Atopic Dermatitis

Atopic dermatitis, covid 19, and hand dermatitis

Most Recent Atopic Dermatitis Updates

1. J Trop Pediatr. 2021 Jan 29;67(1):fmab011. doi: 10.1093/tropej/fmab011.

Fluctuating Palmar Erythema in a Toddler during COVID-19 Pandemic: Do You Know

the Offender?

Panda PK, Sharawat IK.

Palmar erythema in children can be due to various reasons, such as chronic liver

disease, rheumatological disorders, medications, irritant contact dermatitis and

atopic dermatitis. Recently, there are few reports about contact dermatitis

caused by frequent, daily use of hand sanitizers during this COVID-19 pandemic.

A 3-year-old toddler brought with the concern of waxing-waning bilateral palmar

erythema for the past 2 weeks. The parents revealed that the child liked the

bright color of a recently bought hand sanitizer bottle so much he used to wash

his hands every 20-30 min throughout the day. The atypical presentation of

contact dermatitis might be because the child was using the sanitizer more

frequently during the daytime. The dermatitis resolved with stopping excessive

use of the hand sanitizer by the toddler. Clinicians should be aware of contact

dermatitis during these pandemic times. Instead of investigating them

extensively, careful history taking and merely advising them to judicially

utilize the sanitizer can lead to complete reversal of symptoms.

reserved. For permissions, please email: journals.permissions@oup.com.

DOI: 10.1093/tropej/fmab011

PMID: 33620073

2. Dermatol Ther. 2021 Feb 22:e14911. doi: 10.1111/dth.14911. Online ahead of

print.

DECISA Project (DErmatology Clinics in Italy: Survey on Alitretinoin): a

real-life retrospective cohort multicentre study on 438 subjects with chronic

hand eczema.

Ferrucci S(1), Persichini P(1), Gola M(2), Scandagli I(2), Pigatto P(3), Legori

A(3), Musumeci ML(4), Micali G(4), D'Agata E(4), Schena D(5), Azzolini A(5),

Gallo R(6), Trave I(6), Cristaudo A(7), Patruno C(8), Napolitano M(9), Zucca

M(10), Piras V(11), Stingeni L(12), Bianchi L(12), Corazza M(13), Zedde P(13),

Foti C(14), Romita P(14), Cannavò SP(15), Guarneri F(15).

Author information:

(1)U.O.C. Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore

Policlinico Milano, Milan, Italy.

(2)SAS di Dermatologia Allergologica e Professionale - AUSL Toscana Centro e

Università degli Studi di Firenze, Florence, Italy.

(3)UO Dermatologia IRCCS Ospedale Galeazzi & Università degli Studi di Milano,

Milan, Italy.

(4)Dermatology Clinic, University of Catania, PO G. Rodolico, AOU

Policlinico-Vittorio Emanuele, Catania, Italy.

(5)Section of Dermatology and Venereology, Department of Medicine, University of

Verona, Verona, Italy.

(6)Clinica Dermatologica - DISSAL, Università di Genova e Ospedale Policlinico

San Martino - IRCCS, Genoa, Italy.

(7)UOSD Dermatologia MST, Ambientale, Tropicale e Immigrazione Istituto

Dermatologico San Gallicano (IRCCS), Rome, Italy.

(8)Unit of Dermatology, Department of Health Sciences, University Magna Graecia

of Catanzaro, Catanzaro, Italy.

(9)Department of Health Sciences "Vincenzo Tiberio", University of Molise,

Campobasso, Italy.

(10)Dermatologic Clinic, Hospital S.Giovanni di Dio, Cagliari, Italy.

(11)Department of Medical Sciences and Public Health, University of Cagliari,

Cagliari, Italy.

(12)Dermatology Section, Department of Medicine, University of Perugia, Italy.

(13)Sezione di Dermatologia, Dipartimento di Scienze Mediche, Università di

Ferrara, Ferrara, Italy.

(14)Dipartimento di Scienze Biomediche ed Oncologia Umana, Clinica

Dermatologica, Policlinico di Bari, Bari, Italy.

(15)Dipartimento di Medicina Clinica e Sperimentale - Dermatologia, Università

di Messina, Messina, Italy.

Alitretinoin is the only systemic agent approved to treat moderate-severe

chronic hand eczema (CHE) unresponsive to potent topical corticosteroids. No

nationwide Italian data regarding real-life efficacy, safety, and tolerability

of treatment are available. The DECISA project (DErmatology Clinics in Italy:

Survey on Alitretinoin) retrospectively examined data from a registry including

fifteen Dermatology Clinics authorized to prescription of alitretinoin for CHE

patients. Disease severity was assessed at baseline, and after 3 and 6 months of

treatment, using the 5-point Physician Global Assessment (PGA) and the modified

Total Lesion-Symptoms-Severity (mTLSS) scores. Between November 2010 and July

2018, data of 248 male and 190 female patients (mean age 49.71 ± 13.20 years)

treated with alitretinoin were collected. Of them, 43.2% had irritant contact

dermatitis, 22.2% allergic contact dermatitis, 18.0% atopic dermatitis, 16.7%

mixed (irritant/allergic) type of eczema. At 3 months, the 420 re-evaluated

patients showed significantly reduced mTLSS and PGA (P < 0.0000001 vs baseline

for both); PGA was clear/almost clear in 35.6% of cases. At 6 months, the 341

re-evaluated patients showed significant (P < 0.0000001) improvement of mTLSS

and PGA vs baseline and 3 months (PGA clear/almost clear: 41.4%). Relapses

occurred in 125 patients; 58 underwent an additional course of alitretinoin,

with similarly good results. No relevant safety issues were reported; 86

patients experienced adverse effects, which forced 40 to prematurely stop

treatment. The DECISA project results confirm the real-life efficacy, safety and

tolerability of alitretinoin in the treatment of moderate to severe CHE

refractory to standard topical therapies. This article is protected by

DOI: 10.1111/dth.14911

PMID: 33619833

3. Nat Med. 2021 Feb 22. doi: 10.1038/s41591-021-01256-2. Online ahead of print.

Development of a human skin commensal microbe for bacteriotherapy of atopic

dermatitis and use in a phase 1 randomized clinical trial.

Nakatsuji T(1), Hata TR(1), Tong Y(1), Cheng JY(1), Shafiq F(1), Butcher AM(1),

Salem SS(1), Brinton SL(1), Rudman Spergel AK(2), Johnson K(3), Jepson B(3),

Calatroni A(3), David G(3), Ramirez-Gama M(4), Taylor P(4), Leung DYM(4), Gallo

RL(5).

Author information:

(1)Department of Dermatology, University of California, San Diego, La Jolla, CA,

USA.

(2)Division of Allergy, Immunology and Transplantation, National Institute of

Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD,

USA.

(3)Rho Federal Systems Division, Inc., Durham, NC, USA.

(4)Division of Allergy and Immunology, Department of Pediatrics, National Jewish

Health, Denver, CO, USA.

(5)Department of Dermatology, University of California, San Diego, La Jolla, CA,

USA. rgallo@health.ucsd.edu.

Staphylococcus aureus colonizes patients with atopic dermatitis (AD) and

exacerbates disease by promoting inflammation. The present study investigated

the safety and mechanisms of action of Staphylococcus hominis A9 (ShA9), a

bacterium isolated from healthy human skin, as a topical therapy for AD. ShA9

killed S. aureus on the skin of mice and inhibited expression of a toxin from S.

aureus (psmα) that promotes inflammation. A first-in-human, phase 1,

double-blinded, randomized 1-week trial of topical ShA9 or vehicle on the

forearm skin of 54 adults with S. aureus-positive AD (NCT03151148) met its

primary endpoint of safety, and participants receiving ShA9 had fewer adverse

events associated with AD. Eczema severity was not significantly different when

evaluated in all participants treated with ShA9 but a significant decrease in S.

aureus and increased ShA9 DNA were seen and met secondary endpoints. Some S.

aureus strains on participants were not directly killed by ShA9, but expression

of mRNA for psmα was inhibited in all strains. Improvement in local eczema

severity was suggested by post-hoc analysis of participants with S. aureus

directly killed by ShA9. These observations demonstrate the safety and potential

benefits of bacteriotherapy for AD.

