特应性皮炎流行病学

This global study on atopic dermatitis (AD) reveals an overall prevalence of 9.6% among adults aged 16 and older, with the highest rates in Asia, followed by Latin America and Europe. Findings highlight significant variations in prevalence by age, gender, and ethnicity, challenging common beliefs and establishing new benchmarks for understanding AD's global distribution and impact.

This study evaluated the prevalence, incidence, and relative risk of comorbid atopic dermatitis (AD) among patients with alopecia areata (AA) using data from the Merative™ MarketScan® Research Databases. Eligible patients had ≥1 inpatient or ≥2 outpatient claims for AA between 01/01/2017 and 10/31/2023, were aged ≥12 years, and were continuously enrolled during the ≥5-year baseline period through the 6-month follow-up period; index date was the earliest date of AA diagnosis. AD prevalence (%) and incidence (cases/1000 person-years) among patients with AA are reported and stratified by disease severity; a subgroup analysis was performed among adolescents (12-17 years). Adjusted hazard ratios for being diagnosed with AD are reported for patients with moderate-to-severe versus mild AA. Prevalence of AD among patients with AA at baseline was 3.2% (overall prevalence in database: 12.1%), with most having moderate-to-severe AD; prevalence was higher among adolescents with AA (7.6%). Incidence of AD increased with AA disease severity, regardless of age. Those with moderate-to-severe AA had 78% higher risk of being diagnosed with AD than those with mild disease. Dermatologist-diagnosed patients had higher rates of comorbid AD regardless of AA severity. These data demonstrate the importance of increased risk of comorbid AD when making treatment decisions for patients with AA.

We aimed to estimate the prevalence, severity, and burden of pediatric atopic dermatitis (AD) in China. EPI-CARE China was a cross-sectional online survey that assessed AD in the general pediatric populations (aged 0.5‒17 years) between 21 March 2021 and 5 April 2021 in China. Diagnosis of AD prevalence was based on both International Study of Asthma and Allergies in Childhood criteria and self-reported or parent-reported physician confirmation of ever having had AD. Severity (mild, moderate, and severe) in the preceding week was assessed by patient global assessment. Health-related quality of life (HRQoL) was assessed using established dermatology patient-reported outcomes tools (Infant Dermatitis Quality of Life and Children’s Dermatology Life Quality Index). Outcomes included type 2 inflammatory comorbidities and itch, skin pain, and sleep disturbance in the previous 24 h (numeric rating scale [NRS]: 0–10 [no symptoms–worst symptoms]), stratified by age group (aged ≤ 5 years, 6–11 years, and 12–17 years). In 7148 patients, AD prevalence was 3.2% (≤ 5 years, 3.8%; 6–11 years, 4.1%; 12–17 years, 1.7%). Of these, 59.1% (≤ 5 years, 66.1%; 6–11 years, 60.1%; 12–17 years, 39.4%), 38.8% (≤ 5 years, 33.9%; 6–11 years, 38.0%; 12–17 years, 53.1%), and 2.0% (≤ 5 years, 0.0%; 6–11 years, 1.9%; 12–17 years, 7.5%) had mild, moderate, and severe AD, respectively. Patients with moderate AD reported greater impacts on HRQoL than patients with mild AD (too few patients with severe AD provided HRQoL data for comparison). Overall, 90.5% patients reported ≥ 1 atopic comorbid condition. The mean (SD) itch, skin pain, and sleep disturbance NRS values were 5.9 (2.4), 5.6 (2.6), and 5.9 (2.3), respectively. These results demonstrate that AD is associated with substantial patient burden in pediatric patients in China.

Introduction. One of the frequent comorbid conditions in alopecia areata is atopic dermatitis. Existing epidemiological data on alopecia areata and its association with atopic dermatitis remain contradictory and insufficiently studied, which underscores the relevance of this research.Aim. To study the epidemiological characteristics of alopecia areata in Moscow and its association with atopic dermatitis based on population and registry data.Materials and methods. A multicenter retrospective cohort study was conducted by analyzing medical records of patients diagnosed with alopecia areata and atopic dermatitis monitored at the Moscow Center for Dermatovenereology and Cosmetology from 2020 to 2024. Federal statistics (Form No. 12), outpatient records (No. 025/u-04), and a specialized alopecia areata registry were used. Rates per 100 000 population were calculated.Results. Significant differences in alopecia areata epidemiology were found (p < 0.001): prevalence in children (36.8/100 000) was 2.7 times higher than in adults (13.7/100 000), incidence – 22.2 vs. 7.9/100 000/year. Overall morbidity increased by +83.3%, prevalence by +62.6% (p < 0.001). The association between alopecia areata and atopic dermatitis was significant (p < 0.001): overall frequency 2.66% (95% CI: 2.37–2.95), higher in children (4.09%; OR = 8.3, 95% CI: 7.1–9.7) than adults (1.85%; OR = 14.1, 95% CI: 11.9–16.7). The highest increase occurred in 2021. In the adult alopecia areata registry, atopic dermatitis was present in 15.9% (64/403).Conclusions. The significant age-dependent association between alopecia areata and atopic dermatitis confirms atopic dermatitis as an established risk factor. Registry data provide more accurate information on comorbidities. The results justify screening for atopy in alopecia areata patients and the need for a multidisciplinary management approach.

Background Atopic Dermatitis (AD) is a highly pruritic, chronic-recurrent inflammatory skin condition associated with erythematous lesions that affect a significant proportion of the population. Although AD is a non-communicable disease, it can cause pain, unbearable itchiness, sleep disturbance, loss of work productivity, and reduced quality of life. As a heterogeneous disease, AD is influenced by multiple genes and environmental triggers. As such, it is imperative to gain a deeper insight into the intricate gene-environment relationship that results in the manifestation of AD. Methods There are 3 objectives in our study. We first aim to update the epidemiological status of AD amongst young adults in Singapore and Malaysia, in particular amongst the Chinese ethnic background. Next, we re-evaluated the possible associated risk factors, identified in our previous meta-analysis and review studies, on the current cohort. Finally, we described here a detailed disease presentation and symptoms profile of our Singapore and Malaysia Cross-Sectional Genetics Epidemiology Study (SMCGES) cohort, which forms the base population for the discovery of associated genetic factors in relation to asthma, allergic diseases and skin conditions. Based on a skin prick test (SPT) and investigator-administered medical history responses, we assessed the AD profiles of 11 494 participants and the significant modifiable and non-modifiable factors associated with disease presentation. Results The prevalence of AD in the combined population was 13.5%. Chronic and moderate/severe AD were observed in 35.5% and 40.5% of the individuals with AD, respectively. Family history of atopic diseases, prior history of drug allergies, a history of acne, increased household family monthly income, higher number of individuals in the shared household, parental education, sedentary lifestyle, physical activities, alcoholic consumption, and even quality of diet was significantly associated with AD presentation, chronicity, and severity. Among all the factors evaluated, family and personal history of atopic diseases imposed the strongest associated risk. Conclusions These findings supported our previous review studies and affirmed that familial history or genetic factors critically influence the development of AD in our population and environment. Environmental and other modifiable factors can also trigger AD throughout the lifetime of individuals who have especially inherited the atopic disease disposition. A better understanding of how these risk factors affect AD individuals in our population can facilitate disease surveillance, monitor disease control, and serve as a description for our future genetic epidemiology studies.

Introduction Atopic dermatitis (AD) is a common, chronic, recurrent inflammatory skin disease. To date, no meta-analysis have been conducted on the prevalence and risk factors of AD in children aged 1–7 years in Mainland China. Methods We conducted a meta-analysis of the prevalence and risk factors of AD among children aged 1–7 years in China. Chinese and English publications were searched in Chinese and English databases on AD epidemiology published between 1999 and 2023. Two researchers independently screened the literature, extracted the data, and evaluated their quality. A meta-analysis was performed using a random-effects model (I2 > 50%) with 95% confidence intervals (CIs) for the forest plots. Data were processed using the RevMan 5.3. Results Nineteen studies (data from 127,660 samples) met the inclusion criteria. The pooled prevalence of AD in Chinese children aged 1–7 years was 8%. Over the last decade, the prevalence of AD has increased. The prevalence of AD among children in southern China was higher than that in northern China and was the highest at the provincial level in Zhejiang, Shanxi, and Anhui. The prevalence of AD was dependent on the family history of allergy, passive smoking, households with pets, plush toys, and residential area. Discussion The prevalence of AD in children (age 1–7 years) in China has increased. Further studies are needed to monitor the prevalence of AD in Chinese children. Therefore, early prevention and screening should be performed for children with a family history of AD, and their living environment should be improved to reduce allergen stimulation, thus reducing the development of AD.

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Atopic dermatitis (AD) is a common chronic inflammatory skin disease with significant unmet needs globally.1 European prevalence rates range from up to 8% and 20% of adults and children respectively.2 In the E.U., a 12-month prevalence of AD has been reported at 4.4%.4 Self-reported moderate-to-severe AD affects between 46-66% of E.U. adult AD patients.4 However, global prevalence estimates vary widely. In Ireland, the epidemiology of AD is not fully understood. The aim of this study was to estimate the prevalence of patients aged 12 years or older presenting to secondary care dermatology clinics in Ireland with moderate-to-severe AD. The primary objective was to estimate the prevalence of patients aged 12 years and over with moderate or severe AD within secondary care clinics in Ireland. Secondary objectives included estimating the prevalence and incidence of moderate-to-severe AD patients aged 12–17 and ≥ 18 years respectively within secondary care clinics in Ireland. Three secondary care sites located in the south of Ireland collated the number of AD patients ≥ 12 years old (one visit per patient only) with moderate or severe AD presenting between August 2021 and March 2022. The aggregated six-month data from each site was expected to include all patients with AD being actively treated within secondary care in the Munster region. As this epidemiological study was exploratory in nature, no limit was placed on the volume of aggregated patient data collected. Prevalence of AD was standardised to the regional population by dividing the total number of patients with a clinic visit, by the regional population covered by the sites using the 2016 census data. Incidence of AD was standardised similarly by dividing the total number of new patients attending clinic by the regional population covered by the sites using the 2016 census data. The regional prevalence and incidence estimates were stratified by age group and gender and then multiplied by the total Irish population (per the 2016 county level census data) to estimate the national number of cases of moderate and severe AD in secondary care over a six-month period. The outcome of the analysis estimates an overall prevalence rate for moderate-to-severe AD in secondary care in Ireland of 2.893 patients per 10,000 people in the Irish population. The total estimated number of moderate-to-severe AD cases in secondary care was 1,141. The prevalence rate (95% CI) was 1.456 (1.236, 1.704) and 1.437 (1.218, 1.683) per 10,000 for patients with moderate AD and severe AD respectively. The highest overall prevalence rate of 6.03 patients per 10,000 of the Irish population was observed for patients aged 12–17 years with moderate-to-severe AD in secondary care. Amongst adults, similar prevalence rates were reported for moderate and severe AD patients (1.204 and 1.359 patients per 10,000 respectively) with the highest prevalence rates for 18–24 year olds (2.680 and 2.776 patients per 10,000 for moderate and severe AD respectively). An overall incidence rate of 0.385 patients per 10,000 (in 6-months) was observed for patients aged 12 years and older with moderate-to-severe AD in secondary care, with an estimated 152 new AD patients entering secondary care in Ireland in 6 months. Twenty percent of all current AD patients had attended their first secondary care AD clinic visit during the study period. Considering E.U. prevalence estimates of AD4, the findings of this study suggest that a very small proportion of patients with moderate-to-severe AD are being seen in secondary care clinics in Ireland.

No abstract available

Background There are gaps in our understanding of the epidemiology of atopic dermatitis (AD) in adults. Objective To evaluate the prevalence and severity of AD in adults from countries/regions within Asia, Eurasia, Latin America, Middle East, and Russia. Methods This international, web-based survey was performed in Argentina, Brazil, China, Colombia, Egypt, Hong Kong, Israel, Malaysia, Mexico, Russia, Kingdom of Saudi Arabia (KSA), Singapore, Taiwan, Thailand, Turkey, and United Arab Emirates. Questionnaires were sent to adult members of online respondent panels for determination of AD and assessment of severity. A diagnosis of AD required respondents to meet the modified United Kingdom (UK) Working Party criteria and to self-report they had a physician diagnosis of AD. Severity of AD was determined using Patient-Oriented Scoring of Atopic Dermatitis (PO-SCORAD), Patient-Oriented Eczema Measure (POEM), and Patient Global Assessment (PGA). Results Among respondents by country/region the prevalence of AD ranged from 3.4% in Israel to 33.7% in Thailand. The prevalence was generally higher in females versus males. Severity varied by scale, although regardless of scale the proportion of respondents with mild and moderate disease was higher than severe disease. PGA consistently resulted in the lowest proportion of severe AD (range 2.4% China - 10.8% Turkey) relative to PO-SCORAD (range 13.4% China - 41.6% KSA) and POEM (range 5.1% China - 16.6% Israel). Conclusions This survey highlights the importance of AD in adults, with high prevalence and high morbidity among respondents and emphasizes that AD is not just a disease of childhood-there is disease persistence and chronicity in adults.

Atopic dermatitis (AD) affects children and adults worldwide. Advances have been made towards unravelling the pathogenesis, identifying various triggers, linking the environment and psychosocial factors with disease and the development of therapeutic targets to improve disease control. This article describes the global epidemiology and disparities that exist in various populations and regions across the globe. AD prevalence and burden varies widely both within and between countries inhabited by the same ethnic groups suggesting strong environmental influences in disease expression, socioeconomics and affluence being the main drivers. Inequities in access to healthcare and the quality of healthcare provided amongst racial and ethnic minority groups is well documented. Disparities in access to various topical and systemic therapies are barriers to registration and approval, cost, manufacturing, supply and approval by medical insurance companies and governments. Identifying the factors driving the inequities in access is central to better patient care.

The prevalence rates of attention deficit hyperactivity disorder (ADHD), depression, anxiety and suicide are increasing in patients with atopic dermatitis (AD), although no research has systematically examined these trends yet. Here, we explore the prevalence of the occurrence of comorbidities, such as ADHD, depression, anxiety and suicide with AD. We searched seven electronic databases from inception to October 2022 to identify relevant studies, and the Agency for Healthcare Research and Quality (AHRQ) and Newcastle–Ottawa Scale (NOS) tools were used to assess the quality of observational studies. Statistical analysis was performed using R software. Publication bias was evaluated using Egger's and Begg's linear tests. The global prevalence rates of ADHD, depression, anxiety and suicidal ideation in patients with AD were 7%, 17%, 21% and 13%, respectively, between 1998 and October 2022. Among children (aged <18 years), North American children with AD had the highest prevalence rates of ADHD (10%), depression (13%) and anxiety (20%). Among the adult (aged ≥18 years) population, patients with AD in Africa had the highest prevalence rates of depression (36%) and anxiety (44%), while Asian adults with AD had the highest prevalence rates of ADHD (7%) and suicidal ideation (20%). These results highlight the high prevalence and comorbidity rates of mental illnesses with AD, which should be brought to the attention of patients with AD and their physicians.

Latin America (LA) encompasses about 8.5% of the world’s population, exhibits ethnic/racial heterogeneity and social inequality. We hereby present a 20-year literature review (2004–2023) on epidemiology, diagnosis, clinical and laboratory features, quality of life and management of atopic dermatitis (AD) in LA. Highest AD prevalence for children aged 6–7 years was reported in Ecuador (22.5%) and Colombia (20.9%), for adolescents in Colombia (24.6%) and for all ages, in Brazil (20.1%). Regions with a predominantly Black population in LA varied significantly, ranging from 4.4% in Northern Brazil to 10.1% in Cuba, indicating genetic variation among African subgroups. Filaggrin loss-of-function mutations showed variants seen in Europeans in 9.3% of Chilean patients and studies in Brazil revealed impaired expression of filaggrin and claudin-1 in the skin but increased expression in conjunctival epithelia of AD patients. The most reported AD features included erythema, pruritus, and dry skin, with marked lichenification. Severe pruritus was reported by 54.4% of patients and a high impact on quality of life was detected in 50% of adults with AD. In Brazilian referral hospitals, 65.6% of patients were classified as having severe AD, and 56% had one or more hospitalizations during their lifetime, indicating a need for better disease control. Diagnosing AD is challenging due to broad clinical features, ethnoracial variations and lack of universal diagnostic criteria. Furthermore, lack of physician training, barriers to medication access, and socioeconomic inequalities hinder effective disease management in LA.

Atopic dermatitis (AD) is a global condition that has a rising prevalence in developing countries such as those within South-east Asia and Latin America. Recent research re-presents the condition as a heterogenous disease of distinct endotypes among different ethnic groups. Variation between ethnic groups in physiological measures such as transepidermal water loss, ceramide-to-cholesterol ratio, skin sensitivity, alongside pathological barrier and immune system dysfunction processes, may ultimately lead to the distinct phenotypes seen clinically. AD in patients of Caucasian ethnicities is typified by filaggrin dysfunction, more Th1 and less Th17 involvement, with less epidermal thickness compared to patients of Black or Asian ethnicities. AD in patients of Black ethnic groups is Th2/Th22-skewed, with robust IgE expression, and less Th1 and Th17 involvement than patients of Asian or Caucasian ethnicities. AD across South Asian and East Asian populations is characterised by Th17/Th22 upregulation. Differences also exist in how AD psychosocially impacts individuals of different ethnic groups.

Background The prevalence of atopic dermatitis (AD) has been increasing in recent years, especially in Asia. There is growing evidence to suggest the importance of dietary patterns in the development and management of AD. Here, we seek to understand how certain dietary patterns in a Singapore/Malaysia population are associated with various risks of AD development and exacerbation. Methods A standardized questionnaire following the International Study of Asthma and Allergies in Childhood (ISAAC) guidelines was investigator-administered to a clinically and epidemiology well-defined allergic cohort of 13,561 young Chinese adults aged 19–22. Information on their sociodemographic, lifestyle, dietary habits, and personal and family medical atopic histories were obtained. Allergic sensitization was assessed by a skin prick test to mite allergens. Spearman’s rank-order correlation was used to assess the correlation between the intake frequencies of 16 food types. Dietary patterns were identified using principal component analysis. Four corresponding dietary scores were derived to examine the association of identified dietary patterns with allergic sensitization and AD exacerbations through a multivariable logistic regression that controlled for age, gender, parental eczema, BMI, and lifestyle factors. Results The correlation is the strongest between the intake of butter and margarine ( R  = 0.65). We identified four dietary patterns, “high-calorie foods”, “plant-based foods”, “meat and rice”, and “probiotics, milk and eggs”, and these accounted for 47.4% of the variance in the dietary habits among the subjects. Among these patterns, moderate-to-high intake of “plant-based foods” conferred a negative association for chronic (Adjusted odds ratio (AOR): 0.706; 95% confidence interval (CI): 0.589–0.847; p  < 0.001) and moderate-to-severe AD (AOR: 0.756; 95% CI: 0.638–0.897; p  < 0.01). “Meat and rice” and “probiotics, milk and eggs” were not significantly associated with AD exacerbation. While frequent adherence to “high-calorie foods” increased the associated risks for ever AD and moderate-to-severe AD, having a higher adherence to “plant-based foods” diminished the overall associated risks. Conclusions Frequent adherence to “plant-based foods” was associated with reduced risks for AD exacerbation in young Chinese adults from Singapore/Malaysia. This provides the initial evidence to support the association between dietary factors and AD. Further research is needed to better understand the pathomechanisms underlying diet and AD exacerbations.

Atopic dermatitis (AD) prevalence in Poland is more frequent in individuals who live in a city. There are more studies demonstrating that long-term exposure to air pollutants is an independent risk factor for developing AD. The aim of the study was to assess the epidemiology of AD and food allergy (FA) in school children and adolescents living in Krakow, and to find a potential relationship between the incidence of atopic dermatitis with exposure to polluted air. In this paper, we presented the incidence of AD and FA between 2014 and 2018. We analyzed data collected from nearly 30,000 children aged 7–8 and adolescents aged 16–17 from the population of children and youth in Krakow. We correlated it with annual mean concentrations of PM10 and PM2.5, which indicated a gradual improvement in the air quality in Krakow. As our research results show that the prevalence of atopic dermatitis decreased with food allergy prevalence depending on the age group. We can suspect that this is the result of children growing out of a food allergy. It may be also influenced by more consequential eating habits in a group of adolescents and the elimination of allergenic foods from the diet. The decreasing incidence of atopic dermatitis appears to be also related to improvement in air quality.

Abstract: Introduction: Atopic dermatitis, also known as eczema or atopic eczema, is a chronic inflammatory skin disorder characterized by the presence of pruritus accompanied by itching. In Colombia, epidemiological and healthcare resource utilization information regarding this pathology is limited. Objective: To describe atopic dermatitis epidemiological characteristics and healthcare resource utilization patterns in Colombia. Material and methods: A retrospective database study using real-world data obtained from the national claims database SISPRO (Sistema de Información para la Protección Social) for the 2015-2020 period was carried out. Sociodemographic (age, and health services delivery), epidemiological (incidence, prevalence, and comorbidities), and healthcare resource utilization data were extracted from the SISPRO database. Results: The epidemiological results showed increased incidence and prevalence of atopic dermatitis in Colombia in the 2018-2019 period compared to 2015-2017. Accordingly, the number of medical consultations (particularly with specialists), the number of procedures, and the number of hospitalizations of patients with atopic dermatitis increased. Topic and systemic corticoids were the most frequently prescribed drugs. Conclusions: Diagnoses of atopic dermatitis in Colombia increased with a concomitant increase in healthcare resource utilization during 2015-2020, which was possibly slowed down by the arrival of the Covid-19. This study may help physicians gaining a better understanding of the disease, improving atopic dermatitis patient management.

Background: Atopic dermatitis (AD) in high-burden skin areas such as the head-and-neck, the hands, and the genitals is associated with a high disease burden and impaired quality-of-life.Objective: We investigated the prevalence of AD in high-burden skin areas, clinical and demographic characteristics, and association with disease severity in adults with AD.Methods: A cross-sectional survey was sent to 16,718 adults seen with AD (ICD-10, L20.x) at a Danish hospital. Severity was assessed with the Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD).Results: 7049 completed the survey (42.2% response), and 6716 who reported anatomical site of AD were included. The point prevalence of hand eczema (HE), head-and-neck dermatitis (HND), and genital eczema (GE) increased with AD severity and was 68.7%, 60.0%, and 5.9% in moderate, and 81.7%, 75.6%, and 14.1% in severe AD (P < 0.001). HND and HE patients were primarily women with childhood-onset and more severe AD. GE patients tended to be male, had severe AD, had more atopic comorbidities, and had higher corticosteroid and antibiotic use.Conclusions: AD in high-burden areas is common in adult Danes with AD and characterized by more severe AD and specific patient characteristics. This subgroup warrants recognition as difficult-to-treat, requiring close monitoring and earlier use of advanced systemic therapy.

Background The relationship between atopic dermatitis (AD) severity, sleep disturbance (SD), and health-related outcomes is not fully elucidated. Objective The aim of the study was to determine the prevalence of SD in adult AD and its relationship with AD severity and health outcomes among the US population. Methods A cross-sectional, US population–based survey study of 2893 adults was performed. Results Among adults meeting the UK Diagnostic Criteria for AD, 255 (40.7%) reported 1 or more, 67 (11.1%) reported 3 to 4, and 57 (9.5%) reported 5 to 7 nights of SD in the past week; 475 (79.7%) reported at least some trouble sleeping in the past 3 days. Moderate and severe Patient-Oriented Scoring AD, Patient-Oriented Eczema Measure, and Numeric Rating Scale–itch and Numeric Rating Scale–skin pain scores were associated with more severe SD compared with those without AD. More frequent and severe SDs were associated with higher Dermatology Life Quality Index, lower 12-item Short-Form Health Survey, and higher Hospital Anxiety and Depression Scale (HADS) scores. Significant mediation by SD severity was observed between Patient-Oriented Eczema Measure and Numeric Rating Scale–itch with Dermatology Life Quality Index, 12-item Short-Form Health Survey physical and mental component scores, HADS-anxiety and HADS-depression scores, diagnosed anxiety, and heart disease. Conclusions Atopic dermatitis and AD severity are associated with SDs. Sleep disturbances considerably impact quality of life and other health outcomes in adults with AD.

Real-world data on the epidemiology and economic burden of atopic dermatitis (AD) are limited. Here we describe the epidemiology and economic burden of AD using electronic healthcare data from Israel. A retrospective study was performed using the Maccabi Healthcare Services database. AD incidence in 2008–2017 and point prevalence (ADprev) on 31 December 2017 were described using diagnosis codes for overall patients, and sex and age subgroups. For ADprev, severity was defined using recently dispensed treatments for AD. Annual healthcare resource utilization in AD prevalent patients was compared with non-AD matched controls using generalized linear modelling. Direct annual costs were estimated also. AD incidence was 7.0/1000 person-years; overall prevalence was 4.4% (female patients 4.5%, male patients 4.3%; age 0 to less than 6 months, 0.9%; 6 months to less than 12 years, 11.0%; 12 to less than 18 years, 5.8%; 18 years or older, 2.2%). Among ADprev (n = 94,483), mild, moderate, and severe AD comprised 57.7%, 36.2%, and 6.1% (adults 43.8%, 46.3%, 9.9%), respectively. Dermatologist and allergist visits and hospitalization rates (at least one) were 40.7%, 6.6%, and 3.8% in 2017. Compared with controls, overall and moderate-to-severe AD were associated with 36% and 52% increases in annual per-person costs (incremental costs $126 and $190). AD epidemiology in Israel is comparable with other real-world database studies. AD imposes an economic burden that increases with disease severity. Occurrence and costs of atopic dermatitis in Israel Atopic dermatitis is a disease that causes the skin to be inflamed and itchy. Atopic dermatitis is most common in children but can also occur in adolescents and adults. Using data from a large healthcare provider in Israel, this study aimed to describe how common atopic dermatitis is within the population. Costs related to the use of healthcare services (such as visits to dermatologists and creams to treat atopic dermatitis) in the year 2017 were compared between persons with versus without atopic dermatitis. For the years 2008 to 2017, approximately 7 out of 1000 people were newly diagnosed with atopic dermatitis each year (incidence). Among people alive on 31 December 2017, 4.4% had atopic dermatitis (prevalence), with 42.3% suggestive of moderate to severe disease. Patients with atopic dermatitis, particularly those with more severe disease, used healthcare services more frequently. Compared with people without atopic dermatitis, medical costs among patients with atopic dermatitis were 36% higher (corresponding to added costs of $126 per person per year). This study helps to better understand how many people have atopic dermatitis, and what healthcare resources are needed to manage this disease.

Background Information on the prevalence of atopic dermatitis (AD) varies greatly, and so far, only a few studies describe the healthcare of patients with AD in Germany. Objective The aim of the study is to describe the prevalence and medications of people with AD in Germany. Methods Health insurance data for the year 2019 were examined. Prevalence rates, the severity of disease, comorbidities and pharmaceutical supply were analyzed. Insured persons with AD were identified with at least one outpatient or inpatient International Classification Code of Diseases (L20). Results In 2019, 4.21% [95% CI 4.21−4.22%] of insured persons had AD (3.6 million). Women were affected slightly more frequently than men (4.74% [95% CI 4.73−4.74%] and 3.64% [95% CI 3.64−3.65%]). Adolescents and children under the age of 15 had the highest prevalence of AD compared to other age groups (9.44% [95% CI 9.42−9.46%]). Majority of the insured persons with AD were affected by a mild to moderate form of the disease. The most common co-morbidity was infections of the skin (RR 5.00 [95% CI 4.97−5.02%]). Some patients were treated by a dermatologist, while others by a general practitioner, 39.10% and 36.74%, respectively. Of the anti-inflammatory drugs, systemic glucocorticosteroids preparations were used most frequently and were most frequently prescribed by the general practitioner. With a total of 42,841 prescriptions (1.53%), methotrexate (third-line treatment option) was prescribed more frequently than ciclosporin with 19,628 prescriptions (0.70%) or azathioprine with 25,696 prescriptions (0.92%). Ciclosporin (first-line treatment option) was prescribed much more frequently by a dermatologist (44.00% versus 14.32% by general practitioner). The biological dupilumab was prescribed 30,801 times (1,10%) and was also primarily prescribed by a dermatologist (66.67%). Conclusion The present results reveal that a specialist treats approximately one-third of the patients with AD and that there is still a drug undersupply in some cases, especially concerning innovative drugs.

Background Atopic dermatitis is known to be common among children, but there are few studies examining the epidemiology across the life course. In particular, there is a paucity of data on atopic dermatitis among older adults. Objective To evaluate participant characteristics, patterns of disease activity and severity, and calendar trends in older adult atopic dermatitis in comparison to other age groups in a large population-based cohort. Methods This was a cohort study of 9,154,936 individuals aged 0–99 years registered in The Health Improvement Network, a database comprised of electronic health records from general practices in the United Kingdom between 1994 and 2013. Atopic dermatitis was defined by a previously validated algorithm using a combination of at least one recorded atopic dermatitis diagnostic code in primary care and two atopic dermatitis therapies recorded on separate days. Cross-sectional analyses of disease prevalence were conducted at each age. Logistic mixed effect regression models were used to identify predictors of prevalent disease over time among children (0–17 years), adults (18–74 years), and older adults (75–99 years). Results Physician-diagnosed atopic dermatitis was identified in 894,454 individuals with the following proportions in each age group: 18.3% of children, 7.7% of adults, and 11.6% of older adults. Additionally, atopic dermatitis prevalence increased across the 2-decade period (beta from linear regression test for trend in the change in proportion per year = 0.005, p = 0.044). In older adults, atopic dermatitis was 27% less common among females (adjusted OR 0.73, 95% CI 0.70–0.76) and was more likely to be active (59.7%, 95% CI 59.5–59.9%) and of higher severity (mean annual percentage with moderate and severe disease: 31.8% and 3.0%, respectively) than in other age groups. Conclusion In a large population-based cohort, the prevalence of physician-diagnosed atopic dermatitis has increased throughout adulthood and was most common among males age 75 years and above. Compared to children ages 0–17 and adults ages 18–74, older adult atopic dermatitis was more active and severe. Because the prevalence of atopic dermatitis among older adults has increased over time, additional characterization of disease triggers and mechanisms and targeted treatment recommendations are needed for this population.

RATIONALE Atopic dermatitis(AD) causes sleep disturbance, yet the epidemiology is not known. OBJECTIVE Estimate the US prevalence of sleep disturbance and its impact on psychological and neurocognitive function. METHODS Cross-sectional survey of 180 parent-child dyads with AD, using stratified sampling based on disease severity(POEM,Patient Oriented Eczema Measure,mild(n=30)/moderate(n=75)/severe (n=75)), age, and race (White/Black or African American/Other). Symptoms of sleep and psychologic health were assessed using PROMIS(Patient Reported Outcome Measurement Information System). To estimate prevalence of sleep disturbance, we calculated weights using post-stratification adjustment making marginal frequencies of AD severity, race, and age similar to marginal frequencies in the 2007 National Survey of Children's Health(NSCH). Unweighted regression models examined associations with sleep disturbance. RESULTS In children 5-17 years with AD, we estimated sleep disturbance occurs in 66.9% [95% CI: 53.3-80.5%; 3,116,305 children]. The odds of severe sleep disturbance(worse than 95% of US children) were highest in moderate/severe vs mild AD (2.03[1.00-4.10],P=0.0495/8.68[1.82-41.49],P=0.0068). Predictors of parent-proxy reported sleep disturbance were itch intensity(adjusted β [95% CI]:1.33[0.62,2.04]) and low income(<$50k:6.64[2.05,11.23], $50to<100k:4.75[0.35,9.14]). Controlling for disease severity, itch intensity, and significant socio-demographics- parent-proxy reported sleep disturbance was associated with increased severity of sleep-related impairment, depression, fatigue, and anxiety, in addition to worse inattention and impulsivity. In fully adjusted models, children who self-reported sleep disturbance(T-score ≥60) had increased odds of sleep-related impairment(1.20[1.11-1.29]), depression(1.13[1.03, 1.24]), fatigue(1.28[1.06-1.54]), and anxiety(1.16[1.02-1.31]). CONCLUSIONS Sleep disturbance is a common symptom of AD affecting ∼3 million US children and associated with neuropsychiatric impairment, including depression, anxiety, and inattention. Clinicians should screen for these symptoms in school-aged children, particularly with moderate-to-severe AD.

Atopic dermatitis (AD) is a common chronic inflammatory skin disorder. In Greece, there is a lack of data on AD epidemiology. The objective of the present study was to estimate the self-reported prevalence of AD and the prevalence of moderate/severe AD in the adult population in Greece. A nationwide cross-sectional survey with a structured questionnaire was conducted, between June 17th, 2021 and July 12th, 2021, using Computer Assisted Telephone Interviewing (CATI) and Computer Assisted web Interviewing (CAWI) data collection methods. Several different self-reported AD definitions, as extracted from the literature, were used. Self-reported moderate/severe atopic dermatitis was estimated using the Patient Oriented Eczema Measure (POEM). More than 30,500 persons were invited to participate; among them, 3,001 were recruited for the survey. The 12-month self-reported AD prevalence in Greece ranged from 1.7% to 6.4%, while lifetime prevalence reached 11.4%. At least half of the responders who identified with AD during the last 12 months had moderate to very severe eczema. The multivariate analysis confirmed that age, atopy-related comorbidities (asthma, allergies, and rhinitis), a family history of AD, rhinitis, and asthma were factors that are independently associated with AD, irrespective of the definition used. The 12-month and lifetime prevalence of AD in adults in Greece ranges from 1.7% to 6.4% and 3.7% to 11.4%, respectively. At least half of the adults with AD suffer from moderate-to-severe disease. Our study is a first step in understanding AD epidemiology in Greece and may provide useful insights for healthcare decision makers.

