Zinc penetration through the skin barrier in atopic dermatitis and rosacea using reflectance confocal microscopy.

Atopic dermatitis (AD) is a chronic, recurrent eczematous disorder with a complex pathophysiology caused by skin barrier abnormalities. Rosacea is a common chronic immune-mediated inflammatory disorder that results in diminished skin barrier function. Reflectance confocal microscopy (RCM) is a non-invasive method for visualizing the dynamic status of epidermal and upper dermal structures. In this study, we compared skin barrier permeability among normal, AD and rosacea groups. To assess skin barrier permeability, zinc was applied to lesional skin and the RCM reflectance intensity of zinc penetration was measured. Reflectance confocal microscopy revealed that the intensity in patients with rosacea and AD was higher than that in the normal group at depths of 8-24 µm in both the face and forearm, which were considered as the stratum corneum (SC) and tight junction (TJ) level (p < 0.0001). When comparing AD and rosacea, the intensity of rosacea was higher than that of AD at a depth of 8 µm in the face (p < 0.0001). The intensity of AD was higher than that of rosacea at a depth of 24 µm (p = 0.009). This suggests that skin barrier permeability is increased in the upper epidermis of patients with AD and rosacea. On the face, patients with rosacea had more SC weakness than did those with AD, whereas patients with AD had more TJ weakness than those with rosacea.

Hyperspectral imaging-based erythema classification in atopic dermatitis.

BACKGROUND/PURPOSE: Among the characteristics that appear in the epidermis of the skin, erythema is primarily evaluated through qualitative scales, such as visual assessment (VA). However, VA is not ideal because it relies on the experience and skill of dermatologists. In this study, we propose a new evaluation method based on hyperspectral imaging (HSI) to improve the accuracy of erythema diagnosis in clinical settings and investigate the applicability of HSI to skin evaluation. METHODS: For this study, 23 subjects diagnosed with atopic dermatitis were recruited. The inside of the right arm is selected as the target area and photographed using a hyperspectral camera (HS). Subsequently, based on the erythema severity visually assessed by a dermatologist, the severity classification performance of the RGB and HS images is compared. RESULTS: Erythema severity is classified as high when using (i) all reflectances of the entire HSI band and (ii) a combination of color features (R of RGB, a* of CIEL*a*b*) and five selected bands through band selection. However, as the number of features increases, the amount of calculation increases and becomes inefficient; therefore, (ii), which uses only seven features, is considered to perform classification more efficiently than (i), which uses 150 features. CONCLUSION: In conclusion, we demonstrate that HSI can be applied to erythema severity classification, which can further increase the accuracy and reliability of diagnosis when combined with other features observed in erythema. Additionally, the scope of its application can be expanded to various studies related to skin pigmentation.

Parameter-based transfer learning for severity classification of atopic dermatitis using hyperspectral imaging.

BACKGROUND/PURPOSE: Because atopic dermatitis (AD) is a chronic inflammatory skin condition that causes structural changes, there is a growing need for noninvasive research methods to evaluate this condition. Hyperspectral imaging (HSI) captures skin structure features by exploiting light wavelength variations in penetration depth. In this study, parameter-based transfer learning was deployed to classify the severity of AD using HSI. Therefore, we aimed to obtain an optimal combination of classification results from the four models after constructing different source- and target-domain datasets. METHODS: We designated psoriasis, skin cancer, eczema, and AD datasets as the source datasets, and the set of images acquired via hyperspectral camera as the target dataset for wavelength-specific AD classification. We compared the severity classification performances of 96 combinations of sources, models, and targets. RESULTS: The highest classification performance of 83% was achieved when ResNet50 was trained on the augmented psoriasis dataset as the source, with the resulting parameters used to train the model on the target Near-infrared radiation (NIR) dataset. The second highest classification accuracy of 81% was achieved when ResNet50 was trained on the unaugmented psoriasis dataset as the source, with the resulting parameters used to train the model on the target R dataset. ResNet50 demonstrated potential as a generalized model for both the source and target data, also confirming that the psoriasis dataset is an effective training resource. CONCLUSION: The present study not only demonstrates the feasibility of the severity classification of AD based on hyperspectral images, but also showcases combinations and research scalability for domain exploration.