DOI: 10.1038/s41591-021-01256-2

PMID: 33619370

4. J Am Pharm Assoc (2003). 2021 Feb 19:S1544-3191(21)00002-9. doi:

10.1016/j.japh.2021.01.001. Online ahead of print.

Analysis of prior authorization success and timeliness at a community-based

specialty care pharmacy.

Hecht B, Frye C, Holland W, Holland CR, Rhodes LA, Marciniak MW.

BACKGROUND: Specialty medications may require a prior authorization (PA) before

a patient can access the medication. Providers often identify PA approval as a

burden for the practice. Pharmacists can facilitate the completion of the PA

process.

OBJECTIVE: The primary objective was to evaluate the time to first PA decision

(approval or denial) for dermatologic medications dispensed by a community-based

specialty pharmacy. A secondary objective was to compare PA timeliness (time to

PA approval and time to first medication fill) between a community-based

specialty pharmacy and a dermatology provider office.

PRACTICE DESCRIPTION: Realo Specialty Care is a community-based independent

specialty pharmacy that provides comprehensive care to patients with complex and

chronic conditions such as plaque psoriasis, hidradenitis suppurativa, and

atopic dermatitis. Pharmacy services include PA assistance, comprehensive

medication management, patient education, and adherence monitoring.

PRACTICE INNOVATION: Pharmacy dispensing system data were used to conduct a

retrospective analysis of the effectiveness at resolving PA requests. PAs are

traditionally completed by a provider's practice, and data are documented within

the pharmacy system as a PA task.

EVALUATION METHODS: Data included PA tasks for dermatology prescriptions for

patients aged 18 years or older between January 1, 2017, and June 30, 2019.

Initial receipt of the prescription, PA decision, and PA decision date were

noted in the PA task and confirmed via fax documentation. The date of first fill

was confirmed by prescription data.

RESULTS: The pharmacy completed 677 PA tasks with a mean time to PA decision of

1.9 days, whereas the provider's office averaged 20.9 days (P < 0.001). The

pharmacy demonstrated a mean time to first fill of 6.6 days, whereas the

provider's office averaged 16.2 days (P < 0.001).

CONCLUSION: Pharmacies can effectively complete PAs to expedite the filling

process for patients and increase medication access. Provider practices could

benefit from delegating these tasks to a partnered pharmacy.

DOI: 10.1016/j.japh.2021.01.001

PMID: 33618986

5. Dermatol Pract Concept. 2021 Jan 29;11(1):e2021132. doi: 10.5826/dpc.1101a132.

eCollection 2021 Jan.

Diet and Skin Barrier: The Role of Dietary Interventions on Skin Barrier

Function.

Parke MA(1), Perez-Sanchez A(2), Zamil DH(1), Katta R(3).

Author information:

(1)Baylor College of Medicine, Houston, TX, USA.

(2)Internal Medicine, University of Texas Health Science Center at San Antonio,

TX, USA.

(3)Department of Dermatology, McGovern Medical School at UTHealth, Houston TX,

USA.

Multiple research studies have examined the role of specific dietary

interventions and their effects on skin barrier function. The skin barrier is

one of the body's first lines of protection against environmental insults, and

disruption of this natural line of defense can result in xerosis, irritation,

chronic dermatitis, and other cutaneous effects. Multiple laboratory, animal,

and human studies have demonstrated that certain dietary interventions have the

potential to impact skin barrier function. Measurements of skin barrier function

include stratum corneum hydration and transepidermal water loss. In this review,

we examine this research and provide an overview of the effects of prebiotics,

probiotics, fatty acids, and emerging research on other substances.

DOI: 10.5826/dpc.1101a132

PMCID: PMC7875671

PMID: 33614213

Conflict of interest statement: Competing interests: Rajani Katta, MD, serves on

an advisory board for Vichy Laboratories and is the author of a book on diet and

dermatology for the general public. The other authors have no conflicts of

interest to disclose.

6. Dermatol Pract Concept. 2021 Jan 29;11(1):e2021118. doi: 10.5826/dpc.1101a118.

eCollection 2021 Jan.

General Practice Registrars' Management of and Specialist Referral Patterns for

Atopic Dermatitis.

Willems A(1)(2), Tapley A(3)(4), Fielding A(3)(4), Tng V(5), Holliday EG(3), van

Driel ML(6), Ball JI(7), Davey AR(3)(4), FitzGerald K(8)(9), Spike NA(1)(2),

Magin PJ(3)(4).

Author information:

(1)Eastern Victoria GP Training, General Practice Training Organisation,

Melbourne, VIC, Australia.

(2)The University of Melbourne, Department of General Practice, Melbourne, VIC,

Australia.

(3)The University of Newcastle, School of Public Health and Medicine, Callaghan,

NSW, Australia.

(4)GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation

Unit, Newcastle, NSW, Australia.

(5)Department of Dermatology, John Hunter Hospital, Newcastle, NSW, Australia.

(6)The University of Queensland Faculty of Medicine, Primary Care Clinical Unit,

Brisbane, QLD, Australia.

(7)Hunter Medical Research Institute, Clinical Research Design, IT and

Statistical Support Unit (CReDITSS), New Lambton, NSW, Australia.

(8)University of Tasmania, School of Medicine, Hobart, TAS, Australia.

(9)General Practice Training Tasmania (GPTT), Regional Training Organisation,

Hobart, TAS, Australia.

BACKGROUND: Atopic dermatitis (AD) is a common presentation in the general

practice (GP) setting. Implementation of appropriate referral pathways is

instrumental for best patient care and is an essential skill for Australian GP

registrars.

OBJECTIVES: We aimed to explore the prevalence and associations of GP registrar

referrals to specialists for AD management.

METHODS: A cross-sectional analysis utilizing data from the Registrar Clinical

Encounters in Training (ReCEnT) project, an ongoing cohort study that documents

in-consultation clinical and educational experience of Australian GP registrars.

Registrar, patient, and consultation factors associated with referrals for AD

were established using logistic regression.

RESULTS: A total of 2,783 registrars (96% response rate) provided data from

381,180 consultations from 2010 to 2019. A total of 3,285 (0.55%) of 595,412

diagnoses managed were AD, of which 222 (6.8%) resulted in referral. Of these

referrals, 70% were to dermatologists, 17% to allergists/immunologists, and 10%

to pediatricians. Associations of referral included registrar female gender,

patient age, longer consultation duration; an established (rather than new) AD

diagnosis; supervisor advice being sought; and learning goals being generated.

CONCLUSIONS: Both registrar and patient factors influence AD referral patterns.

Registrars referred established rather than newly diagnosed AD, suggesting a

level of comfort in initial management. Referral was associated with longer

consultations, seeking supervisor advice, and generation of learning

goals-suggesting these are more complex presentations and, possibly, registrar

learning opportunities. A significant proportion of referrals were to

non-dermatologist specialists. The implication of this for optimal patient care

is a subject for further study.

DOI: 10.5826/dpc.1101a118

PMCID: PMC7875659

PMID: 33614210

Conflict of interest statement: Competing interests: The authors have no

conflicts of interest to disclose.

7. Oxf Med Case Reports. 2021 Feb 15;2021(2):omaa143. doi: 10.1093/omcr/omaa143.

eCollection 2021 Feb.

Rickets and gross motor delay in a child with atopic dermatitis.

Salloum S(1), Hatcher V(2).

Author information:

(1)Department of Pediatric Hospital Medicine, Dayton Children's Hospital,

Dayton, OH, USA.

(2)PGY-3, Dayton Children's Hospital, Dayton, OH, USA.

We report a case of a 14-month-old boy with atopic dermatitis (AD) who presented

to our hospital with hypocalcemic tetany and gross motor delay. Further

laboratory and imaging confirmed the diagnosis of vitamin D deficiency and

rickets. He was breastfeeding and on a restricted diet due to presumed multiple

food allergies. He received calcium and vitamin D supplementation which

corrected his hypocalcemia. The patient developed Staphylococcus aureus

bacteremia and superficial septic thrombophlebitis for which he was treated with

antibiotics and anticoagulation. An elimination diet should be avoided in AD

patients as true food-induced AD is rare and management should focus on optimal

skincare. AD patients have a higher rate of S. aureus skin colonization, which

increases their risk for infectious complications. This case also highlights the

importance of maintaining a high index of suspicion for rickets in children with

isolated gross motor delay, especially in those with risk factors.