BACKGROUND The epidemiology of atopic dermatitis (AD) in Greenland has been sparsely investigated. AIM To examine the point and overall prevalence, cumulative incidence at different ages, and associated risk factors for AD among children in Greenland. METHODS Between 2019 and 2020, three towns in Greenland, representing 48% of the total population, were visited. A cross-sectional study was conducted, including children aged 0-7 years attending daycare centres. Parents completed a questionnaire with questions on AD and related risk factors. A diagnosis of AD was based on the UK Working Party's criteria along with a clinical examination. RESULTS In total, 839 children aged 0-7 years were included. The overall prevalence of AD was 35% according to physician's diagnosis and assessment. The point prevalence was 28% and peaked among 1-year-old children (36%) and declined with age. The cumulative incidence at ages 1-6 years varied between 29% and 41% and was highest in 1-year-old children and showed a slight decline with increasing age. In the fully adjusted multivariate model, AD was associated with being of Inuit descent [odds ratio (OR) 1.7, 95% confidence interval (CI) 1.1-2.8]; food allergy in the child (OR 3.6, 95% CI 2.3-5.6); ear infection in the child (OR 1.4, 95% CI 1.0-1.9); having a mother with a high educational level (OR 1.5, 95% CI 1.0-2.3); maternal atopy (OR 1.4, 95% CI 1.1-2.0); and paternal atopy (OR 2.0, 95% CI 1.5-2.8). No environmental risk factors were identified. CONCLUSION The overall prevalence of AD in children in Greenland is high and has likely increased over the past 20 years. The point prevalence was highest in the youngest children indicating early onset of disease. Inuit descent, family atopy predisposition and having a higher socioeconomic status (based on parental educational level and housing) increased the risk of AD. Insight into possible Inuit-specific genetic predisposition is needed.

The prevalence of allergic diseases, such as bronchial asthma, atopic dermatitis, nasal allergies (pollinosis), and food allergies, has been increasing in many countries. The hygiene hypothesis was recently considered from the perspective of exposure to antimicrobial agents and preservatives, such as parabens (CAS number, 94-13-3). It currently remains unclear whether parabens, which are included in many daily consumer products such as cosmetics, shampoos, and personal care products as preservative antimicrobial agents, induce or aggravate allergies. Therefore, the aim of the present study was to examine the relationship between exposure to parabens and the prevalence of allergic diseases in Japanese children. The cross-sectional epidemiology of 236 children aged 0–3 years who underwent health examinations in Shika town in Japan assessed individual exposure to parabens using urinary concentrations of parabens. The results obtained showed that the prevalence of atopic dermatitis was significantly higher in children with high urinary concentrations of parabens than in those with low concentrations (p < 0.001). This relationship remained significant after adjustments for confounding factors, such as age, sex, Kaup’s index, and passive smoking (p < 0.001). In conclusion, the present results from a population study suggested a relationship between atopic dermatitis and exposure to parabens. A longitudinal study using a larger sample number and a detailed examination of atopic dermatitis, including EASI scores and exposure to parabens, will be necessary.

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Background Global patterns in atopic dermatitis (AD) incidence and their associations with modifiable risk factors remain unclear. Objective We sought to analyze global trends in AD incidence and identify associated socioeconomic, environmental, and lifestyle factors contributing to its global disparities and epidemics. Methods Data on AD in 204 countries and territories from 1990 to 2021 were extracted from the Global Burden of Diseases Study 2021. Age-standardized incidence rates (ASIRs) were calculated by sex and region. Socioeconomic development was measured by the Sociodemographic Index, a composite indicator of income, education, and fertility. Modifiable risk factors—including high body mass index, low physical activity, air pollution, and unhealthy diets—were quantified using summary exposure values, reflecting the population-level exposure to each risk. Dietary risks included diet high in sugar-sweetened beverages, processed meat, and sodium, and low intake of whole grains. Relationships between ASIRs and summary exposure values were independently assessed using restricted cubic spline regression. Results In 2021, 16.0 million new cases of AD were recorded globally, with the highest ASIRs in high-income Asia Pacific (474.8 per 100,000 population) and Western Europe (421.7 per 100,000 population) geographically and higher ASIRs in women. AD incidence strongly increased with socioeconomic development. Among modifiable risk factors, high body mass index, low physical activity, and nitrogen dioxide pollution formed positive associations with AD risk. Diets rich in sugar-sweetened beverages, processed meat, and sodium and diet low in whole grains further increased the risk. Conclusions Global disparities in AD incidence trends are closely linked to socioeconomic development and modifiable risk factors, including obesity, air pollution, and unhealthy diets. Addressing these factors through targeted public health policies is essential to mitigating the global burden of AD, particularly in industrialized and rapidly developing regions.

No abstract available

Background This claims-based study aimed to assess recent nationwide trends in pediatric incidence of atopic diseases in Germany. Methods Incidence of atopic dermatitis, asthma, and hay fever was assessed from 2013 to 2021 in annual cohorts of 0- to 17-year-old children and adolescents with statutory health insurance (N = 11,828,525 in 2021). Results Incidence of atopic dermatitis remained largely unchanged (15.2 cases per 1000 children in 2021) while hay fever incidence exhibited a fluctuating trend over the study period and amounted to 8.8 cases per 1000 in 2021. Asthma incidence decreased gradually between 2013 (12.4/1000) and 2019 (8.9/1000). This downward trend was followed by a further disproportionate reduction from 2019 to 2020 (6.3/1000) and a re-increase in 2021 (7.2/1000). Conclusion The findings complement nationwide prevalence surveys of atopic diseases in children and adolescents in Germany. Knowledge about temporal variations in risk of atopic diseases are crucial for future investigations of explanatory factors to enhance the development of preventive measures. While asthma incidence followed a declining trend throughout the study period, an unprecedentedly strong reduction in pediatric asthma risk was observed in 2020, the first year of the COVID-19-pandemic.

The aim of this study was to assess the long-term time trends of the prevalence of asthma, allergic rhinitis and atopic eczema in young Finnish men. A retrospective analysis was carried out on cross-sectional data from the Finnish Defence Forces taken from call-up examinations of candidates for military conscription and examinations of conscripts discharged from service because of poor health. Roughly 1.7 million men aged 18‒19 years (98% of men of conscription age) were examined from 1966 to 2017. A proportional but unknown number of young men were examined from 1926 to 1961. The main outcome measures were asthma recorded at call-up examination as the main diagnosis in 1926‒2017 and any diagnosis in 1997‒2017, exemption or discharge from military service due to asthma, and allergic rhinitis and atopic eczema recorded as the main diagnosis in 1966‒2017 and any diagnosis in 1997‒2017. During 1926–1961 the prevalence of asthma remained low at between 0.02% and 0.08%. A linear rise began between 1961 and 1966, with a 12-fold increase in the prevalence from 0.29% in 1966 to 3.44% in 2001. Thereafter, the prevalence of asthma as the main diagnosis stabilised but continued to increase to 5.19% in 2017 if secondary diagnoses of asthma were included. Exemption rates from military service due to asthma have similarly increased but fluctuated more. The prevalence of allergic rhinitis increased from 0.06% to 10.70% and atopic eczema from 0.15% to 2.90% during the period 1966‒2017. In Finland, an increase in asthma and allergic conditions among young men became evident in the mid-1960s. The increase slowed in the 2000s and may be levelling off in the 2020s. Asthma and allergic conditions have been on an almost linear rise in young Finnish men since the 1960s. The prevalence increase slowed down in the 2000s and may be levelling off in the 2020s. https://bit.ly/30DbsqS

Healthcare workers (HCWs) are considered a high‐risk group for developing hand eczema (HE), mainly owing to wet work and contact with allergens at work. To meta‐analyse the prevalence and incidence of HE in HCWs, as well as mapping the prevalence of atopic dermatitis (AD) and HE severity in HCWs. A systematic review and meta‐analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta‐analyses 2020 guidelines. Published literature from 2000 to 2022 was eligible based on predefined inclusion and exclusion criteria. A total of 18 studies were included. Pooled life‐time, 1‐year and point prevalence of self‐reported HE in HCWs was 33.4% (95% confidence interval [CI]: 28.3–38.6), 27.4% (95% CI: 19.3–36.5) and 13.5% (95% CI: 9.3–18.4), respectively. AD prevalence was 15.4% (95% CI: 11.3–19.9). Overall, the majority of HCWs reported mild HE. One included study assessed HE incidence reporting 34 cases/1000 person years. Most studies scored low‐moderate using the New Ottawa Scale and the pooled point prevalence data showed broad CIs. In conclusion, the high prevalence of HE in HCWs underlines the increased risk and need for preventive measures for this professional group. There is, however, a need of further standardized high‐quality studies.

Background: Atopic dermatitis (AD) is a common chronic inflammatory skin disease often affecting infants. However, its significance in adult populations is increasingly recognized. Notably, its prevalence and impact among elderly individuals remain poorly understood, highlighting the need for a deeper understanding of its global burden. This study aims to evaluate the prevalence, incidence, and Disability-Adjusted Life Years (DALYs) of AD in individuals aged 60 and older from 1990 to 2021, with projections to 2045. Methods: Data from the Global Burden of Disease (GBD) Study were used to analyze trends in the global burden of AD by region and sex. Key metrics were calculated using annual average percentage changes (AAPC). Based on historical trends, projections for 2022–2045 were developed. Results: In 2021, the prevalence of AD in the elderly exhibited substantial regional variation, with the highest rates observed in Northern Europe and North America. Although global prevalence slightly declined from 1990 to 2021, females consistently demonstrated a higher burden than males. Projections indicate a substantial increase in AD cases by 2045, particularly among elderly females, with the 60–64 age group expected to exceed 4 million cases. The disease burden correlated with Universal Health Coverage (UHC) indices, suggesting healthcare access impacts disease reporting and management. Conclusions: The increasing burden of AD, especially in elderly females, highlights the urgent need for targeted healthcare strategies to manage AD in aging populations. Further research is required to address regional and gender disparities in AD care.

Key Points Question Is the incidence rate of pediatric atopic dermatitis still increasing? Findings In this cohort study, all children resident in Norway younger than 6 years from January 1, 2009, through December 31, 2015, were included. The overall incidence rate of atopic dermatitis increased from 0.028 per person-year in 2009 to 0.034 per person-year in 2014, and for children younger than 1 year, the incidence rate increased from 0.052 per person-year in 2009 to 0.073 per person-year in 2014. Meaning This nationwide study suggests an increase in the incidence rate of pediatric atopic dermatitis, especially among children younger than 1 year.

BACKGROUND Pediatric allergic diseases are a growing global public health concern due to their increasing prevalence and impact on children's quality of life. In Tunisia, the incidence of these conditions has risen markedly, with evolving clinical and allergenic patterns over time. AIMS This study aims to describe the epidemiological evolution of clinical and allergenic profiles in atopic children in Tunisia over a 30-year period. METHODS We conducted a retrospective study of children aged 1-16 years who were referred for allergic manifestations to the allergy clinic of the Internal Security Forces Hospital (FSI), La Marsa, and underwent skin prick testing (SPT) between 1992 and 2022. Trends were compared across three decades (D1:1992-2001, D2: 2002-2011, and D3:2012-2022) for the entire cohort and within three age groups (preschool, school-aged, and adolescents. RESULTS A total of 4313 children were included (mean age: 7.7 ± 3.5 years; sex ratio: 1.39). A family history of atopy was reported in 58.9 % of cases. Rhinitis (76.4 %) and asthma (63.9 %) were the most common presentations. Multiple allergic manifestations were more frequent than isolated ones (58.8 % vs. 41.1 %). SPTs were positive in 57.4 % of cases; dust mites were the most frequent allergen (66.6 %), followed by animal dander and pollens. Polysensitization was observed in 49.7 % of children, most frequently involving dust mites in combination with other allergens. Over the three decades, there was a marked increase in the prevalence of multiple allergic manifestations (from 51.4 % in D1 to 68.5 % in D3; p < 0.001) and polysensitization among sensitized children (from 35.5 % in D1 to 61.1 % in D3; p < 0.001). The age-stratified analysis revealed that this trend towards complexity begins in early childhood, with the rate of polysensitization in preschoolers (1-5 years) soaring from 27.0 % to 62.0 % (p < 0.001). In adolescents (≥12 years), asthma prevalence remained stable (p = 0.124), while rhinitis, rhinoconjunctivitis, and polysensitization continued to increase significantly. CONCLUSION This study highlights significant changes towards greater frequency and complexity of pediatric allergic diseases over the past 30 years, characterized by a rise in multiple manifestations and polysensitization. These trends, particularly pronounced in preschoolers, suggest an accelerated allergic march, warranting adapted clinical and public health strategies.

The quality of indoor environment is a risk factor for early childhood eczema and atopic dermatitis; however, its influence during pregnancy on childhood eczema in Japan has not been investigated. In this study, we aimed to determine the indoor environmental factors that are associated with eczema in children up to 3 years of age, using national birth cohort data from the Japan Environment and Children's Study (JECS). Information on indoor environments and eczema symptoms until 3 years of age was collected using self-administered questionnaires to the mothers. A total of 71,883 and 58,639 mother-child pairs at 1.5- and 3-years-old, respectively, were included in the former analyses. To account for prenatal indoor risk factors, 17,568 (1.5-years-old) and 7063 (3-years-old) children without indoor mold and/or ETS exposure were included in the final analysis. A higher mold index, gas heater use, parquet flooring use, and frequent insecticide use showed significantly increased risks for childhood eczema up to 3 years of age. These associations were consistent after stratification analysis among children whose parents did not have a history of allergies. The updated WHO guidelines on indoor air quality should be implemented based on recent findings regarding the effects of prenatal exposure to indoor dampness on health effects of children further in life, including asthma, respiratory effects, eczema, and other immunological effects.

In the last decade, new treatments for atopic dermatitis (AD) have emerged. We aimed to describe trends of the diagnosis, disease course, and treatment of AD over a decade (2012–2021) using data from Maccabi Healthcare Services (a 2.7-million-member healthcare provider in Israel). The AD prevalence was stable (4.0% on 31 December 2021 vs. 4.3% on 31 December 2012). The annual AD incidence was also stable (5.8/1000 in 2012 and 5.7/1000 in 2021). AD-related treatment use was highest in the first year post-diagnosis, and it included, among children (n = 87,414) vs. adults (n = 36,865), low-potency topical corticosteroids (TCS) (41.8% vs. 27.1%), mid-potency TCS (30.1% vs. 28.1%), high-potency TCS (34.9% vs. 60.3%), topical calcineurin inhibitor (10.8% vs. 10.1%), phosphodiesterase-4-inhibitor (0.3% vs. 0.7% overall; approved in 2019), phototherapy (0.1% vs. 2.3%), and systemic/biologic treatments (13.0% vs. 13.3%). Among children diagnosed in 2012 and followed through to 2021 (n = 5248), 21.5% had ≥1 AD diagnosis/treatment 10 years later (among 3223 adults: 38.3%). We conclude that the incidence and prevalence rates of AD were comparable to those in similar database studies and remained relatively stable over the past decade. The results underscore the burden of medication use among children and adults, particularly in the first year after AD diagnosis, and the low rate of AD diagnosis among patients originally diagnosed as children 10 years earlier.

Background. Allergic rhinitis and atopic dermatitis are common allergic diseases in children. Analysis of the incidence and trends of allergic diseases development is necessary for successful solving the problem of morbidity, helping the child population at the regional level, disease forecasting and control. Purpose of the study. To study the long-term dynamics of the main epidemiological indicators of the general and primary incidence of allergic rhinitis and atopic dermatitis in the child population of the Grodno region. Material and methods. Retrospective analysis of indicators of general and primary incidence of allergic rhinitis and atopic dermatitis in the child population of the Grodno region was performed. The study periods were 1999-2023 years (children aged 0-14 years old) and 2008-2023 years (children aged 15-17 years old). Results. The average long-term age-standardized overall morbidity rate of allergic rhinitis in children aged 0-14 years old was 266.89 (95% CI: 238.33-295.47), the primary morbidity rate was 67.67 (95% CI: 57.36-77.9) per 100,000 children of the corresponding age. The average long-term overall incidence rate of allergic rhinitis in children aged 15-17 years (2008-2023) was 791.97 (95% CI: 680.79-903.14), the primary incidence rate was 113.73 (95% CI: 92.84- 134.61) per 100,000 children of the same age. The average long-term age-standardized rate of overall incidence of atopic dermatitis in children aged 0-14 years old was 872.89 (95% CI: 825.27-919.782) per 100,000 children of the corresponding age, the primary incidence rate was 459.1 (95% CI: 399. 96-518.24) per 100,000 children of the same age. The average long-term overall incidence rate of atopic dermatitis in children aged 15-17 years was 415.68 (95% CI: 377.63-453.73), the primary incidence rate was 143.88 (95% CI: 120.53-167.23) per 100,000 child population of the corresponding age. The long-term epidemic dynamics of allergic rhinitis was characterized by a moderately pronounced tendency towards an increase in the overall incidence rate among children aged 0-14 years old (average growth (decrease) rate = +2.4%) and 15-17 years old (average growth (decrease) rate = +3.62 %) as well as stabilization of the primary morbidity rate in children aged 0-14 years old (average growth (decrease) rate = -0.67%) and 15-17 years old (average growth (decrease) rate = +0.72%). The long-term epidemic dynamics of atopic dermatitis was characterized by a moderately pronounced tendency towards a decrease in the overall morbidity rate for children aged 0-14 years old (average growth (decrease) rate = -1.57%) and an increase in the morbidity rate for children of 15-17 years old (average growth (decrease) rate = +2.1%). There also was a pronounced downward trend in the primary morbidity rate of children aged 0-14 years old (average growth (decrease) rate = -5.42%) and children aged 15-17 years old (average growth (decrease) rate = -5.89%). The cartograms of the territorial distribution of incidence rates of allergic rhinitis and atopic dermatitis in the child population of the Grodno region in the periods 1999-2023 (0-14 years old) and 2008-2023 (15-17 years old) are presented. Conclusions. The reasons for the established patterns of changes in the incidence of allergic diseases in children of different age groups, as well as those living in different territories, are most likely due to the influence of environmental and socio-economic factors. The presented cartograms make it possible to visualize the incidence rates of allergic rhinitis and atopic dermatitis in individual territorial and administrative regions of the region.

OBJECTIVE The objective of this systematic review is to analyze the incidence and prevalence of atopic disease in second- and subsequent-generation immigrants from Asia in Australia. INTRODUCTION Atopic diseases are IgE-mediated hypersensitivity diseases that have increased significantly globally. Western countries have conspicuously more incidences of atopic disease than Eastern countries. An increase in second-generation immigrants in Australia has revealed an emerging disparity between the atopic profile of first-generation immigrants, second-generation immigrants, and non-immigrants. Second-generation immigrants from Asia seem to be markedly more susceptible to atopic disease than non-immigrants and their first-generation parents. ELIGIBILITY CRITERIA Studies including atopic disease, specifically food allergies, asthma, atopic dermatitis (eczema), and allergic rhinitis (hay fever), will be included; other presentations of atopic disease will be excluded. The population of interest will be second-generation Asian immigrants and any subsequent generations. Each paper's definition of Asian will be accepted as presented. The context of interest is Australia. METHODS This systematic review will follow JBI methodology and the PERSyst manual for systematic reviews of prevalence and incidence. PubMed, Scopus, CINAHL, and Embase will be searched for English-language studies from 1990 to the present. Gray literature and trial registries will also be searched. Prevalence and incidence data will be screened against the eligibility criteria and critically appraised by 2 independent reviewers. Data such as age, gender, and country of origin will be extracted via a customized tool. The data will undergo meta-analysis and be presented in narrative format with figures and tables where statistical pooling is not possible. REVIEW REGISTRATION PROSPERO CRD42024612805.

A BSTRACT Aspergillus sensitization is increasingly recognized as a key factor in atopic diseases. This study aimed to measure the incidence of Aspergillus skin prick test (SPT) positivity among patients with atopic and nonatopic symptoms visiting a tertiary care center. This hospital-based, analytical cross-sectional study was conducted over 18 months at a tertiary care hospital. A total of 190 patients were enrolled using consecutive sampling and categorized into symptomatic (atopic) and asymptomatic (nonatopic) groups. SPTs for various Aspergillus species were performed, along with clinical evaluations. Moreover, absolute eosinophil count (AEC) and serum immunoglobulin E (IgE) levels were analyzed. Statistical comparisons were made using Chi-square tests and binary logistic regression. The incidence of Aspergillus SPT positivity was significantly higher in symptomatic patients (atopic) (55.8%) including expectoration, chest tightness, allergic rhinitis (AR), eczema, wheezing, AEC positivity, and total serum IgE compared to asymptomatic patients (nonatopic) (10.5%). Allergens from Aspergillus species, such as Aspergillus fumigatus , Aspergillus flavus , and Penicillium spp., were more prevalent among symptomatic patients ( P < 0.01). Elevated AEC and serum IgE levels were strongly associated with Aspergillus positivity. Multivariate analysis identified chest tightness, dyspnea, AR, and smoking as significant predictors of Aspergillus sensitization. Furthermore, moderate disease severity was the most common presentation among Aspergillus -positive individuals. The study underscores the significant association of Aspergillus sensitization with atopic symptoms and disease severity. These findings emphasize the importance of early allergen identification and targeted management in atopic patients to mitigate disease progression and improve quality of life.

BACKGROUND We investigated whether maternal exposure to phthalate and bisphenol A (BPA) mixtures is associated with eczema in children, as most studies have only addressed single chemical exposures. METHODS Nine phthalate metabolites and BPA were quantified in urine at gestational weeks 34-36 (n = 540) and total, inhalant, and food allergen-specific immunoglobulin (Ig)E levels (sx1, and fx5) were measured in serum from 4-year-old children of the LiNA cohort (n = 219). The association of prenatal exposure to phthalates and BPA, both single and mixed, with eczema and IgE was assessed in children stratified by atopy status. Three independent statistical models adjusted for covariates were used: logistic regression -also in the sex-stratified analysis-, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR). Moreover, an in silico toxicogenomic analysis was conducted to explore putative underlying mechanisms. RESULTS The adjusted logistic regression showed that monobenzyl phthalate (MBzP; OR = 2.64, 95% CI: 1.29-6.4) and the sum of di-2-ethylhexyl phthalate metabolites (2.09, 1.1-4.32) were significantly associated with eczema exclusively in atopic boys. The BKMR suggested a positive trend between chemical exposure and IgE values in the atopic subgroup. In the WQS model, the mixture' positive effect on eczema among atopic children was significant (1.90, 1.80-2.01) with MBzP (65.9%), monoethyl phthalate (13.3%), and BPA (10.9%) being the main contributors, which jointly modulate antibody-mediated immunity and inflammation gene pathways in the toxicogenomic profiling. CONCLUSIONS Maternal exposure to mixtures of phthalates and BPA differentially impacts eczema risk among atopy-stratified children. The in silico chemical-gene interaction analysis in atopic children identified genes involved in immune cell activation and Ig production. Compared to non-atopic children, individual phthalates were significantly associated with eczema in atopic boys, suggesting that chemicals may have a larger effect size in predisposed populations.

Allergic diseases cannot conclusively be controlled due to highly complex mechanisms. Eczema, food allergy, and rhinitis have attracted much parental attention and concern. Cumulative reports indicate more current cases than the previous generation. The present study inquired into parental knowledge regarding food labeling among households with children suffering eczema, food allergy, and rhinitis. With knowledge on food labeling not received comparable attention, and inadequate studies addressing this occupation within diverse allergic diseases, the research is anticipated to further relevant policies in allergy management. Eczema, food allergy, and rhinitis are chronic, IgE-mediated allergic diseases. Among children aged 8 to 12, the prevalence of eczema, food allergy, and rhinitis was 30.3%, 13.4%, and 28.8%, respectively, with the first presenting the highest prevalence. The incidence of eczema was significantly increased, particularly among children aged 2–4 in South Korea. Diagnostic criteria and severity scales have been widely adopted to uniformly share disease status. Eczema is regarded as the first stepping-stone and plays an important role in the allergy march. The hygiene hypothesis postulates that excessive hygiene and a decrease in early exposure to microbes have triggered the rapid rise in atopic diseases. Food allergy frequently occurs at the initial stage of atopic disorders and is strictly removed during sick leave, contributing significantly to the qu2cef1ba2-d5e2-4821-98bd-553cf703da2bty of life. Avoiding specific allergens is essential to prevent anaphylaxis, a potentially life-threatening condition. Rhinitis has a profound impact on daily life, with 75%–80% of individuals affected by allergic and non-allergic types. The understanding of allergen labeling, including the regulatory definition of allergens and common ambiguities, is limited. For example, foods that “may contain” allergens are usually concerned by manufacturers due to the uncertain

Maternal influences on infantile atopic eczema are complex, with emerging evidence for a protective role for maternal T helper (Th)1 inflammation during pregnancy. Substantial literature on characterization of a proinflammatory dietary pattern, led us to hypothesize that analyses of maternal diet and markers of inflammation might help identify mechanisms influencing the risk of infantile atopic eczema. The aim of this study was to examine the associations between energy-adjusted dietary inflammatory index (eDII) scores indicative of a proinflammatory diet pattern, maternal serum neopterin levels (a biomarker elevated in Th1 immune activation which counteracts Th2 inflammation seen in atopic eczema), and infantile risk of atopic eczema. Within the UK Southampton Women’s Survey, scores for the eDII were derived from mothers’ diets (questionnaires at preconception, early and late pregnancy). Atopic eczema was ascertained at age 6 and 12 months using the UK Working Party Diagnostic Criteria (n = 262 and 270, respectively). Late pregnancy maternal serum neopterin levels were measured in a subsample (n = 497). Directed acyclic graphs were used to determine covariates to be included in linear regression analyses. A higher eDII score in late pregnancy was associated with a reduced risk of atopic eczema at age 6 months [odd ratios (OR) 0.89, 95% CI confidence interval (CI) 0.81–0.98; P = 0.02], with a similar trend at age 12 months (OR 0.91, 95% CI 0.83–1.00; P = 0.06). Consistent with this, and adjusting for maternal body mass index, education, smoking during pregnancy, and recent eczema, and infant filaggrin single-nucleotide polymorphism rs7512552, breastfeeding duration and sex, higher maternal serum concentrations of neopterin were associated with lower risks of infant eczema at age 6 months (OR 0.72, 95% CI 0.51–1.01; P = 0.05) and 12 months (OR 0.71, 95% CI 0.53–0.96; P = 0.03). These findings suggest that a proinflammatory maternal diet that promotes a Th1 predominant environment protects the developing infant from Th2 inflammation and reduces the risk of atopic eczema.

BACKGROUND Chronic inflammatory conditions have been linked to dementia, but little is known about the role of atopic eczema, a inflammatory condition recently recognized to be common among older adults. OBJECTIVE To determine whether active atopic eczema is associated with incident dementia. METHODS Longitudinal cohort study of 1,767,667 individuals ages 60 to 99 years registered with The Health Improvement Network (THIN), a primary care cohort in the UK. Atopic eczema and dementia diagnoses were identified using medical record codes. RESULTS The incidence rate of dementia diagnoses was 57/10,000 person-years among those with atopic eczema during follow-up (12.1% of the population), as compared to 44/10,000 person-years in the control group. This translated to a 27% increased risk of (HR 1.27, 95%CI 1.23-1.30) in adjusted Cox proportional hazard models. Similar associations were observed in subgroup analyses of vascular dementia and Alzheimer's disease. The association persisted after additionally adjusting for systemic corticosteroid use (HR 1.29, 95% CI 1.26-1.33) and potential mediators (HR 1.19, 95%CI 1.16-1.22). More severe eczema was associated with a higher risk of dementia. LIMITATIONS Lack of detailed severity data. CONCLUSIONS Atopic eczema was associated with a small but increased risk of incident dementia. The association increased with atopic eczema severity.

Atopic dermatitis, psoriasis, alopecia areata, and vitiligo have been associated with comorbid conditions, including infections, malignancies, and cardiovascular diseases. This study evaluated the prevalence and incidence rates of these comorbidities in patients from Japan. This retrospective cohort study used data collected from the JMDC claims database between June 2013 and December 2020. Patients with a diagnosis of atopic dermatitis, psoriasis, alopecia areata, or vitiligo were matched (1:1) by age, sex, and index month with individuals with no claims records for atopic dermatitis, psoriasis, alopecia areata, or vitiligo diagnosis. Data included 691 338, 51 988, 43 692, and 8912 patients in the atopic dermatitis, psoriasis, alopecia areata, and vitiligo cohorts, respectively, and matched controls. The most prevalent comorbidities in the atopic dermatitis cohort versus matched controls included allergic rhinitis (47% vs 37%), conjunctivitis (33% vs 23%), asthma (27% vs 20%), viral infection (22% vs 15%), and acne (11% vs 3%). Incidence rates per 100 000 person‐years of comorbidities in the atopic dermatitis cohort versus matched controls were: venous thromboembolism, 51.4 (95% confidence interval [CI], 48.3–54.7) versus 31.7 (95% CI, 29.2–34.2); lymphoma, 13.8 (95% CI,12.2–15.6) versus 5.7 (95% CI, 4.7–6.8); cutaneous T‐cell lymphoma, 1.6 (95% CI, 1.1–2.2) versus 0.1 (95% CI, 0.0–0.4); and herpes zoster, 740.9 (95% CI, 728.8–753.1) versus 397.6 (95% CI, 388.9–406.6). Similar trends were observed in the psoriasis versus nonpsoriasis cohorts, with 95% CIs mostly overlapping for alopecia areata and vitiligo cohorts versus controls. Overall, patients from Japan with dermatologic diseases have a higher prevalence and incidence of certain health conditions, particularly venous thromboembolism, lymphoma, and infections in patients with atopic dermatitis and psoriasis, compared with individuals without these dermatologic diseases.

This cross-sectional study of National Health Interview Survey data examines differences among sociodemographic subgroups in reported incidence of eczema in children in the US.

Background Major atopic diseases such as atopic dermatitis (AD), allergic rhinitis (AR), and asthma share the same atopic background, but they often show differences in their epidemiological behavior. Objective We aimed to report the profile of these atopic diseases in a large Mexican population, including their age-related incidences, male:female (M:F) ratios, recent time trends, and association with altitude. Methods Registries from the largest, nationwide health institution in Mexico (more than 34 million insured subjects), were reviewed. New cases of AD, AR, and asthma diagnosed each year by family physicians from 2007 to 2019 were adjusted by the corresponding insured population to estimate incidence rates. Results Incidences of the 3 atopic diseases were highest in the 0–4 years age-group and progressively decreased thereafter until adolescence. Asthma and AR, but not AD, were more frequent in males during childhood (M:F ratios of 1.5, 1.3, and 0.95, respectively), but predominated in females during adulthood (M:F ratios of 0.52, 0.68, and 0.73, respectively). Time trends showed an initial increasing trend of annual incidences, with a peak around 2009–2011, and a downward trend afterward. This decreasing trend was seen in all age-groups and was more evident for AD (∼50% drop) and asthma (∼40% drop) than for AR (∼20% drop). Geographical distribution suggested that incidences of asthma and AR, but not of AD, had an inverse association with altitude. Conclusion Annual incidences of the 3 major atopic diseases have declined in recent years in almost all age groups, and their epidemiological profile during the life span showed contrasting differences according to age, sex, and ecological association with altitude, mainly regarding AD.

Background Atopic dermatitis (AD) is an important global health problem affecting children and adolescents and detailed national information of disease burden in China is lacking. We aimed to evaluate the national disease burden of AD in Chinese children and adolescent, to provide the temporal trends over the past 30 years and to predict the burden for the next 10 years. Methods The data of AD in China, including incidence, prevalence, and DALY, and population data were obtained from the Global Burden of Disease Study 2019 (GBD study 2019), which were estimated using the DisMod-MR 2.1. We analyzed the three measures by age and sex; the age groups were <5 years, 5–9 years, 10–14 years, and 15–19 years. The joinpoint regression analyses was conducted to assess the temporal trends from 1990 to 2019. The Bayesian age-period cohort (BAPC) model was used to predict measures from 2020 to 2030. Results In 2019, the highest incidence case and rate were observed in <5 years group; for prevalence and disability adjusted life year (DALY), the groups of <5 years and 5–9 years showed similar higher levels and the groups of 10–14 years and 15–19 years had similar relatively lower levels. Overall, the male-to-female ratios were >1 in <5 years group and <1 in 10–14 and 15–19 age groups. The trend analyses found an overall trend of decrease in cases of the three measures; in recent about 3 years, slight increase trends were shown in cases and rates of the three measures in <5 years group. The prediction analyses found a slight decreasing trend for cases of these measures and a slight increasing trend for rates of these measures in the <5 years group in the next 10 years; the 5–9 years group was predicted to increase slightly in rates of the three measures. Conclusion In conclusion, the groups of <5 years and 5–9 years are two important populations that need targeted measures to reduce disease burden of AD in China. Regarding sex disparity, we should pay more attention to males in <5 years group and to females in 10–19 years group.

