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1.
Phytomedicine ; 67: 153137, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31918393

RESUMO

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease, which is caused by several genetic, immunological, and environmental factors. In addition to skin manifestations, AD is associated with an increased risk of depression and suicidal ideation. Furthermore, this association is underappreciated and therefore insufficiently studied. HYPOTHESIS/PURPOSE: We investigated the association between AD and depression and the effect of I. inflexus (Thunb.) Kudo extract (IIE) treatment in a Dermatophagoides farinae extract (DfE)-induced mouse model of AD. STUDY DESIGN: We evaluated the effects of IIE on depressive behavior in AD mice using four experimental groups: normal (untreated), AD mice (untreated Dfe-induced), IIE-treated (Dfe-induced AD mice), and positive control (tacrolimus-treated Dfe-induced AD mice). METHODS: An AD model was established by the application of 4% sodium dodecyl sulfate to the shaved dorsal neck skin and ears of NC/Nga mice 1 h before application of 100 mg DfE twice per week for 3 weeks. After the first week of DfE application, mice were treated with IIE every day for the remaining 2 weeks. We performed behavioral testing, histology, ELISA, and western blotting to assess depressive-like behavior and neuroinflammatory responses and to measure IgE, histamine, corticosterone, and serotonin levels. RESULTS: Compared with normal mice, AD mice showed more scratching behavior, increased ear swelling, and higher serum levels of IgE and histamine. AD mice also exhibited evidence of depressive-like behavior in the open-field and sucrose preference tests as well as altered serum corticosterone and brain serotonin concentrations. Histopathological analyses revealed increased infiltration of inflammatory cells and mast cells into the skin and ear tissue and elevated microglia activation and neuroinflammatory response in the brains of AD mice. Topical application of IIE reversed the effects of AD on scratching behavior, ear swelling, open-field locomotion, sucrose preference, and levels of IgE, histamine, corticosterone, serotonin, and inflammatory markers. Moreover, IIE treatment reduced inflammatory cytokine responses in keratinocyte cells. CONCLUSION: IIE is a candidate anti-AD therapy due to its ability to exert neuroprotective and antidepressant effects.


Assuntos
Depressão/tratamento farmacológico , Dermatite Atópica/tratamento farmacológico , Dermatophagoides farinae/química , Isodon/química , Extratos Vegetais/farmacologia , Animais , Comportamento Animal/efeitos dos fármacos , Linhagem Celular , Corticosterona/sangue , Citocinas/metabolismo , Depressão/etiologia , Dermatite Atópica/induzido quimicamente , Dermatite Atópica/psicologia , Modelos Animais de Doenças , Histamina/sangue , Humanos , Imunoglobulina E/sangue , Queratinócitos/efeitos dos fármacos , Masculino , Mastócitos/efeitos dos fármacos , Camundongos , Extratos Vegetais/química , Pele/efeitos dos fármacos , Pele/patologia
3.
J Dtsch Dermatol Ges ; 17(9): 923-931, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31487109

RESUMO

BACKGROUND AND OBJECTIVES: In recent years, the hypothesis that increasing the empowerment of patients can help to improve health outcomes and rationalize the use of health services has become relevant, especially for chronic diseases. Developing validated measurement tools is necessary to achieve this goal. In the field of dermatology, there are few studies related to empowerment of the patient. The aim of the present research is to develop and validate a self-administered questionnaire for adult patients diagnosed with atopic dermatitis (AD) in order to measure their level of empowerment. METHODS: After a literature review and the establishment of consulting groups of patients and dermatologists, a large battery of 35 items was generated, based on the dimensions included in previous empowerment descriptions. A multidisciplinary group selected the 20 most suitable items to include in the questionnaire. A cross-sectional study was carried out with the items included in the questionnaire as well as demographic and clinical characteristics. To reduce the number of items and measure the construct validity, an exploratory factorial analysis (EFA) of the primary components and varimax rotation were used. Cronbach's α was used to measure the reliability of the individual scales and the global questionnaire. RESULTS: 242 valid questionnaires were included. After completion of the EFA, the final Dermatitis Atópica EMPoderamiento (DATEMP) questionnaire was composed of 17 items that converged on four factors. The four scales had adequate reliability: "Knowledge" (Cronbach's alpha = 0.808), "Abilities" (Cronbach's alpha = 0.744), "Intention to change" (Cronbach's alpha = 0.798) and "Coping skills" (Cronbach's alpha = 0.772). The overall Cronbach's α of the questionnaire was 0.764. CONCLUSIONS: The DATEMP questionnaire is the first specific empowerment measurement instrument developed for patients with AD that has demonstrated adequate levels of reliability and construct validity. It is a self-administered questionnaire that is simple and quick to answer.


