儿童特应性皮炎患病率约为 12%

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.

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.

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.

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 (PM2.5, PM10, NO2, SO2, CO and O3) and daily outpatient visits for pediatric AD in 66 hospitals, covering all districts in Shanghai, China. The over-dispersed Poisson generalized additive model (GAM) was applied to fit the associations of criteria air pollutants with hospital visits. Two-pollutant models were fitted and stratified analyses by sex, age and season were conducted. We identified 477,833 outpatient visits for pediatric AD. Each interquartile range (IQR) increase in PM2.5 (IQR: 30.9 μg/m3), PM10 (8.9 μg/m3), NO2 (25.5 μg/m3), SO2 (5.8 μg/m3) and CO (0.283 mg/m3) on the concurrent day was significantly associated with increments of 2.08 % (95 % CI: 0.53 %, 3.65 %), 2.53 % (95 % CI: 0.87 %, 4.22 %), 8.14 % (95 % CI: 6.24 %, 10.08 %), 5.67 % (95 % CI: 3.58 %, 7.80 %), and 2.27 % (95 % CI: 0.70 %, 3.87 %) in pediatric AD outpatient visits, respectively. The effects of NO2 remained robust after adjustment for other air pollutants. The exposure-response curves for PM2.5 and PM10 were steeper for moderate-lower concentrations, with a flatten curves at high concentration; nearly linear relationships were found for NO2. Higher associations of NO2 exposure on AD were detected in children under 6 years old (p=0.01); and we observed larger effect of air pollutants in cool seasons (p<0.001 for PM2.5, PM10, NO2 and CO; p=0.043 for SO2). This study indicated that short-term exposure to air pollution could increase risk of outpatient visits for pediatric 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.

Background Pediatric atopic dermatitis (AD) demonstrate significantly higher rates of both general behavioral problems and condition-specific maladaptive behaviors. These behavioral challenges often interfere with parental treatment adherence and compromise disease management effectiveness. The Eczema Behavior Checklist Extent Scale (EBC-ES), initially developed and validated in Australia, represents the first psychometric tool specifically designed to evaluate AD-specific behavioral problems in children. However, its cross-cultural applicability and validation in Chinese populations remain unexplored. Objective This study aimed to culturally adapt and validate the Chinese version of the EBC-ES for assessing AD-specific behavioral problems in pediatric patients across China. Methods The Chinese EBC-ES utilized Brislin's validated back-translation protocol for cultural adaptation. This cross-sectional study recruited 674 parents (mean age 35.5 ± 4.7 years, range 24–49) of 3–10-year-old children (mean 5.9 ± 1.8) with physician-diagnosed AD. The sample comprised 369 boys (54.7%) and 305 girls (45.3%). Participants completed the Chinese EBC-ES and the Eyberg Child Behavior Inventory-Intensity scale (ECBI-IS). Psychometric evaluation included exploratory and confirmatory factor analyses (EFA, CFA) to assess construct validity, content validity indices (CVI), internal consistency (Cronbach's α, McDonald's ω), split-half reliability, and test-retest reliability. Results The final 24-item Chinese EBC-ES demonstrated a stable three-factor structure (eigenvalues >1), accounting for 80.44% of the total variance. The Kaiser-Meyer-Olkin measure confirmed sampling adequacy (KMO = 0.942), and Bartlett's test supported factorability (χ² = 14,091.013; p < 0.001). CFA indicated excellent model fit: chi-square degree of freedom (χ²/df) = 2.855, root mean square error of approximation (RMSEA) = 0.075, standardized root mean square residual (SRMR) = 0.041. Comparative Fit Index (CFI) = 0.948, Tucker Lewis Index (TLI) = 0.942, Normed Fit Index (NFI) = 0.923, and Incremental Fit Index (IFI) = 0.948. The scale showed strong content validity (CVI = 0.96), high internal consistency (α=0.968, ω = 0.987), excellent test-retest reliability (r = 0.969), and satisfactory split-half reliability (r = 0.895). Conclusion The Chinese version of the EBC-ES demonstrates robust psychometric properties, confirming its reliability and validity for AD-specific child behavioral problems in both clinical practice and research settings within Chinese populations.

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Atopic dermatitis (AD) is an inflammatory skin condition with a childhood prevalence of up to 25%. Microbial dysbiosis is characteristic of AD, with Staphylococcus aureus the most frequent pathogen associated with disease flares and increasingly implicated in disease pathogenesis. Therapeutics to mitigate the effects of S. aureus have had limited efficacy and S. aureus–associated temporal disease flares are synonymous with AD. An alternative approach is an anti–S. aureus vaccine, tailored to AD. Experimental vaccines have highlighted the importance of T cells in conferring protective anti–S. aureus responses; however, correlates of T cell immunity against S. aureus in AD have not been identified. We identify a systemic and cutaneous immunological signature associated with S. aureus skin infection (ADS.aureus) in a pediatric AD cohort, using a combined Bayesian multinomial analysis. ADS.aureus was most highly associated with elevated cutaneous chemokines IP10 and TARC, which preferentially direct Th1 and Th2 cells to skin. Systemic CD4+ and CD8+ T cells, except for Th2 cells, were suppressed in ADS.aureus, particularly circulating Th1, memory IL-10+ T cells, and skin-homing memory Th17 cells. Systemic γδ T cell expansion in ADS.aureus was also observed. This study suggests that augmentation of protective T cell subsets is a potential therapeutic strategy in the management of S. aureus in AD.

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) is a chronic, relapsing inflammatory skin disorder with a significant impact on psychosocial health and quality of life. Despite growing prevalence in India, particularly among adults, a comprehensive, India-specific guideline incorporating recent advances is lacking. Objective To develop a standardised, evidence-based consensus on the diagnosis and management of paediatric and adult AD in India through a modified Delphi methodology. Methods A total of 14 dermatology experts across India, with over 15 years of clinical and academic experience, formed the Special Interest Group of Paediatric Dermatology under IADVL. A systematic literature review was conducted using databases such as PubMed, Embase, and Cochrane, focusing on Indian and global literature up to December 2024. Based on this, 29 draft statements were generated covering domains of diagnosis, severity assessment, non-pharmacological measures, and topical and systemic therapies. A two-round, web-based, modified Delphi process was conducted anonymously to reach consensus. Statements with ≥75% agreement were retained. Results Consensus was achieved on all 29 statements. Thirteen statements were finalised after the first round, and 16 were refined and approved in the second round. Key recommendations included the use of modified Hanifin and Rajka criteria for diagnosis, SCORAD and IGA for severity assessment, therapeutic patient education, and individualised use of moisturisers, topical corticosteroids, and topical calcineurin inhibitors. For systemic therapy, cyclosporine remains first-line for moderate-to-severe AD, with conditional recommendations for methotrexate, mycophenolate, and JAK inhibitors such as abrocitinib. Emerging therapies like topical tofacitinib and crisaborole were discussed with caution due to limited Indian data. Limitation Although several new therapies-such as abrocitinib and dupilumab-have been approved for pediatric atopic dermatitis, consensus among Delphi panelists remains limited. There is lack of sufficient clinical experience and pediatric-specific data on these agents, highlighting the urgent need for more robust studies to inform expert alignment and clinical practice. Conclusion This updated Indian consensus guideline provides comprehensive, evidence-based, and context-sensitive recommendations for diagnosing and managing AD across age groups. It addresses previously unmet needs in adult AD. This consensus is expected to enhance clinical outcomes and standardise AD management nationally.

Background Dupilumab is a safe and effective treatment for moderate to severe atopic dermatitis (AD), but real-world data in pediatric patients in China are limited. Currently, there is no exploration of changes in blood cell counts derived indexes in pediatric patients, especially under 6 years old. Purpose To investigate the changes in blood cell counts derived indexes before and after dupilumab treatment in Chinese children with AD, the relationship with clinical scores, and the potential role of these indexes on treatment efficacy. Patients and Methods We conducted a retrospective study of 109 children with moderate to severe AD treated with dupilumab. Derived inflammatory indexes, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), eosinophil-to-lymphocyte ratio (ELR), eosinophil-to-neutrophil Ratio (ENR), monocyte-to-lymphocyte ratio (MLR), inflammation response index (SIRI), systemic inflammation index (SII), and aggregate inflammation systemic index (AISI) were calculated. The correlation between clinical scores and inflammatory indexes at different treatment time points were analyzed. Logistic regression and ROC curve was employed to explore factors associated with treatment efficacy. Results Baseline ELR and ENR were positively correlated with the baseline Eczema Area and Severity Index (EASI) and the Scoring Atopic Dermatitis (SCORAD). Additionally, baseline ENR levels showed a positive correlation with the baseline Peak Pruritus Numeric Rating Scale (PP-NRS). At 4 and 16 weeks of treatment, the percentage reduction in ELR was significantly associated with the percentage reduction in EASI and PP-NRS. Logistic regression results indicated that high baseline ELR could predict a poor response to dupilumab treatment. Conclusion ELR was significantly correlated with disease severity score during the treatment with dupilumab. Baseline ELR could act as a predictor of the efficacy of dupilumab in the treatment of children with atopic dermatitis under 6 years of age.

Atopic dermatitis (AD) is a common chronic inflammatory skin disease in pediatric populations, yet treatment adherence remains a persistent challenge. This study aims to assess caregivers' perceptions of treatment and investigate the factors influencing treatment adherence in children with AD in China.

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.

