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Safely patch test children for contact dermatitis
ASHEVILLE, N.C. – “Children really do develop contact dermatitis, and they are frequently mislabeled as cases of eczema,” Dr. Bruce Brod said at the annual meeting of the Noah Worcester Dermatological Society.
When taking a history in a child with potential contact dermatitis, keep the most likely allergens in mind, especially nickel, said Dr. Brod of the University of Pennsylvania, Philadelphia. Nickel remains the most common allergen in adults and young children, and more than a quarter of patients are positive on patch testing.
Consider all possible sources of nickel. In addition to the old standbys of jewelry and buckles, ask patients and families about the use of flip-style cell phones, as well as first generation iPads (the cases contained nickel). “Old cell phones do not make great toys,” Dr. Brod emphasized.
Patch testing children with potential contact dermatitis makes sense in several situations, including cases of new-onset dermatitis; progressing or deteriorating dermatitis; involvement of specific body sites, such as the face, eyelids, or neck folds; an increase in the total body surface area affected; clinical presentation of dyshidrosis; and dermatitis that resists standard therapies and only improves with oral or extremely potent topical steroids, he said.
Children with atopic dermatitis are more prone to irritation from patch testing, so shorten the exposure time and use a lower concentration of allergens such as nickel, formaldehyde, and rubber additives, advised Dr. Brod. Shorten the exposure time for children younger than 5 years of age, whether or not they have atopy, he added. Videos or video games can work well as a distraction.
When taking a history, consider the most the common allergens in children, defined in a recent study of patch testing results (Dermatitis 2014;25:345-55), said Dr. Brod. He offered the mnemonic MAFLPP (More Allergies for Lovable Pediatric Patients) to characterize the top categories: metals (nickel and cobalt), antibiotics (neomycin and bacitracin), fragrance (fragrances and balsam of Peru), lanolin, phenylenediamine, and preservatives (including quatemium-15 and methylisothiazolinone).
After patch testing, describe the allergen to patients and their families, and explain where it is found, Dr. Brod said. The site mypatchlink.com has helpful information. Also remind patients to read product labels, and to check pharmacy websites such as drugstore.com or cvs.com.
Members of the American Contact Dermatitis Society can access the Contact Allergen Management Program (CAMP) database to help patients identify allergen-free products based on their patch test results, he said.
Dr. Brod had no relevant financial conflicts to disclose.
ASHEVILLE, N.C. – “Children really do develop contact dermatitis, and they are frequently mislabeled as cases of eczema,” Dr. Bruce Brod said at the annual meeting of the Noah Worcester Dermatological Society.
When taking a history in a child with potential contact dermatitis, keep the most likely allergens in mind, especially nickel, said Dr. Brod of the University of Pennsylvania, Philadelphia. Nickel remains the most common allergen in adults and young children, and more than a quarter of patients are positive on patch testing.
Consider all possible sources of nickel. In addition to the old standbys of jewelry and buckles, ask patients and families about the use of flip-style cell phones, as well as first generation iPads (the cases contained nickel). “Old cell phones do not make great toys,” Dr. Brod emphasized.
Patch testing children with potential contact dermatitis makes sense in several situations, including cases of new-onset dermatitis; progressing or deteriorating dermatitis; involvement of specific body sites, such as the face, eyelids, or neck folds; an increase in the total body surface area affected; clinical presentation of dyshidrosis; and dermatitis that resists standard therapies and only improves with oral or extremely potent topical steroids, he said.
Children with atopic dermatitis are more prone to irritation from patch testing, so shorten the exposure time and use a lower concentration of allergens such as nickel, formaldehyde, and rubber additives, advised Dr. Brod. Shorten the exposure time for children younger than 5 years of age, whether or not they have atopy, he added. Videos or video games can work well as a distraction.
When taking a history, consider the most the common allergens in children, defined in a recent study of patch testing results (Dermatitis 2014;25:345-55), said Dr. Brod. He offered the mnemonic MAFLPP (More Allergies for Lovable Pediatric Patients) to characterize the top categories: metals (nickel and cobalt), antibiotics (neomycin and bacitracin), fragrance (fragrances and balsam of Peru), lanolin, phenylenediamine, and preservatives (including quatemium-15 and methylisothiazolinone).
After patch testing, describe the allergen to patients and their families, and explain where it is found, Dr. Brod said. The site mypatchlink.com has helpful information. Also remind patients to read product labels, and to check pharmacy websites such as drugstore.com or cvs.com.
Members of the American Contact Dermatitis Society can access the Contact Allergen Management Program (CAMP) database to help patients identify allergen-free products based on their patch test results, he said.
Dr. Brod had no relevant financial conflicts to disclose.
ASHEVILLE, N.C. – “Children really do develop contact dermatitis, and they are frequently mislabeled as cases of eczema,” Dr. Bruce Brod said at the annual meeting of the Noah Worcester Dermatological Society.
When taking a history in a child with potential contact dermatitis, keep the most likely allergens in mind, especially nickel, said Dr. Brod of the University of Pennsylvania, Philadelphia. Nickel remains the most common allergen in adults and young children, and more than a quarter of patients are positive on patch testing.
Consider all possible sources of nickel. In addition to the old standbys of jewelry and buckles, ask patients and families about the use of flip-style cell phones, as well as first generation iPads (the cases contained nickel). “Old cell phones do not make great toys,” Dr. Brod emphasized.
Patch testing children with potential contact dermatitis makes sense in several situations, including cases of new-onset dermatitis; progressing or deteriorating dermatitis; involvement of specific body sites, such as the face, eyelids, or neck folds; an increase in the total body surface area affected; clinical presentation of dyshidrosis; and dermatitis that resists standard therapies and only improves with oral or extremely potent topical steroids, he said.
Children with atopic dermatitis are more prone to irritation from patch testing, so shorten the exposure time and use a lower concentration of allergens such as nickel, formaldehyde, and rubber additives, advised Dr. Brod. Shorten the exposure time for children younger than 5 years of age, whether or not they have atopy, he added. Videos or video games can work well as a distraction.
When taking a history, consider the most the common allergens in children, defined in a recent study of patch testing results (Dermatitis 2014;25:345-55), said Dr. Brod. He offered the mnemonic MAFLPP (More Allergies for Lovable Pediatric Patients) to characterize the top categories: metals (nickel and cobalt), antibiotics (neomycin and bacitracin), fragrance (fragrances and balsam of Peru), lanolin, phenylenediamine, and preservatives (including quatemium-15 and methylisothiazolinone).
After patch testing, describe the allergen to patients and their families, and explain where it is found, Dr. Brod said. The site mypatchlink.com has helpful information. Also remind patients to read product labels, and to check pharmacy websites such as drugstore.com or cvs.com.
Members of the American Contact Dermatitis Society can access the Contact Allergen Management Program (CAMP) database to help patients identify allergen-free products based on their patch test results, he said.
Dr. Brod had no relevant financial conflicts to disclose.
EXPERT ANALYSIS FROM NOAH 57
Aspirin desensitization making headway in U.S.
HOUSTON – About 63% of allergists and fellows in training perform aspirin desensitization for aspirin-exacerbated respiratory disease, according to a national survey.
That figure is lower than it should be, given the wealth of published evidence that aspirin desensitization is a safe and effective component of the treatment of aspirin-exacerbated respiratory disease (AERD), Dr. Jeremy D. Waldram asserted in presenting the survey findings at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Moreover, the figure likely overcalls the true rate, since participation in the survey was voluntary and fans of aspirin desensitization were probably more inclined to complete the 16-item questionnaire, added Dr. Waldram, a fellow in allergy and immunology at the Scripps Clinic in San Diego.
Was he surprised to find that aspirin desensitization isn’t more widely utilized?
“I think the number that surprised me more was that among the 37.5% of allergists who don’t do aspirin desensitization, almost 30% of them don’t even refer their patients to others who do the procedure. We don’t know why they don’t refer out; it wasn’t a question included in the survey. Perhaps they see patients who are of a less severe phenotype,” he said in an interview.
The 684 survey responses represented a 15% response rate. While 37.5% of respondents indicated they don’t perform aspirin desensitization, 73% of those who reported doing the procedure said they do an average of 1-5 cases annually.
Among allergists who don’t perform aspirin desensitization, safety concerns were the leading reason cited. Indeed, 70% of those who don’t do aspirin desensitization indicated safety risks were the main reason. More than one reason could be given, however, and 30% of allergists cited poor compensation for the procedure as a deterrent, nearly 60% said the logistics of monitoring care were too onerous, and one-third said they didn’t perform aspirin desensitization because they hadn’t been trained to do it.
Of allergists who reported doing aspirin desensitization, 52% perform the procedure in an outpatient setting unattached to a hospital. Another 21% do so in an outpatient clinic that’s physically attached to a hospital.
Within the past 5 years, 9% of respondents said that they’ve had a patient react severely to aspirin desensitization, requiring an unanticipated transfer to a higher level of care. That’s contrary to the experience among allergists at the Scripps Clinic, which is widely credited with pioneering the outpatient approach.
“We essentially do all our aspirin desensitizations for AERD in the outpatient setting. In 1,500 treated patients we’ve never had one that we had to transfer to a higher level of care. We don’t have any special setup. It’s a typical outpatient clinic. We usually don’t start IVs or do anything above and beyond,” Dr. Waldram said.
While 26% of respondents reported they generally recommend aspirin desensitization immediately upon identifying a patient history that supports the diagnosis of AERD, another 54% said they usually recommend the procedure to patients only after they’ve failed to improve on typical medical therapy.
Twenty percent of physicians rated aspirin desensitization as “extremely helpful for the majority of patients,” another 49% said they find it most beneficial as an adjuvant to ongoing medical therapy.
Forty-four percent of allergists who perform aspirin desensitization reported that they learned to do the procedure during fellowship training. Fourteen percent said they learned to the procedure at an annual meeting, and 36% picked it up by reviewing the relevant literature.
Several allergists commented that had Dr. Waldram’s survey been conducted even a couple of years ago the rate of utilization of aspirin desensitization would have been far lower. They interpreted his reported 62.5% rate as a sign of progress. Dr. Waldram said he believes the key to further boosting utilization of aspirin desensitization lies in increasing exposure to the procedure during fellowship training. He noted that internal medicine-trained fellows who responded to the survey had a significantly higher aspirin desensitization utilization rate than those who came to their allergy fellowship with a background in pediatrics.
The hallmarks of AERD are difficult-to-treat nasal polyps, chronic eosinophilic sinusitis, and asthma in a patient with sensitivity to aspirin and other COX-1 inhibitors.
Dr. Waldram reported having no financial conflicts with regard to his study, which was conducted free of commercial support.
HOUSTON – About 63% of allergists and fellows in training perform aspirin desensitization for aspirin-exacerbated respiratory disease, according to a national survey.
That figure is lower than it should be, given the wealth of published evidence that aspirin desensitization is a safe and effective component of the treatment of aspirin-exacerbated respiratory disease (AERD), Dr. Jeremy D. Waldram asserted in presenting the survey findings at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Moreover, the figure likely overcalls the true rate, since participation in the survey was voluntary and fans of aspirin desensitization were probably more inclined to complete the 16-item questionnaire, added Dr. Waldram, a fellow in allergy and immunology at the Scripps Clinic in San Diego.
Was he surprised to find that aspirin desensitization isn’t more widely utilized?
