Eczema Determined by Genetics or Environment?

MedicalResearch.com Interview with:
“Eczema” by NIAID is licensed under CC BY 2.0Hans Bisgaard, MD, DMSc

Professor of Pediatrics
C‌openhagen U‌niversity H‌ospital, H‌erlev-G‌entofte
Copenhagen

MedicalResearch.com: What is the background for this study? What are the main findings?

 Response: The uniqueness of this study, is that we for the first time have day-to-day recordings of symptoms and use og local treatment during the first 3 years of life showing the disease peaks at 2 years of age and children start outgrowing thereafter.Previous studies including our own have analyzed eczema at a certain age.Since eczema is highly variable over time, our disease description is novel.This has allowed us a more reliable analyses of factors determining eczema in young children 

MedicalResearch.com: What should readers take away from your report?

Response: What we see it that eczema is determined by genetics and with no know external factors causing or deteriorating the severity.

 MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We are currently aiming to analyze the interaction between genetics and the environment. In other words though eczema is highly genetically determined, we have reason to believe that external factors triggers such genes.
 No conflicts of interest   

Citation:  

Thorsteinsdottir S, Stokholm J, Thyssen JP, et al. Genetic, Clinical, and Environmental Factors Associated With Persistent Atopic Dermatitis in Childhood. JAMA Dermatol. Published online November 14, 2018. doi:10.1001/jamadermatol.2018.4061

 

Nov 15, 2018 @ 12:52 pm

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IXORA-S Study Suggest Taltz May Provide Significantly Greater Clearance of Nail Psoriasis

MedicalResearch.com Interview with:

Lotus Mallbris, M.D., Ph.D., Vice president, Immunology Development Lilly Bio-Medicines 

Dr. Mallbris

Lotus Mallbris, M.D., Ph.D.,
Vice president, Immunology Development
Lilly Bio-Medicines 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: By exploring creative clinical approaches and patient-centric pathways to more thoroughly address the key aspects of treating these complex conditions, Lilly is bringing innovation forward in hopes of reducing the burden of dermatologic disease for people around the world.

The results of the IXORA-S study suggest that Taltz may provide significantly greater clearance of nail psoriasis than ustekinumab. This is significant because nail lesions are a common feature of psoriasis. It’s often associated with discomfort, which can lead to functional impairment and distress, further supporting the importance of complete clearance.   Continue reading

Atopic Dermatitis (Eczema) Patients Have Higher Likelihood of Osteoporosis

MedicalResearch.com Interview with:

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois

Dr. Jonathan Silverberg

Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois

MedicalResearch.com: What is the background for this study?

Response: Persons with atopic dermatitis have a number of risk factors for osteopenia and osteoporosis, including systemic atopy and inflammation, being less physically active and using a lot of topical and/or systemic corticosteroids. We aimed to determine whether adults with atopic dermatitis in fact have higher rates of physician-diagnosed osteopenia and osteoporosis.

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Inflammatory Cells That Suppress Skin Allergic Reactions Identified

MedicalResearch.com Interview with:
elstarNidhi Malhotra PhD

Boston Children’s Hospital
Division of Allergy and Immunology
Senior Scientist at Elstar Therapeutics Inc.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Allergies such as Atopic Dermatitis (AD) are rampant in the industrialized nations. Why are we more predisposed to developing hypersensitive reactions to innocuous proteins (allergens) is not well understood. To gain better understanding and to develop better therapies, we need to first delve deeper into how our immune system regulates homeostasis in tissues such as skin. The main cell types that thwart inflammatory reactions are known as regulatory T cells. These cells are generated in thymus and reside in secondary lymphoid tissues but they are also prominent at tissue sites such as in dermal layer of skin. In this study, I focused on understanding how Tregs resident in skin are distinct from the Tregs in secondary lymphoid organs such as lymph nodes (LNs). I uncovered that functioning of Tregs in skin is underpinned by a distinct set of genes. One main gene that I found to be highly expressed in skin Tregs but not in LN Tregs is Rora, which encodes for the transcription factor ROR alpha (RORa).

