Background: Atopic dermatitis (AD) induces alterations of external appearance and self-esteem, with impact on the personal development of the children. However, tools for estimating such suffering are lacking. We aimed to assess how children with AD represent themselves through their drawings. Methods: In this retrospective study, we included children (<18 years) suffering from AD who followed the instruction "draw yourself with and without eczema" at the end of a routine follow-up consultation. Drawings were interpreted with the child and then classified in different analysis groups by 5 independent evaluators. Results: A total of 64 children (41 [64.1%] girls and 23 [35.9%] boys, median [range] age 8 [3-7] years) made 64 drawings. Five groups of drawing were identified: "amputee" (n = 8, 12.5%), "identical" (n = 18, 28.1%), "sad" (n = 19, 29.7%), "complex" (n = 11, 17.2%), and "other" (n = 8, 12.5%). Univariate analysis found that age was differently distributed among the different drawing groups (P = 0.0047), as was the predominance of light colors (P = 0.038). The distribution of the other variables (gender, investigator global assessment score, active AD, and duration of activity) was not different among drawing groups. Conclusions: The drawing allows a majority of the AD children to express their self-image with and without eczema, as well as their feelings and their interactions with the environment and with their entourage. The visual tool proposed herein could be used during consultations, to (a) become aware of the need to treat AD, (b) better evaluate the impact of AD burden in childhood, and (c) adjust appropriately AD treatment.
{"title":"Atopic Dermatitis and Self-Image Design: A Real-Life Study in Children Using Drawings.","authors":"Camille Braun, Magali Bourrel-Bouttaz, Olivier Revol, Virginie Verdu, Anaïs Montagnon, Frédéric Bérard, Audrey Nosbaum","doi":"10.1089/derm.2022.0056","DOIUrl":"10.1089/derm.2022.0056","url":null,"abstract":"<p><p><u><b><i>Background:</i></b></u> Atopic dermatitis (AD) induces alterations of external appearance and self-esteem, with impact on the personal development of the children. However, tools for estimating such suffering are lacking. We aimed to assess how children with AD represent themselves through their drawings. <u><b><i>Methods:</i></b></u> In this retrospective study, we included children (<18 years) suffering from AD who followed the instruction \"draw yourself with and without eczema\" at the end of a routine follow-up consultation. Drawings were interpreted with the child and then classified in different analysis groups by 5 independent evaluators. <u><b><i>Results:</i></b></u> A total of 64 children (41 [64.1%] girls and 23 [35.9%] boys, median [range] age 8 [3-7] years) made 64 drawings. Five groups of drawing were identified: \"amputee\" (<i>n</i> = 8, 12.5%), \"identical\" (<i>n</i> = 18, 28.1%), \"sad\" (<i>n</i> = 19, 29.7%), \"complex\" (<i>n</i> = 11, 17.2%), and \"other\" (<i>n</i> = 8, 12.5%). Univariate analysis found that age was differently distributed among the different drawing groups (<i>P</i> = 0.0047), as was the predominance of light colors (<i>P</i> = 0.038). The distribution of the other variables (gender, investigator global assessment score, active AD, and duration of activity) was not different among drawing groups. <u><b><i>Conclusions:</i></b></u> The drawing allows a majority of the AD children to express their self-image with and without eczema, as well as their feelings and their interactions with the environment and with their entourage. The visual tool proposed herein could be used during consultations, to (<i>a</i>) become aware of the need to treat AD, (<i>b</i>) better evaluate the impact of AD burden in childhood, and (<i>c</i>) adjust appropriately AD treatment.</p>","PeriodicalId":11047,"journal":{"name":"Dermatitis","volume":" ","pages":"S98-S102"},"PeriodicalIF":5.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9090370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-08-01DOI: 10.1089/derm.2023.0058
Shanthi Narla, Jonathan I Silverberg
Recently, 3 oral Janus kinase (JAK) inhibitors-abrocitinib, baricitinib, and upadacitinib-were approved in many regions around the world for the treatment of moderate-severe atopic dermatitis (AD). These JAK inhibitors generally have rapid onset of action and short half-life. Higher doses of abrocitinib and upadactinib even demonstrated superior efficacy to dupilumab. However, JAK inhibitors can be associated with rare serious and potentially life-threatening adverse events. Heterogeneity in study designs and lack of head-to-head studies make safety comparison between JAK inhibitors difficult. Dose reduction and patient selection are the most important considerations for risk mitigation. This narrative review examines the efficacy data for abrocitinib, baricitinib, and upadacitinib from large phase III double-blinded randomized controlled trials in AD and discusses risk stratification for oral JAK inhibitors in AD patients.