For Permissions, please email: journals.permissions@oup.com.

DOI: 10.1093/omcr/omaa143

PMCID: PMC7885143

PMID: 33614053

8. Front Immunol. 2021 Feb 3;11:603059. doi: 10.3389/fimmu.2020.603059. eCollection

2020.

Regulatory T Cells Developing Peri-Weaning Are Continually Required to Restrain

Th2 Systemic Responses Later in Life.

Knoop KA(1)(2), McDonald KG(1), Hsieh CS(1), Tarr PI(1)(3), Newberry RD(1).

Author information:

(1)Department of Internal Medicine, Washington University School of Medicine,

St. Louis, MO, United States.

(2)Department of Immunology, Mayo Clinic, Rochester, MN, United States.

(3)Department of Pediatrics and Molecular Medicine, Washington University School

of Medicine, St. Louis, MO, United States.

Atopic disorders including allergic rhinitis, asthma, food allergy, and

dermatitis, are increasingly prevalent in Western societies. These disorders are

largely characterized by T helper type 2 (Th2) immune responses to environmental

triggers, particularly inhaled and dietary allergens. Exposure to such stimuli

during early childhood reduces the frequency of allergies in at-risk children.

These allergic responses can be restrained by regulatory T cells (Tregs),

particularly Tregs arising in the gut. The unique attributes of how early life

exposure to diet and microbes shape the intestinal Treg population is a topic of

significant interest. While imprinting during early life promotes the

development of a balanced immune system and protects against immunopathology, it

remains unclear if Tregs that develop in early life continue to restrain

systemic inflammatory responses throughout adulthood. Here, an inducible

deletion strategy was used to label Tregs at specified time points with a

targeted mechanism to be deleted later. Deletion of the Tregs labeled

peri-weaning at day of life 24, but not before weaning at day of life 14,

resulted in increased circulating IgE and IL-13, and abrogated induction of

tolerance towards new antigens. Thus, Tregs developing peri-weaning, but not

before day of life 14 are continually required to restrain allergic responses

into adulthood.

DOI: 10.3389/fimmu.2020.603059

PMCID: PMC7891039

PMID: 33613522

Conflict of interest statement: RN, KK, and KM are inventors on U.S.

Nonprovisional Application Serial No. 15/880,658 Compositions and Methods for

Modulation of Dietary and Microbial Exposure. PT discloses a financial conflict

of interest with MediBeacon Inc (member of their Scientific Advisory Board,

consultant, and equity holder), is a consultant to Kallyope Inc., and is a

potential recipient of royalties from a patent to test human gut permeability

noninvasively. The remaining author declares that the research was conducted in

the absence of any commercial or financial relationships that could be construed

as a potential conflict of interest.

Atopic Dermatitis

1. Vet Dermatol. 2020 Aug 13. doi: 10.1111/vde.12873. Online ahead of print.

Measurement of serum Interleukin 34 (IL-34) and correlation with severity and

pruritus scores in client-owned dogs with atopic dermatitis.

Gow DJ(1), Jackson H(2), Forsythe P(2), Nuttall T(1), Gow AG(1), Mellanby RJ(1),

Hume DA(1).

Author information:

(1)R(D)SVS and The Roslin Institute, Hospital for Small Animals, The University

of Edinburgh, Edinburgh, EH25 9RG, Scotland, UK.

(2)The Dermatology Referral Service, 528 Paisley Road West, Glasgow, G51 1RN,

UK.

BACKGROUND: Atopic dermatitis (AD) is a common inflammatory skin disease of

dogs. Interleukin (IL)-34 is a monocyte/macrophage growth factor, produced

mainly by keratinocytes, that has been implicated in several human inflammatory

conditions including human AD.

HYPOTHESIS: Canine serum IL-34 concentrations are increased in dogs with AD and

correlate with clinical lesion and pruritus scores.

ANIMALS: Forty seven client-owned dogs diagnosed with AD and 25 healthy,

unaffected control dogs.

METHODS AND MATERIALS: A commercially available IL-34 ELISA was optimized for

the measurement of IL-34 in canine serum samples. Information regarding

treatment, clinical lesion scores [Canine Atopic Dermatitis Extent and Severity

Index, 4th iteration (CADESI-04)] and pruritus Visual Analog Score (pVAS) were

recorded for each dog at the time of serum collection.

RESULTS: Dogs with AD had significantly increased serum IL-34 concentrations

compared to controls. There was a significant positive correlation between IL-34

concentrations and CADESI-04 and pVAS scores. Concentrations of IL-34 remained

increased in dogs with AD receiving steroids or the JAK1 inhibitor, oclacitinib,

compared to unaffected control dogs.

CONCLUSIONS AND CLINICAL IMPORTANCE: Serum IL-34 concentrations are increased in

dogs with AD and are correlated with clinical severity and pruritus. IL-34 may

be a suitable candidate therapeutic target for canine AD.

Publisher: CONTEXTE: La dermatite atopique (AD) est une dermatose inflammatoire

fréquente chez le chien. L’interleukine (IL)-34 est un facteur de croissance des

monocytes/macrophages principalement produit par les kératinocytes, et est

impliqué dans plusieurs maladies inflammatoires de l’homme dont la dermatite

atopique. HYPOTHÈSES: Les concentrations sériques d’IL-34 canin sont augmentées

chez le chien atopique et corrèlent avec les scores de lésions cliniques et de

prurit.

SUJETS: Quarante sept chiens de propriétaires avec diagnostic d’AD et 25 chiens

sains contrôles. MATÉRIELS ET MÉTHODES: Un test ELISA IL-34 disponible dans le

commerce a été optimisé pour la mesure d’IL-34 des échantillons de serum de

chien. Les données concernant le traitement, les scores clinique [Canine Atopic

Dermatitis Extent and Severity Index, 4th iteration (CADESI-04)] et de prurit

pVAS (pruritus Visual Analog Score) ont été enregistrés pour chaque chien au

moment du prélèvement de serum. RÉSULTATS: Les chiens avec AD avaient des

concentrations sériques d’IL-34 significativement plus élevées comparé aux

contrôles. Il y avait une corrélation positive significative entre les

concentrations d’IL-34 et les scores de CADESI-04 et pVAS. Les concentrations

d’IL-34 restaient élevées chez les chiens atopiques recevant des corticoïdes ou

l’inhibiteur de JAK1, l’oclacitinib, comparé aux chiens non atteints.

CONCLUSIONS ET IMPORTANCE CLINIQUE: Les concentrations sériques d’IL-34 sont

augmentées chez les chiens atopiques et sont corrélés avec la sévérité du prurit

et la clinique. L’IL-34 pourrait être une cible thérapeutique adaptée pour l’AD

canine.

Publisher: INTRODUCCIÓN: la dermatitis atópica (AD) es una enfermedad cutánea

inflamatoria común en los perros. La interlequina (IL)-34 es un factor de

crecimiento de monocitos/macrófagos, producido principalmente por

queratinocitos, que se ha implicado en varias afecciones inflamatorias humanas,

incluida la AD humana. HIPÓTESIS: las concentraciones de IL-34 en suero canino

están aumentadas en perros con AD y se correlacionan con las lesiones clínicas y

los valores de prurito. ANIMALES: cuarenta y siete perros propiedad de clientes

diagnosticados con AD y 25 perros de control sanos y no afectados. MÉTODOS Y

MATERIALES: se optimizó un ELISA IL-34 disponible comercialmente para la

medición de IL-34 en muestras de suero canino. La información sobre el

tratamiento, los valores de lesiones clínicas (Índice de extensión y severidad

de la dermatitis atópica canina, 4ta reevaluación (CADESI-04)) y el valor visual

análogo del prurito (pVAS) se registraron para cada perro en el momento de la

recolección de suero. RESULTADOS: los perros con AD presentaron un incremento

significativo en las concentraciones séricas de IL-34 en comparación con los

controles. Hubo una correlación positiva significativa entre las concentraciones

de IL-34 y los valores de CADESI-04 y pVAS. Las concentraciones de IL-34

permanecieron aumentadas en perros con AD que recibieron esteroides o el

inhibidor de JAK1, oclacitinib, en comparación con los perros de control no

afectados. CONCLUSIONES E IMPORTANCIA CLÍNICA: las concentraciones séricas de

IL-34 aumentan en perros con AD y se correlacionan con la gravedad clínica y el

prurito. IL-34 puede ser un candidato adecuado a objetivo terapéutico para la AD

canina.