“I think the number that surprised me more was that among the 37.5% of allergists who don’t do aspirin desensitization, almost 30% of them don’t even refer their patients to others who do the procedure. We don’t know why they don’t refer out; it wasn’t a question included in the survey. Perhaps they see patients who are of a less severe phenotype,” he said in an interview.
The 684 survey responses represented a 15% response rate. While 37.5% of respondents indicated they don’t perform aspirin desensitization, 73% of those who reported doing the procedure said they do an average of 1-5 cases annually.
Among allergists who don’t perform aspirin desensitization, safety concerns were the leading reason cited. Indeed, 70% of those who don’t do aspirin desensitization indicated safety risks were the main reason. More than one reason could be given, however, and 30% of allergists cited poor compensation for the procedure as a deterrent, nearly 60% said the logistics of monitoring care were too onerous, and one-third said they didn’t perform aspirin desensitization because they hadn’t been trained to do it.
Of allergists who reported doing aspirin desensitization, 52% perform the procedure in an outpatient setting unattached to a hospital. Another 21% do so in an outpatient clinic that’s physically attached to a hospital.
Within the past 5 years, 9% of respondents said that they’ve had a patient react severely to aspirin desensitization, requiring an unanticipated transfer to a higher level of care. That’s contrary to the experience among allergists at the Scripps Clinic, which is widely credited with pioneering the outpatient approach.
“We essentially do all our aspirin desensitizations for AERD in the outpatient setting. In 1,500 treated patients we’ve never had one that we had to transfer to a higher level of care. We don’t have any special setup. It’s a typical outpatient clinic. We usually don’t start IVs or do anything above and beyond,” Dr. Waldram said.
While 26% of respondents reported they generally recommend aspirin desensitization immediately upon identifying a patient history that supports the diagnosis of AERD, another 54% said they usually recommend the procedure to patients only after they’ve failed to improve on typical medical therapy.
Twenty percent of physicians rated aspirin desensitization as “extremely helpful for the majority of patients,” another 49% said they find it most beneficial as an adjuvant to ongoing medical therapy.
Forty-four percent of allergists who perform aspirin desensitization reported that they learned to do the procedure during fellowship training. Fourteen percent said they learned to the procedure at an annual meeting, and 36% picked it up by reviewing the relevant literature.
Several allergists commented that had Dr. Waldram’s survey been conducted even a couple of years ago the rate of utilization of aspirin desensitization would have been far lower. They interpreted his reported 62.5% rate as a sign of progress. Dr. Waldram said he believes the key to further boosting utilization of aspirin desensitization lies in increasing exposure to the procedure during fellowship training. He noted that internal medicine-trained fellows who responded to the survey had a significantly higher aspirin desensitization utilization rate than those who came to their allergy fellowship with a background in pediatrics.
The hallmarks of AERD are difficult-to-treat nasal polyps, chronic eosinophilic sinusitis, and asthma in a patient with sensitivity to aspirin and other COX-1 inhibitors.
Dr. Waldram reported having no financial conflicts with regard to his study, which was conducted free of commercial support.
HOUSTON – About 63% of allergists and fellows in training perform aspirin desensitization for aspirin-exacerbated respiratory disease, according to a national survey.
That figure is lower than it should be, given the wealth of published evidence that aspirin desensitization is a safe and effective component of the treatment of aspirin-exacerbated respiratory disease (AERD), Dr. Jeremy D. Waldram asserted in presenting the survey findings at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Moreover, the figure likely overcalls the true rate, since participation in the survey was voluntary and fans of aspirin desensitization were probably more inclined to complete the 16-item questionnaire, added Dr. Waldram, a fellow in allergy and immunology at the Scripps Clinic in San Diego.
Was he surprised to find that aspirin desensitization isn’t more widely utilized?
“I think the number that surprised me more was that among the 37.5% of allergists who don’t do aspirin desensitization, almost 30% of them don’t even refer their patients to others who do the procedure. We don’t know why they don’t refer out; it wasn’t a question included in the survey. Perhaps they see patients who are of a less severe phenotype,” he said in an interview.
The 684 survey responses represented a 15% response rate. While 37.5% of respondents indicated they don’t perform aspirin desensitization, 73% of those who reported doing the procedure said they do an average of 1-5 cases annually.
Among allergists who don’t perform aspirin desensitization, safety concerns were the leading reason cited. Indeed, 70% of those who don’t do aspirin desensitization indicated safety risks were the main reason. More than one reason could be given, however, and 30% of allergists cited poor compensation for the procedure as a deterrent, nearly 60% said the logistics of monitoring care were too onerous, and one-third said they didn’t perform aspirin desensitization because they hadn’t been trained to do it.
Of allergists who reported doing aspirin desensitization, 52% perform the procedure in an outpatient setting unattached to a hospital. Another 21% do so in an outpatient clinic that’s physically attached to a hospital.
Within the past 5 years, 9% of respondents said that they’ve had a patient react severely to aspirin desensitization, requiring an unanticipated transfer to a higher level of care. That’s contrary to the experience among allergists at the Scripps Clinic, which is widely credited with pioneering the outpatient approach.
“We essentially do all our aspirin desensitizations for AERD in the outpatient setting. In 1,500 treated patients we’ve never had one that we had to transfer to a higher level of care. We don’t have any special setup. It’s a typical outpatient clinic. We usually don’t start IVs or do anything above and beyond,” Dr. Waldram said.
While 26% of respondents reported they generally recommend aspirin desensitization immediately upon identifying a patient history that supports the diagnosis of AERD, another 54% said they usually recommend the procedure to patients only after they’ve failed to improve on typical medical therapy.
Twenty percent of physicians rated aspirin desensitization as “extremely helpful for the majority of patients,” another 49% said they find it most beneficial as an adjuvant to ongoing medical therapy.
Forty-four percent of allergists who perform aspirin desensitization reported that they learned to do the procedure during fellowship training. Fourteen percent said they learned to the procedure at an annual meeting, and 36% picked it up by reviewing the relevant literature.
Several allergists commented that had Dr. Waldram’s survey been conducted even a couple of years ago the rate of utilization of aspirin desensitization would have been far lower. They interpreted his reported 62.5% rate as a sign of progress. Dr. Waldram said he believes the key to further boosting utilization of aspirin desensitization lies in increasing exposure to the procedure during fellowship training. He noted that internal medicine-trained fellows who responded to the survey had a significantly higher aspirin desensitization utilization rate than those who came to their allergy fellowship with a background in pediatrics.
The hallmarks of AERD are difficult-to-treat nasal polyps, chronic eosinophilic sinusitis, and asthma in a patient with sensitivity to aspirin and other COX-1 inhibitors.
Dr. Waldram reported having no financial conflicts with regard to his study, which was conducted free of commercial support.
AT 2015 AAAAI ANNUAL MEETING
Key clinical point: Aspirin desensitization for patients with aspirin-exacerbated respiratory disease is catching on among U.S. allergists.
Major finding: Roughly 63% of allergists and allergy fellows who responded to a national survey indicated they perform aspirin desensitization for aspirin-exacerbated respiratory disease.
Data source: This was a 16-question survey of aspirin desensitization practices among U.S. allergists and allergy fellows. The national survey drew 684 responses.
Disclosures: The presenter reported having no financial conflicts with regard to his study, which was funded without commercial support.
Risk factors identified for gestational eczema
HOUSTON– New-onset eczema during pregnancy is a common phenomenon with several newly identified risk factors.
This disease entity deserves a proper name: gestational eczema, Dr. Wilfried J.J. Karmaus asserted at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
In contrast, the likelihood of new-onset asthma arising during pregnancy isn’t significantly more common than in an affected woman’s male partner during the same time frame.
“There was no large difference in wheezing between the women and men. Therefore, we cannot propose the term ‘gestational asthma,’” said Dr. Karmaus, professor of epidemiology at the University of Memphis. “Investigations into how to prevent eczema and asthma in pregnancy are really important, because eczema and asthma in pregnancy can increase the risk of these diseases in the offspring. This is a totally undeveloped field.”
He presented new findings from the Isle of Wight study, a prospective study in which a cohort of women has been followed from birth through pregnancy across three generations.
Eczema and asthma are common atopic diseases, and they are particularly common during pregnancy. Indeed, eczema is the most common skin disease seen in pregnancy, accounting for 35%-50% of all dermatoses in previous studies by other investigators. In those studies, only 20%-40% of women with eczema during pregnancy had a prepregnancy history of the disease.
In the Isle of Wight cohort, women were evaluated for asthma and eczema symptoms at ages 1, 2, 4, 10, and 18 years and again during pregnancy at gestational weeks 20 and 28. A total of 26 of 116 women developed eczema during pregnancy, with eight of them (31%) experiencing the skin disease for the first time in their lives. In contrast, only six of their male partners had eczema during the pregnancy time frame, and just one of them had new-onset eczema.
A history of maternal eczema in the preceding generation was associated with a 52% increased relative risk of having eczema by age 18 and a 3.1-fold increased likelihood of eczema during pregnancy. Also, methylation of the filaggrin gene at the cytosine-phosphate-guanine site cg13447818 when assessed at age 18 was associated with a significantly increased likelihood of eczema in a subject’s mother as well as increased risk of gestational eczema 1-7 years later, Dr. Karmaus continued.
Eighteen percent of women in the Isle of Wight cohort had asthma during pregnancy, as did a similar proportion of their male partners. Twenty-seven percent of women with asthma during pregnancy had no previous history of the respiratory disease, a rate which was again comparable in their male partners with asthma.
DNA methylation of the IL1RL1 gene at cg17738684 was significantly associated with asthma heritability across three generations in the Isle of Wight study. The IL1RL1 gene at cg17738684 is a candidate gene for asthma that encodes for interleukin-33. This finding raises the possibility that addressing this DNA methylation could prove fruitful as a transgenerational asthma prevention strategy.
The Isle of Wight birth cohort study is funded by the National Institutes of Health, Asthma UK, and the Isle of Wight Trust. Dr. Karmaus reported having no financial conflicts of interest.
HOUSTON– New-onset eczema during pregnancy is a common phenomenon with several newly identified risk factors.
This disease entity deserves a proper name: gestational eczema, Dr. Wilfried J.J. Karmaus asserted at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
In contrast, the likelihood of new-onset asthma arising during pregnancy isn’t significantly more common than in an affected woman’s male partner during the same time frame.
“There was no large difference in wheezing between the women and men. Therefore, we cannot propose the term ‘gestational asthma,’” said Dr. Karmaus, professor of epidemiology at the University of Memphis. “Investigations into how to prevent eczema and asthma in pregnancy are really important, because eczema and asthma in pregnancy can increase the risk of these diseases in the offspring. This is a totally undeveloped field.”
He presented new findings from the Isle of Wight study, a prospective study in which a cohort of women has been followed from birth through pregnancy across three generations.
Eczema and asthma are common atopic diseases, and they are particularly common during pregnancy. Indeed, eczema is the most common skin disease seen in pregnancy, accounting for 35%-50% of all dermatoses in previous studies by other investigators. In those studies, only 20%-40% of women with eczema during pregnancy had a prepregnancy history of the disease.
