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1.
J Am Acad Dermatol ; 90(3): 561-568, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37984723

RESUMEN

BACKGROUND: Atopic dermatitis (AD) is thought to precede the onset of other allergic illness (OAI) in a temporal progression (ie, atopic march), yet the timing and progression has been questioned. It is also unclear how parental allergic illness impacts the development of these illnesses in offspring. OBJECTIVE: (1) Explore risk of incident AD and (2) timing of allergic disease onset in children of mothers with AD compared with mothers without AD from the United Kingdom. METHODS: We created a birth cohort of mother-child pairs using IQVIA Medical Research Data database and developed Cox proportional models to examine the above associations (hazard ratio, HR [95% confidence interval, CI]). RESULTS: Among 1,224,243 child-mother pairs, mean child (standard deviation) follow-up time was 10.8 (8.3) years and 50.1% were males (N = 600,905). Children were 59% (HR = 1.59 [1.57, 1.60]) more likely to have AD if their mothers had AD compared with no AD with mean age of first AD diagnosis at 3.3 (4.8) years. Most children with any diagnosis of AD present with AD first (91.0%); however, in those with asthma, only 67.8% developed AD first. CONCLUSION: Children born to mothers with AD are more prone to develop AD and some develop OAI first, suggesting that not all follow the same sequential pathway.


Asunto(s)
Asma , Dermatitis Atópica , Hipersensibilidad , Masculino , Humanos , Preescolar , Femenino , Dermatitis Atópica/epidemiología , Dermatitis Atópica/diagnóstico , Estudios de Cohortes , Asma/epidemiología , Reino Unido/epidemiología , Factores de Riesgo
2.
J Am Acad Dermatol ; 86(3S): S9-S17, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-34942293

RESUMEN

Terrestrial sunlight is the portion of electromagnetic radiation that is emitted by the sun and reaches Earth's surface. It encompasses 3 major components: UV radiation (290-400 nm), visible light (400-700 nm), and infrared radiation. The deleterious effects of UV radiation have been appreciated for decades, particularly among those with light skin tones (Fitzpatrick skin types I-II) who primarily manifest with burns of varying degrees of severity with sun exposure. In recent years, studies have increasingly shown the negative impact of visible light on skin health, particularly in individuals with skin of color (Fitzpatrick skin types IV-VI), including the exacerbation of hyperpigmentation disorders such as melasma and post-inflammatory hyperpigmentation, as well as induction of the former. Recommendations from medical societies and the US Food and Drug Administration for photoprotection have been evolving along with the knowledge base. Yet, misconceptions about skin damage related to sunlight and the benefits of photoprotection (particularly among those with Fitzpatrick skin types V-VI) are still prevalent among both clinicians and patients. Among patients with skin of color, disorders of hyperpigmentation and other consequences from sun exposure have been associated with impaired skin health and negative burden on quality of life. This review summarizes currently available evidence of the impact of both UV and visible wavelengths and the low utilization of photoprotection measures among people with skin of color, with the goal of providing recommendations to help educate patients.


Asunto(s)
Hiperpigmentación , Protectores Solares , Humanos , Hiperpigmentación/prevención & control , Rayos Infrarrojos , Calidad de Vida , Piel , Pigmentación de la Piel , Protectores Solares/uso terapéutico , Rayos Ultravioleta/efectos adversos
3.
J Am Acad Dermatol ; 86(3S): S1-S8, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-34942296

RESUMEN

The negative effects of sun exposure have become better accepted among health care professionals and the lay public over recent decades. Most attention has been focused on the effects of UV light, particularly UVB wavelengths (290-320 nm). Accordingly, products to protect skin from sunlight-associated harm (sunscreens) have been developed to minimize UVB exposure. The effects of longer wavelengths, including UVA (320-400 nm) and visible light (VL, 400-700 nm), are increasingly appreciated. VL accounts for approximately half of the solar radiation that reaches the earth's surface and understanding of its effects on the skin is improving. Studies have shown that VL can induce hyperpigmentation in individuals with dark skin types (Fitzpatrick skin types IV-VI). In addition, VL can contribute to the exacerbation of pigmentary disorders, including melasma. Because these findings are relatively new, there are gaps in understanding the needs for photoprotection and guidance for clinicians. A panel of dermatologists and photobiologists was convened to develop consensus recommendations and clinical guidance about sunscreen use relevant to the current understanding of risks associated with sun exposure using a modified Delphi method.


