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Efficacy and Risk Stratification of Janus Kinase Inhibitors in the Treatment of Moderate-to-Severe Atopic Dermatitis. Janus 激酶抑制剂治疗中重度特应性皮炎的疗效和风险分层。
IF 5.2 3区 医学 Q1 Medicine Pub Date : 2024-01-01 Epub Date: 2023-08-01 DOI: 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。
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引用次数: 0
Patients' and Caregivers' Preferences for Mental Health Care and Support in Atopic Dermatitis. 特应性皮炎患者和护理人员对心理健康护理和支持的偏好。
IF 5.2 3区 医学 Q1 Medicine Pub Date : 2024-01-01 Epub Date: 2023-08-09 DOI: 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.

背景:特应性皮炎(AD)对患者和护理人员的心理健康有很大影响,但他们对如何缓解这些影响的偏好却知之甚少。目的:了解患者和护理人员对减轻特应性皮炎影响的偏好:了解患者和护理者对与特应性皮炎相关的心理健康护理和支持的偏好。方法:我们对 279 名成年注意力缺失症患者进行了调查:我们对 26 个国家的 279 名成人注意力缺失症患者和 154 名儿童注意力缺失症患者的照顾者进行了调查,内容涉及他们与注意力缺失症相关的心理健康负担、改善注意力缺失症相关心理健康的首选策略以及注意力缺失症心理健康护理的经验。结果:在控制注意力缺失症严重程度的情况下,照护者报告的总体心理健康状况(P = 0.01)和焦虑程度(P = 0.03)明显差于成年患者。在成年患者中,58%的人选择治疗注意力缺失症,51%的人选择控制瘙痒,44%的人选择穿衣服遮盖皮肤,43%的人选择避免社交场合,41%的人选择独处,他们认为这些策略可以改善自己与注意力缺失症相关的心理健康。照顾者最常选择的改善自身(分别为 76% 和 75%)和子女(分别为 75% 和 61%)心理健康的方法是止痒和治疗注意力缺失症。成年患者对心理健康服务提供者提供的心理健康护理的满意度低于非心理健康服务提供者(P 结 论:对心理健康服务提供者提供的心理健康护理的满意度低于非心理健康服务提供者(P 结 论):有效的注意力缺失管理是改善患者和照护者心理健康的首选方法,他们的心理健康可能会受到最大的影响。在共同决策方法中,应考虑自我护理策略。
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引用次数: 0
Atopic Dermatitis and Self-Image Design: A Real-Life Study in Children Using Drawings. 特应性皮炎与自我形象设计:使用绘画对儿童进行真实生活研究。
IF 5.2 3区 医学 Q1 Medicine Pub Date : 2024-01-01 Epub Date: 2023-02-01 DOI: 10.1089/derm.2022.0056
Camille Braun, Magali Bourrel-Bouttaz, Olivier Revol, Virginie Verdu, Anaïs Montagnon, Frédéric Bérard, Audrey Nosbaum

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.

背景:特应性皮炎(AD)会导致外貌和自尊的改变,影响儿童的个人发展。然而,目前还缺乏评估这种痛苦的工具。我们旨在评估患有特应性皮炎的儿童如何通过绘画表现自己。研究方法在这项回顾性研究中,我们纳入了儿童(结果:共有 64 名儿童(41 名[64.1%]女孩和 23 名[35.9%]男孩,年龄中位数[范围]为 8 [3-7] 岁)创作了 64 幅绘画作品。画作分为五组:"截肢者"(8 人,占 12.5%)、"相同"(18 人,占 28.1%)、"悲伤"(19 人,占 29.7%)、"复杂"(11 人,占 17.2%)和 "其他"(8 人,占 12.5%)。单变量分析发现,年龄在不同绘画组中的分布不同(P = 0.0047),浅色占主导地位也不同(P = 0.038)。其他变量(性别、研究者总体评估得分、活动性注意力缺失症和活动持续时间)在不同绘画组之间的分布没有差异。结论大多数注意力缺失症儿童都能通过绘画来表达有湿疹和无湿疹时的自我形象,以及他们的感受、与环境和同伴的互动。本文提出的可视化工具可在咨询时使用,以便:(a) 意识到治疗注意力缺失症的必要性;(b) 更好地评估注意力缺失症对儿童的影响;(c) 适当调整注意力缺失症的治疗。
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引用次数: 0
Sulfites: Allergen of the Year 2024. 亚硫酸盐2024 年的过敏原
IF 5.2 3区 医学 Q1 Medicine Pub Date : 2024-01-01 Epub Date: 2023-08-17 DOI: 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.