In the Isle of Wight cohort, women were evaluated for asthma and eczema symptoms at ages 1, 2, 4, 10, and 18 years and again during pregnancy at gestational weeks 20 and 28. A total of 26 of 116 women developed eczema during pregnancy, with eight of them (31%) experiencing the skin disease for the first time in their lives. In contrast, only six of their male partners had eczema during the pregnancy time frame, and just one of them had new-onset eczema.
A history of maternal eczema in the preceding generation was associated with a 52% increased relative risk of having eczema by age 18 and a 3.1-fold increased likelihood of eczema during pregnancy. Also, methylation of the filaggrin gene at the cytosine-phosphate-guanine site cg13447818 when assessed at age 18 was associated with a significantly increased likelihood of eczema in a subject’s mother as well as increased risk of gestational eczema 1-7 years later, Dr. Karmaus continued.
Eighteen percent of women in the Isle of Wight cohort had asthma during pregnancy, as did a similar proportion of their male partners. Twenty-seven percent of women with asthma during pregnancy had no previous history of the respiratory disease, a rate which was again comparable in their male partners with asthma.
DNA methylation of the IL1RL1 gene at cg17738684 was significantly associated with asthma heritability across three generations in the Isle of Wight study. The IL1RL1 gene at cg17738684 is a candidate gene for asthma that encodes for interleukin-33. This finding raises the possibility that addressing this DNA methylation could prove fruitful as a transgenerational asthma prevention strategy.
The Isle of Wight birth cohort study is funded by the National Institutes of Health, Asthma UK, and the Isle of Wight Trust. Dr. Karmaus reported having no financial conflicts of interest.
HOUSTON– New-onset eczema during pregnancy is a common phenomenon with several newly identified risk factors.
This disease entity deserves a proper name: gestational eczema, Dr. Wilfried J.J. Karmaus asserted at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
In contrast, the likelihood of new-onset asthma arising during pregnancy isn’t significantly more common than in an affected woman’s male partner during the same time frame.
“There was no large difference in wheezing between the women and men. Therefore, we cannot propose the term ‘gestational asthma,’” said Dr. Karmaus, professor of epidemiology at the University of Memphis. “Investigations into how to prevent eczema and asthma in pregnancy are really important, because eczema and asthma in pregnancy can increase the risk of these diseases in the offspring. This is a totally undeveloped field.”
He presented new findings from the Isle of Wight study, a prospective study in which a cohort of women has been followed from birth through pregnancy across three generations.
Eczema and asthma are common atopic diseases, and they are particularly common during pregnancy. Indeed, eczema is the most common skin disease seen in pregnancy, accounting for 35%-50% of all dermatoses in previous studies by other investigators. In those studies, only 20%-40% of women with eczema during pregnancy had a prepregnancy history of the disease.
In the Isle of Wight cohort, women were evaluated for asthma and eczema symptoms at ages 1, 2, 4, 10, and 18 years and again during pregnancy at gestational weeks 20 and 28. A total of 26 of 116 women developed eczema during pregnancy, with eight of them (31%) experiencing the skin disease for the first time in their lives. In contrast, only six of their male partners had eczema during the pregnancy time frame, and just one of them had new-onset eczema.
A history of maternal eczema in the preceding generation was associated with a 52% increased relative risk of having eczema by age 18 and a 3.1-fold increased likelihood of eczema during pregnancy. Also, methylation of the filaggrin gene at the cytosine-phosphate-guanine site cg13447818 when assessed at age 18 was associated with a significantly increased likelihood of eczema in a subject’s mother as well as increased risk of gestational eczema 1-7 years later, Dr. Karmaus continued.
Eighteen percent of women in the Isle of Wight cohort had asthma during pregnancy, as did a similar proportion of their male partners. Twenty-seven percent of women with asthma during pregnancy had no previous history of the respiratory disease, a rate which was again comparable in their male partners with asthma.
DNA methylation of the IL1RL1 gene at cg17738684 was significantly associated with asthma heritability across three generations in the Isle of Wight study. The IL1RL1 gene at cg17738684 is a candidate gene for asthma that encodes for interleukin-33. This finding raises the possibility that addressing this DNA methylation could prove fruitful as a transgenerational asthma prevention strategy.
The Isle of Wight birth cohort study is funded by the National Institutes of Health, Asthma UK, and the Isle of Wight Trust. Dr. Karmaus reported having no financial conflicts of interest.
AT 2015 AAAAI ANNUAL MEETING
Key clinical point: Thirty-one percent of cases of eczema and 27% of asthma in a group of pregnant women occurred for the first time in the woman’s life.
Major finding: A history of maternal eczema was associated with a 3.1-fold increased likelihood of eczema during the offspring’s pregnancy.
Data source: The Isle of Wight birth cohort study is a prospective study following three generations from birth through pregnancy.
Disclosures: The study is funded by the National Institutes of Health, Asthma UK, and the Isle of Wight Trust. The presenter reported having no financial conflicts of interest.
Yoga for Dermatologic Conditions
Regardless of its spiritual origins, yoga has become a popular way of reaching mind and body well-being with nearly 30 million people practicing regularly worldwide.1 Yoga, which is the combination of physical postures, controlled breathing, and meditation or mindfulness, has long been used in complementary and alternative medicine around the world and recently has gained popularity as a therapeutic practice, with nearly 14 million Americans reporting that yoga was recommended to them by a physician or therapist.2,3 Studies suggest that people who participate in even brief yoga programs may see improvements in anxiety, somatic stress and discomfort, health-related quality of life, and self-rated sleep quality, all benefits that can help medical conditions, especially those that are dermatologic in nature.4,5
Stress and Dermatologic Conditions
The interaction between the mind, skin, and body is well known. Research in psychoneuroimmunology, the interaction between psychological processes and the nervous and immune systems, has examined the role of neuropeptides, hormones, and neurotransmitters in psychodermatological disorders. The correlation between neuroimmunological pathways and skin inflammation is now well recognized, specifically the interactions between the brain and skin underlying many dermatological diseases (eg, acne, alopecia areata, various types of eczema and dermatitis, oral and genital herpes, hyperhidrosis, pruritus, psoriasis, rosacea, urticaria, warts, breaking or ridging of the nails).6-9
Two biological systems are known to be affected by the systemic stress response: (1) the hypothalamic-pituitary-adrenal axis, which regulates the release of adrenocorticotropin, ß-endorphin, and cortisol, and (2) the sympathoadrenal medullary system, which regulates the release of catecholamines (eg, epinephrine, norepinephrine).7 Cortisol and catecholamines have been shown to have potent effects on the immune system as well as the inflammatory response.9 Additionally, it has been shown that cutaneous sensory nerve terminals release neuropeptides, including calcitonin gene-related peptide and substance P, both of which have different effects on the local inflammatory response.10,11
Psychological stress is well known to trigger many dermatologic conditions, but it also may lead to abnormal skin barrier function.12 The mechanism in which skin barrier function is affected appears to involve a stress-induced increase of endogenous glucocorticoids, which may consequently disrupt skin barrier function and recovery rates, stratum corneum cohesion, and epidermal antimicrobial function.13,14
Atopic dermatitis, for example, is classified as a psychophysiological disorder. Although it is not caused by stress, atopic dermatitis has been described to be precipitated or exacerbated by stress in patients.15 In fact, it was found that stressful life events preceded the onset of itching in more than 70% of patients with atopic dermatitis,16 which is especially relevant, as there is no cure and patients often experience a lifelong struggle with the condition. Additionally, stress mediates the degranulation of mast cells via corticotropin-releasing hormone and neuropeptides, and the upregulation of mast cell corticotropin-releasing hormone receptors supporting its putative role in the pathogenesis of urticaria.9,17 Furthermore, the increase in cortisol also has been described in the exacerbation of acne during times of stress.18
Psychological factors affect the management of skin conditions in more than one-third of reported dermatology patients; therefore, it is important to consider these factors in the treatment of chronic dermatological conditions, especially when they are inquired by the patient.19,20
Yoga Benefits in the Literature
The therapeutic potential of yoga has been explored in a growing number of randomized controlled trials to date.21 A recently published bibliometric analysis provided a comprehensive review of the characteristics of the randomized yoga trials available in the literature.22 The review included 366 full-text articles, with the 2 earliest studies published in 1975 and nearly 90% published within the last decade. In addition to healthy patients, it was found these randomized controlled yoga trials most commonly enrolled patients with breast cancer, depression, asthma, and type 2 diabetes mellitus.22 Another study examined psychological (eg, self-rated stress and stress behavior, anger, exhaustion, quality of life) and physiological (eg, blood pressure, heart rate, urinary catecholamines, salivary cortisol) measurements obtained before and after a 10-session yoga program that participants completed over a 4-month period, with results showing significant improvements (P<.05) on almost all stress-related subjective and physiological variables. Results were comparable with cognitive behavioral therapy.23
Not only has it been shown that yoga helps patients on a psychological level, but a recent study reported that 90-minute sessions of mindfulness meditation and gentle Hatha yoga over an 8-week period led to observable benefits on a cellular level, as telomere length was maintained in distressed breast cancer survivors compared to decreases in telomere length in the control group with patients who solely participated in a stress management seminar.24 To date, there are no known studies examining the effects of yoga on patients with skin cancer. However, a few studies have specifically examined the effect of yoga in managing non–cancer-related dermatologic issues. Specifically, one small study of psoriasis patients found that those who listened to mindfulness meditation tapes while undergoing standard phototherapy (psoralen plus UVA) healed faster than those who underwent phototherapy treatment alone.25
Because some dermatologic problems have comorbidities and increased risk factors of other medical problems, such as psoriasis with psoriatic arthritis and metabolic diseases (eg, abdominal obesity, diabetes, nonalcoholic fatty liver disease, dyslipidemia, metabolic syndrome, chronic kidney disease), it is even more pertinent to recommend approaches for healthy mind and body well-being as a supplement to medical care.26
Final Thoughts
With accurate diagnosis by a dermatologist, appropriate conventional treatments can improve dermatologic problems. These treatments alone can reduce patients’ stress and improve skin, hair, and nail conditions; however, if it is clear that stress is interfering with a patient’s overall well-being and ability to cope with his/her dermatologic condition, concurrent stress management interventions may be warranted. In some instances, recommending yoga sessions, mindful meditation, or breathing exercises may help, while in others referral to a mental health professional may be necessary.
Beyond the direct physiological effects of stress, it also is worth mentioning that patients who deal with stress also tend to scratch, pick, or irritate their skin more and often lack the motivation to adhere to skin care regimens or treatments, again supporting the idea that our approach in managing these patients must be multifaceted. As dermatologists in training, residents should be cognizant of the potential psychological sequelae of some dermatologic problems and be aware of the possible use of supplemental interventions by our patients.
1. Dangerfield A. Yoga wars. BBC News. http://news.bbc.co.uk/1/hi/7844691.stm. Published January 23, 2009. Accessed March 25, 2015.
2. Yoga Journal releases 2012 yoga in America market study [press release]. San Francisco, CA: Yoga Journal; December 6, 2012.
3. De Michaelis E. A History of Modern Yoga: Patanjali and Western Esotericism. London, United Kingdom: A&C Black; 2005.
4. Telles S, Singh N, Yadav A, et al. Effect of yoga on different aspects of mental health. Indian J Physiol Pharmacol. 2012;56:245-254.
5. Rodriguez-Vallecillo E, Woodbury-Fariña MA. Dermatological manifestations of stress in normal and psychiatric populations. Psychiatr Clin North Am. 2014;37:625-651.