BACKGROUND Asthma and atopic dermatitis are common allergic conditions that contribute to substantial health loss, economic burden, and pain across individuals of all ages worldwide. Therefore, as a component of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we present updated estimates of the prevalence, disability-adjusted life-years (DALYs), incidence, and deaths due to asthma and atopic dermatitis and the burden attributable to modifiable risk factors, with forecasted prevalence up to 2050. METHODS Asthma and atopic dermatitis prevalence, incidence, DALYs, and mortality, with corresponding 95% uncertainty intervals (UIs), were estimated for 204 countries and territories from 1990 to 2021. A systematic review identified data from 389 sources for asthma and 316 for atopic dermatitis, which were further pooled using the Bayesian meta-regression tool. We also described the age-standardised DALY rates of asthma attributable to four modifiable risk factors: high BMI, occupational asthmagens, smoking, and nitrogen dioxide pollution. Furthermore, as a secondary analysis, prevalence was forecasted to 2050 using the Socio-demographic Index (SDI), air pollution, and smoking as predictors for asthma and atopic dermatitis. To assess trends in the burden of asthma and atopic dermatitis before (2010-19) and during (2019-21) the COVID-19 pandemic, we compared their average annual percentage changes (AAPCs). FINDINGS In 2021, there were an estimated 260 million (95% UI 227-298) individuals with asthma and 129 million (124-134) individuals with atopic dermatitis worldwide. Asthma cases declined from 287 million (250-331) in 1990 to 238 million (209-272) in 2005 but increased to 260 million in 2021. Atopic dermatitis cases consistently rose from 107 million (103-112) in 1990 to 129 million (124-134) in 2021. However, age-standardised prevalence rates decreased-by 40·0% (from 5568·3 per 100 000 to 3340·1 per 100 000) for asthma and 8·3% (from 1885·4 per 100 000 to 1728·5 per 100 000) for atopic dermatitis. In 2021, there were substantial variations in the burden of asthma and atopic dermatitis across different SDI groups, with the highest age-standardised DALY rate found in south Asia for asthma (465·0 [357·2-648·9] per 100 000) and the high-income super-region for atopic dermatitis (3552·5 [3407·2-3706·1] per 100 000). During the COVID-19 pandemic, the decline in asthma prevalence had stagnated (AAPC pre-pandemic -1·39% [-2·07 to -0·71] and during the pandemic 0·47% [-1·86 to 2·79]; p=0·020); however, there was no significant difference in atopic dermatitis prevalence in the same period (pre-pandemic -0·28% [-0·33 to -0·22] and during the pandemic -0·35% [-0·78 to 0·08]; p=0·20). Modifiable risk factors were responsible for 29·9% of the global asthma DALY burden; among them, high BMI was the greatest contributor (39·4 [19·6-60·2] per 100 000), followed by occupational asthmagens (20·8 [16·7-26·5] per 100 000) across all regions. The age-standardised DALY rate of asthma attributable to high BMI was highest in high-SDI settings, whereas the contribution of occupational asthmagens was highest in low-SDI settings. According to our forecasting models, we expect 275 million (224-330) asthma cases and 148 million (140-158) atopic dermatitis cases in 2050, with population growth driving this increase. However, age-standardised prevalence rates are expected to remain stable (-23·2% [-44·4 to 5·3] for asthma and -1·4% [-9·1 to 7·0] for atopic dermatitis) from 2021 to 2050. INTERPRETATION Although the increases in the total number of asthma and atopic dermatitis cases will probably continue until 2050, age-standardised prevalence rates are expected to remain stable. A considerable portion of the global burden could be managed through efforts to address modifiable risk factors. Additionally, the contribution of risk factors to the burden substantially varied by SDI, which suggests the need for tailored initiatives for specific SDI settings. The growing number of individuals expected to be affected by asthma and atopic dermatitis in the future suggests that it is essential to improve our understanding of risk factors for asthma and atopic dermatitis and collect disease prevalence data that are globally generalisable. FUNDING Gates Foundation.

BACKGROUND Globally, atopic dermatitis (AD) is highly prevalent; however, there is a paucity of research focusing on its burden and trends. OBJECTIVE To understand the current epidemic situation of AD and to suggest measures may help reduce its global burden. METHODS Global trends of AD, including prevalence, incidence, and disability-adjusted life years were analyzed using data from the Global Burden of Disease Study database 2021. RESULTS In 2021, the global prevalence of AD reached 129 million cases, reflecting a 20% increase since 1990. However, the age-standardized prevalence rate decreased slightly during the same period, measuring 1,728.5 per 100,000 individuals in 2021. The highest burden of AD was observed in high-income regions, with a notable prevalence among females and children under 5 years of age. However, the burden decreased across all sociodemographic index (SDI) regions, with the most significant decline in high-SDI countries. Regionally, South Asia reported the highest prevalence, while globally, India, China, and the USA exhibited the highest number of cases. LIMITATIONS Variations in data sources and quality, and the absence of data regarding severity and environmental factors. CONCLUSION The global burden of AD prevalence was highest in high-income countries and among females and young children.

Background: The 2017 Global Burden of Disease (GBD) report identified atopic dermatitis (AD) as the skin disease with the highest disease burden, assessed in terms of disability-adjusted life-years (DALYs), and a modest increase in the number of AD-associated DALYs was observed in 2019 compared to 2017. Objective: This study aims to provide updated insights from the GBD 2021 database. Methods: Data on the prevalence and DALYs of AD in 2021 were extracted from the GBD database. Statistical analyses were performed by R software (version 4.4.1). Results: In 2021, AD still represented the highest age-standardized DALY rate (ASDR) among all skin disorders. Globally, the age-standardized prevalence rate (ASPR) and ASDR of AD were 1728.5 (95% UI: 1658.5-1798.6) and 75.5 (95% UI: 38.8-125.6) per 100,000 population, respectively. The ASPR and ASDR were highest in high-income Asia Pacific but lowest in Central Sub-Saharan Africa. The burden of AD was mainly in children, declining with age; however, a modest rise in ASPR and ASDR was noted among the elderly. Women generally experienced a higher burden than men. Conclusions: In 2021, AD remained the leading cause of DALYs among skin diseases, disproportionately affecting children and older adults, especially in urban areas.

Atopic dermatitis (AD) has a high disease burden worldwide. However, the specific impact and geographical variations of AD in China remain unclear.

The recent epidemiological studies indicate that atopic dermatitis (AD) can persist as a lifelong condition following its onset [1]. In light of societal development and an ageing population, elderly AD has emerged as a distinct clinical subtype, garnering significant attention [2]. Given that global socioeconomic development levels demonstrate a clear correlation with disease burden [3]

Given the diverse population and regional differences across Asia, a comprehensive analysis of allergic diseases is crucial for guiding healthcare planning, resource allocation, and prevention strategies. Therefore, utilising the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we aimed to thoroughly investigate the burden of allergic conditions and their attributable risk factors in Asia.

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Atopic Dermatitis (AD) is a common, pruritic inflammatory skin disease associated with marked disease burden and substantial health care costs. AD does not discriminate between populations; prevalence estimates vary widely with most studies focusing on general or pediatric populations and a limited number of studies in adult populations solely. The costs of treating AD are staggering. Studies that examine differences in prevalence may be difficult to compare due to differences in study designs. However, understanding the prevalence of AD across populations is critical if we are to improve the lives of patients and caregivers living with this disease.

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The Global Burden of Disease (GBD) Study provides an annually updated resource to study disease‐related morbidity and mortality worldwide.

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Introduction Numerous population-based studies have focused on the global prevalence of atopic dermatitis (AD), but there are few studies on the global trends of the burden associated with AD. Methods We analyzed the global AD trends in 2017 in 195 countries worldwide using the Global Burden of Disease (GBD) Study database, including prevalence rates, age and sex patterns, and AD burden, using disability-adjusted life years (DALYs). Age-standardized DALYs were also compared to the sociodemographic index values of all the countries in 2017. Results The age-specific DALYs in 2017 showed a right-skewed distribution, with the highest DALYs between 1 and 5 years of age. Females had a higher burden of AD throughout all age groups and geographic regions. The GBD super region with the greatest burden of DALYs caused by AD was high income (178.63 DALYs per 100,000 males, 231.8 for females), and the country with the highest DALYs was Sweden (326.91). The GBD super region with the lowest age-standardized DALY burden caused by AD was south Asia (84.51 DALYs per 100,000 males, 100.54 for females). Conclusion There is a large GBD caused by AD. The observed burden is the greatest in resource-rich countries, females, and young children.

Background Atopic dermatitis (AD) is a chronic disease with growing prevalence and has become a global public health problem. However, little is known about the burden caused by AD in China. Objective To access the prevalence and burden of AD in China. Methods We estimated the prevalence and year lived with disability (YLD) of AD in China, by different age and sex groups. We also compared the burden of AD in China with other countries in the Group of Twenty (G20). We analyzed the changes in the number of AD patients and their YLDs by cause decomposition from 1990 to 2019. Results AD was the twenty-fourth leading cause of the burden of 369 diseases in China in 2019. From 1990 to 2019, the age-standardized prevalence and YLD rate of AD in China increased by 1.04% and 1.43% respectively, which were the second and the largest increase among the G20 and both higher than the global average (−4.29% and −4.14%). The number of patients with AD increased by 25.65%, of which 20.16% was due to population growth, 3.85% due to population aging, and 1.64% due to age-specific prevalence. Both the prevalence and YLD rate of AD were higher in 1 to 4 year-olds and 95+ years age group. Before the age of 10, the prevalence and YLD rate of AD in males were higher than those in females, while there was a marked sex shift at the ages of 10 to 14. Conclusion AD is a serious public health problem in China. Substantial variations exist in burden due to AD between male and female, and in age groups. Considering these findings will be important for developing preventive strategies and treatments to reduce the burden of AD.

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Background With the aging global population, older adult atopic dermatitis (AD) is emerging as an increasingly significant health challenge. This study aimed to evaluate the global burden of older adult AD from 1990 to 2021 and to project its change to 2050. Methods The estimates and 95% uncertainty intervals of prevalence, incidence, and disability-adjusted life-years (DALYs) attributable to AD among individuals aged over 60 years were extracted from the Global Burden of Diseases (GBD) Study 2021. We used joinpoint regression analysis, decomposition analysis, cross-country inequality analysis, frontier analysis and prediction model to epidemiological analysis. Results From 1990 to 2021, the global prevalence of older adult AD increased to 11,009,630 cases (95% UI: 9,915,829 to 12,170,941), even as ASRs declined, which were primarily driven by population growth. It was observed that females and 75–79 years old had higher incidence rates. SDI relative and frontier analysis exhibited that incidence, prevalence and DALYs rates were positively correlated with SDI levels, while SDI-related inequalities had a significant decrease. Predictions up to 2050 anticipated increasing older adult AD incidence, prevalence, and DALYs numbers, while only age-standardized disability-adjusted life-year rates (ASDRs) were expected to decline. Conclusion The burden of older adult AD varied by genders, age groups, regions, countries and climatic conditions. Although the ASRs had shown a decline over time, the burden of older adult AD remained significant, especially in regions with high SDI levels. In the future, the burden of older adult AD was projected to continue rising until 2050, thereby targeted interventions and public health strategies were needed to address this trend.

Atopic dermatitis (AD) is a common chronic skin disorder in children. We aimed to investigate trends and regional disparities of burden in paediatric AD at global, regional and national levels, and to explore potential associated factors.

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Background and objective The association between breastfeeding and the risk of atopic dermatitis (AD) in children is a subject of ongoing debate. While a broad consensus suggests a protective effect, several regional cohort studies have reported null or even risk-associated outcomes, creating clinical uncertainty. This study aimed to clarify this relationship by evaluating the association between breastfeeding practices and AD prevalence by using large-scale, population-level data. Methods We conducted a cross-sectional analysis using two independent, publicly available datasets. First, we used the Global Burden of Disease (GBD) 2019 study to analyze the correlation between AD prevalence in children aged one to four years and various risk factors across 204 countries using linear regression. Second, we analyzed data from the U.S. National Health and Nutrition Examination Survey (NHANES) 2005-2006 for 1,605 children aged one to six years, using logistic regression to assess the link between breastfeeding duration and doctor-diagnosed AD. Results The GBD analysis revealed that discontinuous breastfeeding was a highly significant risk factor for childhood AD (R² = 0.21, p<0.001) and remained a key independent predictor in the final multivariate model (p = 0.016). The NHANES analysis corroborated this finding, showing that children with AD had a significantly shorter median breastfeeding duration than healthy children (5.1 vs. 6.1 months, p = 0.03). Furthermore, each additional month of breastfeeding was associated with a 3% reduction in the odds of having AD (odds ratio (OR): 0.97, 95% confidence interval (CI): 0.95-0.999, p = 0.04). Conclusions Our findings from two large, independent, and geographically diverse datasets consistently demonstrate a protective association between breastfeeding and childhood AD. This evidence reinforces global public health recommendations and suggests that while local factors may modulate risk in specific cohorts, the overall benefit of breastfeeding for AD prevention is robust at the population level.

ABSTRACT Background Atopic dermatitis (AD) imposes a hidden burden through its negative effects on quality of life and productivity. We aim to estimate this hidden burden in adults and adolescents in Central and Eastern European (CEE) countries. Methods We created a burden of disease model to quantify AD’s hidden burden. Humanistic burden was calculated by estimating the monetary value of quality-adjusted life years (QALYs) lost, using prevalence data from the Global Burden of Disease study and gross domestic product (GDP) per capita for each country. Indirect economic burden was estimated based on productivity loss from absenteeism and presenteeism, adjusted for labor force participation and unemployment rates. Total hidden burden was determined by combining productivity losses and QALYs lost. Results QALY loss due to AD ranged from 1,832 to 58,596 annually in CEE countries, equating to 38 million to approximately 1 billion Euros per country. Productivity losses ranged from 3.6 to 148.9 million Euros annually. The total hidden burden of AD represents 0.11% to 0.43% of the GDP. Conclusions Our estimates reflect significant differences in population size, prevalence, and economic strength among CEE countries. Adjusting findings to country-specific GDP provided insights into AD’s true hidden burden, offering valuable information for decision-making. Plain Language Summary Atopic dermatitis (AD), commonly known as eczema, is a widespread skin condition causing itchiness and discomfort. While it is well known that treating eczema costs money and affects patients’ health, there is more to its impact than meets the eye. Our study closely examined eczema’s ‘hidden’ effects in Central and Eastern European (CEE) countries, such as its impact on work ability and life enjoyment. We found that eczema’s impact is not just about the direct costs of treatment. It also includes how the condition leads to lost workdays and reduced productivity, and more importantly, how it lowers the quality of life for those who have it. This part of eczema’s impact, which is not always easy to see or measure, can be just as significant. Our research is important because it shows that when health officials and policymakers think about how to deal with eczema, they need to consider these hidden effects too. Different countries in Central and Eastern Europe experience these effects in varying degrees. By understanding this, healthcare systems can make better decisions about where to put their healthcare resources. For example, they might decide to invest more in treatments or support that can improve the quality of life for people with eczema. In summary, our study highlights the need to look at the full picture of eczema’s impact. This includes not only the costs of treatment but also how it affects people’s lives in ways that are not always immediately obvious.

Asthma and atopic dermatitis (AD) represent significant global health challenges in children. This study aimed to investigate trends in incidence, prevalence, and disability-adjusted life years (DALYs) for childhood asthma and AD from 1990 to 2021. The study utilized information from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study 2021. The sample size for this study consisted of children with asthma or AD between the ages of 0 and 14. From 1990–2021, we calculated asthma and AD’s age-standardized incidence, prevalence, and DALYs by area, age, sex, and socio-demographic index. In 2021, global childhood asthma prevalence reached 95.7 million cases (age-standardized rate: 4,758 per 100,000), with the Low SDI region recording 25.4 million cases. For AD, global prevalence was 72.4 million cases (age-standardized rate: 3,600 per 100,000), predominantly in Middle SDI regions (19.7 million cases). Between 1990 and 2021, age-standardized incidence rates decreased for both conditions. Geographic variations were notable: High-income North America showed the highest asthma incidence, while Western Europe led in AD prevalence. The global burden of asthma-related DALYs declined from 6.9 million in 1990 to 4.6 million in 2021, with significant regional disparities. Despite decreasing age-standardized rates, childhood asthma and AD continue to pose substantial health burdens globally, with marked variations across regions and socioeconomic strata. These findings emphasize the need for targeted, region-specific interventions.

Atopic dermatitis (AD), a relapsing, inflammatory skin disease, is associated with pruritus that can negatively affect patients' quality of life. Understanding the burden of AD is critical for informing and tailoring treatment and disease management to improve patient outcomes. This study characterized global treatment patterns and the clinical, psychosocial and economic burden of moderate‐to‐severe AD.

BACKGROUND AD is severely burdensome, and there has been poor characterization of any differences in impact based on the area affected. OBJECTIVE To estimate the prevalence and HRQoL impact of Head/Face/Neck/Hand (HFNH) involvement among patients with moderate-to-severe AD. METHODS All TARGET-DERM AD registry patients with moderate/severe Investigator Global Assessment (vIGA-AD) were assessed using the Patient Oriented SCORing Atopic Dermatitis, Patient Oriented Eczema Measure (POEM) and the (Children's) Dermatology Life Quality Index ((C)DLQI). RESULTS 541 participants met criteria (75.0% adults) and 84% (N=453) reported HFNH involvement. HFNH and non-HFNH involved participants had similar characteristics; 55.2% female and 46.9% White. Compared to the non-HFNH involved, the involved had severe vIGA-AD (28.5% vs. 16.3%, p=0.02) and higher median body surface area affected (15% vs. 10%, p≤0.01) and were twice as likely to have higher (C)DLQI and POEM scores. LIMITATIONS This was an analysis of real-world and patient reported outcome data. CONCLUSION Real-world HFNH involved AD patients were associated with significantly worse quality of life, POEM/(C)DLQI, and more severe disease. Detailed assessments of specific areas affected by AD are needed to personalize treatment.

BACKGROUND Few large-scale international studies broadly characterized the burden of atopic dermatitis (AD) across age groups among children and adolescents. OBJECTIVE To better characterize the AD burden in pediatric subjects by disease severity. METHODS This cross-sectional, web-based survey of pediatric subjects (6 months to <18 years old) was conducted in 18 countries representing North America, Latin America, Europe, Middle East/Eurasia, and East Asia. Subjects with diagnosed AD were identified based on the International Study of Asthma and Allergies in Childhood criteria and self-/parent-report of ever being told by a physician that they/their child had eczema. AD severity was assessed using Patient Oriented Eczema Measure and Patient Global Assessment. Outcomes included measures of itch, skin pain, sleep, health-related quality-of-life (HRQoL), missed school days, and atopic comorbidities. RESULTS The survey included 1489 children 6 months to < 6 years; 2898 children 6 to < 12 years; and 3078 adolescents 12 to < 18 years diagnosed with AD. Although the burden of mild AD was substantial, pediatric subjects with moderate or severe AD had more itch, skin pain, sleep problems, and impaired HRQoL, and missed more school days relative to those with mild AD; greater burden was observed among severe relative to moderate AD. At least one atopic comorbidity was present in 92·5% of all respondents. CONCLUSIONS These results highlight the burden of AD in pediatric subjects especially those with moderate-to-severe disease, and suggest the need for assessments that include the impact of AD on function and daily life.

Ichthyosis vulgaris (IV) affects up to 1 in 250 people, presenting with a spectrum of severity. Loss of function (LoF) filaggrin variants cause IV and are implicated in atopic eczema (AE). These have been widely investigated in White European populations but not in South Asian patients. Studies suggest that 2.5–37% patients with AE have IV. We aimed to investigate its prevalence, phenotype and link to LoF variants in Bangladeshi patients. British Bangladeshi patients with AE aged 0–30 years were recruited from secondary care between May 2018 and December 2020. Targeted gene sequencing was undertaken using DNA from saliva. Univariable and multivariable logistic regression models estimated odds ratios of LoF variants for each pattern. Statistical analysis performed with R (v4.3.1; R Foundation, Vienna, Austria). In total, 568 patients had suitable data for analysis: 318 were male (56%), the mean age was 10.2 years, mean Patient-Oriented Eczema Measure was 12.6, and mean Eczema Area and Severity Index was 7.2. Overall, 175 (31%) had ichthyosis. Four patterns were identified: (i) smooth (clear), (ii) hyperlinear, (iii) diamond scales and (iv) hyperkeratotic. Hyperlinear may represent a subtle or precursor form of IV, but for current analyses types three and four were classed as IV. Patients with hyperkeratosis had the lowest mean vitamin D (21.3 nmol L−1) and corneometry (22.4 AU). When compared with smooth pattern, odds ratios (ORs) demonstrated significant association between LoF variants and diamond scale (OR 2.42, 95% confidence interval 1.43–4.14; P = 0.001) and hyperkeratosis (OR 2.37, 95% confidence interval 1.27–4.48; P = 0.007). The top 10 variants in patients with both IV and AE, vs. AE only are seen in the Table. In summary, IV is common (31%) in Bangladeshi patients with AE, four patterns exist, and severe phenotypes show strong links to LoF variants. Future work should further explore specific LoF variants in IV, the effect of climate on masking subtle phenotypes, and examination of healthy controls to distinguish subtle patterns as normal variants or IV.TableTop 10 filaggrin LoF variants seen in patients with AE and IV, and AE only90/175 patients (51%) with AE and IV with LoF variants.123/393 patients (31%) with AE only with LoF variantsLoF filaggrin variantPatients with LoF variantLoF filaggrin variantPatients with LoF variantc.7031C>G, S2344*18c.7031C>G, S2344*17c.2282_2285del; S761Cfs*3615c.2282_2285del; S761Cfs*3614c.3191G>A; W1064*10c.2976_2977del; R992Sfs*317c.2767_2768insT; S923Ffs*27c.2767_2768insT; S923Ffs*25c.3418C>T; R1140*7c.3191G>A; W1064*5c.2476C>T; R826*6c.3424del; Q1142Kfs*445c.2976_2977del; R992Sfs*315c.7339C>T; R2447*5c.3424del; Q1142Kfs*444c.1501C>T; R501*4c.2185C>T; Q729*2c.2185C>T; Q729*4c.6986_6987del; R2329Tfs*372c.2476C>T; R826*421 other variants36 other variants

Ichthyosis vulgaris (IV) affects up to 1 in 250 people, presenting with a spectrum of severity. Loss-of-function filaggrin variants cause IV and are implicated in atopic eczema (AE). Variants have not been widely investigated in people of South Asian ancestry. We aimed to investigate its prevalence, phenotype and link to loss-of-function (LoF) variants in a Bangladeshi cohort. British Bangladeshi patients with AE and aged 0–30 years were recruited between May 2018 and December 2020. Targeted gene sequencing was undertaken using DNA from saliva. Univariable and multivariable logistic regression models were used to estimate odds ratios of the LoF variant for each pattern. Statistical analysis performed with R v4.3.1 (R Foundation, Vienna, Austria). In total, 568 patients had suitable data for analysis: 318 were male (56%), the mean age was 10.2 years, the mean Patient-Oriented Eczema Measure was 12.6, and the mean Eczema Area and Severity Index (EASI) was 7.2. Overall, 175 (31%) had ichthyosis. Four patterns were identified: (i) smooth, (ii) hyperlinear, (iii) diamond scales and (iv) hyperkeratotic. Hyperlinear may represent a precursor form of IV, but for the current analyses types (iii) and (iv) were classed as IV. When compared with the smooth pattern, odds ratios (ORs) demonstrated significant association between LoF variants and diamond scale [OR 2.42, 95% confidence interval (CI) 1.43–4.14, P = 0.001)] and hyperkeratotic patterns (OR 2.37, 95% CI 1.27–4.48, P = 0.007). Significant differences were seen between leg patterns in EASI (P < 0.001), corneometry (P < 0.001; Kruskal–Wallis test) and palmar pattern (P < 0.001; χ2-test). Prominent diamond palmar pattern had the strongest association with IV (OR 5.49, 95% CI 2.61–11.9, P < 0.001). The 10 most common variants in patients with both IV and AE, vs. AE only are seen in the Table. In summary, IV is common (31%) in Bangladeshi patients with AE, four patterns exist, and severe phenotypes show strong links to LoF variants. Future work should explore the specific variants in IV, the effect of climate on masking subtle phenotypes, and examination of healthy controls to distinguish subtle patterns as normal variants or IV.90 patients (out of 175, 51%) with AE and IV with LoF variants123 patients (out of 393, 31%) with AE only with LoF variantsFilaggrin variantNumber with variantFilaggrin variantNumber with variantc.7031C>gG, S2344*18c.7031C>gG, S2344*17c.2282_2285del, S761Cfs*3615c.2282_2285del, S761Cfs*3614c.3191G>A, W1064*10c.2976_2977del, R992Sfs*317c.2767_2768insT, S923Ffs*27c.2767_2768insT, S923Ffs*25c.3418C>T, R1140*7c.3191G>A, W1064*5c.2476C>T, R826*6c.3424del, Q1142Kfs*445c.2976_2977del, R992Sfs*315c.7339C>T, R2447*5c.3424del, Q1142Kfs*444c.1501C>T, R501*4c.2185C>T, Q729*2c.2185C>T, Q729*4c.6986_6987del, R2329Tfs*372c.2476C>T, R826*421 other variants36 other variants

No abstract available

Atopic eczema (AE) and asthma are chronic inflammatory conditions with significant health impacts, sharing common genetic, immunological, and environmental triggers, such as Th2-driven immune responses and elevated immunoglobulin E (IgE) levels. This study explored the prevalence of AE and its association with asthmatic immunological imbalance in the Saudi population, focusing on contributing factors like environmental exposures and genetic predispositions. A cross-sectional design was employed, involving n=579 participants from diverse regions of Saudi Arabia. Data was collected through a structured bilingual questionnaire covering demographics, medical history, symptom severity, treatment strategies, and environmental exposures. Statistical analyses were conducted to identify predictors and associations, including chi-square tests and logistic regression. The prevalence of AE and asthma was n=365 (63%), with family history emerging as the strongest predictor ( p = 0.045). Urban residency, exposure to allergens, and smoking significantly contributed to symptom severity. Despite n=365 (63%) of participants receiving treatment, n=231 (40%) experienced daily symptoms, highlighting the chronic and debilitating nature of these conditions. Environmental factors such as dust, pollen, and smoking were identified as major triggers, exacerbating symptom severity and quality-of-life impacts. This study reveals a high burden of AE and asthma in the Saudi population, driven by genetic predispositions and environmental exposures. Findings emphasize the need for family-based screening, public health strategies (e.g., anti-smoking campaigns, environmental regulations), reduced environmental triggers, and improved access to advanced treatment modalities. The study provides a valuable foundation for future research and targeted healthcare interventions to mitigate the burden of atopic diseases in Saudi Arabia.

Purpose We aimed to investigate the prevalence of atopic dermatitis (AD) and its associated risk factors in Korean children in 2022, and to compare to our findings with previous results to identify changes or trends over time. Methods A nationwide, cross-sectional study of randomly selected schoolchildren aged 6-7, 9-10, and 12-13 years, respectively, was completed. Information was obtained through the International Study of Asthma and Allergies in Childhood questionnaire, and comparisons between the current and prior surveys performed in 1995, 2000, and 2010 were conducted using a trend test. Results In the 2022 survey, the prevalence of “itchy eczema, ever” was 18.3% in 6- to 7-year-olds, 21.6% in 9- to 10-year-olds, and 18.8% in 12- to 13-year-olds. The prevalence of “AD diagnosis, ever” in 6- to 7-year-olds rose from 20.9% in 1995 to 35.4% in 2010, then dropped to 13.6% in 2022 (P < 0.001), while in 12- to 13-year-olds, it increased from 7.1% in 1995 to 23.7% in 2010, then declined to 17.5% in 2022 (P < 0.001). In 6- to 7-year-olds, the prevalence of "AD only" and "AD and asthma" decreased between 1995 and 2022 (all P < 0.001). In 12- to 13-year-olds, the prevalence of "AD only," "AD and rhinitis," and "AD and asthma and rhinitis" all increased during the same period (all P < 0.001). Conclusions The prevalence of AD decreased in Korean children aged 6-7 years and increased in those aged 12-13 years, respectively, between 1995 and 2022, with a concomitant rise in allergic comorbidities among adolescents, suggesting age-dependent trends influenced by diverse AD phenotypes.

Background: Atopic dermatitis (AD), or allergic dermatitis or atopic eczema, is a common, chronic, relapsing, and inflammatory skin disease characterized by dry and itchy skin and increased and recurring lesions affecting the general population of all ages. Aim: The aim of the study is to investigate the prevalence, knowledge, and attitude associated with the factors affecting AD in the adult population of Saudi Arabia. Materials and Methods: A Cross-sectional study was conducted in Saudi Arabia from January to March 2023, and 922 participants were recruited. An online questionnaire was designed by Google Forms and distributed digitally via social media applications. Logistic regression analysis was conducted to investigate the associated factors affecting AD in the population. Results: The findings revealed a 30% prevalence of AD among the adult population in Saudi Arabia. This indicates a significant burden of the disease in the country. The knowledge level on AD was fair in 43% of participants, good in 25.9%, and poor in 31.1%. Similarly, the attitude towards AD was fair in 53% of participants, good in 2.6%, and poor in 44.4%. These results suggest a need for improving the understanding and perception of AD among the population. Conclusion: The study findings an immediate requirement for better public education about AD in Saudi Arabia. This education should increase awareness of AD’s symptoms, causes, and treatments.

Background In children, atopic dermatitis or eczema is the most common inflammatory disease of the skin. According to the International Study of Asthma and Allergies in Childhood (ISAAC) Phase IIIB in Mexico, 5.8% of children and 4.9% of adolescents had eczema symptoms. In 2012, Global Asthma Network (GAN) was established to update the prevalence of eczema and estimate potential factors contributing to its development. Objective To estimate the prevalence and associated factors for atopic eczema symptoms and diagnosis in children and adolescents according to GAN Phase I and compare the results with ISAAC Phase IIIB in Mexico. Methods A cross-sectional, multicenter survey was conducted in 15 Mexican centers during the period of 2015–2017 using the GAN Phase I questionnaires in children (6–7-year-olds) and adolescents (13–14-year-olds). The prevalences obtained from the GAN Phase I study, were compared with ISAAC Phase IIIB results; a Spearman's correlation analysis was conducted between temperature, relative humidity, and altitude and eczema symptoms, and a logistic regression was performed to predict current eczema symptoms by age group. Results A total of 35 777 children and 41 399 adolescents were included. Since ISAAC Phase IIIB, the prevalence of itchy rash in the past 12 months significantly increased in the children's group [6.6% (95% CI 5.7–7.4) vs 7.8 (95% CI 7.5–8.1), p = 0.000] and adolescents' group [5.8% (95% CI 5.0–6.7) vs 6.7% (95% CI 6.5–7.0), p = 0.000]. In the adolescents' group, the prevalence of nocturnal awakenings caused by rash symptoms on more than one night per week had a negative correlation between altitude (Spearman's Rho = −0.558, p value = 0.031), and a positive correlation with the average annual temperature (Spearman's Rho = 0.604, p value = 0.017) and annual relative humidity (Spearman's Rho = 0.742, p value = 0.002). The most significant associations in children were the presence of sneezing or runny or blocked nose in the past 12 months [(OR 3.13, 95% CI 2.60–3.77), p = 0.000], the use of paracetamol in the first year of life ([OR 1.52, 95% CI 1.15–2.01), p = 0.003] and the use of antibiotics in the first year of life [(OR 1.30, 95% CI 1.08–1.55) p = 0.004]. Moreover, altitude at 100–1000 m above sea level was associated with current eczema symptoms in adolescents (p = 0.001). Conclusions There has been a significant increase in eczema symptoms in both age groups since ISAAC Phase IIIB study. Additionally, eczema symptoms were associated with temperature, relative humidity, asthma, hay fever symptoms, the use of paracetamol and antibiotics.

OBJECTIVE This study aimed to estimate the prevalence of atopic eczema (AE) in children/adolescents and adults and variables associated with risk factors. METHODS We used data from a cross-sectional, population-based study performed in six cities of Colombia during 2009-2010. A nested case-control study was used to determine AE-associated risk factors. RESULTS In adults, AE was mainly associated with a family history of AE (adjusted OR [aOR] 4.66, 95%IC:3.18 to 6.82) and Allergic Rhinitis (AR) (aOR 2.21, 95%CI: 1.61 to 3.03). We also found a dose-dependent positive association between acetaminophen use and AE, being more assertive at once per week (aOR 2.12, 95%CI: 1.47 to 3.06) than once per month (aOR 1.82, 95%CI: 1.28 to 2.59). Female gender (aOR 1.49, 95%CI: 1.15 to 1.93), smoking (aOR 1.60, 95%CI: 1.19 to 2.14), and cats at home (aOR 1.57, 95%CI: 1.06 to 2.31), were positively associated with AE. In contrast, meat (aOR 0.45, 95%CI: 0.27 to 0.74), and seafood consumption (aOR 0.71, 95%CI: 0.56 to 0.91) were negatively associated. In children/adolescents, family history of AR (aOR 2.97, 95%CI: 1.79 to 4.93) and acetaminophen consumption once per week (aOR 4.00, 95%CI: 1.39 to 11.50) were associated with AE. CONCLUSIONS The most critical risk factors for AE were a family history of atopy and acetaminophen exposure, supporting an essential contribution of both genetic and environmental factors in disease presentation.