This observation was intriguing as previous studies had elucidated the requirement of RORa in the development of inflammatory type-2 innate lymphoid cells (ILC2s) and it has been considered the antagonizing RORa functioning would curb allergic responses. However, I observed that Tregs require RORa to suppress allergic responses. In particular, RORa regulates the expression of a TNF receptor family member DR3, which binds to the cytokine TL1A. TL1A has a role in enhancing suppressive activity of Tregs while also enhancing type-2 cytokine production from ILC2s. Hence, in the absence of DR3 in Tregs, we believe more TL1A is available to ILC2s resulting in unrestrained allergic responses.  Continue reading

Atopic Dermatitis: Skin Microbiome Altered in Lesional and Non-Lesional Skin

MedicalResearch.com Interview with:

“Eczema” by NIAID is licensed under CC BY 2.0

Eczema – Atopic Dermatitis

Maja-Lisa Clausen MD, Ph.D.-fellow
Department of Dermatology
Copenhagen University Hospital Bispebjerg 

MedicalResearch.com: What is the background for this study?

Response: ​The human microbiome seems to play an important role in health and disease, by influencing host cells and contributing to host immunity. A balanced interplay between host cells and resident bacteria is important, and dysbiosis is linked to several diseases, including skin diseases like atopic dermatitis. Patients with atopic dermatitis suffer from ​frequent skin infections, and their skin microbiome is dominated by S. aureus. Frequent skin infections lead to frequent use of antibiotics, and with worldwide increase in resistant bacteria, a better understanding of the interplay between host and bacteria is paramount in order to develop new treatment strategies.

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Atopic Dermatitis: IF Used At All, Systemic Steroids Should Be Short Term Bridge To Other Therapies

MedicalResearch.com Interview with:

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois

Dr. Jonathan Silverberg

Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Systemic corticosteroids are commonly used as systemic treatments for atopic dermatitis. However, few studies assessed the efficacy and safety of systemic corticosteroids in atopic dermatitis. This systematic review sought to summarize the available evidence for their use in atopic dermatitis.

Overall, 52 reviews and 12 studies were included in this systematic review. Most studies suffered from small sample size, low quality. In one of the only randomized-controlled trials performed, systemic corticosteroids were less effective than cyclosporine and led to more rebound flares. There were numerous safety and tolerability concerns with both short and long-term treatment with systemic corticosteroids. One study found that even short-term use of systemic corticosteroids was associated with increased sepsis, venous thromboembolism and fractures.

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Should Bleach Baths Be Used To Treat Eczema?

MedicalResearch.com Interview with:

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois

Dr. Jonathan Silverberg

Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Bleach baths have become widely used in clinical practice for the treatment of atopic dermatitis (AD). However, there have been conflicting results about the efficacy of bleach baths across different studies. We performed a systematic review and meta-analysis to determine whether bleach baths are consistently effective in decreasing the severity of atopic dermatitis.

Bleach baths were shown to be effective at reducing AD severity in all 4 of the included studies. However, when comparing bleach baths vs. regular water baths, only 2 found significantly greater decreases in atopic dermatitis severity with bleach baths, 1 found greater decreases with water baths, and 1 found no significant differences. There were 15 different severity assessment evaluations across studies at 4 weeks: only 3 assessments demonstrated that bleach baths were more effective than water baths, 11 reported no difference, and 1 reported regular water baths to be more effective. In pooled meta-analyses, there were no significant differences observed between bleach vs water baths at 4 weeks vs baseline for the Eczema Area and Severity Index or body surface area. Finally, there were no differences of Staphylococcus aureus density, other bacteriological assessments or skin infection rates between bleach vs. water baths.