Assuntos
Dermatite Atópica/psicologia , Inquéritos e Questionários/normas , Adaptação Psicológica , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Tamanho da Amostra , Adulto Jovem
4.
J Autism Dev Disord ; 49(11): 4626-4633, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31435817

RESUMO

Several studies have shown a strong association between atopic diseases and autism spectrum disorder (ASD). However, the risk of atopic diseases in individuals having ASD-affected siblings has never been investigated. This nationwide population-based cohort study included 2762 individuals with ASD-affected siblings and 11,048 controls. Diagnoses of atopic diseases, including asthma, atopic dermatitis, allergic rhinitis, and allergic conjunctivitis, were ascertained from 1996 or the birth data to the end of 2011. Individuals with ASD-affected siblings had a higher risk for asthma, atopic dermatitis, allergic rhinitis, allergic conjunctivitis, and multiple atopic diseases compared with controls. In conclusion, individuals with ASD-affected siblings were more likely than were the controls to develop atopic diseases, suggesting shared familial mechanisms underlying the two conditions.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/genética , Dermatite Atópica/epidemiologia , Dermatite Atópica/genética , Vigilância da População , Irmãos , Adolescente , Asma/epidemiologia , Asma/genética , Asma/psicologia , Transtorno do Espectro Autista/psicologia , Criança , Estudos de Coortes , Dermatite Atópica/psicologia , Feminino , Humanos , Masculino , Fatores de Risco , Irmãos/psicologia , Taiwan/epidemiologia
5.
Dermatitis ; 30(4): 247-254, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31261226

RESUMO

Atopic dermatitis (AD) is a pruritic or painful dermatologic disease characterized by xerosis and eczema lesions. The symptoms/signs of AD can significantly impact patients' health-related quality of life (HRQoL). This study aimed to qualitatively explore the adult and adolescent experience of AD. A targeted literature review and qualitative concept elicitation interviews with clinicians (n = 5), adult AD patients (n = 28), and adolescent AD patients (n = 20) were conducted to elicit AD signs/symptoms and HRQoL impacts experienced. Verbatim transcripts were analyzed using thematic analysis. Twenty-nine symptoms/signs of AD were reported, including pruritus, pain, erythema, and xerosis. Atopic dermatitis symptoms/signs were reported to substantially impact HRQoL. Scratching was reported to influence the experience of symptoms and HRQoL impacts. Four proximal impacts (including discomfort and sleep disturbance) were reported. Ten domains of distal impact were reported, including impacts on psychological and social functioning and activities of daily living. A conceptual model was developed to summarize these findings. This study highlights the range of symptoms and HRQoL impacts experienced by adults and adolescents with AD. To our knowledge, this study was first to explore the lived experience of AD in both adult and adolescent patients, providing valuable insight into the relatively unexplored adolescent experience of AD.


Assuntos
Efeitos Psicossociais da Doença , Dermatite Atópica/psicologia , Qualidade de Vida/psicologia , Índice de Gravidade de Doença , Atividades Cotidianas , Adolescente , Adulto , Dermatite Atópica/complicações , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino
7.
Ann Allergy Asthma Immunol ; 123(2): 179-185, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31201863