Asunto(s)
Piel , Protectores Solares , Consenso , Humanos , Luz Solar/efectos adversos , Protectores Solares/farmacología , Protectores Solares/uso terapéutico , Rayos Ultravioleta/efectos adversos
4.
Dermatol Ther ; 35(12): e15954, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36270978

RESUMEN

To address the need for long-term efficacy and patient-reported outcomes (PROs) data for patients with atopic dermatitis (AD) treated with baricitinib 2 mg, a study was conducted to evaluate the efficacy of baricitinib 2 mg in adult patients with moderate-to-severe AD. Data presented here provided efficacy and outcomes data for patients treated for 52 weeks. Patients who participated in the originating study, BREEZE-AD5 (NCT03435081), and met additional eligibility criteria could enroll in the multicenter, open-label, Phase 3, long-term extension study BREEZE-AD6 (NCT03559270). Patients received baricitinib 2 mg for the duration of BREEZE-AD6. In BREEZE-AD6, the proportion of patients who achieved a 75% improvement in the Eczema Area and Severity Index (EASI75) and validated Investigator Global Assessment for AD (vIGA-AD™) of 0 (clear) or 1 (almost clear) were assessed through 52 weeks, in addition to several PROs. At week 52, the proportion of patients treated with baricitinib 2 mg daily achieving EASI75 was 48.6% (70/144), and 31.3% (45/144) of patients achieved a vIGA-AD score of 0 or 1 (clear or almost clear). Improvements in PROs such as SCORing Atopic Dermatitis (SCORAD, itch and sleep) scores, Dermatology Life Quality Index (DLQI) total score, and DLQI ≤5 response were observed, and these responses were sustained through 52 weeks. Long-term efficacy of baricitinib in patients with AD was demonstrated by both clinician and patient-reported outcome measures.


Asunto(s)
Dermatitis Atópica , Adulto , Humanos , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/tratamiento farmacológico , Índice de Severidad de la Enfermedad , Medición de Resultados Informados por el Paciente , América del Norte , Resultado del Tratamiento , Método Doble Ciego
5.
Qual Life Res ; 30(6): 1705-1713, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33538979

RESUMEN

PURPOSE: "Not relevant" responses (NRRs) on the Dermatology Life Quality Index (DLQI) are common among adults with psoriasis and may be associated with underestimation of disease burden. Little is known about "not relevant" responses among adults with atopic dermatitis. We aimed to examine the frequency of NRRs on the DLQI and to determine whether NRRs are associated with underestimation of disease burden among adults with atopic dermatitis. METHODS: Adults with atopic dermatitis were identified and evaluated via online survey. We evaluated the frequency of NRRs on the DLQI, stratified by sociodemographic characteristics. To examine the association between NRRs and other measures of disease burden, Patient-Oriented Eczema Measure (POEM), Patient-Oriented SCORAD (PO-SCORAD), and Short-Form (SF)-12 scores were compared between those who responded "not relevant" versus "not at all". RESULTS: Among 764 adults with atopic dermatitis, most had mild disease. The median (interquartile range [IQR]) POEM, PO-SCORAD, and DLQI scores were 5 (2-10), 24 (14-34), and 2 (1-6), respectively. Most (55.2%) also had at least one NRR, and 17.9% had 4 or more "not relevant" responses, with differences across several sociodemographic characteristics. There were no substantial differences in SF-12, POEM, and PO-SCORAD scores between those who responded "not relevant" versus "not at all". CONCLUSION: NRRs on the DLQI are common among adults with atopic dermatitis and differ across sociodemographic characteristics, suggesting issues with content validity. There is not a clear association between NRRs and other measures of disease severity among adults with mostly mild atopic dermatitis.


