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Source publication
Using the 2003 National Survey of Children's Health sponsored by the federal Maternal and Child Health Bureau, we calculated prevalence estimates of eczema nationally and for each state among a nationally representative sample of 102,353 children 17 years of age and under. Our objective was to determine the national prevalence of eczema/atopic derm...
Contexts in source publication
Context 1
... those children with eczema, 30.7% reported con- current hay fever and 22.8% reported concurrent asthma consistent with similar AD populations in Europe ( Asher et al., 2006;Van der Hulst et al., 2007). As expected, age of the child was a significant determinant of eczema prevalence, given the natural course of the disease (Table 2). ...
Context 2
... was a significant effect of the highest reported education level in the household on eczema prevalence, with those households reporting education levels greater than high school having the greatest prevalence of eczema (Table 2). Other significant demographic variables showing positive associations with disease prevalence included living in a metropolitan area (defined using RUCA (Rural-Urban Commuting Area) codes), speaking English as the primary language, and being of Black or multiple race (Table 2). ...
Context 3
... was a significant effect of the highest reported education level in the household on eczema prevalence, with those households reporting education levels greater than high school having the greatest prevalence of eczema (Table 2). Other significant demographic variables showing positive associations with disease prevalence included living in a metropolitan area (defined using RUCA (Rural-Urban Commuting Area) codes), speaking English as the primary language, and being of Black or multiple race (Table 2). The birthplace of parents or child was associated with disease prevalence. ...
Citations
... Atopic dermatitis (AD) is a chronic inflammatory skin condition with a higher prevalence among adolescent patients (28,29). It negatively impacts the quality of life for both patients and their families (30) and is associated with issues such as poor academic performance, social problems, anxiety, and depression (31). ...
Importance
Due to comorbidities and associated safety risks, the management of severe atopic dermatitis (AD) in pediatric and adolescent patients poses significant challenges.
Objective
To examine the efficacy and safety of systemic therapies for the treatment of moderate-to-severe atopic dermatitis in children and adolescents.
Evidence review
On Feb 29, 2024, a systematic literature search was conducted in Embase, PubMed, and the Cochrane Central Register of Controlled Trials (Central). No date restrictions were applied. Randomized clinical trials, cohort studies, large case series, and meta-analyses were assessed to evaluate the efficacy (or effectiveness) and/or safety of systemic treatments for moderate-to-severe atopic dermatitis in children and adolescents.
Findings
A preliminary search yielded 1457 results, from which 19 unique articles with a total of 3741 patients were included in the analysis. Overall, the available data for each systemic medication are limited, and the overall quality of the included studies on conventional systemic treatments is relatively low. When Dupilumab was used as a standalone treatment, 30%-40% of infants and toddlers aged 6 months to 2 years achieved EASI-75, while 50% of patients aged 2 to 6 years achieved EASI-75. In children aged 6 to 12 years, 33.0%-59.0% of atopic dermatitis patients achieved EASI-75, and when combined with topical corticosteroids (TCS), 69.7%-74.6% achieved EASI-75. Long-term data showed EASI-75 rates ranging from 75.0% to 94.0% for this age group. For adolescents aged 12 to 18 years, 40%-71% of patients achieved EASI-75 within 12 to 16 weeks, and by week 52, 80.8% of patients achieved EASI-75.Abrocitinib treatment resulted in 68.5%-72.0% of patients achieving EASI-75. Omalizumab treatment at week 24 showed a percentage change in SCORAD scores of -12.4%. In the Methotrexate treatment group, there was a SCORAD change of -26.25% at week 12, while the Cyclosporine A group had a SCORAD change of -25.01%. Patients treated with IVIG (Intravenous Immunoglobulin) showed a -34.4% change in SCORAD percentage scores at week 4, which further decreased by 47.12% at week 24. Patients receiving 4mg of Baricitinib and TCS had a 52.5% rate of EASI-75 at 16 weeks, and patients receiving different doses of upadacitinib had a 63-75% rate of EASI-75 at 16 weeks. The rate of EASI-75 at 16 weeks was around 28% in patients who received various doses of Tralokinumab.The most common adverse events observed were nasopharyngitis, respiratory events and dermatitis atopic.