Atopic dermatitis (AD) is a multifactorial, chronic relapsing disease. Staphylococcus aureus is the key microbial factor in AD, linked to disease activity. However, there is limited knowledge of genomic prevalence characteristics and phenotypic features of S. aureus in AD patients in China. We investigated 108 S. aureus of AD in China and globally publicly available genome sequences of 579 S. aureus of AD. Sequence type (ST) 7, ST15 and ST188 were the major lineages in China. Genes esaC, esxB, and sea were only detected in ST7, potentially contributing to its prevalence in AD. ST188 exhibited high virulence and adhesion, possibly due to the cna gene. Phylogenetic and population structure analysis revealed that 579 strains of global AD were classified into 15 sequence clusters (SCs), with SC5, SC2, and SC7 dominating. S. aureus of Chinese AD patients was mainly distributed in SC2, SC7, and SC12. Comparative genomic highlighted genes linked to AD, including enterotoxins (seh, selk, selq, entH), adhesion genes (fnbA, fnbB, sdrD, map, fib, narH). From China and global perspectives, we analyzed S. aureus’s genomic epidemic traits, phylogeny, and population structure in AD skin. These findings contribute to understanding S. aureus-host interactions and genomic diversity in AD.

Background The prevalence of atopic eczema is unknown in many countries. The International Study of Asthma and Allergies in Childhood (ISAAC) is an epidemiological landmark in the study of allergic diseases. Objective To validate and assess the reproducibility of the ISAAC Written Atopic Eczema Questionnaire (WAEQ) for children aged between 6 and 7 years by telephone contact. Methods Observational study through interviews with guardians of children aged 6 to 7 years using the ISAAC atopic eczema module questionnaire in three different phases separated by 2 weeks: telephone interviews in the first and third contacts and in-person interviews under supervision in the second contact. Reproducibility was estimated using the Kappa index and validation using the sensitivity and specificity coefficients. Results Data from 88 children (32 from the atopic eczema group) were analyzed. Reproducibility showed almost perfect agreement for the questions “Recurrent pruritic lesions” and “Lesions in typical locations” (Kappa between 0.81–0.82), while a substantial agreement was observed for all other indicators (Kappa variation between 0.66 and 0.78). The validation showed high specificity (≥ 80.4%) and sensitivity (≥ 87.5%) for all questions, except those related to chronicity and medical diagnosis (34.4% and 40.6%, respectively). Study limitations Non-random selection, no sample size calculation, participants from a tertiary hospital and study period coincident with the Coronavirus pandemic. Conclusions Our results showed that the ISAAC atopic eczema module questionnaire by telephone interviews has good reproducibility and high agreement with the clinical diagnosis of atopic eczema. It may be an appropriate alternative tool in epidemiological studies of childhood atopic eczema, especially in periods of social isolation.

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Adiposity in early life has been associated with an increased risk of infantile and childhood atopic eczema but evidence for this has been inconsistent. Examining this association can help identify mechanisms which influence the risk of developing atopic eczema and point to measures that may help prevent or control the condition. The aim of this study was to examine the association between adiposity and atopic eczema through infancy and early childhood. Within the Southampton Women Survey, infant/child total body fat was assessed using dual-energy X-ray absorptiometry (DXA) as means of evaluating body composition at birth (n = 933), 4 years (n = 797) and 6 years (n = 1141). Atopic eczema was ascertained using the UK Working Party Diagnostic Criteria at ages 6 months (n = 154/1679, 12 months (n = 174/1655), 3 years (n = 233/1583) and 6 years (n = 217/1427). A directed acyclic graph determined confounders, which were: maternal body mass index, education, smoking during pregnancy, maternal history of eczema in the last 12 months, parity and infant sex. Analyses also adjusted for infant gestational age and age of DXA scan as they directly impact total body fat. Logistic regressions examined the associations between total body fat and atopic eczema at the various timepoints. Total body fat at birth, 4 years and 6 years were not related to atopic eczema in infancy or early childhood. However, total body fat > 80th centile at age 4 years was associated with a higher risk of atopic eczema at age 6 years and remained significant after adjusting for confounders (adjusted odds ratio 1.69, 95% confidence interval 1.03–2.77; P = 0.04). These findings suggest that excess total body fat > 80th centile in early childhood is associated with a higher risk of childhood atopic eczema. Further research is needed to establish the mechanisms that link excess adiposity at age 4 years and atopic eczema in childhood.

Atopic dermatitis (AD) is a chronic, inflammatory disease characterized by dry, pruritic skin. In the U.S., the prevalence of AD has increased over three-fold since the 1970s. We previously reported a geographic association between isocyanate-containing air pollution and AD as well as mechanistic data demonstrating that isocyanates induce skin dysbiosis and activate the host itch receptor TRPA1. However, non-spatial models are susceptible to spatial confounding and may overlook other meaningful associations. We added spatial analysis to our prior model, contrasting pollution data with clinical visits. In addition, we conducted a retrospective case-control survey of childhood exposure to BTEX-related products. Finally, we assessed implicated compounds, in pure form and as part of synthetic fabric, for their effect on the growth and metabolism of skin commensal bacteria. Spatial analysis implicate benzene, toluene, ethylbenzene, and, most significantly, xylene (BTEX) compounds. Survey odds ratios for AD were significant for xylene-derived polyester bed sheets (OR = 9.5; CI 2.2–40.1) and diisocyanate-containing wallpaper adhesive (OR = 6.5; CI 1.5–27.8). Staphylococcus aureus lives longer on synthetic textiles compared to natural textiles. Meanwhile, synthetic fabric exposure shifts the lipid metabolism of health-associated commensals (Roseomonas mucosa and S. epidermidis) away from therapeutic pathways. We propose that BTEX chemicals in their raw forms and in synthetic products represent a unifying hypothesis for environmentally induced AD flares through their ability to create dysbiosis in the skin microbiota and directly activate TRPA1. Unequal distribution of these pollutants may also influence racial disparities in AD rates. Atopic dermatitis (AD) is a chronic, inflammatory disease characterized by dry, itchy skin that has become increasingly more common since around 1970. We aimed to identify chemicals that may cause atopic dermatitis (eczema). Building on prior work, we discovered that these chemicals could prevent the good bacteria that live on the skin from making the lipids and oils needed to keep human skin healthy. In this study, we combined new research methods with patient surveys. We link eczema to the chemical xylene, which is found in numerous home products. Exposure to xylene, benzene, or isocyanate containing fabrics (polyester, nylon, or spandex) disrupted the normal functions of skin bacteria. Our results indicate exposure to synthetic fabrics and other sources of these chemicals may contribute to eczema and deepen the understanding of how the environment can drive common diseases. Ratley, Zeldin et al. implicate xylene in the pathogenesis of atopic dermatitis by combining spatial analysis and patient surveys with prior epidemiological and mechanistic data. They propose that exposure of healthy skin commensals to xylene, benzene and isocyantes in synthetic fabrics disrupts normal lipid metabolism and activates itching.

BACKGROUND There is limited evidence on the association between maternal anemia during pregnancy and the risk of childhood allergic disorders, with regards to atopic eczema. The current pre-birth cohort study aimed to examine the association between maternal anemia during pregnancy and the risk of atopic eczema in Japanese 2-year-olds. METHODS The study included 1354 Japanese mother-child pairs. Maternal anemia during pregnancy was determined based on self-reported iron treatment for anemia during pregnancy. Eczema was defined according to the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC). Physician-diagnosed atopic eczema was evaluated through a questionnaire completed by the mothers. RESULTS The prevalence of maternal anemia during pregnancy was 52.8%. The study found that maternal anemia during pregnancy was associated with an increased risk of physician-diagnosed atopic eczema in children; with an adjusted odds ratio of 1.79 and a 95% confidence interval of 1.04-3.17. However, there was no observed association between maternal anemia during pregnancy and the risk of eczema as defined by the ISAAC criteria. CONCLUSIONS Although the study relied on self-reported information, it suggested a potential positive association between maternal anemia during pregnancy and the risk of atopic eczema in children.

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 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.

Prevalence of atopic dermatitis (AD) is increasing worldwide. Up to date, there has been no face-to-face nation-wide study in China. We aim to explore the prevalence of clinical diagnosed AD in children aged 1–7 ys in China. Twelve metropolises were chosen from different areas of China. In each region, we selected 4–10 kindergartens and 2–5 vaccination clinics randomly. A complete history-taking and skin examination were performed by dermatologists. The definite diagnosis of AD and the severity were determined by two or three dermatologists. All criteria concerned in UK diagnosis criteria, characteristic presentation of AD and atypical manifestations were recorded in detail. A total of 13998 children from 84 kindergartens and 40 vaccination clinics were included. The prevalence of AD was 12.94% by clinical diagnosis of dermatologists overall, with 74.6% of mild AD. Comparatively, prevalence of AD based on UK diagnostic criteria was 4.76%. This is the first face-to-face nation-wide study in Chinese children aged 1–7 ys, revealing that the prevalence of AD in children is closer to that of wealthier nations.