Publisher: HINTERGRUND: Die atopische Dermatitis (AD) ist eine häufige

entzündliche Hauterkrankung bei Hunden. Interleukin (IL)-34 ist ein

Monozyten/Makrophagen Wachstumsfaktor, der hauptsächlich von Keratinozyten

produziert wird und bei mehreren entzündlichen Erkrankungen des Menschen wie

auch der humanen AD eine Rolle spielt.

HYPOTHESE: Die caninen IL-34 Serumkonzentrationen sind bei Hunden mit AD erhöht

und korrelieren mit klinischen Veränderungen und den Pruritus Werten.

TIERE: Siebenundvierzig Hunde in Privatbesitz, die mit AD diagnostiziert worden

waren sowie 25 gesunde, nicht betroffene Kontrollhunde nahmen an der Studie

teil.

METHODEN UND MATERIALIEN: Ein kommerziell erhältlicher IL-34 ELISA wurde für die

IL-34 Messung in caninen Serumproben optimiert. Es wurden die Informationen in

Bezug auf die Behandlung, die klinischen Veränderungswerte [Canine Atopic

Dermatitis Extent and Severity Index, 4te Ausgabe (CADESI-04)] und die Pruritus

Visual Analog Score (pVAS) für jeden Hund zum Zeitpunkt der Serumgewinnung

festgehalten.

ERGEBNISSE: Hunde mit AD zeigten im Vergleich zu den Kontrollen signifikant

erhöhte IL-34 Konzentrationen. Es bestand eine signifikant positive Korrelation

zwischen den IL-34 Konzentrationen und dem CADESI-04 und den pVAS Werten. Die

Konzentrationen von IL-34 blieben bei Hunden mit AD während der Verabreichung

von Steroiden oder dem JAK1 Inhibitor, Oclacitinib, im Vergleich zu nicht

betroffenen Kontrollhunden erhöht.

SCHLUSSFOLGERUNGEN UND KLINISCHE BEDEUTUNG: Die Serum IL-34 Konzentrationen sind

bei Hunden mit AD erhöht und mit dem klinischen Schweregrad und dem Juckreiz

korreliert. IL-34 könnte ein passender Kandidat als therapeutisches Ziel für die

AD des Hundes sein.

Publisher: 背景: 异位性皮炎 (AD) 是犬常见的炎性皮肤病。白细胞介素

(IL)-34是一种单核/巨噬细胞生长因子，主要由角质细胞产生，角质细胞也参与包括人AD在内的多种人类炎症。假设:

AD患犬的血清IL-34浓度升高，并且与临床病变和瘙痒评分相关。动物: 诊断为AD的47只私家犬和25只健康、无症状的对照犬。方法和材料:

对测定犬血清IL-34的市售IL-34ELISA进行优化。采集血清时，记录每只犬的治疗信息、临床病变评分 [犬异位性皮炎程度和严重性指数，第4版

(CADESI-04)] 和瘙痒评分 (pVAS)。结果: 与对照组相比，

AD患犬的血清IL-34浓度显著升高。IL-34浓度与CADESI-04、pVAS评分呈显著正相关。与无症状对照犬相比，接受类固醇或JAK1抑制剂-奥拉替尼的AD患犬，其IL-34浓度保持升高。

结论和临床重要性: AD患犬血清IL-34浓度升高，并且与临床严重性和瘙痒相关。IL-34可能是犬AD治疗的合适备选靶点。.

Publisher: 背景:

アトピー性皮膚炎（AD）は、犬の一般的な炎症性皮膚疾患である。インターロイキン（IL）-34は、主にケラチノサイトによって産生される単球/マクロファージ増殖因子であり、人ADを含むいくつかの人の炎症疾患に関与しているとされている。

仮説: イヌの血清IL-34濃度は、AD犬で増加し、臨床病変および掻痒スコアと相関する。被験動物:

ADと診断されたクライアント所有犬47頭および健常で弛緩していない対照犬25頭。材料と方法: 商業的に利用可能なIL-34

ELISAが、犬血清サンプル中のIL-34の測定用に最適化された。治療に関する情報、臨床病変スコア[犬のアトピー性皮膚炎の程度と重症度指数（CADESI-04）]および掻痒性視覚アナログスコア（pVAS）は、血清採取時に各犬について記録された。

結果: AD犬は、対照群と比較して血清IL-34濃度が大幅に増加した。 IL-34濃度とCADESI-04およびpVASスコアの間に有意な正の相関があった。

IL-34の濃度は、罹患していない対照犬と比較して、ステロイドまたはJAK1阻害剤であるオクラシチニブを投与されているAD犬で増加したままであった。

結論と臨床的重要性: AD犬では血清IL-34濃度が増加し、臨床的重症度と掻痒と相関している。 IL-34は犬ADの適切な候補治療標的であり得る。.

Publisher: CONTEXTO: A dermatite atópica (DA) é uma dermatopatia inflamatória

comum de cães. A interleucina (IL) -34 é um fator de crescimento de monócitos /

macrófagos, produzido principalmente por queratinócitos, que tem sido implicado

em várias condições inflamatórias humanas, incluindo a DA. HIPÓTESE: As

concentrações séricas de IL-34 canina aumentam em cães com DA e se correlacionam

com os escores clínicos de lesões e prurido.

ANIMAIS: Quarenta e sete cães diagnosticados com DA pertencentes a clientes e 25

cães saudáveis e não afetados. MÉTODOS E MATERIAIS: Um kit de ELISA para IL-34

disponível comercialmente foi otimizado para a mensuração de IL-34 em amostras

de soro canino. Informações sobre o tratamento, escores de lesões [Índice de

severidade e extensão da dermatite atópica canina, 4ª iteração (CADESI-04)] e a

escala analógica visual de prurido (pVAS) foram registrados para cada cão no

momento da coleta de soro.

RESULTADOS: Cães com DA apresentaram aumento significativo das concentrações

séricas de IL-34 em comparação aos controles. Houve uma correlação positiva

significativa entre as concentrações de IL-34 e os escores CADESI-04 e pVAS. As

concentrações de IL-34 permaneceram aumentadas em cães com DA recebendo

esteroides ou o inibidor de JAK1, oclacitinib, em comparação com cães controle

não afetados. CONCLUSÕES E IMPORTÂNCIA CLÍNICA: As concentrações séricas de

IL-34 estão aumentadas em cães com DA e estão correlacionadas com a gravidade

clínica e o prurido. A IL-34 pode ser uma candidata adequada a alvo terapêutico

para a DA canina.

DOI: 10.1111/vde.12873

PMID: 32794277

2. Allergy. 2020 Aug 13. doi: 10.1111/all.14557. Online ahead of print.

Predicting persistence of atopic dermatitis in children using clinical

attributes and serum proteins.

Lauffer F(1), Baghin V(1), Standl M(2), Stark SP(3), Jargosch M(1), Wehrle

J(4)(5)(6), Thomas J(3), Schmidt-Weber C(3)(7), Biedermann T(1), Eyerich S(3),

Eyerich K(1)(8), Garzorz-Stark N(1)(8).

Author information:

(1)Technical University of Munich, Department of Dermatology and Allergy,

Munich, Germany.

(2)Institute of Epidemiology, Helmholtz Zentrum München - German Research Center

for Environmental Health, Neuherberg, Germany.

(3)Center of Allergy and Environment (ZAUM), Technical University of Munich and

Helmholtz Zentrum Munich, Munich and Neuherberg, Germany.

(4)Department of Medicine I, Medical Center - University of Freiburg, Freiburg,

Germany.

(5)German Cancer Consortium (DKTK), Freiburg, Germany.

(6)German Cancer Research Center (DKFZ), Heidelberg, Germany.

(7)Member of the German Center of Lung Research (DZL), Germany.

(8)Division of Dermatology and Venereology, Department of Medicine Solna, and

Center for molecular medicine, Karolinska Institutet, Stockholm, Sweden.