Illuminating characteristic patterns of inflammatory dermatoses: A comprehensive dual-imaging approach using Optical coherence tomography and Line-field confocal optical coherence tomography.

BACKGROUND: Inflammatory skin diseases, such as psoriasis, atopic eczema, and contact dermatitis pose diagnostic challenges due to their diverse clinical presentations and the need for rapid and precise diagnostic assessment. OBJECTIVE: While recent studies described non-invasive imaging devices such as Optical coherence tomography and Line-field confocal OCT (LC-OCT) as possible techniques to enable real-time visualization of pathological features, a standardized analysis and validation has not yet been performed. METHODS: One hundred forty lesions from patients diagnosed with atopic eczema (57), psoriasis (50), and contact dermatitis (33) were imaged using OCT and LC-OCT. Statistical analysis was employed to assess the significance of their characteristic morphologic features. Additionally, a decision tree algorithm based on Gini's coefficient calculations was developed to identify key attributes and criteria for accurately classifying the disease groups. RESULTS: Descriptive statistics revealed distinct morphologic features in eczema, psoriasis, and contact dermatitis lesions. Multivariate logistic regression demonstrated the significance of these features, providing a robust differentiation between the three inflammatory conditions. The decision tree algorithm further enhanced classification accuracy by identifying optimal attributes for disease discrimination, highlighting specific morphologic criteria as crucial for rapid diagnosis in the clinical setting. CONCLUSION: The combined approach of descriptive statistics, multivariate logistic regression, and a decision tree algorithm provides a thorough understanding of the unique aspects associated with each inflammatory skin disease. This research offers a practical framework for lesion classification, enhancing the interpretability of imaging results for clinicians.

Improve the dupilumab therapy evaluation with dermoscopy and high-frequency ultrasound in moderate-to-severe atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory disease. Monoclonal antibody dupilumab was approved to treat moderate-to-severe AD in recent years. An objective assessment of treatment response by skin imaging modality is adjuvant for clinical evaluations. This study aimed to explore the value of dermoscopy and high-frequency ultrasound (HFUS) imaging characteristics in treatment evaluation for moderate-to-severe AD patients treated with dupilumab. METHODS: Moderate-to-severe AD patients refractory to conventional therapy were enrolled in the study. All patients went through at least a 16-week standardized treatment of dupilumab. Clinical scores (eczema area scoring index [EASI], SCOARD, numerical rating scale of pruritus, dermatology life quality index), dermoscopy, and HFUS examinations were conducted at 0, 2, 4, 8, 12, and 16 weeks of treatment. Erythema, scales, erosion, and pigmentation under dermoscopy were scored, and subepidermal low-echogenic band (SLEB) thickness under HFUS was measured as quantitative indexes. Descriptive analysis and mixed effect linear regression models were used for statistical analysis. RESULTS: Sixteen patients were enrolled in the study and their average age was 45.63 ± 18.18 years. All clinical scores decreased with significant difference after 16-week treatment compared with baseline. All patients achieved EASI 50 (EASI score decreased by 50% or more), and 9/16 patients reached EASI 75 after 16-week treatment. Dermoscopy evaluation of erythema, scales and erosion scores were decreased, and the sign of pigmentation score was increased after treatment. For HFUS, the mean SLEB value was 0.51 ± 0.29 mm and decreased to 0.27 ± 0.15 mm after 16-week treatment (p < 0.01). SLEB value decreased linearly with treatment time and correlated with clinical scores. However, SLEB values of two patients were 0.57 and 0.68 mm at week 16, respectively, which were higher than the average, and one of the patients showed EASI 75. CONCLUSION: Dermoscopy and HFUS were able to reveal deeper inflammation response than clinical scores in AD and can be an effective method to evaluate and monitor clinical improvement during dupilumab treatment for AD patients. The preliminary value of imaging methods for predicting the treatment endpoint of dupilumab remains to be verified.

