Dermatitis atópica en niños y adolescentes asistidos en un hospital general de la Ciudad Autónoma de Buenos Aires / Atopic dermatitis in children and adolescents seen at a general hospital in the City of Buenos Aires

La dermatitis atópica (DA) es una enfermedad inflamatoria de la piel de alta prevalencia en pediatría, de acuerdo a estudios internacionales. Existe escasa información sobre las características epidemiológicas en la población pediátrica Argentina. El objetivo fue describir la prevalencia y características clínicas de la DA en una población de niños argentinos atendidos en el servicio de pediatría de un hospital general. Estudio observacional, de corte transversal. Se incluyeron 500 pacientes al azar, media de edad de 10 años (DE 5), el 50 % (250) de sexo femenino, de los cuales 24 presentaron DA. La prevalencia global fue del 5 % (IC95 % 3-7) y 3/24 fueron formas graves. La comorbilidad atópica más frecuente fue asma. La DA es una enfermedad con una prevalencia en nuestra población similar a la de otros países. Nuestro estudio aporta nuevos datos acerca de las características epidemiológicas de la dermatitis atópica en nuestra región

Atopic dermatitis (AD) is an inflammatory skin disease highly prevalent in pediatrics as per international studies. There is scarce information on the epidemiological characteristics of AD in the Argentine pediatric population. The objective of this study was to describe the prevalence and clinical characteristics of AD in a population of Argentine children seen at the Department of Pediatrics of a general hospital. Observational, cross-sectional study. Five hundred patients were randomly included; their mean age was 10 years (SD: 5); 50% (250) were female. A total of 24 had AD. The overall prevalence was 5% (95% confidence interval: 3­7) and 3/24 were severe forms. The most frequent atopic comorbidity was asthma. The prevalence of AD in our population is similar to that of other countries. Our study provides new data on the epidemiological characteristics of AD in our region.

Epidemiology and healthcare resource utilization in atopic dermatitis in Colombia: A retrospective analysis of data from the National Health Registry from 2015 to 2020 / Epidemiología y uso de recursos de salud en dermatitis atópica en Colombia: análisis retrospectivo de datos del Registro Nacional de Salud de 2015 a 2020

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

Introducción. La dermatitis atópica, también conocida como eczema o eczema atópico, es un trastorno inflamatorio crónico de la piel caracterizado por la presencia de prurito acompañado de picor. En Colombia, la información epidemiológica y de utilización de recursos sanitarios sobre esta enfermedad es limitada. Objetivo. Describir las características epidemiológicas y los patrones de utilización de recursos sanitarios para la dermatitis atópica en Colombia. Materiales y métodos. Se trata de un estudio retrospectivo en el cual se utilizan datos de la práctica clínica real obtenidos del registro nacional SISPRO (Sistema de Información para la Protección Social) en el período 2015-2020. Se extrajeron datos sociodemográficos (incluida la edad y la prestación de servicios de salud), epidemiológicos (incluidos la incidencia, la prevalencia y las comorbilidades) y los correspondientes a la utilización de los recursos sanitarios. Resultados. Los resultados epidemiológicos han demostrado un aumento de la incidencia y prevalencia de la dermatitis atópica en Colombia en el periodo 20182019, en comparación con el periodo 2015-2017. Aumentó el número de consultas médicas (particularmente, con especialistas) de pacientes con dermatitis atópica, el de procedimientos y el de hospitalizaciones. Los corticoides tópicos y sistémicos fueron los medicamentos más prescritos. Conclusiones. Los diagnósticos de dermatitis atópica en Colombia aumentaron con un incremento concomitante en la utilización de recursos sanitarios durante 2015-2020, que posiblemente se vio atenuado por la llegada del Covid-19. Este estudio puede ayudar a los médicos a tener un mejor conocimiento de la enfermedad y, por lo tanto, mejorar el tratamiento de los pacientes con dermatitis atópica.

Development, physicochemical evaluation, and in vivo permeation studies of topical formulations containing 0.1% tacrolimus

Abstract The objective of this paper was to develop and evaluate two semi-solid pharmaceutical forms containing 0.1% tacrolimus: cream (CRT01) and gel (GLT01). For the evaluation of physicochemical stability, at times 0, 30, 60 and 90 days, at 23°C and at 40°C, High Performance Liquid Chromatography coupled with a Diode Array Detector (HPLC-DAD) was employed. This method was developed and validated for tacrolimus quantification. The occlusivity test and skin permeation assay were also performed, using an animal model (Wistar rats), and the CRT01 and GLT01 were compared to the 0.1% tacrolimus ointment (PFU01) obtained from the University Pharmacy, Federal University of Rio de Janeiro, Brazil. CRT01 and GLT01 presented a homogeneous aspect and consistency adequate for topical products, along with sensory characteristics above PFU01. They also presented adequate physicochemical stability for 90 days and a lower occlusive effect than PFU01 (p<0.05). CRT01 showed greater affinity for the skin when compared to PFU01 and GLT01, with low systemic absorption. The CRT01 semi-solid formulation was considered the most adequate one to treat patients with atopic dermatitis or other dermatologic inflammatory diseases, promoting rational use of tacrolimus

Ozonated oil alleviates dinitrochlorobenzene-induced allergic contact dermatitis via inhibiting the FcεRI/Syk signaling pathway / 中南大学学报(医学版)