BACKGROUND: Atopic dermatitis (AD) is the most common inflammatory skin disease

in children, with 30% of all those diagnosed developing chronic or relapsing

disease by adolescence. Such disease persistence cannot yet be predicted. The

aim of the present study was to predict the natural course of AD using clinical

parameters and serum proteins.

METHODS: Sera of 144 children with AD (age 0-3 years) were analyzed for IgE and

33 cytokines, chemokines, and growth factors. Patient disease course until the

age of 7 years was assessed retrospectively. Unsupervised k-means clustering was

performed to define disease endotypes. Identified factors associated with AD

persistence at the age of 7 years were validated in children with AD in an

independent cohort (LISA Munich; n=168). Logistic regression and XGBoosting

methods followed by cross-validation were applied to predict individual disease

outcomes.

RESULTS: Three distinct endotypes were found in infancy, characterized by a

unique inflammatory signature. Factors associated with disease persistence were

disease score (SCORAD), involvement of the limbs, flexural lesion distribution

at the age of 3 years, allergic comorbidities and disease exacerbation by the

trigger factors stress, pollen exposure, and change in weather. Persistence was

predicted with a sensitivity of 81.8% and a specificity of 82.4%. Factors with a

high impact on the prediction of persistence were SCORAD at the age of 3 years,

trigger factors, and low VEGF serum levels.

CONCLUSIONS: AD in infancy comprises three immunological endotypes. Disease

persistence can be predicted using serum cytokines and clinical variables.

DOI: 10.1111/all.14557

PMID: 32794228

3. Am J Ophthalmol Case Rep. 2020 Aug 5;19:100848. doi: 10.1016/j.ajoc.2020.100848.

eCollection 2020 Sep.

Corneal ulceration associated with dupilumab use in a patient with atopic

dermatitis.

Li G(1), Berkenstock M(1), Soiberman U(1).

Author information:

(1)The Wilmer Eye Institute, The Johns Hopkins University School of Medicine,

600 North Wolfe St, Baltimore, MD, 21237, USA.

PURPOSE: To describe a case of corneal ulceration associated with dupilumab use

for atopic dermatitis.

OBSERVATIONS: A patient developed an inflammatory corneal ulcer 3 weeks after

starting bi-weekly intravenous dupilumab therapy. Symptoms resolved with topical

prednisolone and discontinuation of the systemic therapy with dupilumab.

CONCLUSION AND IMPORTANCE: Dupilumab is known to cause ocular surface

inflammation, but we report a novel association between dupilumab use and

potentially sight-threatening corneal ulceration.

DOI: 10.1016/j.ajoc.2020.100848

PMCID: PMC7415768

PMID: 32793843

Conflict of interest statement: No conflicting relationship exists for any

author.

4. Postepy Dermatol Alergol. 2020 Jun;37(3):390-395. doi: 10.5114/ada.2020.96112.

Epub 2020 Jul 16.

Evaluation of contact sensitivity to food additives in children with atopic

dermatitis.

Anıl H(1), Harmancı K(1).

Author information:

(1)Department of Paediatric Allergy and Immunology, Faculty of Medicine,

Osmangazi University, Eskisehir, Turkey.

INTRODUCTION: Atopic dermatitis (AD) is a chronic inflammatory disease caused by

the complex interaction of genetic, immune and environmental factors such as

food and airborne allergens. The atopy patch test (APT) is a useful way to

determine delayed-type hypersensitivity reactions to food and aeroallergens.

Many studies have also suggested that food additives are associated with

dermatologic adverse reactions and the aggravation of pre-existing atopic

dermatitis symptoms.

AIM: To elucidate the contact sensitivity to food additives in children

suffering from AD by using standardized atopy patch testing.

MATERIAL AND METHODS: A total of 45 children with AD and 20 healthy children

have been enrolled. All the children have regularly consumed food containing

additives, and were subjected to atopy patch tests.

RESULTS: In total, 28 (62%) children with AD and 4 (20%) healthy children have

had positive patch test reactions to ≥ 1 allergens. There has been a significant

difference (p = 0.04) between the groups in terms of the positivity rate in the

patch test and the most common allergen that elicited positive patch test

results in the AD group was azorubine (n = 11, 24.4%, p = 0.014).

CONCLUSIONS: In our study, contact sensitivity was detected more frequently in

AD patients. Food additives may play a role in the development and exacerbation

of AD. Atopy patch testing with food additives can be useful in the treatment

and follow-up of children with AD.

DOI: 10.5114/ada.2020.96112

PMCID: PMC7394164

PMID: 32792881

Conflict of interest statement: The authors declare no conflict of interest.

5. Postepy Dermatol Alergol. 2020 Jun;37(3):319-325. doi: 10.5114/ada.2020.96260.

Epub 2020 Jul 16.

The ambiguous pruritogenic role of interleukin-31 in cutaneous T-cell lymphomas

in comparison to atopic dermatitis: a review.

Olszewska B(1), Sokołowska-Wojdyło M(1), Lakomy J(2), Nowicki RJ(1).

Author information:

(1)Department of Dermatology, Venereology and Allergology, Medical University of

Gdansk, Gdansk, Poland.

(2)Department of Pathology, Medical University of Gdansk, Gdansk, Poland.

Cutaneous T-cell lymphomas (CTCLs) comprise a group of chronic heterogeneous

diseases of unknown pathogenesis, characterized by non-specific skin lesions

such as patches, plaques and tumours. CTCL is accompanied by persistent pruritus

poorly responding to antihistamines and therefore significantly reducing quality

of life in patients with lymphomas. According to research data, interleukin-31

(IL-31) contributes to initiation and maintenance of the inflammatory process of

the skin and pruritus in inflammatory dermatoses such as atopic dermatitis (AD),

which is well established. The studies of a similar role of IL-31 in CTCLs are

less homogenous. Due to contradictory reports concerning IL-31 and CTCL we have

analysed available literature to summarize its role, focusing on CTCL and AD.

DOI: 10.5114/ada.2020.96260

PMCID: PMC7394154

PMID: 32792870

Conflict of interest statement: The authors declare no conflict of interest.

6. Cell Death Dis. 2020 Aug 13;11(8):617. doi: 10.1038/s41419-020-02845-8.

Costello syndrome model mice with a Hras(G12S/+) mutation are susceptible to

develop house dust mite-induced atopic dermatitis.

Katata Y(1)(2), Inoue SI(1), Asao A(3), Kobayashi S(3)(4), Terui H(5),

Inoue-Shibui A(1), Abe T(1), Niihori T(1), Aiba S(5), Ishii N(3), Kure S(2),

Aoki Y(6).

Author information:

(1)Department of Medical Genetics, Tohoku University Graduate School of

Medicine, Sendai, Japan.

(2)Department of Pediatrics, Tohoku University Graduate School of Medicine,

Sendai, Japan.

(3)Department of Microbiology and Immunology, Tohoku University Graduate School

of Medicine, Sendai, Japan.

(4)Department of Organ Anatomy, Tohoku University Graduate School of Medicine,

Sendai, Japan.

(5)Department of Dermatology, Tohoku University Graduate School of Medicine,

Sendai, Japan.

(6)Department of Medical Genetics, Tohoku University Graduate School of

Medicine, Sendai, Japan. aokiy@med.tohoku.ac.jp.

Costello syndrome is an autosomal dominant disorder that is caused by germline

HRAS mutations. Patients with Costello syndrome present craniofacial

abnormalities, cardiac defects, and cancer predisposition, as well as skin

abnormalities, including papillomas, keratosis pilaris, and eczematous

dermatitis. However, the mechanisms underlying the dermatological abnormalities

remain unclear. Here, we demonstrated that knock-in mice expressing an Hras G12S

mutation (HrasG12S/+ mice) are susceptible to develop atopic dermatitis

(AD)-like skin lesions, including eczema, pruritus, elevated serum IgE levels,

acanthosis, and the infiltration of mast cells, basophils, and type-2 innate

lymphoid cells in the dermis, after stimulation with house dust mite allergens

(Dermatophagoides farinae, Dfb). Reduced skin barrier function, increased

proliferation of phosphorylated ERK (p-ERK)-positive epidermal cells, and

increased Th2-type cytokines as well as epithelial cell-derived cytokines,

including IL-33, were observed in the skin tissue of HrasG12S/+ mice compared

with Hras+/+ mice. Cultured HrasG12S/+ keratinocytes exhibited increased IL-33

expression after Dfb stimulation. PD0325901, an MEK inhibitor, ameliorated

AD-like symptoms in HrasG12S/+ mice, showing decreased proliferation of

p-ERK-positive epidermal cells and decreased expression of IL-33. Our findings

indicate that the epidermis of HrasG12S/+ mice stimulated by Dfb strongly

induced IL-33 expression and type-2 innate lymphoid cells, resulting in AD-like

skin lesions. These results suggest that the epidermis of HrasG12S/+ mice are

prone to development of eczematous dermatitis stimulated with house dust mite

allergens.

