Search Results (149)

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

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: Recurring infections in children with allergies pose significant clinical challenges, with these conditions often exacerbating each other through complex immunological interactions. This narrative review examines the connection between recurring infections and allergic conditions in pediatric patients, focusing on how immune system dysfunction influences infection susceptibility in respiratory allergies. Methods: A comprehensive literature search across PubMed, Web of Science, and SciELO databases was conducted from January 2014 to May 2024. Studies involving children and adolescents up to 18 years old with diagnosed respiratory allergies were included, while reviews, opinion pieces, case reports, and studies not addressing immune–infection interactions were excluded. Results: Analysis reveals significant immune dysfunction in allergic children, affecting both innate and adaptive immunity components. Children with allergic rhinitis and asthma demonstrate decreased interferon-gamma production, increasing vulnerability to viral infections (particularly rhinovirus) and bacterial infections such as Mycoplasma pneumoniae. Rhinovirus represents the most common pathogen, present in 75% of asthma exacerbations. Atopic children exhibit markedly higher bacterial infection rates, with 27.1% showing Mycoplasma pneumoniae involvement versus 4.9% in non-atopic children. Conclusions: Recurring infections in allergic pediatric patients result from significant immune dysfunction involving altered cytokine production and immune cell function. These complex interactions highlight the need for targeted therapeutic approaches that enhance immune responses and reduce infection risks. Future research should focus on identifying specific biomarkers and immune mechanisms for developing more effective interventions. 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

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

Biologic therapies have revolutionized the treatment of severe allergic diseases, including asthma, atopic dermatitis (AD), chronic spontaneous urticaria (CSU), chronic rhinosinusitis with nasal polyps (CRSwNP), eosinophilic gastrointestinal diseases (EGIDs), and allergic rhinitis (AR). These molecularly targeted agents provide significant benefits for patients unresponsive to conventional treatments by addressing underlying immune mechanisms, particularly type 2 inflammation driven by cytokines such as IL-4, IL-5, and IL-13. Recent advancements include biologics targeting alarmins like thymic stromal lymphopoietin (TSLP) and IL-33, which may address both type 2 and non-type 2 inflammation, broadening their therapeutic scope. Despite their effectiveness, biologics remain expensive, posing socioeconomic challenges, and there are concerns regarding long-term safety and inter-individual variability in responses. Promising innovations such as bispecific antibodies and ultra-long-acting agents are under investigation, alongside digital health tools like remote biomarker monitoring and AI-driven decision support systems, which aim to enhance personalized care. However, disparities in access, particularly for underserved populations, underscore the need for policy reforms and affordable biosimilars. This review synthesizes recent findings and emerging trends, highlighting the evolving role of biologics in transforming allergic disease management and offering insights into future research directions. Full article

Background/Objective: Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by diverse clinical manifestations. However, variations in its clinical presentations across different ages, genders, anatomical sites, and seasons remain incompletely understood. The objective was to explore the clinical heterogeneities of AD using data from the Chinese non-selective registration system. Methods: A prospective analysis was conducted on 3829 AD patients enrolled in the Chinese Non-selective Registry for AD (CNRAD) at hospital settings from 2020 to 2022. Demographic profiles; distribution, type, and severity of the skin lesion; laboratory findings; allergic comorbidities; family history; and exacerbating factors were analyzed. Results: The male-to-female ratio was 0.92 among adolescent and adult AD patients but increased to 2.11 in elderly AD patients, highlighting an age-dependent gender difference in AD prevalence. Age groups displayed distinct anatomical preferences for lesion distribution, with reduced involvement of the cubital and popliteal fossae in adult and elderly patients. Based on skin lesion characteristics, ten clinical subtypes of AD were proposed. Elderly AD patients exhibited higher severity, compared to adolescence and adult AD patients, with male patients being more severe than females. Elderly AD patients showed a lower proportion of extrinsic type, compared to childhood AD patients. Seasonal change emerged as the most important factor triggering AD flares. Conclusions: This study provides new insights into the heterogeneities of AD clinical manifestations in the Chinese population, demonstrating their significant dependence on temporal factors, including age and season. Full article