Background There is growing evidence suggesting that air pollution may act as an important environmental risk factor in the development and aggravation of childhood atopic dermatitis (AD). Methods We collected data from the Taiwan National Health Insurance (NHI) research database and linked the data to the Taiwan Air Quality-Monitoring Database. From January 1, 2000 to December 31, 2012; children aged below 18 years were selected from the database and followed longitudinally until the diagnosis of AD, withdrawal from the NHI, or December 31, 2012. Children with missing data or those diagnosed with AD before enrolment in this study were excluded. We measured the incidence rate and hazard ratios (HRs) for AD and stratified them by quartiles (Q1–Q4) of air pollutant concentration. Multivariable Cox proportional hazards models were also applied by adjusting for age, sex, monthly income, and level of urbanization. Results When compared with the concentrations of pollutants in the Q1 quartile, the adjusted HR for AD increased with an increase in the exposure concentrations of total hydrocarbons (THCs), non-methane hydrocarbons (NMHCs), and methane (CH 4 ) from 1.65 (95% confidence interval [CI]: 1.47–1.84) to 10.6 (95% CI: 5.85–7.07), from 1.14 (95% CI: 1.06–1.24) to 2.47 (95% CI: 2.29–2.66), and from 1.70 (95% CI: 1.52–1.89) to 11.9 (95% CI: 10.8–13.1), respectively. Patients exposed to higher levels of THCs, NMHCs, and CH 4 exhibited greater incidence rates of childhood AD. Conclusions The present study demonstrated that exposure to higher concentrations of THCs, NMHCs, and CH 4 were associated with an increased risk of childhood AD.

BACKGROUND Long-term safety of topical calcineurin inhibitors is not well understood. APPLES™ (A Prospective Pediatric Longitudinal Evaluation to Assess the Long-Term Safety of Tacrolimus Ointment for the Treatment of Atopic Dermatitis (AD); NCT00475605) examined incidence of lymphoma and other cancers in a pediatric AD population. OBJECTIVE To quantify incident malignancies during 10 years in children with AD who used topical tacrolimus for ≥6 weeks. METHODS Standardized Incidence Ratios (SIRs) for cancer events were analysed relative to sex-, age-, and race-matched control data from national cancer registries. RESULTS 7954 eligible patients enrolled at 314 sites in 9 countries. Over 44629 person-years, six confirmed incident cancers occurred (SIR 1.01 (95% CI 0.37 to 2.20)). No lymphomas occurred. LIMITATIONS Observational prospective cohort study. CONCLUSIONS Cancer incidence was as expected, given matched background data. This finding provides no support for the hypothesis that topical tacrolimus increases long-term cancer risk in children with AD.

Abstract: Background: Atopic dermatitis (AD) is a common skin disease that affects patients' quality of life, especially in the pediatric population. Dupilumab has shown good efficacy and safety in the treatment of AD in adolescents and adults, but the real data on younger children using dupilumab are scarce. Objectives: We investigated the doses, efficacy, and safety of dupilumab in children with moderate-to-severe AD aged ≥6 months to 11 years. Methods: This single-center retrospective cohort analysis included dupilumab-treated patients with severe AD under 12 years of age. Primary endpoints included the proportion of Validated Investigator Global Assessment (vIGA) 0/1 achieved and the percentage change from baseline in eczema area and severity index (EASI) and SCORing Atopic Dermatitis (SCORAD) at week 24 (W24). Secondary endpoints were mean change in pruritus numerical rating score (P-NRS) and body surface area (BSA) after W24 of treatment, description of adverse events, and Children's Dermatology Life Quality Index (CDLQI) improvement from baseline in endpoints. Results: Fifty-seven patients were included (mean age 7.2 ± 3.0 years). The primary endpoint (vIGA = 0/1) was achieved by 51 of 57 (89.5%) patients at W24. Significant improvements in EASI, SCORAD, P-NRS, and CDLQI scores were observed from baseline to W24 with dupilumab treatment and remained until W40. In different age groups, the endpoint vIGA achieved 0/1: 95.2% (20/21) of younger children and 88.9% (32/36) of older children. No serious adverse drug reactions were reported. Conclusions: This study aimed to describe the safety and efficacy of dupilumab in pediatric patients and examined differences of efficacy with various doses. The outcomes are comparable with those of existing clinical trials. Phase III Clinical Trial: NCT03346434.

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 Current systemic treatments for children younger than 6 years with moderate-to-severe atopic dermatitis that is uncontrolled with topical therapies might have suboptimal efficacy and safety. Dupilumab is approved for older children and adults with atopic dermatitis and for other type 2 inflammatory conditions. We aimed to evaluate efficacy and safety of dupilumab with concomitant low-potency topical corticosteroids in children aged 6 months to younger than 6 years with moderate-to-severe atopic dermatitis. METHODS This randomised, double-blind, placebo-controlled, parallel-group, phase 3 trial was conducted in 31 hospitals, clinics, and academic institutions in Europe and North America. Eligible patients were aged 6 months to younger than 6 years, with moderate-to-severe atopic dermatitis (Investigator's Global Assessment [IGA] score 3-4) diagnosed according to consensus criteria of the American Academy of Dermatology, and an inadequate response to topical corticosteroids. Patients were randomly assigned (1:1) to subcutaneous placebo or dupilumab (bodyweight ≥5 kg to <15 kg: 200 mg; bodyweight ≥15 kg to <30 kg: 300 mg) every 4 weeks plus low-potency topical corticosteroids (hydrocortisone acetate 1% cream) for 16 weeks. Randomisation was stratified by age, baseline bodyweight, and region. Patient allocation was done via a central interactive web response system, and treatment allocation was masked. The primary endpoint at week 16 was the proportion of patients with IGA score 0-1 (clear or almost clear skin). The key secondary endpoint (coprimary endpoint for the EU and EU reference market) at week 16 was the proportion of patients with at least a 75% improvement from baseline in Eczema Area and Severity Index (EASI-75). Primary analyses were done in the full analysis set (ie, all randomly assigned patients, as randomly assigned) and safety analyses were done in all patients who received any study drug. This study was registered with ClinicalTrials.gov, NCT03346434. FINDINGS Between June 30, 2020, and Feb 12, 2021, 197 patients were screened for eligibility, 162 of whom were randomly assigned to receive dupilumab (n=83) or placebo (n=79) plus topical corticosteroids. At week 16, significantly more patients in the dupilumab group than in the placebo group had IGA 0-1 (23 [28%] vs three [4%], difference 24% [95% CI 13-34]; p<0·0001) and EASI-75 (44 [53%] vs eight [11%], difference 42% [95% CI 29-55]; p<0·0001). Overall prevalence of adverse events was similar in the dupilumab group (53 [64%] of 83 patients) and placebo group (58 [74%] of 78 patients). Conjunctivitis incidence was higher in the dupilumab group (four [5%]) than the placebo group (none). No dupilumab-related adverse events were serious or led to treatment discontinuation. INTERPRETATION Dupilumab significantly improved atopic dermatitis signs and symptoms versus placebo in children younger than 6 years. Dupilumab was well tolerated and showed an acceptable safety profile, similar to results in older children and adults. FUNDING Sanofi and Regeneron Pharmaceuticals.

In previous epidemiological study, the prevalence of atopic dermatitis (AD) was 12.94% among children aged 1–7 years by clinical diagnosis, whereas that was 4.76% and 3.51% using U.K., and Hanifin and Rajka diagnostic criteria.

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Allergic diseases are a major public health challenge for children. To date, a comprehensive assessment of the disease burden of major allergic diseases in Chinese children is still limited. This study aimed to analyze the epidemiological characteristics of major allergic diseases in China through the Global Burden of Disease Study 2021 (GBD 2021). The incidence and prevalence of asthma, atopic dermatitis (AD), and urticaria among children aged 0 to 14 years in China from 1990 to 2021 were assessed through data from GBD 2021. Moreover, subgroup analyses by sex, age, and China/global comparisons were performed to analyze the differences more accurately. We used Joinpoint regression analyses to quantify temporal trends, calculate annual percentage changes, and average annual percentage changes. From 1990 to 2021, China experienced significant declining trends in childhood asthma, with incidence and prevalence falling by approximately −26% and −23%, respectively. These rates were consistently higher in boys (male-to-female ratio >1.3). In contrast, AD presented a mixed pattern: a slight decrease in incidence (−6.7%) alongside a marginal rise in prevalence (+1.5%), diverging from the global decline. AD showed a consistent female predominance. Meanwhile, urticaria remained relatively stable nationally (incidence: −2.3%, prevalence: −0.4%), but exhibited a pronounced female skew, with incidence and prevalence rates about 60% higher in girls. Although the burden of asthma has decreased, the prevalence of AD has been increasing, whereas the prevalence trend of urticaria has been relatively stable. The burden of allergic diseases is still large, and there are obvious sex differences.

Background Early-life gut microbiota and metabolism are increasingly linked to immune development and atopic diseases. However, predictive microbial and metabolic markers present during the neonatal period for later atopic dermatitis (AD) remain poorly defined. This study aimed to identify early-life gut microbiome and metabolite signatures associated with the development of AD by one year of age. Methods We conducted a prospective birth cohort study in Beijing, China, enrolling 18 infants with fecal samples collected at 42 days of age. Infants were followed for one year and classified into AD (n = 6) or non-AD (n = 12) groups. Fecal samples underwent 16S rRNA gene sequencing and untargeted metabolomic profiling. Key microbial taxa, differential metabolites, and functional pathways were identified and integrated via multi-omics correlation analysis. Results While overall microbial diversity was similar between groups, Staphylococcus was significantly less abundant in the AD group. Bifidobacterium and Lactobacillus showed strong correlations with lipid- and amino acid-related metabolites, including linoleic acid and N2-acetyl-L-ornithine. AD infants exhibited reduced levels of linoleic acid and choline phosphate. KEGG analysis revealed enrichment in linoleic acid metabolism, sphingolipid signaling, and AGE-RAGE signaling pathways. Integrated network analysis identified microbial–metabolite modules potentially involved in immune and barrier regulation. Conclusion Multi-omics profiling of the infant gut at 42 days identified microbial and metabolic features associated with later AD development. These findings support the gut–skin axis and suggest potential early-life biomarkers for predicting AD risk and informing targeted prevention strategies.