最近,全球许多地区批准了三种口服 Janus 激酶(JAK)抑制剂--阿罗西替尼、巴利替尼和乌达替尼,用于治疗中度-重度特应性皮炎(AD)。这些 JAK 抑制剂一般起效快、半衰期短。高剂量的阿罗西替尼和乌达替尼的疗效甚至优于杜匹单抗。然而,JAK抑制剂可能会出现罕见的严重不良反应,甚至可能危及生命。研究设计的异质性和头对头研究的缺乏使得很难对 JAK 抑制剂进行安全性比较。减少剂量和选择患者是降低风险最重要的考虑因素。这篇叙述性综述研究了阿罗西替尼、巴利昔替尼和乌达替尼在AD大型III期双盲随机对照试验中的疗效数据,并讨论了AD患者口服JAK抑制剂的风险分层。
{"title":"Efficacy and Risk Stratification of Janus Kinase Inhibitors in the Treatment of Moderate-to-Severe Atopic Dermatitis.","authors":"Shanthi Narla, Jonathan I Silverberg","doi":"10.1089/derm.2023.0058","DOIUrl":"10.1089/derm.2023.0058","url":null,"abstract":"<p><p><u><b><i></i></b></u> Recently, 3 oral Janus kinase (JAK) inhibitors-abrocitinib, baricitinib, and upadacitinib-were approved in many regions around the world for the treatment of moderate-severe atopic dermatitis (AD). These JAK inhibitors generally have rapid onset of action and short half-life. Higher doses of abrocitinib and upadactinib even demonstrated superior efficacy to dupilumab. However, JAK inhibitors can be associated with rare serious and potentially life-threatening adverse events. Heterogeneity in study designs and lack of head-to-head studies make safety comparison between JAK inhibitors difficult. Dose reduction and patient selection are the most important considerations for risk mitigation. This narrative review examines the efficacy data for abrocitinib, baricitinib, and upadacitinib from large phase III double-blinded randomized controlled trials in AD and discusses risk stratification for oral JAK inhibitors in AD patients.</p>","PeriodicalId":11047,"journal":{"name":"Dermatitis","volume":" ","pages":"S24-S38"},"PeriodicalIF":5.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9917157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-08-09DOI: 10.1089/derm.2023.0111
Albert C Chong, Alan Schwartz, Jessica Lang, Peck Y Ong, Ian A Myles, Jonathan I Silverberg, Korey Capozza
Background: Atopic dermatitis (AD) has large mental health impacts for patients and caregivers, yet their preferences regarding how to relieve these impacts are poorly understood. Objective: To understand patients' and caregivers' preferences for AD-related mental health care and support. Methods: We surveyed 279 adult AD patients and 154 caregivers of children with AD across 26 countries regarding their AD-related mental health burden, preferred strategies for improving AD-related mental health, and experiences with mental health care in AD. Results: Caregivers reported significantly worse overall mental health (P = 0.01) and anxiety (P = 0.03) than adult patients when controlling for AD severity. Among adult patients, 58% selected treating the AD, 51% managing itch, 44% wearing clothing to cover up skin, 43% avoiding social situations, and 41% spending time alone, as strategies they felt would improve their own AD-related mental health. Caregivers selected managing itch and treating the AD most frequently for both their own (76% and 75%, respectively) and their children's (75% and 61%) mental health. Adult patients were less satisfied with mental health care from mental health providers versus nonmental health providers (P < 0.001). Conclusions: Effective AD management is the preferred method for improving mental health among patients as well as caregivers, who may experience the greatest mental health impacts. Self-care strategies should be considered in a shared decision-making approach.