Atopic dermatitis (AD) is a common inflammatory skin disease. However, limited data exist on its prevalence and incidence in Irish secondary care. REVEAL AD had two distinct but related objectives: (1) Estimate prevalence of moderate‐to‐severe AD in patients aged 12 years and older presenting to secondary care clinics in Ireland, and (2) Evaluate disease control and associated disease burden amongst patients diagnosed with moderate or severe AD treated in secondary care dermatology clinics in Ireland, via a cross‐sectional, non‐interventional multi‐centre study. In Part One, aggregated 6‐month data from 3 secondary care Dermatology clinics in Munster were used to estimate prevalence based on routine visits of patients with moderate‐to‐severe AD. For Part Two, eligible patients attending one of four Irish Dermatology centres were invited to participate. Consented patients attended a single routine study visit. Disease activity was assessed using SCORing Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), Body Surface Area (BSA), and patient quality of life using the Dermatology Life Quality Index (DLQI) or Children's Dermatology Life Quality Index (CDLQI). Overall prevalence rate for moderate‐to‐severe AD patients treated in secondary care in Ireland was estimated as 2.893 patients per 10,000 people in the Irish population. Prevalence rates (95% CI) for moderate and severe AD were 1.456 (1.236, 1.704) and 1.437 (1.218, 1.683) per 10,000, respectively. Mean BSA, SCORAD and EASI values for the moderate and severe groups were 39.0, 46.8, 19.6 and 32.8, 45.2, 14.9, respectively. Mean DLQI (SD) scores for the moderate and severe groups were 10.8 (6.96) and 11.6 (8.92), respectively. Only a very small proportion of patients with AD have accessed secondary care clinics in Ireland. Outcomes in secondary care are sub‐optimal, with both moderate and severe AD patient cohorts reporting a ‘severe' effect on their quality of life.

The objective of the study was to investigate the association between outdoor and indoor air pollution sources and atopic eczema among preschool children in South Africa. A cross-sectional design, following the International Study of Asthma and Allergies in Childhood (ISAAC) Phase III protocol, was applied. The study was conducted in Mabopane and Soshanguve Townships in the City of Tshwane Metropolitan Municipality in Gauteng, South Africa. A total population of 1844 preschool children aged 7 years and below participated in the study; 1840 were included in the final data analysis. Data were analyzed using multilevel logistic regression analysis. The prevalence of eczema ever (EE) and current eczema symptoms (ESs) was 11.9% and 13.3%, respectively. The use of open fires (paraffin, wood, or coal) for cooking and heating increased the likelihood of EE (OR = 1.63; 95% CI: 0.76–3.52) and current ESs (OR = 1.94; 95% CI: 1.00–3.74). Environmental tobacco smoke (ETS) exposure at home increased the likelihood of EE (OR = 1.66; 95% CI: 1.08–2.55) and current ESs (OR = 1.61; 95% CI: 1.07–2.43). Mothers or female guardians smoking cigarettes increased the likelihood of EE (OR = 1.50; 95% CI: 0.86–2.62) and current ESs (OR = 1.23; 95% CI: 0.71–2.13). The use of combined building materials in homes increased the likelihood of EE, and corrugated iron significantly increased the likelihood of current ESs. The frequency of trucks passing near the preschool children’s residences on weekdays was found to be associated with EE and current ESs, with a significant association observed when trucks passed the children’s residences almost all day on weekdays. Atopic eczema was positively associated with exposure to outdoor and indoor air pollution sources.

Background: Eczema affects around 10% of children in Western countries and has become much more common in ‘developing’ countries in recent years. Numerous factors have been identified as contributing to the rising prevalence of eczema and other atopic diseases. It has been proposed by the hygiene hypothesis that eczema occurs more frequently in urban areas than in rural ones. Therefore, we studied the prevalence and risk factors of chronic eczema among the adult population living in urban and rural areas. Materials and Methods: This was a retrospective observational study conducted in the Department of Dermatology, Eastern Medical College Hospital, Cumilla, Bangladesh during the period from July 2023 to June 2024. In this study, we included 100 suspected patients of chronic eczema attending the dermatology department coming from urban and rural areas. Results: Most of our study patients (61%) were female followed by male (39%). The mean age was 46.32±14.02 & 44.32±16.02 years in urban & rural groups respectively. The most common symptom was an itchy rash reported by 62% & 44% of urban & rural patients respectively. The prevalence of eczema was 68% & 56% and chronic eczema was found in 24% & 18% of urban & rural groups respectively. Family history (80.43% vs 78.38%), antibiotics used more than 3 times per day (50% vs 56.76%), and environmental factors (54.35% & 43.24%) were the most common risk factors among our urban & rural populations respectively. Conclusion: This study shows that the prevalence of chronic eczema appears to vary significantly between urban and rural populations, influenced by environmental, genetic, and lifestyle factors. Eastern Med Coll J. July 2025; 10 (1): 65-70

Background: Atopic eczema (also known as atopic dermatitis, or simply eczema) was traditionally considered to remit in most children by adolescence. However, increasing genetic and epidemiologic evidence suggests that it is an episodic, inflammatory disorder that can occur throughout life (1). Atopic eczema affects between 10% and 25% of children in industrialized countries, but relatively little is known about physician-diagnosed adult disease (2). Objective: To estimate the age-specific prevalence of active atopic eczema across the lifespan in a large primary care population. Methods and Findings: We analyzed data between 1994 and 2013 from The Health Improvement Network. This U.K. cohort is known to be accurate; complete; and representative of the population in the United Kingdom, where primary care physicians manage 97% of cases of atopic eczema (3). We identified patients with atopic eczema on the basis of a previously validated algorithm shown to have good positive predictive value for both children and adults in this cohort (90% and 82%, respectively) (4). Because atopic eczema is an episodic disorder that may remit for years, we then calculated the prevalence of active disease requiring a physician visit or prescription during each year of follow-up. We also examined the number and types of prescriptions given to patients and rates of asthma and rhinitis/seasonal allergies by age. Among 8604333 persons aged 0 to 99 years, the cumulative lifetime prevalence of atopic eczema was 9.9% and rates of active disease were highest among children and older adults (Table and Figure). Patients received a median of 6 prescriptions for atopic eczema per year (interquartile range, 2 to 13 prescriptions), including topical steroids and systemic treatments, and the number of annual prescriptions was similar across ages. Rates of comorbid atopic disease were highest among adults aged 18 to 74 years. Table. Characteristics of Patients With AE, by Age Group Figure. Annual prevalence of active AE, by age. Local polynomial smoothed plot with shading indicating the 95% CIs generated from cross-sectional calculations of the prevalence of active AE at each age using Stata 15 (StataCorp). Active disease was defined by a visit or prescription code during each year of follow-up among patients who previously met the definition of AE (characterized by 1 of the following diagnosis codes: M111.00 [atopic dermatitis/eczema], M1120.0 [infantile eczema], M113.00 [flexural eczema], M114.00 [allergic/intrinsic eczema], and M12z100 [eczema not otherwise specified]) and were assigned 2 treatment codes for any AE-related therapy on separate dates (4). AE= atopic eczema. We performed sensitivity analyses to assess for ascertainment and misclassification bias. Because adults may not visit providers as frequently as children and older persons, we tested the effect of basing the definition of active disease only on prescriptions rather than on prescriptions and medical codes from clinic visits. We also examined the effect of excluding persons diagnosed with conditions that may either overlap with or be misdiagnosed as atopic eczema (for example, contact dermatitis, psoriasis, scabies, ichthyosis, erythroderma, photodermatitis, and seborrheic dermatitis) (4) and found results similar to those from our primary analysis (Table). Discussion: We have shown that rates of active atopic eczema (as defined by diagnosis and treatment codes applied by physicians) increase with age among adults in primary care, addressing a gap in evidence about the epidemiology of this condition after childhood. The cohort is representative of the U.K. population; however, the true population prevalence of disease activity may be higher than our estimates, because medical records do not capture over-the-counter treatments and providers may not record mild disease. For example, a population-based study of U.S. adults aged 18 to 65 years found a higher 1-year prevalence of self-reported dermatitis overall (10.2%), with the highest rates among persons aged 62 to 85 years (11.4%) (5). The presentation and terminology surrounding eczema are heterogeneous, and additional research is needed to understand whether disease pathogenesis is the same across ages. We cannot exclude misclassification bias, which may be higher among adults; however, sensitivity analyses show a similar U-shaped prevalence curve after persons with possible overlapping diagnoses were excluded. Atopic eczema is known to substantially affect emotional and physical aspects of health-related quality of life but is often undertreated. This circumstance may change as more therapies become available: The U.S. Food and Drug Administration approved 2 new medications for this condition in 2016 and 2017, and more than a dozen additional agents are under development and clinical testing. As new targeted therapies become available, primary care providers will probably play a larger role in managing adults with atopic eczema. Attention should be paid to clinical testing in older adults, who may require special considerations for pharmacology, polypharmacy, and multimorbidity.

Background There has been research about the prevalence and risk factors of eczema, hay fever, and asthma in children, but little is known about these conditions in adults in China. Objectives To explore the prevalence of adult eczema/atopic dermatitis (AD) and its risk factors in northern China. Methods A cluster sampling randomized population-based survey was conducted using a face-to-face questionnaire combined with skin prick tests of ten common aeroallergens including nine pollen allergens and Dermatophagoides pteronyssinu (Dp) allergen. The questionnaire was designed by specialists and included questions on the prevalence of eczema, hay fever, and asthma, socioeconomic risk factors, family history of atopy and environmental exposures. The prevalence of eczema with asthma and/or hay fever (EAH) was applied as a proxy of AD in this study. Results Overall, 2096 subjects were enrolled and completed the study. The prevalence of eczema was 15.7% (95% CI 14.3–17.4), while the prevalence of hay fever and asthma were 20.6% (95% CI 18.9–22.4) and 6.5% (95% CI 5.5–7.6), respectively. In particular, the prevalence of EAH was 5.1% (95% CI 4.4–7.0). The prevalence of eczema and EAH was significantly associated with younger age, atopy family history, high education level, urbanization, and antibiotic overuse ( P  < 0.05, logistic regression). The sensitization rate was higher in EAH compared with eczema (48.2% vs 41.0%, P  = 0.018), with weed pollen sensitization being the most common. Subjects with two or more concomitant allergic diseases had increased risk of eczema and EAH ( P  < 0.001). Allergen sensitization increased the risk of eczema and EAH ( P  < 0.001, both). Conclusions Adult eczema and EAH are prevalent in northern China under high pollen exposure. Socioeconomic and environmental factors affected the prevalence of adult AD in China. Dp had a particular impact on the prevalence of eczema/AD in the grassland region.

BACKGROUND Atopic dermatitis (AD) shows characteristics of a systemic disease due to underlying systemic inflammation and reports on various comorbidities. OBJECTIVE This study aimed to examine the associations between AD and (non-atopic) multimorbidity in a population-based cohort from the Northern Netherlands and to identify differences in multimorbidity patterns between multimorbid participants with and without AD. METHODS We assessed lifetime prevalence of 52 diseases, from 15 domains, combining data from questionnaires, medication records and clinical assessments within the Lifelines Cohort. Lifetime AD was self-reported, physician-diagnosed and disease severity based on the Patient Oriented Eczema Measure. Multimorbidity was defined as lifetime presence of at least two diseases, while non-atopic multimorbidity excluded asthma, rhinitis and food allergy. A composite morbidity score (cMS) indicated the degree of multimorbidity. We analysed associations of AD and AD severity with multimorbidity and cMS using binary and multinomial logistic regression, adjusting for age and sex and additionally adjusting for socioeconomic and lifestyle factors. Patterns of non-atopic multimorbidity based on disease domains were explored using Latent Class Analysis (LCA), stratified by AD presence. RESULTS Among 37,193 participants, 8.7% had AD. The odds for non-atopic multimorbidity was 1.47-fold higher in participants with AD, particularly for those with moderate-to-severe disease (adjusted Odds Ratio (aOR) 1.74 vs. mild AD aOR 1.41). The association strengthened with higher degrees of non-atopic multimorbidity, reaching 2.09-fold for ≥5 diseases. When considering atopic diseases in the definition of multimorbidity and the cMS, the associations with AD were even stronger. Further adjustments for socioeconomic and lifestyle factors were corroborative. We identified five distinct multimorbidity classes, among participants with and without AD, with two differing across the groups. One class, characterized by the orofacial domain was only present among those with AD, while another class, resemblant of the metabolic syndrome showed more respiratory contribution in AD with further differences regarding cardiometabolic involvement. CONCLUSION Participants with AD, especially moderate-to-severe cases, are more likely to experience (non-atopic) multimorbidity and showed unique patterns of non-atopic multimorbidity with regards to orofacial and cardiometabolic diseases. Our findings highlight the importance of promoting awareness for interdisciplinary approaches to managing patients with AD.

BACKGROUND Atopic dermatitis (AD), or eczema, is a chronic, pruritic inflammatory skin disease affecting children and adults. Socioeconomic status (SES) plays a significant role in developing AD. However, mixed evidence from a previous study by Bajwa et al makes it difficult to determine the directionality of the association. There is a literature gap in understanding the causal association between AD and socioeconomic factors. AIM To evaluate the impact of disparities in SES on pediatric AD populations. METHODS Based on the eligibility criteria, the literature review identified eight articles since July 2021, and a descriptive analysis was conducted using an Excel spreadsheet on key components collected from the identified studies. RESULTS Eight observational studies assessed SES in pediatric AD. Five observational studies showed mixed associations between AD and SES. Sub-analysis revealed that urban areas had a higher prevalence of AD, and four studies identified a positive association between parental education and AD in the pediatric population. Socioeconomic variables, such as residential areas and household income, significantly influence disease outcomes. CONCLUSION There is mixed association between pediatric AD and SES, with AD positively associated with parental education. There is critical need to evaluate global impact of SES variables on pediatric AD.

Rationale: There are few previous studies exploring the relationship between eczema and asthma status in the context of atopy. The purpose of this study is to investigate this relationship in a region with a high prevalence of asthma, within the New York City borough of the Bronx. Methods: We reviewed 120 charts of asthma patients at Montefiore’s Asthma Center (MAC) at their initial evaluation and last evaluation, with asthma severity assessed by Asthma Control Test (ACT) scores. Patient criteria for atopy included 1 positive skin prick test and/or positive specific immunoglobulin E test, and eczema status was determined by the presence of eczema history at the time of patients’ initial evaluation. Demographic factors including BMI and healthcare utilization were also assessed. Linear regression and t-tests were used for analyses. Results: We observed no significant association between eczema status and baseline ACT scores in a high-risk population (p = 0.1364). However, significant improvements in ACT scores from baseline to the last visit were observed in both eczema (p < 0.0001) and atopic patients (p < 0.0001). No significant change in ACT scores was noted in non-atopic patients. Conclusions: There appears to be an association between eczema and asthma status in the context of atopy. The findings demonstrate that early identification and management of eczema within this context are vital for adequate asthma control. Further understanding of this relationship can aid in providing tailored treatment strategies to treat both diseases, optimizing health care outcomes and improving quality of life for affected individuals.

To address issues regarding health disparities and differential access to health care in diverse racial and ethnic populations, many of whom are part of underserved communities, current and robust data on atopic dermatitis (AD) prevalence by race/ethnicity are needed. Whereas data on pediatric prevalence of atopic dermatitis in diverse race/ethnicity populations have been reported, there are limited epidemiologic data on adult populations with AD. Analyses were conducted using cross-sectional data from the 2021 National Health Interview Survey. Weighted overall frequencies of subject reports of diagnosed AD or eczema were estimated by race/ethnicity. Adjusted odds ratios were estimated to compare prevalence rates between subgroups. Corresponding population denominators for use in estimating prevalence rates were obtained from the US Census Bureau (2020 Census Demographic Profile). Prevalence is reported as percentage (standard error). Pediatric data was also analyzed for the presentation. Overall US prevalence of AD in adults ages 18-64 was 7.6% (0.2) and age 65+ was 6.1% (0.3), with a weighted US estimate of 15.3 and 3.2 million respectively. Race/ethnicity prevalence rates for all adults were Black/African American 8.5% (0.6), White 7.7% (0.2), Asian 6.5% (0.7), American Indian/Alaskan Native 4.9% (2.1), and Hispanic 4.8% (0.4). The odds ratio for Hispanic vs Non-Hispanic White was 0.6 (95%CI 0.5-0.7; p<0.0001). Total US prevalence of AD in all adults is approximately 18 million. Hispanic adults have a lower prevalence AD than all other adult groups. Additional studies are needed to understand sociodemographic variations in AD prevalence.

BACKGROUND Little is known about the current global prevalence of atopic dermatitis (AD) in the pediatric population. OBJECTIVE To estimate the real-world global prevalence of AD in the pediatric population and by disease severity. METHODS This international, cross-sectional, web-based survey of children/adolescents (6 months to <18 years old) was conducted in 18 countries: North America (Canada, United States), Latin America (Argentina, Brazil, Columbia, Mexico), Europe (France, Germany, Italy, Spain, United Kingdom), Middle East/Eurasia (Israel, Saudi Arabia, Turkey, United Arab Emirates, Russia), and East Asia (Japan, Taiwan). Prevalence was determined using two defintions: 1) diagnosed AD according to the International Study of Asthma and Allergies in Childhood (ISAAC) criteria and self/parent-report of ever being told by a physician that they/their child had AD (eczema); 2) reported AD based on ISAAC crtieria only. Severity was assessed using the Patient Global Assessment (PtGA) and Patient Oriented Eczema Measure (POEM). RESULTS Among 65,661 responders, the 12-month diagnosed AD prevalence (ISAAC+self-reported diagnosis) ranged from 2.7% to 20.1% across countries; reported AD (ISAAC only) was 13.5% to 41.9%. Severe AD assessed with both PtGA and POEM was generally <15%; more subjects rated AD as mild on PtGA than suggested by POEM. No trends in prevalence were observed based on age or sex; prevalence was generally lower in rural residential settings relative to urban/suburban. CONCLUSION This global survey in 18 countries showed that AD affects a substantial proportion of the pediatric population. Although prevalence and severity varied across age groups and countries, <15% had severe AD.

Atopic dermatitis and its co-morbidity with asthma and allergy is well described in younger age groups. However, population-based studies on adults with atopic dermatitis in childhood are sparse. The aims of this study were to determine: (i) the prevalence of self-reported childhood atopic dermatitis in the population; and (ii) its association with present self-reported hand eczema, eczema, allergy, urticaria and asthma. A questionnaire was sent to a cross-sectional random sample of the Swedish population (n=7,985), age range 18-84 years (response rate 61.1%). The questionnaire included the question "Have you had childhood eczema?" and questions on 5 other medical problems (hand eczema, other eczema, asthma, urticaria and allergy). Persons reporting eczema in childhood reported increased odds ratios (OR) for hand eczema (4.01), other eczema (3.88), urticaria (2.50), allergy (2.98), and asthma (2.06) as adults. The combination of eczema, allergy and asthma had an OR of 14.10 (95% confidence interval 8.44-23.54). Adults in the age range 18-84 years reporting childhood atopic dermatitis still have high co-morbidity with eczema, asthma, urticaria and allergy.

Abstract Background Eczema is the most common form of dermatitis and also the starting point of atopic march. Although many eczema‐associated allergic and immunologic disorders have been studied, there remains a gap in the systematic quantitative knowledge regarding the relationships between all childhood disorders and eczema. This study aimed to systematically explore eczema‐associated childhood diseases using a real‐world, long‐term clinical dataset generated from millions of children in China. Methods Data were collected at 8,907,735 outpatient healthcare visits from 2,592,147 children between January 1, 2013, and August 15, 2019, at the largest comprehensive pediatric medical center in Zhejiang Province of China. The period prevalence differences in various pediatric diseases between children with and without eczema were used to test the independence of various pediatric disorders and eczema using Fisher's exact test. Bonferroni correction was used to adjust the p value in multiple testing. Odds ratio >2 with 95% confidence interval not including 1 and adjusted p < 0.05 was used to identify eczema‐associated diseases. Results Overall, 234 pediatric disorders were identified from more than 6000 different pediatric disorders. An interactive eczema‐associated disease map that has related quantitative epidemiological features called ADmap was published at http://pedmap.nbscn.org/admap. Thirty‐six of these disease associations have not been reported in previous studies. Conclusion This systematic exploratory study confirmed the associations of many well‐known diseases with eczema in Chinese children and also identified some novel and interesting associations. These results are valuable for the development of a comprehensive approach to the management of eczema in childhood.

Importance Atopic eczema is characterized by a heterogenous waxing and waning course, with variable age of onset and persistence of symptoms. Distinct patterns of disease activity such as early-onset/resolving and persistent disease have been identified throughout childhood; little is known about patterns into adulthood. Objectives To identify subtypes of atopic eczema based on patterns of disease activity through mid-adulthood, to examine whether early life risk factors and participant characteristics predict these subtypes, and to determine whether subtypes are associated with other atopic diseases and general health in mid-adulthood. Design Two population-based birth cohort studies. Setting United Kingdom, 1958-2016. Participants Members of the 1958 National Childhood Development Study (NCDS) and the 1970 British Cohort Study (BCS70). Main outcomes and measures Subtypes of atopic eczema patterns were identified based on self-reported atopic eczema period prevalence at multiple occasions. These subtypes were the outcome in models of early life characteristics and an exposure variable in models of mid-life health. Results Latent class analysis identified four subtypes with distinct patterns of disease activity among 15,939 individuals from the NCDS and 14,966 individuals from the BCS70: ‘rare/no’ atopic eczema (88-91%), ‘decreasing’ (4%), ‘increasing’ (2-6%), and persistently ‘high’ (2-3%) probability of reporting prevalent atopic eczema with age. Early life factors, including sex at birth, social class, region of residence, tobacco smoke exposure, and breastfeeding, predicted differences between the three atopic eczema subtypes and the infrequent/no atopic eczema group, but only female sex differentiated the high and decreasing probability subtypes. Individuals in the high subtype were most likely to experience asthma and rhinitis, and those in the increasing subtype were at higher risk of poor self-reported general (OR 1.29, 95%CI 1.09 to 1.53) and mental (OR 1.45, 95%CI 1.23 to 1.72) health in mid-life. Conclusions and Relevance Extending the window of observation beyond childhood, we observed clear subtypes of atopic eczema based on patterns of disease activity. A newly identified subtype with increasing probability of activity in adulthood warrants additional attention given observed associations with poor self-reported health in mid-life.

Infantile wheezing and eczema are associated with the subsequent onset of asthma and other atopic diseases. However, there are no large population-based surveys on infantile allergic symptoms in Japan. The objective of the study was to determine the prevalence of wheezing and asthma in infants in Nagoya, Japan. This population-based cross-sectional study was performed in the metropolitan city of Nagoya, Japan. We surveyed parents to ascertain the prevalence of wheezing and eczema in infants who attended group health checkups at 3, 18, and 36 months of age. Their parents completed modified questionnaires from the International Study of Asthma and Allergies in Childhood. More than 90% of the approximately 40,000 children in each study group living in the target area were included in the survey. The prevalence of wheezing was 8%, 17%, and 13% at 3, 18, and 36 months, respectively, and was characterized by birth season. The prevalence of eczema was 24%, 30%, and 31%, at 3, 18, and 36 months, respectively. Participants born in autumn and winter had a higher incidence of eczema in each age group. Three-quarters of the children had a parental history of allergic conditions. Parental allergic diseases and male gender are risk factors for wheezing and eczema in children. This survey had a high response rate and covered almost the entire population of the target age groups in a large city. We believe that the results of this study, therefore, provide a much higher level of confidence regarding the prevalence of allergies in infants in Japan than that in previous studies with limited cohorts.

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Purpose: This study aimed to explore the prevalence of and possible risk factors for hand eczema with respect to the dissemination of information about new hand hygiene habits to protect against ongoing COVID-19 cross-transmission. The authors conducted a survey among health care workers (HCWs) and non-HCW populations in Khon Kaen, Thailand. Results: A total of 805 participants participated. The prevalence of hand eczema in the study population was 20.87%. There were several risk factors, including working as a HCW, having a history of previous hand eczema, having underlying atopic dermatitis, wearing gloves in everyday life, and washing hands frequently (more than 10 times/day). Hand hygiene with alcohol-based products was shown to be a risk factor for hand eczema, (OR (95% CI) 1.86 (1.03-3.35), P = .04). Conclusion: In terms of hand eczema prevention, we suggest that the use of alcohol-based products should be discontinued if other handwashing methods are available. The following factors increase the risk of hand eczema: being a HCW, having previous hand eczema, and having underlying atopic dermatitis. Proper strategies in terms of hand eczema prevention should be addressed, especially in this group, since we need to continue performing hand hygiene during the ongoing COVID-19 pandemic.

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Background Hand eczema (HE) is a common disorder that negatively impacts the quality of life. During the COVID-19 pandemic, several studies have shown an increase in HE in health care workers. However, data on the general population are lacking. Objective To assess the prevalence and risk factors of HE among the Saudi general population during the pandemic. Methods This cross-sectional study was conducted using an online questionnaire composed of 4 sections (participant characteristics, history of atopic disorders, hand hygiene methods, and HE symptoms). It was distributed on Twitter during the lockdown period, between August 2020 and September 2020. Descriptive, bivariate, and multivariable analyses were conducted using STATA v16. Results A total of 582 (52.6% women and 47.4% men) participants responded to the questionnaire. The 6-month prevalence of HE was 34%. In multivariable analysis, having a past history of eczema, rhinitis/conjunctivitis, using soaps for >5 times daily, using gloves daily, and using moisturizers were significantly associated with HE. Interestingly, using sanitizers for >5 times daily was not a statistically significant risk factor. Limitations Due to its internet-based nature, the response rate cannot be accurately calculated. In addition, the response bias and the small sample size limit the generalizability of the results and prevent drawing broad conclusions and accurate measurement of prevalence. Conclusion HE prevalence increased during the pandemic in the Saudi general population. Frequent use of soaps and gloves, but not sanitizers, increased HE risk.

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BACKGROUND Little is known about the predictors of health care utilization among US adults with atopic dermatitis (AD). OBJECTIVE To determine the proportion and predictors of utilization in outpatient, urgent care, emergency department (ED), and hospital settings in US adults with AD. METHODS A cross-sectional, population-based study of 3495 adults was performed. AD was determined using modified United Kingdom Working Party criteria. AD severity was assessed using the Patient-Oriented Eczema Measure (POEM), the Patient-Oriented Scoring AD (PO-SCORAD), and the Numeric Rating Scale (NRS)-itch. Weighted frequency and prevalence (95% CIs) of utilization were determined. RESULTS Overall, 10.42% (95% CI, 8.55%-12.28%; weighted frequency, 25,844,871) reported a diagnosis of AD or eczema, 7.39% (95% CI, 5.81%-8.97%; weighted frequency, 18,324,869) met United Kingdom Working Party criteria, and 3.56% (95% CI, 2.40%-4.72%; weighted frequency, 8,830,095) met both. A total of 31.8% (2,711,690) had a severe score for POEM, PO-SCORAD, and/or NRS-itch, with 4.0% (337,586) having severe scores for all 3. Outpatient utilization for AD was low for mild disease (29.3%-34.7%) and increased by severity (moderate: 36.2%-49.8%; severe: 50.6%-86.6%). Timeliness of appointments, expenses, and insurance coverage were also predictors of outpatient utilization. Severe POEM, PO-SCORAD, and/or NRS-itch were associated with being uninsured, not having full prescription coverage, AD prescriptions being denied by insurers, and costs of AD medications being problematic. One in 10 adults with AD had 1 or more urgent care, ED, or hospital visit in the past year. Urgent care or ED visits were significantly more common among blacks and Hispanics, those with lower household income, those with lower education level, and those with AD prescriptions being denied by the insurance company. CONCLUSIONS Adults with AD had low rates of outpatient and high rates of urgent care, ED, and hospital visits. The major predictor of outpatient utilization for AD care was AD severity. Racial/ethnic, socioeconomic, and/or health care disparities reduce outpatient utilization and increase urgent care, ED, and hospital utilization.

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Atopic dermatitis (AD) is the most prevalent chronic recurrent inflammatory skin disease in children. However, there are currently limited epidemiological data on children with AD in East China, and few studies have assessed its impact on parental anxiety and depression. Therefore, we aimed to explore the epidemiology of pediatric AD in Shanghai and its impact on parental anxiety and depression.

Atopic dermatitis (AD) is a chronic, inflammatory, relapsing skin disorder with early age of onset in infancy and early childhood. A gradual increase in the prevalence of AD has been observed recently, especially in low-income countries like ours. We aimed to study the epidemiology and clinical profile of AD among pediatric age group in a tertiary care hospital in North India. A hospital-based cross-sectional study was conducted over 1 year in the department of dermatology and sexually transmitted diseases in a tertiary care center in India. All children diagnosed with AD, aged 0–18 years, were recruited, and their clinical and demographic data were recorded. In the 62 children having AD, the mean age was 7.7 ± 6.3 years. Majority of children belonged to the age group of 1–5 years. The mean age of onset of AD was 2.3 ± 2.2 years. A personal history of atopy was present in 53.2% of children, whereas 48.3% of children had a family history of atopy. Acute AD was the most common clinical type that was noted in 43.5%. Hyperlinearity of palms, keratosis pilaris, pityriasis alba, and periorbital darkening were found in 59.6%, 33.8%, 24.1%, and 29% of children, respectively. The prevalence of AD is low in developing countries like India, but it is slowly rising due to rapidly evolving urbanization and environmental changes. Disease manifestation is usually mild to moderate in Indian patients; hence, vigilant eyes and high clinical suspicion are required for accurate diagnosis and efficient management of AD in Indian settings.

Atopic dermatitis (AD) is a chronic skin condition that is associated with significant patient burden and decreased health‐related quality of life (HRQoL). We report results of the real‐world Epidemiology of Children with Atopic Dermatitis Reporting on their Experience study in Japanese pediatric patients, focusing on the impact of AD severity on disease burden.

Pediatric atopic dermatitis (AD) can negatively impact the family quality of life (QoL). We report data from the real-world Epidemiology of Children with Atopic Dermatitis Reporting on their Experience (EPI-CARE) study in Japanese pediatric patients, focusing on disease impact on family QoL. Children and adolescents aged 6 months to <18 years completed an online survey between September 2018–December 2019. The impact of disease severity on family QoL and its effect on parents’ time were assessed using the dermatitis family impact (DFI) questionnaire. The impact of a family history of allergic conditions, current residency, second-hand smoke exposure, and household pets on AD prevalence and severity was also assessed. Family QoL decreased as AD severity increased, particularly in families with children aged <6 years; but had the greatest impact on sleep and tiredness in families with children aged <12 years. Parents spent at least 4.6 h/week caring for children <6 years, including those with mild symptoms. Most children (>80%) had a family history of allergic conditions; AD prevalence was increased in those exposed to second-hand smoke or household pets. This study demonstrated that pediatric AD in Japanese individuals has negative impacts on family QoL and that family and household environments can influence pediatric AD prevalence.

Background: The burden of immuno-inflammatory diseases, such as atopic dermatitis (AD), is increasing, and data on their epidemiology and management from Indian settings are scarce. This study assesses the perspective of Indian dermatologists on AD burden, management, and unmet needs. Methodology: This was an online questionnaire-based survey that captured the perspectives of 150 Indian dermatologists on AD prevalence, signs and symptoms, management, and treatment adherence. Results: Most dermatologists reported that 5-10% of their patients had AD, with pediatric-onset comprising >60% of cases. The reported severity was mild in 41-60% of cases, moderate in 21-40%, and severe in <20% of cases. As per participating dermatologists, >60% and 21-40% of patients had a family history of atopy and AD, respectively. The most commonly reported signs and symptoms included itch, dryness, and sleep disturbances, with itch being proportional to disease severity in more than 60% of patients. Most mild AD cases experienced one to five flare-ups per year, as reported by 84.67% of dermatologists. Moderate cases had one to five flare-ups annually, as per 64.67% of the dermatologists. Severe cases were reported to experience six to 10 flares/year. Flare triggers included hot/humid conditions, stress, and a history of atopy. Topical corticosteroids and calcineurin inhibitors were the preferred first-line therapies for mild/moderate AD, whereas severe cases often required systemic conventional therapies and off-label drug usage with targeted therapies. Topical calcineurin inhibitors and moisturizers were the most commonly preferred for AD maintenance. Most dermatologists reported nonadherence to treatment due to loss of follow-up in <25% of patients. Notably, 78% believed that newer steroid-sparing options would improve adherence. Regional variations in onset and treatment preferences were also observed. Conclusion: Significant gaps exist in the management of AD in India. Targeted therapies and newer steroid-sparing options could enhance patient outcomes. Challenges encountered included delayed diagnosis, preference for alternative medicine, and inappropriate treatment. Nonadherence to treatment was influenced by steroid phobia, lack of awareness, and cost of therapy. The findings should be interpreted with caution due to limitations, including recall bias and the lack of patient-level data.