DOI: 10.1038/s41419-020-02845-8

PMID: 32792500

7. Medicine (Baltimore). 2020 Jul 24;99(30):e21255. doi:

10.1097/MD.0000000000021255.

Atopic dermatitis in Taiwanese children: The laboratory values that correlate

best to the SCORAD index are total IgE and positive Cheddar cheese IgE.

Kuo HC(1), Chu CH, Su YJ, Lee CH.

Author information:

(1)aDepartment of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung

Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung

bClinical Trial Center cDepartment of Internal Medicine dDepartment of

Dermatology, Kaohsiung Chang Gung Memorial Hospital, 83301, Taiwan.

Atopic dermatitis (AD) is a common chronic relapsing inflammatory skin disease

associated with a personal or family history of atopic diseases. Determining the

objective severity scoring of AD index (SCORAD) and total immunoglobulin E (IgE)

to help to stage the severity (lesions extent and intensity of the lesions and

then the itch and sleep disturbance they may cause) of AD in children.In this

study, we adopted the SCORAD index, which consists of severity, area, and sleep

disturbance, to evaluate the AD status of children up to 18 years old. We

examined the blood levels of total serum IgE, white blood cell

count/differential count (WBC/DC), eosinophil counts (EC), eosinophil cationic

protein (ECP) and specific IgE.A total of 208 children with AD were enrolled in

this study. Serum IgE values and a number of specific IgE that are positive

significantly different SCORAD index through simple linear regression; however,

after multiple linear regression, only IgE values (95% CI: 0.001-0.004,

P < .001), total WBC count (95% CI: 0.112-1.736, P = .026), EC (95% CI:

0.045-6.706, P = .047), and specific IgE to Cheddar cheese (95% CI:

1.814-16.731, P = .015) remain different. After applying the Phi coefficient, we

found that specific IgE to tuna (r = 0.632), codfish (r = 0.613), and clam

(r = 0.613) each had a moderate correlation with specific IgE to Cheddar cheese.

The 6 most common allergens were found to be mite (D. Farinae: 65.9%), mite (D.

Pterony: 64.9%), house dust (47.6%), cockroach mix (37.0%), shrimp (30.8%), and

crab (22.6%). Covariates of SCORAD index, severity, area, and sleep disturbance

differed.In this study, we found that total IgE values, specific IgE values,

WBC, EC, and specific IgE to Cheddar cheese have significant correlations with

SCORAD index in AD of Taiwanese children.

DOI: 10.1097/MD.0000000000021255

PMID: 32791702

8. Environ Anal Health Toxicol. 2020 Sep;35(3):e2020012-0. doi:

10.5620/eaht.2020012. Epub 2020 Jul 16.

Age-period-cohort analysis of asthma, allergic rhinitis, and atopic dermatitis

prevalence in Japan.

Okui T(1).

Author information:

(1)Medical Information Center, Kyusyu University Hospital, Fukuoka city, Japan.

This study aims to analyze the trends in the Japanese prevalence of asthma,

allergic rhinitis, and atopic dermatitis by using age-period-cohort (APC)

analysis. Data regarding the prevalence of diseases from 1999 to 2017 were

collected from Patient Survey in Japan. The data were divided according to age

groups ranging from 0-4 years old up to 65-69 years old in 5-year increments. A

cohort was defined for each age group of each year with a one-year shift, and

cohorts born from 1930-1934 up to 2013-2017 were examined. We used Bayesian APC

analysis to decompose the changes in prevalence into age, period, and cohort

effects. Results show that the period effect for asthma began to increase in

2008, and those of allergic rhinitis and atopic dermatitis began to increase in

1999. The cohort effects for asthma and atopic dermatitis increased rapidly in

cohorts born from approximately 1950 to 1980 and then decreased thereafter.

Furthermore, the cohort effect for allergic rhinitis increased from cohorts born

in approximately the late 1970s for men and in 1990 for women. The time points

with increasing cohort effects for asthma and atopic dermatitis are consistent

with the history of air pollution accompanied by rapid economic growth in Japan.

The onset of the increased cohort effect for allergic rhinitis was also

relatively consistent with the time point at which the mass scattering of pollen

began.

DOI: 10.5620/eaht.2020012

PMID: 32791576

9. J Allergy Clin Immunol Pract. 2020 Aug 10:S2213-2198(20)30810-2. doi:

10.1016/j.jaip.2020.07.051. Online ahead of print.

The use of probiotics and bacteria-derived preparations in topical treatment of

atopic dermatitis - a systematic review.

Ambrożej D(1), Kunkiel K(1), Dumycz K(1), Feleszko W(2).

Author information:

(1)Department of Pediatric Respiratory Diseases and Allergy,The Medical

University of Warsaw, Warsaw, Poland.

(2)Department of Pediatric Respiratory Diseases and Allergy,The Medical

University of Warsaw, Warsaw, Poland. Electronic address:

wojciech.feleszko@wum.edu.pl.

DOI: 10.1016/j.jaip.2020.07.051

PMID: 32791245

10. Brain Behav Immun. 2020 Aug 10:S0889-1591(20)30486-4. doi:

10.1016/j.bbi.2020.08.003. Online ahead of print.

Depressive and anxiety symptomatology among people with asthma or atopic

dermatitis: a population-based investigation using the UK Biobank data.

Hussain S(1), Ronaldson A(2), Arias de la Torre J(3), Sima R(4), Hatch S(2),

Hotopf M(5), Dregan A(6).

Author information:

(1)Department of Psychological Medicine, Institute of Psychiatry, Psychology,

and Neuroscience, King's College London, London, United Kingdom; School of

Psychology, Victoria University of Wellington, Wellington, New Zealand.

(2)Department of Psychological Medicine, Institute of Psychiatry, Psychology,

and Neuroscience, King's College London, London, United Kingdom.

(3)Department of Psychological Medicine, Institute of Psychiatry, Psychology,

and Neuroscience, King's College London, London, United Kingdom; CIBER

Epidemiology and Public Health (CIBERESP), Madrid, Spain.

(4)USAMV, Cluj-Napoca, Romania.

(5)Department of Psychological Medicine, Institute of Psychiatry, Psychology,

and Neuroscience, King's College London, London, United Kingdom; South London

and Maudsley NHS Foundation Trust, London, United Kingdom.

(6)Department of Psychological Medicine, Institute of Psychiatry, Psychology,

and Neuroscience, King's College London, London, United Kingdom. Electronic

address: alexandru.dregan@kcl.ac.uk.

The present study investigated the association of depression and anxiety

symptomatology (DAS) with asthma and atopic dermatitis (AD) diagnosis during

mid-adult years. The study employed data from 502,641 participants in the UK

Biobank. Neutrophils to Lymphocytes Ratios (NLRs) of patients with asthma and AD

were calculated and evaluated in relation to DAS, measured via the Patient

Health Questionnaire-4 (PHQ-4). Age of asthma or AD onset association with DAS

were also estimated. Multivariable regression analyses were implemented among

participants with asthma or AD, compared to those without these disorders. Out

of 58,833 participants with asthma and 13,462 with AD, the prevalence of DAS was

11.7% and 2.7%, respectively. DAS increased among participants with either

asthma or AD, being highest within patients having both (β= 0.41, 95% confidence

interval (95%CI), 0.34,0.49). NLR showed a linear increase with PHQ scores in

asthma patients, (tertile 1, β= 0.30, 95% CI, 0.27,0.34; tertile 2, β= 0.36,

95%CI, 0.32,0.39, and tertile 3, β= 0.43, 95%CI, 0.39,0.46). An inverted

U-shaped association was seen between age of asthma onset and PHQ, with the

40-59 age group (β= 0.54, 95%CI, 0.48,0.59) showing the highest risk followed by

the 60+ (β= 0.43, 95%CI, 0.34,0.51 and 20-39 groups (β= 0.32, 95%CI, 0.27,0.38).