6. Stander S, Raap U, Weisshaar E, et al. Pathogenesis of pruritus. J Dtsch Dermatol Ges. 2011;9:456-463.
7. Arck PC, Slominski A, Theoharides TC, et al. Neuroimmunology of stress: skin takes center stage. J Invest Dermatol. 2006;126:1697-1704.
8. Recognizing the mind-skin connection. Harvard Health Publications Web site. http://www.health.harvard.edu/newsletter_article/Recognizing_the_mind-skin_connection. Published November 1, 2006. Accessed March 31, 2015.
9. Tausk F, Elenkov I, Moynihan J. Psychoneuroimmunology. Dermatol Ther. 2008;21:22-31.
10. Pavlovic S, Liezmann C, Blois SM, et al. Substance P is a key mediator of stress-induced protection from allergic sensitization via modified antigen presentation. J Immunol. 2011;186:848-855.
11. Toyoda M, Nakamura M, Makino T, et al. Nerve growth factor and substance P are useful plasma markers of disease activity in atopic dermatitis. Br J Dermatol. 2002;147:71-79.
12. Koo JYM, Lee CS. General approach to evaluating psychodermatological disorders. In: Koo JYM, Lee CS, eds. Psychocutaneous Medicine. New York, NY: Marcel Dekker; 2003:1-29.
13. Garg A, Chren MM, Sands LP, et al. Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders. Arch Dermatol. 2001;137:53-59.
14. Elias PM, Sun R, Eder AR, et al. Treating atopic dermatitis at the source: corrective barrier repair therapy based upon new pathogenic insights. Expert Rev Dermatol. 2013;8:27-36.
15. Morren MA, Przybilla B, Bamelis M, et al. Atopic dermatitis: triggering factors. J Am Acad Dermatol. 1994;31:467-473.
16. Faulstich ME, Williamson DA. An overview of atopic dermatitis: toward a bio-behavioural integration. J Psychosom Res. 1985;29:647-654.
17. Theoharides TC, Donelan JM, Papadopoulou N, et al. Mast cells as targets of corticotropin-releasing factor and related peptides. Trends Pharmacol Sci. 2004;25:563-568.
18. Suh DH, Kwon HH. What’s new in the physiopathology of acne [published online ahead of print Jan 24, 2015]? Br J Dermatol. doi:10.1111/bjd.13634.
19. Picardi A, Mazzotti E, Pasquini P. Prevalence and correlates of suicidal ideation among patients with skin disease. J Am Acad Dermatol. 2006;54:420-426.
20. Ponarovsky B, Amital D, Lazarov A, et al. Anxiety and depression in patients with allergic and non-allergic cutaneous disorders. Int J Dermatol. 2011;50:1217-1222.
21. Khalsa SB. Yoga as a therapeutic intervention: a bibliometric analysis of published research studies. Indian J Physiol Pharmacol. 2004;48:269-285.
22. Cramer H, Lauche R, Dobos G. Characteristics of randomized controlled trials of yoga: a bibliometric analysis. BMC Complement Altern Med. 2014;14:328.
23. Granath J, Ingvarsson S, von Thiele U, et al. Stress management: a randomized study of cognitive behavioural therapy and yoga. Cogn Behav Ther. 2006;35:3-10.
24. Carlson LE, Beattie TL, Giese-Davis J, et al. Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors. Cancer. 2015;121:476-484.
25. Kabat-Zinn J, Wheeler E, Light T, et al. Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosom Med. 1998;60:625-632.
26. Gisondi P, Galvan A, Idolazzi L, et al. Management of moderate to severe psoriasis in patients with metabolic comorbidities. Front Med (Lausanne). 2015;2:1.
Regardless of its spiritual origins, yoga has become a popular way of reaching mind and body well-being with nearly 30 million people practicing regularly worldwide.1 Yoga, which is the combination of physical postures, controlled breathing, and meditation or mindfulness, has long been used in complementary and alternative medicine around the world and recently has gained popularity as a therapeutic practice, with nearly 14 million Americans reporting that yoga was recommended to them by a physician or therapist.2,3 Studies suggest that people who participate in even brief yoga programs may see improvements in anxiety, somatic stress and discomfort, health-related quality of life, and self-rated sleep quality, all benefits that can help medical conditions, especially those that are dermatologic in nature.4,5
Stress and Dermatologic Conditions
The interaction between the mind, skin, and body is well known. Research in psychoneuroimmunology, the interaction between psychological processes and the nervous and immune systems, has examined the role of neuropeptides, hormones, and neurotransmitters in psychodermatological disorders. The correlation between neuroimmunological pathways and skin inflammation is now well recognized, specifically the interactions between the brain and skin underlying many dermatological diseases (eg, acne, alopecia areata, various types of eczema and dermatitis, oral and genital herpes, hyperhidrosis, pruritus, psoriasis, rosacea, urticaria, warts, breaking or ridging of the nails).6-9
Two biological systems are known to be affected by the systemic stress response: (1) the hypothalamic-pituitary-adrenal axis, which regulates the release of adrenocorticotropin, ß-endorphin, and cortisol, and (2) the sympathoadrenal medullary system, which regulates the release of catecholamines (eg, epinephrine, norepinephrine).7 Cortisol and catecholamines have been shown to have potent effects on the immune system as well as the inflammatory response.9 Additionally, it has been shown that cutaneous sensory nerve terminals release neuropeptides, including calcitonin gene-related peptide and substance P, both of which have different effects on the local inflammatory response.10,11
Psychological stress is well known to trigger many dermatologic conditions, but it also may lead to abnormal skin barrier function.12 The mechanism in which skin barrier function is affected appears to involve a stress-induced increase of endogenous glucocorticoids, which may consequently disrupt skin barrier function and recovery rates, stratum corneum cohesion, and epidermal antimicrobial function.13,14
Atopic dermatitis, for example, is classified as a psychophysiological disorder. Although it is not caused by stress, atopic dermatitis has been described to be precipitated or exacerbated by stress in patients.15 In fact, it was found that stressful life events preceded the onset of itching in more than 70% of patients with atopic dermatitis,16 which is especially relevant, as there is no cure and patients often experience a lifelong struggle with the condition. Additionally, stress mediates the degranulation of mast cells via corticotropin-releasing hormone and neuropeptides, and the upregulation of mast cell corticotropin-releasing hormone receptors supporting its putative role in the pathogenesis of urticaria.9,17 Furthermore, the increase in cortisol also has been described in the exacerbation of acne during times of stress.18
Psychological factors affect the management of skin conditions in more than one-third of reported dermatology patients; therefore, it is important to consider these factors in the treatment of chronic dermatological conditions, especially when they are inquired by the patient.19,20
Yoga Benefits in the Literature
The therapeutic potential of yoga has been explored in a growing number of randomized controlled trials to date.21 A recently published bibliometric analysis provided a comprehensive review of the characteristics of the randomized yoga trials available in the literature.22 The review included 366 full-text articles, with the 2 earliest studies published in 1975 and nearly 90% published within the last decade. In addition to healthy patients, it was found these randomized controlled yoga trials most commonly enrolled patients with breast cancer, depression, asthma, and type 2 diabetes mellitus.22 Another study examined psychological (eg, self-rated stress and stress behavior, anger, exhaustion, quality of life) and physiological (eg, blood pressure, heart rate, urinary catecholamines, salivary cortisol) measurements obtained before and after a 10-session yoga program that participants completed over a 4-month period, with results showing significant improvements (P<.05) on almost all stress-related subjective and physiological variables. Results were comparable with cognitive behavioral therapy.23
Not only has it been shown that yoga helps patients on a psychological level, but a recent study reported that 90-minute sessions of mindfulness meditation and gentle Hatha yoga over an 8-week period led to observable benefits on a cellular level, as telomere length was maintained in distressed breast cancer survivors compared to decreases in telomere length in the control group with patients who solely participated in a stress management seminar.24 To date, there are no known studies examining the effects of yoga on patients with skin cancer. However, a few studies have specifically examined the effect of yoga in managing non–cancer-related dermatologic issues. Specifically, one small study of psoriasis patients found that those who listened to mindfulness meditation tapes while undergoing standard phototherapy (psoralen plus UVA) healed faster than those who underwent phototherapy treatment alone.25
Because some dermatologic problems have comorbidities and increased risk factors of other medical problems, such as psoriasis with psoriatic arthritis and metabolic diseases (eg, abdominal obesity, diabetes, nonalcoholic fatty liver disease, dyslipidemia, metabolic syndrome, chronic kidney disease), it is even more pertinent to recommend approaches for healthy mind and body well-being as a supplement to medical care.26
Final Thoughts
With accurate diagnosis by a dermatologist, appropriate conventional treatments can improve dermatologic problems. These treatments alone can reduce patients’ stress and improve skin, hair, and nail conditions; however, if it is clear that stress is interfering with a patient’s overall well-being and ability to cope with his/her dermatologic condition, concurrent stress management interventions may be warranted. In some instances, recommending yoga sessions, mindful meditation, or breathing exercises may help, while in others referral to a mental health professional may be necessary.
Beyond the direct physiological effects of stress, it also is worth mentioning that patients who deal with stress also tend to scratch, pick, or irritate their skin more and often lack the motivation to adhere to skin care regimens or treatments, again supporting the idea that our approach in managing these patients must be multifaceted. As dermatologists in training, residents should be cognizant of the potential psychological sequelae of some dermatologic problems and be aware of the possible use of supplemental interventions by our patients.