Abstract: Background: Accurate evaluation of atopic dermatitis (AD) severity is crucial to determine and adjust treatment options. Previous studies have found the product of Investigator’s Global Assessment (IGA) and affected body surface area (BSA) to be a simple tool, which requires further verification. Objective: To determine the validity of IGA*BSA in assessing the severity of AD across all age, sex, BMI and disease severity groups. Method: We performed a retrospective study of AD using data from a national cohort (China Type II Inflammatory Skin Disease Clinical Research and Standardized Diagnosis and Treatment Project). Results: Overall, 3051 participants were included in the final analysis. IGA*BSA correlated better with objective measures than with subjective measures. IGA*BSA significantly correlated with Eczema Area and Severity Index (EASI) (r = 0.81), which was stronger than either IGA or BSA alone with EASI, regardless of age, sex, Body Mass Index (BMI), and disease severity groups. Besides, IGA*BSA mild, moderate, and severe groups were associated with significantly higher scores of other assessments and had moderate to fair concordance with other assessments severity strata. At follow-up, the concordance of improvement between IGA*BSA 50/75/90 and EASI 50/75/90 was observed (ĸ = 0.65, 0.62, 0.58, respectively). Conclusion: IGA*BSA appears to be a valid objective assessment of AD severity and improvement over time across all age, sex, BMI, and disease severity subgroups in the clinical practice.

Abstract Background: Atopic dermatitis (AD) is a chronic inflammatory skin disorder impacting populations worldwide, although its clinical characteristics and patient demographics remain uncharacterized in China. The aim of this study was to investigate the demographics, comorbidities, aggravating factors, and treatments in AD patients across different age groups in China. Methods: This cross-sectional study included Chinese AD patients from 205 hospitals spanning 30 provinces. Patients completed dermatologist-led surveys of general medical history, comorbidities, AD-related aggravating factors, and medications. Two-level mixed-ordered logistic regression was used to evaluate aggravating factors. Results: Overall, 16,838 respondents were included in the final analysis (aged 30.9 ± 24.1 years). The proportion of severe AD was the highest in patients with AD onset at ≥60 years (26.73%). Allergic rhinitis and hypertension were the most common atopic and metabolism-related non-atopic comorbidities, respectively. AD severity was significantly associated with chronic urticaria, food allergies, and diabetes. Aggravating factors including foods, seasonal changes, and psychological factors were also linked to AD severity. The cross-sectional survey implied that severe AD may be related to the undertreatment of effective systemic or topical interventions. Conclusion: To enhance the management of AD, it is crucial to consider both aggravating factors and the increased utilization of systemic immunotherapy. Registration: ClinicalTrials.gov, NCT05316805

Background Many studies reported the influence of infants' gut microbiota on atopic dermatitis (AD) postnatally, yet the role of maternal gut microbiota and plasma metabolites in infants’ AD remains largely unexplored. Methods Sixty-three pregnant mother-infants were enrolled and followed after childbirth in Guangzhou, China. Demographic information, maternal stool and plasma samples, and records for infants’ AD were collected. Maternal gut microbiota/metabolome and plasma metabolome were profiled using shotgun metagenomics and non-targeted metabolomics. Logistic regression and multi-omics analysis were used to explore characteristic maternal gut microbiota in the AD and health groups. Results The α-diversity of maternal gut microbiota in health group was significantly higher than AD group (Shannon diversity P = 0.02, Simpson diversity P = 0.04). Short-chain fatty acids (SCFAs) producing microorganisms, including Faecalibacterium, Roseburia, Butyricicoccus, and Ruminococcus, as well as the abundance of phenylalanine, tyrosine, and tryptophan biosynthesis pathway, were enriched in health group (LDA>2 and P < 0.05). Virulent factors (VFs) involved in immune modulation were enriched in the health group, while VFs involving in adhesin were enriched in the AD group (P < 0.05). Metabolomic analysis showed that a polyunsaturated fatty acid/linoleic acid, 13S-hydroxyoctadecadienoic, were negatively associated with AD in both the gut and plasma samples (FDR<0.05). Several other linoleic acids and flavonoids were negatively associated with AD (FDR<0.05). Neural network analysis revealed that microorganisms enriched in health group may produce these protective fatty acids. Conclusions Our findings show that maternal gut microorganisms/metabolites and plasma metabolites during pregnancy impact subsequent pathogenesis of infants AD. This illuminates new strategies against early AD in offspring.

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Psoriasis (Ps) and atopic dermatitis (AD) are chronic systemic immune‐mediated diseases that can coexist in an overlapping condition called psoriasis dermatitis (PD). PD patients have intermediate lesions with characteristics of both Ps and AD. PD is very rare in adults but much more frequent in children. Little is known, however, about the course of PD in the pediatric population. The aim of this study was to evaluate the percentage of PD cases in children that evolved to a definite form of Ps or AD and to identify any clinical or epidemiological variables that could predict the course of the disease.

Although atopic dermatitis (AD) is the most common chronic inflammatory skin disorder worldwide, the scientific community has to admit practical issues related to its diagnosis in different age ranges as well as with regards to the differences in the clinical phenotype related to distinct ethnic backgrounds. Clearly, validated diagnostic criteria are missing for both edges of life, i.e. the young infants and the elderly. Most of the diagnostic criteria have been established and validated starting from a paediatric Caucasian population but their adaptation to variations in the phenotypes according to the age and worldwide has not been in the focus of our interest for many decades. This is reflected by intriguing results in global epidemiologic studies such as ISAAC which have suggested that the prevalence of paediatric AD (6–7 years of age) is particularly low (2.8–3.9) in countries with clear Chinese ethnic background such as Taiwan, Hong-Kong and Singapore. This problematic issue is further accentuated by the fact that in the traditional Chinese approach, the phenotypic spectrum of what is called AD in western countries is typically split into two distinct entities: on one hand ‘eczema’ which mostly covers the mild and moderate forms of AD and on the other hand ‘atopic dermatitis’ which covers the more moderate to severe forms of the phenotype. Besides the consequences in our epidemiological understanding of the disease, the putative impact of this dichotomic view in China and potentially in other countries such as Africa on the pathophysiological understanding, the global drug development programs and regulatory issues are obvious. In the recent years, in an effort to address this critical issue, a group of Chinese dermatologists lead by Prof. Yao from Jiao Tong University in Shanghai have published a series of studies dealing with the appropriateness of the classical diagnostic criteria such as those of Hanifin and Rajka and the UK working party for the diagnosis of AD in the Chinese paediatric population. In a first approach and previous publications, this group clearly showed that the stringent application of the Hanifin and Rajka criteria in Chinese children leads to a significant underestimation of the diagnosis of AD in this population when compared to the results obtained by clinically experienced dermatologists. These results clearly showed the urgent need for refined diagnostic criteria better adapted to assess the disease in this particular ethnic background and to overcome the traditional dichotomic approach of the phenotype. The next step as exposed in the commented paper published in this issue of the JEADV was the attempt to define and validate new diagnostic criteria which should better reflect the situation in this country. The golden standard for this endeavour was the long-lasting clinical expertise of highly experienced dermatologists which was tested against the classical diagnostic criteria of Hanifin and Rajka as well as the UK diagnostic criteria in a large number of children with AD and controls. Surprisingly, the resulting criteria were rather simple including only the three following features: (i) pruritus, (ii) typical morphology and distribution or atypical morphology and distribution combined with xerosis, (iii) a chronic or chronically relapsing course. Using these criteria, the authors reached an overall remarkable sensitivity and specificity compared to the so far established criteria. Another unexpected aspect is the lack of any anamnestic item such as a familial history of atopic diseases. The reason could be that this has been considered by the authors as ambiguous in the Chinese population based on their experience with this major item in the stringent use of the Hanifin and Rajka criteria, e.g. when eczema is mentioned instead of AD in the family history and therefore is not considered as relevant information. These new diagnostic criteria for AD in children can be considered as an important milestone in the evolving field of the Chinese perspective of this disease and the discussions along the dichotomic approach of the phenotype, i.e. eczema versus AD. This pioneer work could also be the starting point for similar projects in other countries where it is felt that the classical criteria of Hanifin and Rajka or of the UK working party may need some adaptation to better reflect the particularities and phenotypic variations of the disease in a different ethnic background.