Conclusions and relevance
Awareness of adverse events and concomitant medications is crucial, and appropriate dosing and frequent laboratory and clinical monitoring are also essential. More real-world evidence and prospective cohort studies analyzing the effectiveness and safety of systemic therapies in children and adolescents are of paramount importance for optimizing personalized, effective, and safe management of the growing population of patients with atopic dermatitis in this age group.
... Half the patients scored 5 or above on an analogical scale for suffering (1)(2)(3)(4)(5)(6)(7)(8)(9)(10), and 20% scored 7 or higher. The mean score was 4.4. ...
Atopic dermatitis (AD) is a common inflammatory skin condition that significantly affects patients' lives and imposes both economic and non-economic burdens. The precise societal and individual consequences of AD remain incompletely understood. This study aimed to characterize AD in Portuguese patients and assess its personal, familial, and societal implications, including health status and quality of life. The research, conducted from June 2019 to January 2020, involved 204 confirmed AD patients in Portugal, who completed a 70-question questionnaire. Results show that, on average, patients experienced a two-year delay in diagnosis, with two-thirds having allergic comorbidities. Late-onset AD (after age 20) was found to be correlated with worsening symptoms post-diagnosis. Globally, patients reported substantial effects on health, quality of life, and mental well-being. Effects include significant levels of anxiety, frustration and sleep disorders. Severe AD correlated with more suffering and reduced perceived health, indicating a link between disease severity and quality of life. Remarkably, despite questionable effectiveness, 92% of severe AD patients were prescribed antihistamines, while only 19% received biological treatments. In Portugal, delayed AD diagnosis hinders timely treatment, and despite its profound impact and high comorbidity rates, AD patients tend to remain undertreated. Recognizing the personal and societal repercussions is crucial for enhancing care, contributing to improving QoL, social functioning and global well-being.
... Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder with a hallmark of impaired skin barrier function affecting up to 11% of children and 7% of adults in the US and up to 20% of people worldwide and constantly increasing in prevalance (1). AD is considered to be a major risk factor for the development of other allergic diseases (2). ...
Introduction
Atopic dermatitis (AD) is an allergic skin disease mediated by skin barrier impairment and IL-13-driven immune response. Activation of the aryl hydrocarbon receptor (AHR) has shown promise in early clinical trials for AD; however, the mechanism by which AHR partially ameliorates AD is not well known.
Methods
Gene expression data from human biopsies were analyzed, and compared to gene expression from RNA-sequencing in our in-vitro HaCaT cell model system. Western blot, ELISA qRT-PCR were used to further explore the relationship between AHR and IL-13 signaling in HaCaT cells.
Results
The AHR target gene CYP1A1 was decreased in lesional skin compared with healthy control skin (p = 4.30 × 10⁻⁹). Single-cell RNA sequencing (scRNAseq) demonstrated increased AHR expression (p < 1.0 × 10⁻⁴) and decreased CYP1A1 expression in lesional AD keratinocytes compared with healthy control keratinocytes (p < 0.001). Activation of AHR by AHR agonists in HaCaT cells reversed IL-13-dependent gene expression of several key genes in AD pathogenesis, most notably the eosinophil chemoattractant CCL26 (eotaxin-3). Differentially expressed genes in keratinocytes of patients with AD substantially overlapped with genes regulated by AHR agonists from HaCaT cells by RNAseq, but in reverse direction. Mechanistically, there was evidence for direct transcriptional effects of AHR; AHR binding motifs were identified in the differentially expressed genes from lesional AD keratinocytes compared to control keratinocytes, and AHR activation did not modify IL-13-dependent signal transducer and activator of transcription 6 (STAT6) translocation to the nucleus.
Discussion
Together, these data suggest that the AHR pathway is dysregulated in AD and that AHR modulates IL-13 downstream signaling in keratinocytes through genome-wide, transcriptional regulatory effects.
... A growing number of reports even dating back to the mid-90s already identified a higher prevalence of AD in populations of African ancestry in the UK (26). More recent data, from the US and UK also report an increasing prevalence and a significantly higher risk of severe forms of AD and asthma in individuals of African ancestry compared with those of European descent (22, [26][27][28][29][30]. Based on ISAAC phase I and III data AD prevalence in Latin America ranges from 4% to 25% (3). ...
