This study aimed to examine whether positive and negative mood composites statistically mediate the association between radiation dermatitis severity and social integration among patients with head and neck cancer undergoing radiotherapy. Employing a cross-sectional design, this study recruited 223 eligible patients with head and neck cancer undergoing radiotherapy through consecutive sampling at a tertiary-level hospital in Liaoning Province, China, from January to December 2024. Research instruments included a demographic questionnaire, the Radiation-Induced Skin Reaction Assessment Scale, the Profile of Mood States-Short Form, and the Social Cohesion Scale. The mediation analysis focused on the subsample of 183 patients with dermatitis. A parallel mediation analysis was performed using the SPSS PROCESS macro (Model 4), controlling for potential confounders including age, sex, marital status, education, radiation dose, and concurrent chemotherapy. The severity of radiation dermatitis was significantly negatively correlated with social integration and positive emotions, while being significantly positively correlated with negative emotions. After controlling for covariates, the direct association between dermatitis severity and social integration was not statistically significant. The bootstrap-based mediation analysis revealed statistically significant indirect associations through both the positive and negative mood composites. Specifically, greater dermatitis severity was associated with higher negative emotions and lower positive emotions, which in turn were associated with reduced social integration. These cross-sectional findings suggest that mood states may represent relevant pathways linking radiation dermatitis severity to social integration in patients with head and neck cancer undergoing radiotherapy. As the present design cannot establish causality, the observed associations are hypothesis-generating. Psychological screening and supportive care warrant further evaluation alongside dermatitis management. Longitudinal and interventional studies are required to confirm the directionality of these pathways and to determine whether targeting mood states improves social integration outcomes in this population.
Sleep disturbance is one of the most frequent and clinically consequential problems in atopic dermatitis. Current evidence indicates that it is not merely a secondary symptom of pruritus but a complex disease domain associated with higher inflammatory activity, sleep fragmentation, impaired quality of life, daytime fatigue, and anxiety or depressive symptoms. The best established pathway runs from active dermatitis to impaired sleep: nocturnal itch, scratching, pain, xerosis, heat sensation, and epidermal barrier dysfunction promote repeated awakenings and difficulty maintaining sleep. However, growing mechanistic and epidemiological evidence supports a bidirectional model. Insufficient, fragmented, or circadian-misaligned sleep may impair barrier repair, increase transepidermal water loss, alter neuroimmune itch signaling, and perpetuate behavioral amplification through scratching, stress, and reduced treatment adherence. This narrative review synthesizes recent literature on the epidemiology, sleep phenotype, biological mechanisms, assessment tools, therapeutic evidence, and research gaps linking sleep disturbance with aggravation of atopic dermatitis. The clinical implication is practical: sleep should be assessed as a core treatment outcome in atopic dermatitis, and persistent sleep disruption should be interpreted as a marker of undercontrolled disease and a potential amplifier of cutaneous inflammation.
The purpose of study is to characterize the skin microbiome profile of breast cancer patients before and during radiation therapy, and evaluate the relationship between the microbiome profile and the severity of acute radiation dermatitis (aRD). In this observational, single-center, single-arm study, breast cancer patients received RT at Rambam Health Care Campus from November 2020 to July 2021. Skin assessments and skin microbiome samples were collected from all patients before, weekly during RT, after completion of the treatment. The outcome measures were: aRD grade, skin microbiome composition at baseline and during RT. 640 skin samples were collected from 86 patients, bacterial DNA was extracted, and 16S rDNA was amplified and sequenced.At mid-treatment, the bacterial family Clostridiaceae was unique to patients later diagnosed with moderate/severe acute dermatitis, and present in 30% of the samples (p-value = 0.002038). An unknown species of Anaerococcus, designated Anaerococcus US436, was unique to patients in the moderate/severe aRD group at mid-treatment (21.67% in this group, p-value = 0.002038).To increase sample size and reduce noise, we collected all treated samples from all time points and compared the microbiome composition between the groups of dermatitis severity. The Clostridiaceae family and Clostridium genus remained significantly enriched in the moderate/severe group (p-value = 0.002095 and 0.004269, respectively), as well as the Anaerococcus genus and its unknown species (p-value = 0.001825 and 0.007104, respectively).The treated samples for each patient were summed up, and each bacterium was examined for at least one appearance per patient during the treatment. Granulicatella elegans was enriched in the moderate/severe group (p-value = 0.000512), and Bacillus thuringiensis was enriched in the mild group (p-value = 0.000595). A bacterial composition associated with moderate/severe aRD was identified: Clostridium, Anaerococcus US436, and Granulicatella elegans.