Regardless of its spiritual origins, yoga has become a popular way of reaching mind and body well-being with nearly 30 million people practicing regularly worldwide.1 Yoga, which is the combination of physical postures, controlled breathing, and meditation or mindfulness, has long been used in complementary and alternative medicine around the world and recently has gained popularity as a therapeutic practice, with nearly 14 million Americans reporting that yoga was recommended to them by a physician or therapist.2,3 Studies suggest that people who participate in even brief yoga programs may see improvements in anxiety, somatic stress and discomfort, health-related quality of life, and self-rated sleep quality, all benefits that can help medical conditions, especially those that are dermatologic in nature.4,5
Stress and Dermatologic Conditions
The interaction between the mind, skin, and body is well known. Research in psychoneuroimmunology, the interaction between psychological processes and the nervous and immune systems, has examined the role of neuropeptides, hormones, and neurotransmitters in psychodermatological disorders. The correlation between neuroimmunological pathways and skin inflammation is now well recognized, specifically the interactions between the brain and skin underlying many dermatological diseases (eg, acne, alopecia areata, various types of eczema and dermatitis, oral and genital herpes, hyperhidrosis, pruritus, psoriasis, rosacea, urticaria, warts, breaking or ridging of the nails).6-9
Two biological systems are known to be affected by the systemic stress response: (1) the hypothalamic-pituitary-adrenal axis, which regulates the release of adrenocorticotropin, ß-endorphin, and cortisol, and (2) the sympathoadrenal medullary system, which regulates the release of catecholamines (eg, epinephrine, norepinephrine).7 Cortisol and catecholamines have been shown to have potent effects on the immune system as well as the inflammatory response.9 Additionally, it has been shown that cutaneous sensory nerve terminals release neuropeptides, including calcitonin gene-related peptide and substance P, both of which have different effects on the local inflammatory response.10,11
Psychological stress is well known to trigger many dermatologic conditions, but it also may lead to abnormal skin barrier function.12 The mechanism in which skin barrier function is affected appears to involve a stress-induced increase of endogenous glucocorticoids, which may consequently disrupt skin barrier function and recovery rates, stratum corneum cohesion, and epidermal antimicrobial function.13,14
Atopic dermatitis, for example, is classified as a psychophysiological disorder. Although it is not caused by stress, atopic dermatitis has been described to be precipitated or exacerbated by stress in patients.15 In fact, it was found that stressful life events preceded the onset of itching in more than 70% of patients with atopic dermatitis,16 which is especially relevant, as there is no cure and patients often experience a lifelong struggle with the condition. Additionally, stress mediates the degranulation of mast cells via corticotropin-releasing hormone and neuropeptides, and the upregulation of mast cell corticotropin-releasing hormone receptors supporting its putative role in the pathogenesis of urticaria.9,17 Furthermore, the increase in cortisol also has been described in the exacerbation of acne during times of stress.18
Psychological factors affect the management of skin conditions in more than one-third of reported dermatology patients; therefore, it is important to consider these factors in the treatment of chronic dermatological conditions, especially when they are inquired by the patient.19,20
Yoga Benefits in the Literature
The therapeutic potential of yoga has been explored in a growing number of randomized controlled trials to date.21 A recently published bibliometric analysis provided a comprehensive review of the characteristics of the randomized yoga trials available in the literature.22 The review included 366 full-text articles, with the 2 earliest studies published in 1975 and nearly 90% published within the last decade. In addition to healthy patients, it was found these randomized controlled yoga trials most commonly enrolled patients with breast cancer, depression, asthma, and type 2 diabetes mellitus.22 Another study examined psychological (eg, self-rated stress and stress behavior, anger, exhaustion, quality of life) and physiological (eg, blood pressure, heart rate, urinary catecholamines, salivary cortisol) measurements obtained before and after a 10-session yoga program that participants completed over a 4-month period, with results showing significant improvements (P<.05) on almost all stress-related subjective and physiological variables. Results were comparable with cognitive behavioral therapy.23
Not only has it been shown that yoga helps patients on a psychological level, but a recent study reported that 90-minute sessions of mindfulness meditation and gentle Hatha yoga over an 8-week period led to observable benefits on a cellular level, as telomere length was maintained in distressed breast cancer survivors compared to decreases in telomere length in the control group with patients who solely participated in a stress management seminar.24 To date, there are no known studies examining the effects of yoga on patients with skin cancer. However, a few studies have specifically examined the effect of yoga in managing non–cancer-related dermatologic issues. Specifically, one small study of psoriasis patients found that those who listened to mindfulness meditation tapes while undergoing standard phototherapy (psoralen plus UVA) healed faster than those who underwent phototherapy treatment alone.25
Because some dermatologic problems have comorbidities and increased risk factors of other medical problems, such as psoriasis with psoriatic arthritis and metabolic diseases (eg, abdominal obesity, diabetes, nonalcoholic fatty liver disease, dyslipidemia, metabolic syndrome, chronic kidney disease), it is even more pertinent to recommend approaches for healthy mind and body well-being as a supplement to medical care.26
Final Thoughts
With accurate diagnosis by a dermatologist, appropriate conventional treatments can improve dermatologic problems. These treatments alone can reduce patients’ stress and improve skin, hair, and nail conditions; however, if it is clear that stress is interfering with a patient’s overall well-being and ability to cope with his/her dermatologic condition, concurrent stress management interventions may be warranted. In some instances, recommending yoga sessions, mindful meditation, or breathing exercises may help, while in others referral to a mental health professional may be necessary.
Beyond the direct physiological effects of stress, it also is worth mentioning that patients who deal with stress also tend to scratch, pick, or irritate their skin more and often lack the motivation to adhere to skin care regimens or treatments, again supporting the idea that our approach in managing these patients must be multifaceted. As dermatologists in training, residents should be cognizant of the potential psychological sequelae of some dermatologic problems and be aware of the possible use of supplemental interventions by our patients.
1. Dangerfield A. Yoga wars. BBC News. http://news.bbc.co.uk/1/hi/7844691.stm. Published January 23, 2009. Accessed March 25, 2015.
2. Yoga Journal releases 2012 yoga in America market study [press release]. San Francisco, CA: Yoga Journal; December 6, 2012.
3. De Michaelis E. A History of Modern Yoga: Patanjali and Western Esotericism. London, United Kingdom: A&C Black; 2005.
4. Telles S, Singh N, Yadav A, et al. Effect of yoga on different aspects of mental health. Indian J Physiol Pharmacol. 2012;56:245-254.
5. Rodriguez-Vallecillo E, Woodbury-Fariña MA. Dermatological manifestations of stress in normal and psychiatric populations. Psychiatr Clin North Am. 2014;37:625-651.
6. Stander S, Raap U, Weisshaar E, et al. Pathogenesis of pruritus. J Dtsch Dermatol Ges. 2011;9:456-463.
7. Arck PC, Slominski A, Theoharides TC, et al. Neuroimmunology of stress: skin takes center stage. J Invest Dermatol. 2006;126:1697-1704.
8. Recognizing the mind-skin connection. Harvard Health Publications Web site. http://www.health.harvard.edu/newsletter_article/Recognizing_the_mind-skin_connection. Published November 1, 2006. Accessed March 31, 2015.
9. Tausk F, Elenkov I, Moynihan J. Psychoneuroimmunology. Dermatol Ther. 2008;21:22-31.
10. Pavlovic S, Liezmann C, Blois SM, et al. Substance P is a key mediator of stress-induced protection from allergic sensitization via modified antigen presentation. J Immunol. 2011;186:848-855.
11. Toyoda M, Nakamura M, Makino T, et al. Nerve growth factor and substance P are useful plasma markers of disease activity in atopic dermatitis. Br J Dermatol. 2002;147:71-79.
12. Koo JYM, Lee CS. General approach to evaluating psychodermatological disorders. In: Koo JYM, Lee CS, eds. Psychocutaneous Medicine. New York, NY: Marcel Dekker; 2003:1-29.
13. Garg A, Chren MM, Sands LP, et al. Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders. Arch Dermatol. 2001;137:53-59.
14. Elias PM, Sun R, Eder AR, et al. Treating atopic dermatitis at the source: corrective barrier repair therapy based upon new pathogenic insights. Expert Rev Dermatol. 2013;8:27-36.
15. Morren MA, Przybilla B, Bamelis M, et al. Atopic dermatitis: triggering factors. J Am Acad Dermatol. 1994;31:467-473.
16. Faulstich ME, Williamson DA. An overview of atopic dermatitis: toward a bio-behavioural integration. J Psychosom Res. 1985;29:647-654.
17. Theoharides TC, Donelan JM, Papadopoulou N, et al. Mast cells as targets of corticotropin-releasing factor and related peptides. Trends Pharmacol Sci. 2004;25:563-568.
18. Suh DH, Kwon HH. What’s new in the physiopathology of acne [published online ahead of print Jan 24, 2015]? Br J Dermatol. doi:10.1111/bjd.13634.
19. Picardi A, Mazzotti E, Pasquini P. Prevalence and correlates of suicidal ideation among patients with skin disease. J Am Acad Dermatol. 2006;54:420-426.
20. Ponarovsky B, Amital D, Lazarov A, et al. Anxiety and depression in patients with allergic and non-allergic cutaneous disorders. Int J Dermatol. 2011;50:1217-1222.
21. Khalsa SB. Yoga as a therapeutic intervention: a bibliometric analysis of published research studies. Indian J Physiol Pharmacol. 2004;48:269-285.
22. Cramer H, Lauche R, Dobos G. Characteristics of randomized controlled trials of yoga: a bibliometric analysis. BMC Complement Altern Med. 2014;14:328.
23. Granath J, Ingvarsson S, von Thiele U, et al. Stress management: a randomized study of cognitive behavioural therapy and yoga. Cogn Behav Ther. 2006;35:3-10.
24. Carlson LE, Beattie TL, Giese-Davis J, et al. Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors. Cancer. 2015;121:476-484.
25. Kabat-Zinn J, Wheeler E, Light T, et al. Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosom Med. 1998;60:625-632.
26. Gisondi P, Galvan A, Idolazzi L, et al. Management of moderate to severe psoriasis in patients with metabolic comorbidities. Front Med (Lausanne). 2015;2:1.
1. Dangerfield A. Yoga wars. BBC News. http://news.bbc.co.uk/1/hi/7844691.stm. Published January 23, 2009. Accessed March 25, 2015.
2. Yoga Journal releases 2012 yoga in America market study [press release]. San Francisco, CA: Yoga Journal; December 6, 2012.
3. De Michaelis E. A History of Modern Yoga: Patanjali and Western Esotericism. London, United Kingdom: A&C Black; 2005.
4. Telles S, Singh N, Yadav A, et al. Effect of yoga on different aspects of mental health. Indian J Physiol Pharmacol. 2012;56:245-254.
5. Rodriguez-Vallecillo E, Woodbury-Fariña MA. Dermatological manifestations of stress in normal and psychiatric populations. Psychiatr Clin North Am. 2014;37:625-651.
6. Stander S, Raap U, Weisshaar E, et al. Pathogenesis of pruritus. J Dtsch Dermatol Ges. 2011;9:456-463.
7. Arck PC, Slominski A, Theoharides TC, et al. Neuroimmunology of stress: skin takes center stage. J Invest Dermatol. 2006;126:1697-1704.
8. Recognizing the mind-skin connection. Harvard Health Publications Web site. http://www.health.harvard.edu/newsletter_article/Recognizing_the_mind-skin_connection. Published November 1, 2006. Accessed March 31, 2015.
9. Tausk F, Elenkov I, Moynihan J. Psychoneuroimmunology. Dermatol Ther. 2008;21:22-31.
10. Pavlovic S, Liezmann C, Blois SM, et al. Substance P is a key mediator of stress-induced protection from allergic sensitization via modified antigen presentation. J Immunol. 2011;186:848-855.
11. Toyoda M, Nakamura M, Makino T, et al. Nerve growth factor and substance P are useful plasma markers of disease activity in atopic dermatitis. Br J Dermatol. 2002;147:71-79.
12. Koo JYM, Lee CS. General approach to evaluating psychodermatological disorders. In: Koo JYM, Lee CS, eds. Psychocutaneous Medicine. New York, NY: Marcel Dekker; 2003:1-29.
13. Garg A, Chren MM, Sands LP, et al. Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders. Arch Dermatol. 2001;137:53-59.
14. Elias PM, Sun R, Eder AR, et al. Treating atopic dermatitis at the source: corrective barrier repair therapy based upon new pathogenic insights. Expert Rev Dermatol. 2013;8:27-36.
15. Morren MA, Przybilla B, Bamelis M, et al. Atopic dermatitis: triggering factors. J Am Acad Dermatol. 1994;31:467-473.
16. Faulstich ME, Williamson DA. An overview of atopic dermatitis: toward a bio-behavioural integration. J Psychosom Res. 1985;29:647-654.
17. Theoharides TC, Donelan JM, Papadopoulou N, et al. Mast cells as targets of corticotropin-releasing factor and related peptides. Trends Pharmacol Sci. 2004;25:563-568.
18. Suh DH, Kwon HH. What’s new in the physiopathology of acne [published online ahead of print Jan 24, 2015]? Br J Dermatol. doi:10.1111/bjd.13634.
