For children with atopic dermatitis (AD), early childhood stressful life events are associated with an increased risk for disease activity, according to a study published online Jan. 28 in the Journal of Investigative Dermatology.

Katrina Abuabara, M.D., from the University of California in San Francisco, and colleagues conducted a longitudinal cohort study of 13,972 children ages 1 to 8.5 years from the Avon Longitudinal Study of Parents and Children to examine the impact of stressful life events throughout early childhood on AD activity and severity.

The researchers found that for each standard deviation increase in stressful life events, there was a small increased risk for concurrent AD activity after adjusting for potential confounders (odds ratio, 1.04), which was higher for moderate-to-severe AD and for a cumulative measure of stressful events across childhood (odds ratios, 1.13 and 1.11, respectively). Common stressful life events such as starting a new school or having a new sibling drove the association more than severe adverse childhood events such as being separated from a parent or being abused.

"These results suggest that parents and providers may anticipate and proactively moisturize or treat to prevent potential AD flares around life events," the authors write. "In addition, multiple stress-reducing modalities have been shown to improve AD symptoms and may be helpful for patients experiencing stressful life events."

One author disclosed ties to the pharmaceutical and cosmetic industries.

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Comorbid chronic inflammatory diseases (CIDs) influence the prognosis of alopecia areata (AA), according to a research letter published online Jan. 8 in Allergy.

Annika Friedrich, from the University of Bonn in Germany, and colleagues used self-reported data from 2,657 mainly Central European AA patients to conduct a comprehensive analysis of associations between comorbid CIDs and selected AA-clinical features of relevance to prognosis.

Overall, 53.7 percent of the AA cohort reported one or more comorbid CID of any type: 44.5 and 17.4 percent reported one or more comorbid atopic CID and nonatopic CID, respectively. The researchers found that compared with patients with no comorbid CIDs, those with comorbid atopic dermatitis (AD), bronchial asthma, or Hashimoto thyroiditis were significantly more likely to report early-onset, severe, and prolonged AA. A significantly increased risk for prolonged AA was seen for patients with comorbid rhinitis or vitiligo. Compared with comorbid AD or rhinitis, comorbid bronchial asthma was associated with a higher risk for early-onset, severe, or prolonged AA. A more pronounced association was seen for CID comorbidity status with AA duration than with age of onset or severity. A significantly higher number of self-reported atopic comorbidities was seen in early-onset, severe, and prolonged AA compared with late-onset, mild, and nonprolonged disease, respectively. Per additional atopic comorbidity, the odds of early-onset, severe, and prolonged AA increased by 1.179, 1.130, and 1.202, respectively. The mean age of onset for AA was almost 10 years earlier in patients with AD + bronchial asthma + rhinitis compared with patients with AA only.

"Our findings suggest that distinct comorbid constellations may indicate AA subtypes with differing prognoses," the authors write.

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Self-reported manifestations of topical steroid withdrawal (TSW) in atopic dermatitis (AD) include erythema, desquamation, dryness, and oozing affecting the face, neck, and upper extremities, according to a study published online Jan. 3 in Acta Dermato-Venereologica.

Mikael Alsterholm, M.D., Ph.D., from the Karolinska Institutet in Stockholm, and colleagues conducted an observational cross-sectional study involving adults reporting both AD and TSW. A questionnaire was posted in a Swedish TSW-themed Facebook group and was accessed by 98 participants and completed by 82.

Most respondents were female (95 percent), self-diagnosed with TSW (84 percent), and reported current symptoms of AD and TSW. The researchers note that TSW was defined as dependence on topical glucocorticoids (TGCs) and adverse reactions to their use. The most reported signs were erythema, desquamation, dryness, and oozing affecting the face, neck, and upper extremities. The most reported symptoms were pruritus, sleep disturbance, and signs of anxiety and depression. Sixty percent of respondents reported recurring episodes of manifestations attributed to TSW. Ninety-three percent believed that TGCs were the personal trigger factor, while 33 percent also identified oral glucocorticoids. Twenty-one percent currently use TGCs.