Background: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease. Hanifin and Rajka's criteria is the most common diagnostic criteria used for the clinical diagnosis of this condition. However, many find that it is too exhaustive to be used in routine practice, and the specificity of many of the minor criteria poses challenges, particularly from Asian countries with type III, IV, and V skin. Aims and Objectives: The aim of the study is to evaluate the effectiveness of the minor features of the Hanifin and Rajka criteria for AD in comparison to the UK working party's diagnostic criteria in pediatric populations of India. Methodology: A hospital-based cross-sectional study of 100 patients in the pediatric age group (3 months–12 years) with AD was conducted based on history, clinical, and laboratory evaluation. An age-matched control group of 100 pediatric patients who did not have a personal or family history of atopic dermatitis was included after obtaining informed consent to find out the prevalence of minor criteria among the control group. Results: Mean of the number of minor clinical criteria found positive in our study population in the infantile and toddler (below 2 years) and childhood groups (2–12 years) was (4.72 ± 1.75) and (5.67 ± 1.78), respectively. Early-onset of disease was the most consistent feature among the minor criteria found in 83% of patients, followed by xerosis (71%), hyperlinearity of palm (56%), pityriasis alba (54%), Denny Morgan fold (52%), elevated serum IgE (47%), perifollicular accentuation (37%), and tendency toward cutaneous infections (37%). Conclusion: We found that though some of the minor criteria are highly sensitive and specific to the diagnosis of AD (xerosis, ichthyosis, palmar hyperlinearity, tendency of cutaneous infections, Dennie–Morgan infraorbital fold, pityriasis alba, and perifollicular accentuation), some other criteria were either very rare or nonspecific for AD. We suggest that many of the minor criteria of Hanifin and Rajka may not have much significance for Indian patients and a multicentric nationwide study with a larger patient pool is required to create a trimmed and improved version of Hanifin and Rajka criteria.

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Background Atopic dermatitis (AD) is a prevalent, chronic inflammatory skin disease with diverse clinical presentations, often overlapping with other dermatoses. Its diagnosis remains largely dependent on clinical expertise, leading to variability and limited diagnostic accuracy, particularly among general practitioners. This study aimed to develop and evaluate a multimodal artificial intelligence (AI) model that integrates lesion image analysis and structured anamnesis to improve AD diagnosis. Methods This diagnostic study was conducted in two phases: Phase 1 used retrospective data from 2021–2024, and Phase 2 involved prospective external validation from multiple hospitals in 2025. Patients with AD or related skin conditions were included, with diagnoses based on AAD 2014 criteria. Multimodal fusion combined ResNet50-extracted image features and MPNet-based anamnesis text features using a late fusion model. This approach mimics clinical reasoning by integrating visual and contextual clinical information to classify cases as AD or non-AD. Results and Discussion The multimodal AI model integrating ResNet50 (image) and MPNet (anamnesis) achieved 98.28% accuracy in classifying AD vs non-AD, outperforming image-or text-only models. It offers clinical advantages by mimicking physician reasoning, improving diagnostic consistency, reducing subjectivity, and enabling mass triage. However, real-world generalizability remains a challenge due to limited training diversity, potential language constraints (Bahasa Indonesia), and narrow differential diagnoses. External validation and explainable AI (XAI) are critical for broader application. Despite limitations, the model aligns with emerging literature, showing multimodal AI can approach or surpass expert-level performance in dermatological diagnosis when rigorously validated. Conclusions The multimodal ResNet50-MPNet model shows near-perfect accuracy in diagnosing AD by mimicking clinician reasoning. It offers consistent, holistic assessment but requires external validation and improved interpretability for clinical adoption. Continued AI-clinician collaboration is vital to translating this promising technology into real-world dermatological care.

Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases among children. This article presents the results of a retrospective study on the prevalence of AD among children in the Samarkand region in 2024. The analysis of the disease was conducted based on region, gender, and age groups, and associated comorbidities were identified. The clinical characteristics of the patients, diagnostic criteria used, and methods for assessing the severity of the disease were determined. Research Objective. The aim of the study is to analyze the frequency of atopic dermatitis (AD) cases among children in the Samarkand region, as well as to investigate the clinical features of the disease. Materials and Methods. The study was conducted in 2024 at the Samarkand branch of the specialized scientific-practical medical center for dermatovenereology and cosmetology. The study included children who sought medical attention for skin diseases. In 2024, the total number of patients visiting the center was 42,917, of whom 1,330 (3.1%) suffered from atopic dermatitis. Research Results. The following clinical forms were identified in patients with atopic dermatitis: Erythematous-squamous form – 61 cases (39 boys, 22 girls); Exudative form – 18 cases (10 boys, 8 girls);  Lichenoid form – 12 cases; Pruriginous form – 9 cases. The SCORAD index was used to diagnostically assess the severity of the disease. According to the examination results: Mild form (up to 40 points) – 51%;  Moderate form (40-60 points) – 37%; Severe form (over 60 points) – 12%. Conclusions. In the Samarkand region, the prevalence of atopic dermatitis among children is 3.1% of the total number of patients with skin diseases. The highest incidence rate was recorded in the Taylak, Urgut, and Samarkand districts, where 60.8% of all cases were identified. Gender analysis showed a predominance of the disease among boys (63.5%).

Background: Atopic Dermatitis is the most common type of dermatitis among children. In severe form besides skin changes, patient is prone to develop eye changes due to excessive rubbing on eyes. In such situations, ophthalmologist consultation is needed to reduce ocular comorbidities. Objective: To determine the association of eye manifestations of Atopic Dermatitis with the severity of Atopic Dermatitis in children up to 14 years of age. Methods: This retrospective study was conducted in Dermatology and Ophthalmology department, Sahiwal Teaching Hospital, Sahiwal from Jan to Dec 2024. Patients fulfilling the Atopic Dermatitis diagnostic criteria (Williams UK working party) of age less than 14 years and either sex were selected in the study. A sample size of 114 patients and nonprobability consecutive sampling technique was used. Clinical severity of Atopic disease were categorized into mild, moderate and severe by using SCORAD index. All data regarding patient demographics, cutaneous and eye examination findings were recorded on a specially designed proforma. The data was analyzed by using SPSS version 25. The association between eye changes and different severity (mild, moderate, severe) of Atopic Dermatitis (SCORAD index) was determined by using χ2 test. If p-value is equal to or less than 0.5, it will be considered significant. Results: Out of total 114 participants, majority belonged to male (65%) gender and mean age with SD was 4.68 ± 2.67 years.  Most of children were of moderate (58%) severity. Eyelid changes frequently observed were dryness of eyelid (65%) followed by blepharitis (42%). Among conjunctival finding, keratoconjunctivitis were most commonly reported (33%). No statistically significant (p-value=0.897) association of eyelid changes with disease severity was observed. Although conjunctival changes and disease severity association was statistically demonstrated significantly (p-value 0.005). Conclusion:   Ocular changes were common in children with atopic dermatitis. While eyelid findings did not correlate with disease severity, conjunctival involvement increased with more severe dermatitis.

Whereas clinically apparent atopic dermatitis (AD) can be confirmed by validated diagnostic criteria, the preclinical phenotype of infants who eventually develop AD is less well-characterized. Analogous to unaffected or nonlesional skin in established AD, clinically normal-appearing skin in infants who will develop clinical AD has distinct changes. Prospective studies have revealed insights into this preclinical AD phenotype. In this study, we review the structural, immunologic, and microbiome nature of the preclinical AD phenotype. Determination of markers that predict the development of AD will facilitate targeting of interventions to prevent the development or reduce the severity of AD in infants.

Breastfeeding influences the immune system development in infants and may even affect various immunological responses later in life. Breast milk provides a rich source of early nutrition for infant growth and development. However, the presence of certain compounds in breast milk, related to an unhealthy lifestyle or the diet of lactating mothers, may negatively impact infants. Based on a cohort study of atopic dermatitis (AD), we find the presence of damage-associated molecular patterns (DAMPs) activity in the mother’s milk. By non-targeted metabolomic analysis, we identify the long-chain saturated fatty acids (LCSFA) as a biomarker DAMPs (+) breast milk samples. Similarly, a mouse model in which breastfed offspring are fed milk high in LCSFA show AD onset later in life. We prove that LCSFA are a type of damage-associated molecular patterns, which initiate a series of inflammatory events in the gut involving type 3 innate lymphoid cells (ILC3s). A remarkable increase in inflammatory ILC3s is observed in the gut, and the migration of these ILC3s to the skin may be potential triggers of AD. Gene expression analysis of ILC3s isolated from the gut reveal upregulation of genes that increase ILC3s and chemokines/chemokine receptors, which may play a role in ILC migration to the skin. Even in the absence of adaptive immunity, Rag1 knockout mice fed a high-LCSFA milk diet develop eczema, accompanied by increased gut ILC3s. We also present that gut microbiota of AD-prone PA milk-fed mice is different from non-AD OA/ND milk-fed mice. Here, we propose that early exposure to LCSFAs in infants may affect the balance of intestinal innate immunity, inducing a highly inflammatory environment with the proliferation of ILC3s and production of interleukin-17 and interleukin-22, these factors may be potential triggers or worsening factors of AD.

Atopic dermatitis (AD) pathogenesis still needs to be elucidated, but invariant natural killer T (iNKT) cell involvement was already described by several groups. Our group has demonstrated that IgG antibodies purified from AD patients can modulate cytokine production by thymic T cells. Here we aimed to investigate if IgG from AD patients can modulate infant non‐atopic thymic iNKT cells cytokine production in order to collaborate with the elucidation of AD development in infancy.