19. Picardi A, Mazzotti E, Pasquini P. Prevalence and correlates of suicidal ideation among patients with skin disease. J Am Acad Dermatol. 2006;54:420-426.
20. Ponarovsky B, Amital D, Lazarov A, et al. Anxiety and depression in patients with allergic and non-allergic cutaneous disorders. Int J Dermatol. 2011;50:1217-1222.
21. Khalsa SB. Yoga as a therapeutic intervention: a bibliometric analysis of published research studies. Indian J Physiol Pharmacol. 2004;48:269-285.
22. Cramer H, Lauche R, Dobos G. Characteristics of randomized controlled trials of yoga: a bibliometric analysis. BMC Complement Altern Med. 2014;14:328.
23. Granath J, Ingvarsson S, von Thiele U, et al. Stress management: a randomized study of cognitive behavioural therapy and yoga. Cogn Behav Ther. 2006;35:3-10.
24. Carlson LE, Beattie TL, Giese-Davis J, et al. Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors. Cancer. 2015;121:476-484.
25. Kabat-Zinn J, Wheeler E, Light T, et al. Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosom Med. 1998;60:625-632.
26. Gisondi P, Galvan A, Idolazzi L, et al. Management of moderate to severe psoriasis in patients with metabolic comorbidities. Front Med (Lausanne). 2015;2:1.
TWEAK/Fn14 interactions associated with cutaneous lupus pathogenesis
Interactions between TNF-like weak inducer of apoptosis and its receptor Fn14 are significantly associated with the pathogenesis of cutaneous lupus, according to Dr. Jessica Doerner and her associates.
Treating murine keratinocytes with TWEAK stimulated both RANTES, a T cell important in the pathogenesis of psoriasis and atopic dermatitis, and apoptosis, indicating the presence of the Fn14 receptor. Ultraviolet B radiation also increased Fn14 expression and RANTES production, with the effect further increased when both TWEAK and UVB light were present. In a small human sample, three out of three skin samples from lesional lupus patients showed significant Fn14 staining.
“We propose that the TWEAK/Fn14 axis contributes to the pathogenesis of cutaneous lupus, and that this signaling pathway represents a potential therapeutic target for biological agents,” the investigators concluded.
Find the full study in the Journal of Investigative Dermatology (doi: 10.1038/jid.2015.124).
Interactions between TNF-like weak inducer of apoptosis and its receptor Fn14 are significantly associated with the pathogenesis of cutaneous lupus, according to Dr. Jessica Doerner and her associates.
Treating murine keratinocytes with TWEAK stimulated both RANTES, a T cell important in the pathogenesis of psoriasis and atopic dermatitis, and apoptosis, indicating the presence of the Fn14 receptor. Ultraviolet B radiation also increased Fn14 expression and RANTES production, with the effect further increased when both TWEAK and UVB light were present. In a small human sample, three out of three skin samples from lesional lupus patients showed significant Fn14 staining.
“We propose that the TWEAK/Fn14 axis contributes to the pathogenesis of cutaneous lupus, and that this signaling pathway represents a potential therapeutic target for biological agents,” the investigators concluded.
Find the full study in the Journal of Investigative Dermatology (doi: 10.1038/jid.2015.124).
Interactions between TNF-like weak inducer of apoptosis and its receptor Fn14 are significantly associated with the pathogenesis of cutaneous lupus, according to Dr. Jessica Doerner and her associates.
Treating murine keratinocytes with TWEAK stimulated both RANTES, a T cell important in the pathogenesis of psoriasis and atopic dermatitis, and apoptosis, indicating the presence of the Fn14 receptor. Ultraviolet B radiation also increased Fn14 expression and RANTES production, with the effect further increased when both TWEAK and UVB light were present. In a small human sample, three out of three skin samples from lesional lupus patients showed significant Fn14 staining.
“We propose that the TWEAK/Fn14 axis contributes to the pathogenesis of cutaneous lupus, and that this signaling pathway represents a potential therapeutic target for biological agents,” the investigators concluded.
Find the full study in the Journal of Investigative Dermatology (doi: 10.1038/jid.2015.124).
VIDEO: Expert compares current atopic dermatitis guidelines
SAN FRANCISCO – Guidelines on atopic dermatitis from the American Academy of Dermatology and the Joint Task Force on Practice Parameters differ in a few important ways.
Dr. Peter Lio of Northwestern University, Chicago, summarized similarities and differences between the guidelines, discussed subtypes of atopic dermatitis, and shared tips on educating parents about food allergies and eczema in an interview at the annual meeting of the American Academy of Dermatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
SAN FRANCISCO – Guidelines on atopic dermatitis from the American Academy of Dermatology and the Joint Task Force on Practice Parameters differ in a few important ways.
Dr. Peter Lio of Northwestern University, Chicago, summarized similarities and differences between the guidelines, discussed subtypes of atopic dermatitis, and shared tips on educating parents about food allergies and eczema in an interview at the annual meeting of the American Academy of Dermatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
SAN FRANCISCO – Guidelines on atopic dermatitis from the American Academy of Dermatology and the Joint Task Force on Practice Parameters differ in a few important ways.
Dr. Peter Lio of Northwestern University, Chicago, summarized similarities and differences between the guidelines, discussed subtypes of atopic dermatitis, and shared tips on educating parents about food allergies and eczema in an interview at the annual meeting of the American Academy of Dermatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT THE AAD ANNUAL MEETING
Pimecrolimus cream safe, effective for atopic dermatitis in young children
Using pimecrolimus cream as a first-line treatment for atopic dermatitis in infants spares the need for topical corticosteroids as frequently and appears safe over the long term, according to a study published online March 23 in Pediatrics.
“The efficacy results suggest that pimecrolimus has similar efficacy to topical corticosteroids in a real-world setting, which is noteworthy because pimecrolimus is not currently widely used as first-line therapy for atopic dermatitis, given the perception of lower efficacy than topical corticosteroids,” Dr. Bardur Sigurgeirsson of the University of Iceland, Reykjavik, and his associates said.
The researchers randomized 2,418 infants, between ages 3 and 12 months, to receive either pimecrolimus 1% cream, a noncorticosteroid topical calcineurin inhibitor that selectively suppresses activation of T cells and mast cells, or topical corticosteroids to treat mild to moderate atopic dermatitis affecting at least 5% of body surface area. The 1,205 infants receiving the pimecrolimus cream also received topical corticosteroids to treat short-term disease flares. Corticosteroids used were typically either 1% hydrocortisone or 0.1% hydrocortisone butyrate cream.
Success was defined as a 0 (clear) or 1 (mostly clear) on the Investigator’s Global Assessment scale, which ranges from 0 to 5.
More than half of the patients in both groups experienced cleared symptoms within the first three weeks (52.6% with pimecrolimus and 50.5% with corticosteroids). Five years later, among 1,710 patients still enrolled, 88.7% receiving pimecrolimus and 92.3% receiving corticosteroids had overall success. Facial treatment success was seen in 96.6% of infants in the pimecrolimus group and 97.2% of of those in the corticosteroids group, Dr. Sigurgeirsson and associates reported (Pediatrics 2015 March 23 [doi: 10.1542/peds.2014-1990]).
Those receiving pimecrolimus only required topical corticosteroids for a median 7 days, compared to 178 days in the corticosteroids group over the 5-year period. Just over a third (36%) of pimecrolimus patients never used topical corticosteroids.
Both groups experienced similar rates of adverse events, and neither showed negative effects on children’s humoral or cellular immunity, with similar antibody responses in both groups to routine vaccinations. Both groups also had similar growth rates, the investigators reported.
Using pimecrolimus cream as a first-line treatment for atopic dermatitis in infants spares the need for topical corticosteroids as frequently and appears safe over the long term, according to a study published online March 23 in Pediatrics.
“The efficacy results suggest that pimecrolimus has similar efficacy to topical corticosteroids in a real-world setting, which is noteworthy because pimecrolimus is not currently widely used as first-line therapy for atopic dermatitis, given the perception of lower efficacy than topical corticosteroids,” Dr. Bardur Sigurgeirsson of the University of Iceland, Reykjavik, and his associates said.
The researchers randomized 2,418 infants, between ages 3 and 12 months, to receive either pimecrolimus 1% cream, a noncorticosteroid topical calcineurin inhibitor that selectively suppresses activation of T cells and mast cells, or topical corticosteroids to treat mild to moderate atopic dermatitis affecting at least 5% of body surface area. The 1,205 infants receiving the pimecrolimus cream also received topical corticosteroids to treat short-term disease flares. Corticosteroids used were typically either 1% hydrocortisone or 0.1% hydrocortisone butyrate cream.
Success was defined as a 0 (clear) or 1 (mostly clear) on the Investigator’s Global Assessment scale, which ranges from 0 to 5.
More than half of the patients in both groups experienced cleared symptoms within the first three weeks (52.6% with pimecrolimus and 50.5% with corticosteroids). Five years later, among 1,710 patients still enrolled, 88.7% receiving pimecrolimus and 92.3% receiving corticosteroids had overall success. Facial treatment success was seen in 96.6% of infants in the pimecrolimus group and 97.2% of of those in the corticosteroids group, Dr. Sigurgeirsson and associates reported (Pediatrics 2015 March 23 [doi: 10.1542/peds.2014-1990]).
Those receiving pimecrolimus only required topical corticosteroids for a median 7 days, compared to 178 days in the corticosteroids group over the 5-year period. Just over a third (36%) of pimecrolimus patients never used topical corticosteroids.
Both groups experienced similar rates of adverse events, and neither showed negative effects on children’s humoral or cellular immunity, with similar antibody responses in both groups to routine vaccinations. Both groups also had similar growth rates, the investigators reported.
Using pimecrolimus cream as a first-line treatment for atopic dermatitis in infants spares the need for topical corticosteroids as frequently and appears safe over the long term, according to a study published online March 23 in Pediatrics.
“The efficacy results suggest that pimecrolimus has similar efficacy to topical corticosteroids in a real-world setting, which is noteworthy because pimecrolimus is not currently widely used as first-line therapy for atopic dermatitis, given the perception of lower efficacy than topical corticosteroids,” Dr. Bardur Sigurgeirsson of the University of Iceland, Reykjavik, and his associates said.
The researchers randomized 2,418 infants, between ages 3 and 12 months, to receive either pimecrolimus 1% cream, a noncorticosteroid topical calcineurin inhibitor that selectively suppresses activation of T cells and mast cells, or topical corticosteroids to treat mild to moderate atopic dermatitis affecting at least 5% of body surface area. The 1,205 infants receiving the pimecrolimus cream also received topical corticosteroids to treat short-term disease flares. Corticosteroids used were typically either 1% hydrocortisone or 0.1% hydrocortisone butyrate cream.
Success was defined as a 0 (clear) or 1 (mostly clear) on the Investigator’s Global Assessment scale, which ranges from 0 to 5.
More than half of the patients in both groups experienced cleared symptoms within the first three weeks (52.6% with pimecrolimus and 50.5% with corticosteroids). Five years later, among 1,710 patients still enrolled, 88.7% receiving pimecrolimus and 92.3% receiving corticosteroids had overall success. Facial treatment success was seen in 96.6% of infants in the pimecrolimus group and 97.2% of of those in the corticosteroids group, Dr. Sigurgeirsson and associates reported (Pediatrics 2015 March 23 [doi: 10.1542/peds.2014-1990]).