"As of now, TSW remains an exclusion diagnosis after careful ruling out of established causes for adverse reactions to TGCs," the authors write. "This stance requires that the patients' concerns and beliefs are respected by empathic and open-minded health care providers who uphold an evidence-based approach and offer alternatives to TGCs when possible."

Several authors disclosed ties to the pharmaceutical industry.

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The U.S. Food and Drug Administration has approved Vtama (tapinarof) 1 percent cream for an additional indication -- the topical treatment of atopic dermatitis in adult and pediatric patients aged 2 years and older.

The cream, an aryl hydrocarbon receptor agonist, was previously approved as a topical, nonsteroidal treatment for plaque psoriasis.

The approval was based on results from the ADORING 1 and ADORING 2 trials, in which a statistically significant difference in the proportion of patients achieving a score of clear (0) or almost clear (1) and a minimum two-grade improvement from baseline at week 8 on the Validated Investigator Global Assessment for AD (vIGA-AD) was seen for Vtama compared with vehicle (ADORING 1: 45.4 versus 13.9 percent; ADORING 2: 46.4 versus 18.0 percent). Statistically significant benefits were seen for secondary end points, including an Eczema Area and Severity Index score improvement of at least 75 percent from baseline at week 8 and achievement of a ≥4-point improvement in the patient-reported Peak Pruritus Numerical Rating Scale from baseline at week 8 in patients aged 12 years and older.

Upper respiratory tract infection (12 percent), folliculitis (9 percent), lower respiratory tract infection (5 percent), headache (4 percent), asthma (2 percent), vomiting (2 percent), ear infection (2 percent), pain in extremity (2 percent), and abdominal pain (1 percent) were the most common adverse reactions reported.

"With the FDA's approval of Vtama cream in atopic dermatitis for adults and children as young as 2 years old, there is now a therapy that offers the potential for powerful skin clearance with no label warnings or precautions, contraindications, and no restrictions on duration of use or percentage of body surface area affected," Kevin Ali, the CEO of Organon, said in a statement.

Approval of Vtama was granted to Organon.

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The U.S. Food and Drug Administration has approved Nemluvio (nemolizumab) for the treatment of moderate-to-severe atopic dermatitis in patients aged 12 years and older.

The approval is for use in combination with topical corticosteroids (TCS) and/or calcineurin inhibitors (TCI) when the disease is not adequately controlled with topical prescription therapies. Nemluvio is the first approved monoclonal antibody that targets interleukin-31 receptor alpha, which drives itch and is involved in inflammation and epidermal dysregulation in atopic dermatitis.

The approval is based on the results of the phase 3 ARCADIA clinical trial program that included 1,728 patients aged 12 years and older with moderate-to-severe atopic dermatitis. After 16 weeks, patients treated with Nemluvio, administered subcutaneously every four weeks, in combination with TCS (with or without TCI) had statistically significant improvements on skin clearance (either clearance or almost-clearance using the Investigator's Global Assessment score). Patients also achieved a 75 percent reduction in the Eczema Area and Severity Index versus placebo in combination with TCS (with or without TCI), after 16 weeks of treatment. All key secondary end points were met, including significant responses on itch as early as week 1 and statistically significant improvements in sleep disturbance. Overall, Nemluvio was well tolerated, with similar safety profiles observed in both the Nemluvio and placebo groups.

"Despite currently available treatment options, atopic dermatitis continues to have a massive impact worldwide, with patients not only burdened by intense itch and recurrent skin lesions, but also potentially several associated symptoms, including sleep issues, pain, anxiety, and depression," lead investigator of the ARCADIA trial, Jonathan Silverberg, M.D., Ph.D., from George Washington University in Washington, D.C., said in a statement. "I look forward to being able to offer this option to atopic dermatitis patients in my practice who are seeking relief from burdensome itch and lesions."