Asunto(s)
Dermatitis Atópica/psicología , Eccema/psicología , Psicometría/estadística & datos numéricos , Calidad de Vida/psicología , Adulto , Costo de Enfermedad , Estudios Transversales , Dermatología/métodos , Humanos , Masculino , Persona de Mediana Edad , Psoriasis/psicología , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios
7.
J Am Acad Dermatol ; 80(6): 1630-1639, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30654078

RESUMEN

BACKGROUND: There has been an increase in the number of psoriasis treatments being investigated in clinical trials. Patients may have undiagnosed issues at the start of a study which may become identified during follow-up as incident medicinal conditions. The prevalence of incidental findings in patients with moderate-to-severe psoriasis presenting for clinical trials is unknown. OBJECTIVE: Determine the prevalence of incidentalomas and rate of malignancy identified by fludeoxyglucose F 18 (FDG) positron emission tomography/computed tomography (PET/CT) imaging in clinical trial patients with moderate-to-severe psoriasis. METHODS: A cross-sectional secondary analysis of patients with moderate-to-severe psoriasis who underwent FDG PET/CT scans at the baseline visit, before randomization, for 3 phase 4 clinical trials on vascular inflammation in psoriasis. Only patients without active infection, malignancy, or uncontrolled comorbidities were eligible for the clinical trials. RESULTS: A total of 259 healthy patients with moderate-to-severe psoriasis underwent an FDG PET/CT scan as part of the study procedures. In all, 31 patients (11.97%) (95% confidence interval [CI], 8.28-16.56) had clinically significant incidentalomas on the baseline FDG PET/CT scan. Univariate logistic regression demonstrated that with every increase of 10 years of age, there was an approximate 30% increased risk of discovery of an incidentaloma (odds ratio, 1.30; 95% CI, 1.01-1.68). Of those patients with findings suggestive of malignancy (n = 28), 6 were confirmed to have cancer, resulting in a 2.31% (95% CI, 0.9-5.0) prevalence of malignancy. The positive predictive value of a true cancer was 31.58% (range, 21%-54%). LIMITATIONS: Generalizability and lost to follow-up. CONCLUSION: Incidentalomas on FDG PET/CT imaging are common in otherwise healthy, asymptomatic patients with moderate-to-severe psoriasis in clinical trials. Our results can help inform interpretation of clinical trial safety data and emphasize the importance of compliance with cancer screening recommendations.


Asunto(s)
Hallazgos Incidentales , Neoplasias/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Psoriasis/complicaciones , Imagen de Cuerpo Entero , Adulto , Anciano , Enfermedades Asintomáticas , Ensayos Clínicos como Asunto , Comorbilidad , Estudios Transversales , Etnicidad , Femenino , Radioisótopos de Flúor , Fluorodesoxiglucosa F18 , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Valor Predictivo de las Pruebas , Prevalencia , Psoriasis/epidemiología , Radiofármacos , Índice de Severidad de la Enfermedad , Fumar/epidemiología
8.
J Am Acad Dermatol ; 81(4): 923-930, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31163241

RESUMEN

BACKGROUND: There are limited data about the impact of narrowband ultraviolet B phototherapy on patient-reported measures of health-related quality of life. OBJECTIVE: To evaluate the impact of adalimumab and phototherapy on health-related quality of life. METHODS: We examined patient-reported outcomes from a multicenter, randomized, placebo-controlled trial (ClinicalTrials.gov no. NCT01553058). The Dermatology Life Quality Index and EQ-5D-3L were evaluated every 4 weeks. RESULTS: We enrolled 97 patients: 30.9% were female, mean age was 43.5 years (standard deviation, 14.0), and median Psoriasis Area and Severity Index score was 16.7 (interquartile range, 13.9-21.6). At week 12, patients being treated with adalimumab (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.02-8.17) and phototherapy (OR, 8.83; 95% CI, 2.47-31.57) were more likely to achieve the minimal clinically important difference in the Dermatology Life Quality Index compared with those receiving placebo. There were higher odds of achieving the minimal clinically important difference for the EQ-5D-3L Index score when comparing phototherapy versus placebo (OR, 9.78; 95% CI, 2.99-31.95) and phototherapy versus adalimumab (OR, 4.07; 95% CI, 1.42-11.70). LIMITATIONS: Small sample size, secondary analysis, generalizability. CONCLUSION: Phototherapy and adalimumab both improve skin-related quality of life and overall health-related quality of life compared with placebo in patients with psoriasis; however, patients treated with phototherapy achieved more improvement in overall health-related quality of life compared with patients treated with adalimumab.