Similar patterns emerged within AD. Asthma and AD were associated with increased

DAS during mid-adult years, being strongest among participants reporting both

disorders. A dose-response relationship between NLR and DAS was observed. Asthma

or AD onset during mid-adult years (40-59) were associated with the highest

increment in DAS.

DOI: 10.1016/j.bbi.2020.08.003

PMID: 32791209

Atopic Dermatitis and Its Associations

1. Dermatol Ther. 2020 May 27:e13687. doi: 10.1111/dth.13687. Online ahead of

print.

Considerations for safety in the use of systemic medications for psoriasis and

atopic dermatitis during the COVID-19 pandemic.

Ricardo JW(1), Lipner SR(1).

Author information:

(1)Department of Dermatology, Weill Cornell Medicine, New York, New York, USA.

Coronavirus disease 2019 (COVID-19) is responsible for at least 2 546 527 cases

and 175 812 deaths as of April 21, 2020. Psoriasis and atopic dermatitis (AD)

are common, chronic, inflammatory skin conditions, with immune dysregulation as

a shared mechanism; therefore, mainstays of treatment include systemic

immunomodulating therapies. It is unknown whether these therapies are associated

with increased COVID-19 susceptibility or worse outcomes in infected patients.

In this review, we discuss overall infection risks of nonbiologic and biologic

systemic medications for psoriasis and AD and provide therapeutic

recommendations. In summary, in patients with active infection, systemic

conventional medications, the Janus kinase inhibitor tofacitinib, and biologics

for psoriasis should be temporarily held until there is more data; in uninfected

patients switching to safer alternatives should be considered. Interleukin

(IL)-17, IL-12/23, and IL-23 inhibitors are associated with low infection risk,

with IL-17 and IL-23 favored over IL-12/23 inhibitors. Pivotal trials and

postmarketing data also suggest that IL-17 and IL-23 blockers are safer than

tumor necrosis factor alpha blockers. Apremilast, acitretin, and dupilumab have

favorable safety data and may be safely initiated and continued in uninfected

patients. Without definitive COVID-19 data, these recommendations may be useful

in guiding treatment of psoriasis and AD patients during the COVID-19 pandemic.

DOI: 10.1111/dth.13687

PMCID: PMC7283778

PMID: 32458536

2. Br J Dermatol. 2020 Apr 29:10.1111/bjd.19161. doi: 10.1111/bjd.19161. Online

ahead of print.

Global reporting of cases of COVID-19 in psoriasis and atopic dermatitis: an

opportunity to inform care during a pandemic.

Mahil SK(1), Yiu ZZN(2), Mason KJ(2), Dand N(3), Coker B(4), Wall D(5)(6),

Fletcher G(6), Bosma A(7), Capon F(3), Iversen L(8), Langan SM(1)(9), Di Meglio

P(3), Musters AH(7), Prieto-Merino D(9), Tsakok T(1), Warren RB(2), Flohr C(1),

Spuls PI(7), Griffiths CEM(2), Barker J(1), Irvine AD(10), Smith CH(1);

Secure-AD and PsoProtect study groups.

Author information:

(1)St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust

and King's College London, London, UK.

(2)Dermatology Centre, Salford Royal NHS Foundation Trust, The University of

Manchester, Manchester Academic Health Science Centre, NIHR Manchester

Biomedical Research Centre, Manchester, UK.

(3)St John's Institute of Dermatology within the, School of Basic & Medical

Biosciences, King's College London, London, UK.

(4)NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust,

London, UK.

(5)Hair Restoration Blackrock, Dublin, Ireland.

(6)National and International Skin Registry Solutions (NISR), Charles Institute

of Dermatology, Dublin, Ireland.

(7)Department of Dermatology, Amsterdam Public Health, Infection and Immunity,

Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

(8)Department of Dermatology, Aarhus University Hospital, Aarhus C, Denmark.

(9)Faculty of Epidemiology, and Population Health, London School of Hygiene and

Tropical Medicine, London, UK.

(10)Clinical Medicine, Trinity College Dublin, Dublin, Ireland.

We wish to bring your attention to the PsoPROTECT (Psoriasis Patient Registry

for Outcomes, Therapy and Epidemiology of Covid‐19 infecTion) and SECURE‐AD

(Surveillance Epidemiology of Coronavirus Under Research Exclusion‐Atopic

Dermatitis) registries; two urgent global initiatives that address an unmet need

for delineating the determinants of COVID‐19 outcomes in the common cutaneous

immune‐mediated inflammatory diseases (IMIDs) psoriasis and atopic dermatitis.

DOI: 10.1111/bjd.19161

PMCID: PMC7267275

PMID: 32348554

3. Cureus. 2020 Apr 2;12(4):e7506. doi: 10.7759/cureus.7506.

Frequent Hand Washing for COVID-19 Prevention Can Cause Hand Dermatitis:

Management Tips.

Beiu C(1), Mihai M(1), Popa L(1), Cima L(2), Popescu MN(3).

Author information:

(1)Oncologic Dermatology, Elias Emergency University Hospital, "Carol Davila"

University of Medicine and Pharmacy, Bucharest, ROU.

(2)Pharmacy, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU.

(3)Physical Medicine and Rehabilitation, "Carol Davila" University of Medicine

and Pharmacy, Bucharest, ROU.

Coronavirus disease 2019 (COVID-19) continues to spread globally, outpacing the

capacity and resources of health systems worldwide. A therapeutic vaccine is not

yet on the rise, and preventive measures are the current approach to restraint

the transmission of cases. As the virus is highly contagious via respiratory

route (droplets from infected persons, widely spread by coughing or sneezing)

and via contact with contaminated surfaces, community transmission and spread

can be decreased through the practice of regular and diligent hand hygiene.

Frequent hand washing implies a prolonged exposure to water and other chemical

or physical agents and may induce several pathophysiologic changes, such as

epidermal barrier disruption, impairment of keratinocytes, the subsequent

release of proinflammatory cytokines, activation of the skin immune system, and

delayed-type hypersensitivity reactions. Adverse dermatologic effects, such as

excessive skin dryness or even contact dermatitis (particularly the irritant

subtype and, to a lesser extent, the allergic subtype), can occur, especially in

individuals with a history of atopic dermatitis. These skin conditions are

perfectly manageable, and applying a moisturizer immediately after washing hands

or after using a portable hand sanitizer is the cornerstone in preventing the

development of eczematous changes in the hands. In the current global context,

the potential occurrence of these dermatological adverse events should in no way

cause people to deviate from strict hand hygiene rules.

DOI: 10.7759/cureus.7506

PMCID: PMC7195203

PMID: 32373409

Conflict of interest statement: The authors have declared that no competing

interests exist.

4. Am J Clin Dermatol. 2020 Jun;21(3):307-311. doi: 10.1007/s40257-020-00514-2.

Managing Cutaneous Immune-Mediated Diseases During the COVID-19 Pandemic.

Torres T(1)(2), Puig L(3).

Author information:

(1)Department of Dermatology, Centro Hospitalar Universitário Do Porto, Porto,

Portugal. torres.tiago@outlook.com.

(2)Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto,

Portugal. torres.tiago@outlook.com.

(3)Department of Dermatology, Hospital de La Santa Creu I Sant Pau, Barcelona,

Spain.

Coronavirus disease 2019 (COVID-19) is a clinical syndrome caused by a novel

coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

COVID-19 has spread rapidly worldwide and has been shown to have a wide spectrum

of severity. COVID-19 has become a public health emergency of relevant

international concern, and it was declared a pandemic by the World Health

Organization on 11 March, 2020. SARS-CoV-2 infection in severe cases involves

the host response as an important contributor to the disease process and tissue

damage, mainly due to dysregulated and excessive innate immune responses. The

primary immune response leads to viral clearance in the majority of cases.