Those receiving pimecrolimus only required topical corticosteroids for a median 7 days, compared to 178 days in the corticosteroids group over the 5-year period. Just over a third (36%) of pimecrolimus patients never used topical corticosteroids.
Both groups experienced similar rates of adverse events, and neither showed negative effects on children’s humoral or cellular immunity, with similar antibody responses in both groups to routine vaccinations. Both groups also had similar growth rates, the investigators reported.
FROM PEDIATRICS
Key clinical point: Pimecrolimus cream is a safe, effective alternative to topical corticosteroids for atopic dermatitis beginning in infancy.
Major finding:After five years, 88.7% of children receiving pimecrolimus cream and 92.3% of children receiving topical corticosteroids achieved overall clearing (IGA score of 0 or 1). Over 95% in both groups achieved facial clearing.
Data source:The findings are based on a 5-year, open-label, multicenter, randomized parallel group trial with 2,418 infants, ages 3 to 12 months, receiving either pimecrolimus 1% cream or topical corticosteroids for treatment of atopic dermatitis.
Disclosures: The research was funded by Novartis Pharmaceuticals Corporation with editorial funding assistance from Meda Pharma GmbH & Co. Dr. Sigurgeirsson and coauthors have various associations with Novartis, Valeant, Astellas, Meda, Galderma, Amgen, Topica, Viamet, Prostrakan and Stiefel. One coauthor is an employee of Meda.
Dupilumab improves moderate to severe atopic dermatitis in adults
SAN FRANCISCO– Dupilumab met its safety endpoints and significantly outperformed placebo for adults with moderate to severe atopic dermatitis, according to final results of a multicenter, international phase IIb study.
At all five doses tested, the biologic significantly improved atopic dermatitis (AD) compared with placebo based on multiple clinical measures, Dr. Lisa A. Beck said at the annual meeting of the American Academy of Dermatology. The highest dose of 300 mg given either weekly or every two weeks provided the most consistent benefits, added Dr. Beck of the University of Rochester Medical Center, Rochester, New York.
Atopic dermatitis (eczema) is caused by immune dysregulation and altered skin barrier function, though the relative contribution of each process is still under debate, Dr. Beck said. Dupilumab is a monoclonal antibody designed to block intracellular signaling by the interleukin 4 and IL-13 cytokines, which are thought to mediate many features of AD.
The study included 380 patients in Europe, the United States, Canada, and Japan who had moderate to severe AD that was inadequately controlled by topical corticosteroids or calcineurin inhibitors. At baseline, patients had been living with AD for more than three years and at least 10% of their body surface area was affected. Patients were randomized to weekly, biweekly, or monthly subcutaneous injections of dupilumab at doses of 300 mg, 200 mg, or 100 mg, or to placebo. The groups were demographically similar.
After 16 weeks of treatment, a linear regression model of Eczema Area and Severity Index (EASI) scores strongly favored dupilumab over placebo and indicated a dose-response trend, Dr. Beck reported. Based on the model, EASI scores dropped by about 45% for the low-dose group, by 63% to 65% for the intermediate-dose groups, by 68% for the high-dose group treated every two weeks, and by almost 74% for patients treated with 300 mg weekly. In contrast, the placebo group improved by about 18% (all P-values < .0001).
About 80% of patients who received the most intensive regimen (300 mg dupilumab weekly) achieved EASI-50, while about 60% achieved EASI-75 and close to 40% achieved EASI-90 (all P-values < .0001 compared with placebo). Responses for the lower-dose cohorts again indicated a dose-response trend. “Even the lowest dose showed an improvement, but it tended to lose that effect through the treatment phase,” Dr. Beck said.
Dupilumab also beat placebo on the Scoring Atopic Dermatitis (SCORAD) assessment, with estimated improvements in AD ranging from 26% for the low-dose group to the 57% for the high-dose group treated weekly, compared with about 14% for placebo (P < .05). Analyses of body surface area (BSA) ranged from about a 26% improvement for the low-dose group to more than 65% for the highest-dose, compared with about 8% for placebo (P < .05).
“We saw really significant drops in BSA with the highest dose group, and the BSA response was very much in line with the response in terms of signs of the disease,” Dr. Beck said. During every week of treatment, patients on dupilumab also reported significant improvements in pruritus compared with placebo based on a numerical rating scale.
Researchers assessed dupilumab’s safety through week 32, and found no dose-limiting adverse events. The dupilumab groups had slightly greater rates of headache, injection site reactions, and conjunctivitis. “We did see a trend of slightly greater herpes infections in the dupilumab-treated patients,” Dr. Beck said. “But if you look at other viral infections, there was no difference, and also herpes infections were highest in the lowest dose group. More studies need to be done to ferret out whether that’s real.”
Regeneron Pharmaceuticals is the maker of dupilumab. Dr. Beck reported having been the principal investigator at her site for the Regeneron trials of dupilumab in AD, and having consulted with the company on study design. She reported having no other relevant disclosures.
SAN FRANCISCO– Dupilumab met its safety endpoints and significantly outperformed placebo for adults with moderate to severe atopic dermatitis, according to final results of a multicenter, international phase IIb study.
At all five doses tested, the biologic significantly improved atopic dermatitis (AD) compared with placebo based on multiple clinical measures, Dr. Lisa A. Beck said at the annual meeting of the American Academy of Dermatology. The highest dose of 300 mg given either weekly or every two weeks provided the most consistent benefits, added Dr. Beck of the University of Rochester Medical Center, Rochester, New York.
Atopic dermatitis (eczema) is caused by immune dysregulation and altered skin barrier function, though the relative contribution of each process is still under debate, Dr. Beck said. Dupilumab is a monoclonal antibody designed to block intracellular signaling by the interleukin 4 and IL-13 cytokines, which are thought to mediate many features of AD.
The study included 380 patients in Europe, the United States, Canada, and Japan who had moderate to severe AD that was inadequately controlled by topical corticosteroids or calcineurin inhibitors. At baseline, patients had been living with AD for more than three years and at least 10% of their body surface area was affected. Patients were randomized to weekly, biweekly, or monthly subcutaneous injections of dupilumab at doses of 300 mg, 200 mg, or 100 mg, or to placebo. The groups were demographically similar.
After 16 weeks of treatment, a linear regression model of Eczema Area and Severity Index (EASI) scores strongly favored dupilumab over placebo and indicated a dose-response trend, Dr. Beck reported. Based on the model, EASI scores dropped by about 45% for the low-dose group, by 63% to 65% for the intermediate-dose groups, by 68% for the high-dose group treated every two weeks, and by almost 74% for patients treated with 300 mg weekly. In contrast, the placebo group improved by about 18% (all P-values < .0001).
About 80% of patients who received the most intensive regimen (300 mg dupilumab weekly) achieved EASI-50, while about 60% achieved EASI-75 and close to 40% achieved EASI-90 (all P-values < .0001 compared with placebo). Responses for the lower-dose cohorts again indicated a dose-response trend. “Even the lowest dose showed an improvement, but it tended to lose that effect through the treatment phase,” Dr. Beck said.
Dupilumab also beat placebo on the Scoring Atopic Dermatitis (SCORAD) assessment, with estimated improvements in AD ranging from 26% for the low-dose group to the 57% for the high-dose group treated weekly, compared with about 14% for placebo (P < .05). Analyses of body surface area (BSA) ranged from about a 26% improvement for the low-dose group to more than 65% for the highest-dose, compared with about 8% for placebo (P < .05).
“We saw really significant drops in BSA with the highest dose group, and the BSA response was very much in line with the response in terms of signs of the disease,” Dr. Beck said. During every week of treatment, patients on dupilumab also reported significant improvements in pruritus compared with placebo based on a numerical rating scale.
Researchers assessed dupilumab’s safety through week 32, and found no dose-limiting adverse events. The dupilumab groups had slightly greater rates of headache, injection site reactions, and conjunctivitis. “We did see a trend of slightly greater herpes infections in the dupilumab-treated patients,” Dr. Beck said. “But if you look at other viral infections, there was no difference, and also herpes infections were highest in the lowest dose group. More studies need to be done to ferret out whether that’s real.”
Regeneron Pharmaceuticals is the maker of dupilumab. Dr. Beck reported having been the principal investigator at her site for the Regeneron trials of dupilumab in AD, and having consulted with the company on study design. She reported having no other relevant disclosures.
SAN FRANCISCO– Dupilumab met its safety endpoints and significantly outperformed placebo for adults with moderate to severe atopic dermatitis, according to final results of a multicenter, international phase IIb study.
At all five doses tested, the biologic significantly improved atopic dermatitis (AD) compared with placebo based on multiple clinical measures, Dr. Lisa A. Beck said at the annual meeting of the American Academy of Dermatology. The highest dose of 300 mg given either weekly or every two weeks provided the most consistent benefits, added Dr. Beck of the University of Rochester Medical Center, Rochester, New York.
Atopic dermatitis (eczema) is caused by immune dysregulation and altered skin barrier function, though the relative contribution of each process is still under debate, Dr. Beck said. Dupilumab is a monoclonal antibody designed to block intracellular signaling by the interleukin 4 and IL-13 cytokines, which are thought to mediate many features of AD.
The study included 380 patients in Europe, the United States, Canada, and Japan who had moderate to severe AD that was inadequately controlled by topical corticosteroids or calcineurin inhibitors. At baseline, patients had been living with AD for more than three years and at least 10% of their body surface area was affected. Patients were randomized to weekly, biweekly, or monthly subcutaneous injections of dupilumab at doses of 300 mg, 200 mg, or 100 mg, or to placebo. The groups were demographically similar.
After 16 weeks of treatment, a linear regression model of Eczema Area and Severity Index (EASI) scores strongly favored dupilumab over placebo and indicated a dose-response trend, Dr. Beck reported. Based on the model, EASI scores dropped by about 45% for the low-dose group, by 63% to 65% for the intermediate-dose groups, by 68% for the high-dose group treated every two weeks, and by almost 74% for patients treated with 300 mg weekly. In contrast, the placebo group improved by about 18% (all P-values < .0001).
About 80% of patients who received the most intensive regimen (300 mg dupilumab weekly) achieved EASI-50, while about 60% achieved EASI-75 and close to 40% achieved EASI-90 (all P-values < .0001 compared with placebo). Responses for the lower-dose cohorts again indicated a dose-response trend. “Even the lowest dose showed an improvement, but it tended to lose that effect through the treatment phase,” Dr. Beck said.
Dupilumab also beat placebo on the Scoring Atopic Dermatitis (SCORAD) assessment, with estimated improvements in AD ranging from 26% for the low-dose group to the 57% for the high-dose group treated weekly, compared with about 14% for placebo (P < .05). Analyses of body surface area (BSA) ranged from about a 26% improvement for the low-dose group to more than 65% for the highest-dose, compared with about 8% for placebo (P < .05).
“We saw really significant drops in BSA with the highest dose group, and the BSA response was very much in line with the response in terms of signs of the disease,” Dr. Beck said. During every week of treatment, patients on dupilumab also reported significant improvements in pruritus compared with placebo based on a numerical rating scale.
