K.R. Patel

Burden of skin pain in atopic dermatitis

BACKGROUNDnAtopic dermatitis (AD) is associated with itch, skin inflammation and barrier disruption, and scratching, all of which may be associated with skin pain.nnnOBJECTIVEnTo characterize the patient burden of skin pain in AD.nnnMETHODSnWe performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist.nnnRESULTSnOverall, 305 patients (age range, 13-97 years) were included in the study, with 564 encounters. The cohort included 195 females (63.9%) and 193 whites (63.7%). The mean (SD) age at enrollment was 42.3 (18.1) years, and the mean (SD) age of patient-reported AD onset was 29.6 (31.9) years. At baseline, 144 patients (42.7%) reported skin pain in the past week, with 42 (13.8%) reporting severe or very severe pain. Twenty-four (16.8%) thought the skin pain was part of their itch, 16 (11.2%) from scratching, and 77 (72.0%) from both. Patients with skin pain were more likely to describe their itch using terms that resembled neuropathic pain. Prevalence of skin pain was increased in patients with vs without excoriations (72.6% vs 57.6%; χ2 test Pu2009=u2009.02) but not other morphologic characteristics. Skin pain severity was most strongly correlated with the Patient-Oriented Eczema Measure (Spearman ρu2009=u20090.54), followed by ItchyQOL (ρu2009=u20090.52), 5-dimensions of itch scale (ρu2009=u20090.47), Dermatology Life Quality Index (ρu2009=u20090.45), numeric rating scale for itch (ρu2009=u20090.43) and sleep (ρu2009=u20090.36), Patient Health Questionnaire 9 (ρu2009=u20090.36), patient-reported global AD severity (ρu2009=u20090.34), Eczema Area and Severity Index (ρu2009=u20090.23), and objective Scoring AD index (ρu2009=u20090.20) (Pu2009<u2009.001 for all). Patients with both severe itch and pain vs those with only one or neither symptom being severe had significant increases in all these measures.nnnCONCLUSIONnSkin pain is a common and burdensome symptom in AD. Skin pain severity should be assessed with itch severity in AD patients and may be an important end point for monitoring treatment response.

A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis

BACKGROUNDnPrevious studies found conflicting results about whether atopic dermatitis (AD) begins in adulthood.nnnOBJECTIVEnTo determine rates, predictors, and phenotypic differences of adult-onset AD.nnnMETHODSnA systematic review was performed with all published observational studies in Medline, Embase, GREAT (Global Resource of EczemA Trials), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library, and Scopus that analyzed the age of AD onset beyond 10xa0years of age. At least two reviewers performed study title, abstract review, and data extraction. Pooled meta-analysis of the proportion of adult-onset AD was performed by using random-effects weighting (I2xa0=xa099.3%).nnnRESULTSnOverall, 25 studies met inclusion criteria. Seventeen studies reported age of AD onset as after 16xa0years of age and had sufficient data for meta-analysis. The pooled proportion (95% confidence interval) of adult-onset AD was 26.1% (16.5%-37.2%). Similar results were found in sensitivity analyses by AD diagnostic method, study region, and sex. Phenotypic differences were observed across studies for adult-onset and child-onset AD, including higher rates of foot dermatitis and personal history of atopy but lower rates of flexural lesions and other signs and symptoms.nnnLIMITATIONSnCharacteristics of adult-onset versus child-onset AD were not commonly reported.nnnCONCLUSIONnAD is not only a disease of childhood; 1 in 4 adults with AD report adult-onset disease, which has distinct clinical characteristics as compared to child-onset AD.

Association of vitiligo with hospitalization for mental health disorders in US adults

Vitiligo has a complex bidirectional relationship with mental health (MH) disturbances. However, little is known about the relationship between vitiligo and MH emergencies.

Vulvar Cancer Association with Groin Hidradenitis Suppurativa: A Large, Urban, Midwestern U.S. Patient Population Study

could be its prognostic limit. Further studies would be needed to assess if a diameter range should be applied to the BDR; although, in general, thin lesions of large diameters correlate with low BDR and thick lesions with a small diameters correlate with high BDRs, lesions with large diameters and focal deep components would suggest a favorable BDR and prognosis but an unfavorable Breslow prognosis.

Association of alopecia areata with hospitalization for mental health disorders in US adults

Patients with alopecia areata have multiple risk factors for mental health disorders, including psychological distress and impaired quality of life. Alopecia areata was associated with increased mental health disorders and hospitalization primarily for a mental health disorders. Alopecia areata patients require close monitoring for mental health disorders.

Allergic contact dermatitis to personal care products and topical medications in adults with atopic dermatitis

Background: Atopic dermatitis (AD) is associated with skin‐barrier disruption, immune dysregulation, and application of emollients and topical medications that might predispose a person toward developing allergic contact dermatitis. Objective: To determine the predictors of allergic contact dermatitis and relevant allergens in AD. Methods: A retrospective chart review was performed for 502 adults (age ≥18 years) who were patch tested to an expanded allergen series during 2014‐2017. Results: Overall, 108 (21.5%) had current AD and 109 (21.7%) had past AD. Patients with and without current AD had similar proportions of any positive (+, ++, or +++ 80 [74.1%] vs 254 [64.5%], respectively, chi‐squared P = .06); strong‐positive (++ and +++ 34 [31.5%] vs 102 [25.9%], respectively, P = .25); and irritant (56 [51.9%] vs 188 [47.7%], respectively, P = .45) patch‐test reactions. AD patients had significantly higher rates of positive reactions to ingredients in their personal care products and topical medications, including fragrance mix II (P = .04), lanolin (P = .03), bacitracin (P = .04), cinnamal (P = .02), budesonide (P = .01), tixocortol (P = .02), and chlorhexidine (P = .001); relevance was established in >90% of these reactions. Polysensitization occurred more commonly in patients with AD than without (35 [32.4%] vs 75 [19.0%]; P = .01). Limitation: Study was performed at a single center. Conclusion: AD patients had more positive patch‐test reactions to ingredients in their personal care products, topical steroids, and antibiotics.

Association between atopic dermatitis, depression and suicidal ideation: A systematic review and meta-analysis

BACKGROUNDnAtopic dermatitis (AD) is associated with psychologic distress. However, previous studies found conflicting results about whether AD is associated with increased depression or suicidality.nnnOBJECTIVESnTo determine the complex relationship between AD and depression.nnnMETHODSnA systematic review of all published observational studies in the MEDLINE, PubMed, Embase, Global Resource for Eczema Trials (GREAT), Latin American and Caribbean Health Sciences (LILACS), the Cochrane Library, Scopus, and PsychInfo databases that analyzed depression in AD was performed. Two reviewers performed study title and/or abstract review and data abstraction. Pooled meta-analysis was performed by using random-effects weighting.nnnRESULTSnOverall, 106 studies met the inclusion criteria; 36 had sufficient data for meta-analysis. The prevalence of any depression was higher in persons with versus without AD (20.1% vs 14.8%). Similar results were found in sensitivity analyses of studies assessing clinical depression, depressive symptoms, and adults; studies with healthy controls; and studies of low and high study quality. AD was associated with significantly higher depression scale scores, parental depression, antidepressant use, and suicidality. No publication bias was detected.nnnLIMITATIONSnIndividual-level data were not available.nnnCONCLUSIONSnPatients with AD have higher odds of depression and suicidality.

Measurement properties of three assessments of burden used in atopic dermatitis in adults

Standardized quality‐of‐life (QoL) assessments can provide important and clinically relevant information. There is currently a lack of standardization in QoL assessments used in atopic dermatitis (AD).