二亚硫酸钠,又称焦亚硫酸钠或焦亚硫酸钠,是一种无机化合物,可能会引起过敏性接触性皮炎。亚硫酸盐可作为抗氧化剂和防腐剂;常见来源包括食品/饮料、药品和个人护理产品。重要的是,亚硫酸盐并不包括在大多数筛查贴片测试系列中,因此可能会作为一种相关的接触性过敏原而被遗漏。美国接触性皮炎协会选择亚硫酸盐作为 2024 年年度过敏原,以提高人们对这一重要过敏原的认识。
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引用次数: 0
Localized Contact Urticaria by Egg in a Baby. 婴儿因鸡蛋引起的局部接触性荨麻疹
IF 5.2 3区 医学 Q1 Medicine Pub Date : 2024-01-01 Epub Date: 2023-04-11 DOI: 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
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引用次数: 0
Dupilumab and Atopic Dermatitis Flares: An Observational Study to Identify Common Clinical Features in Patients Who Have Exacerbations Despite Biological Therapy. 杜匹单抗与特应性皮炎复发:一项观察性研究,旨在确定在接受生物疗法后仍病情加重的患者的共同临床特征。
IF 5.2 3区 医学 Q1 Medicine Pub Date : 2024-01-01 Epub Date: 2023-03-28 DOI: 10.1089/derm.2023.0011
Filomena Russo, Vittoria Cioppa, Alessandra Cartocci, Nicola Milanesi, Angelo Massimiliano D'Erme, Laura Lazzeri, Pietro Rubegni, Francesco Santi
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引用次数: 0
Atopic Dermatitis in Children in the General Population: Baseline Characteristics, Medication Use, and Severity Measures in the Rotterdam Eczema Study. 普通人群中的儿童特应性皮炎:鹿特丹湿疹研究》中的基线特征、药物使用和严重程度测量。
IF 5.2 3区 医学 Q1 Medicine Pub Date : 2024-01-01 Epub Date: 2023-04-04 DOI: 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.

背景:需要有关特应性皮炎(AD)儿童严重程度和治疗方法的真实数据,以评估自我管理情况。目标: 确定一般特应性皮炎儿童的严重程度和外用治疗方法的使用情况:确定普通人群中儿童特应性皮炎的严重程度和局部治疗的使用情况。此外,我们还旨在确定客观和主观特应性皮炎严重程度测量之间的一致性和相关性。研究方法数据来自鹿特丹湿疹研究(Rotterdam Eczema Study),这是一项观察性前瞻性队列研究,其中包含一项实用开放标签随机对照试验。对基线特征、药物使用和严重程度进行了描述性统计。使用卡帕分析和皮尔逊相关性确定一致性和相关性的强度。结果:共招募了 367 名儿童(平均年龄 5.7 岁)。湿疹面积和严重程度指数(EASI)平均得分为 2.1 (±3.2),以患者为导向的湿疹测量(POEM)平均得分为 10.3 (±6.1)。大多数患者每天使用润肤剂(54.9%),过去一周未使用外用皮质类固醇激素(TCS)(51%)。根据 POEM 和 EASI 的严重程度分级,分别有 49.9% 和 24.9% 的儿童治疗不足。没有证据表明 EASI 与 POEM 之间存在一致性(kappa 0.028,n = 178,P = 0.451)。POEM、EASI、婴儿皮炎生活质量指数和儿童皮肤病生活质量指数之间存在中度相关性。POEM 与生活质量 (QoL) 的相关性高于 EASI。结论研究对象充分使用了润肤剂。根据体征或症状,分别有 24.9% 和 49.9% 的儿童治疗不足。POEM 评分与 QoL 的相关性优于 EASI 评分。我们认为,EASI 低估了 AD 的严重程度,根据 EASI 分数进行治疗可能会导致 AD 治疗不足。负责治疗的医生应该意识到TCS的次优使用。
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引用次数: 0
Hair Dyes Sensitization and Cross-Reactions: Challenges and Solutions: A Systematic Review of Hair Dye Allergens' Prevalence. 染发剂致敏和交叉反应:挑战与解决方案:染发剂过敏原流行情况的系统回顾。
IF 5.2 3区 医学 Q1 Medicine Pub Date : 2024-01-01 Epub Date: 2023-06-23 DOI: 10.1089/derm.2023.0019
Antonios Tsimpidakis, Alexandros Katoulis, Electra Nicolaidou, Dimitrios Rigopoulos, Alexander Stratigos, Stamatis Gregoriou