Atopic dermatitis (AD) is driven by a complex gene-environment interaction. Many of the risk factors and genetic underpinning previously observed for pediatric AD may not apply to adult atopic dermatitis, suggesting that these may largely be different disorders. Whereas AD is classically thought of as a pediatric disease, recent studies have shown high rates of disease in adults as well. Risk factors for persistence of childhood-onset AD, as well as adult-onset AD, are reviewed. Adults with AD are particularly vulnerable to exogenous insults from the outside environment, including climate, ultraviolet exposure, pollution, irritants and pruritogens, and microbes. Finally, adult AD is associated with a substantial health care burden, with increased utilization, direct and indirect costs of care, and lost work productivity.

Background Atopic dermatitis (AD) is a chronic inflammatory, non-communicable, and relapsing skin disease that affects all age groups. There is a dearth of literature that reports the disease burden, and epidemiology and highlights unmet needs in the diagnosis and management of AD in India. Methods A total of ten specialists including dermatologists, pediatric dermatologists, and pediatricians with more than ten years of experience and practicing in different parts of India served as the expert panel during the virtual meet conducted on January 24, 2021. A questionnaire comprising 32 questions on different aspects of AD management was categorized among different sections: burden of disease (five questions), age of onset and prevalence (five questions), etiology and pathogenesis (six questions), diagnosis and severity of the disease (seven questions), and treatment (nine questions). Consensus was defined when agreement was provided by ≥90% of the experts. Results Considering the profound impact AD has on the quality of life (QoL) of patients, the expert panel recommended patient counseling while moderate to severe cases of AD need a prompt referral to a specialist. The panel did not recommend any specific diagnostic and severity criteria as a standard due to the inherent limitations associated with every criterion. The role of environment and changing lifestyle in addition to genetic and familial risk factors for AD was also considered. The panel unanimously recommended to conduct a countrywide, multicenter survey/study to estimate the true prevalence of AD in India. Further, the experts recommended to follow proper treatment protocols and to perform longitudinal monitoring for understanding corticosteroid treatment associated side effects. Conclusion This guidance focuses on identifying the unmet gaps and provides practical recommendations for improving QoL, diagnosis, prognosis, and overall management of patients with AD in India.

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Developing countries such as India can offer unique perspectives on and contributions to knowledge of and the literature on atopic dermatitis, including information on epidemiology, the role of environmental factors, clinical features, and treatment strategies in resource‐poor settings using indigenous methodologies. This report will help in understanding atopic dermatitis in the Indian diaspora as well.

BACKGROUND The Ogasawara Islands, away from mainland Japan, belong to a subtropical area. Although the daily eating habits and food are relatively similar to that on the mainland, the living environment is quite different. The prevalence of allergic diseases in the Ogasawara Islands is unknown. This study aimed to identify the prevalence of allergic diseases in the Ogasawara Islands. METHODS A survey was conducted among all children belonging to preschool, elementary school, and junior high school in the Ogasawara Islands. A questionnaire was prepared in accordance with the International Study of Asthma and Allergies in Childhood (ISAAC) core written questionnaire in bronchial asthma (BA) and the West Japan Study of Asthma and Allergies in Childhood core written questionnaire for atopic dermatitis (AD), allergic rhinitis (AR), and food allergy (FA). At the same time, height, weight, duration of dwelling on the island, home environment, lifestyle, and exercise habits were also asked. RESULTS The target population comprised 352 children, of whom 284 (80.6%) completed the questionnaires. The current prevalence was 9.3% for BA, 4.3% for AD, 17.8% for AR, and 3.0% for FA. Significantly lower rates of current BA and AD were observed compared to previous reports from Japan. The percentage of children belonging to sports clubs, and exercising more than 3 times per week at the Ogasawara Islands is higher compared with the national average. CONCLUSIONS The lower prevalence of BA and AD in the Ogasawara Islands implies the influence of differences in the living environment and exercise habits.

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Introduction Atopic dermatitis, also referred to as atopic eczema, infantile eczema, allergic eczema, disseminated neurodermatitis, and prurigo Besnier, is a common and important cause of morbidity in children of all ages. A total of 22% of patients seen in pediatric dermatology clinics have atopic dermatitis. In 1969, Wingert et al reported that 4% of pediatric emergency room visits at the Los Angeles County General Hospital were due to atopic dermatitis, and this did not include patients seen for impetigo, a common complication of atopic dermatitis. The prevalence of atopic dermatitis in the pediatric population has increased over the past 3 decades from 3% to 10%, and it appears to be even higher in heavily populated urban areas. Pediatricians, therefore, must understand its pathogenesis and management. Epidemiology Sixty percent of children who have atopic dermatitis manifest their disease in the first year of life; 90% do so by age 5 years. A genetically prone individual may not manifest the disease until exposed to a particular environmental situation. Onset has been associated with relocation from a rural to an urban location or from a region of high to low humidity. The course of adopic dermatitis is difficult to predict, although one 15-year longitudinal study revealed that the disease persisted in 60% of cases.

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BACKGROUND Food allergies are becoming more prevalent globally. The purpose of this study was to investigate the epidemiology of food allergies in Taiwan. METHODS In 2017, a food allergy questionnaire was administered to 6-7-year-old children, 13-14-year-old adolescents, and their parents in Taipei. The results were compared to those from a previous survey conducted in 2004. RESULTS A total of 16,200 questionnaires were completed, revealing a rise in the prevalence of food allergies from 7.7% to 10.4% in the pediatric group and from 6.4% to 12.5% in the adult group. Peanut allergies also increased to 1.1%. Shrimp and crabs were the most common allergens, with urticaria being the most common symptom. Shortness of breath or wheezing occurred in 10% of individuals, while 2.1% experienced syncope or shock, and 0.1% were admitted to an intensive care unit. Personal history of allergic rhinitis and atopic dermatitis, as well as family histories of food allergies, were risk factors for food allergy in 6-7-year-old children. In the 13-14-year-old group, personal history of asthma, allergic rhinitis, or atopic dermatitis, recent use of acetaminophen, and living with dogs were risk factors. Females, personal histories of asthma, allergic rhinitis, atopic dermatitis, and moist and damp at home were risk factors in adults. Breastfeeding was a protective factor in 6-7-year-old children. CONCLUSION The increasing prevalence of food allergies, including peanut allergies, in Taiwan warrants attention from physicians to provide appropriate care and education to patients with food allergies. The protective effect of breastfeeding against food allergies shall be emphasized.

Background The gestational risk factors predispose to the manifestation of early childhood atopic dermatitis (AD). Objective We evaluated the association between modifiable and non-modifiable gestational and prenatal risk factors that affect the AD prevalence in children. Methods We performed the systematic review and meta-analysis of cohort studies (n=27) in PubMed and EMBASE (2000~2021). A meta-analysis was performed using random-effects models to estimate pooled odds ratios (OR) or hazard ratio (HR). We performed a systematic review according to Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guidelines and summarized cohort studies investigating gestational and prenatal risk factor those predispose to AD in off spring. Leading modifiable and non-modifiable were identified through ORs. Meta-analysis using the random effect model was also conducted to provide an overall estimate for several significant factors. Results Among the non-modifiable risk factors gestational diabetes (7.2, 95% confidence interval [CI]: 1.4~34.5), maternal history of allergy (2.14, 95% CI: 1.54~2.97) and prenatal history of eczema (2.46, 95% CI: 1.0~5.8) were found as major determining risk factors in early manifestation of AD in children. Further, maternal exposure to industrial products (1.89, 95% CI: 1.10~3.16), exposure to antibiotics during pregnancy (3.59, 95% CI: 1.19~10.85) and passive smoking during pregnancy (2.60, 95% CI: 1.11~6.1) are leading causes of early AD manifestation. Conclusion Conclusively, both genetic and environmental factors play a pivotal role in early manifestation of AD. The better managing the environmental factors during gestational phase to the least can help curtail the prevalence of AD in children.

Atopic dermatitis is frequently associated with the onset of other allergic conditions, such as asthma, rhino-conjunctivitis and food allergy. The etiology of atopic dermatitis is marginally understood in spite of the number of predisposing factors, above all, mutations in the Filaggrin gene (FLG). In this study, the association between loss-of-function variants in the FLG gene and other allergic manifestations, in particular food allergy, was evaluated in an Italian pediatric population affected by atopic dermatitis. The 10 more frequently mutated loci in the FLG gene were genotyped in 238 children affected by atopic dermatitis and tested for association with clinical features of allergic disorders by a multivariate logistic regression model. R501X and 2282del4 were the only two mutations identified; 12.2% of children carry one of these variants, corresponding to an allelic frequency of 6.5%. According to multivariate statistical analysis, loss-of-function variants in the FLG gene represent a risk factor for the onset of severe manifestations of food allergy (OR = 8.9; CI: 3.1–28.3). Peanut and hazelnut were identified as high-risk foods in patients with FLG mutations. This study demonstrates that atopic children carrying FLG mutations represent a high-risk population due to their predisposition to develop severe food allergy reactions, such as anaphylaxis.

BACKGROUND A diagnosis of atopic dermatitis (AD) is common during infancy; however, it is unclear whether differential skin barrier development defines this period and signals disease onset in predisposed individuals. OBJECTIVE A longitudinal observational cohort study (NCT03143504) assessed the feasibility of remote skin testing from birth to monitor skin barrier maturation and model association with an AD diagnosis by 12-months of age. METHODS Biophysical testing and infrared spectroscopy were conducted at the maternity ward and family home. Tape stripping collected samples for desquamatory protease and Natural Moisturising factor (NMF) analysis. The four common European Filaggrin (FLG) risk alleles were screened. RESULTS A total of 128 infants completed the study with 20% developing mild disease. Significant changes in permeability barrier function, desquamatory protease activity and molecular composition assessed spectroscopically were observed longitudinally, but only subtle evidence of differential skin barrier development was noted between infant subgroups. Common FLG risk alleles were strongly associated with early onset disease and conferred a significant reduction in NMF and water content by four weeks of age. Accounting for a family history of atopy, these parameters alongside a greater lipid/protein ratio and reduced chymotrypsin-like activity at birth were associated with AD. Measured in ambient conditions, transepidermal water loss did not signal disease risk at any stage. CONCLUSION Skin barrier dysfunction lacked an acquired modality but was considered proportional to cohort severity and suggests that a portfolio of tests used in a community setting, has the potential to improve current AD risk evaluations from birth.

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No abstract available

Objective The objective of this study was to investigate the prevalence of overactive bladder (OAB) and its risk factors related to allergies among children in Northeastern China. Methods A community survey on OAB was conducted in Northeast China from 1 April 2022 to 30 April 2022. The survey targeted children aged 5–14 years and utilized questionnaires. A total of 1,394 children were enrolled, and their parents were requested to fill out a questionnaire to provide basic information about the children. This encompassed details regarding the presence or absence of urgent urination unrelated to urinary tract infection, urinary tract infection, allergic rhinitis, asthma or cough variant asthma, atopic dermatitis, anaphylactic conjunctivitis, urticaria, constipation, and attention deficit hyperactivity disorder (ADHD). The prevalence of OAB was calculated. The chi-squared test was used to analyze OAB-related factors, which were subsequently included in the logistic regression model for multi-factor analysis. Results The overall OAB prevalence was 10.7% (120 of 1,121), including 47 mild cases (39.2%), 71 moderate cases (59.1%), and 2 severe cases (1.7%). OAB prevalence decreased with age (p < 0.05). The risk factors associated with OAB were allergic asthma (OR = 1.87, 95%CI: 1.12–3.13), atopic dermatitis (OR = 2.45, 95%CI: 1.61–3.73), anaphylactic conjunctivitis (OR = 1.61, 95%CI: 1.07–2.42), and urticaria (OR = 1.93, 95%CI: 1.40–2.66). Conclusion OAB prevalence among children in Northeastern China was found to be 10.7%, with its risk factors being allergic asthma, anaphylactic conjunctivitis, urticaria, and atopic dermatitis. The identification of allergy-related risk factors may provide new ideas for the prevention and treatment of OAB.

Background: In the wake of the emerging development of biologics in atopic dermatitis (AD), herpes zoster (HZ) infection has been reported as a treatment-related adverse event. Objectives: This study aims at investigating the association between AD and HZ, and the risk factors within. Methods: 28,677 participants with AD from the Taiwan National Health Insurance Research Database 2000–2015 were enrolled. Risk of HZ infection was compared in the study cohort (with AD) and the control cohort (without AD). Further analyses were conducted in gender-, age-, and treatment strategy-stratified subgroups. Results: Significantly higher adjusted hazard ratios (aHRs) of HZ infection were revealed in AD patients (aHR = 2.303, P < 0.001), and remained this trend in gender- and age-stratified models. All AD groups, irrespective of the treatment type, had higher aHRs (AD without systemic treatment: aHR = 2.356, P < 0.001; AD with systemic treatment: aHR = 2.182, P < 0.001) compared with those without AD. However, no differences in HZ risk were shown between each treatment type. Conclusions: Risk of HZ infection in AD is higher irrespective of treatment type. Considering that AD per se increases susceptibility to HZ infection, the administration of biologics requires careful considerations.

Background It is still unclear whether patients with atopic dermatitis (AD) have an increased risk of developing rheumatoid arthritis (RA). Objective We aimed to investigate the association between AD and risk of RA using systematic review and meta-analysis. Methods We searched Medline and EMBASE up to April 2021 using search strategy, including terms for “atopic dermatitis” and “rheumatoid arthritis.” Eligible cohort study must compare the incidence of RA between patients with AD and comparators without AD. Eligible case-control study must recruit cases with RA and controls without RA. Then, the study must compare the prevalence of AD between the groups. Point estimates with standard errors from each study were combined using the generic inverse variance method. Results The meta-analysis found that AD patients had a significantly higher risk of incident RA than individuals without AD with a pooled odds ratio (OR) of 1.30 (95% confidence interval [CI], 1.17–1.44; I2, 48%). Subgroup analysis revealed a significantly higher risk of RA in cohort study subgroup (pooled OR, 1.37; 95% CI, 1.25–1.50; I2, 63%) but not case-control study subgroup (pooled OR, 0.99; 95% CI, 0.77–1.28; I2, 10%). Conclusions This study found a significantly higher risk of incident RA among AD patients.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin condition influenced by lipid metabolism. Apolipoprotein B (ApoB), a crucial component of lipid transport, may be linked to AD risk, but this relationship has not been extensively studied in large cohorts. Objectives: To investigate the association between ApoB and the risk of developing AD using data from a large, prospective cohort in the UK Biobank (UKB). Methods: The study analyzed 454,974 participants from the UKB, with ApoB measured via blood biochemistry and nuclear magnetic resonance (NMR) spectroscopy. Cox proportional hazard models were used to evaluate the relationship between ApoB and AD risk, adjusting for demographic, lifestyle, and clinical covariates. Restricted cubic spline (RCS) analysis was employed to assess potential nonlinear relationships. Sensitivity analyses included adjusting for lipid-lowering medication use, comparing apolipoprotein A (ApoA) levels, and repeating analyses with NMR-measured ApoB. Results: Higher ApoB levels were significantly associated with a reduced risk of AD (hazard ratio for continuous ApoB: 0.74, 95% confidence interval: 0.64-0.86, P < 0.001). RCS analysis confirmed a linear inverse relationship between ApoB and AD risk (P for overall <0.001; P for nonlinear: 0.803). Sensitivity analyses reinforced these findings, showing consistent results across different measures and adjustments, with no significant association found between ApoA levels and AD. Conclusions: This study establishes a significant inverse association between ApoB levels and AD risk, underscoring the role of lipid metabolism in AD pathogenesis in the UKB population. ApoB might be a potential biomarker or therapeutic target for AD prevention, meriting further investigation.

BACKGROUND Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in both pediatric and adult populations. The development of AD has been linked to antibiotic usage, which causes perturbation of the microbiome and has been associated with abnormal immune system function. However, imbalances in the gut microbiome itself associated with antibiotic usage have been inconsistently linked to AD. OBJECTIVE This study aimed to elucidate the timing and specific factors mediating the relationship between systemic (oral or intravenous) antibiotic usage and AD. METHODS We used statistical modelling and differential analysis to link CHILD participants' history of antibiotic usage and early-life gut microbiome alterations to atopic dermatitis. RESULTS Here we report that systemic antibiotics during the first year of life, as compared to later, are associated with AD risk (adjusted odds ratio (aOR) = 1.81 [95% CI = 1.28 - 2.57], p < 0.001), with an increased number of antibiotic courses corresponding to a dose-response-like increased risk of AD risk (1 course: aOR = 1.67 [95% CI = 1.17 - 2.38]; 2 or more courses: aOR = 2.16 [95% CI = 1.30 - 3.59]). Further, we demonstrate that microbiome alterations associated with both AD and systemic antibiotic usage fully mediate the effect of antibiotic usage on the development of AD (βindirect = 0.072, p < 0.001). Alterations in the 1-year infant gut microbiome of participants who would later develop AD included increased Tyzzerella nexilis, increased monosaccharide utilization, and parallel decreased Bifidobacterium, Eubacterium spp., and fermentative pathways. CONCLUSION Our findings indicate that early-life antibiotic usage, especially in the first year of life, modulates key gut microbiome components that may be used as markers to predict and possibly prevent the development of AD.

Chronic systemic inflammation is a recognized risk factor for cardiovascular disease. Atopic dermatitis (AD) has been associated with multiple comorbidities.1 However, risk of major adverse cardiovascular events (MACE) among patients with moderate-to-severe AD is not well understood in the US population. To characterize risk of MACE in patients with AD vs matched controls without AD (non-AD) and patients with rheumatoid arthritis (RA). To evaluate the effect of disease activity, analyses were repeated in patients with moderate-to-severe disease. In this retrospective analysis of US administrative claims data from Optum's Clinformatics Data Mart, eligible patients were aged ≥18 years with diagnosed AD (≥2 claims for AD or ≥1 claim for AD or eczema with asthma and/or hay fever, food allergies, or allergic rhinitis) from 03/2017–03/2023. The date of the first qualifying disease diagnosis was defined as the cohort entry date. Comparator groups included non-AD controls (matched 1:1 by age, sex, and cohort entry) and patients diagnosed with RA (≥2 claims ≥7 days apart; diagnostic codes identified by rheumatologists). Patients were classified as having moderate-to-severe disease if they received dupilumab for AD or advanced systemic therapy for RA at any time during the follow-up period. Patients with moderate-to-severe AD were also matched to a non-AD control cohort. The crude incidence of MACE, defined as inpatient hospitalization with myocardial infarction or stroke, was quantified. Relative risk was calculated using multivariable Cox proportional hazards model adjusted for baseline demographics, comorbidities, and medication use. This analysis included 391,753 patients with AD (7136 with moderate-to-severe AD) and 97,445 patients with RA (35,846 with moderate-to-severe RA). The matched AD and non-AD cohorts included 381,221 patients each; the matched moderate-to-severe AD and non-AD cohorts comprised 7134 patients each. Mean (SD) age in years at cohort entry was 58.0 (18.8) for AD, 67.0 (13.6) for RA, and 58.1 (18.8) for non-AD controls. Incidence of MACE (per 100 patient-years) in patients with AD (1.78 [95% CI 1.76, 1.81]) was similar to non-AD matched controls (1.83 [1.80, 1.86]) and lower vs patients with RA (2.12 [2.07, 2.17]). Patients with moderate-to-severe AD had a lower MACE incidence (1.18 [95% CI 1.01, 1.35]) than non-AD matched controls (1.52 [1.33, 1.74]) and patients with moderate-to-severe RA (1.67 [1.59, 1.75]). The relative risk of MACE in patients with AD was lower vs non-AD controls (adjusted hazard ratio [aHR] [95% CI]: 0.91 [0.89, 0.93]) and patients with RA (0.83 [0.80, 0.85]). Among patients with moderate-to-severe AD, MACE risk was similar to non-AD matched controls (aHR [95% CI]: 0.92 [0.73, 1.14]) and lower vs moderate-to-severe RA (0.83 [0.73, 0.94]). MACE risk in AD was greater in patients who were older (per year, aHR [95% CI]: 1.05 [1.05, 1.05]), male (1.23 [1.19, 1.27]), Black vs White (1.16 [1.11, 1.21]), received systemic corticosteroids in the 3 months before diagnosis (1.10 [1.06, 1.14]), hospitalized in the year before diagnosis (1.35 [1.30, 1.41]); and had history of smoking (1.20 [1.16, 1.24]) and drug abuse (1.34 [1.25, 1.43]). History of cardiovascular disease and other comorbidities were significantly associated with increased MACE risk. Among patients with AD, the risk of MACE was lower than the risk in non-AD matched controls and patients with RA. Among patients with moderate-to-severe AD, the risk of MACE was similar to the risk in non-AD matched controls but lower than the risk in moderate-to-severe RA. Patients with AD had an increased MACE risk if they were older, male, Black, hospitalized in the year before diagnosis; and had a history of smoking/drug abuse, cardiovascular disease, and other comorbidities. Characterizing the underlying MACE risk in AD can inform treatment benefit-risk assessments.

Objective This study aimed to construct a multi-dimensional risk prediction model for atopic dermatitis (AD) by integrating the maternal-fetal immune axis, genetic risk factors, and environmental exposures. Methods The study prospectively enrolled 503 full-term newborns, with parental allergic history collected via questionnaire, maternal/cord blood biomarkers (IL-4, IL-13, IL-31, IL-33, IgE, TSLP) quantified by ELISA, and dust mite exposure dynamically assessed through quarterly standardized sampling. A 1-year follow-up was conducted to assess AD incidence in the neonatal cohort. Variables were screened via univariate analysis, LASSO regression and multivariable logistic regression to construct a nomogram model, with performance evaluated by ROC curve, calibration curve, Hosmer-Lemeshow test, triple cross-validation (repeated 10-fold, leave-one-out and bootstrap), and decision curve analysis. Results A total of 456 infants were finally included (106 infants in the AD group and 350 infants in the non-AD group). Through a multi-stage screening process, 6 risk factors were identified, including cord blood IgE and TSLP, maternal blood IL-4 and IL-33, mother with allergic history, and dust mite exposure levels; subsequently, a predictive model was constructed based on these factors. Upon evaluation, the model showed good discriminatory ability, calibration degree, robustness, and clinical applicability. Conclusions Cord blood IgE and TSLP, maternal blood IL-4 and IL-33, mother with allergic history, and dust mite exposure levels have shown good predictive value for AD. However, multicenter studies will be required to verify the universality of the model.

Abstract: Background : A higher fracture risk has been reported previously in patients with atopic Dermatitis (AD). The bone mineral density (BMD) was not accounted for in these studies. Objective: To investigate the fracture risk in AD patients after adjustment for factors including BMD. Methods: We retrospectively analyzed AD patients (≥45 years) who underwent BMD examination at our hospital from July 2010 to February 2023. Individuals who received BMD examinations during a health checkup were identified as the controls. We documented their clinical characteristics, BMD, 10-year risk for a major fracture based on FRAX (Fracture Risk Assessment Tool), and development of osteoporotic fractures. Patients were followed until development of new onset fracture or the end of the study period. A cross-sectional comparison of BMD between AD patients and controls at baseline was performed using the Mann–Whitney U test after propensity score matching (PSM). Their fracture risks were compared using the multivariate Cox regression model. BMD and fracture risk were also compared between AD patients who received systemic therapy and those who did not. Results: A total of 50 AD patients and 386 controls were enrolled. The median age was older in AD patients when compared with controls (70 years vs 60 years). Their BMD at all sites was similar after PSM. After a median follow-up of 1.7–2.0 years, 13 osteoporotic fractures were identified. In the multivariate Cox regression analysis, AD was not associated with new onset fractures of all sites (adjusted hazard ratio [aHR] 2.55, 95% confidence interval [CI] 0.72–9.01) but was significantly associated with new onset vertebral fractures (aHR 6.80, 95% CI 1.77–26.17). The BMD and incidence of fractures were similar between AD who received systemic therapy and those who did not. Conclusions: Elderly AD patients had similar BMD but a higher short-term risk for vertebral fractures when compared with the controls.

BACKGROUND The rise in prevalence of atopic dermatitis has been correlated with numerous elements of the exposome, modern-day lifestyle, and familial history. The combined analysis of familial history and other risk elements may allow us to understand the driving factors behind the development of atopic dermatitis. OBJECTIVE We aimed to develop prediction models to assess the risk of developing atopic dermatitis using a large and diverse cohort (N=77,525) and easily-assessed risk factors. METHODS We analyzed electronic medical record data from Leumit Health System. Documented predictive factors include sex, season of birth, environment (urban/rural), socio-economic status, household smoking, diagnosed skin conditions, number of siblings, a paternal, maternal or sibling history of an atopic condition, and antibiotic prescriptions during pregnancy or following birth. Predictive models were trained and validated on the dataset. RESULTS Medium (OR 2.04, CI 1.92-2.17, p<0.001) and high (OR 2.13, CI 1.95-2.34, p<0.001) socioeconomic status, a previous diagnosis of contact dermatitis (OR 2.57, CI 2.37-2.78, p<0.001), presence of siblings with an AD diagnosis (OR 2.21, CI 2.04-2.40, p<0.001) and the percentage of siblings with any atopic condition (OR 2.58, CI 2.09-3.17, p<0.001) drove risk for AD in a logistic regression model. A random forest prediction model with a sensitivity of 61% and a specificity of 84% was developed. Generalized mixed models accounting for the random effect of familial relationships boasted an area under the curve of 0.98. CONCLUSION Predictive modeling using non-invasive and accessible inputs is a powerful tool to stratify risk for developing atopic dermatitis.

Background: Atopic dermatitis (AD) and chronic spontaneous urticaria (CSU) represent two of the most common chronic inflammatory pruritic skin diseases. Any relationship between atopic skin disorders and CSU is controversial, mostly due to the paucity of relevant epidemiologic and pathogenetic data. Objective: To evaluate whether a history of AD in early childhood represents a risk factor for the subsequent occurrence of CSU in a pediatric population. Methods: Retrospective data of new cases of patients who visited the outpatient allergy unit of a tertiary pediatric hospital in Athens, Greece, between June 2014 and August 2016, were analyzed. Diagnoses of CSU and AD were based on diagnostic criteria proposed by the European Academy of Allergy and Clinical Immunology and the Hanifin and Rajka criteria, respectively. The data analyzed included CSU and AD diagnoses and the association with gender and season of birth as well as a personal and family history of allergy-related diseases (e.g., asthma, allergic rhinitis, AD, and food and drug allergies). Results: Records from 2261 children were included in the analysis (1365 boys; mean ± standard deviation [SD] age, 8.7 ± 5.8 years). Fifty-one children (31 boys; mean ± SD age, 9.1 ± 4.6 years) were diagnosed with CSU, whereas AD was reported in 761 children (466 boys; mean ± SD age, 5.2 ± 3.8 years). Multivariate data analysis showed that the children with a history of an early diagnosis of AD were at increased risk for later CSU occurrence (odds ratio 2.923 [95% confidence interval, 1.647-5.189], p < 0.001). No significant associations were observed with respect to other demographic and atopy-associated characteristics of the patients. Conclusion: Results of our study indicated that AD may constitute an important risk factor to the subsequent occurrence of CSU. This notion warrants further study with well-designed prospective cohorts.

BACKGROUND Knowledge of risk factors in early childhood predisposing to moderate-severe persistent asthma (MS-Asthma) in later childhood are needed. OBJECTIVE To identify the risk factors for MS-Asthma at 5-11 years in children with early-onset atopic dermatitis (AD). METHODS Electronic health records identified a birth cohort to 11 years of 10,688 children with AD onset between birth and age 36 months. ICD-9/10 coded visits and laboratory data to 36 months were used to detect potential child and maternal risk factors for MS-Asthma. MS-Asthma was defined as GINA-step care level of ≥3 for ≥4 years from ages 5-11 years. Robust Poisson regression determined risk ratios for MS-Asthma. RESULTS Compared to children who did not develop MS-Asthma (N=10,168), those developing MS-Asthma (N = 520, 4.9%) from 5-11 years were significantly (P<.01) more likely to be male, of non-Hispanic Black ethnicity, preterm, not-exclusively breast-fed for 1-month, and up to age 3 years have more perinatal respiratory disorders and respiratory infections, food allergy, allergic rhinitis, asthma, allergic sensitizations, and elevated blood eosinophil levels. Mothers of children with MS-Asthma had significantly more comorbidities and antibiotics dispensed, and less pre-existing diabetes (P<.001). Significant adjusted risk factors observed prior to 36 months associated with increased MS-Asthma at 5-11 years included: food allergy; ≥6 AD medication dispensings; nasal corticosteroid dispensing, and number of dispensings of inhaled short-acting beta-agonists, montelukast, and inhaled corticosteroids. Significant protective risk factors were 1-month exclusive breastfeeding and pre-existing maternal diabetes. CONCLUSIONS Risk models for MS-Asthma in latter childhood were developed based on early childhood and maternal factors using administrative data.

Abstract: Background: Atopic dermatitis (AD) has the highest burden of any skin disease; however, the severity-associated factors remain unclear. Objective: To evaluate potential severity-associated factors of AD and to design and validate a severity prediction model to inform the management of AD patients. Methods: A cross-sectional study of 900 AD patients was conducted from December 2021 to October 2022 at our hospital. The primary outcome was disease severity, categorized as mild, moderate, or severe using the scoring atopic dermatitis index. Ordinal logistic regression and bootstrapped validation were used to derive and internally validate the model. Results: Increasing age, elevated eosinophil level, higher economic status, and urban residence were associated with severe AD. Breastfeeding, disinfectants and topical emollients use, and short duration of bathing were associated with mild AD. In the prediction model, predictors included age, eosinophil and economic status, residence, feeding, disinfectants and emollients use, and duration of bathing. Prediction models demonstrated good discrimination (bias-corrected concordance index [c-index] = 0.72) and good calibration. Conclusion: Risk factors for the severity of AD were identified that could aid the early prediction of AD progression. The predictive model included variables that are easily evaluated and could inform personalized prevention and therapy.

Background Previous observational studies have shown an association between asthma, atopic dermatitis (AD) and rheumatoid arthritis (RA). However, the bidirectional cause-effect chain between asthma and AD and RA has not been proven yet. Methods We performed bidirectional two-sample Mendelian randomization (TSMR) and selected single nucleotide polymorphisms (SNPs) associated with asthma, AD, and RA as instrumental variables. All of the SNPs were obtained from the latest genome-wide association study in Europeans. Inverse variance weighted (IVW) was the main method used in MR analysis. MR-Egger, weighted model, simple model, and weighted median were used for quality control. The robustness of the results was tested by sensitivity analysis. Results Asthma was found to be the largest effect size for RA susceptibility using the IVW method (OR, 1.35;95%CI, 1.13–1.60; P , 0.001), followed by AD (OR, 1.10;95%CI, 1.02–1.19; P , 0.019). In contrast, there was no causal relationship between RA and asthma (IVW: P  = 0.673) or AD (IVW: P  = 0.342). No pleiotropy or heterogeneity was found in the sensitivity analysis. Conclusion Findings from this study showed a causal relationship between genetic susceptibility to asthma or AD and increased risk of RA, but do not support a causal relationship between genetic susceptibility to RA and asthma or AD.

Skin bacterial infections are often observed in eczema patients, but the risk factors are not fully understood. The current study evaluated the prevalence of clinically suspected bacterial infection and its associated risk factors. Moreover, we investigated the practice of skin infection diagnosis in China. A hospital-based, multicenter, cross-sectional epidemiologic survey of bacterial infection was performed in a total of 6208 outpatients diagnosed with dermatitis and eczema from 39 tertiary hospitals of 15 provinces and municipalities in China. All patients completed a specific questionnaire regarding their demographic characteristics, disease duration, distribution of lesions, severity of itching, and medical history. Univariate analysis and multivariate analysis were used to evaluate risk factors associated with bacterial infection in patients with different types of eczema. The prevalence of clinically suspected bacterial infection was 47.0% in patients with eczema. Compared to atopic dermatitis, widespread eczema (OR = 1.50, P < 0.001) and other eczema (OR = 1.42, P < 0.001) were more likely to suffer bacterial infection. The itching grade was positively associated with the infection (OR = 2.11, 7.04, and 12.3 in patients with mild, moderate, and severe itching, respectively; P < 0.001). Lesion distribution in the cubital fossa, popliteal fossa, ear, shoulder and back, axillary, foot, and pudendum was positively associated with bacterial infection (all OR > 1.0, P < 0.05). In contrast, the face and abdomen were reversely associated with bacterial infection (OR < 1.0, P < 0.005). History of asthma, allergic rhinitis, allergic conjunctivitis, atopic dermatitis, infantile eczema, and flexion dermatitis was positively associated with bacterial infection (all OR > 1.0, P < 0.005), while the history of dry skin was reversely associated with bacterial infection (OR = 0.76, 95% CI: 0.64-0.90; P = 0.002). Patients with eczema were easily infected with bacteria. Widespread eczema and other eczema were more likely to have bacterial infection than atopic dermatitis. The high rate of infection may attribute to the lack of corresponding bacterial detection, suggesting the need of guideline development in China to prevent overuse of topical antibiotics.