{"title":"Patients' and Caregivers' Preferences for Mental Health Care and Support in Atopic Dermatitis.","authors":"Albert C Chong, Alan Schwartz, Jessica Lang, Peck Y Ong, Ian A Myles, Jonathan I Silverberg, Korey Capozza","doi":"10.1089/derm.2023.0111","DOIUrl":"10.1089/derm.2023.0111","url":null,"abstract":"<p><p><u><b><i>Background:</i></b></u> Atopic dermatitis (AD) has large mental health impacts for patients and caregivers, yet their preferences regarding how to relieve these impacts are poorly understood. <u><b><i>Objective:</i></b></u> To understand patients' and caregivers' preferences for AD-related mental health care and support. <u><b><i>Methods:</i></b></u> We surveyed 279 adult AD patients and 154 caregivers of children with AD across 26 countries regarding their AD-related mental health burden, preferred strategies for improving AD-related mental health, and experiences with mental health care in AD. <u><b><i>Results:</i></b></u> Caregivers reported significantly worse overall mental health (<i>P</i> = 0.01) and anxiety (<i>P</i> = 0.03) than adult patients when controlling for AD severity. Among adult patients, 58% selected treating the AD, 51% managing itch, 44% wearing clothing to cover up skin, 43% avoiding social situations, and 41% spending time alone, as strategies they felt would improve their own AD-related mental health. Caregivers selected managing itch and treating the AD most frequently for both their own (76% and 75%, respectively) and their children's (75% and 61%) mental health. Adult patients were less satisfied with mental health care from mental health providers versus nonmental health providers (<i>P</i> < 0.001). <u><b><i>Conclusions:</i></b></u> Effective AD management is the preferred method for improving mental health among patients as well as caregivers, who may experience the greatest mental health impacts. Self-care strategies should be considered in a shared decision-making approach.</p>","PeriodicalId":11047,"journal":{"name":"Dermatitis","volume":" ","pages":"S70-S76"},"PeriodicalIF":5.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10353125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-08-17DOI: 10.1089/derm.2023.0154
Samuel F Ekstein, Erin M Warshaw
Sodium disulfite, also known as sodium metabisulfite or sodium pyrosulfite, is an inorganic compound, which may cause allergic contact dermatitis. Sulfites act as antioxidants and preservatives; common sources include food/beverages, pharmaceuticals, and personal care products. Importantly, sulfites are not included in most screening patch test series and thus may be missed as a relevant contact allergen. The American Contact Dermatitis Society chose sulfites as the Allergen of the Year for 2024 to raise awareness about this significant allergen.
{"title":"Sulfites: Allergen of the Year 2024.","authors":"Samuel F Ekstein, Erin M Warshaw","doi":"10.1089/derm.2023.0154","DOIUrl":"10.1089/derm.2023.0154","url":null,"abstract":"<p><p><b><i><u></u></i></b> Sodium disulfite, also known as sodium metabisulfite or sodium pyrosulfite, is an inorganic compound, which may cause allergic contact dermatitis. Sulfites act as antioxidants and preservatives; common sources include food/beverages, pharmaceuticals, and personal care products. Importantly, sulfites are not included in most screening patch test series and thus may be missed as a relevant contact allergen. The American Contact Dermatitis Society chose sulfites as the Allergen of the Year for 2024 to raise awareness about this significant allergen.</p>","PeriodicalId":11047,"journal":{"name":"Dermatitis","volume":" ","pages":"6-12"},"PeriodicalIF":5.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10011694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-04-11DOI: 10.1089/derm.2022.0066
Ana de-Andrés-Del-Rosario, María Pestana-Eliche, Gabriel Marrero-Alemán, Eva Fagundo-González, José M Ramírez-Conchas, Inmaculada Sánchez-Machín
{"title":"Localized Contact Urticaria by Egg in a Baby.","authors":"Ana de-Andrés-Del-Rosario, María Pestana-Eliche, Gabriel Marrero-Alemán, Eva Fagundo-González, José M Ramírez-Conchas, Inmaculada Sánchez-Machín","doi":"10.1089/derm.2022.0066","DOIUrl":"10.1089/derm.2022.0066","url":null,"abstract":"","PeriodicalId":11047,"journal":{"name":"Dermatitis","volume":" ","pages":"106-107"},"PeriodicalIF":5.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9273818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-03-28DOI: 10.1089/derm.2023.0011
Filomena Russo, Vittoria Cioppa, Alessandra Cartocci, Nicola Milanesi, Angelo Massimiliano D'Erme, Laura Lazzeri, Pietro Rubegni, Francesco Santi