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Children With Eczema and Food Allergies At Increased Risk of Developing Asthma

MedicalResearch.com Interview with:
“Eczema” by NIAID is licensed under CC BY 2.0Malcolm R. Sears, MB ChB

Firestone Institute for Respiratory Health
St Joseph’s Healthcare and McMaster University
Ontario Canada. 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Canadian Healthy Infant Longitudinal Development (CHILD) Study was initiated in 2008, funded by AllerGen NCA and CIHR, to determine root causes of allergy and asthma.

We recruited 3623 pregnant mothers in 4 centers across Canada and are following 3495 eligible children from pregnancy to age 5 years.

In this paper we describe some of the findings in early childhood, namely that children who develop skin conditions generally called eczema or atopic dermatitis, who are also sensitized to food allergens (milk, egg, peanut) at 1 year are at high risk of developing subsequent asthma, whereas those with these skin conditions but not sensitized are not at such risk.

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Atopic Dermatitis Modestly Raises Risk of 5-Year All Cause Mortality

MedicalResearch.com Interview with:

Alexander Egeberg, MD PhD Gentofte Hospital Department of Dermatology and Allergy Kildegårdsvej 28 2900 Hellerup Denmark 

Dr. Egeberg

Alexander Egeberg, MD PhD
Gentofte Hospital
Department of Dermatology and Allergy
Denmark 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In recent years, a number of studies have examined associations between atopic dermatitis and various comorbidities.  However, although comorbidities are extensively being examined, cause-specific mortality in patients with atopic dermatitis has not been examined. We examined 8,686 adults with atopic dermatitis, and compared these with 86,860 age- and sex-matched individuals from the general population.

In total, patients with atopic dermatitis had a 27% higher relative risk of all-cause mortality over a five-year period. Specific causes of death were due to infectious-, cardiovascular-, and urogenital diseases, respectively.

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Why Does Some Eczema Persist Into Adulthood?

MedicalResearch.com Interview with:

Dr. Katrina Abuabara MD, MA, MSCE University of California San Francisco

Dr. Abuabara

Dr. Katrina Abuabara MD, MA, MSCE
University of California San Francisco

MedicalResearch.com: What is the background for this study?

Response: Atopic dermatitis (synonymous with atopic eczema or just “eczema”) is a common and burdensome condition that often presents in childhood but can occur in individuals of any age. It is episodic, meaning that it waxes and wanes over time, and many patients will have periods without signs or symptoms of the disease. Conventional wisdom suggests that “most children” improve by adolescence, but prior studies have not had sufficiently frequent follow-up to detect episodic disease beyond childhood.

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Vitamin D Supplements Will Probably Not Help Asthma or Atopic Dermatitis

MedicalResearch.com Interview with:

Brent Richards, MD, MSc</strong> Associate Professor of Medicine William Dawson Scholar / FRQS Clinical Research Scholar Departments of Medicine, Human Genetics, Epidemiology and Biostatistics McGill University Senior Lecturer, King's College London (Honorary)

Dr. Brent Richards

Brent Richards, MD, MSc
Associate Professor of Medicine
William Dawson Scholar / FRQS Clinical Research Scholar
Departments of Medicine, Human Genetics, Epidemiology and Biostatistics McGill University
Senior Lecturer, King’s College London (Honorary)

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Some previous epidemiological studies have suggested that low vitamin D levels are associated with increased rates of asthma, atopic dermatitis—an itchy inflammation of the skin—and elevated levels of IgE, an immune molecule linked to atopic disease (allergies). In our study, we looked at genetic and health data on more than 100,000 individuals from previous large studies to determine whether genetic alterations that are associated with vitamin D levels predispose people to the aforementioned conditions.

We found no statistically significant difference between rates of asthma (including childhood-onset asthma), atopic dermatitis, or IgE levels in people with and without any of the four genetic changes associated with lower levels of 25-hydroxyvitamin D, the form of vitamin D routinely measured in the blood.