Eczema distribution in girls and boys during infancy: A cohort study on atopic dermatitis Kim M.A. Endre, MD, Linn Landrø, MD, PhD*, Marissa LeBlanc, PhD*, Petter Gjersvik, MD, PhD, Karin Lødrup Carlsen, MD, PhD, Guttorm Haugen, MD, PhD, Gunilla Hedlin, MD, PhD, Christine M. Jonassen, PhD, Björn Nordlund, RN, PhD, Knut Rudi, PhD, Håvard O. Skjerven, MD, PhD, Anne Cathrine Staff, MD, PhD, Cilla Söderhäll, PhD, Riyas Vettukattil, MBBS, PhD, and Eva Maria Rehbinder, MD, PhD

Despite growing awareness on hand eczema (HE) in Western countries, public attention to HE in China is limited. We aimed to investigate the clinical characteristics of HE and examine its association with atopic dermatitis (AD) in the Chinese population. A multicenter cross-sectional study was conducted across 23 tertiary hospitals in China, between September 2018 and November 2019. HE patients completed a survey covering demographics, allergic diseases, HE-specific characteristics, and underwent patch testing. Clinical severity was assessed using the Hand Eczema Severity Index (HECSI). Binary logistic and linear regression models were used. In total 2,072 HE patients were included (mean age 39.8 years, 60.6% female). The most common HE subtype was allergic contact dermatitis, followed by irritant contact dermatitis. One-third had moderate-to-very severe HE, and at least 64.3% had chronic HE. The positive patch test rate was 50.7%. Approximately one-quarter had a physician-confirmed diagnosis of AD, that was associated with greater HE severity, longer persistence of HE, higher disease burden, and altered contact sensitization patterns in HE patients. This study indicates that addressing both HE and AD might improve prognosis, and quality of life for affected individuals, emphasizing the need for targeted preventions and management strategies for this patient population.

Objectives: Atopic dermatitis is a chronic inflammatory skin condition with a multifactorial etiology involving genetic, environmental, and immunologic influences. Although several mechanisms have been proposed, the potential association between ABO/Rh blood groups and the risk of developing atopic dermatitis is still uncertain. The present study sought to investigate the distribution of ABO and Rh blood groups in individuals with atopic dermatitis compared with healthy, age- and sex-matched controls. Methods: A retrospective analysis was performed covering a 10-year interval (2014–2024). The study included 3,470 patients diagnosed with atopic dermatitis and 7,449 matched controls, yielding a total sample of 10,919 individuals. Demographic data and blood group characteristics (ABO and Rh typing) were collected and evaluated. Results: The O Rh– phenotype was observed significantly more often in patients with atopic dermatitis than in controls (5.2% vs. 3.5%; OR=1.52, 95% CI: 1.25–1.85; P<0.001). Conversely, the A Rh– blood group was notably less frequent in atopic dermatitis patients compared with the control group (3.7% vs. 4.7%; OR=0.79, 95% CI: 0.64–0.96; P=0.021). Conclusions: The findings indicate that the general distribution of ABO and Rh blood groups among patients with atopic dermatitis is comparable to that of healthy individuals. However, the increased prevalence of the O Rh– type and the lower frequency of A Rh– among atopic dermatitis patients suggest that specific blood group antigens may influence susceptibility to atopic dermatitis. Future large-scale, multicenter, and prospective studies are required to further elucidate this potential relationship.

BACKGROUND Most previous research on the environmental epidemiology of childhood atopic eczema, rhinitis and wheeze is limited in the scope of risk factors studied. Our study adopted a machine learning approach to explore the role of the exposome starting already in the preconception phase. METHODS We performed a combined analysis of two multi-ethnic Asian birth cohorts, the Growing Up in Singapore Towards healthy Outcomes (GUSTO) and the Singapore PREconception Study of long Term maternal and child Outcomes (S-PRESTO) cohorts. Interviewer-administered questionnaires were used to collect information on demography, lifestyle and childhood atopic eczema, rhinitis and wheeze development. Data training was performed using XGBoost, genetic algorithm and logistic regression models, and the top 15 variables with the highest importance based on Shapley values were identified. Additive explanation values were identified and inputted into a final multiple logistic regression model. Generalised structural equation modelling with maternal and child blood micronutrients, metabolites and cytokines was performed to explain possible mechanisms. RESULTS The final study population included 1151 mother-child pairs. Our findings suggest that these childhood diseases are likely programmed in utero by the preconception and pregnancy exposomes through inflammatory pathways. We identified preconception alcohol consumption and maternal depressive symptoms during pregnancy as key modifiable maternal environmental exposures that increased eczema and rhinitis risk. Our mechanistic model suggested that higher maternal blood neopterin and child blood dimethylglycine protected against early childhood wheeze. After birth, early infection was a key driver of atopic eczema and rhinitis development. CONCLUSION Preconception and antenatal exposomes can programme atopic eczema, rhinitis and wheeze development in utero. Reducing maternal alcohol consumption during preconception and supporting maternal mental health during pregnancy may prevent atopic eczema and rhinitis by promoting an optimal antenatal environment. Our findings suggest a need to include preconception environmental exposures in future research to counter the earliest precursors of disease development in children.

Background Atopic eczema onset is described primarily in early childhood, and the frequency and characteristics of adult-onset disease remain controversial. Objective We sought to determine the proportion of subjects who report atopic eczema symptoms between birth and midadulthood and to examine demographic, immunologic, and genetic factors associated with period of symptom onset. Methods We conducted a longitudinal study using data from 2 nationally representative community-based birth cohorts from the United Kingdom: the British Cohort Studies 1958 and 1970. Subjects were followed from birth through age 42 to 50 years. The primary outcome was the age period of self-reported atopic eczema symptom onset based on repeated measures of self-reported atopic eczema at each survey wave. Results The annual period prevalence of atopic eczema ranged from 5% to 15% in 2 cohorts of more than 17,000 participants each followed from birth through middle age. There was no clear trend in prevalence by age, and among adults reporting active atopic eczema during a given year, only 38% had symptom onset reported in childhood. When compared with subjects whose eczema started in childhood, those with adult-onset disease were more likely to be women, from Scotland or Northern England, of lower childhood socioeconomic group, smokers in adulthood, and less likely to have a history of asthma. In a subanalysis using data from the 1958 cohort only, genetic mutations previously associated with atopic eczema, including filaggrin-null mutations, and allergen-specific IgE were more common among those with childhood-onset disease. Conclusion Rates of self-reported atopic eczema remain high after childhood, and adult-onset atopic eczema has different risk factor associations than childhood-onset eczema.

Abstract: Atopic dermatitis (AD) presents with a wide range of clinical manifestations with variable distribution, morphology, chronicity, and severity that may differ across ethnic and racial groups. A scoping literature review was conducted and included all studies of the clinical manifestations of adult AD in diverse populations. Promoting awareness of the heterogeneous clinical manifestations of AD may benefit the diagnosis, treatment, and characterization of eczema.

Objective: This study aimed to assess the knowledge, attitude, and practices (KAP) of parents regarding atopic dermatitis and to identify associated demographic factors. Methods: A cross-sectional study was conducted among parents in the Al-Baha region, Saudi Arabia. A structured questionnaire was used to collect data on demographic characteristics and KAP related to eczema. Participants were recruited through community centers, schools, and healthcare facilities. Results: The study included 372 parents, with a majority demonstrating moderate to adequate knowledge about atopic dermatitis (65.6%). Most participants were aware that eczema is not contagious (65.6%) and identified itching and rash as primary symptoms (93.8%). However, knowledge gaps were noted regarding its comorbidities (38.2%) and treatment availability (50.3%). Proactive practices, such as regular doctor visits (79.8%), were common, though some participants used alternative remedies (3.8%). Positive attitudes towards children's capabilities were observed but concern about social acceptance and financial burdens persisted. Employment status and prior awareness of eczema were significantly associated with higher knowledge levels (p < 0.05). Conclusion: The findings highlighted adequate parental knowledge and generally positive attitudes toward eczema management, with room for improvement in understanding comorbidities and treatment options. Targeted educational programs and community-based support initiatives are needed to address knowledge gaps and enhance management practices. These efforts could alleviate the condition's social and emotional impact, improving outcomes for affected children.

Background/Objective: Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by diverse clinical manifestations. However, variations in its clinical presentations across different ages, genders, anatomical sites, and seasons remain incompletely understood. The objective was to explore the clinical heterogeneities of AD using data from the Chinese non-selective registration system. Methods: A prospective analysis was conducted on 3829 AD patients enrolled in the Chinese Non-selective Registry for AD (CNRAD) at hospital settings from 2020 to 2022. Demographic profiles; distribution, type, and severity of the skin lesion; laboratory findings; allergic comorbidities; family history; and exacerbating factors were analyzed. Results: The male-to-female ratio was 0.92 among adolescent and adult AD patients but increased to 2.11 in elderly AD patients, highlighting an age-dependent gender difference in AD prevalence. Age groups displayed distinct anatomical preferences for lesion distribution, with reduced involvement of the cubital and popliteal fossae in adult and elderly patients. Based on skin lesion characteristics, ten clinical subtypes of AD were proposed. Elderly AD patients exhibited higher severity, compared to adolescence and adult AD patients, with male patients being more severe than females. Elderly AD patients showed a lower proportion of extrinsic type, compared to childhood AD patients. Seasonal change emerged as the most important factor triggering AD flares. Conclusions: This study provides new insights into the heterogeneities of AD clinical manifestations in the Chinese population, demonstrating their significant dependence on temporal factors, including age and season.

BACKGROUND Atopic dermatitis (AD) is the most common pediatric atopic disease and a risk factor for food allergy (FA) development. Children with AD are prone to developing allergic comorbidities. its relationship with FA phenotype and timing of onset remains unclear. OBJECTIVE To examine associations between AD presence and onset timing with FA-related outcomes and atopic comorbidities. METHODS FORWARD is a longitudinal, multi-center study enrolling children aged <12 years with physician-diagnosed FA between (2017-2024). Written informed consent was obtained. Data collected from baseline survey and electronic medical records (EMR). Logistic regression models adjusted for demographic and socioeconomic factors assessed associations between AD with FA number, type of allergens and atopic comorbidities. RESULTS Among 1,309 children with physician-diagnosed food allergy (FA), 77% reported history of AD. with 30.3% between 1-3 months,50.2%, 4-12 months and 19.5% after 12 months. Multiple FAs, asthma, and allergic rhinitis were each associated with higher odds of AD. late-onset AD was associated to lower odds of multiple food allergies compared with early-onset AD (OR 0.57, 95% CI 0.38-0.85), including lower odds of milk and egg allergy. Conversely, late-onset AD was associated with higher odds of asthma and allergic rhinitis. CONCLUSION Among children with food allergies 77% report a history of AD, with over 80% of children with FA developed AD within the first year of life. Children with multiple FAs and those allergic to milk and egg are more likely to develop AD on earlier age onset while asthma and allergic rhinitis were associated with late-onset AD.

This study was conducted to assess clinico-epidemiological features of atopic dermatitis (AD) in children and evaluate disease severity using the SCORing atopic dermatitis index (SCORAD Index). This was a hospital-based cross-sectional study carried out at the department of Dermatology at a tertiary care centre in North India over a period of 1 year. This study enrolled children aged between 3 months and 16 years of age clinically diagnosed with AD using Hanifin and Rajka criteria (HRC). The prevalence of AD was found to be 8.12%. Age of presentation ranged from 4 months to 16 years of age, with a mean age of 4.18 ± 3.88 years. 42% of patients had personal and 52.50% of patients had a family history of atopy. We report pruritus as a major presenting symptom seen in 100% of children with AD. Typical morphology and distribution were observed in 97.50% of cases, with the face being the most commonly affected site in infants (95.08%) and flexural involvement more common in children (77.70%). Infants had acute eczema (63.93%) and children with AD mostly presented with chronic eczematous lesions (58.27%). The most common minor feature of HRC observed was xerosis, seen in 94% of patients. Amongst atypical features, scalp scaling was the most common feature seen in 17%. SCORAD Index grading was mild in 49.50% of children with AD, moderate in 40.50% and severe grading was seen only in 10% of children. Clinical features, prevalence and severity of AD are affected by various geographical, environmental and local factors such as lifestyle, clothing and eating/dietary factors.

BACKGROUND Atopic dermatitis (AD) is associated with skin lesions, multiple symptoms, and effect of quality of life, all of which factor into disease severity. Self-reported global AD severity may be a valid severity assessment for epidemiologic research. OBJECTIVE To validate self-reported global AD severity in a representative cohort of adults with AD. METHODS Preliminary probing-cognitive interviews were performed (n = 8). Next, a cross-sectional US population-based survey study of adults with AD was performed. AD was diagnosed using an adap/tation of the UK Working Party criteria (n = 602). AD severity was assessed using self-reported global AD severity (mild, moderate, severe), Patient-Oriented Scoring AD (PO-SCORAD), Patient-Oriented Eczema Measure (POEM), Numeric Rating Scale (NRS)-itch, NRS-sleep, NRS-pain, and Hospital Anxiety and Depression Scale (HADS). RESULTS Self-reported global AD severity had good content validity. Self-reported global AD severity had strong correlations with PO-SCORAD (Spearman correlation ρ = 0.61) and objective PO-SCORAD (ρ = 0.61); moderate correlations with POEM (ρ = 0.54), NRS-itch (ρ = 0.44), NRS-pain (ρ = 0.46), and HADS (ρ = 0.41); and weak correlation with NRS-sleep (ρ = .32) (P < .001 for all). Consistent and significant correlations were observed in stratified analyses by age, sex, race/ethnicity, and level of education. There were stepwise increases of PO-SCORAD, NRS-itch, NRS-sleep, NRS-pain, POEM, and HADS with increasing self-reported global AD severity (Kruskal-Wallis test, P < .01). There was weak-moderate concordance between self-reported AD severity and established severity strata for PO-SCORAD (ρ = 0.44), NRS-itch (ρ = 0.30), and POEM (ρ = 0.43). Rather, self-reported global AD severity was best predicted by a combination of PO-SCORAD, POEM, NRS-itch, NRS-pain, and HADS. No differential item reporting was found by age, sex, or race/ethnicity. CONCLUSION Self-reported AD severity simultaneously assesses multiple AD constructs and appears to be sufficiently valid for assessing AD severity in clinical and epidemiologic studies.

Dietary fiber intake may influence the risk and severity of atopic dermatitis (AD), a common chronic allergic skin condition. This cross-sequential study investigated the association between dietary fiber intake and various characteristics of AD, including house dust mites (HDM) allergy and dry skin, in 13,561 young Chinese adults (mean years = 22.51, SD ± 5.90) from Singapore and Malaysia. Dietary habits were assessed using a validated semi-quantitative, investigator-administered food frequency questionnaire from the International Study of Asthma and Allergies in Childhood. We derived an amount-based dietary index to estimate fiber intake while studying its correlation with probiotic drinks intake. AD status was determined by skin prick tests for HDM and symptomatic histories of eczema. Multivariable logistic regression analysis, adjusting for demographic, genetic predisposition, body mass index and lifestyle factors, and synergy factor analysis were used to explore the association and interaction of dietary factors on disease outcomes. High fiber intake (approximately 98.25 g/serving/week) significantly lowered the associated risks for HDM allergy (Adjusted Odds Ratio [AOR]: 0.895; 95% Confidence Intervals [CI]: 0.810–0.989; adjusted p-value < 0.05) and AD (AOR: 0.831; 95% CI: 0.717–0.963; adjusted p-value < 0.05), but not dry skin. While probiotic intake was not associated with AD, it was significantly correlated with fiber intake (R2 = 0.324, p-value < 0.0001). Among those frequently consuming probiotics, moderate fiber intake sufficiently lowered the AD risk (AOR: 0.717; 95% CI: 0.584–0.881; adjusted p-value < 0.01). Moreover, a fibre-rich diet independently mitigated risks associated with high intake of fats, saturated fats, and protein. A high-fiber diet is associated with AD and HDM allergy. Moderate-to-high fiber intake, particularly in conjunction with probiotics, may further mitigate AD risks.

Background The prevalence of eczema has increased with industrialization. Industrial practices generate ambient air pollution, including fine particulate matter of diameter ≤ 2.5μm (PM2.5). Studies investigating the relationship between PM2.5 and eczema in the US are scarce. The objective of this study was to determine the risk of eczema with PM2.5 exposure in a diverse national cohort of American adults. Methods In this cross-sectional study, eczema cases in the All of Us Research Program were linked via three-digit zip code to average annual PM2.5 concentrations from the Center for Air, Climate, and Energy Solutions. Eczema cases and controls were compared using Pearson’s χ2 test for categorical variables and one-way analysis of variance for continuous variables. The relationship between PM2.5 and eczema was assessed via logistic regression adjusting for demographic factors, smoking, and atopic comorbidities. Results Individuals with eczema (n = 12,695) lived in areas with significantly higher PM2.5 concentrations than did individuals without eczema (n = 274,127) (0.83 x 10 μg/m3 v. 0.81 x 10 μg/m3, P < .001). PM2.5 concentration was significantly associated with eczema in univariable analysis (odds ratio 1.97, 95% confidence interval 1.77–2.19, P < .001), and in multivariable analyses, both controlling for demographics and smoking status (odds ratio 2.21, 95% confidence interval 1.98–2.47, P < .001) and with the addition of atopic comorbidities (odds ratio 2.38, 95% confidence interval 2.12–2.67, P < .001). Conclusions The odds of eczema increased with greater PM2.5 concentration in this large, diverse, adult American cohort. Ambient air pollution is an environmental hazard that influences inflammatory skin disease, suggesting possible targeted interventions.

Abstract Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease, placing a significant burden on patients’ quality of life (QoL). The validated Atopic Dermatitis Control Tool (ADCT) is recommended to assess AD control in adults. The aim of this study was to assess AD control and explore associations with demographic characteristics, patient-reported outcome measures (PROMs), and treatment. Methods: In this cross-sectional study, questionnaires were sent to 2,066 adults from two tertiary referral centers who had previously physician-diagnosed AD and had visited the outpatient clinic at least once between 2020 and 2022. Questionnaires were completed between May and October 2022. AD control was assessed by the ADCT, with a score ≥7 indicating uncontrolled AD. AD severity, QoL, and weekly average pruritus were simultaneously measured using the Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), and numeric rating scale (NRS), respectively, with higher scores indicating more severe symptoms. Moreover, treatment-related questions were included. Associations between uncontrolled AD, age, sex, and treatment were explored using multivariate logistic regression analysis. Results: In total, 863 patients (41.8%) filled out the questionnaire and 812 were included in the analysis, of which 59% reported controlled AD. Uncontrolled AD was associated with higher PROM scores and receiving topical anti-inflammatories only (adjusted odds ratio [95% confidence interval] ranged from 1.33 [0.995–1.88] to 2.55 [2.21–2.86]). Of those treated with topical anti-inflammatories only, 54% reported uncontrolled AD. Conclusion: The majority of the patients reported controlled AD. Patients with uncontrolled AD often reported more severe symptoms and were more likely to receive topical anti-inflammatories only. It could be considered to shift patients with uncontrolled AD from topical to systemic treatment. Plain Language Summary Atopic dermatitis (AD) is a common chronic skin disease that affects up to 10% of adults. The burden of AD is not only limited to skin symptoms but also sleep disturbances, mental health effects, declined work productivity, which leads to a general decrease in quality of life. Recently, the Atopic Dermatitis Control Tool (ADCT) was recommended for comprehensively assessing disease control in adults with AD. However, little is known about the use of ADCT in daily practice. In this study, by sending questionnaires to 2,066 adult patients with previously physician-diagnosed AD, we evaluated disease control in adult AD patients using the ADCT in daily practice and assessed its association with age, sex, disease severity, quality of life, itch, and treatment. It was found that around 60% of the patients perceived their AD as controlled. Uncontrolled AD was associated with more severe AD, worse quality of life, increased itchiness, and was more likely to be treated with topical anti-inflammatory agents only. Females were more likely to report uncontrolled AD than males, probably due to their limited use of systemic treatments. Additionally, the ADCT could contribute to switching patients with uncontrolled AD from topical to systemic treatment.

Objectives Atopic skin plays a significant etiological role in the development of prurigo nodularis (PN). In addition to atopic dermatitis (AD), atopic skin diathesis without eczema can also contribute to the development of PN due to its association with itching. This study aims to evaluate PN in terms of AD/atopic skin diathesis, associated comorbidities, and clinical findings. Methods Patients diagnosed with PN based on clinical and histopathological findings between 2014 and 2024 were included in the study. Associated diseases that could contribute to the etiology of pruritus were recorded as comorbidities. The diagnosis of AD was evaluated using the Hanifin-Rajka’s diagnostic criteria and atopic skin diathesis using the Erlangen Atopy Score. Patients were classified as atopic and non-atopic groups, and these groups were compared in terms of demographic and clinical findings. Results The study included a total of 47 patients, of whom 15 (31.9%) were male and 32 (68.1%) were female. At least one comorbidity was identified in 89.4% (n=42) of the patients, and multiple comorbidities were found in 34% (n=16). Atopic dermatitis and/or atopic skin diathesis were present in 55.3% (n=26) of the patients. Among these, 53.8% (n=14) were diagnosed with AD, while 46.2% (n=12) had only an atopic skin diathesis. Compared to the non-atopic group, the atopic group had a lower median age (p=0.001) and higher serum total IgE levels (p=0.031). Conclusion In addition to AD, atopic skin diathesis without eczema also appears to play an important role in the etiology of PN. The lower age and higher IgE levels in patients are factors associated with atopic predisposition.

BACKGROUND Dupilumab effectively treats atopic dermatitis (AD); however, its role in halting the atopic march remains uncertain. OBJECTIVE To investigate dupilumab's effect on atopic march in pediatric AD patients versus conventional immunomodulators. METHODS This retrospective cohort study utilized data from the TriNetX US Collaborative Network (2011-2024). Pediatric AD patients (≤18 years) were categorized into DUPI-cohort (newly prescribed dupilumab) or CONV-cohort (prescribed conventional immunomodulators without dupilumab). After 1:1 propensity-score matching, we analyzed atopic march progression, defined by the incident asthma or allergic rhinitis (AR). Cumulative incidence was plotted using Kaplan-Meier, with risk assessment via Cox regression. RESULTS The study included 2192 patients in each cohort. The 3-year cumulative incidence of atopic march progression was lower in the DUPI-cohort than the CONV-cohort (20.09% vs 27.22%; P < .001). The DUPI-cohort demonstrated significant risk reduction in atopic march progression (hazard ratio [HR] 0.68, 95% CI 0.55-0.83), individual asthma (HR 0.60, 0.45-0.81), and individual AR (HR 0.69, 0.54-0.88). Younger patients on dupilumab exhibited a greater risk reduction for atopic march progression and individual asthma, contrasting with the opposite age-related pattern for individual AR. LIMITATIONS Observational study. CONCLUSION Among pediatric AD patients, dupilumab was associated with reduced risk of atopic march progression compared with conventional therapies.

BACKGROUND Atopic dermatitis and autoimmune diseases are highly heritable conditions that may co-occur from an early age. METHODS The primary study is a national administrative cohort study involving 499,428 children born in 2002, tracked until 2017. Atopic dermatitis was defined as five or more principal diagnoses of atopic dermatitis and two or more topical steroid prescriptions. We estimated the risks for the occurrence of 41 autoimmune diseases, controlling for risk factors. In addition, we sourced a gene library from the National Library of Medicine to conduct a comprehensive gene ontology. We used Gene Weaver to identify gene set similarity and clustering, and used GeneMania to generate a network for shared genes. RESULTS Exposed and unexposed groups included 39,832 and 159,328 children, respectively. During a mean follow-up of 12 years, the exposed group had an increased risk of autoimmune disease (hazard ratio, 1.27 [95 % confidence interval, 1.23-1.32]) compared to the unexposed group. The hazard ratios of autoimmune illnesses consistently increased with two- and five years lag times and alternative atopic dermatitis definitions. Shared genes between atopic dermatitis and autoimmune diseases were associated with comorbidities such as asthma, bronchiolitis, and specific infections. Genetic interactions of these shared genes revealed clustering in Th1, Th2, Th17, and non-classifiable pathways. CONCLUSIONS Atopic dermatitis was significantly associated with an increased risk of subsequent autoimmune disease. we identified the genetically associated disease in atopic dermatitis patients comorbid with autoimmune disease and demonstrated a genetic network between atopic dermatitis and autoimmune diseases.

Abstract Introduction: Atopic dermatitis (AD) is a common chronic skin disease with an inflammatory pathophysiology that includes the activation of the innate and adaptive immune systems. We aimed to investigate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), eosinophil-to-lymphocyte ratio (ELR), and eosinophil-to-neutrophil ratio (ENR) in AD patients, according to age and disease severity. Methods: This is a retrospective, population-based cohort study conducted between the years 2005 and 2020, comparing hematological markers of AD patients and sex-age-ethnicity-matched controls. AD patients were further divided by age and disease severity (mild, moderate-to-severe AD). We created a decision tree to predict moderate-severe AD. Results: A total of 13,928 patients with AD were included in this study: 6,828 adults and 7,100 children, with 13,548 controls. NLR, PLR, and ELR were lower in children compared to adults (p values <0.001). NLR, PLR, ELR, and ENR were increased in moderate-severe AD patients compared to mild AD patients (p values <0.001). PLR, ELR, and ENR were increased in AD patients versus controls (p values <0.001), with an additional increase in the NLR of moderate-to-severe AD patients. Patients with an ELR <0.21, a PLR >161, and ENR ≤0.016 should be considered high risk for developing severe AD, as well as patients with an ELR >0.21 and age at diagnosis <30 or age >30 years and mean platelet volume ≤9. Conclusion: Hematological ratios were significantly higher in moderate-to-severe AD patients, compared to mild AD patients. Hematological markers were lower in children with AD compared to adults, except for ENR, likely reflecting age-related changes in blood count parameters. These markers can assist in the management and follow-up of AD patients.

In this retrospective study spanning from 2002 to 2019, we analyzed data from 355,277 Korean patients diagnosed with atopic dermatitis (AD) through the National Health Insurance System. Our objective was to comprehensively analyze the trends in prevalence, severity profiles, and treatment approaches for AD in Korea over this 18-year period. Initially, AD prevalence stood at 3.88% in 2002 but notably rose to 5.03% by 2019. During the same period, while AD prevalence decreased in the 0–1-year-old group (from 34.52% to 24.83%), it remained relatively stable in the 1–11-year-old group. Conversely, the 12–19-year-old and 20 years or older age groups witnessed substantial increases in AD prevalence, climbing from 2.55 to 6.02% and 1.44% to 3.53%, respectively. Moreover, the proportion of patients classified as having moderate to severe AD grew from 30.96 to 39.78%. Surprisingly, the prescription pattern, predominantly based on corticosteroid administration, exhibited minimal change despite the rising prevalence of moderate and severe AD cases. These findings underline a persistent reliance on corticosteroid-based treatments for AD, even as the condition's severity escalates among Korean adolescents and adults. Consequently, there is a pressing need to develop novel treatment guidelines emphasizing biologics that offer enhanced safety and efficacy.

OBJECTIVE To examine the association between early-life atopic manifestations and later risk of inflammatory bowel disease (IBD), for which prospective data are scarce. STUDY DESIGN The population-based All Babies in Southeast Sweden (ABIS) and Norwegian Mother, Father, and Child (MoBa) cohorts follow children from birth (ABIS 1997-1999; MoBa 2000-2009) to the end of 2021. Based on validated questionnaires, parents prospectively reported information on asthma, food-related allergic symptoms, atopic dermatitis, and allergic rhinitis by age 3. IBD was defined by ≥2 diagnostic records in the national health registries. Cox regression estimated hazard ratios adjusted (aHR) for parental IBD, atopy, education level, smoking habits, and national origin. Cohort-specific estimates were pooled using a random-effects model. RESULTS We compiled data on 83,311 children (ABIS, n=9,041; MoBa, n=74,270). In over 1,174,756 person-years of follow-up, 301 participants were diagnosed with IBD. Children with atopic dermatitis at age 3 had an increased risk of IBD (pooled aHR=1.46 [95% confidence interval [CI]=1.13-1.88]), Crohn's disease (pooled aHR=1.53 [95%CI=1.04-2.26]), and ulcerative colitis (pooled aHR=1.78 [95%CI=1.15-2.75]). Conversely, any atopic manifestation by age 3 was not associated with IBD (pooled aHR=1.20 [95%CI=0.95-1.52]), nor were analyses specifically focused on early-life food-related allergic symptoms, asthma, and allergic rhinitis. CONCLUSION While atopic manifestations in early childhood were overall not associated with IBD, children with atopic dermatitis specifically were at increased risk of developing IBD, suggesting shared etiological traits; these findings might be useful in identifying at-risk individuals for IBD.

BACKGROUND Atopic dermatitis (AD) is associated with immunological dysfunction, which may influence cancer development. Previous studies of AD and cancer demonstrate inconsistent results and few of these studies examined children or AD severity and treatment. OBJECTIVES To determine malignancy risk among children and adults with AD. METHODS We conducted a cohort study using electronic health records data from UK general practices in The Health Improvement Network between 1994 and 2015. Children (< 18 years old) and adults (≥ 18 years old) with AD were matched on age, practice and index date to patients without AD. AD was categorized as mild, moderate or severe using treatments and dermatology referrals as proxies. The primary outcome was any incident malignancy, including in situ malignancy, identified using diagnosis codes and categorized into haematological, skin and solid organ malignancies. Secondary outcomes included specific malignancies: leukaemia, lymphoma, melanoma, nonmelanoma skin cancer (NMSC) and common solid-organ cancers. RESULTS Among 409 431 children with AD (93.2% mild, 5.5% moderate, 1.3% severe) and 1 809 029 children without AD who had median follow-up of 5-7 years, the incidence rates of malignancy were 1.9-3.4 and 2.0 per 10 000 person-years (PY), respectively. The adjusted risk of malignancy overall did not differ with respect to AD [hazard ratio (HR) 1.02 (95% confidence interval 0.92-1.12)]. Severe AD was associated with increased lymphoma risk [HR 3.18 (1.41-7.16), excluding cutaneous T-cell lymphoma (CTCL)], and mild AD was associated with increased NMSC risk [1.55 (1.06-2.27)]. Among 625 083 adults with AD (65.7% mild, 31.4% moderate, 2.9% severe) and 2 678 888 adults without AD who had median follow-up of 5 years, incidence rates of malignancy were 97.4-125.3 per 10 000 PY and 103.7 per 10 000 PY, respectively. The adjusted risk of any malignancy did not differ with respect to AD [HR 1.00 (0.99-1.02)]. However, adults with severe AD had a twofold higher risk of non-CTCL lymphoma. AD was also associated with slightly higher skin cancer risk [HR 1.06 (1.04-1.08)] and slightly lower solid cancer risk [0.97 (0.96-0.98)] but results varied by specific cancers and AD severity. CONCLUSIONS Epidemiological evidence does not support a strong overall malignancy risk in AD but lymphoma risk may be increased with severe AD.

BACKGROUND Atopic dermatitis (AD) is a common inflammatory disease of the skin that begins early in life and can be lifelong. The purpose of our study was to evaluate whether fetal exposure and/or early life exposure of a child to antibiotics increases the risk of early onset AD. OBJECTIVE We hypothesize that antibiotic exposure in utero or early in life (e.g., first 90 days) increases the likelihood that children develop AD. METHODS Utilizing a large prospectively collected electronic medical records database, we studied the association of antibiotic exposure received in utero or very early in life and the relative risk of onset of AD in a population-based cohort study. Associations were estimated using proportional hazards models as hazard ratios (HR) with 95% confidence intervals (CI). RESULTS The risk of AD in childhood was increased after in utero or early life antibiotic exposure. For any in utero AB exposure the HR was 1.38 (1.36,1.39). However, penicillin demonstrated the strongest association with AD for both in utero exposure, 1.43 (1.41,1.44), and for childhood exposure, 1.81(1.79,1.82). HRs were higher in children born to mothers without AD than those with AD pointing to effect modification by maternal AD status. CONCLUSION Children born to mothers exposed to antibiotics while in utero had, depending on the mother's history of AD, approximately a 20 to 40% increased risk of developing AD. Depending on the antibiotic, children who received antibiotics early-in-life had a 40 to 80% increased risk of developing AD. Our study, supports and refines the association between incident AD and antibiotic administration. It also adds population-based support to therapeutic attempts to treat AD by modifying skin microbiome.