{"title":"Dupilumab and Atopic Dermatitis Flares: An Observational Study to Identify Common Clinical Features in Patients Who Have Exacerbations Despite Biological Therapy.","authors":"Filomena Russo, Vittoria Cioppa, Alessandra Cartocci, Nicola Milanesi, Angelo Massimiliano D'Erme, Laura Lazzeri, Pietro Rubegni, Francesco Santi","doi":"10.1089/derm.2023.0011","DOIUrl":"10.1089/derm.2023.0011","url":null,"abstract":"","PeriodicalId":11047,"journal":{"name":"Dermatitis","volume":" ","pages":"107-109"},"PeriodicalIF":5.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9194557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-06-06DOI: 10.1089/derm.2023.0094
Neil K Jairath, Vikash S Oza, Emily C Milam
{"title":"That New Shoe Smell: Allergic Contact Dermatitis to Fragrance in Shoes.","authors":"Neil K Jairath, Vikash S Oza, Emily C Milam","doi":"10.1089/derm.2023.0094","DOIUrl":"10.1089/derm.2023.0094","url":null,"abstract":"","PeriodicalId":11047,"journal":{"name":"Dermatitis","volume":" ","pages":"99-100"},"PeriodicalIF":5.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9571201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-08-18DOI: 10.1089/derm.2023.0052
Vittoria Cioppa, Laura Lazzeri, Andrea Carraro, Ernesto De Piano, Francesca Falcinelli, Marco Galluzzo, Sabatino Pallotta, Ornella De Pità, Filomena Russo
{"title":"Emerging Role of Atopic Dermatitis Control Tool in Long-Term Monitoring of Patients With Moderate-to-Severe Atopic Dermatitis Treated With Dupilumab.","authors":"Vittoria Cioppa, Laura Lazzeri, Andrea Carraro, Ernesto De Piano, Francesca Falcinelli, Marco Galluzzo, Sabatino Pallotta, Ornella De Pità, Filomena Russo","doi":"10.1089/derm.2023.0052","DOIUrl":"10.1089/derm.2023.0052","url":null,"abstract":"","PeriodicalId":11047,"journal":{"name":"Dermatitis","volume":" ","pages":"S107-S108"},"PeriodicalIF":5.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10078685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare drug reaction characterized by a skin rash, eosinophilia, and organ involvement. Objective: Our purpose is to focus on the clinical and epidemiological characteristics of DRESS in the elderly and to identify the incriminated drugs. Methods: This is a retrospective study including patients, hospitalized for DRESS with a RegiSCAR ≥4. The population was divided into 2 groups according to age: 65 years or older (G1) and <65 years (G2). The statistical study was performed using the comparative and multivariate analysis. Results: We included 55 patients (30.9% G1 and 69.1% G2). Skin manifestations were comparable in both groups. Lymphadenopathy was less common in G1 with a statistically significant difference (P = 0.012). Renal impairment was more frequent in the elderly with a statistically significant result (P = 0.005). DRESS in the elderly group was significantly associated with the occurrence of sepsis (P = 0.008). Allopurinol was the most common culprit associated with DRESS in G1 (P = 0.001). Relapses and recurrences were comparable in both groups (P = 0.71). Conclusions: DRESS in the elderly is associated with a high risk of complications, mainly kidney involvement and sepsis. Allopurinol is the most incriminated drug.
{"title":"Characteristics of DRESS Syndrome in the Elderly: A Comparative Study of 55 Patients.","authors":"Emna Bahloul, Khaoula Trimeche, Khadija Sellami, Fatma Hammami, Faten Hayder, Rim Chaabouni, Meriem Amouri, Abderrahmen Masmoudi, Madiha Mseddi, Sonia Boudeya, Hamida Turki","doi":"10.1089/derm.2022.0032","DOIUrl":"10.1089/derm.2022.0032","url":null,"abstract":"<p><p><u><b><i>Background:</i></b></u> Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare drug reaction characterized by a skin rash, eosinophilia, and organ involvement. <u><b><i>Objective:</i></b></u> Our purpose is to focus on the clinical and epidemiological characteristics of DRESS in the elderly and to identify the incriminated drugs. <u><b><i>Methods:</i></b></u> This is a retrospective study including patients, hospitalized for DRESS with a RegiSCAR ≥4. The population was divided into 2 groups according to age: 65 years or older (G1) and <65 years (G2). The statistical study was performed using the comparative and multivariate analysis. <u><b><i>Results:</i></b></u> We included 55 patients (30.9% G1 and 69.1% G2). Skin manifestations were comparable in both groups. Lymphadenopathy was less common in G1 with a statistically significant difference (<i>P</i> = 0.012). Renal impairment was more frequent in the elderly with a statistically significant result (<i>P</i> = 0.005). DRESS in the elderly group was significantly associated with the occurrence of sepsis (<i>P</i> = 0.008). Allopurinol was the most common culprit associated with DRESS in G1 (<i>P</i> = 0.001). Relapses and recurrences were comparable in both groups (<i>P</i> = 0.71). <u><b><i>Conclusions:</i></b></u> DRESS in the elderly is associated with a high risk of complications, mainly kidney involvement and sepsis. Allopurinol is the most incriminated drug.</p>","PeriodicalId":11047,"journal":{"name":"Dermatitis","volume":" ","pages":"55-60"},"PeriodicalIF":5.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10152503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-04-04DOI: 10.1089/derm.2022.0040