Approval of nemolizumab was granted to Galderma.

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Dupilumab treatment improves signs and symptoms of atopic dermatitis (AD) in young children, according to a study published in the December issue of Advances in Therapy.

Mark Boguniewicz, M.D., from University of Colorado School of Medicine in Aurora, and colleagues evaluated the impact of type 2 comorbidities on the response to and safety of dupilumab in young children with AD. The analysis included children (aged 6 months to 5 years) with moderate-to-severe AD.

The researchers found that at week 16, significantly more patients receiving dupilumab versus placebo, with or without asthma and allergic rhinitis (AR), achieved an Investigator’s Global Assessment (IGA) score of 0/1 and a ≥75 percent improvement in the Eczema Area and Severity Index. Significantly more patients receiving dupilumab with food allergies (FAs) and numerically more patients without FAs achieved an IGA score of 0/1 versus placebo. Compared with those taking placebo, numerically more patients receiving dupilumab with asthma and significantly more patients without asthma achieved a ≥4-point reduction in the weekly average of the daily score on the Worst Scratch/Itch Numeric Rating Scale (WSI-NRS). Similarly, a ≥4-point reduction in the weekly average of the daily score on the WSI-NRS was achieved by significantly more patients receiving dupilumab than placebo with or without AR and with or without FAs. Safety was consistent with the known dupilumab safety profile.

"These results suggest that dupilumab treatment may be effective in children with or without other type 2 conditions," the authors write.

The study was funded by Sanofi and Regeneron, which manufacture dupilumab.

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The prevalence of Meniere disease is higher in people with atopic dermatitis (AD), according to a study published online Nov. 12 in The Laryngoscope.

Cha Dong Yeo, M.D., Ph.D., from Jeonbuk National University in Jeonju, South Korea, and colleagues used data from the National Health Insurance Service-National Sample Cohort to explore the potential correlation between AD and Meniere disease. The analysis included 84,579 individuals with and without AD.

The researchers found that the overall risk for Meniere disease was higher in the AD group (hazard ratio [HR], 1.44). Risk varied in a subgroup analysis and was lower for men (adjusted HR, 0.42) and higher in the middle-aged (40 to 59 years; HR, 4.99) and in older-age groups (60 years and older; HR, 8.21). Additionally, the risk for developing Meniere disease was higher in patients with comorbidities, including allergic rhinitis (adjusted HR, 1.18), allergic contact dermatitis (adjusted HR, 1.32), and allergic conjunctivitis (adjusted HR, 1.54).

"These findings highlight the importance of comprehensive management strategies that address both Meniere's disease and AD in affected patients," the authors write. "As our understanding of the relationship between AD and Meniere's disease continues to develop, further research will be crucial in creating targeted interventions to improve outcomes and optimize care for these patients."

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The annual meeting of the American College of Allergy, Asthma & Immunology was held from Oct. 24 to 28 in Boston, drawing attendees from around the world, including allergy and immunology specialists as well as other health care professionals. The conference featured presentations focusing on the latest advances in the prevention and treatment of asthma, food and medication allergies, and immune dysfunction.

In one study, Albert Wu, M.D., from New York City, and colleagues found that minorities are less likely to demonstrate vaccine hesitancy, even when taking into account age, gender, and language.

The authors collected vaccination history and demographic information from 338 new patients presenting to an outpatient allergy/immunology clinic between March 2023 and February 2024. White (37.2 percent), Hispanic (31.6 percent), Asian (18.9 percent), and Black (12.1 percent) ethnicities were included, with 80 percent speaking English as their primary language. The researchers found that minorities were less likely to demonstrate vaccine hesitancy. Age, gender, and language did not significantly affect likelihood for vaccine hesitancy. Mistrust of authority was among the most cited reasons by patients for vaccination hesitancy, including decreased confidence in the health care system and the government, as well as reservations regarding the safety and efficacy of vaccinations.