RESUMO

BACKGROUND: Symptoms of anxiety and depression appear to contribute to the overall burden of atopic dermatitis (AD). However, the burden of mental health symptoms and psychological distress in AD have not been fully elucidated. OBJECTIVE: To determine the prevalence and predictors of depressive symptoms and psychological distress among US adults with AD and how they compare with psoriasis and other disorders. METHODS: We analyzed the 2004-2015 Medical Expenditure Panel Surveys, a representative sample of US adults. Patient Health Questionnaire-2 (PHQ-2) and Kessler-6 index (K-6) scores assessed depressive symptoms and psychological distress, respectively. RESULTS: Atopic dermatitis in adults is associated with increased odds of screening positive for depressive symptoms (PHQ-2 ≥2) (44.3% vs 21.9%; adjusted odds ratio [aOR] [95% confidence interval (CI)]: 2.86 [1.14, 7.16]) and severe psychological distress (K-6≥13) (25.9% vs 5.5%; 6.04 [2.28, 15.99]). Adults with vs without AD had increased K6 scores overall (linear regression, P = .04) and severe psychological distress in particular (K-6≥13; logistic regression; adjusted odds ratio [95% CI]: 6.04 [2.28, 15.99]). K-6 scores were associated with lower household income (linear regression; adjusted beta [95% CI]: 6.22 [0.88, 11.56]) and middle income (4.49 [0.39, 8.59]), but inversely associated with black (-7.36 [-11.70, -3.03]) and multiracial/other (-2.85 [-5.67, -0.03]) race/ethnicity. CONCLUSION: Atopic dermatitis is associated with more depressive symptoms and psychological distress overall, and even worse than many other chronic diseases. These findings highlight the need for clinicians to consider screening for and monitoring mental health symptoms in AD patients. Future studies are needed to develop interventions to reduce psychological distress in AD.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Transtorno Depressivo/epidemiologia , Dermatite Atópica/epidemiologia , Adolescente , Adulto , Ansiedade/psicologia , Depressão/psicologia , Dermatite Atópica/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Estados Unidos/epidemiologia , Adulto Jovem
8.
Yonsei Med J ; 60(7): 694-699, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31250584

RESUMO

Patient education is important for successful management of atopic dermatitis; however, due to limited time and resources, patient education remains insufficient. This study aimed to investigate the current state of education provided by Korean dermatologists, pediatric allergists, and allergists to patients with atopic dermatitis. A questionnaire survey consisting of items regarding educational programs for patients with atopic dermatitis was conducted via e-mail. In total, 153 participants responded to the questionnaires, and 26.8% indicated that they have had separate educational programs. The workforce involved in the educational program included nurses, residents or fellows, dieticians, pharmacists, and clinical psychologists. Most education protocols addressed the characteristics and natural course of atopic dermatitis and environmental management. Overall, 96.7% of the participants replied that an additional charge is needed for education; moreover, additional assistance from an academic society or association, in the form of medical staff, organized data, and advertisement, is required to develop and provide a well-structured educational program. A standardized education protocol will effectively provide appropriate education for patients with atopic dermatitis. Arrangement of education fees, covered by the National Health Insurance Service, will lead to the establishment of a structured educational program and participation of an additional medical workforce.


Assuntos
Dermatite Atópica , Conhecimentos, Atitudes e Prática em Saúde , Dermatite Atópica/psicologia , Humanos , República da Coreia , Inquéritos e Questionários , Fatores de Tempo
9.
Ann Allergy Asthma Immunol ; 123(2): 173-178.e1, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31128232

RESUMO

BACKGROUND: Previous studies found that childhood atopic dermatitis (AD) and asthma are associated with residence in urban areas. However, little is known about the prevalence and determinants of AD in US urban populations and its impact on quality-of-life (QOL) and asthma. OBJECTIVE: To determine AD prevalence and persistence, sociodemographic predictors thereof, and association with QOL and atopic comorbidities in US urban children. METHODS: We analyzed data from The Fragile Families and Child Wellbeing Study, a prospective cohort study of 4898 women and their children born in 20 large US cities between 1998 and 2000. AD prevalence was determined at ages 5, 9, and 15 years, and stratified by sex, race/ethnicity, and household poverty income level. RESULTS: The prevalences (95% confidence interval [CI]) of childhood AD were 15.0% (11.0%-18.9%), 15.1% (11.5%-18.7%), and 14.5% (10.4%%-18.5%) at ages 5, 9, and 15 years, respectively. Female sex (multivariable repeated measures logistic regression; adjusted odds-ratio [95% CI]: 1.56 [1.02-2.37]) and black race (1.80 [1.07-3.01]) were associated with persistent AD across all 3 ages. Children with AD at ages 5 and 15 (2.63 [1.42-4.86]), 5, 8 and 15 (1.47 [1.02-2.12]) and 9 and 15 years (1.61 [1.00-2.60]) had higher odds of poor/fair/good overall health. Children with AD at ages 5 and 9 years had the highest odds of ever having asthma (adjusted odds ratio [95% confidence interval]: 6.05 [5.88-6.22]), followed by children with AD at ages 5, 9, and 15 years (3.17 [3.07%-3.27]). CONCLUSION: Atopic dermatitis prevalence and persistence were highest in US urban children who were female or black. Urban children with persistent AD were more likely to have poor QOL and asthma.