Asunto(s)
Adalimumab/uso terapéutico , Antiinflamatorios/uso terapéutico , Psoriasis/terapia , Calidad de Vida , Terapia Ultravioleta , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diferencia Mínima Clínicamente Importante , Medición de Resultados Informados por el Paciente , Índice de Severidad de la Enfermedad
9.
Eur Heart J ; 39(39): 3608-3614, 2018 10 14.
Artículo en Inglés | MEDLINE | ID: mdl-28444172

RESUMEN

Aims: To determine the risk of venous thromboembolism (VTE) defined as the combined endpoint of deep venous thrombosis (DVT) and pulmonary embolism (PE) among patients with psoriatic arthritis (PsA), psoriasis and rheumatoid arthritis (RA) compared with population controls. Methods and results: A cohort study was conducted in a primary care medical record database in the UK with data from 1994-2014 among patients with PsA, RA, or psoriasis. Cox proportional hazards models were used to calculate the relative hazards for DVT, PE, and VTE. An interaction with disease modifying anti-rheumatic drugs (DMARD) was hypothesized a priori and was significant. Patients with PsA (n = 12 084), RA (n = 51 762), psoriasis (n = 194 288) and controls (n = 1 225 571) matched on general practice and start date were identified. Patients with RA (with and without a DMARD prescription) and patients with mild psoriasis had significantly elevated risks of VTE (HR 1.35, 1.29, and 1.07, respectively) after adjusting for traditional risk factors. Severe psoriasis and PsA prescribed a DMARD had an elevated but not statistically significant risk for VTE. Findings were similar for DVT. The age-and-sex-adjusted risk of PE was elevated in RA, severe psoriasis and PsA patients prescribed a DMARD. Conclusion: While systemic inflammation is a risk factor for VTE, the risk of VTE compared with controls is different among patients with three different inflammatory disorders: RA, PsA, and psoriasis.


Asunto(s)
Artritis Reumatoide , Psoriasis , Tromboembolia Venosa , Adulto , Anciano , Artritis Psoriásica/complicaciones , Artritis Psoriásica/epidemiología , Artritis Reumatoide/complicaciones , Artritis Reumatoide/epidemiología , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Psoriasis/complicaciones , Psoriasis/epidemiología , Factores de Riesgo , Tromboembolia Venosa/complicaciones , Tromboembolia Venosa/epidemiología
10.
Ann Allergy Asthma Immunol ; 121(5): 604-612.e3, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30092266

RESUMEN

BACKGROUND: Atopic dermatitis (AD) has been associated with multiple comorbid extracutaneous and systemic disorders. The relation between AD severity and disease comorbidities is complex and not fully understood. OBJECTIVE: To determine the complex relation between AD severity and comorbidities. METHODS: A cross-sectional US population-based study of 8,217 adults who were participants in a nationally representative internet health panel was performed using a structured questionnaire. A diagnosis of AD was determined using modified United Kingdom Working Party Criteria for AD (n = 602). AD severity was assessed using Patient-Oriented Scoring AD, Patient-Oriented Eczema Measure, Dermatology Life Quality Index, and self-reported global AD severity. Logistic regression and structural equation models were used to explore associations of AD with self-reported allergic, cardiometabolic, anxiety and depression, and autoimmune disease. RESULTS: In multivariable regression models controlling for sociodemographics, AD was associated with higher odds of asthma (adjusted odds ratio [OR] 2.09, 95% confidence interval [CI] 1.71-2.55), hay fever (OR 4.31, 95% CI 3.27-5.69), food allergy (OR 2.07, 95% CI 1.54-2.77), anxiety and depression (OR 2.34, 95% CI 1.91-2.87), autoimmune disease (OR 3.05, 95% CI 2.31-4.03), obesity (OR 1.37, 95% CI 1.13-1.67), diabetes (OR 1.52, 95% CI 1.16-1.99), high blood pressure (OR 1.46, 95% CI 1.18-1.80), and heart disease (OR 1.94, 95% CI 1.40-2.70) compared with controls (P < .01 for all). All these associations were significant in mild and/or moderate disease, with even stronger effects in severe AD. Results of structural equation models showed direct effects of moderate to severe AD on food allergy, anxiety and depression, and diabetes, direct and indirect effects on obesity, and indirect effects on high blood pressure and heart disease. CONCLUSION: There is a strong relation of AD severity to allergic, autoimmune, and cardiovascular comorbidities.