Background Atopic dermatitis (AD) is a common, chronic skin disorder often beginning in infancy. Skin barrier dysfunction early in life serves as a central event in the pathogenesis of AD. In infants at high risk of developing AD, preventative application of lipid-rich emollients may reduce the risk of developing AD. This study aims to measure the effectiveness of this intervention in a population not selected for risk via a pragmatic, randomized, physician-blinded trial in the primary care setting. Methods Infant–parent dyads are recruited from a primary care practice participating through one of four practice-based research networks in Oregon, Colorado, Wisconsin, and North Carolina. Eligible dyads are randomized to the intervention (daily use of lipid-rich emollient) or the control (no emollient) group ( n  = 625 infants in each) and are followed for 24 months. The primary outcome is the cumulative incidence of physician-diagnosed AD and secondary outcomes include caregiver-reported measures of AD and development of other atopic diseases. Data collection occurs via chart review and surveys, with no study visits required. Data will be analyzed utilizing intention-to-treat principles. Discussion AD is a common skin condition in infants that affects quality of life and is associated with the development of other atopic diseases. If a safe intervention, such as application of lipid-rich emollients, in the general population effectively decreases AD prevalence, this could alter the guidance given by providers regarding routine skin care of infants. Because of the pragmatic design, we anticipate that this trial will yield generalizable results. Trial registration ClinicalTrials.gov : NCT03409367 . Registered on 11 February 2018.

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The terms “infant eczema” and atopic dermatitis (AD) often carry with them diagnostic challenges, as well as discrepancies between parental reports and the clinician's diagnosis. To date, noninvasive, accurate diagnostic biomarkers are lacking. YamamotoHanada et al. previously studied the impact of early AD treatment on food allergies. In this month's issue, they present a rigorous prospective study of the molecular pathogenesis of earlyonset AD among 98 onemonth old infants. There was a family history of AD in 47% of the infants, and 41% of them had neonatal acne. A noninvasive RNA analysis in sebum oilblotting film identified molecular changes that characterize the pathophysiology of AD in infants: downregulation of genes related to barrier function and elevation of inflammatory marker expression (i.e. genes related to Th2, Th17 and Th22 type immune responses). They also revealed that neonatal acne in some infants at 1 month could be predictive of subsequent development of AD by mRNAs in sebum. Figure 1 shows that results of the gene analysis differ between healthy and AD infants at 1 and 2 months. This new technology can enable us to have early and objective detection of AD as well as early treatment interventions in young infants. The authors conclude with a hopeful message that they plan to continue studying this area in larger populations with an expanded age range. YamamotoHanada K, SaitoAbe M, Shima K, Fukagawa S, Uehara Y, Ueda Y, et al. mRNAs in skin surface lipids unveiled atopic dermatitis at 1 month. J Eur Acad Dermatol Venereol 2023;37:1385-1395. https://doi.org/10.1111/jdv.19017

BACKGROUND Skin emollients applied during early infancy could prevent atopic dermatitis, and early complementary food introduction might reduce food allergy in high-risk infants. The study aimed to determine if either regular skin emollients applied from 2 weeks of age, or early complementary feeding introduced between 12 and 16 weeks of age, reduced development of atopic dermatitis by age 12 months in the general infant population. METHODS This population-based 2×2 factorial, randomised clinical trial was done at Oslo University Hospital and Østfold Hospital Trust, Oslo, Norway; and Karolinska University Hospital, Stockholm, Sweden. Infants of women recruited antenatally at the routine ultrasound pregnancy screening at 18 weeks were cluster-randomised at birth from 2015 to 2017 to the following groups: (1) controls with no specific advice on skin care while advised to follow national guidelines on infant nutrition (no intervention group); (2) skin emollients (bath additives and facial cream; skin intervention group); (3) early complementary feeding of peanut, cow's milk, wheat, and egg (food intervention group); or (4) combined skin and food interventions (combined intervention group). Participants were randomly assigned (1:1:1:1) using computer- generated cluster randomisation based on 92 geographical living area blocks as well as eight 3-month time blocks. Carers were instructed to apply the interventions on at least 4 days per week. Atopic dermatitis by age 12 months was the primary outcome, based on clinical investigations at 3, 6 and 12 months by investigators masked to group allocation. Atopic dermatitis was assessed after completing the 12-month investigations and diagnosed if either of the UK Working Party and Hanifin and Rajka (12 months only) diagnostic criteria were fulfilled. The primary efficacy analyses was done by intention-to-treat analysis on all randomly assigned participants. Food allergy results will be reported once all investigations at age 3 years are completed in 2020. This was a study performed within ORAACLE (the Oslo Research Group of Asthma and Allergy in Childhood; the Lung and Environment). The study is registered at clinicaltrials.gov, NCT02449850. FINDINGS 2697 women were recruited between Dec 9, 2014, and Oct 31, 2016, from whom 2397 newborn infants were enrolled from April 14, 2015, to April 11, 2017. Atopic dermatitis was observed in 478 (8%) of 596 infants in the no intervention group, 64 (11%) of 575 in the skin intervention group, 58 (9%) of 642 in the food intervention group, and 31 (5%) of 583 in the combined intervention group. Neither skin emollients nor early complementary feeding reduced development of atopic dermatitis, with a risk difference of 3·1% (95% CI -0·3 to 6·5) for skin intervention and 1·0% (-2·1 to 4·1) for food intervention, in favour of control. No safety concerns with the interventions were identified. Reported skin symptoms and signs (including itching, oedema, exanthema, dry skin, and urticaria) were no more frequent in the skin, food, and combined intervention groups than in the no intervention group. INTERPRETATION Neither early skin emollients nor early complementary feeding reduced development of atopic dermatitis by age 12 months. Our study does not support the use of these interventions to prevent atopic dermatitis by 12 months of age in infants. FUNDING The study was funded by several public and private funding bodies: The Regional Health Board South East, The Norwegian Research Council, Health and Rehabilitation Norway, The Foundation for Healthcare and Allergy Research in Sweden-Vårdalstiftelsen, Swedish Asthma and Allergy Association's Research Foundation, Swedish Research Council-the Initiative for Clinical Therapy Research, The Swedish Heart-Lung Foundation, SFO-V at the Karolinska Institute, Freemason Child House Foundation in Stockholm, Swedish Research Council for Health, Working Life and Welfare-FORTE, Oslo University Hospital, the University of Oslo, and Østfold Hospital Trust.

The skin barrier keeps the 'inside in' and the 'outside out', forming a protective blanket against external insults. Epidermal lipids, such as ceramides, fatty acids (FAs), triglycerides, and cholesterol, are integral components driving the formation and maintenance of the epidermal permeability barrier (EPB). A breach in this lipid barrier sets the platform for the subsequent onset and progression of atopic dermatitis (AD). Such lipids are also important in the normal functioning of organisms, both plants and animals, and in diseases, including cancer. Given the doubling of the number of cases of AD in recent years and the chronic nature of this disorder, here we shed light on the multifaceted role of diverse types of lipid in mediating AD pathogenesis.

Atopic dermatitis (AD) is a common, chronic, inflammatory skin condition characterized by recurrent and pruritic skin eruptions. Multiple factors contribute to the pathogenesis of AD, including skin barrier dysfunction, microbial dysbiosis, and immune dysregulation. Interactions among these factors form a complex, multidirectional network that can reinforce atopic skin disease but can also be ameliorated by targeted therapies. This review summarizes the complex interactions among contributing factors in AD and the implications on disease development and therapeutic interventions.

Type 2 immune-mediated diseases give a clear answer to the issue of nature (genetics) versus nurture (environment). Both genetics and environment play vital complementary roles in the development of atopic dermatitis (AD). As a key component of the atopic march, AD demonstrates the interactive nature of genetic and environmental contributions to atopy. From sequence variants in the epithelial barrier gene encoding FLG to the hygiene hypothesis, AD combines a broad array of contributions into a single syndrome. This review will focus on the genetic contribution to AD and where genetics facilitates the elicitation or enhancement of AD pathogenesis.

Biomarkers of atopic dermatitis (AD) are largely lacking, especially in infant AD. Those that have been examined to date have focused mostly on serum cytokines, with few on noninvasive biomarkers in the skin.

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Atopic dermatitis (AD) is a chronic, inflammatory, pruritic form of dermatosis with heterogeneous manifestations that can substantially affect patients' quality of life. AD has a complex pathogenesis, making treatment challenging for dermatologists. The Janus kinase (JAK)–signal transducer and activator of transcription (STAT) pathway plays a central role in modulating multiple immune axes involved in the immunopathogenesis of AD. In particular, Th2 cytokines, including interleukin (IL)-4, IL-5, IL-13, IL-31, and thymic stromal lymphopoietin, which contribute to the symptoms of chronic inflammation and pruritus in AD, are mediated by JAK–STAT signal transduction. Furthermore, JAK–STAT is involved in the regulation of the epidermal barrier and the modulation of peripheral nerves related to the transduction of pruritus. Targeting the JAK–STAT pathway may attenuate these signals and show clinical efficacy through the suppression of various immune pathways associated with AD. Topical and oral JAK inhibitors with variable selectivity have emerged as promising therapeutic options for AD. Notably, topical ruxolitinib, oral upadacitinib, and oral abrocitinib were approved by the U.S. Food and Drug Administration for treating patients with AD. Accordingly, the present study reviewed the role of JAK–STAT pathways in the pathogenesis of AD and explored updated applications of JAK inhibitors in treating AD.