Objectives Patients with atopic dermatitis (AD), also known as eczema, may be at an increased risk for malignancies compared with patients without AD; however, incidence rates (IRs) of malignancies in patients with moderate to severe AD are largely unknown. The objective of this study was to evaluate and compare IRs of malignancies in adults with moderate to severe AD (aged ≥18 years). Design Retrospective cohort study using data from a Kaiser Permanente Northern California (KPNC) cohort. AD severity classification was adjudicated with medical chart review. Covariates and stratification variables included age, sex and smoking status. Setting Data were obtained from the KPNC healthcare delivery system in northern California, USA. Cases of AD were defined by outpatient dermatologist-rendered codes and prescriptions of topical therapy or phototherapy (moderate) or systemic treatment (severe). Participants KPNC health plan members with moderate or severe AD (2007–2018). Primary and secondary outcome measures Malignancy IRs and 95% CIs per 1000 person-years were calculated. Results 7050 KPNC health plan members with moderate and severe AD met eligibility criteria for inclusion. IRs (95% CI) were highest for non-melanoma skin cancer (NMSC) in patients with moderate and severe AD (4.6 (95% CI 3.9 to 5.5) and 5.9 (95% CI 3.8 to 9.2), respectively) and breast cancer (2.2 (95% CI 1.6 to 3.0) and 0.5 (95% CI 0.1 to 3.9), respectively). Except for breast cancer, which was only evaluated in women, malignancies were higher (with non-overlapping CIs) in patients with moderate and moderate to severe AD in men versus women for basal cell carcinoma and NMSC and in former versus never smokers for NMSC and squamous cell carcinoma. Conclusions This study estimated IRs of malignancies in patients with moderate and severe AD and provides valuable information for dermatology clinicians and ongoing clinical trials in these populations.

BACKGROUND Elderly-onset atopic dermatitis (AD) is a remarkable subtype and has been put on the agenda owing to its difficulty to control. Understanding the influence of genetic and environmental exposures is crucial to preventing elderly-onset AD. OBJECTIVES To explore the association between genes and air pollution on incident elderly-onset AD. MATERIAL AND METHODS This study was based on UK Biobank that recruited over 500,000 participants. The genetic risks were categorized into low, intermediate, and high groups according to tertiles of polygenic risk scores. Mixed exposure to various air pollutants was assessed using the weighted quantile sum (WQS) and also categorized based on tertiles. Within each genetic risk group, whether air pollutant mixture was associated with incident elderly-onset AD was estimated. RESULTS 337,910 participants were included in the final analysis, and the mean age was 57.1. The median years for follow-up were 12.0, and the incident cases of AD were 2545. The medium and high air pollution mixture was significantly associated with incident AD compared with the low pollution group, with HRs of 1.182 (P = 0.003) and 1.359 (P < 0.001), respectively. In contrast, HR for medium and high genetic susceptibility was only 1.065 (P = 0.249) and 1.153 (P = 0.008). The population-attributable fraction of air pollution and genetic risk was 15.5 % (P < 0.001) and 6.4 % (P = 0.004). Additionally, compared with low genetic risk and low air pollution, high genetic risk and high air pollution was significantly associated with the incidence of elderly-onset AD with a HR of up to 1.523 (P < 0.001). There were no interactive effects between each group of genetic risks and air pollution. When grouped by sex, females could observe a stronger effect by genetic and air pollutant mixture exposure. CONCLUSION Air pollution and genetics both independently enhance the risk of newly developed AD, and the effect of air pollutants is stronger than the investigated genes.

Atopic dermatitis (AD) may be associated with an increased burden of neuropsychiatric outcomes such as anxiety and depression, but longitudinal data on the impact of AD severity is lacking, and a comprehensive assessment of neuropsychiatric disease in adults with AD is needed.

Purpose Atopic dermatitis (AD) is a chronic inflammatory skin disorder associated with various comorbidities. However, inconsistent results on the risk of myocardial infarction (MI) and mortality have been reported in patients with AD. This study was aimed to evaluate the risk of MI and all-cause mortality in patients with AD. Methods This nationwide population-based retrospective cohort study enrolled 56,205 adults ≥ 20 years of age with AD and 3,825,609 controls without AD from the Korean National Health Service (NHIS) database from 2009 to 2016. Results The risk of MI (adjusted hazard ratio [aHR], 1.111, 95% confidence interval [CI], 1.050–1.176) was increased in patients with AD. By AD severity, patients with moderate-to-severe AD had a higher risk of MI (aHR, 1.163, 95% CI, 1.080–1.251) than individuals without AD. The risk of all-cause mortality was only increased for patients with moderate-to-severe AD (aHR, 1.096, 95% CI, 1.040–1.155) compared to individuals without AD. In subgroup analysis, an increased risk of MI was observed in female, non-obese, non-smoking, non-diabetic, and non-dyslipidemic patients with moderate-to-severe AD compared to individuals without AD. An increased risk of all-cause mortality was observed in patients with moderate-to-severe AD compared to non-AD controls among individuals ≥60 years of age and non-smokers. Conclusions The risk of MI and all-cause death was increased in patients with moderate-to-severe AD. Even without well-known risk factors for MI and mortality, patients with AD require the proper management and screening for comorbidities to prevent MI and decrease all-cause mortality.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder with bimodal incidence peaks in early childhood and middle-aged and older adults. Few studies have focused on the risk of dementia in AD. The aims of this study were to analyse the incidence, and risk factors for dementia in patients with AD. This nationwide population-based retrospective cohort study enrolled 38,391 adults ≥ 40 years of age with AD and 2,643,602 controls without AD from the Korean National Health Insurance System (NHIS) database from 2009 to 2016. The cumulative incidence probability of all-cause dementia, Alzheimer’s disease, or vascular dementia at 8 years was 50, 39, and 7 per 1,000 person-years in patients with AD, respectively. The adjusted risks of all-cause dementia (hazard ratio (HR), 1.072; 95% confidence interval (95% CI) 1.026–1.120), and Alzheimer’s disease (HR 1.051; 95% CI 1.000–1.104) were increased in patients with AD. The effect of AD on the development of all-cause dementia and Alzheimer’s dementia varied according to age and diabetes mellitus (all p for interaction, < 0.05). The risks of all-cause dementia and Alzheimer’s disease were increased in patients with AD. Management of modifiable risk factors is important for preventing dementia in patients with AD. SIGNIFICANCE Little is known about the risk of dementia in patients with atopic dermatitis. This is the first population-based study in Korea identifying the risk of dementia among patients with atopic dermatitis. Atopic dermatitis is associated with an increased risk of all-cause dementia and Alzheimer’s disease. Management of modifiable risk factors is important for preventing dementia in patients with atopic dermatitis.

Atopic dermatitis (AD) contributes to substantial social and financial costs in public health care systems. Antibiotic exposure during pregnancy has been proposed as a risk factor, but findings remain inconsistent. The aim of this study was to investigate the association between prenatal antibiotic use and childhood AD.

Background In previous studies, it was reported that non-alcoholic fatty liver disease (NAFLD) incidence and prevalence increased in children with atopic dermatitis. Nevertheless, the actual association between the two diseases has not been fully proven in large-scale studies, and real-world evidence is missing. The objective of this nationwide, longitudinal cohort study was to evaluate the association between NAFLD and atopic dermatitis. Methods The National Health Insurance Research Database in Taiwan was utilized in this study. Patients with records of NAFLD diagnosis were recruited as the experimental group, and patients having less than three outpatient visits or one inpatient visiting record due to NAFLD were excluded from the study design. Non-NAFLD controls were matched based on a 1:4 propensity score matching. Potential confounders including age, gender, comorbidity, and medical utilization status were considered as covariates. The risk of future atopic dermatitis would be evaluated based on multivariate Cox proportional hazard regression. Results Compared with people without NAFLD, a decreased risk of atopic dermatitis in NALFD patients had been observed (aHR = 0.93, 95% CI 0.87–0.98). The trend was especially presented in young NAFLD patients. In patients younger than 40 years old, a 20% decreased risk of atopic dermatitis was reported (aHR = 0.80, 95% CI 0.70–0.92). Conclusion People with NAFLD were not associated with an increased risk of atopic dermatitis. Conversely, a 0.93-fold risk was noted in NAFLD patients, compared with NAFLD-free controls. Future studies are warranted to evaluate further the mechanism regarding the interplay between the inflammatory mechanisms of NAFLD and atopic dermatitis.

BACKGROUND Atopic dermatitis (AD) is associated with immune dysregulation, but epidemiological data on the pattern of autoimmune comorbidity in people with AD are limited. OBJECTIVE To determine the risk of autoimmune conditions in people newly diagnosed with AD. METHODS Retrospective cohort analysis (January 2009-December 2018), using the UK-based Oxford-Royal College of General Practitioners Research and Surveillance Centre primary care database. We compared baseline prevalence and incidence after diagnosis of autoimmune conditions in 173,709 children and adults with new-onset AD and 694,836 age, sex, and GP-practice matched controls. Outcomes were a composite of any autoimmune condition (Crohn's disease, ulcerative colitis, coeliac disease, pernicious anaemia, type 1 diabetes, autoimmune hypothyroidism, Graves' disease, psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus (SLE), Sjögren's syndrome, vitiligo, alopecia areata, and multiple sclerosis), and each individual autoimmune condition. RESULTS Pre-existing autoimmune conditions were more common in people diagnosed with AD compared to controls (composite 5.8% vs 4.3%). Excluding people with pre-existing autoimmune disease, there was an association between AD and incidence of new-onset autoimmune disease (composite adjusted hazard ratio [aHR] 1.28; 95%CI 1.23-1.34). Risk was highest for more severe AD (aHR 1.99; 95%CI 1.77-2.23) than moderate AD (aHR 1.33; 95%CI 1.19-1.49) or mild AD (aHR 1.22; 95%CI 1.16-1.28). People with AD were at significantly increased risk of developing psoriatic arthritis, Sjögren's syndrome, Crohn's disease, vitiligo, alopecia areata, pernicious anaemia, ulcerative colitis, rheumatoid arthritis and hypothyroidism (aHR range 1.17-2.06), but not other autoimmune conditions. CONCLUSION People with AD have an increased risk of multiple autoimmune conditions, especially those with more severe AD.

Having atopic dermatitis was associated with a small, increased risk for migraines and headaches in children and adults in a population-based cohort study of a UK electronic health records database.

BACKGROUND Atopic Dermatitis (AD) is thought to precede the onset of other allergic illness (OAI) in a temporal progression (i.e., atopic march), yet the timing and progression has been questioned. It is also unclear how parental allergic illness impacts the development of these illnesses in offspring. OBJECTIVE (1) explore risk of incident AD and (2) timing of allergic disease onset in children of mothers with AD compared to mothers without AD from the United Kingdom. METHODS We created a birth-cohort of mother-child pairs using IQVIA Medical Research Data database and developed cox proportional models to examine the above associations (Hazard Ratio [95% Confidence Interval]). RESULTS Among 1,224,243 child-mother pairs, mean child (standard deviation) follow-up time was 10.8 (8.3) years and 50.1% were males (N=600,905). Children were 59% (HR=1.59 [1.57,1.60]) more likely to have AD if their mothers had AD compared to no AD with mean age of first AD diagnosis at 3.3 (4.8) years. Most children with any diagnosis of AD present with AD first (91.0%), however, in those with asthma, only 67.8% developed AD first. CONCLUSION Children born to mothers with AD are more prone to develop AD and some develop OAI first, suggesting that not all follow the same sequential pathway.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder associated with various systemic and ocular complications. This study aimed to investigate the prevalence, risk factors, and clinical characteristics of ocular complications in a cohort of Korean AD patients.

Occupational contact dermatitis (OCD) is a common occupational disease. Atopic dermatitis (AD) is a known risk factor for OCD.

Studies examining the association between type 1 diabetes (T1D) and atopic diseases, i.e., atopic dermatitis, allergic rhinitis and asthma have yielded conflicting results due to different algorithms for classification, sample size issues and risk of referral bias of exposed cohorts with frequent contact to health care professionals. Using Danish national registries and well-established disease algorithms, we examined the bidirectional association between T1D and atopic diseases in childhood and adolescence using Cox Proportional Hazard regression compared to two different unexposed cohorts from a population of 1.5 million Danish children born from 1997 to 2018. We found no associations between T1D and atopic dermatitis, allergic rhinitis, or asthma (defined after age five). However, in multivariable analysis we found an increased risk of persistent wheezing (defined as asthma medication before age five) after T1D with an adjusted hazard ratio (aHR) of 1.70 [1.17–2.45]. We also identified an increased risk of developing T1D after persistent wheezing with aHR of 1.24 [1.13–1.36]. This study highlights similar risks of atopic diseases in children with T1D and of T1D in children with atopic disease after age of five years versus healthy controls. However, more research is needed to understand the possible early immunological effects of the link between persistent wheezing and T1D.

Studies have indicated that atopic dermatitis (AD) is associated with an increased risk of cardiovascular disease (CVD). However, data are conflicting. Furthermore, the longitudinal effect of childhood AD on cardiovascular risk factors in young adulthood is less investigated.

Atopic dermatitis (AD) is a common disease with a broad spectrum of clinical manifestations. AD can manifest differently in adults than children. Core AD features are similar between children and adults overall, including lesions affecting flexural areas, presence of atopy, and xerosis. Adults have more signs of chronic disease, higher prevalence and different patterns of hand eczema, and a stronger relationship of disease activity with emotional factors, whereas children with AD have more exudative lesions, perifollicular accentuation, pityriasis alba, Dennie-Morgan folds, and seborrheic dermatitis-like presentation. These differences may be due in part to pathophysiologic differences in AD in children compared with adults. Atopic diseases commonly co-occur with AD, although most do not temporally have the "atopic march." Further research is warranted to better understand the differential roles of immune dysregulation, epidermal-barrier disruption, and dysbiosis between children and adults and determine whether such differences translate into differences in therapeutic efficacy.

The primary objective of this study was to systematically review and analyse epidemiological studies of the prevalence and incidence of atopic dermatitis (AD) during childhood and adulthood, focusing on data from the 21st century. A systematic search of PubMed, EMBASE and Google (manual search) was performed in June 2019, followed by data abstraction and study quality assessment (Newcastle-Ottawa Scale). Cross-sectional and longitudinal epidemiological studies of individuals with AD (doctor-diagnosed or standardized definition) were included. Of 7,207 references reviewed, 378 moderate/good-quality studies were included: 352 on prevalence of AD and 26 on incidence of AD. In the 21st century, the 1-year prevalence of doctor-diagnosed AD ranged from 1.2% in Asia to 17.1% in Europe in adults, and 0.96% to 22.6% in children in Asia. The 1-year incidence ranged from 10.2 (95% confidence interval (95% CI) 9.9-10.6) in Italy to 95.6 (95% CI 93.4-97.9) per 1,000 person-years in children in Scotland. There were few recent studies on incidence of AD in the 21st century and no studies on adults only; most studies were conducted in Europe and the USA. Epidemiological studies on childhood and adulthood AD in different continents are still needed, especially on the incidence of AD during adulthood.

Population-based estimates on the prevalence of atopic dermatitis in adults vary widely. The objectives of this study were to determine the prevalence of atopic dermatitis in the population of the United States, the distribution of disease severity, and its impact on health-related quality of life. Among 1,278 participating adults, the prevalence (95% confidence interval) of atopic dermatitis was 7.3% (5.9-8.8). Overall, 60.1% (56.1-64.1) of participants were classified as having mild, 28.9% (25.3-32.7) as having moderate, and 11% as having severe (8.6-13.7) disease. Patients with atopic dermatitis and those with more severe disease had higher scores in the dermatology life quality index (mean [standard deviation] for AD patients = 4.71 [6.44] vs. control individuals = 0.97 [2.12]) (P < 0.001) and the hospital anxiety (mean [standard deviation] for AD patients = 7.03 [4.80] vs. control individuals = 4.73 [4.8]) and depression (mean, [standard deviation] for AD patients = 5.83 [4.54] vs. control individuals = 3.62 [3.61]) scales, indicating a worse impact on quality of life and an increased likelihood of anxiety or depression. Based on our prevalence estimates, 16.5 million adults would have a diagnosis of atopic dermatitis, with 6.6 million meeting criteria for moderate to severe disease. Our study confirms the high prevalence and disease burden of atopic dermatitis in this population.

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Atopic dermatitis (AD), a skin disease burden worldwide, is a complex, multifactorial, chronic inflammatory disease. Prevalence of AD is increasing in developing countries and identifying the causative allergens is a major challenge. Aeroallergens are shown to aggravate atopic dermatitis. Explore the prevalence of aeroallergens sensitization in patients with AD and its possible relation with AD severity. Cross-sectional study of 132 patients diagnosed to have atopic dermatitis. Atopy was detected by serum specific IgE to a panel of the most encountered aeroallergens. From the 132 patients, elevated specific IgE was detected in 72.7 % from which 59.1 % were mild and 86.4 % are moderate/severe as well as 15.9 % are mono-sensitized and 54.5 % are poly-sensitized with poly-sensitization being more in severe cases compared to mild cases (68.2 % vs 4.5 %). Regarding specific IgE to different aeroallergens, the most prevalent were Dermatophagoides pteronyssinus (50 %), followed by Dermatophagoides farinae (34.1 %), Birch pollen (20.5 %), cat epithelium (18.2 %) Regweed (15.9 %), and Cockroach (9.1 %). However, moderate to severe cases were more sensitized to candida (p = 0.012), mix grass pollen (p = 0.002), ragweed (0.00), mite (p = 0.037) and cat epithelium (p = 0.007). Dermatophagoides pteronyssinus, Dermatophagoides farinae, Birch pollen, cat epithelium Regweed and Cockroach are the most frequent sensitizing aeroallergens in atopic dermatitis.

Previous studies have examined the prevalence of allergic diseases in adolescents 1-2 years after the emergence of the COVID-19 pandemic. However, more data is needed to understand the long-term impact of COVID-19 on allergic diseases. Thus, we aimed to examine the trend of the atopic dermatitis prevalence in Korean adolescents before and during the COVID-19 pandemic across 14 years. Additionally, we analyze the risk factors of atopic dermatitis (AD) based on the results. The Korean Disease Control and Prevention Agency conducted the Korea Youth Risk Behavior Web-based Survey from 2009 to 2022, from which the data for this study were obtained. Prevalence trends were compared across subgroups, and the β difference (β

Studies on the prevalence of atopic dermatitis (AD) for the adolescent cohort in general-based large populations are scarce worldwide. We performed a retrospective population--based observational cohort study of 76,665 adolescent patients diagnosed with AD in Catalonia (Spain). We studied the prevalence of AD by age, gender, disease severity, comorbidities, serum total immunoglobulin E (tIgE) and appropriate medical treatment (AMT) for the Catalan population. Adolescent individuals (12-17 years) diagnosed with AD by medical records at different health care levels (primary, hospital, emergency) from the Catalan Health System (CHS) were included. Statistical analyses evaluated sociodemographic characteristics, prevalence, comorbidities, serum tIgE and AMT. The overall diagnosed AD prevalence in the adolescent Catalan population (76,665) was 16.9%, being higher for the non-severe (16.7%) than for the severe (0.2%) populations. Topical corticosteroids were the most prescribed drug (49.5%), and the use of all prescribed treatments was higher in severe AD patients, especially systemic corticosteroids (49.7%) and immunosuppressants (45.4%). AD patients had, on average, a serum tIgE of 163.6 KU/L, which was higher for severe than non-severe disease (155.5 KU/L vs 101.9 KU/L, respectively). Allergic rhinitis (15.0%) and asthma (13.5%) were among the most frequent comorbid respiratory and allergy diseases. This is the first Spanish study reporting the overall diagnosed prevalence for a large-scale adolescent cohort (12-17 years old) from Catalonia. It provides new and robust evidence of AD's prevalence and related characteristics in this region.

Atopic dermatitis (AD) and psoriasis (Pso) are highly prevalent chronic inflammatory skin diseases. They share similarities regarding severity and impact on quality of life but display differences regarding risk factors, comorbidities, and pathogenesis. This study sought to assess the prevalence of AD and Pso among the French population, along with associated comorbidities, and to compare these data with those of the age- and gender-adjusted French population with neither AD nor Pso. The survey was conducted by a polling institute between September 1 and November 30, 2016, with proportional quota sampling being applied to render the study population representative of the French population. In all, 20 012 individuals were selected from among 900,000 internet users aged≥15years. Overall, 20,012 adults (48.8% men; 51.2% women) completed a digital questionnaire. The prevalence of AD was 4.65% [95% confidence interval (CI) 4.36%-4.94%] and that of Pso was 4.42% [95% CI: 4.14%-4.71%]. More AD patients presented≥1 comorbidity compared to subjects without AD (57.04% vs. 49.2%, P<0.0001) and more Pso patients presented≥1 comorbidity compared to subjects without Pso (60.68% vs. 49.05%, P<0.0001). After adjustment for gender and age, hypertension and dyslipidemia, a greater prevalence of osteoarticular, respiratory and psychiatric diseases was noted in both AD and Pso patients, whereas increased prevalence of obesity was seen only in Pso patients. The prevalence of components of metabolic syndrome was higher among Pso than AD patients. Further studies are required to consolidate these findings, to better characterize the entire spectrum of AD and Pso comorbidities, and to better identify determinants and risk factors, along with targeted therapies.

The prevalence of atopic dermatitis (AD) has been steadily increasing in recent decades, reaching a steady plateau at the end of the 20th century. However, most of them were surveys of children, and the current prevalence and severity of AD in adults are unknown. A longitudinal survey including 40 649 freshmen attending Hiroshima University between 2002 and 2019 was conducted, with the aim to determine changes in AD prevalence in young adults over the age of 18 years. All data were longitudinally collected at a fixed time of the year. The AD diagnosis and severity assessment were made by dermatologists based on the diagnostic criteria in the Japanese Guidelines for AD. History or comorbidities of asthma and allergic rhinitis/conjunctivitis, current AD management, and use of topical corticosteroids (TCS) were also surveyed using a questionnaire. The prevalence of AD in university freshmen is slightly increasing from 9.1% in 2002 to 12.0% in 2010, remaining steady at around 10-11% until 2019, with poorly controlled AD present in nearly 10%. History or comorbidities of asthma and allergic rhinitis/conjunctivitis slightly increased from 2006 to 2019 in both the students with and without AD. Facial eczema was common among those with severe and most severe AD, whereas approximately 50% of the students with moderate AD and approximately 20% of those with mild AD exhibited facial eczema. The percentage of students treating AD at medical institutions and those self-managing was almost the same. This survey also revealed the presence of substantial anxiety regarding TCS use for AD and the necessity of promoting more effective explanation and education on AD by medical professionals.

Asthma and atopic dermatitis (AD) are chronic allergic conditions, along with allergic rhinitis and food allergy and cause high morbidity and mortality both in children and adults. This study aims to evaluate the global, regional, national, and temporal trends of the burden of asthma and AD from 1990 to 2019 and analyze their associations with geographic, demographic, social, and clinical factors. Using data from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2019, we assessed the age-standardized prevalence, incidence, mortality, and disability-adjusted life years (DALYs) of both asthma and AD from 1990 to 2019, stratified by geographic region, age, sex, and socio-demographic index (SDI). DALYs were calculated as the sum of years lived with disability and years of life lost to premature mortality. Additionally, the disease burden of asthma attributable to high body mass index, occupational asthmagens, and smoking was described. In 2019, there were a total of 262 million [95% uncertainty interval (UI): 224-309 million] cases of asthma and 171 million [95% UI: 165-178 million] total cases of AD globally; age-standardized prevalence rates were 3416 [95% UI: 2899-4066] and 2277 [95% UI: 2192-2369] per 100,000 population for asthma and AD, respectively, a 24.1% [95% UI: -27.2 to -20.8] decrease for asthma and a 4.3% [95% UI: 3.8-4.8] decrease for AD compared to baseline in 1990. Both asthma and AD had similar trends according to age, with age-specific prevalence rates peaking at age 5-9 years and rising again in adulthood. The prevalence and incidence of asthma and AD were both higher for individuals with higher SDI; however, mortality and DALYs rates of individuals with asthma had a reverse trend, with higher mortality and DALYs rates in those in the lower SDI quintiles. Of the three risk factors, high body mass index contributed to the highest DALYs and deaths due to asthma, accounting for a total of 3.65 million [95% UI: 2.14-5.60 million] asthma DALYs and 75,377 [95% UI: 40,615-122,841] asthma deaths. Asthma and AD continue to cause significant morbidity worldwide, having increased in total prevalence and incidence cases worldwide, but having decreased in age-standardized prevalence rates from 1990 to 2019. Although both are more frequent at younger ages and more prevalent in high-SDI countries, each condition has distinct temporal and regional characteristics. Understanding the temporospatial trends in the disease burden of asthma and AD could guide future policies and interventions to better manage these diseases worldwide and achieve equity in prevention, diagnosis, and treatment.

The prevalence of atopic eczema has been found to have increased greatly in some parts of the world. Building on a systematic review of global disease trends in asthma, our objective was to study trends in incidence and prevalence of atopic eczema. Disease trends are important for health service planning and for generating hypotheses regarding the aetiology of chronic disorders. We conducted a systematic search for high quality reports of cohort, repeated cross-sectional and routine healthcare database-based studies in seven electronic databases. Studies were required to report on at least two measures of the incidence and/or prevalence of atopic eczema between 1990 and 2010 and needed to use comparable methods at all assessment points. We retrieved 2,464 citations, from which we included 69 reports. Assessing global trends was complicated by the use of a range of outcome measures across studies and possible changes in diagnostic criteria over time. Notwithstanding these difficulties, there was evidence suggesting that the prevalence of atopic eczema was increasing in Africa, eastern Asia, western Europe and parts of northern Europe (i.e. the UK). No clear trends were identified in other regions. There was inadequate study coverage worldwide, particularly for repeated measures of atopic eczema incidence. Further epidemiological work is needed to investigate trends in what is now one of the most common long-term disorders globally. A range of relevant measures of incidence and prevalence, careful use of definitions and description of diagnostic criteria, improved study design, more comprehensive reporting and appropriate interpretation of these data are all essential to ensure that this important field of epidemiological enquiry progresses in a scientifically robust manner.

The aetiology of asthma and allergic disease remains poorly understood, despite considerable research. The International Study of Asthma and Allergies in Childhood (ISAAC), was founded to maximize the value of epidemiological research into asthma and allergic disease, by establishing a standardized methodology and facilitating international collaboration. Its specific aims are: 1) to describe the prevalence and severity of asthma, rhinitis and eczema in children living in different centres, and to make comparisons within and between countries; 2) to obtain baseline measures for assessment of future trends in the prevalence and severity of these diseases; and 3) to provide a framework for further aetiological research into genetic, lifestyle, environmental, and medical care factors affecting these diseases. The ISAAC design comprises three phases. Phase 1 uses core questionnaires designed to assess the prevalence and severity of asthma and allergic disease in defined populations. Phase 2 will investigate possible aetiological factors, particularly those suggested by the findings of Phase 1. Phase 3 will be a repetition of Phase 1 to assess trends in prevalence.

Physicians are aware that climatic conditions negatively affect the skin. In particular, people living in equator far countries such as the Northern parts of Europe and North America are exposed to harsh weather during the winter and may experience dry and itchy skin, or deterioration of already existing dermatoses. We searched the literature for studies that evaluated the mechanisms behind this phenomenon. Commonly used meteorological terms such as absolute humidity, relative humidity and dew point are explained. Furthermore, we review the negative effect of low humidity, low temperatures and different seasons on the skin barrier and on the risk of dermatitis. We conclude that low humidity and low temperatures lead to a general decrease in skin barrier function and increased susceptible towards mechanical stress. Since pro-inflammatory cytokines and cortisol are released by keratinocytes, and the number of dermal mast cells increases, the skin also becomes more reactive towards skin irritants and allergens. Collectively, published data show that cold and dry weather increase the prevalence and risk of flares in patients with atopic dermatitis.

Allergic diseases are an increasing public health concern, and early life environment is critical to immune development. Maternal diet during pregnancy has been linked to offspring allergy risk. In turn, maternal diet is a potentially modifiable factor, which could be targeted as an allergy prevention strategy. In this systematic review, we focused on non-allergen-specific modifying factors of the maternal diet in pregnancy on allergy outcomes in their offspring. We undertook a systematic review of studies investigating the association between maternal diet during pregnancy and allergic outcomes (asthma/wheeze, hay fever/allergic rhinitis/seasonal allergies, eczema/atopic dermatitis (AD), food allergies, and allergic sensitization) in offspring. Studies evaluating the effect of food allergen intake were excluded. We searched three bibliographic databases (MEDLINE, EMBASE, and Web of Science) through February 26, 2019. Evidence was critically appraised using modified versions of the Cochrane Collaboration Risk of Bias tool for intervention trials and the National Institute for Clinical Excellence methodological checklist for cohort and case-control studies and meta-analysis performed from RCTs. We identified 95 papers: 17 RCTs and 78 observational (case-control, cross-sectional, and cohort) studies. Observational studies varied in design and dietary intakes and often had contradictory findings. Based on our meta-analysis, RCTs showed that vitamin D supplementation (OR: 0.72; 95% CI: 0.56-0.92) is associated with a reduced risk of wheeze/asthma. A positive trend for omega-3 fatty acids was observed for asthma/wheeze, but this did not reach statistical significance (OR: 0.70; 95% CI: 0.45-1.08). Omega-3 supplementation was also associated with a non-significant decreased risk of allergic rhinitis (OR: 0.76; 95% CI: 0.56-1.04). Neither vitamin D nor omega-3 fatty acids were associated with an altered risk of AD or food allergy. Prenatal supplementation with vitamin D may have beneficial effects for prevention of asthma. Additional nutritional factors seem to be required for modulating the risk of skin and gastrointestinal outcomes. We found no consistent evidence regarding other dietary factors, perhaps due to differences in study design and host features that were not considered. While confirmatory studies are required, there is also a need for performing RCTs beyond single nutrients/foods.

Atopic dermatitis (AD) has the highest disease burden among all skin diseases. However, reports on AD prevalence trends in China are limited. This study aimed to investigate the time trends of AD prevalence in China from 1990 to 2021 and to explore the age and sex differences. Data were obtained from the Global Burden of Disease Study, 2021. We analyzed the annual percentage change in the crude prevalence rate and age-standardized prevalence rate (ASPR) of AD from 1990 to 2021 using the Joinpoint model. We predicted the future prevalence of AD from 2022 to 2030 using the Bayesian age-period-cohort model. The total ASPR decreased slightly from 1990 (1357.93 per 100,000) to 2021 (1347.11 per 100,000). The ASPR of females (1457.64 per 100,000) was higher than that of males (1247.04 per 100,000) in 2021. The prevalence rate of AD was highest in the under 5 years old age group (3455.56 per 100,000) and the 5-9 years old age group (3360.31 per 100,000). By 2030, the predicted ASPR of AD will be 1394.36 (per 100,000) in males and 1603.69 in females (per 100,000). The predicted prevalence rate in the under 5 years old (3996.14 per 100,000 in males and 3990.68 per 100,000 in females) and 5-9 years old (3714.61 per 100,000 in males and 3963.96 per 100,000 in females) age groups will be higher than those in other age groups. Despite a slight decrease from 1990 to 2021, there has been an increasing trend since 2015 in the total AD burden. Given the increasing burden of AD on Chinese children and females, healthcare practitioners should enhance community education, improve disease management abilities of patients and caregivers, and reduce the burden and healthcare costs of AD.

Several studies have reported that childhood prevalence of eczema has been increasing worldwide. However, none study quantitatively evaluated prevalence trends of eczema among children and adults in the last 30 years in China. Via a systematic review of literature databases in English and Chinese, we summarized all studies reporting eczema prevalences from 1985 to 2015 in China as well as diagramed prevalence and eczematous population trends against year for different age groups. A total of 93 studies and 17 studies (16 for children and one for adults) were selected for qualitative and quantitative synthesis, respectively. Childhood lifetime-ever eczema prevalences ranged from 10.0% to 30.0%. Prevalences among 3-12-year-olds children showed increasing trends in most specific cities, but national lifetime-ever eczema prevalences among 13-14-year-olds children decreased from 10.6% in 2001 to 8.6% in 2009 in mainland China. We estimated that about 1.5 million children aged 13-14-year-olds in 2009 and 15.5 million children aged 3-6-year-olds in 2012 had lifetime-ever eczema in mainland China. Similar studies were too few to ascertain time-trends of eczema prevalence among adults. About 39.4, 20.0, and 11.6 million adults aged 15-86-year-olds in 2010 had contact dermatitis, seborrheic dermatitis, and atopic dermatitis in the mainland China, respectively. The burden of eczema became heavier in young children, whereas perhaps had been reduced in adolescent in China. More studies for eczema prevalence in adults are warranted.

Atopic eczema (AE) is a chronic inflammatory skin disease characterized by pruritus, dry skin and an ongoing course of exacerbations and remissions. AE is a common disorder in children with a worldwide cumulative prevalence of 15-20% in this age group. AE has a strong familial predisposition. While AE is a complex disease with multiple gene involvement, recent interest has focused on genes involved in skin barrier/epidermal differentiation and in immune response/host defense. Recent developments and future directions on pathogenesis, diagnosis, natural course and prognosis are discussed.