Atopic dermatitis is a complex inflammatory condition characterized by synergist interactions between epidermal and immune related genotypes, skin barrier defects and immune dysregulation as well as microbial dysbiosis. Ethnicity-specific variations in clinical presentation, immune endotypes and genetic susceptibility have been described in diverse populations. We summarize available data with specific consideration of AD in populations of African ancestry. Some highlights include the observation of AD lesions on extensor surfaces, lichen planus-like AD, prurigo type AD and follicular AD in African populations. In addition, a consistent absence of dominant filaggrin gene defects has been reported. The detection of normal filaggrin protein content in AD skin implicates the contribution of alternative mechanisms in the pathogenesis of AD in African patients. Markedly high IgE has been described in paediatric and adult African AD. While Th2, Th22 and Th17 activation in African AD skin shares the same direction as with other populations, it has been noted that the magnitude of activation is dissimilar. Reduced Th17 cytokines have been observed in the circulation of moderate to severe paediatric AD.
... Eczematous dermatitis is a common pediatric skin condition affecting 8.7%-18.1% of children worldwide. [1][2][3] Topical corticosteroids (TCS) are widely used for eczema treatment, but concerns about their potential side effects have led to negative attitudes among caregivers, known as TCS concerns or steroid phobia. 4 The prevalence of TCS concerns varies widely in the literature, ranging from 21.0% to 95.7%. ...
Background
Concerns about the use of topical corticosteroids (TCS) in pediatric eczematous dermatitis management often hinder effective treatment. Limited data exist regarding the prevalence of these concerns and the effectiveness of interventions. This study aimed to assess the prevalence of TCS concerns among caregivers and determine the effectiveness of video education in mitigating these concerns.
Methods
A single‐center prospective study was conducted from 2022 to 2023, involving caregivers of children under 18 years with eczematous dermatitis. Baseline and post‐intervention questionnaires were administered after a 4‐week period. Caregivers received video education on TCS use, and the TOPICOP score was evaluated before and after viewing the video.
Results
The study included 150 caregivers, 85.3% female and 74% had a child with atopic dermatitis. The prevalence of TCS concerns among Thai caregivers was 62%. Following video education, the prevalence of TCS concerns significantly decreased to 10.7%. Mean belief score decreased from 43.81 ± 13.45 to 31.85 ± 16.56, mean worry score decreased from 56.22 ± 18.27 to 40.41 ± 18.55 and mean total TOPICOP score decreased from 50.02 ± 12.65 to 36.13 ± 13.52 ( p ‐value <.001). The intervention also resulted in reduced disease exacerbations, duration of the rash, and duration of TCS use. The optimal TOPICOP cut‐off score to predict TCS concerns was identified as 43.06.
Conclusion
Video education effectively alleviated TCS concerns among caregivers, addressing beliefs, worries, disease exacerbations, and side effects. Integration of this intervention into the management of pediatric eczematous dermatitis can yield optimal outcomes.
... Atopic dermatitis (AD) has been a prevalent condition of skin inflammation that affects about 9.6 million youngsters and 16.5 million adult individuals [1,2]. It is a persistent disorder that frequently starts in the early years of life and can last throughout later life. ...
Background
Atopic dermatitis is an abnormal skin condition that impacts a significant number of people in the US, with an estimated 9.6 million children and 16.5 million adults being affected by it. The study aimed to characterize and optimize clove oil-based nanomicelles for the possible topical use of bacterial infection-led atopic dermatitis. Clove oil-loaded nanomicelles were produced and carefully analyzed for vesicle diameter, polydispersity index (PDI), zeta potential, morphological attributes, entrapment efficiency, in vitro release, stability, dermatokinetic parameters, 2,2-diphenyl-1-picrylhydrazyl (DPPH) scavenging behavior and antibacterial activity. Different models, such as Korsmeyer, Higuchi, first order, and zero order were employed to evaluate the in vitro release from the formulations.
Results
The average size of the clove oil nanomicelles was found to be 100.15 nm with a PDI of 0.2104; they were observed to be darker against a light background. The evaluated mean zeta size was 121.3 nm, the zeta potential was − 15.31 mV. The inhibitory concentration 50 (IC 50 ) of the formulation was 61.32 ± 0.98 μg/mL; clove oil was 73.56 ± 1.63 μg/mL, against ascorbic acid was 54.51 ± 0.79 μg/mL. Among the four models tested for in vitro release kinetics, the Korsmeyer Peppas model was followed by the nanomicelles formulation. Clove oil nanomicelles generated a higher concentration of 148.68 w/v on the skin epidermis within 1.5 h, whereas the conventional formulation exhibited 55.287 w/v. Moreover, clove oil nanomicelles generated a higher concentration of 125.84 µg/mL on the skin's dermis within 2 h, whereas the conventional formulation produced 68.263 µg/mL. The nanomicelles also inhibited bacterial growth within a 24-h period.
