The epidermis protects human subjects from exogenous stressors and helps to maintain internal fluid and electrolyte homeostasis. Filaggrin is a crucial epidermal protein that is important for the ...formation of the corneocyte, as well as the generation of its intracellular metabolites, which contribute to stratum corneum hydration and pH. The levels of filaggrin and its degradation products are influenced not only by the filaggrin genotype but also by inflammation and exogenous stressors. Pertinently, filaggrin deficiency is observed in patients with atopic dermatitis regardless of filaggrin mutation status, suggesting that the absence of filaggrin is a key factor in the pathogenesis of this skin condition. In this article we review the various causes of low filaggrin levels, centralizing the functional and morphologic role of a deficiency in filaggrin, its metabolites, or both in the etiopathogenesis of atopic dermatitis.
Previous studies found conflicting results about the commonality of different atopic dermatitis (AD) signs and symptoms.
To determine the prevalences of AD characteristics and differences by region ...and age.
A systematic review was performed of all published studies in MEDLINE, EMBASE, SCOPUS, LILACS, Cochrane, China National Knowledge Infrastructure, Taiwan Electronic Periodical Services, and CiNii that analyzed the proportion of AD characteristics. Two reviewers performed a review study titles and/or abstracts and data abstraction.
In all, 101 studies reported proportion of AD features with sufficient data for meta-analysis. The most prevalent AD features were pruritus, lichenification, and xerosis. There were differences in AD characteristics by study region. Flexural involvement was less commonly reported in India, the Americas, and Iran. Studies from East Asian reported more erythroderma and truncal, extensor, scalp, and auricular involvement. Studies from Southeast Asia reported more exudative eczema, truncal involvement, lichenification, and prurigo nodularis. Studies from Iran reported more head, face, and neck involvement; pityriasis alba; and xerosis. Studies from Africa reported more papular lichenoid lesions, palmar hyperlinearity, ichthyosis, and orbital darkening.
Heterogeneity between studies and limited reporting of certain AD clinical characteristics.
AD characteristics are heterogeneous and vary by region and age.
Atopic dermatitis (AD) is a common yet complex skin disease, posing a therapeutic challenge with increasingly recognized different phenotypes among variable patient populations. Because therapeutic ...response may vary on the basis of heterogeneous clinical and molecular phenotypes, a shift toward precision medicine approaches may improve AD management. Herein, we will consider biomarkers as potential instruments in the toolbox of precision medicine in AD and will review the process of biomarker development and validation, the opinion of AD experts on the use of biomarkers, types of biomarkers, encompassing biomarkers that may improve AD diagnosis, biomarkers reflecting disease severity, and those potentially predicting AD development, concomitant atopic diseases, or therapeutic response, and current practice of biomarkers in AD. We found that chemokine C-C motif ligand 17/thymus and activation-regulated chemokine, a chemoattractant of TH2 cells, has currently the greatest evidence for robust correlation with AD clinical severity, at both baseline and during therapy, by using the recommendations, assessment, development, and evaluation approach. Although the potential of biomarkers in AD is yet to be fully elucidated, due to the complexity of the disease, a comprehensive approach taking into account both clinical and reliable, AD-specific biomarker evaluations would further facilitate AD research and improve patient management.
Dupilumab, the first biological drug to be approved for the treatment of moderate to severe atopic dermatitis in adolescents and adults, has shown good efficacy and safety in clinical trials.
To ...evaluate real-world data on the efficacy and safety of dupilumab in atopic dermatitis.
PubMed and EMBASE were searched for observational studies with data on efficacy, drug survival, and safety of dupilumab for the treatment of atopic dermatitis. Primary outcomes were mean percentage change in Eczema Area and Severity Index (EASI) score and proportion of atopic dermatitis patients achieving 50%, 75%, and 90% improvement in EASI score after dupilumab therapy.
Twenty-two unique studies encompassing 3303 atopic dermatitis patients were included. After 16 weeks of dupilumab therapy, the pooled proportion of patients achieving 50%, 75%, and 90% EASI score improvement was 85.1%, 59.8%, and 26.8%, respectively, and the weighted mean reduction in EASI score was 69.6%. Conjunctivitis was the most common adverse event, reported in a pooled proportion of 26.1%.
Limited data in terms of size and follow-up time were available.
Real-world data show that dupilumab is a successful and well-tolerated therapy for atopic dermatitis, but ocular adverse events commonly occur. Registries are needed to monitor for adverse events.
Nickel is the most frequent cause of contact allergy worldwide and has been studied extensively. This clinical review provides an updated overview of the epidemiology, exposure sources, methods for ...exposure quantification, skin deposition and penetration, immunology, diagnosis, thresholds for sensitization and elicitation, clinical pictures, prevention, and treatment. The implementation of a nickel regulation in Europe led to a decrease in the prevalence of nickel allergy, and changes in the clinical picture and disease severity. Nevertheless, the prevalences of nickel allergy in the European general population are approximately 8% to 19% in adults and 8% to 10% in children and adolescents, with a strong female predominance. Well‐known consumer items such as jewellery and metal in clothing are still the main causes of nickel allergy and dermatitis, although a wide range of items for both private and occupational use may cause dermatitis. Allergic nickel dermatitis may be localized to the nickel exposure site, be more widespread, or present as hand eczema. Today, efficient methods for exposure quantification exist, and new insights regarding associated risk factors and immunological mechanisms underlying the disease have been obtained. Nevertheless, questions remain in relation to the pathogenesis, the persistent high prevalence, and the treatment of severe cases.
Background
Contact allergy and allergic contact dermatitis are frequent conditions in the general population.
Objectives
To provide an updated estimate of the prevalence of contact allergy in the ...general population based on data from our previous review combined with new data from an updated search for relevant studies published between 2007 and 2017.