Assuntos
Asma/epidemiologia , Dermatite Atópica/epidemiologia , Qualidade de Vida/psicologia , População Urbana/estatística & dados numéricos , Adolescente , Afro-Americanos/estatística & dados numéricos , Criança , Pré-Escolar , Dermatite Atópica/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Nível de Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Estudos Prospectivos , Inquéritos e Questionários , Estados Unidos/epidemiologia
10.
J Eur Acad Dermatol Venereol ; 33(7): 1331-1340, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31002197

RESUMO

BACKGROUND: Atopic eczema (AE, atopic dermatitis) is one of the most common non-communicable inflammatory skin diseases affecting 1-5% of the adult population in Europe with marked impairment in quality of life. In spite of great progress in understanding the pathophysiology of disturbed skin barrier and immune deviation, AE still represents a problem in daily clinical practice. Furthermore, the true impact of AE on individual suffering is often not recognized. OBJECTIVES: With a large European study, we wanted to provide insights into the actual suffering and individual burden of disease in adult patients with AE. METHODS: A total of 1189 adult patients (18-87 years, 56% female) with moderate to severe AE were recruited in nine European countries by dermatologists or allergists together with the help of patient organizations. A computer-assisted telephone interview was performed by experienced interviewers between October 2017 and March 2018. The following instruments were used to assess severity or measure quality of life: Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS-D) and a newly developed Atopic Eczema Score of Emotional Consequences (AESEC). Patients were also asked to self-assess the severity of their disease. RESULTS: Despite current treatment, 45% of participants still had actual moderate to very severe AE in POEM. Due to their skin disease, 57% missed at least 1 day of work in the preceding year. DLQI showed moderate to extremely large impairment in 55%. According to HADS-D, 10% scored on or above the threshold of eight points with signs of depressive symptoms. Assessed with AESEC, 57% were emotionally burdened with feelings such as 'trying to hide the eczema', 'feeling guilty about eczema', having 'problems with intimacy' and more. Of persons actually suffering from severe AE, 88% stated that their AE at least partly compromised their ability to face life. CONCLUSIONS: This real-life study shows that adults with a moderate to severe form of AE are suffering more than what would be deemed acceptable. There is a need for increased awareness of this problem among healthcare professionals, policymakers and the general public to support research in the development of new and more effective treatments and provide access to better and affordable health care for affected patients.


Assuntos
Efeitos Psicossociais da Doença , Depressão/etiologia , Dermatite Atópica/psicologia , Qualidade de Vida , Absenteísmo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Dermatite Atópica/complicações , Dermatite Atópica/terapia , Emoções , União Europeia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Adulto Jovem
11.
Ann Allergy Asthma Immunol ; 123(2): 144-151, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31034875

RESUMO

OBJECTIVE: Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease with substantial patient and population burdens. A number of comorbid health problems occur in patients with AD, aside from the cutaneous signs and symptoms. This review summarizes recent developments in the burden and comorbidities of AD. DATA SOURCES: Literature review. STUDY SELECTIONS: Nonsystematic. RESULTS: Different aspects of AD, such as chronic pruritus, psychosocial distress, and inflammation, can lead to anxiety, depression, or suicidality. Atopic dermatitis is associated with and may predispose to higher risk of other atopic disorders, including asthma, hay fever, food allergy, and eosinophilic esophagitis. Persons with AD appear to be at higher risk for infectious and cardiovascular risk. CONCLUSION: Atopic dermatitis is associated with substantial burden and comorbidities. Identifying AD comorbidities is essential for proper disease management and improving overall patient outcomes.


Assuntos
Asma/epidemiologia , Dermatite Atópica/epidemiologia , Esofagite Eosinofílica/epidemiologia , Hipersensibilidade Alimentar/epidemiologia , Prurido/epidemiologia , Rinite Alérgica Sazonal/epidemiologia , Ansiedade/patologia , Comorbidade , Depressão/psicologia , Dermatite Atópica/psicologia , Humanos , Qualidade de Vida
12.
Int J Clin Pharm ; 41(3): 711-718, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31020600