The expanding use of biologic and oral targeted therapies has transformed the management of psoriasis and atopic dermatitis. These agents are increasingly prescribed to patients with current malignancy, a history of malignancy or an increased cancer risk, populations typically excluded from clinical trials. In the absence of robust long-term safety data, clinicians often rely on real-world evidence to inform treatment decisions. To review the evidence regarding malignancy risk associated with biologic and oral targeted therapies used in psoriasis and atopic dermatitis and to provide expert consensus recommendations for patients with current malignancy, previous malignancy or increased risk of malignancy. We describe the physiological roles of key immune pathways targeted in psoriasis and atopic dermatitis, as well as in cancer immunosurveillance, tumour progression and immune escape. We then summarize evidence from randomized controlled trials regarding the risk of de novo malignancy, followed by a synthesis of real-world data addressing cancer recurrence and progression in patients treated with biologic and oral targeted therapies. Available evidence suggests that the overall malignancy risk associated with most biologic and oral targeted therapies used in psoriasis and atopic dermatitis is low, although differences between therapeutic classes may exist. Real-world data remain limited for several therapeutic classes and in patients with active or previous malignancy. Based on the available evidence, we present consensus-based recommendations developed by a multidisciplinary expert panel convened by the Skin Inflammation & Psoriasis International Network-Fondation René Touraine (SPIN-FRT). These recommendations aim to support treatment decisions by balancing disease control with potential cancer-related risks while highlighting key evidence gaps.
To characterise immunoglobulin A (IgA) levels in the faeces and saliva of dogs with canine atopic dermatitis (CAD) and healthy breed matched controls. Dogs with canine atopic dermatitis were recruited based on history, clinical examination and diagnostic testing where appropriate. Control dogs were over 4 years of age with no history of skin disease. Saliva samples were obtained using chewable synthetic swabs with saliva extracted by centrifugation. Faecal samples were collected from the ground before homogenisation in phosphate buffered saline and centrifugation to extract faecal supernatant. Total immunoglobulin A in saliva and faecal supernatants was measured using a commercial dog immunoglobulin A ELISA kit. Immunoglobulin A concentration was interpolated from a six-point standard curve. Mann-Whitney tests were performed to compare immunoglobulin A concentrations between cases and controls. Mean ranked faecal immunoglobulin A was significantly lower in dogs with canine atopic dermatitis than controls (difference between medians 0.803 g/L, 95% CI 0.064 to 1.721). There was no significant difference in mean ranked salivary immunoglobulin A between the groups (difference between medians 0.108 g/L). Faecal immunoglobulin A and salivary immunoglobulin A were not correlated. There were no dogs in either group with both low faecal and low salivary immunoglobulin A suggestive of selective immunoglobulin A deficiency. This study builds on existing evidence that low immunoglobulin A is associated with canine atopic dermatitis. Further work is required to determine the significance of low faecal immunoglobulin A in the development of tolerance or hypersensitivity to food and environmental allergens which may inform strategies for interventions in high-risk breeds.