OBJECTIVES@#Ozone is widely applied to treat allergic skin diseases such as eczema, atopic dermatitis, and contact dermatitis. However, the specific mechanism remains unclear. This study aims to investigate the effects of ozonated oil on treating 2,4-dinitrochlorobenzene (DNCB)-induced allergic contact dermatitis (ACD) and the underling mechanisms.@*METHODS@#Besides the blank control (Ctrl) group, all other mice were treated with DNCB to establish an ACD-like mouse model and were randomized into following groups: a model group, a basal oil group, an ozonated oil group, a FcεRI-overexpressed plasmid (FcεRI-OE) group, and a FcεRI empty plasmid (FcεRI-NC) group. The basal oil group and the ozonated oil group were treated with basal oil and ozonated oil, respectively. The FcεRI-OE group and the FcεRI-NC group were intradermally injected 25 µg FcεRI overexpression plasmid and 25 µg FcεRI empty plasmid when treating with ozonated oil, respectively. We recorded skin lesions daily and used reflectance confocal microscope (RCM) to evaluate thickness and inflammatory changes of skin lesions. Hematoxylin-eosin (HE) staining, real-time PCR, RNA-sequencing (RNA-seq), and immunohistochemistry were performed to detct and analyze the skin lesions.@*RESULTS@#Ozonated oil significantly alleviated DNCB-induced ACD-like dermatitis and reduced the expressions of IFN-γ, IL-17A, IL-1β, TNF-α, and other related inflammatory factors (all P<0.05). RNA-seq analysis revealed that ozonated oil significantly inhibited the activation of the DNCB-induced FcεRI/Syk signaling pathway, confirmed by real-time PCR and immunohistochemistry (all P<0.05). Compared with the ozonated oil group and the FcεRI-NC group, the mRNA expression levels of IFN-γ, IL-17A, IL-1β, IL-6, TNF-α, and other inflammatory genes in the FcεRI-OE group were significantly increased (all P<0.05), and the mRNA and protein expression levels of FcεRI and Syk were significantly elevated in the FcεRI-OE group as well (all P<0.05).@*CONCLUSIONS@#Ozonated oil significantly improves ACD-like dermatitis and alleviated DNCB-induced ACD-like dermatitis via inhibiting the FcεRI/Syk signaling pathway.

Advances in Diagnostic Criteria and Severity Assessment of Atopic Dermatitis / 中国医学科学院学报

Atopic dermatitis(AD),a chronic and relapsing skin disease,is characterized by dry skin and pruritus,severely affecting the quality of patients' life.Accurately grasping the diagnostic criteria and severity assessment is essential and helps to avoid misdiagnosis and missed diagnosis.Moreover,it facilities the development and adjustment of the therapeutic schedule according to the therapeutic reaction and disease control conditions.This article reviews the research advances in the diagnostic criteria and severity assessment of AD.

Dupilumabe e upadacitinibe comparados a medicamentos imunossupressores para o tratamento de dermatite atópica moderada a grave refratária a terapia tópica: revisão rápida de evidências / Dupilumab and upadacitinib compared to immunosuppressive drugs for the treatment of moderate to severe atopic dermatitis refractory to topical therapy: rapid review of evidence

Tecnologia: Dupilumabe e upadacitinibe. Comparadores: Azatioprina, metotrexato, ciclosporina, micofenolato de mofetila. Indicação: Tratamento de dermatite atópica severa em pacientes adultos. Pergunta: Dupilumabe e upadacitinibe são mais eficazes e tão seguros quanto ciclosporina ou outros agentes imunossupressores para obter os desfechos de saúde no tratamento sistêmico de dermatite atópica moderada a grave refratária à terapia atópica? Métodos: Levantamento bibliográfico foi realizado na base de dados PUBMED e Cochrane Library, seguindo estratégias de buscas predefinidas. Foi feita avaliação da qualidade metodológica das revisões sistemáticas com a ferramenta AMSTAR2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Resultados: Foram selecionados três estudos que atenderam aos critérios de inclusão. Conclusão: Dupilumabe, upadacitinibe, ciclosporina e azatioprina são mais eficazes que placebo nos desfechos de eficácia (reduzir sinais clínicos em escalas, reduzir sintomas em escalas) para tratamento da dermatite atópica moderada a grave refratária à terapia tópica, mas esses medicamentos não diferem entre si. Dupilumabe, upadacitinibe, ciclosporina e azatioprina são bem tolerados e seguros

Technology: Dupilumab, upadacitinibe. Comparators: Azathioprine, methotrexate, cyclosporine, mycophenolate mofetil. Indication: Treatment of severe atopic dermatitis in adult patients. Question: Are dupilumab and upadacitinib more effective and as safe as cyclosporine or other immunosuppressive agents for achieving health outcomes in the systemic treatment of moderate to severe atopic dermatitis refractory to atopic therapy? Methods: A bibliographic survey was done in the PUBMED e Cochrane Library databases, following predefined search strategies. The methodological quality of systematic reviews was evaluated using the AMSTAR-2 tool (Assessing the Methodological Quality of Systematic Reviews Version 2). Results: Three studies that met the inclusion criteria were selected. Conclusion: Dupilumab, upadacitinib, cyclosporine, and azathioprine are more effective than placebo on efficacy endpoints (reduce clinical signs on scales, reduce symptoms on scales) for treating moderate to severe atopic dermatitis refractory to topical therapy, but these drugs do not differ from each other. Dupilumab, upadacitinib, cyclosporine, and azathioprine are well tolerated and safe

Validation study of the Chinese version of atopic dermatitis control tool / 中华预防医学杂志