Atopic dermatitis (AD) is an eczematous skin disorder characterized by type 2 inflammation, barrier disruption, and intense itch. In addition to type 2 cytokines, many other cytokines, such as interferon gamma (IFN-γ), interleukin 17 (IL-17), and interleukin 22 (IL-22), play roles in the pathogenesis of AD. It has been reported that the extracellular signal-regulated kinase (ERK) is downstream of such cytokines. However, the involvement of the ERK pathway in the pathogenesis of AD has not yet been investigated. We examined the expression of p-ERK in mouse and human AD skin. We also investigated the effects of the topical application of an ERK inhibitor on the dermatitis score, transepidermal water loss (TEWL), histological change, and expression of filaggrin, using an AD-like NC/Nga murine model. The effects of an ERK inhibitor on filaggrin expression in normal human epidermal keratinocytes (NHEKs) and on chemokine production from bone marrow-derived dendritic cells (BMDCs) were also evaluated. p-ERK was highly expressed in mouse and human AD skin. Topical application of an ERK inhibitor alleviated the clinical symptoms, histological changes, TEWL, and decrease in expression of filaggrin in the AD-like NC/Nga murine model. The ERK inhibitor also restored the IL-4 induced reduction in the expression of filaggrin in NHEK, and inhibited chemokine production from BMDC induced by IL-4. These results indicate that the ERK pathway is involved in the pathogenesis of AD, and suggest that the ERK pathway has potential as a therapeutic target for AD in the future.

Atopic dermatitis (AD) is characterized clinically by severe dry skin and functionally by both a cutaneous barrier disruption and an impaired water-holding capacity in the stratum corneum (SC) even in the nonlesional skin. The combination of the disrupted barrier and water-holding functions in nonlesional skin is closely linked to the disease severity of AD, which suggests that the barrier abnormality as well as the water deficiency are elicited as a result of the induced dermatitis and subsequently trigger the recurrence of dermatitis. These functional abnormalities of the SC are mainly attributable to significantly decreased levels of total ceramides and the altered ceramide profile in the SC. Clinical studies using a synthetic pseudo-ceramide (pCer) that can function as a natural ceramide have indicated the superior clinical efficacy of pCer and, more importantly, have shown that the ceramide deficiency rather than changes in the ceramide profile in the SC of AD patients plays a central role in the pathogenesis of AD. Clinical studies of infants with AD have shown that the barrier disruption due to the ceramide deficiency is not inherent and is essentially dependent on postinflammatory events in those infants. Consistently, the recovery of trans-epidermal water loss after tape-stripping occurs at a significantly slower rate only at 1 day post-tape-stripping in AD skin compared with healthy control (HC) skin. This resembles the recovery pattern observed in Niemann–Pick disease, which is caused by an acid sphingomyelinase (aSMase) deficiency. Further, comparison of ceramide levels in the SC between before and after tape-stripping revealed that whereas ceramide levels in HC skin are significantly upregulated at 4 days post-tape-stripping, their ceramide levels remain substantially unchanged at 4 days post-tape-stripping. Taken together, the sum of these findings strongly suggests that an impaired homeostasis of a ceramide-generating process may be associated with these abnormalities. We have discovered a novel enzyme, sphingomyelin (SM) deacylase, which cleaves the N-acyl linkage of SM and glucosylceramide (GCer). The activity of SM deacylase is significantly increased in AD lesional epidermis as well as in the involved and uninvolved SC of AD skin, but not in the skin of patients with contact dermatitis or chronic eczema, compared with HC skin. SM deacylase competes with aSMase and β-glucocerebrosidase (BGCase) to hydrolyze their common substrates, SM and GCer, to yield their lysoforms sphingosylphosphorylcholine (SPC) and glucosylsphingosine (GSP), respectively, instead of ceramide. Consistently, those reaction products (SPC and GSP) accumulate to a greater extent in the involved and uninvolved SC of AD skin compared with chronic eczema or contact dermatitis skin as well as HC skin. Successive chromatographies were used to purify SM deacylase to homogeneity with a single band of ≈43 kDa and with an enrichment of >14,000-fold. Analysis of a protein spot with SM deacylase activity separated by 2D-SDS-PAGE using MALDI-TOF MS/MS allowed its amino acid sequence to be determined and to identify it as the β-subunit of acid ceramidase (aCDase), an enzyme consisting of α- and β-subunits linked by amino-bonds and a single S-S bond. Western blotting of samples treated with 2-mercaptoethanol revealed that whereas recombinant human aCDase was recognized by antibodies to the α-subunit at ≈56 and ≈13 kDa and the β-subunit at ≈43 kDa, the purified SM deacylase was detectable only by the antibody to the β-subunit at ≈43 kDa. Breaking the S-S bond of recombinant human aCDase with dithiothreitol elicited the activity of SM deacylase with an apparent size of ≈40 kDa upon gel chromatography in contrast to aCDase activity with an apparent size of ≈50 kDa in untreated recombinant human aCDase. These results provide new insights into the essential role of SM deacylase as the β-subunit aCDase that causes the ceramide deficiency in AD skin.

Association between the gut mycobiome and atopic dermatitis was investigated in 9–12-month-old infants using metagenomics. Two groups of atopic dermatitis infants were classified according to their symptom development as outgrown (recovered) and persisted (still undergoing). The evenness and diversity of the mycobiome in the persisted group were higher than in the healthy and outgrown groups. Dysbiosis of the microbiome in the persisted group was observed by a reduction in the Ascomycota/Basidiomycota ratio. Five fungi were selected as markers from each sample group. In the persisted group, Rhodotorula sp. abundance increased significantly, while Wickerhamomyces sp. and Kodamaea sp. abundance increased in the healthy group, and Acremonium sp. and Rhizopus sp. abundance increased considerably in the outgrown group. Metaproteomic analysis revealed that the persisted group had a high abundance of fungal proteins, particularly those from Rhodotorula sp. Unique proteins such as RAN-binding protein 1 and glycerol kinase from Rhodotorula sp. were hypothesized to be related to atopic dermatitis manifestation in infants.

The individual prognosis of infants with atopic dermatitis (AD) is important for parents, healthcare professionals, and society. The aim of this study was to investigate predictors for remission of infant AD until school age. A systematic review was carried out of clinical and epidemiological studies investigating the effect of filaggrin gene (FLG) loss-of-function mutations, sex, exposure to pets, topical anti-inflammatory treatment, disease severity, and atopic sensitization during infancy on complete remission of infant-onset AD until 6-7 years of age. Systematic electronic searches until September 2013, data abstraction, and study quality assessment (Newcastle-Ottawa Scale) were performed. From 3,316 abstracts identified, 2 studies of good study quality were included. Parental allergies and sex did not significantly affect remission. For non-remission of AD, the included articles reported an association with any atopic sensitization at 2 years old (adjusted odds ratio [aOR] 2.76; 95% confidence interval (CI) 1.29-5.91), frequent scratching with early AD (aOR 5.86; 95% CI 3.04-11.29), objective severity score at 2 years old (aOR 1.10; 95% CI 1.07-1.14), and exposure to pets (cat OR 2.33; 95% CI 0.85-6.38). It is largely unknown which factors predict remission of infant AD. This is a highly relevant research gap that hinders patient information on the prognosis of infant-onset AD.

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Atopic dermatitis (AD) is extremely common in the pediatric population, and most children with AD will first present to their primary care provider (PCP). The PCP can recognize AD by its clinical features, including itch, a chronic relapsing course, and the characteristic eruption. The cornerstone of AD therapy is dry skin care, typically a short daily bath/shower followed by an emollient applied to all skin. Most children with AD will also require topical medications, such as topical corticosteroids and/or topical nonsteroidal therapies. For children with more severe disease, systemic agents, including several novel therapies, may be required. In managing AD, the clinician must monitor for side effects of medications as well as complications of the AD itself, the most common of which is secondary infection. An understanding of the pathogenesis, treatments, and complications of AD is essential for the PCP, as untreated (or undertreated) AD has a significant impact on the quality of life of affected children and their caregivers. [Pediatr Ann. 2024;53(4):e121-e128.].

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The increasing global incidence of atopic dermatitis (AD) in children, especially in Western industrialized nations, has attracted considerable attention. The hygiene hypothesis, which posits that early pathogen exposure is crucial for immune system development, is central to understanding this trend. Furthermore, advanced machine learning algorithms have provided fresh insights into the interactions among various risk factors. This study investigates the relationship between early childhood antibiotic use, the duration of exclusive breastfeeding, indoor environmental factors, and child AD. By integrating machine learning techniques with the hygiene hypothesis, we aim to assess and interpret the significance of these risk factors. In this community-based case–control study with a 1:4 matching design, we evaluated the prevalence of AD in preschool-aged children. Data were collected via questionnaires completed by the parents of 771 children diagnosed with AD, matched with controls based on gender, age, and ethnicity. Univariate analyses identified relevant characteristics, which were further examined using multivariable logistic regression to calculate odds ratios (ORs). Stratified analyses assessed confounders and interactions, while the significance of variables was determined using a machine learning model. Renovating the dwelling during the mother’s pregnancy (OR = 1.50; 95% CI 1.15–1.96) was identified as a risk factor for childhood AD. Additionally, antibiotic use three or more times during the child’s first year (OR = 1.92; 95% CI 1.29–2.85) increased the risk of AD, independent of the parents’ history of atopic disease and the child’s mode of birth. Moreover, exclusive breastfeeding for four months or more (OR = 1.59; 95% CI 1.17–2.17) was identified as a risk factor for AD, particularly in the group without a maternal history of atopic disease. In contrast, having older siblings in the family (OR = 0.76; 95% CI 0.63–0.92) and low birth weight (OR = 0.62; 95% CI 0.47–0.81) were identified as protective factors against AD. Machine learning modeling indicated that the duration of exclusive breastfeeding, having older siblings, low birth weight, and parental history of AD or allergic rhinitis are key predictors of childhood AD. Our findings support the broader interpretation of the hygiene hypothesis. Machine learning analysis highlights the key role of the hygiene hypothesis and underscores the need for future AD prevention and healthcare initiatives focusing on children with a parental history of AD or allergic rhinitis. Moreover, minimizing antibiotic overuse may be essential for preventing AD in children. Further research is necessary to elucidate the impact and mechanisms of exclusive breastfeeding on AD to instruct maternal and child healthcare practices.