"Identifying target populations is a vital initial step in improving long-term vaccine acceptance. Our study found multiple patient characteristics differentially associated with increased vaccination hesitancy, including immunization history, age, and ethnicity," Wu said. "These characteristics could be used to identify patients more at risk for being vaccine-hesitant going forward to make vaccination campaigns more efficient. We can also improve upon current efforts to increase immunization rates by studying successful initiatives from the COVID pandemic."

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In another study, David Stukus, M.D., of Nationwide Children's Hospital and The Ohio State University College of Medicine in Columbus, and colleagues report an 11-fold increase in the number of children referred to a psychologist for food allergy-related anxiety and decreased quality of life during a 10-year period.

In a retrospective chart review of outpatient pediatric psychology referrals between 2013 and 2023, the authors evaluated 250 patients, 88 percent of whom were were referred for food allergy-related concerns and 53 percent of whom had prior documented anaphylaxis. The researchers identified an 11-fold increase in the number of children referred for food allergy-related anxiety and decreased quality of life during a 10-year period. Many of these children were quite young, with a median age of 9 years.

"It is important to address anxiety with all children and caregivers who have food allergies and have services available when this impacts quality of life," Stukus said. "Comprehensive food allergy management should include assessment of anxiety and quality of life."

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In a cross-sectional study, Nadia Makkoukdji, M.D., of the Jackson Health System in Miami, and colleagues found that food elimination diets are still commonly being used by parents of children with atopic dermatitis, with restrictive diets leading to malnutrition, emotional stress, and anxiety or depression, while also adding stress to parents.

The authors used a survey to assess parents' perceptions of the relationship between dietary choices and their child's atopic dermatitis. Participants in this study implemented elimination diets for varying durations, from one month to more than a year. Of those who followed elimination diets, 79 percent eventually reintroduced the suspected allergen, with no significant change in eczema severity. This finding was both statistically and clinically significant, with a P value < 0.001 as determined by a chi-square test.

In addition, the investigators found that 57 percent of parents altered their child's diet due to a belief that certain foods worsened their atopic dermatitis. Milk, tree nuts, seeds, peanuts, and eggs were the most commonly suspected triggers, aligning with well-known allergens globally. Again, dietary modifications did not lead to significant improvement in atopic dermatitis control, reflecting previous studies that showed limited efficacy for food elimination without confirmed food allergies.

"Our statistical analysis underscores the limited effectiveness of dietary restrictions as an eczema management strategy," Makkoukdji said. "These parental perceptions influence treatment decisions and highlight the need to follow guidelines from the American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma & Immunology to optimize atopic dermatitis management."

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ACAAI: ICS + Formoterol and ICS + SABA Better Than SABA Alone for Asthma

TUESDAY, Oct. 29, 2024 (HealthDay News) -- For patients with asthma, inhaled corticosteroids (ICS) combined with short-acting β agonists (SABA) and ICS combined with the long-acting β agonist formoterol are each associated with reduced asthma exacerbations compared with SABA alone, according to a study published online Oct. 28 in the Journal of the American Medical Association. The study was published to coincide with the annual meeting of the American College of Allergy, Asthma & Immunology, held from Oct. 24 to 28 in Boston.

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ACAAI: 2013 to 2023 Saw Rise in Pediatric Psych Referrals Tied to Food Allergies

MONDAY, Oct. 28, 2024 (HealthDay News) -- The number of pediatric psychology referrals for issues related to food allergy increased dramatically during the past decade, according to a study presented at the annual meeting of the American College of Allergy, Asthma & Immunology, held from Oct. 24 to 28 in Boston.

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FRIDAY, Oct. 25, 2024 (HealthDay News) -- Many anaphylaxis protocols are incomplete and/or outdated, and there is a need for patient education regarding treatment of anaphylaxis, according to two studies presented at the annual meeting of the American College of Allergy, Asthma & Immunology, held from Oct. 24 to 28 in Boston.