RESUMO

Background Atopic dermatitis affects 10-20% of the children worldwide. Unfortunately not all patients who receive treatment have optimal treatment outcomes. Objective To assess the view of parents and pharmacy staff in order to optimize pharmaceutical care for young atopic dermatitis patients. Setting Community pharmacies in the Netherlands. Method We first held an expert panel meeting to determine experts' views on treatment of atopic dermatitis and their suggestions for areas of improvement. This input was used to develop the interview guide. We conducted telephone interviews with parents of children (aged 0-12 years) with atopic dermatitis and face-to-face interviews with pharmacy staff members. All interviews were audiotaped and transcribed verbatim. Transcripts were coded using qualitative data analysis software. Codes were used to identify themes. Main outcome measure Perspectives of parents of young atopic dermatitis patients and pharmacy staff about treatment. Results We interviewed 29 parents and 18 pharmacy staff members. Many parents mentioned fear of steroid adverse effects, with intentional nonadherence as a consequence, and difficulties with the application of topical treatment. Pharmacy employees also mentioned to encounter these issues. Some employees themselves expressed concerns towards use of steroids. Most parents were satisfied with the information they received; however, they need more practical lifestyle advices, e.g. about bathing or clothing. Both pharmacists and pharmacy technicians mentioned that technicians often lack knowledge to support patients optimally in correct medication use. Conclusion Parents' perceptions about topical corticosteroids might negatively influence treatment outcomes. Pharmacy staff has an important role to inform parents of children with eczema on the appropriate use of topical corticosteroids and emollients. Counseling should not be influenced by their own prejudices about topical corticosteroids. Close collaboration between primary care providers should ensure that parents receive uniform messages.


Assuntos
Atitude do Pessoal de Saúde , Dermatite Atópica/tratamento farmacológico , Pais , Assistência Farmacêutica/normas , Farmacêuticos/normas , Administração Tópica , Corticosteroides/administração & dosagem , Criança , Pré-Escolar , Dermatite Atópica/epidemiologia , Dermatite Atópica/psicologia , Feminino , Humanos , Lactente , Recém-Nascido , Entrevistas como Assunto/métodos , Entrevistas como Assunto/normas , Masculino , Países Baixos/epidemiologia , Pais/psicologia , Farmacêuticos/psicologia
13.
Clin Exp Dermatol ; 44(7): e235-e237, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30834551

RESUMO

In this study, 211 carers of children and adults with atopic eczema/dermatitis (AE) completed an online questionnaire about diet and allergy. The study group comprised 106 children [mean age 5 years, Patient-Oriented Eczema Measure (POEM) score mean ± SD 13.8 ± 7.8] and 105 adults (mean age 35 years, POEM score 14.5 ± 7.5). We found that 57% of respondents had discussed the role of diet in AE with a health professional and 38% felt this discussion was unhelpful or very unhelpful. Regarding testing, 54% reported having had an allergy test. Food exclusion was common; 68% of children and 46% of adults excluded one or more foods from their diet, with 40% of children and 52% of adults doing so to reduce AE symptoms. The most commonly avoided food among both children (63%) and adults (50%) was cow's milk. Only 17% of adults with modified diets had received dietary advice from a dietitian, compared with 57% of children. Clinicians should routinely ask patients about their views of diet in eczema and any changes that they have made, offering objective assessment where appropriate.


Assuntos
Cuidadores/psicologia , Dermatite Atópica/etiologia , Eczema/etiologia , Hipersensibilidade Alimentar/complicações , Alimentos/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Dermatite Atópica/psicologia , Dieta/efeitos adversos , Dietética , Aconselhamento Diretivo , Eczema/psicologia , Feminino , Hipersensibilidade Alimentar/diagnóstico , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto Jovem
14.
Acta Derm Venereol ; 99(9): 756-761, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30896779

RESUMO

Crisaborole ointment is a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of mild to moderate atopic dermatitis. Using pooled data from two phase 3 studies (NCT02118766/NCT02118792), mediation modeling determined the interrelationship among pruritus, quality of life (QoL), and treatment. Patients aged ≥ 2 years received crisaborole ointment 2% or vehicle twice daily for 28 days. QoL measures were Dermatology Life Quality Index (DLQI) (≥ 16 years) and Children's Dermatology Life Quality Index (CDLQI) (2-15 years). Pruritus was assessed by the Severity of Pruritus Scale (4-point scale from 0 to 3). The indirect effect of crisaborole on QoL mediated through its effect on pruritus was 51% (DLQI model, p < 0.05) and 72% (CDLQI model, p < 0.05). Direct effect (other effects) on QoL was 49% (DLQI model, p < 0.05) and 28% (CDLQI model, p > 0.05). Mediation modeling shows that crisaborole affects QoL mostly indirectly through pruritus severity reduction.