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.

This study aimed to explore time trends in the prevalence of atopic dermatitis (AD) according to age in Korean children. We observed changes in the estimated annual prevalence of AD using data from the Korean National Health Insurance Service (NHIS) and Statistics Korea between 2003 and 2018. In each year, the highest prevalence was evident among children aged 12 to 23 months, and then the prevalence decreased with age. The annual prevalence of AD in Korean children under the age of 18 slightly increased from 4.0% in 2003 to 4.5% in 2018. During this period, the prevalence in children aged 6 to 18 years increased from 1.9% in 2003 to 3.1% in 2018, while that of infants aged less than 24 months substantially decreased. Among children who were born in 1991, 1997, 2000, 2003 and 2006, the slopes of decreasing trend lines over age 6 were similar. Comparing children born in 2009 and 2012 with those born before 2006, the more recent the birth year, the higher the prevalence of AD over age 6. In conclusion, time trends of the annual prevalence of AD in Korean children from 2003 through 2018 were different according to age group. These results suggest that AD development during infancy is decreasing whereas either a late-onset AD or early-onset, persistent phenotype is likely to increase. Different strategies according to age are required for more effective prevention and treatment of AD in Korean children.

Abstract Background Previous studies found that childhood atopic dermatitis (AD) and asthma are associated with residence in urban areas. However, little is known about the prevalence and determinants of AD in US urban populations and its impact on quality-of-life (QOL) and asthma. Objective To determine AD prevalence and persistence, sociodemographic predictors thereof, and association with QOL and atopic comorbidities in US urban children. Methods We analyzed data from The Fragile Families and Child Wellbeing Study, a prospective cohort study of 4898 women and their children born in 20 large US cities between 1998 and 2000. AD prevalence was determined at ages 5, 9, and 15 years, and stratified by sex, race/ethnicity, and household poverty income level. Results The prevalences (95% confidence interval [CI]) of childhood AD were 15.0% (11.0%-18.9%), 15.1% (11.5%-18.7%), and 14.5% (10.4%%-18.5%) at ages 5, 9, and 15 years, respectively. Female sex (multivariable repeated measures logistic regression; adjusted odds-ratio [95% CI]: 1.56 [1.02-2.37]) and black race (1.80 [1.07-3.01]) were associated with persistent AD across all 3 ages. Children with AD at ages 5 and 15 (2.63 [1.42-4.86]), 5, 8 and 15 (1.47 [1.02-2.12]) and 9 and 15 years (1.61 [1.00-2.60]) had higher odds of poor/fair/good overall health. Children with AD at ages 5 and 9 years had the highest odds of ever having asthma (adjusted odds ratio [95% confidence interval]: 6.05 [5.88-6.22]), followed by children with AD at ages 5, 9, and 15 years (3.17 [3.07%-3.27]). Conclusion Atopic dermatitis prevalence and persistence were highest in US urban children who were female or black. Urban children with persistent AD were more likely to have poor QOL and asthma.

Atopic dermatitis is a chronic inflammatory skin disease that typically begins in infancy and extends into adulthood in a small proportion of cases. Around 20% of children and 5% of adults worldwide suffer from atopic dermatitis. In Ethiopia, the majority of data related to atopic dermatitis comes from single-health facility studies. Various sets of diagnostic criteria including United Kingdom Working Party’s, American Academy of dermatology, and Hanifin and Rajika diagnostic criteria guide the diagnosis. The United Kingdom Working Party’s validated criteria for AD developed in 1994 is one well validated for use. Atopic dermatitis, personal or family history of allergic rhinitis and asthma were included in this study. This study aimed to assess the magnitude of atopic dermatitis and identify associated factors among children attending dermatology clinics at government hospitals in Bahirdar. A facility-based cross-sectional study was conducted from October to December 2023, involving 420 children attending dermatology clinics at government hospitals in Bahirdar. Systematic random sampling technique was used to select study participants. Data was collected through an interview-administered questionnaire, and Statistical Package for Social Science version 27.0.1 was used for data analysis. A descriptive analysis was used to characterize the study population. Binary and multivariable logistic regressions were used to identify factors associated with atopic dermatitis. The odds ratio with a 95% confidence interval was utilized to demonstrate the strength of the association, and a p value of 0.05 was declared the cut point. Of the total respondents, 225 (53.5%) were female and 322 (76.6%) were from urban areas. The magnitude of the atopic dermatitis was found to be 17.1% (95% CI 13.7–21.1). In the multivariate logistic regression model, family history of atopic disease (AOR 10.879), history of maternal asthma (AOR 9.908), maternal allergic rhinitis (AOR 4.825), maternal atopic dermatitis (AOR 9.055), paternal asthma (AOR 10.561), paternal allergic rhinitis (AOR 7.014), paternal atopic dermatitis (AOR 9.313), sibling history of atopic disease (AOR 11.750), and fewer siblings (AOR 2.250), were significant predictors of atopic dermatitis. This study revealed a high magnitude of atopic dermatitis compared to most previous national studies. Having fewer siblings, atopic disease in the family, sibling atopic dermatitis, and a history of asthma, allergic rhinitis, and atopic dermatitis in parents emerged as independent predictors of atopic dermatitis among children. Hence, the finding underscores the urgent need to strengthen the national skin disease prevention and control services, in particular in the skin care of children related to atopic dermatitis.

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Abstract Objective In underdeveloped countries, allergic disease prevalence is low but rising in developing countries, while in developed countries, it remains high and stable. This study assessed prevalence and risk factors among schoolchildren in southern region of Bosnia and Herzegovina (BiH). Methods A cross-sectional study (2020) included 1851 children: 937 aged 6–8 years and 914 aged 11–13 years. Data related to asthma, allergic rhinitis, atopic dermatitis, and associated risk factors were collected using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Results Diagnosed asthma prevalence was 1.8% in children aged 6–8 years and 2.4% in 11–13 years. Allergic rhinitis was diagnosed in 5.5 and 10.4%, respectively, significantly higher in older children (p < 0.001). Atopic dermatitis prevalence was 16.6% in 6–8 years and 11.8% in 11–13 years, higher in younger children (p = 0.003). Asthma and allergic rhinitis were more common in boys, while atopic dermatitis was more frequent in girls. Asthma was negatively associated with egg consumption and daycare attendance, while furry animal contact, synthetic pillows, and maternal allergic rhinitis increased risk. Allergic rhinitis was associated with maternal smoking during pregnancy, parental allergic rhinitis, and bird contact. Atopic dermatitis was positively related to maternal atopic dermatitis, bird contact, air conditioning, and daycare attendance, whereas sponge pillow use, room sharing, and dog contact appeared protective. Conclusion In this region, asthma prevalence was low, allergic rhinitis moderate, and atopic dermatitis high. Broader studies across BiH are needed to monitor trends and guide prevention.

Background Staphylococcus aureus has been associated with the exacerbation and severity of atopic dermatitis (AD). Studies have not investigated the colonisation dynamics of S. aureus lineages in African toddlers with AD. We determined the prevalence and population structure of S. aureus in toddlers with and without AD from rural and urban South African settings. Methods We conducted a study of AD-affected and non-atopic AmaXhosa toddlers from rural Umtata and urban Cape Town, South Africa. S. aureus was screened from skin and nasal specimens using established microbiological methods and clonal lineages were determined by spa typing. Logistic regression analyses were employed to assess risk factors associated with S. aureus colonisation. Results S. aureus colonisation was higher in cases compared to controls independent of geographic location (54% vs. 13%, p  < 0.001 and 70% vs. 35%, p  = 0.005 in Umtata [rural] and Cape Town [urban], respectively). Severe AD was associated with higher colonisation compared with moderate AD (86% vs. 52%, p  = 0.015) among urban cases. Having AD was associated with colonisation in both rural (odds ratio [OR] 7.54, 95% CI 2.92–19.47) and urban (OR 4.2, 95% CI 1.57–11.2) toddlers. In rural toddlers, living in an electrified house that uses gas (OR 4.08, 95% CI 1.59–10.44) or utilises kerosene and paraffin (OR 2.88, 95% CI 1.22–6.77) for heating and cooking were associated with increased S. aureus colonisation. However, exposure to farm animals (OR 0.3, 95% CI 0.11–0.83) as well as living in a house that uses wood and coal (OR 0.14, 95% CI 0.04–0.49) or outdoor fire (OR 0.31, 95% CI 0.13–0.73) were protective. Spa types t174 and t1476, and t272 and t1476 were dominant among urban and rural cases, respectively, but no main spa type was observed among controls, independent of geographic location. In urban cases, spa type t002 and t442 isolates were only identified in severe AD, t174 was more frequent in moderate AD, and t1476 in severe AD. Conclusion The strain genotype of S. aureus differed by AD phenotypes and rural-urban settings. Continued surveillance of colonising S. aureus lineages is key in understanding alterations in skin microbial composition associated with AD pathogenesis and exacerbation.

Eczema is a common clinical disease in pediatrics, and its pathogenesis is related to many factors. Modern medicine mostly adopts glucocorticoid external treatment combined with antihistamine