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ACAAI: Gene-Editing Therapy Reduces Angioedema Attacks in Hereditary Angioedema

THURSDAY, Oct. 24, 2024 (HealthDay News) -- For adults with hereditary angioedema, the in vivo gene-editing therapy NTLA-2002, which is based on clustered regularly interspaced short palindromic repeats (CRISPR)-CRISPR-associated protein 9, administered as a single dose reduces angioedema attacks, according to a study published online Oct. 24 in the New England Journal of Medicine to coincide with the annual meeting of the American College of Allergy, Asthma & Immunology, held from Oct. 24 to 28 in Boston.

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Long-term treatment of adolescents with moderate-to-severe atopic dermatitis (AD) with upadacitinib is safe and effective through 76 weeks, according to a study published online Oct. 23 in JAMA Dermatology.

Amy S. Paller, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues evaluated the efficacy and adverse events of upadacitinib in adolescent patients with moderate-to-severe AD through 76 weeks. The analysis included data from 542 adolescents participating in the Measure Up 1, Measure Up 2, and AD Up clinical trials.

The researchers found that at week 76, ≥75 percent reduction in the Eczema Area and Severity Index Score (EASI-75) was achieved by 89.1, 84.4, and 87.8 percent of adolescents taking upadacitinib 15 mg in the Measure Up 1, Measure Up 2, and AD Up trials, respectively. For a dose of 30 mg, EASI-75 was achieved by 96.1, 93.6, and 82.7 percent of adolescents, respectively. Across both upadacitinib doses, results indicated maintenance or improvement of EASI-75 across 76 weeks. Long-term outcomes in trial participants were consistent with the known adverse event profile of upadacitinib (herpetic infection: 4.0, 1.9, and 1.1 events per 100 patient-years, respectively; creatine kinase elevation: 11.6, 11.0, and 7.1 events per 100 patient-years, respectively), with no new signals noted with either dose.

"While the difference in the proportions of patients achieving at least EASI-75 between the two upadacitinib treatment groups is small, the difference between the two doses becomes more pronounced over time in the more stringent efficacy end points, such as EASI-90," the authors write.

Several authors disclosed ties to pharmaceutical companies, including AbbVie, which manufactures upadacitinib and funded the study.

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For patients with moderate-to-severe atopic dermatitis (AD), lebrikizumab has long-term efficacy, according to a study presented at the annual meeting of the European Academy of Dermatology and Venereology, held from Sept. 25 to 28 in Amsterdam.

Diamant Thaçi, Ph.D., from University Lübeck in Germany, and colleagues reported long-term efficacy and safety from the ADjoin long-term extension study. Adults aged 18 years and older and adolescents aged 12 to <18 years were randomly assigned to receive lebrikizumab 250 mg every two weeks (LEBQ2W) or placebo in the ADvocate 1 & 2 trials. Patients receiving lebrikizumab who met protocol-defined response criteria after 16 weeks were randomly assigned to receive LEBQ2W, lebrikizumab 250 mg every four weeks (LEBQ4W), or placebo. Participants who completed 52 weeks were eligible to enroll in ADjoin and received the same treatment regimen. Efficacy was assessed though week 100 of ADjoin.

Overall, 82 patients receiving LEBQ2W and 99 receiving LEBQ4W entered ADjoin. The researchers found that of the patients with Investigator Global Assessment (IGA) scores of 0/1 at week 16 in the LEBQ2W and LEBQ4W groups, respectively, 81.5 and 83.3 percent maintained IGA 0/1 at week 52 (ADjoin week 0) and 82.9 and 84.0 percent maintained IGA 0/1 at week 152. Of the patients with Eczema Area and Severity Index 75 percent improvement (EASI 75) at week 16 in the LEBQ2W and LEBQ4W groups, 96.3 and 93.7 percent and 90.5 and 94.1 percent maintained EASI 75 at week 52 and week 152, respectively. Throughout ADjoin, 14.6 and 24.2 percent of those receiving LEBQ2W and LEBQ4W, respectively, used any rescue therapy.