Assuntos
Compostos de Boro/administração & dosagem , Dermatite Atópica/tratamento farmacológico , Inibidores da Fosfodiesterase 4/administração & dosagem , Prurido/tratamento farmacológico , Administração Cutânea , Adolescente , Adulto , Criança , Pré-Escolar , Ensaios Clínicos Fase III como Assunto , Dermatite Atópica/diagnóstico , Dermatite Atópica/psicologia , Feminino , Humanos , Masculino , Pomadas , Prurido/diagnóstico , Prurido/psicologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Indução de Remissão , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
15.
J Eur Acad Dermatol Venereol ; 33(7): 1341-1348, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30883885

RESUMO

BACKGROUND: The distribution of atopic dermatitis (AD) lesions and its impact on quality of life (QOL) is not well established in the US adult population. OBJECTIVE: To elucidate the distribution of AD lesions and its impact on QOL in US adults with AD. METHODS: A cross-sectional, population-based study of 602 adults was performed. AD was determined using modified UK Diagnostic Criteria, and its lesional distribution was assessed. QOL was assessed using Dermatology Life Quality Index (DLQI). Latent class analysis (LCA) was used to determine distinct phenotypes of AD lesional distribution. Multivariable logistic regression was used to determine the relationship between DLQI and distinct phenotypes. RESULTS: The most common sites of skin lesions were reported to be the popliteal fossae, lower legs, dorsal feet and antecubital fossae. Most persons reported partial (19.0%) or complete (63.0%) symmetry of lesions on the extremities. Lesions on the trunk were significantly more common in blacks and Hispanics. Age ≥ 60 years was associated with significantly lower proportions of active lesions on the face and scalp, and significantly higher proportion of lesions on the buttocks or genitals. LCA identified 5 classes of lesional distribution: 1. lower probabilities of lesions affecting any sites; 2. Higher probability of lesions involving the anterior and posterior neck and trunk; 3. lesions involving the antecubital fossae and upper extremities; 4. lesions involving the arms, posterior hands, genitals and buttocks, and to a lesser extent face, palms and legs; 5. lesions affecting all sites. Class-2 (multivariable logistic regression; adjusted odds ratio [95% confidence interval]: 7.19 [3.21-16.07], class-3 (7.11 [3.20-15.80]), class-4 (6.90 [3.07-15.50]) and class-5 (7.92 [3.54-17.71]) were all significantly associated with higher DLQI scores compared to class 1. CONCLUSION: AD is associated with heterogeneous distribution of AD lesions, and distinct phenotypes that are associated with QOL impact.


Assuntos
Dermatite Atópica/epidemiologia , Dermatite Atópica/psicologia , Qualidade de Vida , Adolescente , Adulto , Afro-Americanos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Braço , Nádegas , Estudos Transversais , Dermatite Atópica/etnologia , Grupo com Ancestrais do Continente Europeu , Dermatoses Faciais/epidemiologia , Dermatoses Faciais/psicologia , Feminino , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/psicologia , Genitália , Dermatoses da Mão/epidemiologia , Dermatoses da Mão/psicologia , Hispano-Americanos , Humanos , Análise de Classes Latentes , Dermatoses da Perna/epidemiologia , Dermatoses da Perna/psicologia , Masculino , Pessoa de Meia-Idade , Prevalência , Dermatoses do Couro Cabeludo/epidemiologia , Dermatoses do Couro Cabeludo/psicologia , Inquéritos e Questionários , Tronco , Estados Unidos/epidemiologia , Adulto Jovem
16.
JAMA Dermatol ; 155(5): 556-563, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30892577

