Atopic Dermatitis

Recent studies have suggested a link between atopic dermatitis and particular neurobehavioral abnormalities. Dr. Lawrence F. Eichenfield of the University of California, San Diego, discusses the evolving perspective on the relationship between atopic dermatitis and attention deficit hyperactivity disorder (ADHD) in children.

Recent studies have suggested a link between atopic dermatitis and particular neurobehavioral abnormalities. Dr. Lawrence F. Eichenfield of the University of California, San Diego, discusses the evolving perspective on the relationship between atopic dermatitis and attention deficit hyperactivity disorder (ADHD) in children.

Recent studies have suggested a link between atopic dermatitis and particular neurobehavioral abnormalities. Dr. Lawrence F. Eichenfield of the University of California, San Diego, discusses the evolving perspective on the relationship between atopic dermatitis and attention deficit hyperactivity disorder (ADHD) in children.

PRAGUE – Reliance upon the time-honored tools for diagnosis of contact allergy due to fragrances will cause physicians to miss many cases, Dr. David E. Cohen said at the annual congress of the European Academy of Dermatology and Venereology.

"The old fragrance mix – fragrance mix I – and the use of balsam of Peru as fragrance screening tools really won’t capture contact dermatitis involving allergens to more modern fragrances," cautioned Dr. Cohen, professor and vice chair of the department of dermatology at New York University.

"I remember my grandmother always smelling like rosewater and naphthalene – like mothballs and rosewater. But we don’t smell like that anymore. Now we tend to use more botanical extracts. We see tea tree oil and jasmine appearing in our personal care products, and if we don’t test for those more contemporary fragrances, we will miss a very important source of contact dermatitis," he continued.

That’s why fragrance mix II (FM II) was developed. FM II has been incorporated into the North American Contact Dermatitis Group’s standard screening tray. It is not, however, part of the widely used T.R.U.E. (Thin-Layer Rapid Use Epicutaneous) test, nor is it included in the European standard screening series.

Multiple studies have documented that a substantial proportion of patients with allergic contact dermatitis will react only to the newer fragrances, and not to FM I or balsam of Peru. For example, a multicenter Hungarian study published earlier this year found that of 565 patients patch tested because of skin symptoms provoked by scented products, 17% exhibited contact hypersensitivity to one or more components of FM II. Moreover, 48% of FM II–positive patients reacted only to FM II, not FM I, balsam of Peru, or other test materials (Dermatitis 2012;23:71-4).

Similarly, a Mayo Clinic study of 945 patients patch tested using both the standard screening tray with FM II and the T.R.U.E. test found that 49% of patients reacted to one or more preservatives and 31% reacted to at least one fragrance or botanical additive. However, the T.R.U.E. test didn’t capture 23% of patients with a preservative allergy and 11% of those with a fragrance or botanical allergy (J. Am. Acad. Dermatol. 2010;63:789-98).

Fragrances pose one of the greatest challenges in the field of contact dermatitis. That’s because there are roughly 3,000 fragrance chemicals utilized in personal care products and cosmetics, and at least 100 of them have been described as causing contact dermatitis in patients. It can be difficult to assess the clinical relevance of positive patch test reactions because physicians don’t know what’s contained in North American fragrances. The fragrance industry is lucrative, secretive, and self-regulated.

Fragrance allergy is on the rise in children and adolescents, probably because they are being exposed to an onslaught of fragrance chemicals at a younger and younger age.

"When I grew up there was a bar of soap in the shower and, if we were lucky, shampoo; and if there was no shampoo we used the bar of soap. I have 19- and 17-year-old daughters, and if you go into their bathroom there are four different shampoos and three conditioners. There are things with glitter in there, and moisturizers and cosmetics, most of which I don’t even know what they’re for. All of them are fragrances. Folks are starting their exposure when they’re 7 and 8 years old. That was never the case before," said Dr. Cohen, who is also director of occupational, environmental, and allergic dermatology at the university.

The commercially available six-ingredient FM II panel is a 14% concentration composed of citronellol 0.5%, hydroxyisohexyl 3-cyclohexenecarboxyaldehyde (Lyral) 2.5%, hexyl cinnamal 5.0%, citral 1.0%, coumarin 2.5%, and farnesol 2.5%.

A long-standing point of contention has been the question of whether patients with atopic disease are more likely than nonatopic individuals to experience contact sensitivity, or less. The latest evidence suggests patients with asthma or severe atopic dermatitis have an overall lower prevalence of contact sensitization compared with nonatopic controls, with one striking exception.

In this very large study conducted by investigators at the Danish National Allergy Research Center, Copenhagen, an inverse association was found between atopic disease and contact allergy to metals and all groups of chemicals ... except fragrances. The prevalence of contact sensitization to fragrances was significantly higher in patients with atopic dermatitis than in controls. The investigators recommended that patients with atopic dermatitis be instructed to avoid scented moisturizers (Allergy 2012;67:1157-64).

The Danes found that patients with severe atopic dermatitis were 30% less likely than controls to be patch test–positive for contact sensitivity overall, whereas mild to moderate atopic dermatitis did not suppress contact sensitization. Again, fragrances constituted the exception: Not only did patients with severe atopic dermatitis have an increased prevalence of contact sensitization to fragrance chemicals, those with mild or moderate atopic dermatitis did, too, Dr. Cohen noted.

He reported having no financial conflicts.

b.jancin@elsevier.com

PRAGUE – Reliance upon the time-honored tools for diagnosis of contact allergy due to fragrances will cause physicians to miss many cases, Dr. David E. Cohen said at the annual congress of the European Academy of Dermatology and Venereology.

"The old fragrance mix – fragrance mix I – and the use of balsam of Peru as fragrance screening tools really won’t capture contact dermatitis involving allergens to more modern fragrances," cautioned Dr. Cohen, professor and vice chair of the department of dermatology at New York University.

"I remember my grandmother always smelling like rosewater and naphthalene – like mothballs and rosewater. But we don’t smell like that anymore. Now we tend to use more botanical extracts. We see tea tree oil and jasmine appearing in our personal care products, and if we don’t test for those more contemporary fragrances, we will miss a very important source of contact dermatitis," he continued.

That’s why fragrance mix II (FM II) was developed. FM II has been incorporated into the North American Contact Dermatitis Group’s standard screening tray. It is not, however, part of the widely used T.R.U.E. (Thin-Layer Rapid Use Epicutaneous) test, nor is it included in the European standard screening series.

Multiple studies have documented that a substantial proportion of patients with allergic contact dermatitis will react only to the newer fragrances, and not to FM I or balsam of Peru. For example, a multicenter Hungarian study published earlier this year found that of 565 patients patch tested because of skin symptoms provoked by scented products, 17% exhibited contact hypersensitivity to one or more components of FM II. Moreover, 48% of FM II–positive patients reacted only to FM II, not FM I, balsam of Peru, or other test materials (Dermatitis 2012;23:71-4).

Similarly, a Mayo Clinic study of 945 patients patch tested using both the standard screening tray with FM II and the T.R.U.E. test found that 49% of patients reacted to one or more preservatives and 31% reacted to at least one fragrance or botanical additive. However, the T.R.U.E. test didn’t capture 23% of patients with a preservative allergy and 11% of those with a fragrance or botanical allergy (J. Am. Acad. Dermatol. 2010;63:789-98).

Fragrances pose one of the greatest challenges in the field of contact dermatitis. That’s because there are roughly 3,000 fragrance chemicals utilized in personal care products and cosmetics, and at least 100 of them have been described as causing contact dermatitis in patients. It can be difficult to assess the clinical relevance of positive patch test reactions because physicians don’t know what’s contained in North American fragrances. The fragrance industry is lucrative, secretive, and self-regulated.

Fragrance allergy is on the rise in children and adolescents, probably because they are being exposed to an onslaught of fragrance chemicals at a younger and younger age.

"When I grew up there was a bar of soap in the shower and, if we were lucky, shampoo; and if there was no shampoo we used the bar of soap. I have 19- and 17-year-old daughters, and if you go into their bathroom there are four different shampoos and three conditioners. There are things with glitter in there, and moisturizers and cosmetics, most of which I don’t even know what they’re for. All of them are fragrances. Folks are starting their exposure when they’re 7 and 8 years old. That was never the case before," said Dr. Cohen, who is also director of occupational, environmental, and allergic dermatology at the university.

The commercially available six-ingredient FM II panel is a 14% concentration composed of citronellol 0.5%, hydroxyisohexyl 3-cyclohexenecarboxyaldehyde (Lyral) 2.5%, hexyl cinnamal 5.0%, citral 1.0%, coumarin 2.5%, and farnesol 2.5%.

A long-standing point of contention has been the question of whether patients with atopic disease are more likely than nonatopic individuals to experience contact sensitivity, or less. The latest evidence suggests patients with asthma or severe atopic dermatitis have an overall lower prevalence of contact sensitization compared with nonatopic controls, with one striking exception.

In this very large study conducted by investigators at the Danish National Allergy Research Center, Copenhagen, an inverse association was found between atopic disease and contact allergy to metals and all groups of chemicals ... except fragrances. The prevalence of contact sensitization to fragrances was significantly higher in patients with atopic dermatitis than in controls. The investigators recommended that patients with atopic dermatitis be instructed to avoid scented moisturizers (Allergy 2012;67:1157-64).

The Danes found that patients with severe atopic dermatitis were 30% less likely than controls to be patch test–positive for contact sensitivity overall, whereas mild to moderate atopic dermatitis did not suppress contact sensitization. Again, fragrances constituted the exception: Not only did patients with severe atopic dermatitis have an increased prevalence of contact sensitization to fragrance chemicals, those with mild or moderate atopic dermatitis did, too, Dr. Cohen noted.

He reported having no financial conflicts.

b.jancin@elsevier.com

PRAGUE – Reliance upon the time-honored tools for diagnosis of contact allergy due to fragrances will cause physicians to miss many cases, Dr. David E. Cohen said at the annual congress of the European Academy of Dermatology and Venereology.