To assess the reliability, validity and responsiveness of the Chinese version of the atopic dermatitis control tool (ADCT). After this study obtained authorization for the Chinese version of the ADCT scale. 114 patients with atopic dermatitis were enrolled from the Department of Dermatology, Peking University First Hospital using convenience sampling from October 2022. Patients were surveyed using the General Information Questionnaire, Chinese version of ADCT, patient-oriented eczema measure (POEM),peak pruritus numerical rating scale (PP-NRS),dermatology life quality index (DLQI) and the global patient self-assessment for disease severity. Mann-Whitney rank sum test and Spearman correlation analysis were used for item analysis; content validity was assessed using content validity index (CVI); exploratory factor analysis was used to assess structural validity; Cronbach' alpha coefficient was used to assess internal consistency; Spearman correlation analysis was used to assess the correlation of ADCT with other scales to assess external responsiveness. The results showed that all items were retained by item analysis. I-CVI was 0.9-1, and S-CVI/Average was 0.983; the scale extracted one common factor by factor analysis, the cumulative variance explanation rate was 77.927%; the Cronbach' alpha coefficient of the scale was 0.937; the correlation coefficients of the Chinese version of ADCT with POEM, PP-NRS, and DLQI were 0.805, 0.861, and 0.709 respectively. In conclusion, the Chinese version of the ADCT has adequate reliability, validity and responsiveness, and is suitable for measuring disease control in Chinese patients with atopic dermatitis.

Factores de riesgo clínicos y sociodemográficos asociados a dermatitis atópica en niños: Un estudio observacional de centro único / Clinical and sociodemographic risk factors associated with atopic dermatitis in children: A single-center observational study

Introducción: La dermatitis atópica es un trastorno cutá-neo atópico, inflamatorio de tipo crónico con aparición más frecuente en niños antes de los 5 años de edad. El objetivo del presente estudio fue determinar factores de riesgo clínicos y sociodemográficos asociados a dermatitis atópica en un grupo de niños escolares en Riobamba-Ecuador. Métodos: El presente estudio observacional incluyó escolares en el periodo junio - agosto 2020. Con una muestra probabilística se incluyeron casos con dermatitis atópica (DA) y un grupo control. Las variables fueron Dermatitis atópica, edad, sexo, antecedentes familiares y personales de atopia, exposición materna al humo del tabaco en el período de gestación o en la infancia, duración de lactancia materna exclusiva, nivel de instrucción de los padres, tipo de residencia, tipo de familia, presencia de niños mayores y mascotas en casa, frecuencia de aseo, duración de la ducha. Se pre-senta Odds Ratio con el inter-valo de confianza del 95%. Resultados: Se incluyeron 175 escolares, 28 (14.2%) con DA. OR para exposición a tabaquismo pasivo en la infancia = 3.7, OR para familias pequeñas = 2.5 (P=0.042), OR para el antecedente materno de rinitis alérgica 2.6, OR para dermatitis atópica en padres = 9.0. Conclusión: Se confirma que el antecedente familiar de enfermedades como rinitis alérgica y dermatitis atópica así como el antecedente personal de enfermedades que forman parte del espectro atópico diferentes de DA, la exposición al humo del tabaco en el hogar y la convivencia con un reducido número de integrantes dentro de la familia son factores de riesgo asociados a dermatitis atópica.

Introduction: Atopic dermatitis is a chronic inflammatory atopic skin disorder with the most frequent onset in children under five. This study aimed to determine clinical and socio-demographic risk factors associated with atopic dermatitis in a group of school children in Riobamba, Ecuador. Methods: The present observational study included school-children in the period June - August 2020. A probabilistic sample included cases with atopic dermatitis (AD) and a control group. The variables were atopic dermatitis, age, sex, family and personal history of atopy, maternal exposure to tobacco smoke during pregnancy or in childhood, duration of exclusive breastfeeding, parental educational level, type of residence, family type, presence of older children and pets at home, frequency of grooming, and duration of showering. The odds ratio is presented with a 95% confidence interval. Results: A total of 175 school-children were included, 28 (14.2%) with AD. Alternatively, for exposure to secondhand smoke in childhood = 3.7, OR small families = 2.5 (P =0.042) OR for maternal history of allergic rhinitis 2.6, OR atopic dermatitis in parents = 9.0. Conclusion: It is confirmed that the family history of diseases such as allergic rhinitis and atopic dermatitis, as well as the personal history of diseases that are part of the atopic spectrum other than AD, expo-sure to tobacco smoke at home and living with a small number of members within the family, are risk factors associated with atopic dermatitis.

The relation between atopic dermatitis and depressive symptoms / A relação entre dermatite atópica e sintomas depressivos