"These three-year results provide compelling evidence of durable efficacy and a consistent safety profile," senior author Eric Simpson, M.D., from Oregon Health & Science University in Portland, said in a statement.

The study was funded by Eli Lilly, the manufacturer of lebrikizumab.

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The U.S. Food and Drug Administration has approved Dupixent (dupilumab) as an add-on maintenance treatment for adults with inadequately controlled chronic obstructive pulmonary disease (COPD) and an eosinophilic phenotype.

The approval was based on results from two pivotal phase 3 trials (BOREAS and NOTUS) that evaluated Dupixent (468 and 470 participants, respectively) compared to placebo (471 and 465 participants, respectively) in adults currently on maximal standard-of-care inhaled therapy (nearly all on triple therapy) with inadequately controlled COPD and blood eosinophils ≥300 cells per μL.

Dupixent was associated with a 30 and 34 percent reduction in the annualized rate of moderate or severe COPD exacerbations over 52 weeks (the primary end point) versus placebo. Greater improvements in postbronchodilator forced expiratory volume in the first second from baseline at week 12 were also seen with Dupixent (74 mL and 68 mL versus placebo) and were sustained at 52 weeks. Safety results were generally consistent with the known safety profile of Dupixent. Cholecystitis was seen in 0.6 percent of patients on Dupixent versus 0.1 percent of patients on placebo.

"This latest FDA approval for Dupixent represents new hope for the hundreds of thousands of COPD patients in the United States who can sometimes struggle just to breathe during their everyday lives," George D. Yancopoulos, M.D., Ph.D., the president and chief scientific officer at Regeneron and a principal inventor of Dupixent, said in a statement. "Dupixent has a proven track record as a first-in-class medicine, providing benefit to the many patients suffering from type 2 inflammatory related diseases such as asthma and atopic dermatitis."

This approval of Dupixent was granted to Regeneron.

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Gupta M, Sharma A, Kumaran M

Link to Publication - https://www.cureus.com/articles/280376-an-insight-into-adolescent-dermatitis-artefacta-a-case-report#!/

Gupta M, Sharma A, Kumaran M (September 05, 2024) An Insight Into Adolescent Dermatitis Artefacta: A Case Report. Cureus 16(9): e68682. doi:10.7759/cureus.68682

Copyright © 2024 Gupta M, Sharma A, Kumaran M 

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

The U.S. Food and Drug Administration has approved Ebglyss (lebrikizumab-lbkz) for adults and children aged 12 years and older with moderate-to-severe atopic dermatitis.

The targeted interleukin-13 inhibitor is administered via a 250-mg/2 mL injection with or without topical corticosteroids in patients with atopic dermatitis not well controlled despite treatment with topical prescription therapies. The approval is dosed as a single monthly maintenance injection (250 mg) following the initial phase of treatment of 500 mg (two 250-mg injections) at week 0 and week 2, followed by 250 mg every two weeks until week 16 or later when adequate clinical response is achieved.

The approval was based on results from the ADvocate 1, ADvocate 2, and ADhere studies, with >1,000 participants. In an average of two studies (ADvocate 1 and 2), 38 percent of those who took Ebglyss achieved clear or almost-clear skin at 16 weeks versus 12 percent with placebo. Ten percent of individuals saw these results as early as four weeks. Among participants achieving clear or almost-clear skin at week 16, 77 percent maintained those results at one year with once-monthly dosing. Furthermore, 48 percent of responders who were switched from Ebglyss to placebo at week 16 maintained results at one year. Participants in both studies showed significant itch relief with Ebglyss (43 percent at 16 weeks versus 12 percent who took placebo).