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Gene Involved in Defective Skin Barrier and Eczema and Ichthyosis Identified

MedicalResearch.com Interview with:

Akio Kihara, PhD. Laboratory of Biochemistry Faculty of Pharmaceutical Sciences, Hokkaido University Sapporo, Japan

Dr. Akio Kihara

Akio Kihara, PhD.
Laboratory of Biochemistry
Faculty of Pharmaceutical Sciences, Hokkaido University
Sapporo, Japan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The skin barrier is the most powerful defensive mechanism terrestrial animals possess against pathogens and harmful substances such as allergens and pollutants. Recent studies indicate that lipids play a central role in skin barrier formation. Multi-lamellar structures consisting of lipids are formed extracellularly in the stratum corneum, the outermost layer of epidermis, and their high hydrophobicity prevents the invasion of external pathogens and compounds.

The stratum corneum-specific lipid acylceramide is especially important for skin barrier formation. Decreases in acylceramide levels are associated with cutaneous disorders such as ichthyosis and atopic dermatitis. However, the mechanism behind acylceramide production is poorly understood, especially regarding the last step of acylceramide production: i.e., esterification of ω-hydroxyceramide with linoleic acid. This means that the broader picture of the molecular mechanisms behind skin barrier formation still remained unclear.

Although PNPLA1 has been identified as an ichthyosis-causative gene, its function in skin barrier formation remains unresolved. In the present study, we revealed that PNPLA1 catalyzes the last step of acylceramide synthesis. Our finding completes our knowledge of the entire pathway of the acylceramide production, providing important insights into the molecular mechanisms of skin barrier formation.

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Smoking Associated With Comorbidities in Atopic Dermatitis

MedicalResearch.com Interview with:

Jacob P. Thyssen MD, PhD, DmSci Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup, Denmark

Dr. Thyssen

Jacob P. Thyssen MD, PhD, DmSci
Department of Dermatology and Allergy
Herlev and Gentofte Hospital
University of Copenhagen
Hellerup, Denmark

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Atopic dermatitis has been associated with various comorbidities. With the emergence of biologics for the treatment of atopic dermatitis, the hypothesis has been raised that atopic dermatitis is a systemic immune disease affecting more than just the skin.

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Safer Immunotherapy Dupilumab (Dupixent) FDA Approved For Atopic Dermatitis

MedicalResearch.com Interview with:

Emma Guttman, MD, PhD Professor, Dermatology, Medicine and Clinical Immunology Vice Chair of Research in the Dermatology Department Director of the center for Excellence  Eczema in the Occupational/Contact Dermatitis clinic  Director of the Laboratory of Inflammatory Skin Diseases Icahn School of Medicine at Mount Sinai Medical Center New York

Dr. Guttman

Emma Guttman, MD, PhD
Professor, Dermatology, Medicine and Clinical Immunology
Vice Chair of Research in the Dermatology Department
Director of the center for Excellence
Eczema in the Occupational/Contact Dermatitis clinic
Director of the Laboratory of Inflammatory Skin Diseases
Icahn School of Medicine at Mount Sinai Medical Center
New York

MedicalResearch.com: Would you briefly explain what is meant by atopic dermatitis? How many people are affected by this disorder?

Response: Atopic dermatitis or eczema as most people know it is an itchy red scaly skin disorder characterized by a very severe itch, that disrupts daily activities, and sleep and severely impairs the quality of life of patients. In the US 30 million people are affected by it, and 1/3 of these we expect to be moderate to severe.

MedicalResearch.com: What is the background for Dupilumab therapy? How does it differ from emollients, steroids or topical immunomodulator treatments for eczema ie Protopic?

Response: The background is that we currently do not have good treatments for long term use for our moderate to severe patients. The only approved drug by the FDA for atopic dermatitis in the US is oral prednisone, that has many long term side effects and causes disease rebound upon discontinuation. Other treatments with many side effects

are broad immune suppressants–Cyclopsorin A, Mycophenolate mofetyl and phototherapy that is not feasible for most patients.