"The old fragrance mix – fragrance mix I – and the use of balsam of Peru as fragrance screening tools really won’t capture contact dermatitis involving allergens to more modern fragrances," cautioned Dr. Cohen, professor and vice chair of the department of dermatology at New York University.

"I remember my grandmother always smelling like rosewater and naphthalene – like mothballs and rosewater. But we don’t smell like that anymore. Now we tend to use more botanical extracts. We see tea tree oil and jasmine appearing in our personal care products, and if we don’t test for those more contemporary fragrances, we will miss a very important source of contact dermatitis," he continued.

That’s why fragrance mix II (FM II) was developed. FM II has been incorporated into the North American Contact Dermatitis Group’s standard screening tray. It is not, however, part of the widely used T.R.U.E. (Thin-Layer Rapid Use Epicutaneous) test, nor is it included in the European standard screening series.

Multiple studies have documented that a substantial proportion of patients with allergic contact dermatitis will react only to the newer fragrances, and not to FM I or balsam of Peru. For example, a multicenter Hungarian study published earlier this year found that of 565 patients patch tested because of skin symptoms provoked by scented products, 17% exhibited contact hypersensitivity to one or more components of FM II. Moreover, 48% of FM II–positive patients reacted only to FM II, not FM I, balsam of Peru, or other test materials (Dermatitis 2012;23:71-4).

Similarly, a Mayo Clinic study of 945 patients patch tested using both the standard screening tray with FM II and the T.R.U.E. test found that 49% of patients reacted to one or more preservatives and 31% reacted to at least one fragrance or botanical additive. However, the T.R.U.E. test didn’t capture 23% of patients with a preservative allergy and 11% of those with a fragrance or botanical allergy (J. Am. Acad. Dermatol. 2010;63:789-98).

Fragrances pose one of the greatest challenges in the field of contact dermatitis. That’s because there are roughly 3,000 fragrance chemicals utilized in personal care products and cosmetics, and at least 100 of them have been described as causing contact dermatitis in patients. It can be difficult to assess the clinical relevance of positive patch test reactions because physicians don’t know what’s contained in North American fragrances. The fragrance industry is lucrative, secretive, and self-regulated.

Fragrance allergy is on the rise in children and adolescents, probably because they are being exposed to an onslaught of fragrance chemicals at a younger and younger age.

"When I grew up there was a bar of soap in the shower and, if we were lucky, shampoo; and if there was no shampoo we used the bar of soap. I have 19- and 17-year-old daughters, and if you go into their bathroom there are four different shampoos and three conditioners. There are things with glitter in there, and moisturizers and cosmetics, most of which I don’t even know what they’re for. All of them are fragrances. Folks are starting their exposure when they’re 7 and 8 years old. That was never the case before," said Dr. Cohen, who is also director of occupational, environmental, and allergic dermatology at the university.

The commercially available six-ingredient FM II panel is a 14% concentration composed of citronellol 0.5%, hydroxyisohexyl 3-cyclohexenecarboxyaldehyde (Lyral) 2.5%, hexyl cinnamal 5.0%, citral 1.0%, coumarin 2.5%, and farnesol 2.5%.

A long-standing point of contention has been the question of whether patients with atopic disease are more likely than nonatopic individuals to experience contact sensitivity, or less. The latest evidence suggests patients with asthma or severe atopic dermatitis have an overall lower prevalence of contact sensitization compared with nonatopic controls, with one striking exception.

In this very large study conducted by investigators at the Danish National Allergy Research Center, Copenhagen, an inverse association was found between atopic disease and contact allergy to metals and all groups of chemicals ... except fragrances. The prevalence of contact sensitization to fragrances was significantly higher in patients with atopic dermatitis than in controls. The investigators recommended that patients with atopic dermatitis be instructed to avoid scented moisturizers (Allergy 2012;67:1157-64).

The Danes found that patients with severe atopic dermatitis were 30% less likely than controls to be patch test–positive for contact sensitivity overall, whereas mild to moderate atopic dermatitis did not suppress contact sensitization. Again, fragrances constituted the exception: Not only did patients with severe atopic dermatitis have an increased prevalence of contact sensitization to fragrance chemicals, those with mild or moderate atopic dermatitis did, too, Dr. Cohen noted.

He reported having no financial conflicts.

b.jancin@elsevier.com

PRAGUE – Tacrolimus 0.03% ointment has earned first-line, treatment-of-choice status in atopic blepharoconjunctivitis, the most common ocular complication of atopic dermatitis, Dr. Ville Kiiski said at the annual congress of the European Academy of Dermatology and Venereology.

In a 10-year, single-center review of 338 patients on long-term topical therapy for atopic blepharoconjunctivitis with either tacrolimus (Protopic), pimecrolimus 1% cream (Elidel), or topical corticosteroids, tacrolimus displayed the best efficacy and tolerability, according to Dr. Kiiski of Helsinki University Central Hospital.

Tacrolimus ointment was the primary therapy in 297 patients as young as 2 years old. Thirty-three patients were on pimecrolimus, while just eight patients were treated mainly with topical steroids. Most Finnish physicians are reluctant to prescribe topical steroids for long-term use in the eyelid area because of the well-known associated increased risks of cataracts, elevated intraocular pressure, and skin atrophy, the dermatologist noted.

The mean follow-up was 1.5 years for treatment efficacy and 5.8 years for malignancy risk.

The treatment discontinuation rate because of intolerance of side effects was 33% with pimecrolimus and 9.1% for tacrolimus. Twenty-two percent of patients placed on pimecrolimus discontinued the drug because of insufficient efficacy, compared with 1.6% on tacrolimus.

The blepharitis response rate was 90% in tacrolimus-treated patients, 79% with pimecrolimus, and 88% in the handful of patients on topical steroids. The conjunctivitis response rates were 80%, 55%, and 50% with tacrolimus, pimecrolimus, and topical steroids, respectively.

Tacrolimus-treated patients were an adjusted 2.37-fold more likely to experience significant improvement in their blepharitis than patients on pimecrolimus and 2.34-fold more likely to see improvement in their conjunctivitis.

Intraocular pressure dropped over time by a mean of 0.6 mm Hg in patients on either of the topical calcineurin inhibitors. None of the three topical therapies was associated with adverse effects on vision, lens, or cornea, nor were there adverse trends in terms of bacterial infections or malignancies.

Atopic blepharoconjunctivitis occurs when inflammatory disease activity at the eyelid margins traumatizes the ocular surface, aggravating keratitis and conjunctivitis.

The study was free of commercial sponsorship or investigator financial conflicts.

PRAGUE – Tacrolimus 0.03% ointment has earned first-line, treatment-of-choice status in atopic blepharoconjunctivitis, the most common ocular complication of atopic dermatitis, Dr. Ville Kiiski said at the annual congress of the European Academy of Dermatology and Venereology.

In a 10-year, single-center review of 338 patients on long-term topical therapy for atopic blepharoconjunctivitis with either tacrolimus (Protopic), pimecrolimus 1% cream (Elidel), or topical corticosteroids, tacrolimus displayed the best efficacy and tolerability, according to Dr. Kiiski of Helsinki University Central Hospital.

Tacrolimus ointment was the primary therapy in 297 patients as young as 2 years old. Thirty-three patients were on pimecrolimus, while just eight patients were treated mainly with topical steroids. Most Finnish physicians are reluctant to prescribe topical steroids for long-term use in the eyelid area because of the well-known associated increased risks of cataracts, elevated intraocular pressure, and skin atrophy, the dermatologist noted.

The mean follow-up was 1.5 years for treatment efficacy and 5.8 years for malignancy risk.

The treatment discontinuation rate because of intolerance of side effects was 33% with pimecrolimus and 9.1% for tacrolimus. Twenty-two percent of patients placed on pimecrolimus discontinued the drug because of insufficient efficacy, compared with 1.6% on tacrolimus.

The blepharitis response rate was 90% in tacrolimus-treated patients, 79% with pimecrolimus, and 88% in the handful of patients on topical steroids. The conjunctivitis response rates were 80%, 55%, and 50% with tacrolimus, pimecrolimus, and topical steroids, respectively.

Tacrolimus-treated patients were an adjusted 2.37-fold more likely to experience significant improvement in their blepharitis than patients on pimecrolimus and 2.34-fold more likely to see improvement in their conjunctivitis.

Intraocular pressure dropped over time by a mean of 0.6 mm Hg in patients on either of the topical calcineurin inhibitors. None of the three topical therapies was associated with adverse effects on vision, lens, or cornea, nor were there adverse trends in terms of bacterial infections or malignancies.

Atopic blepharoconjunctivitis occurs when inflammatory disease activity at the eyelid margins traumatizes the ocular surface, aggravating keratitis and conjunctivitis.

The study was free of commercial sponsorship or investigator financial conflicts.

PRAGUE – Tacrolimus 0.03% ointment has earned first-line, treatment-of-choice status in atopic blepharoconjunctivitis, the most common ocular complication of atopic dermatitis, Dr. Ville Kiiski said at the annual congress of the European Academy of Dermatology and Venereology.

In a 10-year, single-center review of 338 patients on long-term topical therapy for atopic blepharoconjunctivitis with either tacrolimus (Protopic), pimecrolimus 1% cream (Elidel), or topical corticosteroids, tacrolimus displayed the best efficacy and tolerability, according to Dr. Kiiski of Helsinki University Central Hospital.

Tacrolimus ointment was the primary therapy in 297 patients as young as 2 years old. Thirty-three patients were on pimecrolimus, while just eight patients were treated mainly with topical steroids. Most Finnish physicians are reluctant to prescribe topical steroids for long-term use in the eyelid area because of the well-known associated increased risks of cataracts, elevated intraocular pressure, and skin atrophy, the dermatologist noted.

The mean follow-up was 1.5 years for treatment efficacy and 5.8 years for malignancy risk.