"Patients still struggle to control their moderate-to-severe atopic dermatitis with currently available therapies," Jonathan Silverberg, M.D., Ph.D., from George Washington University in Washington, D.C., and first author of a paper published in the New England Journal of Medicine summarizing Ebglyss clinical trials, said in a statement. "Many experience poor long-term disease control, and severe itch can significantly impact their daily lives."

Approval of Ebglyss was granted to Eli Lilly.

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For patients with breast cancer, moderate hypofractionation (MHF) shows an improved safety profile, cosmesis, and quality of life compared with conventional fractionation (CF), with equivalent oncologic outcomes, according to a study published online Sept. 11 in The BMJ.

Shing Fung Lee, M.B.B.S., from the National University Hospital in Singapore, and colleagues conducted a systematic review and meta-analysis of randomized controlled trials focusing on CF (daily fractions of 1.8 to 2 Gy reaching 50 to 50.4 Gy), MHF (2.65 to 3.3 Gy for 13 to 16 fractions), and/or ultra-hypofractionation (UHF; schedule of five fractions) for breast cancer. Fifty-nine articles representing 35 trials with 20,237 patients were assessed.

The researchers found that for MHF versus CF, the risk ratios for grade ≥2 acute radiation dermatitis were 0.54 and 0.68 following breast-conserving therapy and mastectomy, respectively. Hyperpigmentation and grade ≥2 breast shrinkage occurred less often after MHF than CF, with risk ratios of 0.77 and 0.92, respectively, in the combined breast-conserving therapy and mastectomy population. Differences in hyperpigmentation and breast shrinkage were not statistically significant in the breast-conserving therapy-only trials. For breast-conserving therapy and mastectomy populations combined, the risk ratio for grade ≥2 acute radiation dermatitis was not significantly different for UHF versus MHF. Compared with CF, MHF was associated with improved cosmesis and quality of life, while data on UHF were less conclusive. Similar survival and recurrence outcomes were seen for UHF, MHF, and CF.

"These findings justify the wider adoption of moderate hypofractionation as the preferred approach, given its balance of therapeutic efficacy and improved safety," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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The association of prenatal ω-3 long-chain polyunsaturated fatty acid (n-3 LCPUFA) with the risk for childhood atopic dermatitis (AD) varies based on the maternal cyclooxygenase-1 (COX1) genotype, according to a study published online Aug. 28 in JAMA Dermatology.

Liang Chen, from Herlev and Gentofte Hospital in Copenhagen, Denmark, and colleagues examined the association of n-3 LCPUFA supplementation during pregnancy with the risk for childhood AD overall and by maternal COX1 genotype. A total of 736 pregnant women at 24 weeks of gestation were randomly assigned to n-3 LCPUFA (fish oil) or placebo (olive oil) until one-week postpartum; 635 children completed clinical follow-up.

The researchers observed an association between pregnancy n-3 LCPUFA supplementation and lower urinary thromboxane A2 metabolites at age 1 year (β = −0.46), which was also associated with the COX1 rs1330344 genotype (β per C allele, 0.47). There were no associations for n-3 LCPUFA supplementation or the maternal COX1 genotype with the risk for childhood AD until age 10 years; however, evidence of an interaction between these variables was seen. The risk for AD was lower in the n-3 LCPUFA group versus the placebo group among mothers with the TT genotype, while no association was seen for mothers with the CT genotype. An increased risk was seen for offspring of mothers with the CC genotype.

"These findings support use of a personalized prevention strategy for reducing the burden of AD in childhood by only providing n-3 LCPUFA supplementation to pregnant mothers carrying the COX1 rs1330344 TT genotype," the authors write.

Several authors disclosed ties to the biopharmaceutical industry.

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Dietary intake of vitamin E may potentially lower the risk for atopic dermatitis, according to a study published online Aug. 9 in Skin Research & Technology.

