The high-diversity proportion increased significantly over the study period across all vulnerable factors (p for interaction < 0.001). However, no significant interactions were observed between the study years and vulnerable factors, except for food allergy (β Coefficient, −0.0117, p for interaction = 0.004). Conclusions: The increasing trends in high-complementary-food-diversity proportions highlight the substantial progress over the study period. However, persistent disparities in vulnerable populations underline the importance of targeted interventions, including tailored nutritional education and policies, that promote equitable dietary practices during early life. Full article