The treatment discontinuation rate because of intolerance of side effects was 33% with pimecrolimus and 9.1% for tacrolimus. Twenty-two percent of patients placed on pimecrolimus discontinued the drug because of insufficient efficacy, compared with 1.6% on tacrolimus.

The blepharitis response rate was 90% in tacrolimus-treated patients, 79% with pimecrolimus, and 88% in the handful of patients on topical steroids. The conjunctivitis response rates were 80%, 55%, and 50% with tacrolimus, pimecrolimus, and topical steroids, respectively.

Tacrolimus-treated patients were an adjusted 2.37-fold more likely to experience significant improvement in their blepharitis than patients on pimecrolimus and 2.34-fold more likely to see improvement in their conjunctivitis.

Intraocular pressure dropped over time by a mean of 0.6 mm Hg in patients on either of the topical calcineurin inhibitors. None of the three topical therapies was associated with adverse effects on vision, lens, or cornea, nor were there adverse trends in terms of bacterial infections or malignancies.

Atopic blepharoconjunctivitis occurs when inflammatory disease activity at the eyelid margins traumatizes the ocular surface, aggravating keratitis and conjunctivitis.

The study was free of commercial sponsorship or investigator financial conflicts.

Patients often ask their dermatologists for recommendations on over-the-counter moisturizers, said Dr. Joshua Zeichner.

The trouble is that "many dermatologists don’t really know what makes a good moisturizer, and are unfamiliar with the latest advances in moisturizing technology," he said at SDEF Las Vegas Dermatology Seminar.

While the purpose of all moisturizers is simple enough – to boost and maintain the water content of the skin – their formulations and the manner of their activity vary widely. Some work by increasing the expression of aquaporins, the water channels in the skin cell membrane; others by replacing skin lipids, temporarily repairing the skin’s barrier function and improving appearance.

Any high-quality moisturizer will contain a mixture of humectant, emollient, and occlusive ingredients, said Dr. Zeichner, director of cosmetic and clinical research in dermatology at Mount Sinai Medical Center in New York.

Among the novel humectants being incorporated into moisturizers today are natural moisturizing factors (NMF), an umbrella term for the naturally occurring humectants glycerol, urea, and lactic acid, along with the amino acids urocanic acid (UCA) and pyrrolidone carboxylic acid (PCA), which are produced by the breakdown of filaggrin.

Many moisturizers contain ceramides, the major lipids that make up the "mortar" between skin-cell "bricks" in the stratum corneum; moisturizers also may contain ceramide precursors.

"Applying a moisturizer with [the ceramide precursor] pseudoceramide 5 has been shown to lead to an increase in ceramide levels in the stratum corneum," Dr. Zeichner said. "However, it’s unclear whether the ingredient is directly incorporated into those ceramides. Regardless, you can see the clinical improvement."

Generally with all moisturizers, he said, "we need more studies to evaluate the long-term effects to the skin beyond just the immediate effect."

Glyceryl glucoside, a modified glycerin molecule that enhances the activity of aquaporin channels, shows promise as a humectant, Dr. Zeichner said.

He described glyceryl glucoside as a "super humectant" whose effect on skin may last longer than that of other humectants.

Dr. Zeichner also tipped his hat to an old school moisturizer ingredient – colloidal oatmeal.

"There’s a lot of talk about all of these exciting new technologies but you don’t want to forget about tried and true colloidal oatmeal," he said. Oatmeal, which has occlusive, humectant, and emollient properties, "serves as the backbone for many skin brands and works very well. Advances in cosmetic chemistry have made oatmeal formulations much more elegant now – they’re not your grandmother’s oatmeal anymore."

Dr. Zeichner disclosed financial relationships with Allergan, Bayer, Beiersdorf, Galderma, Johnson and Johnson, L’Oreal, Medicis, Onset, Pharmaderm, Procter and Gamble, and Valeant.

SDEF and this news organization are owned by Frontline Medical Communications.

Patients often ask their dermatologists for recommendations on over-the-counter moisturizers, said Dr. Joshua Zeichner.

The trouble is that "many dermatologists don’t really know what makes a good moisturizer, and are unfamiliar with the latest advances in moisturizing technology," he said at SDEF Las Vegas Dermatology Seminar.

While the purpose of all moisturizers is simple enough – to boost and maintain the water content of the skin – their formulations and the manner of their activity vary widely. Some work by increasing the expression of aquaporins, the water channels in the skin cell membrane; others by replacing skin lipids, temporarily repairing the skin’s barrier function and improving appearance.

Any high-quality moisturizer will contain a mixture of humectant, emollient, and occlusive ingredients, said Dr. Zeichner, director of cosmetic and clinical research in dermatology at Mount Sinai Medical Center in New York.

Among the novel humectants being incorporated into moisturizers today are natural moisturizing factors (NMF), an umbrella term for the naturally occurring humectants glycerol, urea, and lactic acid, along with the amino acids urocanic acid (UCA) and pyrrolidone carboxylic acid (PCA), which are produced by the breakdown of filaggrin.

Many moisturizers contain ceramides, the major lipids that make up the "mortar" between skin-cell "bricks" in the stratum corneum; moisturizers also may contain ceramide precursors.

"Applying a moisturizer with [the ceramide precursor] pseudoceramide 5 has been shown to lead to an increase in ceramide levels in the stratum corneum," Dr. Zeichner said. "However, it’s unclear whether the ingredient is directly incorporated into those ceramides. Regardless, you can see the clinical improvement."

Generally with all moisturizers, he said, "we need more studies to evaluate the long-term effects to the skin beyond just the immediate effect."

Glyceryl glucoside, a modified glycerin molecule that enhances the activity of aquaporin channels, shows promise as a humectant, Dr. Zeichner said.

He described glyceryl glucoside as a "super humectant" whose effect on skin may last longer than that of other humectants.

Dr. Zeichner also tipped his hat to an old school moisturizer ingredient – colloidal oatmeal.

"There’s a lot of talk about all of these exciting new technologies but you don’t want to forget about tried and true colloidal oatmeal," he said. Oatmeal, which has occlusive, humectant, and emollient properties, "serves as the backbone for many skin brands and works very well. Advances in cosmetic chemistry have made oatmeal formulations much more elegant now – they’re not your grandmother’s oatmeal anymore."

Dr. Zeichner disclosed financial relationships with Allergan, Bayer, Beiersdorf, Galderma, Johnson and Johnson, L’Oreal, Medicis, Onset, Pharmaderm, Procter and Gamble, and Valeant.

SDEF and this news organization are owned by Frontline Medical Communications.

Patients often ask their dermatologists for recommendations on over-the-counter moisturizers, said Dr. Joshua Zeichner.

The trouble is that "many dermatologists don’t really know what makes a good moisturizer, and are unfamiliar with the latest advances in moisturizing technology," he said at SDEF Las Vegas Dermatology Seminar.

While the purpose of all moisturizers is simple enough – to boost and maintain the water content of the skin – their formulations and the manner of their activity vary widely. Some work by increasing the expression of aquaporins, the water channels in the skin cell membrane; others by replacing skin lipids, temporarily repairing the skin’s barrier function and improving appearance.

Any high-quality moisturizer will contain a mixture of humectant, emollient, and occlusive ingredients, said Dr. Zeichner, director of cosmetic and clinical research in dermatology at Mount Sinai Medical Center in New York.

Among the novel humectants being incorporated into moisturizers today are natural moisturizing factors (NMF), an umbrella term for the naturally occurring humectants glycerol, urea, and lactic acid, along with the amino acids urocanic acid (UCA) and pyrrolidone carboxylic acid (PCA), which are produced by the breakdown of filaggrin.

Many moisturizers contain ceramides, the major lipids that make up the "mortar" between skin-cell "bricks" in the stratum corneum; moisturizers also may contain ceramide precursors.

"Applying a moisturizer with [the ceramide precursor] pseudoceramide 5 has been shown to lead to an increase in ceramide levels in the stratum corneum," Dr. Zeichner said. "However, it’s unclear whether the ingredient is directly incorporated into those ceramides. Regardless, you can see the clinical improvement."

Generally with all moisturizers, he said, "we need more studies to evaluate the long-term effects to the skin beyond just the immediate effect."

Glyceryl glucoside, a modified glycerin molecule that enhances the activity of aquaporin channels, shows promise as a humectant, Dr. Zeichner said.

He described glyceryl glucoside as a "super humectant" whose effect on skin may last longer than that of other humectants.

Dr. Zeichner also tipped his hat to an old school moisturizer ingredient – colloidal oatmeal.

"There’s a lot of talk about all of these exciting new technologies but you don’t want to forget about tried and true colloidal oatmeal," he said. Oatmeal, which has occlusive, humectant, and emollient properties, "serves as the backbone for many skin brands and works very well. Advances in cosmetic chemistry have made oatmeal formulations much more elegant now – they’re not your grandmother’s oatmeal anymore."

Dr. Zeichner disclosed financial relationships with Allergan, Bayer, Beiersdorf, Galderma, Johnson and Johnson, L’Oreal, Medicis, Onset, Pharmaderm, Procter and Gamble, and Valeant.

SDEF and this news organization are owned by Frontline Medical Communications.

RALEIGH, N.C. – Atopic dermatitis is a disease that until now has gone underappreciated by regulatory authorities, the pharmaceutical industry, and the general public, according to thought leaders determined to turn the situation around.

"The first and probably foremost reason atopic dermatitis has been somewhat ignored is that it is perceived as a childhood disease, and that makes development of drugs very, very difficult. First, you have to go through studies in adults and then you have to go through children," Dr. Lisa A. Beck noted during a special plenary session devoted to atopic dermatitis at the conference.