Abnormal brain structure in atopic dermatitis: Evidence from Mendelian randomization study.

BACKGROUND: Structural abnormalities in the brain of patients with atopic dermatitis (AD) have been reported; however, the cause has not been determined yet. Herein, we used Mendelian randomization (MR) to reveal the causal effect of AD on brain structure. METHODS: This study utilized summary statistics from genome-wide association studies (GWASs) to investigate a collection of cerebral structural measures, encompassing cortical thickness (CT), cortical surface area (CA), and subcortical volumes in T1 images. A comprehensive GWAS meta-analysis identified a total of 20 independent single nucleotide polymorphisms linked to AD, surpassing the genome-wide significance threshold (p < 5 × 10⁻8). MR estimates were aggregated through the application of the inverse variance weighted method. Additional complementary analyses (i.e., MR-Egger and weighted median approaches) were conducted to further assess the robustness of the obtained results. Sensitivity analysis and multivariate MR (MVMR) while adjusting for brain structural changes risk factors (i.e., depression and anxiety) were performed to assess the reliability and stability of observed causality. RESULTS: Genetically determined AD exhibited a causal link with reduced caudate volumes (IVW-MR: ß = -0.186, p = 0.001, p-corrected = 0.009). Furthermore, we identified potential causal associations between AD and reduced CT in the cingulate region (posterior cingulate, IVW-MR: ß = -0.065, p = 0.018, p-corrected = 0.551; isthmus cingulate, IVW-MR: ß = -0.086, p = 0.003, p-corrected = 0.188), as well as abnormal cortical surface area (CA) in the supramarginal (IVW-MR: ß = -0.047, p = 0.044, p-corrected = 0.714) and isthmus cingulate (IVW-MR: ß = 0.053, p = 0.018, p-corrected = 0.714). Additional supplementary analyses yielded consistent outcomes. There was no evidence of horizontal pleiotropy. MVMR analysis showed that the causal effects of AD on abnormal brain structure remained significant while adjusting for depression and anxiety. CONCLUSION: This MR study provided suggestive evidence that decreased caudate nucleus, posterior cingulate cortex, isthmus cingulate cortex and supramarginal gyrus are suggestively associated with higher AD risk. Future investigation into the brain regions is recommended, which helps to clarify the underlying mechanisms and point to new therapies against AD.

High-frequency ultrasound biomicroscopy findings of the skin of dogs with atopic dermatitis.

BACKGROUND: The high-frequency ultrasonographic appearance of skin of dogs with atopic dermatitis (cAD) has not been described. OBJECTIVES: To compare high-frequency ultrasonographic findings among lesional, macroscopically nonlesional skin of dogs with cAD, and the macroscopically nonlesional skin of healthy dogs. Additionally, to determine whether there is any correlation between the ultrasonographic findings in lesional skin and local Canine Atopic Dermatitis Extent and Severity Index, 4th iteration (CADESI-04) or its domains (erythema, lichenification, excoriations/alopecia). As a secondary aim, six cAD dogs were re-evaluated after management intervention. ANIMALS: Twenty dogs with cAD (six were re-examined after treatment) and six healthy dogs. MATERIALS AND METHODS: In all dogs, ultrasonographic examination was performed on the same 10 skin sites, using a 50 MHz transducer. Wrinkling of skin surface, presence/width of subepidermal low echogenic band, hypoechogenicity of dermis and thickness of the skin were evaluated and scored/measured blindly. RESULTS: Dermal hypoechogenicity was more common and severe in lesional compared to macroscopically nonlesional skin of dogs with cAD. In lesional skin, presence/severity of wrinkling of skin surface and of dermal hypoechogenicity were positively correlated with presence/severity of lichenification, while severity of dermal hypoechogenicity was positively correlated with local CADESI-04. A positive correlation between the change in skin thickness and the change in the severity of erythema during treatment was noted. CONCLUSIONS AND CLINICAL RELEVANCE: High-frequency ultrasound biomicroscopy may be useful for the evaluation of skin of dogs with cAD and for evaluating the progression of skin lesions during treatment.