Methods
Two authors independently searched PubMed for studies reporting on the prevalence of contact allergy in samples of the general population. Proportion meta‐analyses were performed to calculate the pooled prevalence estimates of contact allergy.
Results
A total of 28 studies were included in the analysis, covering 20 107 patch tested individuals from the general population. Overall, the pooled prevalence of contact allergy was 20.1% (95% confidence interval CI: 16.8%‐23.7%). In children and adolescents (<18 years), the prevalence was 16.5% (95%CI: 13.6%‐19.7%). The prevalence was significantly higher in women (27.9% 95%CI: 21.7%‐34.5%) than in men (13.2% 95%CI: 9.3%‐17.6%). The most common allergen was nickel (11.4% 95%CI: 9.4%‐13.5%), followed by fragrance mix I (3.5% 95%CI: 2.1%‐5.4%), cobalt (2.7% 95%CI: 2.1%‐3.4%), Myroxylon pereirae (1.8% 95%CI: 1.0%‐2.7%), chromium (1.8% 95%CI: 1.3%‐2.6%), p‐phenylenediamine (1.5% 95%CI: 1.0%‐2.1%), methylchloroisothiazolinone/methylisothiazolinone (1.5% 95%CI: 0.8%‐2.5%), and colophonium (1.3% 95%CI: 1.0%‐1.6%).
Conclusions
This meta‐analysis confirmed that at least 20% of the general population are contact‐allergic to common environmental allergens. It highlights the need for more effective preventive strategies for common allergens in consumer goods, cosmetics, and the workplace.
Recent observational data have suggested an increased risk of cerebrovascular accidents associated with exposure to risankizumab. This article discusses these findings and highlights why there is a ...need for future observational studies investigating this potential signal.
The prevalence of metal allergy is high in the general population, and it is estimated that up to 17% of women and 3% of men are allergic to nickel and that 1−3% are allergic to cobalt and chromium. ...Among dermatitis patients, the prevalence of metal allergy is even higher. Metal allergy is mainly an environmental disorder although null mutations in the filaggrin gene complex were recently found to be associated with nickel allergy and dermatitis. Environmental metal exposures include jewelry, buttons, clothing fasteners, dental restorations, mobile phones, and leather. Although consumer exposure is responsible for most cases of metal allergy, the importance of occupational metal exposure remains present and should always be taken into consideration when one interprets allergic patch test reactions to metals. Traditionally, nickel, cobalt, and chromium have been the most important contact allergens. However, recently, gold and palladium have drawn much attention as the prevalence of contact allergy to these metals is high. Palladium allergy is mainly a result of cross-sensitization to nickel, whereas gold allergy is rarely clinically relevant when one takes its high prevalence into account. The epidemiology of metal allergy has recently changed in Europe as nickel allergy among ear-pierced Danish women has decreased following regulatory intervention on nickel release from consumer products. In the United States, the prevalence of nickel allergy is still increasing, which may be explained by the absence of regulation. The prevalence of chromium allergy is increasing in the United States, Singapore, and Denmark among dermatitis patients. This increase is significantly associated with leather exposure in Denmark. Metal allergy may result in allergic contact dermatitis and systemic allergic (contact) dermatitis. Furthermore, metal allergy has been associated with device failure following insertion of intracoronary stents, hip and knee prostheses, as well as other implants. This area is in need of more research.
Factors that are associated with patient-reported importance of obtaining complete or almost complete clearance of psoriasis and atopic dermatitis (AD) are unknown.
To investigate the importance of ...and factors associated with obtaining complete or almost complete clearance of psoriasis or AD.
A cross-sectional study of 4016 and 3842 adults with psoriasis and AD.
Patients with AD reported significantly greater importance of almost complete or complete skin clearance compared with patients with psoriasis. For both patient groups, almost complete was more important that complete skin clearance. Increasing disease severity and itch and skin pain were significantly associated with perceived importance of skin clearance for patients with both diseases. AD and psoriasis located on the face or neck and psoriasis located on the palms, soles, or genitals were significantly associated with patient-perceived importance of almost complete skin clearance. Only 7% and 27% of patients with severe AD and psoriasis, respectively, were currently receiving a systemic therapy.
Specific reasons for infrequent use of systemic treatments was not examined.
Patients with psoriasis or AD expressed a strong request for almost complete or complete skin clearance. Patient education and effective therapies should be used to reduce disease severity.
Background Tobacco exposure might be a modifiable risk factor for atopic dermatitis (AD). Objective We examine the association between AD and exposure to tobacco smoke. Methods We performed a ...systematic review and meta-analysis of observational studies (n = 86) in MEDLINE, EMBASE, Scopus, and Cochrane Library (1823-2015). Quality of evidence was assessed using the Newcastle-Ottawa Scale (NOS). A meta-analysis was performed using random-effects models to estimate pooled odds ratios (OR). Subset analyses were performed for different ages (children, adult), regions, study designs (cross-sectional, longitudinal), study sizes (<5000, ≥5000), study quality (NOS score <6, ≥6), and amount of smoking (mild, extensive). Results A diagnosis of AD was associated with higher odds of active smoking (OR 1.87, 95% confidence interval 1.32-2.63) and exposure to passive smoke (OR 1.18, 95% confidence interval 1.01-1.38), but not maternal smoking during pregnancy (OR 1.06, 95% confidence interval 0.80-1.40). The association between active smoking and AD remained significant in children and adults, all continents studied, and study sizes, but all were cross-sectional designs and had NOS score 6 or greater. Passive smoke was associated with AD in children and adults, cross-sectional studies, South/Central American and African studies, study size less than 5000, and NOS score less than 6. Limitations AD severity and distribution were not assessed. Conclusions Active and passive exposure to smoke are associated with increased AD prevalence.
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