Courtesy Mrs. Emily Boynton, URMC Public Relations Department

Another stumbling block is that researchers haven’t adequately documented the negative effects atopic dermatitis can have on daily life for patients and caregivers. Clinicians who care for atopy patients are aware of it. The outside world is not, observed Dr. Beck, professor of dermatology and medicine at the University of Rochester (N.Y.). Also, better diagnostic criteria for atopic dermatitis are needed. The diagnosis isn’t always as straightforward as in psoriasis, which is "the great comparator in our range of diseases," she said.

A damaging perception that’s particularly entrenched within the regulatory agencies is that atopic dermatitis is not high priority because it lacks serious comorbidities, Dr. Beck continued.

Research Barriers

"That’s something we come up against in atopic dermatitis all the time: the idea that it’s a disease of misery rather than a disease of mortality," agreed Dr. Neil Graham of Regeneron Pharmaceuticals in Tarrytown, N.Y. "However, our view is that human misery is something we should be trying to treat therapeutically, and that this has value both economically and to society. I think we’ve seen this accomplished successfully with psoriasis, which is the template we can use in atopic dermatitis."

Biopharmaceutical companies are interested in applying the psoriasis drug development template to atopic dermatitis. Regeneron is developing a biologic agent that simultaneously blocks interleukins-4 and -13 for the treatment of atopic dermatitis and other diseases whose predominant mechanism involves Th2-driven eosinophilic inflammation, including eosinophilic asthma, chronic sinusitis with nasal polyps, and conjunctival allergic disease. The company wants an agent that can be subcutaneously injected every week or two, noted Dr. Graham.

"We hope eventually to intervene in children and potentially interrupt the atopic march. It will probably take us many years to get there," he said.

Regulatory agencies will almost certainly require that clinical trials involving any biologic agent under development for atopic dermatitis initially be restricted to patients with moderate to severe disease.

That’s a problem, according to Dr. Graham, because the Food and Drug Administration defines the clinical severity of atopic dermatitis using the Investigator’s Global Assessment (IGA) scale: a limited tool that’s not up to the task of capturing the full impact of the disease. Better means of defining the moderate to severely affected patient subset are essential. Also, a standardized, clinically relevant measure of disease severity reduction in response to treatment is needed – something akin to the Psoriasis Area Severity Index (PASI) 50 or -75 as used in psoriasis.

Dr. Eric Simpson agreed that regulatory authorities haven’t devoted sufficient attention to study design requirements or definitions of therapeutic success. For instance, the FDA requires evidence of improvement in the IGA as the bar that must be cleared in order to obtain approval of drugs for atopic dermatitis. Yet the IGA has never been adequately validated, nor has the metric’s definition been standardized. Indeed, the definition changes over time, from one phase-III clinical trial to the next.

"The inter-relater reliability of the IGA is unknown. I think it could be a major issue," said Dr. Simpson of the Oregon Health and Science University, Portland.

He proposed that participants in the SID special session on atopic dermatitis create a position paper recommending better outcome measures to the FDA. "We need to work with the agency to do what’s best for good clinical research," he said.

Identifying Biomarkers

According to Dr. Graham, atopic dermatitis is on the radar of major biotech companies that have biologic agents for psoriasis. They are working to develop biologics for atopic dermatitis, targeting a variety of pathways including interleukins-5, -4, and -13, as well as IgE.

Reliable biomarkers are needed to make drug development in atopic dermatitis go quickly and efficiently. After all, biomarker data are now routinely incorporated into early-phase development of new drugs for psoriasis, and these data are included in support of new drug applications to the FDA. But objective biomarkers have been notably lacking in atopic dermatitis, he noted.

Dr. Emma Guttman-Yassky announced help is at hand. While efforts to identify blood biomarkers have proved deeply disappointing, skin biomarkers are another story. She and her coinvestigators have identified a set of reliable skin biomarkers of therapeutic response in atopic dermatitis patients.

"We believe that these biomarkers represent the molecular fingerprints of the disease and might be key to future development of targeted treatments," said Dr. Guttman-Yassky, director of occupational and contact dermatitis at Mount Sinai Medical Center, New York.

She and her coinvestigators took lesional and nonlesional skin biopsies from 12 atopic dermatitis patients before and after undergoing narrow-band UVB phototherapy three times weekly for 12 weeks, a regimen the patients responded to with a mean 81% reduction in SCORAD index scores. Reversal of epidermal hyperplasia and abnormal keratinocyte differentiation – the histologic hallmarks of atopic dermatitis – was associated with elimination of inflammatory leukocytes and Th2-associated cytokines and chemokines (J. Allergy Clin. Immunol. 2011;128:583-93).

Among the skin biomarkers of atopic dermatitis that reversed with effective therapy were inflammatory dendritic epidermal cells, myeloid and plasmacytoid dendritic cells, CD3+ T cells, and interleukins-4 and -13.

This study, as well as another by Dr. Guttman-Yassky and her colleagues (in press), demonstrated a major role for interleukin-22 in atopic dermatitis. The cytokine was markedly overexpressed in lesional skin, with resultant upregulation of the antimicrobial protein’s S100A7, S100A8, and S100A9. After narrow-band UVB therapy, expression of IL-22 expression was downregulated, as were the IL-22-induced chemokines S100A7-9.

Expression of the three antimicrobial proteins in lesional skin also appears to be useful as a biomarker defining acute disease. Their levels jump within 3 days after onset of acute atopic dermatitis, according to Dr. Guttman-Yassky.

"Are we there yet in terms of biomarkers in atopic dermatitis? That’s the million-dollar question. Regarding biomarker availability, I think yes. We now have biomarkers that are highly informative on the reversal of disease pathology with treatment," she said. "I believe that the next step is clinical trials with specific immune antagonists that incorporate biomarkers of response. I think biomarkers are key if we want to know if new therapies really work. This will enhance early decisions and reduce the cost of developing new treatments."

An important implication of the narrow-band UVB/biomarker study in terms of atopic dermatitis pathogenesis is that the data argue against a fixed genetic phenotype, since the atopic dermatitis epidermal phenotype was shown to be reversed with broad-based immune-targeted phototherapy. Instead, the study results argue in favor of what Dr. Guttman-Yassky called "the inside-out hypothesis" of atopic dermatitis, which postulates that the epidermal abnormalities that define the disease are caused by underlying immune activation.

Her studies were supported by the National Institutes of Health.

HOME Project Seeks Standardization

During the same session, Dr. Hywel C. Williams provided an update on a major international project called Harmonising Outcome Measures for Eczema (HOME). The goal of the HOME project is to develop a consensus on a core set of outcome measures to be used in all atopic dermatitis clinical research. This should make future studies easier to compare, contrast, and synthesize in meta-analyses.

A minimum set of core outcome measures in atopic dermatitis is needed because the situation can be chaotic, noted Dr. Williams, professor of dermatology and director of the Center for Evidence-Based Dermatology at the University of Nottingham (U.K.).

"There are more than 20 named scales for atopic dermatitis, including SCORAD, POEM, SASSAD, ADASI, ADAM, EASI, and the FSSS. Some have been only partly tested. Many have not been tested at all. At international meetings I see people shouting at each other, trying to communicate what the results of their studies mean. Some people are in the SCORAD camp, some are in the SASSAD camp, others are in the EASI camp. How can we possibly communicate? This is a shameful situation which we really have to put right if we are to progress," he said.

The HOME project is modeled after Outcome Measures in Rheumatology, or OMERACT, an international consensus group that meets every 2 years with the goal of raising the quality of rheumatologic research. HOME comprises atopic dermatitis researchers, clinical experts, journal editors, patient advocates, and representatives from the European regulatory agency. The FDA was invited but didn’t attend last year’s HOME meeting in Amsterdam, where working groups were formed to identify the best evidence-based instruments for assessing atopic disease signs, symptoms, flares, quality of life, and treatment efficacy and safety. The HOME group will meet next year in San Diego on April 6-7.

Aside from Dr. Graham, a Regeneron employee, the other speakers in the special session reported receiving research grants from various sources but declared having no conflicts of interest with regard to their presentations.

RALEIGH, N.C. – Atopic dermatitis is a disease that until now has gone underappreciated by regulatory authorities, the pharmaceutical industry, and the general public, according to thought leaders determined to turn the situation around.

"The first and probably foremost reason atopic dermatitis has been somewhat ignored is that it is perceived as a childhood disease, and that makes development of drugs very, very difficult. First, you have to go through studies in adults and then you have to go through children," Dr. Lisa A. Beck noted during a special plenary session devoted to atopic dermatitis at the conference.

Courtesy Mrs. Emily Boynton, URMC Public Relations Department

Another stumbling block is that researchers haven’t adequately documented the negative effects atopic dermatitis can have on daily life for patients and caregivers. Clinicians who care for atopy patients are aware of it. The outside world is not, observed Dr. Beck, professor of dermatology and medicine at the University of Rochester (N.Y.). Also, better diagnostic criteria for atopic dermatitis are needed. The diagnosis isn’t always as straightforward as in psoriasis, which is "the great comparator in our range of diseases," she said.

A damaging perception that’s particularly entrenched within the regulatory agencies is that atopic dermatitis is not high priority because it lacks serious comorbidities, Dr. Beck continued.

Research Barriers

"That’s something we come up against in atopic dermatitis all the time: the idea that it’s a disease of misery rather than a disease of mortality," agreed Dr. Neil Graham of Regeneron Pharmaceuticals in Tarrytown, N.Y. "However, our view is that human misery is something we should be trying to treat therapeutically, and that this has value both economically and to society. I think we’ve seen this accomplished successfully with psoriasis, which is the template we can use in atopic dermatitis."

Biopharmaceutical companies are interested in applying the psoriasis drug development template to atopic dermatitis. Regeneron is developing a biologic agent that simultaneously blocks interleukins-4 and -13 for the treatment of atopic dermatitis and other diseases whose predominant mechanism involves Th2-driven eosinophilic inflammation, including eosinophilic asthma, chronic sinusitis with nasal polyps, and conjunctival allergic disease. The company wants an agent that can be subcutaneously injected every week or two, noted Dr. Graham.