Mild to moderate atopic dermatitis severity can be reliably assessed using smartphone-photographs taken by the patient at home: A validation study.

BACKGROUND: The use of photographs to diagnose and monitor skin diseases is gaining ground. OBJECTIVES: To investigate the validity and reliability of photographic assessments of atopic dermatitis (AD) severity. METHODS: AD severity was evaluated in the clinic by two assessors using the Eczema Area and Severity Index (EASI), SCOring Atopic Dermatitis (SCORAD), and Investigator's Global Assessment (IGA). Participants photographed the lesions with their own smartphone and completed a questionnaire about the extent of eczema the same day from home. The photographs were assessed twice with an 8 weeks interval by five dermatologists experienced in photographic evaluations. Intraclass correlation coefficients (ICC) with 95% confidence interval (CI) were applied. RESULTS: Seventy-nine participants were enrolled. The ICC between clinical EASI and photographic EASI was 0.88 (95% CI 0.81-0.93), and 0.86 (0.70-0.93) between clinical SCORAD and photographic SCORAD. Perfect agreement between clinical IGA and photograph IGA was observed for 62%, with the difference between the two never deviating with more than 1 score. The inter-rater ICC for photographic EASI and photographic SCORAD, respectively, was 0.90 (0.85-0.94), and 0.96 (0.91-0.98). The intra-rater agreements between the first and second assessments varied from 0.95 to 0.98 for photographic EASI, and from 0.86 to 0.94 for photographic SCORAD. CONCLUSION: There was high agreement between mild to moderate AD severity assessed clinically and based on smartphone photographs. Further, the photographic assessments can be reproduced with high reliability.

Altered resting-state functional connectivity of default mode network in brachioradial pruritus.

BACKGROUND: Patients with chronic pruritus (CP) have a low quality of life, thus it is important to gain a better understanding of the underlying processes. Previous functional magnetic resonance imaging studies at rest (rsfMRI) have shown that mainly areas associated with the default mode network (DMN), sensorimotor (SMN), frontoparietal (FPN) and salience networks (SN) are involved in the processing of itch in patients with chronic pruritus (CP), as well as the cortico-striatal circuit, which is involved in the motoric preparation of scratching. rsfMRI studies on functional connectivity (FC) patterns of resting-state networks (RSNs) in patients with inflammatory atopic dermatitis (AD) or with neuropathic brachioradial pruritus (BRP) compared with healthy controls (HC) are lacking. OBJECTIVES: The main goals of this study were to investigate whether functional connectivity within networks and areas associated with itch detection and processing are altered in patients with AD and BRP compared with matched healthy controls by rsfMRI, respectively. METHODS: Patients with AD (n = 28) and with BRP (n = 28) were compared with corresponding matched healthy controls by rsfMRI. Group-specific RSNs were identified by independent component analysis (ICA) and between-group differences in the RSNs were analysed by dual regression technique. Seed-based functional connectivity was analysed in several itch-related brain regions belonging to the DMN, SN and FPN, respectively. RESULTS: ICA and seed-based analyses revealed decreased functional connectivity in BRP compared with HC specially within the DMN including the precuneus and cingulate cortex. For AD patients in comparison with HC, as well as when BRP and AD patients were compared directly, no significant FC differences at rest were seen. CONCLUSIONS: Our findings point towards decreased FC particularly in the DMN at rest in patients with BRP. These results seem to indicate that central connectivity patterns at rest differentially encode itch in BRP and AD.

