Dupilumab in adolescents with uncontrolled moderate-to-severe atopic dermatitis: results from a phase IIa open-label trial and subsequent phase III open-label extension.

Abstract: Dupilumab (monoclonal antibody inhibiting IL-4/IL-13 signalling) is approved for use in adolescents aged ? 12 years with inadequately controlled moderate-to-severe atopic dermatitis (AD). Dupilumab significantly improved AD signs/symptoms in […]

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TREatment of ATopic eczema (TREAT) Registry Taskforce: protocol for a European safety study of dupilumab and other systemic therapies in patients with atopic eczema.

Abstract: A long-term prospective observational safety study is essential to fully characterize the safety profile of systemic immunomodulating therapies for patients with atopic eczema. The TREatment of ATopic eczema (TREAT) […]

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Allergic Diseases and Long Term Risk of Autoimmune Disorders: longitudinal cohort study and cluster analysis.

Abstract: The association between allergic diseases (ADs) and autoimmune disorders (AIDs) is not well established.To determine incidence rates of AIDs in allergic rhinitis/conjunctivitis (ARC), atopic eczema (AE) and asthma, and […]

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Influence of prenatal and early-life exposures on food allergy and eczema in infancy: a birth cohort study.

Few prospective birth cohort studies are available on the effects of prenatal and early-life exposures on food allergy and eczema among Chinese children. The aim of this study was to evaluate the influence of prenatal and early-life exposures on food allergy and eczema during the first year of life in a prospective birth cohort study.This study was based on a prospective, observational birth cohort of 976 mother-child pairs in three Streets in Changsha, China from January to December 2015. Data on prenatal, early-life exposures and allergic outcomes were obtained from questionnaires collected at birth, and 1, 3, 6, 8, and 12?months of age. Multivariate logistic regression models were performed to estimate the effects of prenatal and early-life exposures on food allergy and eczema.Common risk factors for food allergy and eczema in infancy were parental history of allergy, while moderate eggs consumption (3-4 times/week) during pregnancy was protective for both of them compared with low consumption (? 2 times/week). Factors only associated with food allergy were maternal aquatic products consumption during pregnancy, number of older siblings and age of solid food introduction, whereas factors only associated with eczema were maternal milk or milk products consumption during pregnancy, maternal antibiotic exposure during pregnancy, season of birth and antibiotic exposure through medication during the first year of life.Our study suggests that factors associated with food allergy and eczema are multifaceted, which involving hereditary, environmental and nutritional exposures. Furthermore, differential factors influence the development of food allergy and eczema in infants.

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Natural Language Processing of Reddit Data to Evaluate Dermatology Patient Experiences and Therapeutics.

There is a lack of research studying patient-generated data on Reddit, one of the world’s most popular forums with active users interested in dermatology. Techniques within natural language processing, a field of artificial intelligence, can analyze large amounts of text information and extract insights.To apply natural language processing to Reddit comments about dermatology topics to assess for feasibility and potential for insights and engagement.A software pipeline preprocessed Reddit comments from 2005 to 2017 from seven popular dermatology-related subforums on Reddit, applied Latent Dirichlet allocation (LDA), and used spectral clustering to establish cohesive themes and the frequency of word representation and grouped terms within these topics.We created a corpus of 176K comments and identified trends in patient engagement in spaces such as eczema, acne, etc., with a focus on homeopathic treatments and Accutane.LDA is an unsupervised model, meaning there is no ground truth to which the model output can be compared. However, as these forums are anonymous, there seems little incentive for patients to be dishonest.Reddit data has viability and utility for dermatologic research and engagement with the public, especially for common dermatology topics such as tanning, acne, and psoriasis.

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Responsiveness and interpretability of the Hand Eczema Severity Index (HECSI).

The Hand Eczema Severity Index (HECSI) is used to measure severity of hand eczema. It is unclear what HECSI scores mean and what is the minimally important change (MIC). Furthermore, responsiveness has not been studied.To study responsiveness and interpretability of the HECSI.Prospective study covering two time points; baseline and after 4-12 weeks. Responsiveness was assessed using a criterion approach with a ? 1 step improvement on the ‘Photographic guide for severity of hand eczema’ as anchor for important improvement. Interpretability of single scores was determined by defining severity bands based on agreement with the anchor. For change scores, smallest detectable change (SDC) was calculated in unchanged patients and MIC was obtained in changed patients using three methods: mean cut-off, receiver operating curve (ROC) and 95%-limit.N=294 patients participated (N=160 males, mean age 44·9). HECSI scores improved/deteriorated in parallel with the anchor. The area under the ROC curve was 0·86 (95% confidence interval: 0·81-0·91). The final severity band for single scores had a ?-coefficient of agreement of 0·694: clear, 0; almost clear, 1-16; moderate, 17-37; severe, 38-116; very severe, ?117. The SDC in N=93 unchanged patients was 40·3 points. The obtained MIC values were all smaller than the SDC.The HECSI has good responsiveness. This study gives meaning to HECSI scores, which can be applied to clinical decision making and the design of clinical trials. We recommend that an improvement of 41 points on the HECSI is regarded as minimally measurable true change. This article is protected by copyright. All rights reserved.