"We hope eventually to intervene in children and potentially interrupt the atopic march. It will probably take us many years to get there," he said.

Regulatory agencies will almost certainly require that clinical trials involving any biologic agent under development for atopic dermatitis initially be restricted to patients with moderate to severe disease.

That’s a problem, according to Dr. Graham, because the Food and Drug Administration defines the clinical severity of atopic dermatitis using the Investigator’s Global Assessment (IGA) scale: a limited tool that’s not up to the task of capturing the full impact of the disease. Better means of defining the moderate to severely affected patient subset are essential. Also, a standardized, clinically relevant measure of disease severity reduction in response to treatment is needed – something akin to the Psoriasis Area Severity Index (PASI) 50 or -75 as used in psoriasis.

Dr. Eric Simpson agreed that regulatory authorities haven’t devoted sufficient attention to study design requirements or definitions of therapeutic success. For instance, the FDA requires evidence of improvement in the IGA as the bar that must be cleared in order to obtain approval of drugs for atopic dermatitis. Yet the IGA has never been adequately validated, nor has the metric’s definition been standardized. Indeed, the definition changes over time, from one phase-III clinical trial to the next.

"The inter-relater reliability of the IGA is unknown. I think it could be a major issue," said Dr. Simpson of the Oregon Health and Science University, Portland.

He proposed that participants in the SID special session on atopic dermatitis create a position paper recommending better outcome measures to the FDA. "We need to work with the agency to do what’s best for good clinical research," he said.

Identifying Biomarkers

According to Dr. Graham, atopic dermatitis is on the radar of major biotech companies that have biologic agents for psoriasis. They are working to develop biologics for atopic dermatitis, targeting a variety of pathways including interleukins-5, -4, and -13, as well as IgE.

Reliable biomarkers are needed to make drug development in atopic dermatitis go quickly and efficiently. After all, biomarker data are now routinely incorporated into early-phase development of new drugs for psoriasis, and these data are included in support of new drug applications to the FDA. But objective biomarkers have been notably lacking in atopic dermatitis, he noted.

Dr. Emma Guttman-Yassky announced help is at hand. While efforts to identify blood biomarkers have proved deeply disappointing, skin biomarkers are another story. She and her coinvestigators have identified a set of reliable skin biomarkers of therapeutic response in atopic dermatitis patients.

"We believe that these biomarkers represent the molecular fingerprints of the disease and might be key to future development of targeted treatments," said Dr. Guttman-Yassky, director of occupational and contact dermatitis at Mount Sinai Medical Center, New York.

She and her coinvestigators took lesional and nonlesional skin biopsies from 12 atopic dermatitis patients before and after undergoing narrow-band UVB phototherapy three times weekly for 12 weeks, a regimen the patients responded to with a mean 81% reduction in SCORAD index scores. Reversal of epidermal hyperplasia and abnormal keratinocyte differentiation – the histologic hallmarks of atopic dermatitis – was associated with elimination of inflammatory leukocytes and Th2-associated cytokines and chemokines (J. Allergy Clin. Immunol. 2011;128:583-93).

Among the skin biomarkers of atopic dermatitis that reversed with effective therapy were inflammatory dendritic epidermal cells, myeloid and plasmacytoid dendritic cells, CD3+ T cells, and interleukins-4 and -13.

This study, as well as another by Dr. Guttman-Yassky and her colleagues (in press), demonstrated a major role for interleukin-22 in atopic dermatitis. The cytokine was markedly overexpressed in lesional skin, with resultant upregulation of the antimicrobial protein’s S100A7, S100A8, and S100A9. After narrow-band UVB therapy, expression of IL-22 expression was downregulated, as were the IL-22-induced chemokines S100A7-9.

Expression of the three antimicrobial proteins in lesional skin also appears to be useful as a biomarker defining acute disease. Their levels jump within 3 days after onset of acute atopic dermatitis, according to Dr. Guttman-Yassky.

"Are we there yet in terms of biomarkers in atopic dermatitis? That’s the million-dollar question. Regarding biomarker availability, I think yes. We now have biomarkers that are highly informative on the reversal of disease pathology with treatment," she said. "I believe that the next step is clinical trials with specific immune antagonists that incorporate biomarkers of response. I think biomarkers are key if we want to know if new therapies really work. This will enhance early decisions and reduce the cost of developing new treatments."

An important implication of the narrow-band UVB/biomarker study in terms of atopic dermatitis pathogenesis is that the data argue against a fixed genetic phenotype, since the atopic dermatitis epidermal phenotype was shown to be reversed with broad-based immune-targeted phototherapy. Instead, the study results argue in favor of what Dr. Guttman-Yassky called "the inside-out hypothesis" of atopic dermatitis, which postulates that the epidermal abnormalities that define the disease are caused by underlying immune activation.

Her studies were supported by the National Institutes of Health.

HOME Project Seeks Standardization

During the same session, Dr. Hywel C. Williams provided an update on a major international project called Harmonising Outcome Measures for Eczema (HOME). The goal of the HOME project is to develop a consensus on a core set of outcome measures to be used in all atopic dermatitis clinical research. This should make future studies easier to compare, contrast, and synthesize in meta-analyses.

A minimum set of core outcome measures in atopic dermatitis is needed because the situation can be chaotic, noted Dr. Williams, professor of dermatology and director of the Center for Evidence-Based Dermatology at the University of Nottingham (U.K.).

"There are more than 20 named scales for atopic dermatitis, including SCORAD, POEM, SASSAD, ADASI, ADAM, EASI, and the FSSS. Some have been only partly tested. Many have not been tested at all. At international meetings I see people shouting at each other, trying to communicate what the results of their studies mean. Some people are in the SCORAD camp, some are in the SASSAD camp, others are in the EASI camp. How can we possibly communicate? This is a shameful situation which we really have to put right if we are to progress," he said.

The HOME project is modeled after Outcome Measures in Rheumatology, or OMERACT, an international consensus group that meets every 2 years with the goal of raising the quality of rheumatologic research. HOME comprises atopic dermatitis researchers, clinical experts, journal editors, patient advocates, and representatives from the European regulatory agency. The FDA was invited but didn’t attend last year’s HOME meeting in Amsterdam, where working groups were formed to identify the best evidence-based instruments for assessing atopic disease signs, symptoms, flares, quality of life, and treatment efficacy and safety. The HOME group will meet next year in San Diego on April 6-7.

Aside from Dr. Graham, a Regeneron employee, the other speakers in the special session reported receiving research grants from various sources but declared having no conflicts of interest with regard to their presentations.

RALEIGH, N.C. – Atopic dermatitis is a disease that until now has gone underappreciated by regulatory authorities, the pharmaceutical industry, and the general public, according to thought leaders determined to turn the situation around.

"The first and probably foremost reason atopic dermatitis has been somewhat ignored is that it is perceived as a childhood disease, and that makes development of drugs very, very difficult. First, you have to go through studies in adults and then you have to go through children," Dr. Lisa A. Beck noted during a special plenary session devoted to atopic dermatitis at the conference.

Courtesy Mrs. Emily Boynton, URMC Public Relations Department

Another stumbling block is that researchers haven’t adequately documented the negative effects atopic dermatitis can have on daily life for patients and caregivers. Clinicians who care for atopy patients are aware of it. The outside world is not, observed Dr. Beck, professor of dermatology and medicine at the University of Rochester (N.Y.). Also, better diagnostic criteria for atopic dermatitis are needed. The diagnosis isn’t always as straightforward as in psoriasis, which is "the great comparator in our range of diseases," she said.

A damaging perception that’s particularly entrenched within the regulatory agencies is that atopic dermatitis is not high priority because it lacks serious comorbidities, Dr. Beck continued.

Research Barriers

"That’s something we come up against in atopic dermatitis all the time: the idea that it’s a disease of misery rather than a disease of mortality," agreed Dr. Neil Graham of Regeneron Pharmaceuticals in Tarrytown, N.Y. "However, our view is that human misery is something we should be trying to treat therapeutically, and that this has value both economically and to society. I think we’ve seen this accomplished successfully with psoriasis, which is the template we can use in atopic dermatitis."

Biopharmaceutical companies are interested in applying the psoriasis drug development template to atopic dermatitis. Regeneron is developing a biologic agent that simultaneously blocks interleukins-4 and -13 for the treatment of atopic dermatitis and other diseases whose predominant mechanism involves Th2-driven eosinophilic inflammation, including eosinophilic asthma, chronic sinusitis with nasal polyps, and conjunctival allergic disease. The company wants an agent that can be subcutaneously injected every week or two, noted Dr. Graham.

"We hope eventually to intervene in children and potentially interrupt the atopic march. It will probably take us many years to get there," he said.

Regulatory agencies will almost certainly require that clinical trials involving any biologic agent under development for atopic dermatitis initially be restricted to patients with moderate to severe disease.

That’s a problem, according to Dr. Graham, because the Food and Drug Administration defines the clinical severity of atopic dermatitis using the Investigator’s Global Assessment (IGA) scale: a limited tool that’s not up to the task of capturing the full impact of the disease. Better means of defining the moderate to severely affected patient subset are essential. Also, a standardized, clinically relevant measure of disease severity reduction in response to treatment is needed – something akin to the Psoriasis Area Severity Index (PASI) 50 or -75 as used in psoriasis.

Dr. Eric Simpson agreed that regulatory authorities haven’t devoted sufficient attention to study design requirements or definitions of therapeutic success. For instance, the FDA requires evidence of improvement in the IGA as the bar that must be cleared in order to obtain approval of drugs for atopic dermatitis. Yet the IGA has never been adequately validated, nor has the metric’s definition been standardized. Indeed, the definition changes over time, from one phase-III clinical trial to the next.

"The inter-relater reliability of the IGA is unknown. I think it could be a major issue," said Dr. Simpson of the Oregon Health and Science University, Portland.