Machine Learning Assisted Handheld Confocal Raman Micro-Spectroscopy for Identification of Clinically Relevant Atopic Eczema Biomarkers.

Atopic dermatitis (AD) is a common chronic inflammatory skin dermatosis condition due to skin barrier dysfunction that causes itchy, red, swollen, and cracked skin. Currently, AD severity clinical scores are subjected to intra- and inter-observer differences. There is a need for an objective scoring method that is sensitive to skin barrier differences. The aim of this study was to evaluate the relevant skin chemical biomarkers in AD patients. We used confocal Raman micro-spectroscopy and advanced machine learning methods as means to classify eczema patients and healthy controls with sufficient sensitivity and specificity. Raman spectra at different skin depths were acquired from subjects' lower volar forearm location using an in-house developed handheld confocal Raman micro-spectroscopy system. The Raman spectra corresponding to the skin surface from all the subjects were further analyzed through partial least squares discriminant analysis, a binary classification model allowing the classification between eczema and healthy subjects with a sensitivity and specificity of 0.94 and 0.85, respectively, using stratified K-fold (K = 10) cross-validation. The variable importance in the projection score from the partial least squares discriminant analysis classification model further elucidated the role of important stratum corneum proteins and lipids in distinguishing two subject groups.

Assessment of nail findings in children with atopic dermatitis.

BACKGROUND: Cutaneous findings are well known in atopic dermatitis (AD), but nail changes have not received as much attention. AIM: To determine the clinical and disease-related capillaroscopic findings of nail findings in paediatric patients with AD. METHODS: In total, 100 participants aged 2-16 years were sourced from the dermatology outpatient clinic: 50 of these had been diagnosed with AD according to the Hanifin-Rajka criteria, and the others were 50 healthy controls (HCs) without AD. The AD severity score (SCORing Atopic Dermatitis; SCORAD) was calculated for all patients with AD. A digital epiluminescence device was used for nailfold capillaroscopy. RESULTS: The nail findings detected in patients with AD were pitting, punctate leuconychia, trachyonychia, onycholysis and onychomadesis. Pitting was significantly (P < 0.01) more frequent in the patient group (26%) than in the HC group (6%). Similarly, the patient group had significantly higher rates for capillary density decrease (P < 0.01), capillary array irregularity (P < 0.001), capillary dilatation increase (P < 0.001), tortuosity (P = 0.04), ramification increase (P = 0.02), bush-like appearance (P = 0.02) and avascular areas (P < 0.01). Significant correlations were determined between pitting and trachyonychia (P < 0.05, r = 0.21), capillary density decrease (P < 0.05, r = 0.25), avascular areas (P < 0.001; r = 0.29) and SCORAD (P < 0.05, r = 0.35). CONCLUSION: The nailfold capillaroscopic images of children with AD were similar to those of scleroderma spectrum disorder. Thus, we believe it would be beneficial to support detailed clinical examination of patients with a capillaroscopic examination.

Microscopic and functional changes observed with dynamic optical coherence tomography for severe refractory atopic dermatitis treated with dupilumab.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory disease. Recently, dupilumab was approved for moderate-to-severe AD. D-OCT is a noninvasive tool for the characterization of skin diseases. OBJECTIVE: To describe the changes observed with D-OCT in lesional and clinically healthy skin of patients with refractory severe AD under dupilumab treatment. METHODS: We analyzed AD lesions and healthy skin by D-OCT. Clinical scores of AD severity were assessed at baseline (T0) and after 1 and 3 months of treatment (T1, T2). Descriptive statistics, chi-square test, and t test were used to compare the analyzed parameters over time and between AD lesions and clinically healthy skin. RESULTS: At baseline, average EASI was 45.7. During the follow-up, EASI75 and EASI90 were achieved in 57% and 36% of patients at T1 and 100% and 86% of patients at T2, respectively. Lesional skin D-OCT parameters related to epidermal remodeling and inflammation evidenced a significant improvement after 1 month of treatment. In clinically healthy skin, D-OCT parameters improved significantly after 3 months of treatment, especially for collagen remodeling and inflammation. CONCLUSION: The study demonstrates that the clinical improvement of severe AD patients under dupilumab treatment is correlated with specific D-OCT changes of patients' lesional and clinically healthy skin.