Conclusions
The study presents initial evidence regarding the potency of clove oil-based nanomicelles and their enhanced efficiency on the skin. Thus, the prepared formulation can further be studied and incorporated for the possible use against bacterial infection-led atopic dermatitis.
Graphical abstract
... Atopic Dermatitis (AD), also known as eczema, is a chronic, relapsing-remitting, inflammatory skin disease that affects up to 20% of children [1]. AD has profound impacts on patient and caregiver quality of life (QoL). ...
Background
Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects children and adults. Poor treatment adherence in AD requires interventions to promote self-management; patient education in chronic diseases is key to self-management. Many international AD management guidelines published to date include a recommendation for educating patients as part of their treatment but there are no formal recommendations on how to deliver this knowledge.
Main
We performed a scoping review to map the existing literature on patient education practices in AD and to highlight the clinical need for improved patient education in AD. The literature search was performed with the online databases MEDLINE, Embase, Grey Matters, ClinicalTrails.gov and the International Clinical Trials Registry Platform (ICTRP). The search strategy yielded 388 articles. Of the 388 articles screened, 16 studies met the eligibility criteria, and the quantitative data was summarized by narrative synthesis. The majority of studies were randomized controlled trials conducted in Europe, Asia and North America. Since 2002, there have been limited studies evaluating patient education in the treatment of AD. Frequent education methods used included group-based educational programs, educational pamphlets, individual consultations and online resources. Education was most commonly directed at caregivers and their children. Only one study compared the efficacy of different education methods. In all included studies, the heterogenous nature of outcome measures and study design limited the consistency of results. Despite the heterogeneity of studies, patient education was shown to improve quality of life (QoL), disease severity and psychological outcomes in AD patients.
Conclusion
This scoping review highlights that patient education is effective in a variety of domains relevant to AD treatment. Further comparative studies and randomized trials with longer-term follow-up are needed to provide validated and consistent patient education recommendations for AD; these may depend on age and population.
... The prevalence of AD measured over a 12-month period varied widely across studies, with a majority of analyses reporting disease in 10-15% of pre-school children. This is consistent with findings from international studies conducted in high-income countries [22], and higher than the national and international prevalence of AD reported in older children and in adults [8,14]. Severe disease was present in 7.8-11% of pre-school AD patients, with small differences between (a few) Italian studies. ...
... In the USA and Canada, the prevalence in the age group 6 months to <6 years was 10% and 16%, respectively. In the US 2003 National Survey of Children's Health, among a large representative sample of the national paediatric population, approximately 14% of children aged <4 years were reported with a diagnosis of eczema in the previous 12 months [22]. The prevalence of AD during the first year of life was 14.2% in European centres (mainly Spanish) participating in the International Study of Wheezing in Infants, which included almost 8000 subjects [25]. ...
Atopic dermatitis (AD) is one of the most common diseases worldwide. Severe AD has a major impact on the quality of life of patients. We performed a systematic literature review on the epidemiology of AD in Italian pre-school children (age 0–5 years) and we assessed the available data on the severity of AD. In August 2022, we performed a bibliographic search using PubMed/Medline and EMBASE. We identified 10 studies with Italian data on the prevalence and/or incidence of AD in pre-school children. The period (12 months) prevalence of AD varied widely across studies, ranging between 4.0% and 42.2%, with median estimates of 14.3% among all studies and 11.8% among studies from 2010 onwards. Applied to the Italian population, this leads to a prevalence of 309,000–375,000 pre-school AD cases. Only one study computed the incidence of AD, reporting rates of 9 cases per 100 person-years in children aged 0–1 year, and 2.5 cases per 100 person-years in children aged 1–4 years. Severity data from Italy were also reviewed, across three identified three studies. A point estimate found 8.4% of cases were considered severe in one study based on the Patient-Oriented Eczema Measure (POEM), with an overall range of 7.8–11% across different Italian studies and according to various severity score types.