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The oncological survival and prognosis of individuals receiving PD-1 inhibitor with and without immunologic cutaneous adverse events.

The treatment response to new immunotherapy in advanced melanoma patients remains varied between individuals. Immune related cutaneous side effects may have prognostic value.To determine whether developing one or more of the three immune-mediated cutaneous events (eczema, lichenoid reaction or vitiligo-like depigmentation) is associated with improved progression-free survival.A cohort study of adults with stage IIIC/IV melanoma treated with Pembrolizumab or Nivolumab between May 1, 2012 and Feb 1, 2018 at Westmead Hospital, Sydney, Australia. Treatment response was based on ir-RECIST, version 1.1.82 patients with an average age of 59.9 years were included. Median follow-up was 40.7 months. Thirty-three patients had at least one target skin reaction. One-third of individuals developed their skin reaction by six months. At any given time, the instantaneous risk of disease progression/death is lower for individuals who have developed at least one cutaneous adverse events (CAE) prior to this time. In comparison to individuals with no CAE, the hazard ratio is 0.46 with 95% CI 0.23 – 0.91, p = 0.025, time-dependent Cox proportional hazards model.This study demonstrates an association between developing at least one of three CAE and improved progression-free survival in this cohort of patients.

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Eczema apps conformance with clinical guidelines: A systematic assessment of functions, tools and content.

Eczema is a prevalent complex skin condition requiring active disease monitoring and personalized education. No studies have assessed the quality of apps aiming to support eczema self-management.To evaluate quality and comprehensiveness of English, Chinese and Spanish self-management eczema smartphone apps for patients and/or their caregivers.A systematic assessment of eczema apps from July to November 2018. The assessment criteria were based on conformance with international eczema guidelines. Following domains were assessed: consistency and comprehensiveness of eczema specific educational information; quality and comprehensiveness of eczema specific tracking functions; compliance with health information best practice principles.98 apps were assessed. 82 (84%) provided educational information, 38 (39%) tracking functions, and 13 (13%) both. 34% (28/82) of apps provided misleading information, particularly in aspects of treatment and disease progression of eczema. Only 15% (12/82) provided international guidelines supported information on pharmacological therapies and 16% (13/82) on non-pharmacological therapies. Among 38 apps with a tracking function, 82% (31/38) measured specific symptoms, disease severity or current skin condition and 89% (34/38) helped users to record medication usage including application of topicals. 34% (13/38) recorded environmental or dietary allergens. None of the included apps complied with all criteria for educational information, tracking functions or health information principles.The eczema apps have not yet reached their potential. The large variance in quality of eczema apps highlights the need for quality assurance mechanisms for health apps and guidance for clinicians which would enable them to make personalized recommendations to patients and caregivers. This article is protected by copyright. All rights reserved.

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Insomnia and other sleep complaints in inflammatory versus noninflammatory skin disorders: An observational case-control study.

Sleep problems are common in patients with dermatologic disorders. However, it is unknown whether inflammatory skin disorders are associated with more sleep problems than noninflammatory skin disorders.To determine whether sleep problems occur more frequently in people with inflammatory skin disorders compared to noninflammatory skin disorders.Observational case-control study.Patients with inflammatory skin disorders (psoriasis [n = 17] and chronic eczema [n = 30]) and noninflammatory skin disorders (nonmelanoma skin cancers [NMSC] [n = 31]) were enrolled. Data collection occurred during a single visit. Statistical analysis of questionnaire results between groups utilized inverse propensity score weighted (IPSW) ANOVA and logistic regression models.Groups differed in mean (SD) age (P < 0.001) and itch severity (P < 0.001). Based on IPSW ANOVA models, the inflammatory group had significantly higher fatigue scores (mean [95% CI]; 32.0 [28.4-35.5]) than the noninflammatory group (25.5 [21.6-29.3]; P = 0.017). The inflammatory group odds of insomnia were significantly greater based on two definitions of insomnia, ISI ? 15 and PSSQ-I, with odds ratios (95% CI) of 14.4 (2.16-525) and 4.82 (1.45-20.7), respectively. These results were consistent in comparisons between the three groups, with no difference between psoriasis and chronic eczema, but with chronic eczema, significantly more were affected than NMSC.Patients with inflammatory skin disorders report significantly more fatigue and have higher odds of insomnia compared to patients with noninflammatory skin cancers.

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