RESUMO

Importance: The well-being and development of children is strongly influenced by parents' physical and psychosocial health. Data from small, clinic-based studies suggest that sleep loss may be common in parents of children with atopic dermatitis (AD), but longitudinal population-based studies are lacking. Objectives: To compare sleep disturbances over time between mothers of children with and without AD and to determine whether these disturbances are associated with the child's disease severity and the child's sleep disturbances. Design, Setting, and Participants: In the ongoing Avon Longitudinal Study of Parents and Children, all pregnant women residing in Avon, United Kingdom, with an expected delivery date between April 1, 1991, and December 31, 1992, were recruited. Analyses for this study, a secondary analysis of this cohort, were performed from September 2017 to September 2018. Mother-child pairs were followed up with a time-varying measure of child AD activity and severity and self-reported maternal sleep measures repeated at multiple time points between child ages 6 months and 11 years. Main Outcomes and Measures: Time-varying binary measures of maternal sleep duration (<6 vs ≥6 hours per night), difficulty falling asleep, early morning awakening, subjectively insufficient sleep, and daytime exhaustion. Results: The study followed up 13 988 mother-child pairs from birth for a median duration of 11 (interquartile range, 7-11) years. Among the cohort, 11 585 of 13 972 mothers (82.9%) were aged 21 to 34 years and 12 001 of 12 324 (97.4%) were of white race/ethnicity; 7220 of 13 978 children (51.7%) were male. Sleep duration (adjusted odds ratio [AOR], 1.09; 95% CI, 0.90-1.32) and early morning awakenings (AOR, 1.16; 95% CI, 0.93-1.46) were similar between mothers of children with and without AD. In contrast, mothers of children with AD were more likely to report difficulty falling asleep (AOR, 1.36; 95% CI, 1.01-1.83), subjectively insufficient sleep (AOR, 1.43; 95% CI, 1.24-1.66), and daytime exhaustion (AOR, 1.41; 95% CI, 1.12-1.78) independent of the child's comorbid asthma and/or allergic rhinitis. For all measures, worse child AD severity was associated with worse maternal sleep outcomes. The magnitude and significance of the associations were largely unchanged after adjustment for child sleep disturbances. Conclusions and Relevance: Mothers of children with AD reported difficulty falling asleep, subjectively insufficient sleep, and daytime exhaustion throughout the first 11 years of childhood. However, child sleep disturbances did not fully explain maternal sleep disturbances, and future research should investigate other mechanisms. In caring for children with AD, clinicians should consider maternal sleep disturbances and caregiver fatigue.


Assuntos
Dermatite Atópica/psicologia , Mães/psicologia , Transtornos do Sono-Vigília/epidemiologia , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Dermatite Atópica/patologia , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Índice de Gravidade de Doença , Reino Unido , Adulto Jovem
17.
Acta Derm Venereol ; 99(7): 647-651, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30848288

RESUMO

Atopic dermatitis is associated with several comorbidities. Epidemiological studies on psychiatric comorbidities in adult atopic dermatitis patients are sparse. We analyzed psychiatric comorbidities in a Finnish nationwide adult atopic dermatitis cohort. The study included 57,690 adult patients with atopic dermatitis as cases and 40,363 individuals diagnosed with melanocytic naevi as controls. Data was obtained from the statutory Finnish Care Register for Health Care. The prevalence of preselected comorbidities between the atopic dermatitis and control groups was compared. Every psychiatric disorder studied was more common in patients with atopic dermatitis than in controls. At least one psychiatric diagnosis was found in 17.2% of the atopic dermatitis patients and 13.1% of controls. Psychiatric morbidity is significant in patients with atopic dermatitis and therefore assessing patients' mental health status should be considered as part of standard care.


Assuntos
Dermatite Atópica/epidemiologia , Dermatite Atópica/psicologia , Transtornos Mentais/epidemiologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Comorbidade , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Fatores Sexuais , Adulto Jovem
18.
JAMA Pediatr ; 173(5): e190025, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30830151

RESUMO

Importance: Pruritus, a hallmark of atopic dermatitis (AD), is thought to disrupt sleep, yet little is known about how variations in disease activity and severity of this common childhood condition may be associated with sleep patterns over time. Objective: To determine whether children with active AD have impaired sleep duration and quality at multiple time points throughout childhood and whether disease severity affects sleep outcomes. Design, Setting, and Participants: This longitudinal cohort study used data of children enrolled in the Avon Longitudinal Study of Parents and Children, a population-based birth cohort in Avon, United Kingdom. Participants were children (N = 13 988) alive at 1 year and followed up with repeated measures of self-reported AD and sleep through 16 years of age. This study was based on data collected from 1990 to 2008. Data analysis was performed from September 2017 to September 2018. Main Outcomes and Measures: Standardized measure of sleep duration and composite measure of sleep quality, including nighttime awakenings, early morning awakenings, difficulty falling asleep, and nightmares, were repeated at multiple time points between 2 and 16 years of age. Results: The study sample comprised 13 988 children (7220 male [51.6%]) followed up for a median (interquartile range [IQR]) duration of 11 (5-14) years. Of this total, 4938 children (35.3%) met the definition of having atopic dermatitis between 2 and 16 years of age. Total sleep duration was similar between children with active AD and without AD at all ages, and the average estimated difference across childhood was a clinically negligible difference of 2 minutes less per day for children with AD (95% CI, -4 to 0 minutes). In contrast, children with active AD were more likely to report worse sleep quality at all time points, with a nearly 50% higher odds of experiencing more sleep-quality disturbances (adjusted odds ratio [aOR], 1.48; 95% CI, 1.33 to 1.66). Children with more severe active disease (quite bad or very bad AD: aOR, 1.68; 95% CI, 1.42 to 1.98) and with comorbid asthma or allergic rhinitis (aOR, 1.79; 95% CI, 1.54 to 2.09) had worse sleep quality. However, even children with mild AD (OR, 1.40; 95% CI, 1.27 to 1.54) or inactive AD (OR, 1.41; 95% CI, 1.28 to 1.55) had statistically significantly increased odds of impaired sleep quality. Conclusions and Relevance: Atopic dermatitis appeared to be associated with impaired sleep quality throughout childhood; thus, it is suggested that clinicians should consider sleep quality among all children with AD, especially those with comorbid asthma or allergic rhinitis and severe disease, and that interventions to improve sleep quality are needed.