Introdução: O quadro da dermatite atópica (DA) é caracterizado por prurido crônico de evolução flutuante, que pode resultar em distúrbios no padrão de sono e em estigmatização social devido à presença de lesões visíveis e recidivantes, as quais tendem a se tornar progressivamente liquenificadas. Fatores como os já citados e outros associados, como incapacidade laboral, falta de concentração ao longo do dia e isolamento apresentam-se como profundos impactantes para a saúde mental do paciente, podendo resultar em baixa autoestima, depressão e frustração. Além disso, sabe-se que a DA é uma doença essencialmente inflamatória, ao mesmo tempo em que estudos recentes demonstram papel de citocinas no desenvolvimento de síndromes depressivas, podendo haver correlação causal entre os quadros por vias inflamatórias. Objetivos: Essa revisão sistemática de literatura objetivou analisar a relação entre dermatite atópica e sintomas depressivos, identificando possíveis mecanismos responsáveis por essa ligação. Métodos: A busca foi feita entre 17/11/2020 e 18/11/2020 seguindo o modelo PRISMA e utilizando as bases PUBMED, Biblioteca Virtual em Saúde (BVS) - IBECS, LILACS e CUMED - e EMBASE. As palavras-chave "Depression" e "Atopic Eczema", em conjunto com seus termos MeSh e DECS, foram utilizadas e associadas através do método booleano. Critérios para inclusão foram definidos como artigos que são ensaios clínicos ou observacionais envolvendo grupo de pacientes com dermatite atópica e grupo controle, que pôde ser constituído pelo próprio grupo com dermatite atópica, porém, após intervenção. Os sintomas depressivos precisavam ser medidos por escalas ou terem critérios para diagnóstico de síndrome depressiva estabelecidos. A seleção foi feita por todos os autores de forma independente, sendo discordâncias solucionadas por consenso. Resultados: Ao final, quinze estudos restaram, os quais foram classificados entre aqueles que comparam tratamentos e seus desfechos relacionados à depressão e DA, aqueles que propõem DA como agravante de sintomas depressivos, aqueles que propõem sintomas depressivos como agravantes da DA e aqueles que trazem análises estatísticas sem estabelecer claramente onde reside a relação de causalidade entre os dois quadros. Conclusões: Diversos estudos mostraram a existência de relação entre o quadro de DA e sintomas depressivos em vias distintas, tanto analisando a DA como agravante de sintomas depressivos como vice-versa. A partir dessa perspectiva, é possível que haja uma causalidade bidirecional cíclica, na qual um constante feedback positivo gera piora de ambos os quadros até que a abordagem adequada seja tomada, evidenciando a importância da propedêutica multidisciplinar para esses pacientes (AU)

Introduction: Atopic dermatitis (AD) is characterized by chronic itching, presenting with fluctuating evolution, resulting in sleep disorders and social stigmatization due to the presence of visible and recurrent lesions, that might become progressively lichenified. Factors such as those mentioned and others associated, such as incapacity for work, lack of concentration throughout the day and isolation have profound impacts on the patient's mental health, resulting in low self-esteem, depression and frustration. In addition, it is known that AD is essentially an inflammatory disease. And, recent studies demonstrate the role of inflammatory cytokines in the development of depressive syndromes, therefore may be a causal correlation between the conditions by inflammatory pathways. Objectives: This systematic literature review aimed to analyze a relationship between atopic dermatitis and depressive symptoms, identifying mechanisms responsible for this connection. Methods: The research was carried out between 11/17/2020 and 11/18/2020 following the PRISMA model and using PUBMED, Virtual Health Library (VHL) - IBECS, LILACS and CUMED - and EMBASE databases. Keywords "Depression" and "Atopic Eczema", along with its MeSh and DECS terms, were used and associated using the Boolean method. Inclusion criteria were defined as articles that are clinical or observational trials involving a group of patients with atopic dermatitis and a control group, which could be constituted by the group with atopic dermatitis itself, however, after an intervention. The depressive symptoms had to be measured by scales or, at least, the criteria for diagnosis of depressed syndrome must have been established. Results:In the end, fifteen studies remained, which were classified among those that compare treatments and their outcomes related to depression and AD, those that propose AD as an aggravator of depressive symptoms, those that propose depressive symptoms as an aggravating factor for AD and those that bring statistical analysis without clearly establishing where the causality relation resides. Conclusion: Several studies have presented a relationship between the condition of AD and depressive symptoms in distinct pathways, or analyzing AD as an aggravating factor for depressive symptoms or vice-versa. From this perspective, there may be a cyclical bidirectional causality, in which constant positive feedback generates worsening of both conditions until the adequate approach is taken, highlighting the importance of the multidisciplinary propaedeutics for these patients (AU)

Prevalence of sensitization to Malassezia spp. in adults with atopic dermatitis and psoriasis and its correlation with disease severity / Prevalência da sensibilização a Malassezia spp. em pacientes adultos portadores de dermatite atópica e psoríase e sua correlação com a gravidade das doenças

Fundamentals: Atopic Dermatitis (AD) and Psoriasis (PS) share clinical and physiopathological similarities. Objective: Determine the prevalence of sensitization to Malassezia spp. in adults with AD and PS and its correlation with disease severity. Methods: A cross-sectional study was carried out from January 2016 to August 2017 with adults. Malassezia spp.-specific IgE dosages were measured, and skin scrapings for fungal culture performed. Parametric or nonparametric tests were used for analysis. Results: Median age of the 20 participants with AD was 29 years old, and the mean SCO-RAD was 45.35 ± 18.32. Malassezia spp.- specific IgE median dosage was 0.63 kU/l. M. furfur and M. sympodialis were isolated. Spearman's nonparametric correlation analysis showed no correlation between sensitization to Malassezia spp. and disease severity. The median age of the 36 participants with PS was 61 years old, the median body surface area affected was 22%, and Malassezia spp.-specific IgE median dosage was 0.00 kU/l. M. furfur and Malassezia spp. were identified. Study limitations: Assessing the sensitization to Malasseziaspp. was difficult due to the reduced number of participants in the study. Furthermore, there was no uniformity in the location to collect skin scrapings. The use of topical medication was not suspended before collecting skin specimens for mycological examination, therefore interfer-ing with fungal isolation. Conclusion: Sensitization to Malassezia spp. was only detected in the AD sample. Malassezia spp.-specific IgE test did not prove to be a marker for disease severity in our AD sample (AU)