Quantification of cutaneous allergic reactions using 3D optical imaging: A feasibility study.

BACKGROUND: User-independent quantitative measures of cutaneous allergic reactions can help the physicians manage and evaluate the treatment of cutaneous allergic reactions. In this paper, we present and validate a method to quantify the elevation, volume and area of cutaneous allergic reactions to red tattoos. METHODS: The skin surface of allergic tattoo reactions was imaged using an optical 3D scanner. The in-house developed analysis tool measured the elevation, volume and area of the lesions, compared to a reference surface. This reference surface was created by 3D interpolation of the skin after manual removal of the lesions. The error of the interpolation tool was validated using a digital arm model. The error of our optical scanner was determined using a 3D printed lesion phantom. The clinical feasibility of the method was tested in 83 lesions in 17 patients. RESULTS: The method showed clear potential to assess skin elevation, volume change and area of an allergic reaction. The validation measurements revealed that the error due to interpolation increases for larger interpolation areas and largely determined the error in the clinical measurements. Lesions with a width ≥4 mm and an elevation ≥0.4 mm could be measured with an error below 26%. Patient measurements showed that lesions up to 600 mm2 could be measured accurately, and elevation and volume changes could be assessed at follow-up. CONCLUSION: Quantification of cutaneous allergic reactions to red tattoos using 3D optical scanning is feasible and may objectify skin elevation and improve management of the allergic reaction.

Ultrasonography patterns of atopic dermatitis in children.

BACKGROUND: Atopic dermatitis (AD) is one of the most common allergic diseases in children. The aim of the study was to evaluate the ultrasound picture of lesional and non-lesional skin in children with AD. MATERIALS AND METHODS: The study included a group of children with AD and a control group. Inclusion criteria were as follows: age 0-8 years and clinical diagnosis of AD. An ultrasound scanner with a 75 MHz transducer probe was used to produce B-mode skin images in lesions and non-lesional skin. The thickness and the echogenicity of epidermis, dermis, and subepidermal low-echogenic band (SLEB) were measured, and the ratio coefficient per body site was calculated. RESULTS: Ultrasonography of non-lesional skin in children with AD showed uneven epidermis contour, a tendency to increased epidermis and decreased dermis thickness, and the SLEB was observed in 77% of cases. In lesions, there was an increased thickness and a decreased echogenicity of epidermis and dermis, and epidermis had irregular contours in most cases. The SLEB was in all lesions, showing greater thickness and lower echogenicity compared with non-lesional skin. CONCLUSION: HF-USG of the skin allows visualizing the epidermal barrier disruption and inflammation in dermis in children with AD on the entire surface of the skin.

Fluorescent fibre-optic confocal characterization of in vivo epidermal changes in atopic eczema.

BACKGROUND/AIMS: Fibre-optic confocal imaging (FOCI) allows non-invasive visualization of live skin in vivo. A contrast agent, a fluorophore, is injected into the dermis. FOCI images are horizontal optical sections with cellular resolution. The aim was to study in vivo epidermal changes and the cellular structure of keratinocytes in moderate to severe atopic eczema (AE). METHODS: Eight patients with AE with active lesions on the forearms were studied and compared to a control group of six healthy individuals, and two cases of AE without activity. Fluorescein sodium was used as fluorophore. A hand-held fibre-optic laser scanner (Stratum® ) was used. The study included morphometric analyses. RESULTS: The confocal in vivo images identified characteristic features of epidermis and keratinocytes in active AE vs healthy skin controls. FOCI could non-invasively image acanthosis, spongiosis, and parakeratosis in AE. Epidermal oedema and micro-vesicles were visualized. Morphometry based on FOCI demonstrated 14% increased width of keratinocytes of atopic skin vs healthy controls. The epidermal structures and organization in distinctive cell layers were deviant as a result of the disease. CONCLUSIONS: Fibre-optic confocal imaging can visualize essential epidermal structures of atopic eczema directly in vivo, in real-time, and with cellular resolution thus without disturbing the natural state of the skin. FOCI is primarily a research tool, but with a potential to become used in the clinic for non-invasive microscopic diagnosis of AE and monitoring of effect of therapies.