Researchers assessed dupilumab’s safety through week 32, and found no dose-limiting adverse events. The dupilumab groups had slightly greater rates of headache, injection site reactions, and conjunctivitis. “We did see a trend of slightly greater herpes infections in the dupilumab-treated patients,” Dr. Beck said. “But if you look at other viral infections, there was no difference, and also herpes infections were highest in the lowest dose group. More studies need to be done to ferret out whether that’s real.”
Regeneron Pharmaceuticals is the maker of dupilumab. Dr. Beck reported having been the principal investigator at her site for the Regeneron trials of dupilumab in AD, and having consulted with the company on study design. She reported having no other relevant disclosures.
Key clinical point: Dupilumab met its safety endpoints and significantly outperformed placebo on several clinical measures for adults with moderate to severe atopic dermatitis.
Major finding: EASI scores dropped significantly at all dupilumab doses compared with placebo. Patients in the highest-dose group (300 mg weekly) improved by 74%, compared with 18% for placebo.
Data source: Sixteen-week randomized phase IIb trial comparing dupilumab with placebo in 380 patients.
Disclosures: Dr. Beck reported having been the principal investigator at her site for the Regeneron trials of dupilumab in atopic dermatitis, and having consulted with Regeneron Pharmaceuticals on study design. She reported having no other relevant disclosures.
Boron-based cream shows promise for pediatric atopic dermatitis
SAN FRANCISCO– An investigational topical ointment met its safety endpoints and showed signs of efficacy in children and adolescents with mild to moderate atopic dermatitis, according to a small phase II study.
Four weeks of twice-daily treatment with the AN2728 agent yielded an average 78% reduction in affected body surface area, reported Dr. Zoe Draelos at the annual meeting of the American Academy of Dermatology.
At day 29, 65% of patients had achieved Investigator’s Static Global Assessment (ISGA) scores of clear or almost clear, and 47% of patients had achieved those scores plus at least a two-grade improvement from baseline, said Dr. Draelos, a dermatologist in High Point, North Carolina.
The ointment is a 2% formulation of AN2728, a small-molecule compound based on elemental boron that works by suppressing phosphodiesterase type 4 activity, which in turn inhibits the release of cytokines such as TNF-alpha, IL-12, and IL-23. Investigators assessed its safety, pharmacokinetics, and effects on the signs and symptoms of atopic dermatitis (AD), as well as changes in the percentage of body surface area affected and disease severity based on the five-point IGSA scale, ranging from 0 (clear) to 4 (severe disease).
The study enrolled 34 patients aged two to 17 years who had AD affecting 25% to 35% of body surface area. The cream was applied twice daily for 28 days, which was done in the clinic for the first eight days to ensure maximum exposure to the agent.
Plasma levels of the agent measured on days 1 and 8 were low and resembled those previously observed for adults after adjusting for the percentage of body surface area treated. Twelve of the 34 patients had application site reactions, which included paresthesia, papules, itching, and burning, most of which were mild to moderate and resolved spontaneously. However, one patient withdrew from the study because of pain at the application site.
Patients had “marked” reductions in AD signs and symptoms, Dr. Draelos reported. Pruritus scores dropped an average of 60%, with improvements starting on about day 5 of treatment that leveled off at about day 15, she added. The investigators saw similar trends for erythema, lichenification, excoriation, and exudation.
Because patients were not allowed to use emollients during treatment, the adverse events observed were directly tied to twice-daily use of the product, Dr. Draelos noted.
Researchers are enrolling patients in phase III trials of AN2728, with data expected later in 2015, according to a press release from Anacor Pharmaceuticals, which makes the agent. Two carcinogenicity studies wrapped up earlier this year and yielded no evidence of malignancies, the company also reported.
Anacor sponsored the study. Dr. Draelos reported having served as a researcher for and receiving grant support from Anacor for the work.
SAN FRANCISCO– An investigational topical ointment met its safety endpoints and showed signs of efficacy in children and adolescents with mild to moderate atopic dermatitis, according to a small phase II study.
Four weeks of twice-daily treatment with the AN2728 agent yielded an average 78% reduction in affected body surface area, reported Dr. Zoe Draelos at the annual meeting of the American Academy of Dermatology.
At day 29, 65% of patients had achieved Investigator’s Static Global Assessment (ISGA) scores of clear or almost clear, and 47% of patients had achieved those scores plus at least a two-grade improvement from baseline, said Dr. Draelos, a dermatologist in High Point, North Carolina.
The ointment is a 2% formulation of AN2728, a small-molecule compound based on elemental boron that works by suppressing phosphodiesterase type 4 activity, which in turn inhibits the release of cytokines such as TNF-alpha, IL-12, and IL-23. Investigators assessed its safety, pharmacokinetics, and effects on the signs and symptoms of atopic dermatitis (AD), as well as changes in the percentage of body surface area affected and disease severity based on the five-point IGSA scale, ranging from 0 (clear) to 4 (severe disease).
The study enrolled 34 patients aged two to 17 years who had AD affecting 25% to 35% of body surface area. The cream was applied twice daily for 28 days, which was done in the clinic for the first eight days to ensure maximum exposure to the agent.
Plasma levels of the agent measured on days 1 and 8 were low and resembled those previously observed for adults after adjusting for the percentage of body surface area treated. Twelve of the 34 patients had application site reactions, which included paresthesia, papules, itching, and burning, most of which were mild to moderate and resolved spontaneously. However, one patient withdrew from the study because of pain at the application site.
Patients had “marked” reductions in AD signs and symptoms, Dr. Draelos reported. Pruritus scores dropped an average of 60%, with improvements starting on about day 5 of treatment that leveled off at about day 15, she added. The investigators saw similar trends for erythema, lichenification, excoriation, and exudation.
Because patients were not allowed to use emollients during treatment, the adverse events observed were directly tied to twice-daily use of the product, Dr. Draelos noted.
Researchers are enrolling patients in phase III trials of AN2728, with data expected later in 2015, according to a press release from Anacor Pharmaceuticals, which makes the agent. Two carcinogenicity studies wrapped up earlier this year and yielded no evidence of malignancies, the company also reported.
Anacor sponsored the study. Dr. Draelos reported having served as a researcher for and receiving grant support from Anacor for the work.
SAN FRANCISCO– An investigational topical ointment met its safety endpoints and showed signs of efficacy in children and adolescents with mild to moderate atopic dermatitis, according to a small phase II study.
Four weeks of twice-daily treatment with the AN2728 agent yielded an average 78% reduction in affected body surface area, reported Dr. Zoe Draelos at the annual meeting of the American Academy of Dermatology.
At day 29, 65% of patients had achieved Investigator’s Static Global Assessment (ISGA) scores of clear or almost clear, and 47% of patients had achieved those scores plus at least a two-grade improvement from baseline, said Dr. Draelos, a dermatologist in High Point, North Carolina.
The ointment is a 2% formulation of AN2728, a small-molecule compound based on elemental boron that works by suppressing phosphodiesterase type 4 activity, which in turn inhibits the release of cytokines such as TNF-alpha, IL-12, and IL-23. Investigators assessed its safety, pharmacokinetics, and effects on the signs and symptoms of atopic dermatitis (AD), as well as changes in the percentage of body surface area affected and disease severity based on the five-point IGSA scale, ranging from 0 (clear) to 4 (severe disease).
The study enrolled 34 patients aged two to 17 years who had AD affecting 25% to 35% of body surface area. The cream was applied twice daily for 28 days, which was done in the clinic for the first eight days to ensure maximum exposure to the agent.
Plasma levels of the agent measured on days 1 and 8 were low and resembled those previously observed for adults after adjusting for the percentage of body surface area treated. Twelve of the 34 patients had application site reactions, which included paresthesia, papules, itching, and burning, most of which were mild to moderate and resolved spontaneously. However, one patient withdrew from the study because of pain at the application site.
Patients had “marked” reductions in AD signs and symptoms, Dr. Draelos reported. Pruritus scores dropped an average of 60%, with improvements starting on about day 5 of treatment that leveled off at about day 15, she added. The investigators saw similar trends for erythema, lichenification, excoriation, and exudation.
Because patients were not allowed to use emollients during treatment, the adverse events observed were directly tied to twice-daily use of the product, Dr. Draelos noted.
Researchers are enrolling patients in phase III trials of AN2728, with data expected later in 2015, according to a press release from Anacor Pharmaceuticals, which makes the agent. Two carcinogenicity studies wrapped up earlier this year and yielded no evidence of malignancies, the company also reported.
Anacor sponsored the study. Dr. Draelos reported having served as a researcher for and receiving grant support from Anacor for the work.
Key clinical point:The investigational agent AN2728 met its safety endpoints and showed signs of efficacy in a phase II trial of pediatric atopic dermatitis.
Major finding:Four weeks of twice-daily treatment with the topical cream yielded an average 78% reduction in affected body surface area.
Data source: Phase II trial of 34 children and adolescents with mild to moderate atopic dermatitis.
Disclosures: Anacor Pharmaceuticals sponsored the study. Dr. Draelos reported having served as a researcher for and receiving grant support from Anacor for the work.
Contact allergen of 2015: Formaldehyde
SAN FRANCISCO – Formaldehyde has been named the American Contact Dermatitis Society Contact Allergen of the Year for 2015, Dr. David E. Cohen said in the hot topics session at the annual meeting of the American Academy of Dermatology.
Formaldehyde has been a factor in contact dermatitis for a long time, and exposure to it is widespread, said Dr. Cohen of New York University.
However, recent studies have reassessed the clinical relevance of formaldehyde allergy, and a patch test concentration of 2.0% has been recommended by the European Environmental Contact Dermatitis Research group, according to a report published in the journal Dermatitis (Dermatitis 2015;26:3-6).
“Without causing any more irritant reactions, the patch test concentration of 2.0% detects twice as many contact allergies and enables the diagnosis of formaldehyde-allergic patients who otherwise would have been missed,” the authors wrote.
SAN FRANCISCO – Formaldehyde has been named the American Contact Dermatitis Society Contact Allergen of the Year for 2015, Dr. David E. Cohen said in the hot topics session at the annual meeting of the American Academy of Dermatology.
Formaldehyde has been a factor in contact dermatitis for a long time, and exposure to it is widespread, said Dr. Cohen of New York University.
However, recent studies have reassessed the clinical relevance of formaldehyde allergy, and a patch test concentration of 2.0% has been recommended by the European Environmental Contact Dermatitis Research group, according to a report published in the journal Dermatitis (Dermatitis 2015;26:3-6).
“Without causing any more irritant reactions, the patch test concentration of 2.0% detects twice as many contact allergies and enables the diagnosis of formaldehyde-allergic patients who otherwise would have been missed,” the authors wrote.
SAN FRANCISCO – Formaldehyde has been named the American Contact Dermatitis Society Contact Allergen of the Year for 2015, Dr. David E. Cohen said in the hot topics session at the annual meeting of the American Academy of Dermatology.
Formaldehyde has been a factor in contact dermatitis for a long time, and exposure to it is widespread, said Dr. Cohen of New York University.
However, recent studies have reassessed the clinical relevance of formaldehyde allergy, and a patch test concentration of 2.0% has been recommended by the European Environmental Contact Dermatitis Research group, according to a report published in the journal Dermatitis (Dermatitis 2015;26:3-6).
“Without causing any more irritant reactions, the patch test concentration of 2.0% detects twice as many contact allergies and enables the diagnosis of formaldehyde-allergic patients who otherwise would have been missed,” the authors wrote.
AT THE AAD ANNUAL MEETING