Fundamentos: Dermatite atópica (DA) e psoríase apresentam similaridades clínicas e fisiopatológicas. Objetivos: Avaliar a frequência da sensibilização a Malasseziaspp. em adultos portadores de DA e psoríase e correlacionar à gra-vidade dos quadros clínicos. Métodos: De janeiro de 2016 a agosto de 2017, conduziu-se um estudo observacional em indivíduos adultos onde foram realizadas dosagem de IgE específica anti-Malassezia spp. e raspados das lesões para cultura micológica. Testes paramétricos ou não paramétricos foram utilizados para análise. Resultados: Nos 20 portadores de DA, a mediana da idade foi 29 anos. O valor médio do Scoring Atopic Dermatitis foi 45,35 ± 18,32. A mediana de IgE específica anti-Malasseziaspp. foi 0,63 kU/l. M. furfur e M. sympodialis foram isolados. A análise de correlação não-paramétrica de Spearman não mostrou correlação entre a sensibilização à Malassezia spp. e a gra-vidade. Nos 36 pacientes com psoríase, foram obtidas as seguintes medianas: idade 61 anos, comprometimento de superfície corpórea 22% e IgE específica anti-Malassezia spp. 0,00 kU/l. Houve identificação de M. furfur e Malasse-zia spp. Limitações do estudo: O número reduzido de participantes dificultou a avaliação da sensibilização por IgE a Malasseziaspp. Não houve uniformidade nos locais de coleta dos raspados cutâneos. Medicamentos tópicos não foram suspensos anteriormente ao exame micológico, prejudicando o isolamento dos fungos. Conclusões: Sensibili-zação a Malassezia spp. apenas ocorreu nos portadores de DA. O teste de IgE específica anti-Malassezia spp. não se mostrou um marcador de gravidade para a DA neste grupo (AU)

Diretriz Latino-americana sobre o Diagnóstico e Tratamento da Alergia Ocular ­ Em nome da Sociedade Latinoamericana de Alergia, Asma e Imunologia (SLAAI) / Latin American Guideline on the Diagnosis and Treatment of Ocular Allergy ­ On behalf of the Latin American Society of Allergy, Asthma and Immunology (SLAAI)

A alergia ocular, também conhecida como conjuntivite alérgica (CA), é uma reação de hipersensibilidade mediada por imunoglobulina E (IgE) do olho desencadeada por aeroalérgenos, principalmente ácaros da poeira doméstica e pólen de gramíneas. Os sintomas geralmente consistem em prurido ocular ou periocular, lacrimejamento e olhos vermelhos que podem estar presentes durante todo o ano ou sazonalmente. A alergia ocular tem frequência elevada, é subdiagnosticada e pode ser debilitante para o paciente. É potencialmente danosa para a visão, nos casos em que ocasiona cicatrização corneana grave, e na maioria dos pacientes associa-se a outros quadros alérgicos, principalmente rinite, asma e dermatite atópica. É classificada em conjuntivite alérgica perene, conjuntivite alérgica sazonal, ceratoconjuntivite atópica e ceratoconjuntivite vernal. O diagnóstico procura evidenciar o agente etiológico e a confirmação se dá pela realização do teste de provocação conjuntival. O tratamento baseia-se em evitar o contato com os desencadeantes, lubrificação, anti-histamínicos tópicos, estabilizadores de mastócitos, imunossupressores e imunoterapia específica com o objetivo de obter o controle e prevenir as complicações da doença.

Ocular allergy, also known as allergic conjunctivitis, is an immunoglobulin E-mediated hypersensitivity reaction of the eye triggered by airborne allergens, primarily house dust mites and grass pollen. Symptoms usually consist of ocular or periocular itching, watery eyes, and red eyes that may be present year-round or seasonally. Ocular allergy has a high frequency, is underdiagnosed, and can be debilitating for the patient. It is potentially harmful to vision in cases of severe corneal scarring, and in most patients, it is associated with other allergic conditions, especially rhinitis, asthma, and atopic dermatitis. It is classified as perennial allergic conjunctivitis, seasonal allergic conjunctivitis, atopic keratoconjunctivitis, and vernal keratoconjunctivitis. Diagnosis seeks to identify the etiologic agent, and confirmation is given by conjunctival provocation testing. Treatment is based on avoiding contact with triggers, lubrication, topical antihistamines, mast cell stabilizers, immunosuppressants, and specific immunotherapy with the aim of achieving control and preventing disease complications.

Avaliação da expressão da filagrina em biópsias esofágicas de pacientes com esofagite eosinofílica / Evaluation of philagrin expression in esophageal biopsies of patients with eosinophilic esophagitis

Introdução: Mutações do gene da filagrina vêm sendo associadas, classicamente, a alterações da barreira epitelial em doenças alérgicas com comprometimento da pele e das superfícies mucosas. Particularmente na dermatite atópica, a relação entre filagrina, mecanismo fisiopatológico e evolução clínica tem sido demonstrada. Recentemente, alterações da barreira epitelial com redução da expressão da filagrina, também têm sido associadas a mecanismos imunológicos envolvidos na patogênese da esofagite eosinofílica. Devido a disfunções na barreira epitelial, microrganismos e alérgenos são capazes de penetrarem no epitélio da mucosa esofágica, assim como na dermatite atópica. Objetivo: Avaliar a possível correlação da expressão da filagrina com os achados histopatológicos em biópsias esofágicas de pacientes com esofagite eosinofílica. Métodos: A expressão da filagrina foi investigada in situ, por imuno-histoquímica, em biópsias esofágicas nos seguintes grupos: Grupo I, controle (n=8), amostras provenientes de pacientes saudáveis; Grupo II (n=27), amostras provenientes de pacientes com esofagite eosinofílica. Resultados: Os resultados demonstraram uma diminuição da expressão da filagrina na mucosa do esôfago de portadores de esofagite eosinofílica. Adicionalmente, a intensidade da marcação imuno-histoquímica foi menor na mucosa esofágica com maior infiltração de eosinófilos. Conclusão: A diminuição da expressão de filagrina pode ser um fenomeno fisiopatológico associado ao aumento da quantidade de eosinófilos na mucosa esofágica, podendo impactar na evolução clínica da esofagite eosinofílica.