Widespread use of oxidative hair dyes during the past decades has raised questions on the potential allergy reactions and their management, as well as prevention measures for both professionals and consumers. Allergic contact dermatitis can be elicited by various hair dye-related allergens, though the main problem remains with p-phenylenediamine and related aromatic amines. If allergy is suspected, patch testing identifies the responsible hapten. Individuals sensitized to specific permanent hair dyes substances should avoid the exposure to these chemicals, but also be aware of possible cross-sensitization to other similar compounds. Cross-reactions detected in patch-tested populations indicate that one cannot safely use alternatives, although cross-reactivity is not always clinically relevant. An open application hair dye allergy self-test is recommended by manufacturers for early detection of allergy predisposition in consumers, although the lack of standardized conditions makes the efficacy of this process doubtful. Appropriate use of hand gloves, especially nitrile, is the most efficient prevention measure for professional hand eczema. In this systematic review, we focus on cross-reactions among hair dye-related allergens and make an attempt to answer some, frequently encountered by physicians, questions, while presenting the prevalence of the hair dye-related allergens.

在过去的几十年中,氧化型染发剂的广泛使用引发了潜在过敏反应、过敏反应的处理以及专业人士和消费者的预防措施等问题。各种与染发剂有关的过敏原都可能引起过敏性接触性皮炎,但主要问题仍然是对苯二胺和相关的芳香胺。如果怀疑是过敏,可通过斑贴试验来确定过敏原。对特定永久性染发剂物质过敏的人应避免接触这些化学物质,但也要注意可能会对其他类似化合物产生交叉过敏。在贴片测试人群中检测到的交叉反应表明,人们不能安全地使用替代品,尽管交叉反应并不总是与临床相关。生产商建议使用开放式染发剂过敏自测法,以便及早发现消费者的过敏倾向,但由于缺乏标准化条件,该方法的有效性值得怀疑。适当使用手套,尤其是丁腈手套,是预防职业手部湿疹的最有效措施。在这篇系统性综述中,我们重点关注染发剂相关过敏原之间的交叉反应,并试图回答一些医生经常遇到的问题,同时介绍染发剂相关过敏原的流行情况。
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引用次数: 0
That New Shoe Smell: Allergic Contact Dermatitis to Fragrance in Shoes. 新鞋的味道:鞋中香料引起的过敏性接触性皮炎。
IF 5.2 3区 医学 Q1 Medicine Pub Date : 2024-01-01 Epub Date: 2023-06-06 DOI: 10.1089/derm.2023.0094
Neil K Jairath, Vikash S Oza, Emily C Milam
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引用次数: 0
Emerging Role of Atopic Dermatitis Control Tool in Long-Term Monitoring of Patients With Moderate-to-Severe Atopic Dermatitis Treated With Dupilumab. 特应性皮炎控制工具在长期监测接受杜匹单抗治疗的中重度特应性皮炎患者中的新作用
IF 5.2 3区 医学 Q1 Medicine Pub Date : 2024-01-01 Epub Date: 2023-08-18 DOI: 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
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引用次数: 0
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Dermatitis
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