However, in a subgroup of patients, the secondary immune response may be

exaggerated, leading to inflammatory-induced lung injury and other complications

including pneumonitis, acute respiratory distress syndrome, respiratory failure,

shock, organ failure, and potentially death. Several cutaneous immune-mediated

diseases, including psoriasis, atopic dermatitis, and hidradenitis suppurativa,

are therapeutically managed with biologic and non-biologic immunosuppressive and

immunomodulatory drugs. The outbreak of COVID-19 affects the management of these

chronic conditions, not only for those who are already receiving treatment but

also for those who are about to start a new treatment to control their disease.

In this article, the management of cutaneous immune-mediated diseases during the

COVID-19 pandemic is discussed.

DOI: 10.1007/s40257-020-00514-2

PMCID: PMC7147535

PMID: 32277351 [Indexed for MEDLINE]

Conflict of interest statement: Tiago Torres has received consultancy and/or

speaker’s honoraria from and/or participated in clinical trials sponsored by

AbbVie, Amgen, Arena Pharmaceuticals, Boehringer Ingelheim, Bristol Myers

Squibb, Celgene, Janssen, Biocad, LEO Pharma, Eli Lilly, MSD, Novartis, Pfizer,

Samsung-Bioepis, Sanofi-Genzyme, and Sandoz. Luis Puig has received consultancy

and/or speaker’s honoraria from and/or participated in clinical trials sponsored

by AbbVie, Almirall, Amgen, Baxalta, Biogen, Boehringer Ingelheim, Celgene,

Gebro, Janssen, LEO Pharma, Eli Lilly and Company, Merck-Serono, MSD, Mylan,

Novartis, Pfizer, Regeneron, Roche, Sandoz, Samsung-Bioepis, Sanofi, and UCB.

5. J Allergy Clin Immunol Pract. 2020 May;8(5):1477-1488.e5. doi:

10.1016/j.jaip.2020.03.012. Epub 2020 Mar 26.

COVID-19: Pandemic Contingency Planning for the Allergy and Immunology Clinic.

Shaker MS(1), Oppenheimer J(2), Grayson M(3), Stukus D(3), Hartog N(4), Hsieh

EWY(5), Rider N(6), Dutmer CM(5), Vander Leek TK(7), Kim H(8), Chan ES(9), Mack

D(10), Ellis AK(11), Lang D(12), Lieberman J(13), Fleischer D(5), Golden

DBK(14), Wallace D(15), Portnoy J(16), Mosnaim G(17), Greenhawt M(18).

Author information:

(1)Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology,

Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH.

(2)UMDMJ Rutgers University School of Medicine, Newark, NJ.

(3)Nationwide Children's Hospital, The Ohio State University School of Medicine,

Columbus, Ohio.

(4)Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Mich.

(5)Children's Hospital Colorado, University of Colorado School of Medicine,

Aurora, Colo.

(6)The Texas Children's Hospital, Section of Immunology, Allergy, and

Retrovirology and the Baylor College of Medicine, Houston, Texas.

(7)Pediatric Allergy and Asthma, Department of Pediatrics, University of

Alberta, Edmonton, AB, Canada.

(8)Western University and McMaster University, London, ON, Canada.

(9)BC Children's Hospital, The University of British Columbia, Vancouver, BC,

Canada.

(10)McMaster University, Hamilton, ON, Canada; Halton Pediatric Allergy,

Burlington, ON, Canada.

(11)Division of Allergy and Immunology, Department of Medicine, Queen's

University, Kingston, ON, Canada.

(12)Department of Medicine, Section of Allergy and Immunology, Cleveland Clinic,

Cleveland, Ohio.

(13)Division of Allergy and Immunology, The University of Tennessee, Memphis,

Tenn.

(14)Division of Allergy and Clinical Immunology, John Hopkins University School

of Medicine, Baltimore, Md.

(15)Nova Southeastern University College of Allopathic Medicine, Fort

Lauderdale, Fla.

(16)Children's Mercy, University of Missouri-Kansas City School of Medicine,

Kansas City, Mo.

(17)Division of Pulmonary, Allergy and Critical Care, Department of Medicine,

NorthShore University Health System, Evanston, Ill.

(18)Children's Hospital Colorado, University of Colorado School of Medicine,

Aurora, Colo. Electronic address: Matthew.Greenhawt@childrenscolorado.org.

Comment in

J Allergy Clin Immunol Pract. 2020 May;8(5):1475-1476.

J Allergy Clin Immunol Pract. 2020 Jul - Aug;8(7):2452-2453.

J Paediatr Child Health. 2020 Jun;56(6):995.

In the event of a global infectious pandemic, drastic measures may be needed

that limit or require adjustment of ambulatory allergy services. However, no

rationale for how to prioritize service shut down and patient care exists. A

consensus-based ad-hoc expert panel of allergy/immunology specialists from the

United States and Canada developed a service and patient prioritization

schematic to temporarily triage allergy/immunology services. Recommendations and

feedback were developed iteratively, using an adapted modified Delphi

methodology to achieve consensus. During the ongoing pandemic while social

distancing is being encouraged, most allergy/immunology care could be

postponed/delayed or handled through virtual care. With the exception of many

patients with primary immunodeficiency, patients on venom immunotherapy, and

patients with asthma of a certain severity, there is limited need for

face-to-face visits under such conditions. These suggestions are intended to

help provide a logical approach to quickly adjust service to mitigate risk to

both medical staff and patients. Importantly, individual community circumstances

may be unique and require contextual consideration. The decision to enact any of

these measures rests with the judgment of each clinician and individual health

care system. Pandemics are unanticipated, and enforced social

distancing/quarantining is highly unusual. This expert panel consensus document

offers a prioritization rational to help guide decision making when such

situations arise and an allergist/immunologist is forced to reduce services or

makes the decision on his or her own to do so.

DOI: 10.1016/j.jaip.2020.03.012

PMCID: PMC7195089

PMID: 32224232 [Indexed for MEDLINE]

6. J Eur Acad Dermatol Venereol. 2020 Jun 25:10.1111/jdv.16774. doi:

10.1111/jdv.16774. Online ahead of print.

Cutaneous manifestations of SARS-CoV-2 infection: a clinical update.

Gisondi P(1), PIaserico S(2), Bordin C(1), Alaibac M(2), Girolomoni G(1), Naldi

L(3)(4).

Author information:

(1)Section of Dermatology and Venereology, Department of Medicine, University of

Verona, Verona, Italy.

(2)Section of Dermatology, Department of Medicine, University of Padua, Padua,

Italy.

(3)Division of Dermatology, San Bortolo Hospital, Vicenza, Italy.

(4)Centro Studi GISED, Bergamo, Italy.

On 11 March 2020, the World Health Organization (WHO) has declared the novel

coronavirus disease (COVID-19) a global pandemic, caused by the severe acute

respiratory syndrome coronavirus 2 (SARS-CoV-2 virus). A consistent number of

case reports and clinical series have been already published describing a

complex spectrum of skin manifestations associated with the SARS-CoV-2

infection. We carried out a review of the English-language literature up to 20

May 2020, reporting original cases or case series of the cutaneous

manifestations of SARS-CoV-2 virus infection. The following databases were

consulted: PubMed, Embase, Google Scholar and ResearchGate. The search of papers

was conducted by using the key term 'COVID-19' or 'SARS-CoV-2' or 'coronavirus'

combined with each of the following: 'skin', 'cutaneous', 'dermatologic' or

'dermatology', 'manifestation', 'lesions', or 'rash'. The patterns of

dermatological manifestations associated with SARS-CoV-2 infection could be

classified into four categories: exanthema (varicella-like, papulo-vesicular and

morbilliform rash), vascular (chilblain-like, purpuric/petechial and livedoid

lesions), urticarial and acro-papular eruption. Lastly, other skin

manifestations to be considered are the cutaneous adverse reactions to the drugs

prescribed for the treatment of COVID-19. Whether SARS-CoV-2 infection can

directly cause a worsening of chronic inflammatory diseases such as psoriasis or

atopic dermatitis remains to be determined. Dermatology's outlook in the

COVID-19 pandemic is multidimensional.

DOI: 10.1111/jdv.16774

PMCID: PMC7362144

PMID: 32585074