Asunto(s)
Enfermedades Autoinmunes/epidemiología , Enfermedades Cardiovasculares/epidemiología , Dermatitis Atópica/epidemiología , Hipersensibilidad a los Alimentos/epidemiología , Hipertensión/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Asociación , Asma/epidemiología , Comorbilidad , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Rinitis Alérgica Estacional/epidemiología , Autoinforme , Índice de Severidad de la Enfermedad , Reino Unido/epidemiología , Adulto Joven
11.
Ann Allergy Asthma Immunol ; 121(6): 729-734.e4, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30092267

RESUMEN

BACKGROUND: Atopic dermatitis (AD) is associated with skin lesions, multiple symptoms, and effect of quality of life, all of which factor into disease severity. Self-reported global AD severity may be a valid severity assessment for epidemiologic research. OBJECTIVE: To validate self-reported global AD severity in a representative cohort of adults with AD. METHODS: Preliminary probing-cognitive interviews were performed (n = 8). Next, a cross-sectional US population-based survey study of adults with AD was performed. AD was diagnosed using an adap/tation of the UK Working Party criteria (n = 602). AD severity was assessed using self-reported global AD severity (mild, moderate, severe), Patient-Oriented Scoring AD (PO-SCORAD), Patient-Oriented Eczema Measure (POEM), Numeric Rating Scale (NRS)-itch, NRS-sleep, NRS-pain, and Hospital Anxiety and Depression Scale (HADS). RESULTS: Self-reported global AD severity had good content validity. Self-reported global AD severity had strong correlations with PO-SCORAD (Spearman correlation ρ = 0.61) and objective PO-SCORAD (ρ = 0.61); moderate correlations with POEM (ρ = 0.54), NRS-itch (ρ = 0.44), NRS-pain (ρ = 0.46), and HADS (ρ = 0.41); and weak correlation with NRS-sleep (ρ = .32) (P < .001 for all). Consistent and significant correlations were observed in stratified analyses by age, sex, race/ethnicity, and level of education. There were stepwise increases of PO-SCORAD, NRS-itch, NRS-sleep, NRS-pain, POEM, and HADS with increasing self-reported global AD severity (Kruskal-Wallis test, P < .01). There was weak-moderate concordance between self-reported AD severity and established severity strata for PO-SCORAD (ρ = 0.44), NRS-itch (ρ = 0.30), and POEM (ρ = 0.43). Rather, self-reported global AD severity was best predicted by a combination of PO-SCORAD, POEM, NRS-itch, NRS-pain, and HADS. No differential item reporting was found by age, sex, or race/ethnicity. CONCLUSION: Self-reported AD severity simultaneously assesses multiple AD constructs and appears to be sufficiently valid for assessing AD severity in clinical and epidemiologic studies.


Asunto(s)
Dermatitis Atópica/diagnóstico , Dolor/diagnóstico , Autoinforme/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Piel/patología , Estados Unidos
12.
Ann Allergy Asthma Immunol ; 121(3): 340-347, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-30025911

RESUMEN

BACKGROUND: The patient burden and quality of life (QOL) impact of atopic dermatitis (AD) in the United States population is not well established. OBJECTIVE: To elucidate the patient burden of AD in the US population. METHODS: A cross-sectional, population-based study of 602 adults was performed. Atopic dermatitis was determined using modified UK Diagnostic Criteria for AD. Its severity was assessed using self-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Patient-Oriented Scoring AD (PO-SCORAD), PO-SCORAD-itch, and sleep. Quality of life was assessed using short-form (SF-)12 mental and physical health scores and Dermatology Life Quality Index (DLQI). RESULTS: Adults with AD reported higher proportions of having only fair/poor overall health (25.8% vs. 15.8%), being somewhat/very dissatisfied with life (16.7% vs 11.4%), lower weighted mean (standard deviation [SD]) SF-12 mental (45.9 [9.9] vs 50.9 [9.2]) and physical health subscores (53.0 [2.5] vs 53.5 [2.3]) and higher DLQI (4.9 [6.5] vs 1.1 [2.8]). In multivariable regression models adjusting for sociodemographics and multiple comorbid health disorders, significant stepwise decreases by AD severity (self-reported, POEM, PO-SCORAD) of overall health, life satisfaction, SF-12 mental health, and increases of DLQI scores were seen. The SF-12 physical health scores were only associated with moderate AD. Concurrently, severe PO-SCORAD, POEM, or PO-SCORAD-itch was associated with very low mean SF-12 mental health (34.7) and high DLQI scores (24.7). Atopic dermatitis commonly limited lifestyle (51.3%), led to avoidance of social interaction (39.1%), and impacted activities (43.3%). The most burdensome AD symptoms were itch (54.4%), excessive dryness/scaling (19.6%), and red/inflamed skin (7.2%). CONCLUSION: These data support the heavy burden that AD places on patients, particularly those with moderate and severe AD.