Background/Objectives: Eyelid dermatitis is an inflammatory disease affecting the palpebral skin characterized by itching, edema, and scaling of the periorbital area. This entity can be a manifestation of various underlying dermatological diseases, but allergic contact dermatitis (ACD) is the predominant etiology of eyelid dermatitis among patients, being diagnosed in 43.4% of cases. The thin and highly permeable nature of eyelid skin increases its susceptibility to allergens, making it a distinct clinical entity. This study aimed to identify the primary haptens associated with eyelid ACD and compare these findings with the allergens implicated in non-eyelid ACD over a 25-year period in a large cohort of patients. Methods: We conducted a monocentric, retrospective study on a dataset of 7955 patients patch-tested for ACD at the Outpatient Allergy Dermatology Clinic of the Azienda Ospedaliera Universitaria Senese (AOUS) from 1997 to 2021. Eyelid ACD cases were identified based on clinical features and positive patch test results. Data on demographics, occupation, and personal history of atopy were collected. The statistical analyses assessed the associations between allergens and eyelid ACD. The trends in the sensitization rates for the most prevalent allergens were also evaluated. Results: Eyelid ACD was identified in 4.6% of the study population, predominantly affecting women (88.6%). Patients with eyelid ACD were more likely to exhibit single-hapten positivity (54.6%) and an atopic phenotype (52.3%) compared to non-eyelid ACD cases. Nickel sulfate (54%), cobalt chloride (13.4%), and thimerosal (12.6%) were the most common allergens associated with eyelid ACD. While thimerosal sensitization decreased significantly following its removal from topical products, nickel sensitization increased, likely due to exposure from electronic devices and hand–eye contact. Conclusions: The haptens identified in eyelid ACD largely overlap with those found in other body regions, including metals, fragrances, and preservatives. However, the unique characteristics of eyelid skin and hand–eye contact patterns play a significant role in sensitization. This study highlights the need for further investigation into the pathophysiology of eyelid allergic contact dermatitis, with particular emphasis on elucidating the mechanisms of hapten sensitization. Such insights could contribute to the development of effective strategies aimed at reducing allergen exposure. Full article

Background: Dupilumab, a fully human monoclonal antibody targeting the interleukin (IL)-4/IL-13 pathway, is able to dampen T helper (Th)2-mediated inflammation in several conditions characterized by this particular type of phlogosis. The aim of this study was to review the efficacy and safety of dupilumab treatment in conditions underpinned by Th2-type inflammation in a cohort of real-world patients referred to our outpatient clinic. Methods: Data from all patients with atopic dermatitis, chronic rhinosinusitis with nasal polyps, asthma, and other Th2-type-mediated inflammatory conditions treated with dupilumab were retrospectively reviewed. Results: Twenty-two patients were included in the study: 14 with atopic dermatitis, 5 with chronic rhinosinusitis with nasal polyps, 2 with asthma, and 1 with prurigo nodularis; some of the patients had more than one atopic condition. A complete response was observed in 13 out of 22 patients (59.1%); when partial responses were included in the analysis, the overall response rate was 86.4%. No adverse events were recorded, either locally or systemically. Total IgE levels dropped in all patients, in some cases reaching values close to those typically observed in nonatopic subjects. When eosinophilia was present at baseline, this also normalized during dupilumab treatment. Conclusions: Dupilumab was safe and effective across multiple conditions driven by Th2-type chronic inflammation; effective interference with the Th2-type pathway was inferred by the progressive reduction in serum total IgE levels, which reached the normal range in a fraction of patients, and by the reduction in peripheral blood eosinophil counts. Further studies in different Th2-mediated diseases are warranted. Full article