He proposed that participants in the SID special session on atopic dermatitis create a position paper recommending better outcome measures to the FDA. "We need to work with the agency to do what’s best for good clinical research," he said.

Identifying Biomarkers

According to Dr. Graham, atopic dermatitis is on the radar of major biotech companies that have biologic agents for psoriasis. They are working to develop biologics for atopic dermatitis, targeting a variety of pathways including interleukins-5, -4, and -13, as well as IgE.

Reliable biomarkers are needed to make drug development in atopic dermatitis go quickly and efficiently. After all, biomarker data are now routinely incorporated into early-phase development of new drugs for psoriasis, and these data are included in support of new drug applications to the FDA. But objective biomarkers have been notably lacking in atopic dermatitis, he noted.

Dr. Emma Guttman-Yassky announced help is at hand. While efforts to identify blood biomarkers have proved deeply disappointing, skin biomarkers are another story. She and her coinvestigators have identified a set of reliable skin biomarkers of therapeutic response in atopic dermatitis patients.

"We believe that these biomarkers represent the molecular fingerprints of the disease and might be key to future development of targeted treatments," said Dr. Guttman-Yassky, director of occupational and contact dermatitis at Mount Sinai Medical Center, New York.

She and her coinvestigators took lesional and nonlesional skin biopsies from 12 atopic dermatitis patients before and after undergoing narrow-band UVB phototherapy three times weekly for 12 weeks, a regimen the patients responded to with a mean 81% reduction in SCORAD index scores. Reversal of epidermal hyperplasia and abnormal keratinocyte differentiation – the histologic hallmarks of atopic dermatitis – was associated with elimination of inflammatory leukocytes and Th2-associated cytokines and chemokines (J. Allergy Clin. Immunol. 2011;128:583-93).

Among the skin biomarkers of atopic dermatitis that reversed with effective therapy were inflammatory dendritic epidermal cells, myeloid and plasmacytoid dendritic cells, CD3+ T cells, and interleukins-4 and -13.

This study, as well as another by Dr. Guttman-Yassky and her colleagues (in press), demonstrated a major role for interleukin-22 in atopic dermatitis. The cytokine was markedly overexpressed in lesional skin, with resultant upregulation of the antimicrobial protein’s S100A7, S100A8, and S100A9. After narrow-band UVB therapy, expression of IL-22 expression was downregulated, as were the IL-22-induced chemokines S100A7-9.

Expression of the three antimicrobial proteins in lesional skin also appears to be useful as a biomarker defining acute disease. Their levels jump within 3 days after onset of acute atopic dermatitis, according to Dr. Guttman-Yassky.

"Are we there yet in terms of biomarkers in atopic dermatitis? That’s the million-dollar question. Regarding biomarker availability, I think yes. We now have biomarkers that are highly informative on the reversal of disease pathology with treatment," she said. "I believe that the next step is clinical trials with specific immune antagonists that incorporate biomarkers of response. I think biomarkers are key if we want to know if new therapies really work. This will enhance early decisions and reduce the cost of developing new treatments."

An important implication of the narrow-band UVB/biomarker study in terms of atopic dermatitis pathogenesis is that the data argue against a fixed genetic phenotype, since the atopic dermatitis epidermal phenotype was shown to be reversed with broad-based immune-targeted phototherapy. Instead, the study results argue in favor of what Dr. Guttman-Yassky called "the inside-out hypothesis" of atopic dermatitis, which postulates that the epidermal abnormalities that define the disease are caused by underlying immune activation.

Her studies were supported by the National Institutes of Health.

HOME Project Seeks Standardization

During the same session, Dr. Hywel C. Williams provided an update on a major international project called Harmonising Outcome Measures for Eczema (HOME). The goal of the HOME project is to develop a consensus on a core set of outcome measures to be used in all atopic dermatitis clinical research. This should make future studies easier to compare, contrast, and synthesize in meta-analyses.

A minimum set of core outcome measures in atopic dermatitis is needed because the situation can be chaotic, noted Dr. Williams, professor of dermatology and director of the Center for Evidence-Based Dermatology at the University of Nottingham (U.K.).

"There are more than 20 named scales for atopic dermatitis, including SCORAD, POEM, SASSAD, ADASI, ADAM, EASI, and the FSSS. Some have been only partly tested. Many have not been tested at all. At international meetings I see people shouting at each other, trying to communicate what the results of their studies mean. Some people are in the SCORAD camp, some are in the SASSAD camp, others are in the EASI camp. How can we possibly communicate? This is a shameful situation which we really have to put right if we are to progress," he said.

The HOME project is modeled after Outcome Measures in Rheumatology, or OMERACT, an international consensus group that meets every 2 years with the goal of raising the quality of rheumatologic research. HOME comprises atopic dermatitis researchers, clinical experts, journal editors, patient advocates, and representatives from the European regulatory agency. The FDA was invited but didn’t attend last year’s HOME meeting in Amsterdam, where working groups were formed to identify the best evidence-based instruments for assessing atopic disease signs, symptoms, flares, quality of life, and treatment efficacy and safety. The HOME group will meet next year in San Diego on April 6-7.

Aside from Dr. Graham, a Regeneron employee, the other speakers in the special session reported receiving research grants from various sources but declared having no conflicts of interest with regard to their presentations.

In this month's program, Dr. Jeffrey Curtis discusses his study, which found new evidence supporting the safety of the shingles vaccine for patients on biologics.

Then, Dr. Jonathan Silverberg talks about the best climates for children with eczema.

Dr. Bruce Brod of the American Academy of Dermatology reports on which states have the toughest laws on indoor tanning, and he highlights the latest legislation on the matter.

Meanwhile, Dr. Lily Talakoub talks about a common summer skin condition, Pityrosporum folliculitis, and Dr. Alan Rockoff presents his musical marketing plan.

Don't miss another episode of The Skinny Podcast; subscribe for free on iTunes!

In this month's program, Dr. Jeffrey Curtis discusses his study, which found new evidence supporting the safety of the shingles vaccine for patients on biologics.

Then, Dr. Jonathan Silverberg talks about the best climates for children with eczema.

Dr. Bruce Brod of the American Academy of Dermatology reports on which states have the toughest laws on indoor tanning, and he highlights the latest legislation on the matter.

Meanwhile, Dr. Lily Talakoub talks about a common summer skin condition, Pityrosporum folliculitis, and Dr. Alan Rockoff presents his musical marketing plan.

Don't miss another episode of The Skinny Podcast; subscribe for free on iTunes!

In this month's program, Dr. Jeffrey Curtis discusses his study, which found new evidence supporting the safety of the shingles vaccine for patients on biologics.

Then, Dr. Jonathan Silverberg talks about the best climates for children with eczema.

Dr. Bruce Brod of the American Academy of Dermatology reports on which states have the toughest laws on indoor tanning, and he highlights the latest legislation on the matter.

Meanwhile, Dr. Lily Talakoub talks about a common summer skin condition, Pityrosporum folliculitis, and Dr. Alan Rockoff presents his musical marketing plan.

Don't miss another episode of The Skinny Podcast; subscribe for free on iTunes!

Oral immunotherapy using egg-white powder represents a highly promising therapeutic intervention for children with egg allergy, according to findings from a randomized, placebo-controlled trial reported online in the July 19 issue of the New England Journal of Medicine.

After 10 months of immunotherapy, none of the 15 children with egg allergy who received placebo as part of the double-blind study passed an oral food challenge of 5 g of egg-white powder, whereas 22 (55%) of 40 children who received oral immunotherapy passed the oral food challenge and were considered to be desensitized. At 22 months, 30 (75%) of the 40 children who received oral immunotherapy passed an oral food challenge with 10 g of egg-white powder, Dr. A. Wesley Burks, chair of the department of pediatrics at the University of North Carolina and chief physician of N.C. Children’s Hospital, his colleagues reported on behalf of the Consortium of Food Allergy Research.

Photo © paci77/iStockphoto.com

Of the 30 children who passed the oral food challenge at 22 months, 29 were rechallenged at 24 months with 10 g of egg-white powder, followed 1 hour later with one whole cooked egg (after having discontinued immunotherapy and egg consumption for 4-6 weeks); 11 (28%) passed the challenge and were considered to have "sustained unresponsiveness," the investigators reported (N. Engl. J. Med. 2012 July 19 [doi:10.1056/NEJMoa1200435]).

These 11 children then were instructed to add egg to their diet ad libitum. No adverse events were reported at the 30- and 36-month follow-ups.

Study participants were children aged 5-18 years (median, 7 years) with a convincing clinical history of egg allergy and a serum egg-specific IgE antibody level of more than 5 kU/L for those aged 6 years and older, and 12 kU/L or more for those aged 5 years. Those with a history of severe anaphylaxis after egg consumption were excluded.

The protocol for oral immunotherapy consisted of an initial-day dose escalation, a build-up phase, and a maintenance phase involving ingestion of up to 2 g of egg-white powder (equivalent of about one-third of an egg) daily.

Factors that were found to be associated with sustained unresponsiveness at 24 months were higher egg-specific IgG4 antibody levels at 10 months, smaller wheal diameter on skin-prick allergy testing at 22 months, and a decrease in wheal size from baseline to 22 months, the investigators noted.

Oral immunotherapy in this study was generally well tolerated, with adverse events occurring most frequently in association with oral-immunotherapy dosing. Most of the events were mild (grade 1), with only 1% being graded as moderate (grade 2). No severe adverse events occurred. Most events were oral or pharyngeal, and were associated with 25% of the 11,860 doses of oral immunotherapy, and with 3.9% of the 4,018 doses of placebo. The rate of symptoms decreased to 8.3% of 15,815 doses in the oral immunotherapy group after 10 months.

The findings could have important implications, given that the cumulative prevalence of egg allergy is approximately 2.6% by 2.5 years of age, and that egg avoidance (which is difficult and can adversely affect quality of life) is the only available treatment for egg allergy, investigators said.