Asunto(s)
Dermatitis Atópica/epidemiología , Estado de Salud , Satisfacción Personal , Calidad de Vida/psicología , Adulto , Estudios Transversales , Dermatitis Atópica/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Estados Unidos/epidemiología
14.
J Am Acad Dermatol ; 76(3): 519-526, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-27923500

RESUMEN

BACKGROUND: Many factors influence anxiety and satisfaction of patients undergoing Mohs micrographic surgery (MMS). OBJECTIVE: We sought to determine the effect of a preoperative educational telephone call on anxiety and satisfaction for patients undergoing same-day office consultation and MMS. METHODS: Patients with skin cancer (N = 104) scheduled for same-day office consultation and MMS were randomly assigned to receive or not to receive an educational telephone call during the week before surgery. All patients rated their anxiety levels immediately before and after the same-day office consultation and MMS by completing the State-Trait Anxiety Inventory and an anxiety visual analog scale. Patients also rated satisfaction immediately after MMS by completing the Visit-Specific Patient Satisfaction Questionnaire. RESULTS: Patients undergoing same-day office consultation and MMS reported similar levels of increased anxiety and high satisfaction, regardless of whether they received a preoperative educational telephone call. LIMITATIONS: Lack of control for patients' prior surgery or self-education is a limitation. CONCLUSION: Preoperative educational telephone calls did not relieve anxiety or improve satisfaction for patients undergoing same-day office consultation and MMS. Preoperative education and counseling has uncertain benefits to anxiety and satisfaction of patients undergoing MMS.


Asunto(s)
Ansiedad/etiología , Ansiedad/prevención & control , Cirugía de Mohs/psicología , Educación del Paciente como Asunto/métodos , Satisfacción del Paciente , Neoplasias Cutáneas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Visita a Consultorio Médico , Periodo Preoperatorio , Escalas de Valoración Psiquiátrica , Encuestas y Cuestionarios , Teléfono
15.
Adv Exp Med Biol ; 1027: 11-19, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29063427

RESUMEN

Multiple risk factors have been associated with the development of atopic dermatitis (AD). Recent advances in understanding the role of genetics in this disease have been made, with discovery of the filaggrin (FLG) gene as the most notable so far. In addition to FLG gene mutations as a risk factor for AD, a positive family history of atopic or allergic disease in either parent, has been shown to confer a greater risk of developing AD. Atopic dermatitis usually presents early in life and is thought to represent the initial-step in the "atopic march" which is characterized by the development of other atopic diseases later in life such as asthma, allergic rhinitis and/or rhinoconjunctivitis, food allergies and hay fever. Other comorbid diseases that have been associated with AD include increase risk of viral and bacterial skin infections, neuropsychiatric diseases such as attention-deficit hyperactivity disorders (ADHD) and autistic spectrum disorder (ASD). Patients with AD, have also been found to have worse sleep quality overall compared to patients without AD. In this chapter, we will discuss the risk factors associated with development of atopic dermatitis as well as the most commonly reported comorbidities in patients with this disease.