... Extensive research has been conducted in recent years to identify environmental elements that increase the risk of AD and to find interventions to reduce or prevent the disease. Epidemiological data suggest a higher prevalence of AD in wealthy industrialized countries compared to developing countries [55][56][57][58]. This is believed to be attributed to stringent hygiene practices in developed countries, which limit exposure to beneficial microbes, impacting the education of the host immune system [51,59]. ...
Atopic dermatitis (AD) is a chronic inflammatory skin disease that occurs in genetically predisposed individuals. It involves complex interactions among the host immune system, environmental factors (such as skin barrier dysfunction), and microbial dysbiosis. Genome-wide association studies (GWAS) have identified AD risk alleles; however, the associated environmental factors remain largely unknown. Recent evidence suggests that altered microbiota composition (dysbiosis) in the skin and gut may contribute to the pathogenesis of AD. Examples of environmental factors that contribute to skin barrier dysfunction and microbial dysbiosis in AD include allergens, irritants, pollution, and microbial exposure. Studies have reported alterations in the gut microbiome structure in patients with AD compared to control subjects, characterized by increased abundance of Clostridium difficile and decreased abundance of short-chain fatty acid (SCFA)-producing bacteria such as Bifidobacterium. SCFAs play a critical role in maintaining host health, and reduced SCFA production may lead to intestinal inflammation in AD patients. The specific mechanisms through which dysbiotic bacteria and their metabolites interact with the host genome and epigenome to cause autoimmunity in AD are still unknown. By understanding the combination of environmental factors, such as gut microbiota, the genetic and epigenetic determinants that are associated with the development of autoantibodies may help unravel the pathophysiology of the disease. This review aims to elucidate the interactions between the immune system, susceptibility genes, epigenetic factors, and the gut microbiome in the development of AD.
... Atopic dermatitis (AD) is one of the most common skin conditions in childhood, affecting between 15 and 20% of children in the USA and over a million children in more than 90 other countries [1][2][3][4][5]. It is a chronic inflammatory condition characterized by recurrent eczematous lesions and intense pruritus [5]. ...
Atopic dermatitis (AD) is one of childhood’s most common skin conditions. Although pediatricians often diagnose and manage it, more than half refer even mild cases to dermatologists. In this study, we aimed to evaluate pediatric residents’ and pediatricians’ self-confidence regarding their ability to diagnose and manage AD. A cross-sectional questionnaire study was conducted with Israeli pediatric residents and pediatricians in 2022. The questionnaire was designed to distinguish participants with high vs. low self-confidence characteristics regarding their ability to diagnose and treat AD. In total, 171 participants completed the questionnaire (59.4% women; age, 41.1 ± 10.6 years); 39.1% of the participants were residents, while 60.9% were board-certified pediatricians. Overall, 64.4% of the responders reported below or average confidence (score ≤ 3, on a scale of 1–5) in diagnosing and treating AD in children. The group with higher self-confidence was significantly older (44.39 vs. 39.14 years, P = 0.003), had more years of experience in evaluating pediatric AD (P = 0.004), had trained in dermatology during their residency (P = 0.02) with a longer training period (P = 0.01), and with more than three training methods (P = 0.009). Multivariable logistic regression analysis showed that high self-confidence was associated with age older than 40 years and training in dermatology during residency (odds ratios = 5.63 [P = 0.04] and 3.36 [P = 0.05], respectively).
Conclusion: Most pediatric residents and pediatricians were not particularly confident in treating children with AD. Those with high self-confidence were older, had been exposed to more patients, and had been trained in dermatology during their residency with various methods and for longer periods. Therefore, we encourage the implementation of a training program in dermatology during pediatric residency programs.
What is Known:
• Atopic dermatitis (AD) is one of childhood’s most common skin conditions and often presents to pediatricians for diagnosis and management.
• Many pediatricians refer children with even mild cases of AD to dermatologists.
What is New:
• Most pediatric residents and pediatricians report low confidence in diagnosing and treating pediatric AD.
• Physicians with high self- confidence were older, exposed to more AD patients, and had been trained in dermatology during their residency with various methods and for longer periods. Therefore, the implementation of a training program in dermatology during pediatric residency programs is warranted.