Asthmatic children who tested positive for COVID-19 experienced changes in lung function and persistent symptoms following SARS-CoV-2 infection, even for several months after diagnosis, and with the same features as in an acute phase. This study aimed to analyze a pediatric age group (between 0 and 17 years old) diagnosed with asthma, and SARS-CoV-2 infection attending regular monitoring visits in a Pediatric Department of a Regional Tertiary Hospital (Filantropia Clinical Municipal Hospital Craiova, Romania) during the COVID-19 pandemic and post-pandemic time interval (i.e., March 2020–July 2024), and identify how the infection influenced their long-term symptoms and treatment. Materials and Methods. The following variables were recorded: demographic data (gender, age group, residence), data related to allergies (allergic rhinitis, atopic dermatitis, and food allergies), the presence of exacerbations, the fraction of exhaled nitric oxide, the ventilatory function, the asthma phenotype (allergic or non-allergic), as well as the GINA assessment of asthma control at clinical visits were analyzed. SARS-CoV-2 infections were evaluated in terms of year of infection, symptoms, cough presence and persistence, and modifications of the asthma treatment during and after COVID-19 disease. The data were statistically analyzed with SPSS, using the Mann–Whitney U, Kruskal–Wallis H, and Chi-Square tests. Results. A lower incidence of COVID-19 cases was recorded in the first pandemic of asthmatic patients (2020 and 2021), but an increase in the rate of cases was observed at the beginning of the second pandemic, in 2022. The nitric oxide values in asthmatic children who were infected with SARS-CoV-2 were statistically significantly increased (p < 0.0005), especially for children with persistent cough for more than 4 weeks. A significant increase in the number of exacerbations was also observed in patients who tested positive for SARS-CoV-2 infection (p < 0.0005). Ventilatory function values were statistically significantly different in asthmatic children with and without SARS-CoV-2 infection (p < 0.05). Conclusions. The persistence of cough after the acute phase of SARS-CoV-2 infection as well as the changes in ventilatory tests emphasize the need of periodic medical check-ups, as well as the implementation of a therapeutic regimen appropriate for each pediatric patient. Full article

Non-specific Lipid Transfer proteins (nsLTPs) are relevant allergens of several pollens and plant foods. Sensitization to nsLTPs is not typical in our region. Still, it has become an increasingly common cause of IgE-mediated food allergies and food-induced anaphylaxis in Northern Europe in recent decades. No in-depth studies describe the prevalence of sensitization of molecular components to nsLTPs in Lithuania. This study aimed to determine the sensitization profile of atopic patients at the Immunology and Allergy Department of Kauno Klinikos to the components of nsLTPs, using molecular allergen component analysis. Sixty Lithuanian adults with symptoms of allergic rhinitis and/or allergic asthma and/or food allergies were included into the study. Specific immunoglobulin E (IgE) levels were measured using two in vitro techniques: allergen extract and molecular component analysis. Results showed that 25% of subjects were sensitized to nsLTP-containing allergen sources, mostly to Zea m 14, Mal d 3, Vit v 1, and Art v 3. The median amount of total IgE was higher in nsLTP-sensitized patients than in nsLTP-nonsensitized patients. Based on Cohen’s Kappa and McNemar tests, the results of allergen extract and component analysis tests do not always agree, especially when we determine the sensitization to allergen sources containing nsLTPs. Molecular allergen component analysis could be the first choice in determining detailed sensitization to nsLTPs in patients who experienced anaphylaxis of unknown origin. Full article

Background/Objectives: The prevalence of food allergy (FA) in children is increasing. Dysbiosis of the microbiome has been linked to FA but needs to be better understood. We aimed to characterize the gut and skin microbiome of young food-allergic children over time and within different types of immunoglobulin E (IgE)-mediated FA. Methods: We studied 23 patients, as a pilot study of an ongoing prospective multicenter cohort study including children < 2y with newly diagnosed IgE-mediated FA. Samples (feces/skin swabs) were collected at enrollment and at 1-year follow-up and sequenced for the bacterial 16S rRNA gene (hypervariable v1–v2 region). Results: Gut and skin bacterial diversity was significantly higher in patients compared with controls and increased over time (beta test, Shannon diversity, p < 0.01). Within different types of IgE-mediated FA, bacterial diversity was similar. Community composition differed significantly over time and within IgE-mediated FA types (PERMANOVA: p < 0.01). Several significantly different genus abundances were revealed. We observed a positive correlation between high total IgE and a high abundance of the genus Collinsella in patients with a higher number of allergies/sensitizations (≥3), and patients with tree nut and/or peanut allergy. Conclusions: This study revealed an increased bacterial diversity in children with FA compared with non-atopic children. Importantly, the gut and skin microbiome differed in their composition over time and within different types of IgE-mediated FA. These findings contribute to the understanding of microbiome changes in children with FA and indicate the potential of the genus Collinsella as a biomarker for tree nut and/or peanut allergy and possibly for allergy persistence. Full article