Asunto(s)
Dermatitis Atópica/etiología , Comorbilidad , Dermatitis Atópica/genética , Proteínas Filagrina , Hipersensibilidad a los Alimentos/complicaciones , Humanos , Factores de Riesgo
17.
Arch Dermatol Res ; 316(7): 409, 2024 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-38878253

RESUMEN

Atopic dermatitis (AD) is a chronic skin condition that can manifest in childhood and persist into adulthood or can present de novo in adults. The clinical presentation of adults with AD may differ among those with pediatric-onset versus adult-onset disease and potential differences between both groups remain to be better characterized. These atypical features might not be encompassed as part of current diagnostic criteria for AD, such as the Hanifin-Rajka (H-R) and the U.K. Working Party (UKWP) criteria. We conducted a retrospective chart review of the electronic medical records of a large, single, academic center to compare the clinical characteristics between adult-onset and pediatric onset AD and examine the proportion of patients who meet the H-R and/or UKWP criteria. Our single-center retrospective chart review included adults (≥ 18 years of age) with any AD-related ICD-10 codes, ≥ 2 AD-related visits, and a recorded physician-confirmed AD diagnosis. Descriptive statistics were used to compare adults with pediatric-onset (< 18 years of age) and adult-onset (≥ 18 years of age) AD. Logistic regression and x2 test were used to compare groups. We found that, compared to pediatric-onset AD, adults with adult-onset AD had less flexural involvement, flexural lichenification and a personal and family history of other atopic diseases. Compared to adults with pediatric-onset AD, adults with adult-onset AD had greater involvement of the extensor surfaces and more nummular eczema compared to pediatric-onset AD. In our cohort, adults with adult-onset AD were less likely to meet H-R and UKWP criteria compared to pediatric-onset AD. Adults with adult-onset AD may present with a clinical presentation that is different from those with pediatric-onset AD, which may not be completely captured by current AD criteria such as the H-R and UWKP criteria. This can lead to possibly mis- or underdiagnosing AD in adults. Thus, understanding the differences and working towards modifying criteria for adult-onset AD has the potential to improve accurate diagnosis of adults with AD.


Asunto(s)
Edad de Inicio , Dermatitis Atópica , Humanos , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/epidemiología , Estudios Retrospectivos , Adulto , Femenino , Masculino , Niño , Adolescente , Estados Unidos/epidemiología , Adulto Joven , Persona de Mediana Edad , Registros Electrónicos de Salud/estadística & datos numéricos , Anciano
18.
Int J Dermatol ; 2024 Jun 14.
Artículo en Inglés | MEDLINE | ID: mdl-38876467

RESUMEN

Seborrheic dermatitis (SD) is a highly prevalent dermatological condition globally. The condition demonstrates bimodal presentation with what is commonly thought to be two subtypes: adult/adolescent seborrheic dermatitis (ASD) and infantile seborrheic dermatitis (ISD). Despite the common prevalence of ASD and ISD, there remains uncertainty around the underlying pathogenetic mechanisms, risk factors, and appropriate classification of the disease(s). This narrative review summarizes the current understanding of the epidemiology, presentation, and pathogenetic factors like epidermal barrier dysfunction, lipid abnormalities, and cutaneous microbiome for ASD and ISD. Elements such as immune responsiveness, neuroendocrine factors, and genetics in these disease states are also investigated. Throughout our review, we highlight shared features and discrepancies between ASD and ISD that are present in the literature and discuss potential avenues for future research that explore these disease states. We aim to contribute to the medical discourse on ASD and ISD and increase awareness of the need for additional research around these conditions, ultimately informing better targeting of therapeutics moving forward.

19.
J Dermatolog Treat ; 35(1): 2310633, 2024 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38297490

RESUMEN

Purpose: Ruxolitinib (selective Janus kinase [JAK] 1 and JAK2 inhibitor) cream demonstrated efficacy and safety in patients with atopic dermatitis (AD) in the phase 3 TRuE-AD studies. In TRuE-AD1/TRuE-AD2 (NCT03745638/NCT03745651), adults and adolescents with mild to moderate AD were randomized to apply twice-daily ruxolitinib cream or vehicle for eight weeks. Here, we evaluated the efficacy and tolerability of ruxolitinib cream by anatomic region, focusing on head/neck (HN) lesions that are typically difficult to manage and disproportionately affect quality of life (QoL).Materials and methods: Eczema Area and Severity Index (EASI) responses in anatomic regions were evaluated in the pooled population (N = 1208) and among patients with baseline HN involvement (n = 663). Itch, Investigator's Global Assessment (IGA), QoL, and application site tolerability were also assessed.Results: By Week 2 (earliest assessment), ruxolitinib cream application resulted in significant improvements across all EASI anatomic region subscores and AD signs versus vehicle, with further improvements through Week 8. Significantly more patients with HN involvement who applied ruxolitinib cream versus vehicle achieved clinically meaningful improvements in itch, IGA, and QoL. Application site reactions with ruxolitinib cream were infrequent (<3%), including in patients with HN involvement.Conclusions: These results support the use of ruxolitinib cream for AD treatment across all anatomic regions, including HN.