Thus there is a large unmet need for safer and better treatments for moderate to severe atopic dermatitis patients.

Dupilumab is different since it only targets one immune axis–Th2 axis, providing a safer alternative, with high efficacy, that is equal or even better than cyclosporin A, that is the current gold standard immune suppressant, and harbors many side effects including permanent effects on the kidneys after long term use. Topical treatments, while useful for mild patients, are often not adequate or sufficient to control moderate to severe patients that usually have more than 10% body surface area involved and need a systemic treatment.

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Poorly Controlled Atopic Dermatitis Causes Significant Inpatient Financial Burden

MedicalResearch.com Interview with:

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois

Dr. Jonathan Silverberg

Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Atopic dermatitis (AD) is associated with considerable morbidity and quality of life impairment. AD patients may require hospitalization for acute treatment of serious flares and/or inadequately controlled chronic disease.

We examined data from the 2002-2012 National Inpatient Sample, which contains a representative 20% sample of all hospitalizations in the United States. We found that there were substantial numbers of children and adults hospitalized in the United States for AD. Hospitalization rates for atopic dermatitis were highest in the northeast during the winter likely due to cold and dry weather and south during the summer likely due to heat and humidity. Further, hospitalization rates for AD significantly increased in adults between 2002 and 2012. The costs per individual hospitalization were lower in children and adults with AD compared to those without  atopic dermatitis. However, the high prevalence of hospitalization resulted in total inpatient costs of >$8 and >$3 million per-year for adults and children, respectively.

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Prenatal Tobacco Smoke Raises Risk of Atopic Dermatitis in Offspring

MedicalResearch.com Interview with:

Dr. Saskia Trump PhD Helmholtz-Centre for Environmental Research – UFZ Department of Environmental Immunology Leipzig, Germany

Dr. Saskia Trump

Dr. Saskia Trump PhD
Helmholtz-Centre for Environmental Research – UFZ
Department of Environmental Immunology
Leipzig, Germany

MedicalResearch.com: What is the background for this study?

Response: Environmental chemicals have long been discussed to contribute to the exacerbation or even the development of allergic diseases. In our study we were particularly interested in the effect of tobacco smoke exposure, which is the main source for indoor benzene exposure, on regulatory T cell (Treg) function and its relation to the development of childhood atopic dermatitis (AD). Tregs play a critical in controlling T effector cell activity by avoiding overexpression. A deficiency in this T cell subset increases the risk for allergic inflammation.

We have previously described that exposure to tobacco smoke during pregnancy can decrease the number of regulatory T cells (Treg) in the cord blood and predispose the child to the development of AD (1). In this subsequent study we were interested in the underlying mechanism involved.

Benzene itself is not considered to be toxic, however its metabolization leads to the formation of highly reactive molecules. In humans for example the metabolite 1,4-benzochinone (1,4-BQ) can be found in the blood as a consequence of benzene exposure.

To further assess the effect of benzene on Treg and the development of AD we combined in vitro studies, evaluating the impact of 1,4-BQ on human expanded Treg, with data from our prospective mother-child cohort LINA. The LINA study, recruited in Leipzig, Germany, is a longitudinal evaluation of mother-child pairs with respect to lifestyle and environmental factors that might contribute to disease development in the child. Based on this deeply phenotyped cohort we were able to translate our in vitro findings to the in vivo scenario.

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Moisturizers Reduce Severity of Eczema

MedicalResearch.com Interview with:

Dr. Esther van Zuuren

Dr. Esther van Zuuren

Esther van Zuuren MD
on behalf of the authors
Department of Dermatology
Leiden University Medical Center
Leiden, Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In view of the high prevalence of eczema and the exponential increase in number of clinical trials over recent years, the NIHR designated this clinical topic, emollients and moisturisers for eczema, as a high priority. Widely prescribed as the basis of eczema management the treatment strategy is often supported by a mixed array of reviews and guidelines. Evidence for the effectiveness of emollients and moisturisers is also of variable quality.