Introduction:Filaggrin gene mutations have been classically associated with changes in the epithelial barrier in allergic diseases involving the skin and mucosal surfaces. Particularly in atopic dermatitis, the relationship between filaggrin, pathophysiological mechanism and clinical evolution hás been demonstrated. Recently, changes in the epithelial barrier with reduced expression of filaggrin have also been associated with immunological mechanisms involved in the pathogenesis of eosinophilic esophagitis. Due to dysfunction in the epithelial barrier, microorganisms and allergens are able to penetrate the epithelium of the esophageal mucosa, as well as in atopic dermatitis. Objective: To evaluated the possible correlation of filaggrin expression with histopathological findings in esophageal biopsies of patients with eosinophilic esophagitis. Methods: Filaggrin expression was investigated in situ by immunohistochemistry in esophageal biopsies in the following groups: Group I, control (n = 8), samples from healthy patients; Group II (n = 27), samples from patients with eosinophilic esophagitis. Results: The results demonstrated a decrease in the expression of filaggrin in the esophageal mucosa of patients with eosinophilic esophagitis. Additionally, the intensity of the immunohistochemical labeling was lower in the esophageal mucosa with greater infiltration of eosinophils. Conclusion: The reduction of filaggrin expression may be a pathophysiological phenomenon associated with an increase in the quantity of eosinophils in the esophageal mucosa, which may impact on the clinical evolution of eosinophilic esophagitis.

A relação entre dermatite atópica e sintomas depressivos / The relation between atopic dermatitis and depressive symptoms

RESUMO: Introdução: O quadro da dermatite atópica (DA) é caracterizado por prurido crônico de evolução flutuante, que pode resultar em distúrbios no padrão de sono e em estigmatização social devido à presença de lesões visíveis e recidivantes, as quais tendem a se tornar progressivamente liquenificadas. Fatores como os já citados e outros associados, como incapacidade laboral, falta de concentração ao longo do dia e isolamento apresentam-se como profundos impactantes para a saúde mental do paciente, podendo resultar em baixa autoestima, depressão e frustração. Além disso, sabe-se que a DA é uma doença essencialmente inflamatória, ao mesmo tempo em que estudos recentes demonstram papel de citocinas no desenvolvimento de síndromes depressivas, podendo haver correlação causal entre os quadros por vias inflamatórias. Objetivos: Essa revisão sistemática de literatura objetivou analisar a relação entre dermatite atópica e sintomas depressivos, identificando possíveis mecanismos responsáveis por essa ligação. Métodos: A busca foi feita entre 17/11/2020 e 18/11/2020 seguindo o modelo PRISMA e utilizando as bases PUBMED, Biblioteca Virtual em Saúde (BVS) - IBECS, LILACS e CUMED - e EMBASE. As palavras-chave "Depression" e "Atopic Eczema", em conjunto com seus termos MeSh e DECS, foram utilizadas e associadas através do método booleano. Critérios para inclusão foram definidos como artigos que são ensaios clínicos ou observacionais envolvendo grupo de pacientes com dermatite atópica e grupo controle, que pôde ser constituído pelo próprio grupo com dermatite atópica, porém, após intervenção. Os sintomas depressivos precisavam ser medidos por escalas ou terem critérios para diagnóstico de síndrome depressiva estabelecidos. A seleção foi feita por todos os autores de forma independente, sendo discordâncias solucionadas por consenso. Resultados: Ao final, quinze estudos restaram, os quais foram classificados entre aqueles que comparam tratamentos e seus desfechos relacionados à depressão e DA, aqueles que propõem DA como agravante de sintomas depressivos, aqueles que propõem sintomas depressivos como agravantes da DA e aqueles que trazem análises estatísticas sem estabelecer claramente onde reside a relação de causalidade entre os dois quadros. Conclusões: Diversos estudos mostraram a existência de relação entre o quadro de DA e sintomas depressivos em vias distintas, tanto analisando a DA como agravante de sintomas depressivos como vice-versa. A partir dessa perspectiva, é possível que haja uma causalidade bidirecional cíclica, na qual um constante feedback positivo gera piora de ambos os quadros até que a abordagem adequada seja tomada, evidenciando a importância da propedêutica multidisciplinar para esses pacientes.(AU)

ABSTRACT: Introduction: Atopic dermatitis (AD) is characterized by chronic itching, presenting with fluctuating evolution, resulting in sleep disorders and social stigmatization due to the presence of visible and recurrent lesions, that might become progressively lichenified. Factors such as those mentioned and others associated, such as incapacity for work, lack of concentration throughout the day and isolation have profound impacts on the patient's mental health, resulting in low self-esteem, depression and frustration. In addition, it is known that AD is essentially an inflammatory disease. And, recent studies demonstrate the role of inflammatory cytokines in the development of depressive syndromes, therefore may be a causal correlation between the conditions by inflammatory pathways. Objectives: This systematic literature review aimed to analyze a relationship between atopic dermatitis and depressive symptoms, identifying mechanisms responsible for this connection. Methods: The research was carried out between 11/17/2020 and 11/18/2020 following the PRISMA model and using PUBMED, Virtual Health Library (VHL) - IBECS, LILACS and CUMED - and EMBASE databases. Keywords "Depression" and "Atopic Eczema", along with its MeSh and DECS terms, were used and associated using the Boolean method. Inclusion criteria were defined as articles that are clinical or observational trials involving a group of patients with atopic dermatitis and a control group, which could be constituted by the group with atopic dermatitis itself, however, after an intervention. The depressive symptoms had to be measured by scales or, at least, the criteria for diagnosis of depressed syndrome must have been established. Results:In the end, fifteen studies remained, which were classified among those that compare treatments and their outcomes related to depression and AD, those that propose AD as an aggravator of depressive symptoms, those that propose depressive symptoms as an aggravating factor for AD and those that bring statistical analysis without clearly establishing where the causality relation resides. Conclusion: Several studies have presented a relationship between the condition of AD and depressive symptoms in distinct pathways, or analyzing AD as an aggravating factor for depressive symptoms or vice-versa. From this perspective, there may be a cyclical bidirectional causality, in which constant positive feedback generates worsening of both conditions until the adequate approach is taken, highlighting the importance of the multidisciplinary propaedeutics for these patients. (AU)