Asunto(s)
Dermatitis Atópica , Nitrilos , Pirazoles , Pirimidinas , Adolescente , Adulto , Humanos , Dermatitis Atópica/patología , Método Doble Ciego , Emolientes , Inmunoglobulina A , Prurito/tratamiento farmacológico , Prurito/etiología , Calidad de Vida , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Ensayos Clínicos Fase III como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto
20.
JAMA Dermatol ; 159(10): 1085-1092, 2023 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-37647058

RESUMEN

Importance: Data on the association between atopic dermatitis (AD) and inflammatory bowel disease (IBD) are inconsistent. Few studies have examined the association of AD or AD severity with risk of ulcerative colitis (UC) and Crohn disease (CD) separately. Objectives: To examine the risk of new-onset IBD, UC, and CD in children and adults with AD. Design, Setting, and Participants: This population-based cohort study assessed patients with AD matched with up to 5 controls on age, practice, and index date. Treatment exposure was used as a proxy for AD severity. Data were retrieved from The Health Improvement Network, a UK electronic medical record database, for January 1, 1994, to February 28, 2015. Data analysis was performed from January 8, 2020, to June 30, 2023. Main Outcomes and Measures: Outcomes of interest were incident IBD, UC, and CD. Logistic regression was used to examine the risk for each outcome in children and adults with AD compared with controls. Results: A total of 1 809 029 pediatric controls were matched to 409 431 children with AD (93.2% mild, 5.5% moderate, and 1.3% severe). The pediatric cohort ranged in median age from 4 to 5 years (overall range, 1-10 years), was predominantly male (936 750 [51.8%] controls, 196 996 [51.6%] with mild AD, 11 379 [50.7%] with moderate AD, and 2985 [56.1%] with severe AD), and with similar socioeconomic status. A total of 2 678 888 adult controls were matched to 625 083 adults with AD (65.7% mild, 31.4% moderate, and 2.9% severe). The adult cohort ranged in median age from 45 to 50 years (overall range, 30-68 years) and was predominantly female (1 445 589 [54.0%] controls, 256 071 [62.3%] with mild AD, 109 404 [55.8%] with moderate AD, and 10 736 [59.3%] with severe AD). In fully adjusted models, children with AD had a 44% increased risk of IBD (hazard ratio [HR], 1.44; 95% CI, 1.31-1.58) and a 74% increased risk of CD (HR, 1.74; 95% CI, 1.54-1.97), which increased with worsening AD; however, they did not have increased risk of UC (HR, 1.09; 95% CI, 0.94-1.27) except for those with severe AD (HR, 1.65; 95% CI, 1.02-2.67). Adults with AD had a 34% (HR, 1.34; 95% CI, 1.27-1.40) increased risk of IBD, a 36% (HR, 1.36; 95% CI, 1.26-1.47) increased risk of CB, and a 32% (HR, 1.32; 95% CI, 1.24-1.41) increased risk of UC, with risk increasing with worsening AD. Conclusion and Relevance: In this cohort study, children and adults with AD had an increased risk of IBD, with risk varying by age, AD severity, and IBD subtype. These findings provide new insights into the association between AD and IBD. Clinicians should be aware of these risks, particularly when selecting systemic treatments for AD in patients who may have coincident gastrointestinal symptoms.


Asunto(s)
Colitis Ulcerosa , Enfermedad de Crohn , Dermatitis Atópica , Enfermedades Inflamatorias del Intestino , Adulto , Humanos , Masculino , Femenino , Niño , Lactante , Preescolar , Persona de Mediana Edad , Anciano , Estudios de Cohortes , Dermatitis Atópica/epidemiología , Dermatitis Atópica/complicaciones , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/epidemiología , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/epidemiología , Colitis Ulcerosa/diagnóstico , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/epidemiología , Enfermedad de Crohn/diagnóstico , Factores de Riesgo
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