However, for oral immunotherapy to be recommended as a standard of care, it is important to better define risks, compared with allergen avoidance; to determine the dosing regimens with the most favorable outcomes; to identify the patients most likely to benefit; and to develop postdesensitization strategies, the investigators concluded.

This study was supported by the National Institute of Allergy and Infectious Diseases and the National Institutes of Health–National Center for Research Resources Clinical Translational Science Awards and Clinical Research Centers. Dr. A. Wesley Burks has been a consultant for companies including Dannon Co. Probiotic, McNeil Nutritionals, Merck, the Food Allergy & Anaphylaxis Network, and Novartis, and has grants or grants pending from the Food Allergy Initiative, the NIH, the National Peanut Board, and others. Some of his associates were consultants for companies including DBV Technologies, Allertein Therapeutics, and Sunovion, or received grants from various companies; other associates had no relevant financial disclosures.

CLARIFICATION 7/20/2012: The institutional affiliation of Dr. Burks has been updated to reflect his current position.

Oral immunotherapy using egg-white powder represents a highly promising therapeutic intervention for children with egg allergy, according to findings from a randomized, placebo-controlled trial reported online in the July 19 issue of the New England Journal of Medicine.

After 10 months of immunotherapy, none of the 15 children with egg allergy who received placebo as part of the double-blind study passed an oral food challenge of 5 g of egg-white powder, whereas 22 (55%) of 40 children who received oral immunotherapy passed the oral food challenge and were considered to be desensitized. At 22 months, 30 (75%) of the 40 children who received oral immunotherapy passed an oral food challenge with 10 g of egg-white powder, Dr. A. Wesley Burks, chair of the department of pediatrics at the University of North Carolina and chief physician of N.C. Children’s Hospital, his colleagues reported on behalf of the Consortium of Food Allergy Research.

Photo © paci77/iStockphoto.com

Of the 30 children who passed the oral food challenge at 22 months, 29 were rechallenged at 24 months with 10 g of egg-white powder, followed 1 hour later with one whole cooked egg (after having discontinued immunotherapy and egg consumption for 4-6 weeks); 11 (28%) passed the challenge and were considered to have "sustained unresponsiveness," the investigators reported (N. Engl. J. Med. 2012 July 19 [doi:10.1056/NEJMoa1200435]).

These 11 children then were instructed to add egg to their diet ad libitum. No adverse events were reported at the 30- and 36-month follow-ups.

Study participants were children aged 5-18 years (median, 7 years) with a convincing clinical history of egg allergy and a serum egg-specific IgE antibody level of more than 5 kU/L for those aged 6 years and older, and 12 kU/L or more for those aged 5 years. Those with a history of severe anaphylaxis after egg consumption were excluded.

The protocol for oral immunotherapy consisted of an initial-day dose escalation, a build-up phase, and a maintenance phase involving ingestion of up to 2 g of egg-white powder (equivalent of about one-third of an egg) daily.

Factors that were found to be associated with sustained unresponsiveness at 24 months were higher egg-specific IgG4 antibody levels at 10 months, smaller wheal diameter on skin-prick allergy testing at 22 months, and a decrease in wheal size from baseline to 22 months, the investigators noted.

Oral immunotherapy in this study was generally well tolerated, with adverse events occurring most frequently in association with oral-immunotherapy dosing. Most of the events were mild (grade 1), with only 1% being graded as moderate (grade 2). No severe adverse events occurred. Most events were oral or pharyngeal, and were associated with 25% of the 11,860 doses of oral immunotherapy, and with 3.9% of the 4,018 doses of placebo. The rate of symptoms decreased to 8.3% of 15,815 doses in the oral immunotherapy group after 10 months.

The findings could have important implications, given that the cumulative prevalence of egg allergy is approximately 2.6% by 2.5 years of age, and that egg avoidance (which is difficult and can adversely affect quality of life) is the only available treatment for egg allergy, investigators said.

However, for oral immunotherapy to be recommended as a standard of care, it is important to better define risks, compared with allergen avoidance; to determine the dosing regimens with the most favorable outcomes; to identify the patients most likely to benefit; and to develop postdesensitization strategies, the investigators concluded.

This study was supported by the National Institute of Allergy and Infectious Diseases and the National Institutes of Health–National Center for Research Resources Clinical Translational Science Awards and Clinical Research Centers. Dr. A. Wesley Burks has been a consultant for companies including Dannon Co. Probiotic, McNeil Nutritionals, Merck, the Food Allergy & Anaphylaxis Network, and Novartis, and has grants or grants pending from the Food Allergy Initiative, the NIH, the National Peanut Board, and others. Some of his associates were consultants for companies including DBV Technologies, Allertein Therapeutics, and Sunovion, or received grants from various companies; other associates had no relevant financial disclosures.

CLARIFICATION 7/20/2012: The institutional affiliation of Dr. Burks has been updated to reflect his current position.

Oral immunotherapy using egg-white powder represents a highly promising therapeutic intervention for children with egg allergy, according to findings from a randomized, placebo-controlled trial reported online in the July 19 issue of the New England Journal of Medicine.

After 10 months of immunotherapy, none of the 15 children with egg allergy who received placebo as part of the double-blind study passed an oral food challenge of 5 g of egg-white powder, whereas 22 (55%) of 40 children who received oral immunotherapy passed the oral food challenge and were considered to be desensitized. At 22 months, 30 (75%) of the 40 children who received oral immunotherapy passed an oral food challenge with 10 g of egg-white powder, Dr. A. Wesley Burks, chair of the department of pediatrics at the University of North Carolina and chief physician of N.C. Children’s Hospital, his colleagues reported on behalf of the Consortium of Food Allergy Research.

Photo © paci77/iStockphoto.com

Of the 30 children who passed the oral food challenge at 22 months, 29 were rechallenged at 24 months with 10 g of egg-white powder, followed 1 hour later with one whole cooked egg (after having discontinued immunotherapy and egg consumption for 4-6 weeks); 11 (28%) passed the challenge and were considered to have "sustained unresponsiveness," the investigators reported (N. Engl. J. Med. 2012 July 19 [doi:10.1056/NEJMoa1200435]).

These 11 children then were instructed to add egg to their diet ad libitum. No adverse events were reported at the 30- and 36-month follow-ups.

Study participants were children aged 5-18 years (median, 7 years) with a convincing clinical history of egg allergy and a serum egg-specific IgE antibody level of more than 5 kU/L for those aged 6 years and older, and 12 kU/L or more for those aged 5 years. Those with a history of severe anaphylaxis after egg consumption were excluded.

The protocol for oral immunotherapy consisted of an initial-day dose escalation, a build-up phase, and a maintenance phase involving ingestion of up to 2 g of egg-white powder (equivalent of about one-third of an egg) daily.

Factors that were found to be associated with sustained unresponsiveness at 24 months were higher egg-specific IgG4 antibody levels at 10 months, smaller wheal diameter on skin-prick allergy testing at 22 months, and a decrease in wheal size from baseline to 22 months, the investigators noted.

Oral immunotherapy in this study was generally well tolerated, with adverse events occurring most frequently in association with oral-immunotherapy dosing. Most of the events were mild (grade 1), with only 1% being graded as moderate (grade 2). No severe adverse events occurred. Most events were oral or pharyngeal, and were associated with 25% of the 11,860 doses of oral immunotherapy, and with 3.9% of the 4,018 doses of placebo. The rate of symptoms decreased to 8.3% of 15,815 doses in the oral immunotherapy group after 10 months.

The findings could have important implications, given that the cumulative prevalence of egg allergy is approximately 2.6% by 2.5 years of age, and that egg avoidance (which is difficult and can adversely affect quality of life) is the only available treatment for egg allergy, investigators said.

However, for oral immunotherapy to be recommended as a standard of care, it is important to better define risks, compared with allergen avoidance; to determine the dosing regimens with the most favorable outcomes; to identify the patients most likely to benefit; and to develop postdesensitization strategies, the investigators concluded.

This study was supported by the National Institute of Allergy and Infectious Diseases and the National Institutes of Health–National Center for Research Resources Clinical Translational Science Awards and Clinical Research Centers. Dr. A. Wesley Burks has been a consultant for companies including Dannon Co. Probiotic, McNeil Nutritionals, Merck, the Food Allergy & Anaphylaxis Network, and Novartis, and has grants or grants pending from the Food Allergy Initiative, the NIH, the National Peanut Board, and others. Some of his associates were consultants for companies including DBV Technologies, Allertein Therapeutics, and Sunovion, or received grants from various companies; other associates had no relevant financial disclosures.

CLARIFICATION 7/20/2012: The institutional affiliation of Dr. Burks has been updated to reflect his current position.

RALEIGH, N.C. – The infra-auricular fissure present in the overwhelming majority of atopic dermatitis patients provides a simple and convenient guide to disease severity, according to the results of a prospective study.

Infra-auricular fissures are highly prevalent in atopic dermatitis patients of all ages and racial/ethnic groups and in both genders. And the form the lesion takes shows a good correlation with disease severity as measured with the Eczema Area and Severity Index (EASI) and other metrics, Dr. Gil Yosipovitch said at the annual meeting of the Society for Investigative Dermatology.

"I’m not saying this is an ideal test, but I think that it’s a very easy bedside marker that we could use in our clinics. We can’t use the EASI all the time in busy fast-track clinics," observed Dr. Yosipovitch, professor of dermatology at Wake Forest University in Winston-Salem, N.C.

He and his coinvestigators assigned an infra-auricular fissure score of 1 to atopic dermatitis patients with an infra-auricular line and a score of 2 in those with an infra-auricular line accompanied by erythema and a small fissure. Those patients with a deeper infra-auricular fissure with significant erosion got a 3.

An infra-auricular fissure was present in every one of 81 consecutive children and adults with clinician-diagnosed atopic dermatitis. Fifty-eight percent had an infra-auricular fissure score of 1, 27% had a 2, and 15% scored 3. The infra-auricular fissure score showed a strong correlation with results on the validated EASI, with a correlation coefficient of 0.6.