Eczema is a chronic skin disorder, the main symptoms being dry skin and intense itching with a significant impact on quality of life. As dry skin is an important feature, moisturisers are a cornerstone of eczema treatment, but there was uncertainty about their efficacy and whether one moisturiser is preferable to another. The main finding of our review is that indeed moisturisers are effective.

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Moisturizers Are Cost-Effective Mainstay of Eczema Treatment

MedicalResearch.com Interview with:

Steve Xu MD, MSc Resident Physician Department of Dermatology Northwestern Feinberg School of Medicine

Dr. Steve Xu

Steve Xu MD, MSc
Resident Physician
Department of Dermatology
Northwestern Feinberg School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Given the limited data on the effectiveness or safety of the different moisturizers examined in the study, how much do you think parents should decide what to use on their babies based on the “cost-effectiveness” determined in this study? Would you just say cheapest is best since we don’t know how well these things work? Or what’s the message?

Price. Petrolatum is an extremely effective moisturizer. It also happens to be one of the most affordable. Unlike adults, I don’t suspect newborns will complain too much about the greasiness of petrolatum. They’re less concerned that their work clothes will get ruined. They are less likely to care about cosmetic elegance.

I also will say that petrolatum is less likely to include any artificial fragrances, preservatives that could serve as irritants or allergens in the future. That’s an added bonus.

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10-Year Mortality Risk Raised With Atopic Dermatitis, But Lower Than Psoriasis

MedicalResearch.com Interview with:

Alexander Egeberg, MD PhD National Allergy Research Centre, Departments of Dermato-Allergology and Cardiology Herlev and Gentofte University Hospital, University of Copenhagen Hellerup, Denmark

Dr. Alexander Egeberg

Alexander Egeberg, MD PhD
Gentofte Hospital
Department of Dermatology and Allergy
Hellerup Denmark

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In recent years, numerous studies have examined the impact of psoriasis and associated comorbidities, and found a reduced lifespan in particular among patients with severe disease. However, little is known about the impact and burden of adults with atopic dermatitis. We looked at the 10-year survival among patients hospitalized for atopic dermatitis, and compared these with patients hospitalized for psoriasis, as well as with subjects from the general population.

Our main finding was that, although the mortality risk was higher for atopic dermatitis compared with general population control subjects, the risk was significantly lower compared with psoriasis patients.

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Vitamin B3 in Pregnancy and Atopic Dermatitis in Childhood

MedicalResearch.com Interview with:
Dr Sarah El-Heis MBBS, MRCP (London)
Clinical Research Fellow
MRC Lifecourse Epidemiology Unit
University of Southampton
Southampton General Hospital
Southampton

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Atopic eczema is a common, multifactorial and potentially distressing skin condition. Evidence that it partly originates in utero is increasing with some studies suggesting links with aspects of maternal diet during pregnancy.

Nicotinamide is a naturally occurring nutrient that is maintained through the dietary intakes of vitamin B3 and tryptophan. As a topical treatment it has been used in the management of some skin conditions including atopic eczema, and has been shown to have anti-inflammatory effects, to stabilise mast cells and to alter lipids in the outer layers of the skin.

The objective of our study was to examine the link between maternal serum concentrations of nicotinamide and related tryptophan metabolites to the risk of atopic eczema in the offspring.

We found that maternal late pregnancy concentrations of nicotinamide and related metabolite concentrations were not associated with offspring atopic eczema at age 6 months. Higher maternal serum concentrations of nicotinamide and anthranilic acid were, however, associated with a 30% lower risk of eczema at age 12 months.