Skin pH mapping and its relationship with transepidermal water loss, hydration and disease severity in adult patients with atopic dermatitis.

BACKGROUND: Defective skin's acidic mantle is a component of atopic dermatitis (AD) pathophysiology. We mapped the skin pH and determine its relationship with transepidermal water loss (TEWL), hydration and disease severity. MATERIALS AND METHODS: A cross-sectional study involving patients aged ≥18 years. Eczema Area and Severity Index (EASI) was assessed. Skin pH, TEWL and hydration were measured at 18 pre-determined sites. RESULTS: Forty-eight patients participated, 33(68.8%) females and 15(31.3%) males aged 28.46 ± 12.07 years. The overall skin pH was 5.32 ± 0.68 ranging from 5.16 ± 0.75 to 5.52 ± 0.59. The lowest pH 5.16 ± 0.75 was at anterior leg, popliteal fossae 5.18 ± 0.67, lower back 5.21 ± 0.64, forehead 5.22 ± 0.62, upper back 5.25 ± 0.65 and neck 5.26 ± 0.76. Highest pH was at the cheek 5.52 ± 0.59, anterior thigh 5.47 ± 0.68, dorsal arm 5.46 ± 0.68, volar arm 5.43 ± 0.67 and abdomen 5.39 ± 0.67. Lesional areas' pH (5.40 ± 0.13) was higher than nonlesional (5.27 ± 0.14), P = .01. pH at AD predilection sites was significantly lower non-predilection sites (5.26 ± 0.59 vs 5.34 ± 0.64). pH did not correlate with TEWL (r = .23, P = .12), EASI (r = .19, P = .20) and itch (r = .06, P = .70) but correlated with hydration r = -.33, P = .02. CONCLUSION: Skin pH was lower at AD predilection sites. There was no correlation between pH with AD severity and TEWL, pH correlated with hydration.

Comparative study of skin autofluorescence expression in atopic dermatitis and psoriasis: A prospective in vivo study.

BACKGROUND/PURPOSE: Treatment of atopic dermatitis (AD) and psoriasis requires their differentiation from other eczematoid dermatitis and a determination of disease severity. However, both can be clinically difficult and the findings subjectively interpreted. We investigated the utility of in vivo autofluorescence (AF) measurements for diagnosis of both diseases, and determination of severity. MATERIALS AND METHODS: Thirty patients with AD and 30 with psoriasis were recruited, together with sex- and age-matched patients with healthy skin. AF intensity was measured using the EcoSkin® fluorescence video dermatoscope. In AD and psoriasis patients, AF in non-sun-exposed lesional and non-lesional skin was measured. To identify the locations that reflect characteristics of AD, AF was also measured at the other sites in the patients with AD. RESULTS: AD was associated with lower AF and psoriasis with higher AF intensity peaking around 620 nm. In addition, skin AF intensity of each disease was associated with severity of lesion. CONCLUSIONS: Non-invasive measurement of skin AF in vivo can aid in diagnosis of AD and psoriasis as well as in treatment monitoring.

Brain mechanism of itch in atopic dermatitis and its possible alteration through non-invasive treatments.