Siqing Wang, from the Beijing University of Chinese Medicine, and colleagues conducted a Mendelian randomization analysis to explore the causal relationship between dietary antioxidant vitamin intake (vitamin C, vitamin E, carotene, and retinol) and atopic dermatitis. 

The researchers observed a causal relationship between vitamin E intake and atopic dermatitis (odds ratio, 0.859; 95 percent confidence interval, 0.745 to 0.992; P = 0.038). No causal relationship was seen between the other three vitamins and atopic dermatitis (odds ratios [95 percent confidence intervals], 0.953 [0.826 to 1.099; P = 0.507], 1.011 [0.864 to 1.184; P = 0.890], and 1.063 [0.893 to 1.264; P = 0.492] for vitamin C, carotene, and retinol, respectively). In a sensitivity analysis, none of the single-nucleotide polymorphisms were detected as heterogeneous and no significant pleiotropy was observed.

"The analysis suggests that dietary intake of vitamin E could potentially reduce the risk of atopic dermatitis. Conversely, intake of vitamin C, retinol, and carotene does not appear to be causally related to atopic dermatitis," the authors write. "Although vitamin E intake could be protective against atopic dermatitis, intake of dietary antioxidant vitamins to prevent or treat atopic dermatitis is not necessary."

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Early childhood obesity may increase the risk for pediatric immune-mediated skin diseases, according to a study published online Aug. 21 in the Journal of Investigative Dermatology.

Seong Rae Kim, M.D., from the Seoul National University College of Medicine in South Korea, and colleagues examined associations between body mass index or body mass index changes and the development of three main immune-mediated skin diseases: alopecia areata, atopic dermatitis (AD), and psoriasis in a longitudinal cohort of roughly 2.16 million Korean children (2009 to 2020).

The researchers found that children with obesity had a significantly higher risk for pediatric immune-mediated skin diseases than those with normal weight. A higher risk for AD was seen with an increase in body mass index, while a decrease in body mass index correlated with a reduced risk for AD. Transitioning from normal weight to overweight was associated with higher AD risk compared with maintaining a normal weight (adjusted hazard ratio, 1.15). However, those with a decrease in body mass index (overweight to normal weight) had lower AD risk (adjusted hazard ratio, 0.87) versus children who maintained overweight.

"Implementing purposeful interventions, including nutritional strategies, to decrease body weight may aid in reducing the risk of developing immune-mediated skin diseases in children," the authors write.

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For patients with atopic dermatitis (AD), dupilumab maintains its clinical effectiveness up to five years and is discontinued by 23.8 percent of patients, according to a study published online Aug. 7 in JAMA Dermatology.

Celeste M. Boesjes, M.D., from the University Medical Center Utrecht in the Netherlands, and colleagues examined clinical effectiveness and reasons for discontinuation of dupilumab treatment in 130 children, 1,025 adults, and 131 older adults with AD with up to five years of treatment.

The researchers found that most adults maintained controlled AD, with an Eczema Area and Severity Index (EASI) score of 7 or lower varying from 78.6 to 92.3 percent and a numeric rating scale (NRS) for pruritus of 4 or lower varying from 72.2 to 88.2 percent for up to five years of treatment; up to 70.5 percent of all patients extended the dosing interval to mostly 300 mg every three or four weeks. After five years of treatment, the mean EASI and NRS for pruritus were 2.7 and 3.5, respectively. After six months of treatment, median thymus- and activation-related chemokine levels decreased considerably, from 1,751 to 390 pg/mL, and remained low. The median eosinophil levels increased temporarily to week 16, then decreased significantly over time. After a median of 54.0 weeks, 23.8 percent of patients discontinued dupilumab, with adverse events and ineffectiveness being the most frequently reported reasons (7.6 and 6.6 percent, respectively).

"This study highlights the importance of multicenter registries to evaluate long-term treatment effects in large daily practice cohorts," the authors write.

Several authors disclosed ties to pharmaceutical companies, including Sanofi and Regeneron, which manufacture dupilumab.

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