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Early Immune Intervention May Prevent Atopic March of Eczema and Allergies

MedicalResearch.com Interview with:
Emma Guttman-Yassky, MD, PhD

Professor of Dermatology and Immunology
Vice Chair of the Department of Dermatology at the Icahn School of Medicine and
Amy S. Paller, MD
Walter J. Hamlin Professor
Chair of the Department of Dermatology at Northwestern

MedicalResearch.com: What is the background for this study?

Response: Researchers for the first time have identified the skin phenotype of pediatric eczema or atopic dermatitis (AD) in infants, opening the door for personalized treatment approaches for young children with eczema. The study, led by researchers at the Icahn School of Medicine at Mount Sinai and Northwestern University’s Feinberg School of Medicine, was published online today in the Journal of Allergy and Clinical Immunology.

Emma Guttman-Yassky, MD, PhD, Professor of Dermatology and Immunology, and Vice Chair of the Department of Dermatology at the Icahn School of Medicine, and Amy S. Paller, MD, Walter J. Hamlin Professor and Chair of the Department of Dermatology at Northwestern, investigated lesional and non-lesional skin biopsies from 19 AD infants under the age of five, and compared them to age-matched pediatric controls, in addition to adult AD biopsies. The researchers found that the non-lesional, or normal-appearing, skin of young children with early eczema is already highly abnormal with significant immune activation, simulating that of lesional skin of adults with many years of active disease.

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Which Come First? Atopic Dermatitis or Staph Aureus Colonisation?

MedicalResearch.com Interview with:

Prof. Alan Irvine DSc Consultant Dermatologist Our Lady’s Children’s Hospital Associate Professor of Dermatology Trinity College Dublin

Prof. Alan Irvine

Prof. Alan Irvine DSc
Consultant Dermatologist Our Lady’s Children’s Hospital
Associate Professor of Dermatology
Trinity College Dublin

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background is that atopic dermatitis (AD) has a close relationship with staphylococcus aureus (SA) colonisation, and this is known to drive flares or exacerbations of AD but before our report it was not known which came first-AD colonisation or atopic dermatitis?

By following a cohort pf patients very carefully over a 1 year period and regularly sampling their skin microbiome we were able to show that SA colonisation did not precede development of AD and in fact that several non SA species of staphylococcus actually appeared to be protective for developing atopic dermatitis.

This is an important new finding in the complex relationship between the microbiome and skin inflammation, suggesting that some commensal bacterial are anti-inflammatory or protective.

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Most Childhood Atopic Dermatitis Lasts About Three Years

MedicalResearch.com Interview with:

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois

Dr. Jonathan Silverberg

Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois

MedicalResearch.com: What is the background for this study?

Response: Some children with atopic dermatitis may have disease activity persist into adolescence and adulthood, although most children are thought to “grow out of it.” There have been a number of studies with varied results about how commonly atopic dermatitis actually persists later in life. Moreover, the risk factors for persistence of atopic dermatitis are unclear. We sought to systematically analyze the extant literature of research studies to determine the rates and predictors of atopic dermatitis persistence over time.
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Could Melatonin Improve Both Sleep and Skin in Atopic Dermatitis?

Prof-Bor-Luen-Chiang.png

Prof. Chiang

MedicalResearch.com Interview with:
Prof. Bor-Luen Chiang
Vice Superintendent, National Taiwan University Hospital
Professor of Graduate Institute of Clinical Medicine and Pediatrics
National Taiwan University
Attending Physician, Department of Medical research
National Taiwan University Hospital and

Yung-Sen Chang, MD MPH
Attending physician, Department of Pediatrics,
Taipei City Hospital Renai Br.
Adjunct Attending Physician, Department of Pediatrics
National Taiwan University Children’s Hospital
Adjunct Instructor, School of Medicine, National Yang-Ming University

Medical Research: What is the background for this study?