Acupuncture attenuates comorbid anxiety- and depressive-like behaviors of atopic dermatitis through modulating neuroadaptation in the brain reward circuit in mice

Atopic dermatitis (AD) is highly comorbid with negative emotions such as anxiety and depression. Although acupuncture has demonstrated efficacy in AD, its influence on comorbid anxiety and depression remains unclear. We sought to explore the impact and mechanisms of action of acupuncture on comorbid anxiety and depression of AD. AD-like skin lesions were induced by the topical application of MC903 to the mouse cheek. Acupuncture was performed at Gok-Ji (LI11) acupoints. AD-like phenotypes were quantified by lesion scores, scratching behavior, and histopathological changes. The effects of acupuncture on comorbid anxiety and depression-like behaviors were assessed using the elevated plus-maze (EPM), open-field tests (OFT), and tail-suspension test (TST). In addition, biochemical changes in the brain reward regions were investigated by immunoblotting for the expression of tyrosine hydroxylase (TH), dopamine D1 receptor (D1R), phospho-dopamine and cAMP-regulated phosphoprotein-32 kDa (pDARPP-32), phospho-cAMP response element binding protein (pCREB), ΔFosB, and brain-derived neurotrophic factor (BDNF) in the nucleus accumbens, dorsolateral striatum, and ventral tegmental area. Acupuncture effectively improved the chronic itching and robust AD-like skin lesions with epidermal thickening. Additionally, it considerably reduced comorbid anxiety- and depression-like symptoms, as indicated by more time spent in the open arms of the EPM and in the center of the open field and less time spent immobile in the TST. Higher pCREB, ΔFosB, BDNF, and pDARPP-32 levels, and reduced TH and D1R protein expression in the brain reward regions of AD mice were reversed by acupuncture treatment. The beneficial effects of acupuncture on clinical symptoms (scratching behavior) and comorbid psychological distress in AD strongly correlated with dorsal striatal ΔFosB levels. Collectively, these data indicate that acupuncture had a significant, positive impact on comorbid anxiety- and depression-like behaviors by modulating neuroadaptation in the brain reward circuit in mice with AD, providing a novel perspective for the non-pharmacological management of psychiatric comorbidities of AD.

Dermatite atópica em crianças e adolescentes durante a pandemia COVID-19: piora clínica associada ao medo de infecção / Atopic dermatitis in children and adolescents during the COVID-19 pandemic: disease exacerbation associated with fear of infection

Introdução: A dermatite atópica é uma doença crônica e recidivante, influenciada por fatores ambientais, que necessita prescrições médicas frequentes. O objetivo deste estudo foi investigar se crianças e adolescentes com dermatite atópica atendidos em um serviço público tiveram agravamento das lesões ou dificuldades no autocuidado durante a pandemia COVID-19.Métodos: Estudo longitudinal retrospectivo. Os dados foram coletados do prontuário de pacientes com dermatite atópica menores de 18 anos atendidos em um ambulatório público de referência do Rio Grande do Sul. A percepção sobre o agravamento das lesões foi avaliada pelos testes Qui-quadrado ou Exato de Fisher e regressão de Poisson foi utilizada para estimar o risco de agravamento das lesões conforme o medo da COVID-19.Resultados: Foram avaliados 33 pacientes, sendo 70% do sexo feminino e 57,6% residentes na capital. A média de idade foi de 9,6 ± 3,9 anos e o tempo médio de acompanhamento pelo serviço 4,6 ± 2,9 anos. A percepção de agravamento das lesões durante o período de suspensão dos atendimentos esteve presente em 81,8% das crianças/adolescentes. As crianças relataram com frequência o aumento de coceira (78,3%) e descamação (60,9%), enquanto os adolescentes referiram maior aumento da vermelhidão (60%). O medo de contrair o vírus foi associado a um risco oito vezes maior de apresentar agravamento das lesões.Conclusões: O alto percentual de crianças/adolescentes com agravamento das lesões e a associação da piora da doença com o medo relacionado à pandemia reforçam a importância do acompanhamento destes por equipe multidisciplinar que observe fatores fisiopatológicos e psicossociais.