Assuntos
Dermatite Atópica/complicações , Transtornos do Sono-Vigília/etiologia , Adolescente , Criança , Pré-Escolar , Dermatite Atópica/psicologia , Humanos , Lactente , Estudos Longitudinais , Prurido/complicações , Prurido/psicologia , Fatores de Risco , Autorrelato , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/epidemiologia
19.
Clin Exp Dermatol ; 44(4): 376-380, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30706507

RESUMO

This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE). It presents the key findings from 11 systematic reviews published in 2016 that focus on AE outcome assessment, disease impact and nomenclature. Systematic reviews on the treatment and prevention of AE are summarized in Part 1 of this update, and systematic reviews on the epidemiology of and risk factors for AE are summarized in Part 2. Six reviews summarized what outcome measurement instruments have been used in published AE trials, or summarized validation studies for the available instruments. These reviews were used to inform consensus decisions by the Harmonising Outcome Measures for Eczema initiative. Although validated instruments exist for clinical signs and patient-reported symptoms, there are currently no validated instruments for capturing quality of life or long-term control. Four reviews examined the impact of AE on children and their families, but few studies were included. One birth cohort study found no association between AE and educational attainment at 11 years. AE has a moderate impact on health-related quality of life and a substantial impact on family life. AE is a major risk factor for occupational hand dermatitis, and it is advised that young atopic individuals are informed about high-risk occupations. Further efforts are required to standardize the nomenclature for AE, which is also commonly known as 'atopic dermatitis' or 'eczema', and preferred terms vary around the world.


Assuntos
Dermatite Atópica/epidemiologia , Dermatite Atópica/terapia , Dermatite Ocupacional/epidemiologia , Eczema/diagnóstico , Criança , Estudos de Coortes , Dermatite Atópica/prevenção & controle , Dermatite Atópica/psicologia , Dermatite Ocupacional/prevenção & controle , Humanos , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Fatores de Risco , Índice de Gravidade de Doença
20.
Immunopharmacol Immunotoxicol ; 41(1): 117-122, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30773959

RESUMO

Context: Atopic dermatitis (AD) is a chronic, inflammatory, itching skin disorder, which may worsen due to stress, depression and anxiety. Tachykinins may be involved in inflammation signaling as well as they may have a role in stress, depression and anxiety. Objective: This study aimed to measure the expression of tachykinin markers, in the skin of patients with AD, and the correlation of these tachykinins with clinical and psychodemographic parameters. Materials and methods: Twenty-eight adult patients with AD were investigated regarding tachykinin expression in skin biopsies, using an immunohistochemical technique. The patients were characterized with clinical and psychodemographic parameters. Results: The number of substance P and neurokinin (NK)A positive nerve fibers, as well as NKA positive mononuclear dermal cells, was increased in lesional compared to non-lesional skin. Interestingly, the depression score and the number of dermal NK-1 receptor (R) positive cells in lesional as well as in non-lesional skin showed a correlation. Conclusion: These findings indicate an upregulation of the tachykinergic system in the inflamed skin of AD.


Assuntos
Dermatite Atópica/metabolismo , Neurocinina A/metabolismo , Receptores da Neurocinina-1/metabolismo , Pele/metabolismo , Substância P/metabolismo , Adulto , Biópsia , Estudos Transversais , Dermatite Atópica/imunologia , Dermatite Atópica/patologia , Dermatite Atópica/psicologia , Feminino , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/imunologia , Fibras Nervosas/metabolismo , Fibras Nervosas/patologia , Neurocinina A/genética , Receptores da Neurocinina-1/genética , Pele/imunologia , Pele/patologia , Substância P/genética , Inquéritos e Questionários , Regulação para Cima , Adulto Jovem
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