Prof. Chang: Sleep disturbance is a common disorder in the children with atopic dermatitis (AD) (reported in 47 to 60%), but no effective way of managing this problem had been established. In our preceding study, we found that lower nocturnal melatonin level was significantly associated with sleep disturbance in the patients with AD. Melatonin is a hormone secreted by the pineal gland which plays an important role in sleep regulation. In addition to sleep-inducing effects, melatonin also has anti-inflammatory and immunomodulatory properties which might be helpful for the management o fatopic dermatitis. Furthermore, melatonin has an excellent safety profile with minimal adverse effects, making it a good choice for children. Therefore, we aimed to evaluate whether melatonin is effective for improving the sleep problems and the dermatitis severity in children with atopic dermatitis.

Medical Research: What are the main findings?

Prof. Chang: From our double-blind, placebo-controlled crossover study, we found that after melatonin treatment, the sleep onset latency shortened by 21.4 minutes compared with placebo (from a mean of 44.9 minutes to 21.6 minutes). The Scoring Atopic Dermatitis Index (higher scores representing more severe dermatitis) also decreased by 9.9 compared with placebo (from a mean of 49.1 to 40.2). No adverse events were reported throughout the study.

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Why Do Dilute Bleach Baths Improve Atopic Dermatitis?

Adam Friedman, MD, FAADAssociate Professor of Dermatology Residency Program Director Director of Translational Research Department of Dermatology George Washington School of Medicine and Health ScienceMedicalResearch.com Interview with:
Adam Friedman, MD, FAAD
Associate Professor of Dermatology
Residency Program Director
Director of Translational Research
Department of Dermatology
George Washington School of Medicine and Health Sciences

Medical Research: What is the background for this study? What are the main findings?

Dr. Friedman: Given pruritus is not only a hallmark symptom of atopic dermatitis, and in fact is even part of the diagnostic criteria, we sought to evaluate whether factors known to cause itch or inhibit said pruritogens in other disease states are over or under expressed in skin from patients diagnosed with atopic dermatitis. Over the past 10 years considerable attention has been paid to the complexity of the immune dysregulation and plethora of inflammatory and neurogenic factors involved in the activity and progression of this disease. Our study showed significant differences between atopic dermatitis skin and normal skin.  Specifically, we found significantly elevated levels of several well-known components of both the inflammatory and pruritus cascade including interleukin-2, BLT1 (the receptor for leukotriene B4, recently implicated in atopic dermatitis), 5-lipoxygenase and Matrix Metalloproteinase-7.  Interestingly, for the first time to our knowledge, α-2 macroglobulin, a ubiquitous protein found in the skin that binds a host of proteases, growth factors (TGF-b, PDGF, b-NGF) and inflammatory cytokines (TNF-α, IL-1b, IL-2, IL-6, IL-8), was found to be significant unregulated in atopic skin. Because it has a known an important role in the modulation of inflammation, as its binding acts to inhibit the majority of these mediators, this overexpression may in fact be a compensatory mechanism for ongoing disease. Importantly, when activated through chloramination by, for example, bleach, it can very effeectively scavenge these pro-inflammatory mediators. Thus leading to the second goal of this study.

One of the driving forces for selecting the various “itch or anti-itch factors” is that all can be augmented by hypochlorous acid, which is what bleach disassociates into when mixed with water. Bleach baths have been used for years as an adjuvant to treatment in atopic dermatitis.  When mixed with water, sodium hypochlorite (NaOCL) produces hypochlorous acid (HOCl), a compound stable between pH 3 and 6. HOCl is known to have antimicrobial properties, and therefore it was believed that bleach baths lowered bacterial burden on the skin and prevented and treated localized skin infections and colonization by organisms such as Staphylococcus aureus. Recent studies have found that HOCl intact has potent anti-inflammatory properties, and therefore we sought to expand this data by evaluating whether factors augmented by HOCl are overexposed in atopic dermatitis skin, giving some insight into how bleach bathes or HOCl products may aid in disease and symptom management. Continue reading