Atopic dermatitis (AD) is a common chronic skin disease that is characterized by intense pruritus and has high impairment of quality of life. AD is often described as "the itch that rashes, rather than the rash that itches". Several studies suggest that mechanisms of central modulation play an important role in the development and maintenance of chronic itch. Therefore, treating the neurosensory aspects of itch is an important part in the management of chronic itch. However, little attention has been paid to the role of the central nervous system in the processing of itch in AD. Targeting itch-related anatomical structures in the brain with non-invasive treatments such as psychological interventions and transcranial Direct Current Stimulation (tDCS) could have an antipruritic effect in AD. Therefore, in this review article, we discuss the current progress in brain imaging research of itch, as well as the efficacy of non-invasive interventions for itch relief in this patient group.

Monitoring of therapy in atopic dermatitis--observations with the use of high-frequency ultrasonography.

BACKGROUND: In reactive and proactive therapy of atopic dermatitis a well established agent is tacrolimus, a member of calcineurin inhibitors' family. The clinical safety and efficacy of this drug were evaluated previously in randomized multicenter trials. However, so far in clinical studies the assessment of its action on the skin has been made only on the basis of different scores and scales. We present the 6-month observations of tacrolimus therapy in atopic dermatitis patients monitored with the use of noninvasive techniques like high-frequency ultrasonography and evaporimetry. METHODS: The study consisted of 39 patients with AD and their mean age was 26.3 ± 12.8 years. The study lasted 6 months and every 4 weeks patient visited the outpatient clinic (totally 7 visits). The evaluation of disease severity within right antecubital fossa was obtained on the basis of Investigator's Global Assessment (IGA) score. During every control visit noninvasive measurements were carried in the form of HF-USG (with determination of subepidermal low echogenic band, SLEB) and evaporimetry. RESULTS: 39 patients started the study and 22 of them (54.6%) finished it. Out of 39 patients, 31 (79.5%) received at least 4 week long proactive treatment. We observed statistically significant change of IGA, mean SLEB value and TEWL during underwent therapy. There were also statistically significant differences in mean SLEB and TEWL values between lesional and nonlesional measures. CONCLUSIONS: This report shows the usefulness of HF-USG in monitoring tacrolimus therapy in atopic dermatitis. It is worth emphasizing, that this tool is easily reproducible and allows clinicians to visualize pathologic changes of all skin in vivo. As a noninvasive and independent of subjective judgment method, HF-USG should be included in overall evaluation of atopic dermatitis disease severity together with common scores or scales, especially in the era of evidence based medicine.

Superoxide Dismutase-Mimetic Polyphenol-Based Carbon Dots for Multimodal Bioimaging and Treatment of Atopic Dermatitis.

Polyphenols have been investigated for their potential to mitigate inflammation in the context of atopic dermatitis (AD). In this study, epigallocatechin-3-gallate (EGCG)-based carbon dots (EGCG@CDs) were developed to enhance transdermal penetration, reduce inflammation, recapitulate superoxide dismutase (SOD) activity, and provide antimicrobial effects for AD treatment. The water-soluble EGCG@CDs in a few nanometers size exhibit a negative zeta potential, making them suitable for effective transdermal penetration. The fluorescence properties, including an upconversion effect, make EGCG@CDs suitable imaging probes for both in vitro and in vivo applications. By mimicking the SOD enzyme, EGCG@CDs scavenge reactive oxygen species (ROS) and actively produce hydrogen peroxide through a highly catalytic capability toward the oxygen reduction reaction, resulting in the inhibition of bacterial growth. The enhanced antioxidant properties, high charge mobility, and various functional groups of EGCG@CDs prove effective in reducing intracellular ROS in an in vitro AD model. In the mouse AD model, EGCG@CDs incorporated into a hydrogel actively penetrated the epidermal layer, leading to ROS scavenging, reduced mast cell activation, and histological recovery of skin barriers. This research represents the versatile potential of EGCG@CDs in addressing AD and advancing tissue engineering.