Atopic dermatitis (DA) is a chronic inflammatory skin disease. Its incidence and prevalence is increasing, especially in industrialized countries. The prevalence of AD in adults is estimated at 1-3 % ...of the general population and can present as adult-onset AD, or as infantile/childhood AD that persists, or recurs in adulthood. There are no specific diagnostic criteria for adult AD. Diagnosis may be also complicated by the fact that the clinical manifestations sometimes differ from pediatric AD. Moreover, many recent studies have identified adult AD as a systemic disease. Due to its chronicity and comorbidities, Adult AD has a major impact on quality of life and working abilities of affected patients. With the emergence of new treatments, we should see more and more adult AD in the future, a better knowledge of its characteristics is therefore required.
Pityriasis rubra pilaris (PRP) is a rare inflammatory skin disease. Recently, the use of anti-TNF-α in treating resistant forms of PRP has been reported.
To evaluate the clinical efficacy of ...infliximab in the treatment of PRP along with the evolution of secretion of some serum cytokines during treatment.
Patients presenting widespread PRP were included consecutively and treated with infliximab. We compared cytokine profiles (notably CXCL-10 and TNF-α) by ELISA in sera from both patients with PRP and controls (healthy/psoriasis) at the time of diagnosis and after clinical remission (PRP).
4 patients were treated with infliximab and achieved complete remission without any recurrence after treatment ending. The serum level of TNF-α and CXCL-10 was increased at the time of inclusion and normalized after treatment. Analysis of the typical component of the T helper cell 1 (Th1) and Th2 cytokine network did not show modification.
Infliximab is an effective treatment of PRP. The analysis of the cytokine profile is in agreement with an absence of further recurrence of PRP by an early and unique inflammatory mechanism without significant underlying autoimmunity.
Summary
Background
Psoriasis is associated with higher prevalences of cardiovascular and metabolic comorbidities in adults but the relationship of age at onset and those prevalences is unknown.
...Objective
To evaluate whether the childhood onset of psoriasis (COP) is correlated with the frequency of cardiovascular and metabolic comorbidities in adulthood.
Methods
This noninterventional, cross‐sectional, multicentre study of adults with psoriasis was conducted in 29 dermatology centres in France. Data on sex, age at onset of psoriasis and its clinical characteristics, and cardiovascular risk factors, including weight, body mass index, waist circumference, dyslipidaemia, diabetes, hypertension, smoking, and personal/familial major adverse cardiovascular events (MACE) were systematically recorded.
Results
Two thousand two hundred and one patients with psoriasis (male: 56%; mean age: 49 years; 25% with COP) were included consecutively in the study. Univariate analysis showed that COP was associated with lower frequencies of obesity, high waist circumference, diabetes, dyslipidaemia, hypertension, familial cardiovascular disease, MACE and metabolic syndrome, but more frequent active smoking. Multivariate analysis retained age as being associated with frequency of cardiovascular and metabolic comorbidities, and sex with smoking, but not age at the onset of psoriasis. Psoriasis severity was associated with higher frequencies of obesity and psoriatic arthritis.
Conclusion
Our results showed that COP does not seem to be an additional risk factor for higher frequencies of cardiovascular and metabolic comorbidities during adulthood.
What's already known about this topic?
Psoriasis and its severity are associated with higher prevalence of cardiovascular and metabolic comorbidities in adults.
Childhood onset of psoriasis is not associated with obesity in adulthood.
What does this study add?
Childhood onset of psoriasis is not associated with cardiovascular and metabolic comorbidities in adulthood.
In France, as in most countries, psoriasis is associated with high frequencies of cardiovascular and metabolic comorbidities in adults.
Background
Dupilumab is the first biotherapy available for the treatment of moderate‐to‐severe childhood atopic dermatitis (AD).
Objective
The aim of this study was to evaluate the effectiveness and ...safety of dupilumab in daily practice.
Methods
Patients aged 6–11, who had received a first dose of dupilumab, were included in this multicentre retrospective cohort study. The primary endpoint was change in SCORAD after 3 months of treatment. Secondary endpoints were change in IGA score at 3 months, proportion of patients with SCORAD50 and SCORAD75, description of adverse events and proportion of children in our cohort who would be excluded from pivotal phase 3 clinical trial.
Results
Eighty patients were included. After 3 months of treatment, there was a significant decrease in SCORAD (mean: 21.8 ± 13.8 vs 53.9 ± 18.5; P < 0.0001) and IGA (1.3 ± 0.8 vs 3.5 ± 0.7; P < 0.0001). Conjunctivitis was observed in 11.3% (n = 9/80); three patients experienced dupilumab facial redness (DFR); 17.5% (n = 14/80) reported injection site reactions; 6.3% (n = 5/80) discontinued treatment. 61.2% (n = 49/80) children were ineligible in the phase 3 trial.
Limitations
There is no control group. Because it was a real life study based on information from patient medical records in a French multicentre cohort, we cannot rule out the presence of reporting bias generated by the use of patient reported characteristics and missing information.
Conclusion
These real‐life data confirm the efficacy and safety of dupilumab in children with moderate to severe AD extended to dyshidrosis and atopic prurigo, but it also revealed a lower frequency of DFR and conjunctivitis. However, administration in injectable form may be a barrier in this age group.
The impact of atopic dermatitis on sexual health Misery, L.; Seneschal, J.; Reguiai, Z. ...
Journal of the European Academy of Dermatology and Venereology,
February 2019, 2019-Feb, 2019-02-00, 20190201, 2019-02, Letnik:
33, Številka:
2
Journal Article
Recenzirano
Background
Sexual health is frequently affected by chronic diseases but has been poorly investigated in patients with atopic dermatitis (AD).
Objective
To evaluate the risk factors for impaired ...sexual desire and its relationship with the burden and quality of life of patients with AD.
Methods
A multicentre prospective transversal study in patients with AD. Socio‐demographic and clinical data were obtained from all patients using a specifically developed questionnaire. In addition, patients were asked to answer validated scales, that is ABS‐A, DLQI, SF‐12 and EQ‐5D.
Results
A total of 1024 patients participated in the study. Severity of AD, sites involved and treatment type was found to negatively impact the sexual desire of patients and their partners. In addition, the involvement of the genital and visible areas was associated with a higher burden and more significant alterations in quality of life.
Conclusions
The results of this study are substantial and clearly demonstrate the deep impact of AD on sexual health, its relationship with disease‐related burden and alterations to quality of life. Psychosociological as well as neurosensory phenomena could help to understand these data.
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