Introduction: Atopic dermatitis is a chronic and recurrent condition, influenced by environmental factors, that requires frequent medical prescriptions. The aim of this study was to investigate if children and adolescents with atopic dermatitis treated at a public clinic reported exacerbation of the disease or self-care problems during the COVID-19 pandemic.Methods: We conducted a retrospective longitudinal study. Data were collected from the medical records of patients aged < 18 years with atopic dermatitis treated at a public outpatient clinic in Rio Grande do Sul, Brazil. The perception of disease exacerbation in children and adolescents was evaluated using the chi-square test or Fisher's exact test. Poisson regression was used to estimate the risk of worsening of skin lesions according to the fear of COVID-19. Results: The study sample included 33 patients, of whom 70% were female and 57.6% lived in the state's capital city. Mean patient age was 9.6 ± 3.9 years, and mean time of clinic follow-up was 4.6 ± 2.9 years. The perception of disease exacerbation during the pandemic was reported by 81.8% of children/adolescents. Children reported increased itching (78.3%) and desquamation (60.9%), whereas adolescents reported increased redness (60%). The fear of contracting COVID-19 was associated with an eight-fold increased risk of worsening of skin lesions.Conclusion: The high percentage of children/adolescents with worsening of skin lesions and the association between disease exacerbation and the fear of COVID-19 reinforce the importance of a multidisciplinary approach that focuses on pathophysiological and psychosocial factors in patients with atopic dermatitis.

Successfully treated recalcitrant atopic eczema with acupoint autohemotherapy: A case report and hypothesized mechanism of the therapy / 中西医结合学报

Acupoint autohemotherapy at bilateral Zusanli (ST36) and Xuehai (SP10) was used to treat a 26-year-old female patient who had suffered from recalcitrant atopic eczema (AE) for five years. The treatment was applied at a frequency of once per week for the first month, followed by a three-month period of once every other week. At the end of treatment, the patient's AE symptoms were entirely resolved, and by the end of a six-month follow-up her immunoglobulin E level had returned to the normal range. Further, there was no relapse of AE symptoms during the six-month follow-up. Therefore, we hypothesized that after the repeated treatments the local inflammatory reaction induced by autologous blood injection triggered a local immune response, followed by a systemic immune response after the repeated treatment, finally leading to the anti-inflammation and immunomodulation effects. This case suggests that acupoint autohemotherapy could be used as an effective complementary treatment for recalcitrant AE, especially in cases where other treatments have failed. Further comparative studies are needed to corroborate the value and mechanisms of this therapy.

Acupoint Autohemotherapy Attenuates Atopic Dermatitis Lesions by Regulating Th1/Th2 Balance in DNCB-Induced BALB/c Mice / 中国结合医学杂志

OBJECTIVE@#To evaluate the therapeutic effects of acupoint autohemotherapy (A-AHT) on 1-chloro-2,4-dinitrobenzene (DNCB)-induced atopic dermatitis (AD) in mice focusing on regulating T helper 1/T helper 2 (Th1/Th2) immune responses.@*METHODS@#Thirty BALB/c mice were divided into 5 groups by a random number table, including normal control (NC), AD model (AD), A-AHT, sham A-AHT (sA-AHT), and acupoint injection of normal saline (A-NS) groups, 6 mice per group. Mice were challenged by DNCB for the establishment of experimental AD model. On the 8th day, except for the NC and AD groups, the mice in the other groups received management once every other day for a total of 28 days. For the A-AHT and sA-AHT groups, 0.05 mL of autologous whole blood (AWB) was injected into bilateral Zusanli (ST 36) and Quchi (LI 11) and sham-acupoints (5 mm lateral to ST 36 and LI 11), respectively. The A-NS group was administrated with 0.05 mL of normal saline by acupoint injection into ST 36 and LI 11. Dermatitis severity for dorsal skin of mice was determined using the Severity Scoring of Atopic Dermatitis (SCORAD) every week. The total immunoglobulin E (IgE), interleukin-4 (IL-4), and interferon-gamma (IFN-γ) cytokine levels in serum were examined by enzyme-linked immunosorbent assay (ELISA). Spleen Th1/Th2 expression were analyzed via flow cytometry and immunohistochemical assay was used to detect T-box expressed in T cell (T-bet) and GATA-binding protein 3 (GATA3) expressions in skin lesions of mice.@*RESULTS@#Compared with the AD group, both A-AHT and sA-AHT reduced the SCORAD index and serum IgE level (P<0.05 or P<0.01); A-AHT, sA-AHT and A-NS down-regulated serum IL-4 level and upregulated IFN-γ/IL-4 ratio (P<0.05 or P<0.01); A-AHT regulated the Th1/Th2 shift specifically and increased the related transcription factors such as T-bet expression and T-bet/GATA3 ratio (P<0.05).@*CONCLUSION@#A-AHT showed significant effectiveness on the AD model mice, through regulating Th1/Th2 immune responses.

Social isolation: main dermatosis and the impact of stress during the COVID-19 pandemic

ABSTRACT Objective To analyze the pattern of triggering and exacerbation of dermatological diseases between March and July 2020 and to compare this pattern to the corresponding period of 2019. Methods This was a quantitative, descriptive, comparative and documentary study that was carried out through the retrospective analysis of medical records (March to July 2019 and 2020) of individuals assisted at a private dermatology practice service located in the southern area of the city of São Paulo (SP). Results We evaluated 992 medical consultations in 2019 and 1,176 in 2020. In 2020, we observed a significant increase in cases of telogen effluvium (276%), psoriasis (1,400%), atopic dermatitis (178%), seborrheic dermatitis (200%), herpes zoster (1,200%) and vitiligo (433%). All diseases had stress as a possible initial trigger. In addition, fragile nail syndrome and contact dermatitis, pathologies associated with behavioral measures, also had an important increase in the prevalence (6,400% and 5,500%, respectively). However, the number of aesthetic procedures decreased by approximately 54% during the pandemic period. Conclusion During the pandemic period, the pattern of incidence of dermatoses had changed compared with the previous year. An emphasis was observed on diseases triggered by a psychological component, as well as those pathologies that have behavioral measures as the main cause. For this reason, the impacts of COVID-19 is greater than only among those infected.