Comorbidities in childhood atopic dermatitis: A population-based study.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disease that is associated with allergic comorbidities. However, studies examining comorbidities in childhood AD are incomplete, which may contribute to suboptimal care. OBJECTIVE: The objective was to compare the risk of developing different allergic and non-allergic comorbidities among children with AD to that of a matched non-AD reference cohort in Sweden. METHODS: This was a nationwide population-based cohort study using longitudinal data from primary and specialist care registers. Patients with AD were identified by confirmed diagnosis in primary or specialist care. The non-AD reference cohort was randomly drawn from the general population and matched 1:1 with the AD patients. The risk of developing the following conditions was evaluated: hypersensitivity and allergic disorders, neurological disorders, psychiatric disorders, infections, immunological and inflammatory disorders, Type 1 diabetes (T1D), endocrine and metabolic disorders, skeletal disorders, ocular disorders and malignancies. RESULTS: This study included 165,145 patients with AD (mild-to-moderate [n = 126,681] and severe [n = 38,464]) and an equally sized reference cohort. Patients with AD displayed a higher risk of developing comorbid conditions for all investigated categories, except for T1D and skeletal disorders, compared with the reference cohort. The highest risk compared with the reference cohort was observed for hypersensitivity and allergic disorders (hazard ratio [HR]: 3.87), followed by malignancies (HR: 2.53) and immunological and inflammatory disorders (HR: 2.36). Patients with AD also had higher risk of developing multiple comorbidities (≥2). The risk of comorbidity onset increased alongside AD severity and patients with active AD were associated with increased risk of comorbidity onset compared with patients in remission. CONCLUSIONS: The clinical burden of AD is substantial for children with AD and patients are at an increased risk of developing several comorbid conditions extending beyond the atopic march. Our results also showed a positive association between worsening severity of AD and an increased risk of comorbidity onset.

Crisaborole reverses dysregulation of the mild to moderate atopic dermatitis proteome toward nonlesional and normal skin.

BACKGROUND: Safe and effective long-term topical treatments for atopic dermatitis (AD) remain limited. OBJECTIVE: In this phase 2a, single-center, intrapatient, and vehicle-controlled study, we examine the mechanism of action of crisaborole 2% ointment, a topical nonsteroidal PDE4 (phosphodiesterase-4) inhibitor, in a proteomic analysis of 40 adults with mild to moderate AD and 20 healthy subjects. METHODS: Within the AD cohort, 2 target lesions were randomized in an intrapatient (1:1) manner to double-blind crisaborole/vehicle applied twice daily for 14 days. Punch biopsy specimens were collected for biomarker analysis at baseline from all participants, then from AD patients only at day 8 (optional) and day 15. RESULTS: Compared to the vehicle, crisaborole significantly reversed dysregulation of the overall lesional proteome and of key markers and pathways (eg, Th2, Th17/Th22, and T-cell activation) associated with AD pathogenesis toward both nonlesional and normal skin. Significant clinical correlations were observed with markers associated with nociception and Th2, Th17, and neutrophilic activation. LIMITATIONS: Study limitations include predominance of white patients in the cohort, relatively short treatment time, and regimented administration of crisaborole. CONCLUSION: Our results demonstrate crisaborole-induced normalization of the AD proteome toward a nonlesional molecular phenotype and further support topical PDE4 inhibition in the treatment of mild to moderate AD.

Electronic Cigarette Use Among U.S. Adults, 2018.

In 2018, an estimated 8.1 million U.S. adults were current electronic cigarette (e-cigarette) users (1). E-cigarette use is a public health concern (2), and it has been linked to a recent outbreak of lung injury and deaths among adults (3). Although the potential long-term health risks of e-cigarettes are not yet as well-known as they are with cigarettes, e-cigarettes usually contain nicotine, and nicotine is highly addictive (2). Moreover, the most common tobacco product combination among adults is e-cigarettes and cigarettes (4). This report examines e-cigarette use among U.S. adults aged 18 and over by selected sociodemographic characteristics and in relation to cigarette smoking status.

Postcholecystectomy biliary symptoms.

Patients with postcholecystectomy biliary symptoms beyond their original surgery present a diagnostic challenge for the practicing surgeon. The diagnostic algorithm is the same as in an initial episode and should rule out nonbiliary causes of right upper quadrant pain. If biliary causes are suspected, the most common diagnosis is retained common bile duct stones.(1) Among the less common diagnoses, congenital anomalies of the biliary system must also be considered. Anatomical variants are well described in medical literature and must be anticipated by the general surgeon. Here the course and imaging of 2 different patients with postcholecystectomy biliary symptoms are presented followed by a discussion of several etiologies that could cause these symptoms. These cases are presented to remind the general surgeon of the wide variety of presentations possible with biliary disease. In these situations, knowledge of a patient's surgical history can lead to confusion when attempting to make an accurate diagnosis. A prepared surgeon can help shed light on a case complicated by inconsistencies between imaging studies and patient history.