Moreover, among the 29 patients seen at follow-up 1-2 months later, reductions in visual analog scale itch intensity, EASI score, and Investigator Global Assessment scores in response to treatment showed a significant correlation with improvement in the infra-auricular fissure score.

Dr. Yosipovitch reported having no financial conflicts.

RALEIGH, N.C. – The infra-auricular fissure present in the overwhelming majority of atopic dermatitis patients provides a simple and convenient guide to disease severity, according to the results of a prospective study.

Infra-auricular fissures are highly prevalent in atopic dermatitis patients of all ages and racial/ethnic groups and in both genders. And the form the lesion takes shows a good correlation with disease severity as measured with the Eczema Area and Severity Index (EASI) and other metrics, Dr. Gil Yosipovitch said at the annual meeting of the Society for Investigative Dermatology.

"I’m not saying this is an ideal test, but I think that it’s a very easy bedside marker that we could use in our clinics. We can’t use the EASI all the time in busy fast-track clinics," observed Dr. Yosipovitch, professor of dermatology at Wake Forest University in Winston-Salem, N.C.

He and his coinvestigators assigned an infra-auricular fissure score of 1 to atopic dermatitis patients with an infra-auricular line and a score of 2 in those with an infra-auricular line accompanied by erythema and a small fissure. Those patients with a deeper infra-auricular fissure with significant erosion got a 3.

An infra-auricular fissure was present in every one of 81 consecutive children and adults with clinician-diagnosed atopic dermatitis. Fifty-eight percent had an infra-auricular fissure score of 1, 27% had a 2, and 15% scored 3. The infra-auricular fissure score showed a strong correlation with results on the validated EASI, with a correlation coefficient of 0.6.

Moreover, among the 29 patients seen at follow-up 1-2 months later, reductions in visual analog scale itch intensity, EASI score, and Investigator Global Assessment scores in response to treatment showed a significant correlation with improvement in the infra-auricular fissure score.

Dr. Yosipovitch reported having no financial conflicts.

RALEIGH, N.C. – The infra-auricular fissure present in the overwhelming majority of atopic dermatitis patients provides a simple and convenient guide to disease severity, according to the results of a prospective study.

Infra-auricular fissures are highly prevalent in atopic dermatitis patients of all ages and racial/ethnic groups and in both genders. And the form the lesion takes shows a good correlation with disease severity as measured with the Eczema Area and Severity Index (EASI) and other metrics, Dr. Gil Yosipovitch said at the annual meeting of the Society for Investigative Dermatology.

"I’m not saying this is an ideal test, but I think that it’s a very easy bedside marker that we could use in our clinics. We can’t use the EASI all the time in busy fast-track clinics," observed Dr. Yosipovitch, professor of dermatology at Wake Forest University in Winston-Salem, N.C.

He and his coinvestigators assigned an infra-auricular fissure score of 1 to atopic dermatitis patients with an infra-auricular line and a score of 2 in those with an infra-auricular line accompanied by erythema and a small fissure. Those patients with a deeper infra-auricular fissure with significant erosion got a 3.

An infra-auricular fissure was present in every one of 81 consecutive children and adults with clinician-diagnosed atopic dermatitis. Fifty-eight percent had an infra-auricular fissure score of 1, 27% had a 2, and 15% scored 3. The infra-auricular fissure score showed a strong correlation with results on the validated EASI, with a correlation coefficient of 0.6.

Moreover, among the 29 patients seen at follow-up 1-2 months later, reductions in visual analog scale itch intensity, EASI score, and Investigator Global Assessment scores in response to treatment showed a significant correlation with improvement in the infra-auricular fissure score.

Dr. Yosipovitch reported having no financial conflicts.

RALEIGH, N.C. – Climate and weather can be added to the short list of factors known to influence the prevalence of atopic dermatitis, according to Dr. Jonathan I. Silverberg.

He presented a first-of-its-kind analysis in which he merged data from the Department of Health and Human Services’ 2007 National Survey of Children’s Health with state-by-state data from the National Oceanic and Atmospheric Administration’s National Climatic Data Center and the National Weather Service.

The National Survey of Children’s Health involved in-depth telephone interviews with parents in 91,642 households having one or more children under age 18 years.

Among the key findings: The prevalence of eczema was significantly lower in areas of the country with high relative humidity during the previous 2 years, especially during the months of November through April. The prevalence of eczema was also lower in areas with a high-to-extreme UV index, and with a higher-than-average outdoor air temperature, noted Dr. Silverberg of St. Luke’s–Roosevelt Hospital Center, New York.

In contrast, eczema prevalence was increased in regions with a high heating degree day index, which is a statewide, population-based measure of the energy demand needed to heat indoor structures by 1° F for 1 day using a baseline temperature of 65° F.

Children living in areas in the top tertile nationally in terms of mean relative humidity had a 20% lower risk of having eczema than did those residing in the lowest tertile. Children living in the top tertile for mean annual outdoor air temperature had a 23% lower prevalence of eczema than did those in the lowest tertile. Similarly, children living in areas with a high-to-extreme UV index, a measure which incorporates clear-sky days, had a 24% lower eczema prevalence than did children living under the condition of a low-to-moderate UV index.

Children residing in regions in the top tertile in terms of heating degree days had a 30% higher prevalence of eczema than did those living in the lowest tertile.

The most likely explanation for the effects climactic factors exert upon eczema prevalence involves the environmental impact upon skin barrier function. However, this study can’t pinpoint causality. Other possible mechanisms that might account for the observed association include vitamin D status, immune responses, or allergen exposures, according to Dr. Silverberg.

Previously established risk factors for eczema include family history, race/ethnicity, urban living, and socioeconomic status.

This study was funded in part by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Silverberg reported having no financial conflicts.

RALEIGH, N.C. – Climate and weather can be added to the short list of factors known to influence the prevalence of atopic dermatitis, according to Dr. Jonathan I. Silverberg.

He presented a first-of-its-kind analysis in which he merged data from the Department of Health and Human Services’ 2007 National Survey of Children’s Health with state-by-state data from the National Oceanic and Atmospheric Administration’s National Climatic Data Center and the National Weather Service.

The National Survey of Children’s Health involved in-depth telephone interviews with parents in 91,642 households having one or more children under age 18 years.

Among the key findings: The prevalence of eczema was significantly lower in areas of the country with high relative humidity during the previous 2 years, especially during the months of November through April. The prevalence of eczema was also lower in areas with a high-to-extreme UV index, and with a higher-than-average outdoor air temperature, noted Dr. Silverberg of St. Luke’s–Roosevelt Hospital Center, New York.

In contrast, eczema prevalence was increased in regions with a high heating degree day index, which is a statewide, population-based measure of the energy demand needed to heat indoor structures by 1° F for 1 day using a baseline temperature of 65° F.

Children living in areas in the top tertile nationally in terms of mean relative humidity had a 20% lower risk of having eczema than did those residing in the lowest tertile. Children living in the top tertile for mean annual outdoor air temperature had a 23% lower prevalence of eczema than did those in the lowest tertile. Similarly, children living in areas with a high-to-extreme UV index, a measure which incorporates clear-sky days, had a 24% lower eczema prevalence than did children living under the condition of a low-to-moderate UV index.

Children residing in regions in the top tertile in terms of heating degree days had a 30% higher prevalence of eczema than did those living in the lowest tertile.

The most likely explanation for the effects climactic factors exert upon eczema prevalence involves the environmental impact upon skin barrier function. However, this study can’t pinpoint causality. Other possible mechanisms that might account for the observed association include vitamin D status, immune responses, or allergen exposures, according to Dr. Silverberg.

Previously established risk factors for eczema include family history, race/ethnicity, urban living, and socioeconomic status.

This study was funded in part by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Silverberg reported having no financial conflicts.

RALEIGH, N.C. – Climate and weather can be added to the short list of factors known to influence the prevalence of atopic dermatitis, according to Dr. Jonathan I. Silverberg.

He presented a first-of-its-kind analysis in which he merged data from the Department of Health and Human Services’ 2007 National Survey of Children’s Health with state-by-state data from the National Oceanic and Atmospheric Administration’s National Climatic Data Center and the National Weather Service.

The National Survey of Children’s Health involved in-depth telephone interviews with parents in 91,642 households having one or more children under age 18 years.

Among the key findings: The prevalence of eczema was significantly lower in areas of the country with high relative humidity during the previous 2 years, especially during the months of November through April. The prevalence of eczema was also lower in areas with a high-to-extreme UV index, and with a higher-than-average outdoor air temperature, noted Dr. Silverberg of St. Luke’s–Roosevelt Hospital Center, New York.

In contrast, eczema prevalence was increased in regions with a high heating degree day index, which is a statewide, population-based measure of the energy demand needed to heat indoor structures by 1° F for 1 day using a baseline temperature of 65° F.

Children living in areas in the top tertile nationally in terms of mean relative humidity had a 20% lower risk of having eczema than did those residing in the lowest tertile. Children living in the top tertile for mean annual outdoor air temperature had a 23% lower prevalence of eczema than did those in the lowest tertile. Similarly, children living in areas with a high-to-extreme UV index, a measure which incorporates clear-sky days, had a 24% lower eczema prevalence than did children living under the condition of a low-to-moderate UV index.

Children residing in regions in the top tertile in terms of heating degree days had a 30% higher prevalence of eczema than did those living in the lowest tertile.

The most likely explanation for the effects climactic factors exert upon eczema prevalence involves the environmental impact upon skin barrier function. However, this study can’t pinpoint causality. Other possible mechanisms that might account for the observed association include vitamin D status, immune responses, or allergen exposures, according to Dr. Silverberg.

Previously established risk factors for eczema include family history, race/ethnicity, urban living, and socioeconomic status.

This study was funded in part by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Silverberg reported having no financial conflicts.