Karlijn F van Halewijn, Floor van der Most, Arthur M Bohnen, Suzanne G M A Pasmans, Patrick J E Bindels, Gijs Elshout
Background: Real-life data on severity and treatments in children with atopic dermatitis (AD) are needed to evaluate self-management. Objectives: To determine severity and use of topical treatments in children with AD in the general population. Furthermore, we aim to determine agreement and correlation between objective and subjective AD severity measures. Methods: Data were used from the Rotterdam Eczema Study, an observational prospective cohort study with an embedded pragmatic open-label randomized controlled trial. Descriptive statistics were used for baseline characteristics, medication use, and severity. Strength of agreement and correlation were determined using kappa analysis and Pearson correlation. Results: In total, 367 children (mean age 5.7 years) were recruited. The mean eczema area and severity index (EASI) score was 2.1 (±3.2) and mean patient-oriented eczema measure (POEM) score was 10.3 (±6.1). The majority applied emollients on a daily basis (54.9%) and had not used topical corticosteroids (TCSs) over the past week (51%). Based on severity banding of POEM and EASI, 49.9% and 24.9% of the children were undertreated, respectively. No evidence was found for an agreement between EASI and POEM (kappa 0.028, n = 178, P = 0.451). A moderate correlation between POEM, EASI, infants' dermatitis quality of life index, and children's dermatology life quality index was found. POEM showed higher correlation with quality of life (QoL) than EASI. Conclusion: Emollients were used sufficiently in the study population. Based on signs or symptoms, 24.9% and 49.9% of children are undertreated, respectively. POEM scores correlated better with QoL than with EASI scores. We argue that EASI underestimates severity of AD, and treatment based on EASI scores may lead to undertreatment of AD. Treating physicians should be aware of suboptimal use of TCSs.
{"title":"Atopic Dermatitis in Children in the General Population: Baseline Characteristics, Medication Use, and Severity Measures in the Rotterdam Eczema Study.","authors":"Karlijn F van Halewijn, Floor van der Most, Arthur M Bohnen, Suzanne G M A Pasmans, Patrick J E Bindels, Gijs Elshout","doi":"10.1089/derm.2022.0040","DOIUrl":"10.1089/derm.2022.0040","url":null,"abstract":"<p><p><u><b><i>Background:</i></b></u> Real-life data on severity and treatments in children with atopic dermatitis (AD) are needed to evaluate self-management. <u><b><i>Objectives:</i></b></u> To determine severity and use of topical treatments in children with AD in the general population. Furthermore, we aim to determine agreement and correlation between objective and subjective AD severity measures. <u><b><i>Methods:</i></b></u> Data were used from the Rotterdam Eczema Study, an observational prospective cohort study with an embedded pragmatic open-label randomized controlled trial. Descriptive statistics were used for baseline characteristics, medication use, and severity. Strength of agreement and correlation were determined using kappa analysis and Pearson correlation. <u><b><i>Results:</i></b></u> In total, 367 children (mean age 5.7 years) were recruited. The mean eczema area and severity index (EASI) score was 2.1 (±3.2) and mean patient-oriented eczema measure (POEM) score was 10.3 (±6.1). The majority applied emollients on a daily basis (54.9%) and had not used topical corticosteroids (TCSs) over the past week (51%). Based on severity banding of POEM and EASI, 49.9% and 24.9% of the children were undertreated, respectively. No evidence was found for an agreement between EASI and POEM (kappa 0.028, n = 178, <i>P</i> = 0.451). A moderate correlation between POEM, EASI, infants' dermatitis quality of life index, and children's dermatology life quality index was found. POEM showed higher correlation with quality of life (QoL) than EASI. <u><b><i>Conclusion:</i></b></u> Emollients were used sufficiently in the study population. Based on signs or symptoms, 24.9% and 49.9% of children are undertreated, respectively. POEM scores correlated better with QoL than with EASI scores. We argue that EASI underestimates severity of AD, and treatment based on EASI scores may lead to undertreatment of AD. Treating physicians should be aware of suboptimal use of TCSs.</p>","PeriodicalId":11047,"journal":{"name":"Dermatitis","volume":" ","pages":"61-69"},"PeriodicalIF":5.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9247233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}