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Atopic dermatitis is a major public health issue worldwide, but data on trends in prevalence in children in European countries are sparse. The aim of this study was to assess the trends in the prevalence of atopic dermatitis in children under 5 in the Central, Eastern, and Western European sub-regions from 1990 to 2019. In this study, a descriptive, observational epidemiological method was applied. In addition, an ecological study design was used. Joinpoint regression analysis was used to assess trends. A total of 118 million (54 million males and 64 million females) prevalent cases of atopic dermatitis in children under 5 were reported in European countries in 1990-2019. More than half of all cases of atopic dermatitis in children under 5 in Europe were recorded in the Western European sub-region. The highest prevalence rates of atopic dermatitis in children under 5 were observed in the Eastern European sub-region, with the highest rates in both males and females recorded in Estonia (equally at about 15,000 per 100,000), followed by the Russian Federation (equally at about 12,000 per 100,000). Moreover, the lowest prevalence rates were reported in the Eastern European sub-region (equally at about 5000 per 100,000 in Romania and Latvia). A sex disparity in the prevalence and trends of atopic dermatitis in children under 5 was observed. A significantly increased trend in atopic dermatitis prevalence in children under 5 was recorded in the Eastern European sub-region from 1990 to 2019 (by +0.3% per year in males and by +0.1% per year in females). Conversely, in the Western and Central European sub-regions, trends in the prevalence of atopic dermatitis in children under 5 slightly decreased (about -0.1% per year). The Pearson coefficient showed a significant negative correlation between the prevalence of atopic dermatitis in children under 5 and the Human Development Index in most countries in the Eastern European sub-region, while a significant positive correlation was reported between the prevalence and HDI in high-income countries in the Western European sub-region. High prevalence rates and mostly stable trends during the last three decades make atopic dermatitis still a major health issue in children under 5 in European countries.

After a continuous increase of asthma, hay fever, and eczema during 1991-2003 among schoolchildren in Patras, Greece, the prevalence of current wheeze/asthma (diagnosed wheezing and/or asthma in the past 2 years) has reached a plateau (6.9%) during the period 2004-2008. Using methodology identical to the three previously conducted cross-sectional, parental questionnaire surveys (1991, n = 2417; 1998, n = 3076; 2003, n = 2725) we examined further trends in the prevalence of rhinoconjunctivitis and eczema in the same urban environment among third and fourth grade schoolchildren (8-9 years old) in 2008 (n = 2688). In the four surveys, respective prevalence rates of rhinoconjunctivitis were 2.1, 3.4, 4.6, and 5.1% (absolute prevalence increase: 1998 versus 1991, 61.9%; 2003 versus 1998, 35.5%; 2008 versus 2003, 10.9%) and those of eczema were 4.5, 6.3, 9.5, and 10.8% (absolute prevalence increase: 1998 versus 1991, 40.0%; 2003 versus 1998, 50.8%; 2008 versus 2003, 13.7%; sex-adjusted p for trend, <0.001). Among current wheezer/asthmatic patients there was an increase in lifetime rhinoconjunctivitis (sex-adjusted p for trend, <0.001) and lifetime eczema (sex-adjusted p for tend, <0.001) over the period 1991-2008. The proportion of atopic wheeze/asthma (current asthma with lifetime rhinoconjunctivitis and/or eczema) increased further during 2003-2008 (p < 0.05; p for trend during 1991-2008, <0.001). In conclusion, there is a continuous increase in the prevalence of allergic manifestations-rhinoconjunctivitis and eczema-among preadolescent children in Patras, Greece, during the period 1991-2008. After a steep rise during 1991-2003, the frequency of atopic wheeze/asthma continued to increase at a decelerating rate during 2003-2008, while wheeze/asthma prevalence remained unchanged during the same 5-year period.

The environment plays an important part in the aetiology of atopic eczema, but specific causes are unknown. Exposure to hard water is thought to be a risk factor for eczema. We undertook an ecological study of the relation between domestic water hardness and the prevalence of eczema among Nottinghamshire schoolchildren. Questionnaire details of 1-year period and lifetime prevalence of eczema were obtained from parents of 4141 randomly selected primary-school children and 3499 secondary-school children in southern Nottinghamshire. Geographical information systems (GIS) were used to link the geographical distribution of eczema prevalence with domestic water-hardness data (four categories). Adjustment was made for potential confounding by sex, age, socioeconomic status, and access to health care. Among the primary-school children there was a significant direct relation between both 1-year period and lifetime prevalence of eczema and water hardness, both before and after adjustment for confounders. The 1-year period prevalence was 17.3% (261/1509) in the highest water-hardness category and 12.0% (94/786) in the lowest (adjusted odds ratio 1.54 [95% CI 1.19-1.99] p for trend <0.001). The corresponding values for lifetime prevalence were 25.4% (384/1509) and 21.2% (167/786; adjusted odds ratio 1.28 [1.04-1.58], p for trend=0.02). Eczema prevalence trends in the secondary-school population were not significant (adjusted odds ratio for highest compared with lowest hardness category for 1-year prevalence 1.03 [0.79-1.33], p for trend=0.46; for lifetime prevalence 0.99 [0.83-1.23], p for trend=0.93). Eczema prevalence in primary-school children increased in relation to chlorine content of water, but the trend across four chlorine-content categories was not independently significant after adjustment for confounders. Exposure to hard water in the home may increase the risk of eczema in children of primary-school age.

The patient burden and quality of life (QOL) impact of atopic dermatitis (AD) in the United States population is not well established. To elucidate the patient burden of AD in the US population. A cross-sectional, population-based study of 602 adults was performed. Atopic dermatitis was determined using modified UK Diagnostic Criteria for AD. Its severity was assessed using self-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Patient-Oriented Scoring AD (PO-SCORAD), PO-SCORAD-itch, and sleep. Quality of life was assessed using short-form (SF-)12 mental and physical health scores and Dermatology Life Quality Index (DLQI). Adults with AD reported higher proportions of having only fair/poor overall health (25.8% vs. 15.8%), being somewhat/very dissatisfied with life (16.7% vs 11.4%), lower weighted mean (standard deviation [SD]) SF-12 mental (45.9 [9.9] vs 50.9 [9.2]) and physical health subscores (53.0 [2.5] vs 53.5 [2.3]) and higher DLQI (4.9 [6.5] vs 1.1 [2.8]). In multivariable regression models adjusting for sociodemographics and multiple comorbid health disorders, significant stepwise decreases by AD severity (self-reported, POEM, PO-SCORAD) of overall health, life satisfaction, SF-12 mental health, and increases of DLQI scores were seen. The SF-12 physical health scores were only associated with moderate AD. Concurrently, severe PO-SCORAD, POEM, or PO-SCORAD-itch was associated with very low mean SF-12 mental health (34.7) and high DLQI scores (24.7). Atopic dermatitis commonly limited lifestyle (51.3%), led to avoidance of social interaction (39.1%), and impacted activities (43.3%). The most burdensome AD symptoms were itch (54.4%), excessive dryness/scaling (19.6%), and red/inflamed skin (7.2%). These data support the heavy burden that AD places on patients, particularly those with moderate and severe AD.

The International Society of AD (ISAD) organized a roundtable on global aspects of AD at the WCD 2023 in Singapore. According to the Global Burden of Disease (GBD) consortium, at least 171 million individuals were affected with AD in 2019, corresponding to 2.23% of the world population, with age-standardized prevalence and incidence rates that were relatively stable from 1990 to 2019. Based on the panel experience, most AD cases are mild-to-moderate. Without parallel data on disease prevalence and severity, the GBD data are difficult to interpret in many regions. This gap is particularly important in countries with limited medical infrastructure, but indirect evidence suggests a significant burden of AD in low-and-medium resource settings, especially urban areas. The Singapore roundtable was an opportunity to compare experiences in World Bank category 1 (Madagascar and Mali), 3 (Brazil, China) and 4 (Australia, Germany, Qatar, USA, Singapore, Japan) countries. The panel concluded that current AD guidelines are not adapted for low resource settings and a more pragmatic approach, as developed by WHO for skin NTDs, would be advisable for minimal access to moisturizers and topical corticosteroids. The panel also recommended prioritizing prevention studies, regardless of the level of existing resources. For disease long-term control in World Bank category 3 and most category 4 countries, the main problem is not access to drugs for most mild-to-moderate cases, but rather poor compliance due to insufficient time at visits. Collaboration with WHO, patient advocacy groups and industry may promote global change, improve capacity training and fight current inequalities. Finally, optimizing management of AD and its comorbidities needs more action at the primary care level, because reaching specialist care is merely aspirational in most settings. Primary care empowerment with store and forward telemedicine and algorithms based on augmented intelligence is a future goal.

Atopic dermatitis is a chronic, inflammatory skin disease characterized by intense pruritus and eczematous lesions. It is considered one of the most common chronic conditions, with an estimated global prevalence of nearly 230 million. As in the rest of the world, prevalence of atopic dermatitis has been increasing in Asian countries over the last few decades. This increased prevalence in Asian countries has been attributed to factors such as rapid urbanization, increasingly Westernized lifestyles, and improved standards of living and education. As a result, it is important to understand the increasing burden of disease in Asian countries and the differences between the countries in terms of epidemiology, diagnostic criteria, management, quality of life and economic burden.

A high burden of bacterial skin infections (BSI) is well documented in remote-living Indigenous children and young people (CYP) in high-income countries (HIC). Atopic dermatitis (AD) is the most common chronic inflammatory skin condition seen in CYP and predisposes to BSI. Despite the rate of urbanization for Indigenous people increasing globally, research is lacking on the burden of AD and BSI for urban-living Indigenous CYP in HIC. Indigenous people in HIC share a history of colonization, displacement and subsequent ongoing negative impacts on health. To provide a global background on the burden of AD and BSI in urban-living Indigenous CYP in HIC. A systematic review of primary observational studies on AD and BSI in English containing epidemiologic data was performed. MEDLINE, EMBASE, EMCARE, Web of Science, and PubMed databases were searched for articles between January 1990 and December 2021. From 2278 original manuscripts, 16 were included: seven manuscripts documenting eight studies on AD; and nine manuscripts documenting nine studies on BSI. Current and severe symptoms of AD were more common in urban-living Indigenous CYP in HIC compared with their non-Indigenous peers, with children having a higher prevalence than adolescents. Urban-living Indigenous CYP in HIC had a higher incidence of all measures of BSI compared with their non-Indigenous peers, and were over-represented for all measures of BSI compared with their proportion of the background population. Limitations include incomplete representation of all Indigenous populations in HIC. A significant burden of AD and BSI exists in urban-living Indigenous CYP in HIC.

Atopic eczema is a common inflammatory skin disease. Various inflammatory conditions have been linked to cardiovascular disease, a major cause of global mortality and morbidity. We sought to systematically review and meta-analyze population-based studies assessing associations between atopic eczema and specific cardiovascular outcomes. MEDLINE, Embase, and Global Health were searched from inception to December 2017. We obtained pooled estimates using random-effects meta-analyses. We used a multivariate Bayesian meta-regression model to estimate the slope of effect of increasing atopic eczema severity on cardiovascular outcomes. Nineteen relevant studies were included. The effects of atopic eczema reported in cross-sectional studies were heterogeneous, with no evidence for pooled associations with angina, myocardial infarction, heart failure, or stroke. In cohort studies atopic eczema was associated with increased risk of myocardial infarction (n = 4; relative risk [RR], 1.12; 95% CI, 1.00-1.25), stroke (n = 4; RR, 1.10; 95% CI, 1.03-1.17), ischemic stroke n = 4; RR, 1.17; 95% CI, 1.14-1.20), angina (n = 2; RR, 1.18; 95% CI, 1.13-1.24), and heart failure (n = 2; RR, 1.26; 95% CI, 1.05-1.51). Prediction intervals were wide for myocardial infarction and stroke. The risk of cardiovascular outcomes appeared to increase with increasing severity (mean RR increase between severity categories, 1.15; 95% credibility interval, 1.09-1.21; uncertainty interval, 1.04-1.28). Significant associations with cardiovascular outcomes were more common in cohort studies but with considerable between-study heterogeneity. Increasing atopic eczema severity was associated with increased risk of cardiovascular outcomes. Improved awareness among stakeholders regarding this small but significant association is warranted.

The prevalence of atopic dermatitis (AD) has increased over several decades and now affects about one-fifth of all children in high-income countries (HICs). While the increase continues in lower-income countries, the prevalence of AD might have reached a plateau in HICs. To investigate trends in the prevalence of AD and atopic comorbidity in schoolchildren in Sweden. The study population consisted of three cohorts of children (median age 8 years) in Norrbotten, Sweden, for 1996 (n = 3430), 2006 (n = 2585) and 2017 (n = 2785). An identical questionnaire that included questions from the International Study of Asthma and Allergies in Childhood (ISAAC) protocol was used in all three cohorts. Trends in AD prevalence were estimated, as well as trends in atopic comorbidity. AD prevalence was estimated both according to the ISAAC definition of AD and by adding the reported diagnosis by a physician (D-AD). The prevalence of AD decreased in the last decade, from 22.8% (1996) and 21.3% (2006) to 16.3% (2017; P < 0.001). The prevalence of D-AD was lower, but the same pattern of decrease was seen, from 9.3% (1996) and 9.4% (2006) to 5.7% (2017; P < 0.001). In all three cohorts, AD was more common among girls than boys (18.9% vs. 13.8% in 2017; P < 0.001). Children from the mountain inlands had a higher prevalence of AD than children from coastal cities (22.0% vs. 15.1% in 2017; P < 0.001). In comparing D-AD, there were no significant differences between the sexes or between inland or coastal living. Concomitant asthma increased over the years from 12.2% (1996) to 15.8% (2006) to 23.0% (2017; P < 0.001). Concomitant allergic rhinitis and allergic sensitization increased from 1996 (15.0% and 27.5%) to 2006 (24.7% and 49.5%) but then levelled off until 2017 (21.0% and 46.7%). The prevalence of AD among schoolchildren in Sweden decreased over the study period, whereas atopic comorbidity among children with AD increased. Although a decrease was seen, AD is still common and the increase in atopic comorbidity among children with AD, especially the increase in asthma, is concerning.

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Studies on the prevalence of atopic dermatitis (AD) in adults in general populations are scarce worldwide. We performed a retrospective population-based observational cohort study of 537 098 adult patients diagnosed with AD in Catalonia, Spain, a larger population than in previous studies. Objectives: To study the prevalence of AD by age, sex, disease severity, multimorbidity, serum total immunoglobin E (tIgE), and appropriate medical treatment (AMT) for the population of Catalonia. The study population comprised adult individuals (≥18 years) diagnosed with AD according to medical records at different health care levels (primary, hospital, emergency) in the Catalan Health System. Statistical analyses were conducted to evaluate sociodemographic characteristics, prevalence, multimorbidity, serum tIgE, and AMT. The prevalence of AD in the adult Catalan population was 8.7%, being higher for nonsevere disease (8.5%) than for severe disease (0.2%) and in females (10.1%) than in males (7.3%). Topical corticosteroids were the most prescribed drug (66.5%), and treatment was prescribed more frequently in severe AD patients, especially systemic corticosteroids (63.8%) and immunosuppressants (60.7%). More than half of severe AD patients (52.2%) had serum tIgE ≥100 kU/L, and higher values were observed for those with multimorbidity. The most frequent comorbid respiratory diseases were acute bronchitis (13.7%), allergic rhinitis (12.1%), and asthma (8.6%). We provide new and robust evidence of the prevalence of AD and related characteristics in adults using a large-scale population-based study and a more significant cohort of individuals.

Atopic dermatitis (AD) and hand eczema often co-occur, particularly among adults. To examine the interplay between AD and hand eczema in the general population, by characterising prevalence, disease severity, contact sensitization, and comorbidities in individuals with one or both conditions. In this cross-sectional study, 100 000 randomly selected adults in the Danish general population received a questionnaire via a secure, digital mailbox linked to their civil registration number. Participants answered questions regarding eczema, disease severity, patch testing, and comorbidities. A total of 40 007 individuals responded to the question on a lifetime prevalence of AD, and the prevalence among adult Danes was 9.0%. Nearly one third of individuals with AD reported moderate to severe disease. AD was associated with contact sensitization and increased hand eczema prevalence. Individuals with both AD and hand eczema reported worse disease severity. Furthermore, having both conditions was associated with an increased risk of psychiatric comorbidities. This study provided updated information about unselected adults with AD in Denmark. Individuals with both AD and hand eczema represent a vulnerable subgroup that physicians should be attentive to.

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Eczema and atopic dermatitis (AD) are recognized as major health problems worldwide. Prevalence estimates are as high as one-third of the population, depending on the country studied, the age range of the subjects, and the diagnostic criteria used. National estimates of prevalence for the US population are lacking. To examine the public health problem posed by eczema, AD, and eczematous conditions in the United States by analyzing disease and symptom prevalence, estimating the number of undiagnosed cases, and assessing comorbidities. A self-administered questionnaire was sent to a sample of households (N = 60,000) representative of the US population. A designated member responded with information on symptoms, diagnoses, and impact for affected household members; 42,249 households (70%) responded, representing 116,202 individuals. Empirical eczema was defined by itching/scratching and red/inflamed rash or excessive dryness/scaling. Empirical AD was defined by itching/scratching and red/inflamed rash, excessive dryness/scaling, skinfold location, early onset, symptoms lasting or 14 days, or a physician diagnosis of asthma or of allergic rhinitis or hay fever. Of the population studied, 17.1% reported at least one of four eczematous symptoms; empirically defined eczema was found in 10.7%, and empirically defined AD was found in 6%. Prevalence decreased with increasing income. Approximately two-thirds of individuals with an empirical diagnosis of eczema or AD had moderate to severe symptoms, one-third had sleep disturbances, and one-quarter had chronic unremitting symptoms. Just over one-third (37.1%) of those with symptoms reported a physician diagnosis. Peak onset for empirical AD occurred in the group of subjects aged <or= 5 years. For empirical eczema, peak onset occurred in the group aged 18 to 29 years, and comorbid asthma and hay fever/allergic rhinitis were more prevalent. A substantial proportion of the US population has symptoms of eczema or eczematous conditions; 31.6 million met the empirical symptom criteria for eczema, and 17.8 million met the empirical criteria for AD. Most cases are not diagnosed by a physician, which indicates that these conditions are undertreated and/or managed with nonprescription remedies.

Describe the pattern of atopic disease prevalence from infancy to adulthood. Cross-sectional household survey. Community-based demographic surveillance site, Mirzapur, Bangladesh. 7275 individuals in randomly selected clusters within 156 villages. The 12-month prevalence of atopic dermatitis (by UK Working Party Criteria (UK criteria) and International Study of Asthma and Allergies in Childhood (ISAAC)), asthma and rhinitis (by ISAAC); disease severity (by ISAAC); history of ever receiving a medical diagnosis. Children aged 2 years had the highest prevalence of atopic dermatitis-18.8% (95% CI 15.2% to 22.4%) by UK criteria and 14.9% (95% CI 11.6% to 18.1%) by ISAAC- and asthma (20.1%, 95% CI 16.4% to 23.8%). Prevalence of rhinitis was highest among 25-29 year olds (6.0%, (95% CI% 4.5 to 7.4%). History of a medical diagnosis was lowest for atopic dermatitis (4.0%) and highest for rhinitis (27.3%) and was significantly associated with severe disease compared with those without severe disease for all three conditions (atopic dermatitis: 30.0% vs 11.7%, p=0.015; asthma; 85.0% vs 60.4%, p<0.001; rhinitis: 34.2% vs 7.3%, p<0.001) and having a higher asset-based wealth score for asthma (29.7% (highest quintile) vs 7.5% (lowest quintile), p<0.001) and rhinitis (39.8% vs 12.5%, p=0.003). Prevalence of having Atopic disease burden was high in this rural Bangladeshi population. Having one atopic condition was significantly associated with the presence of another. Low incidence of ever obtaining a medical diagnosis highlights an important opportunity to increase availability of affordable diagnosis and treatment options for all age groups.

Patients with hand eczema frequently have a history of atopic dermatitis or atopy. No specific morphologic pattern of hand eczema helps distinguish atopic hand eczema from other etiologies. There are few studies of hand eczema prevalence and morphology in a well-defined population of patients with atopic dermatitis. We evaluated 777 consecutive patients with atopic dermatitis (diagnosed by standard criteria) for hand involvement. An additional 100 patients had further evaluations, including evaluation of the historical and morphologic characteristics of their hand eczema. The prevalence of hand involvement in patients with active atopic dermatitis was 58.9% (458 of 777 patients). Nail dystrophy was present in 16% (124 of 777) of patients. There was a significant trend toward an increasing prevalence of hand involvement with increasing age. Hand eczema tended to involve primarily the dorsal hand surfaces and the volar wrist. The hands are frequently involved in patients with active atopic dermatitis and present unique physical, social, and therapeutic challenges for patients. During the evaluation of patients presenting with hand eczema, the involvement of dorsal hand surfaces and the volar wrist may suggest atopic dermatitis as a contributing etiologic factor.

The development of early-onset cow's milk protein allergy and atopic dermatitis during the first months of life is multifactorial, including both genetic and nutritional aspects. This study aims to assess the impact of different feeding patterns on the incidence of cow's milk protein allergy, atopic dermatitis, and growth among infants with a family history of allergy. A total of 551 high-risk infants were randomly recruited from 3 European countries in three feeding regimens: exclusive breastfeeding, partially hydrolyzed formula, or standard formula with intact protein either exclusively or supplementary to breastfeeding. During the first 6 months of intervention, amongst infants with a family history of atopic dermatitis, 6.5% of partially hydrolyzed formula-fed infants and 22.7% of exclusively breastfed infants (

Cardiovascular guidelines recommend early screening and preventative treatment for children with chronic inflammatory diseases. Atopic dermatitis (AD) is associated with cardiovascular risk in adults, but data in children are limited. We systematically searched for studies that examined the association between childhood AD and cardiovascular risk factors and outcomes. Data from 10 publications, including 577,148 individuals, revealed an association between AD and ischemic heart disease (n = 3, OR = 1.68, 95% confidence interval [CI] = 1.29-2.19) and diabetes (n = 4, OR = 1.31, 95% CI = 1.12-1.53), but this did not persist among studies that adjusted for potential confounders (n = 2, OR = 0.98, 95% CI = 0.35-2.75). Similarly, there was an association with lipid disorders but not across the entire population distribution (n = 7, OR = 1.24, 95% CI = 1.13-1.36, 95% prediction interval = 0.95-1.61). AD was not associated with hypertension (n = 5, OR = 1.15, 95% CI = 0.98-1.34, 95% prediction interval = 0.81-1.62) or stroke (n = 2, OR = 1.24, 95% CI = 0.94-1.62). Studies lacked detail on AD severity and important confounders such as body mass index, and the certainty of evidence was very low to low on the basis of GRADE (Grading of Recommendations, Assessment, Development and Evaluation) assessments. Currently, data do not support a clinically meaningful increase in cardiovascular risk for children with AD.

To evaluate the impact of atopic dermatitis on families of pediatric patients. This cross-sectional, web-based survey of children/adolescents (6 months to <18 years old) with atopic dermatitis and their parents and caregivers was conducted in 18 countries encompassing North America, Latin America, Europe, Middle East/Eurasia, and East Asia. Children and adolescents with atopic dermatitis and their parents and caregivers were identified by the International Study of Asthma and Allergies in Childhood criteria and ever being told by a physician that they had "eczema". Atopic dermatitis severity was assessed using the Patient-Oriented Eczema Measure and the Patient Global Assessment. Atopic dermatitis impact on families' lives was evaluated using the Dermatitis Family Impact questionnaire and stand-alone questions on hours of atopic dermatitis-related care (past week) and missed work days (past 4 weeks) owing to their child's atopic dermatitis. A total of 7465 pairs of pediatric participants with atopic dermatitis and their parents or caregivers were surveyed. Across age groups, the Dermatitis Family Impact questionnaire total score for all regions ranged from 7.1 to 8.6, 13.2 to 14.9, and 17.0 to 17.2 for Patient-Oriented Eczema Measure mild, moderate, and severe atopic dermatitis, respectively. Subscale scores showed that greater atopic dermatitis severity had a greater impact on all family life domains, including sleep and tiredness. No specific patterns or trends were observed across age groups. Time spent on childcare and missed work days increased with atopic dermatitis severity. Across pediatric age groups and geographic regions, greater atopic dermatitis severity was associated with a greater negative impact on physical, emotional, social, and economic components of family life.

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Limited evidence was available on ambient air pollution and pediatric atopic dermatitis (AD). The study aimed to evaluate the associations between short-term exposure to air pollutants and outpatient visits for pediatric AD. From 2016-2018, we collected data on six criteria air pollutants (PM

The association of diet with atopic dermatitis (AD) remains poorly understood and could help explain heterogeneity in disease course. To determine the extent to which a higher level of dietary sodium intake, estimated using urine sodium as a biomarker, is associated with AD in a large, population-based cohort. This cross-sectional study of adult participants (aged 37-73 years) from the UK Biobank examined 24-hour urine sodium excretion, which was estimated using a single spot urine sample collected between March 31, 2006, and October 1, 2010, and calculations from the sex-specific International Cooperative Study on Salt, Other Factors, and Blood Pressure equation, incorporating body mass index; age; and urine concentrations of potassium, sodium, and creatinine. The data were analyzed between February 23, 2022, and March 20, 2024. The primary exposure was 24-hour urinary sodium excretion. The primary outcome was AD or active AD based on diagnostic and prescription codes from linked electronic medical records. Multivariable logistic regression models adjusted for age, sex, race and ethnicity, Townsend Deprivation Index, and education were used to measure the association. The analytic sample comprised 215 832 participants (mean [SD] age, 56.52 [8.06] years; 54.3% female). Mean (SD) estimated 24-hour urine sodium excretion was 3.01 (0.82) g per day, and 10 839 participants (5.0%) had a diagnosis of AD. Multivariable logistic regression revealed that a 1-g increase in estimated 24-hour urine sodium excretion was associated with increased odds of AD (adjusted odds ratio [AOR], 1.11; 95% CI, 1.07-1.14), increased odds of active AD (AOR, 1.16; 95% CI, 1.05-1.28), and increased odds of increasing severity of AD (AOR, 1.11; 95% CI, 1.07-1.15). In a validation cohort of 13 014 participants from the National Health and Nutrition Examination Survey, a 1 g per day higher dietary sodium intake estimated using dietary recall questionnaires was associated with a higher risk of current AD (AOR, 1.22; 95% CI, 1.01-1.47). These findings suggest that restriction of dietary sodium intake may be a cost-effective and low-risk intervention for AD.

Data on the association between atopic dermatitis (AD) and inflammatory bowel disease (IBD) are inconsistent. Few studies have examined the association of AD or AD severity with risk of ulcerative colitis (UC) and Crohn disease (CD) separately. To examine the risk of new-onset IBD, UC, and CD in children and adults with AD. This population-based cohort study assessed patients with AD matched with up to 5 controls on age, practice, and index date. Treatment exposure was used as a proxy for AD severity. Data were retrieved from The Health Improvement Network, a UK electronic medical record database, for January 1, 1994, to February 28, 2015. Data analysis was performed from January 8, 2020, to June 30, 2023. Outcomes of interest were incident IBD, UC, and CD. Logistic regression was used to examine the risk for each outcome in children and adults with AD compared with controls. A total of 1 809 029 pediatric controls were matched to 409 431 children with AD (93.2% mild, 5.5% moderate, and 1.3% severe). The pediatric cohort ranged in median age from 4 to 5 years (overall range, 1-10 years), was predominantly male (936 750 [51.8%] controls, 196 996 [51.6%] with mild AD, 11 379 [50.7%] with moderate AD, and 2985 [56.1%] with severe AD), and with similar socioeconomic status. A total of 2 678 888 adult controls were matched to 625 083 adults with AD (65.7% mild, 31.4% moderate, and 2.9% severe). The adult cohort ranged in median age from 45 to 50 years (overall range, 30-68 years) and was predominantly female (1 445 589 [54.0%] controls, 256 071 [62.3%] with mild AD, 109 404 [55.8%] with moderate AD, and 10 736 [59.3%] with severe AD). In fully adjusted models, children with AD had a 44% increased risk of IBD (hazard ratio [HR], 1.44; 95% CI, 1.31-1.58) and a 74% increased risk of CD (HR, 1.74; 95% CI, 1.54-1.97), which increased with worsening AD; however, they did not have increased risk of UC (HR, 1.09; 95% CI, 0.94-1.27) except for those with severe AD (HR, 1.65; 95% CI, 1.02-2.67). Adults with AD had a 34% (HR, 1.34; 95% CI, 1.27-1.40) increased risk of IBD, a 36% (HR, 1.36; 95% CI, 1.26-1.47) increased risk of CB, and a 32% (HR, 1.32; 95% CI, 1.24-1.41) increased risk of UC, with risk increasing with worsening AD. In this cohort study, children and adults with AD had an increased risk of IBD, with risk varying by age, AD severity, and IBD subtype. These findings provide new insights into the association between AD and IBD. Clinicians should be aware of these risks, particularly when selecting systemic treatments for AD in patients who may have coincident gastrointestinal symptoms.

The associations of atopic dermatitis (AD) with multiple cardiovascular comorbidities have been investigated because of its pathomechanisms regarding chronic systemic inflammation and potential vascular effects. Nevertheless, the association between AD and incident venous thromboembolism (VTE) in adulthood is largely unknown. This study aimed to investigate the association of AD with incident VTE. To examine the risk of incident VTE among patients with AD. This population-based nationwide cohort study included adults 20 years or older (adults with AD newly diagnosed between 2003 and 2017 and matched controls) from the National Health Insurance Research Database. Patients with AD were subgrouped according to the severity of the disease. A Cox regression model was used to estimate hazard ratios (HRs) for VTE. Stratified analyses according to age and sex, and a sensitivity analysis excluding systemic steroid users were performed. Hazard ratios (HRs) for incident VTE associated with AD. This analysis included a total of 284 858 participants, with 142 429 participants each in the AD (mean [SD] age, 44.9 [18.3] years; 78 213 women) and non-AD cohorts (mean [SD] age, 44.1 [18.1] years; 79 636 women). During the follow-up, 1066 patients (0.7%) in the AD cohort and 829 patients (0.6%) in the non-AD cohort developed VTE, with incidence rates of 1.05 and 0.82 per 1000 person-years, respectively. Adults with AD had a significantly increased risk of incident VTE (HR, 1.28; 95% CI, 1.17-1.40) compared with adults without AD. Individual outcome analyses suggested that AD was associated with higher risks of deep vein thrombosis (HR, 1.26; 95% CI, 1.14-1.40) and pulmonary embolism (HR, 1.30; 95% CI, 1.08-1.57). The results of this cohort study suggest that AD in adulthood is associated with an increased risk of VTE; however, the absolute risk difference of VTE between adults with and without AD appears small. Nevertheless, cardiovascular examination and imperative management may be considered for adults with AD who present with symptoms suggestive of VTE. Future research is warranted to elucidate the pathophysiology underlying the association between AD and VTE.

There is a lack of information about which risk factors accompany food allergy (FA) in infants with atopic dermatitis (AD). We hypothesized that we would be able to predict FA through risk factors in infants with AD. This prospective descriptive cross-sectional study was performed with infants aged 1-12 months with newly diagnosed AD. The SCORing Atopic Dermatitis (SCORAD) and Eczema Area and Severity Index (EASI), Infants` Dermatitis Quality Of Life (IDQOL), and Family Dermatological Life Quality (FDLQ) index scores were calculated at first admission. We developed a new tool, Sites of Eczema (SoE), to score sites of eczema on the body. A total of 279 infants with AD were included. FA was found in 166 (59.5%) infants with AD, of whom 112 had single and 54 had multiple FAs. The SCORAD index, EASI scores, IDQOL1, IDQOL2, and FDQL, and SoE scores were higher in the subgroup with FA compared to that without FA (p < 0.001). In the multivariate regression model, eosinophil count (odds ratio [OR]=1.00, 95% confidence interval: [CI, 1.00-1.00]; p=0.008), serum total IgE level (OR=1.02, 95% CI: [1.00-1.03]; p=0.002), pruritus score (OR=0.87, 95% CI: [0.77-0.97]; p=0.019), SCORAD index (OR=1.04, 95% CI: [1.01-1.08]; p=0.008), FDQL index (OR=1.09, 95% CI: [1.01-1.18]; p=0.014), and SoE score (OR=1.48, 95% CI: [1.00-2.19]; p=0.046) were identified as the highest risk factors for FA in infants with AD. Serum total IgE levels, eosinophil counts and ratio, SCORAD index and EASI scores, IDQOL and FDLQ index, pruritus and sleep disturbance scores, and SoE scores were identified as risk factors for FA in infants with AD in this study. The SoE score is an important risk factor for FA in infants with AD. We recommend that the risk factors for FA in patients with AD guide the management of these patients.

The risk of skin malignancy among atopic dermatitis (AD) patients is not well established. We reviewed the epidemiological evidence on the association between AD, naevi count, and the risk of cutaneous melanoma and keratinocyte skin cancer (KSC). We included all studies that compared the naevi count and the risk of skin cancer (melanoma and/or KSC) between AD patients and unaffected individuals. We calculated summary relative risks (SRRs) and 95% confidence intervals (CI) through random effects models; explored correlates of between-studies heterogeneity using sub-group and sensitivity analysis; and assessed publication bias using a funnel-plot-based approach. The number of common naevi larger ≥2mm on the whole body was consistently lower among AD patients vs. unaffected individuals when measured by trained health professionals. The risk of melanoma was not increased among AD patients (SRR=0.77, 95%CI 0.44-1.35, I AD patients may be at increased BCC risk; however, methodological limitations prevented from drawing definitive conclusions. Despite the lack of strong scientific evidence, AD patients should avoid excessive sun exposure, regularly perform skin self examination, and consult a doctor in case of a suspicious skin lesion.