Atopic dermatitis (AD) is characterized by substantial clinical heterogeneity. Global severity is typically assessed using scores such as the POEM; however, lesion localization -- particularly on the face -- may generate psychosocial consequences partly independent of overall disease severity. This cross-sectional observational study (VISEABLE) included 1,400 French adults with physician-confirmed AD. Severity was measured using the POEM (Clear/Almost Clear: 0-7 vs. Moderate-severe: ≥8) and facial involvement using the BoFA (0-109; threshold=36, population median). Six phenotypes were defined through a 2×3 combination. The POEM and BoFA correlation was moderate (r=0.365; ρ=0.389; p<0.001). Phenotype Ph3 (Clear/Almost Clear POEM / Severe facial involvement, n=58) exhibited stigmatization scores (PUSH-d=21.93) and life trajectory impact (DLLIM=14.76) not significantly different from Ph4 (Moderate-severe POEM / No facial involvement, n=527; p>0.25 for all comparisons). In multiple regression analysis restricted to patients with facial involvement, BoFA was the dominant independent predictor of stigmatization (β=11.44, p<0.001; partial R²=46.2 %; overall R²=0.532), superseding POEM (p=0.076, ns; partial R²=0.6%). Mild eczema with severe facial involvement generates a psychosocial burden comparable to that of moderate-to-severe eczema without facial involvement. Systematic BoFA assessment is essential in all patients with AD.
Infective endocarditis (IE) is a rare, life-threatening infection of the cardiac endocardium caused by bacterial seeding. On the other hand, atopic dermatitis (AD) is a common inflammatory skin condition that disrupts the epidermal barrier, increasing susceptibility to Staphylococcus aureus colonisation and recurrent bacteraemia. This provides a biologically plausible bridge to IE, which we explore in this current literature review. MEDLINE, Embase and CENTRAL were searched from inception to 7 April 2025. Sixteen studies were included - 15 case reports and one retrospective cohort study - which were grouped into three categories: well-controlled AD with no predisposing risk factors, AD with predisposing risk factors, and uncontrolled AD or alternative AD management. This review is made up of 24 patients with IE secondary to AD. Of the 16 studies, nine originated from Japan. Mean age was 29.6 years (range 15-42 years), which is significantly younger than classic IE cohorts (mean 60.0 years). Staph. aureus accounted for 23/24 patients, and the mitral valve was affected in 18/24 cases. In terms of patient outcomes, all but one patient survived, but valve surgery was necessary in 20/24 patients. In conclusion, AD-related IE shows a distinct pattern: younger patients, Staph. aureus dominance and mitral valve involvement requiring mitral valve surgery in the majority. This potential link appears to be under-recognised, hence, greater cross-speciality awareness and rigorous AD control for those at high risk is recommended. The heavy Japanese skew in the literature highlights the need for broader case documentation in other regions to confirm this link across different patient demographics.
Tapinarof cream 1%, a non-steroidal topical aryl hydrocarbon receptor-modulating agent, is approved in Japan for atopic dermatitis (AD) and plaque psoriasis. Real-world data on longitudinal outcomes, treatment continuation, interruption and restart, and adverse-event timing are limited. This single-center retrospective study included patients newly prescribed tapinarof cream 1% from November 2024 to July 24, 2025. The full analysis set comprised 37 AD and 58 plaque psoriasis patients. Primary endpoints were Eczema Area and Severity Index 50% improvement (EASI50) at week 8 for AD and Psoriasis Area and Severity Index 75% improvement (PASI75) at week 12 for psoriasis. Observed-case and non-responder imputation (NRI) analyses were reported. In AD, week-8 EASI50 was achieved by 12/24 evaluable patients (50.0%) and 12/37 under NRI (32.4%). Mean EASI decreased from 5.94 at baseline to 2.56 at week 8 and 0.83 at week 52. Week-52 EASI was available for 13/37 overall (13/27 with ascertainable status at the data cutoff). In psoriasis, week-12 PASI75 was achieved by 15/33 evaluable patients (45.5%) and 15/58 under NRI (25.9%). Mean PASI decreased from 2.95 at baseline to 1.18 at week 12 and 0.43 at week 52. Week-52 PASI was available for 25/58 overall (25/49 with ascertainable status at the data cutoff); long-term summaries were observed-case and potentially responder-enriched. Any adverse event was recorded in 11/37 AD patients and 12/58 psoriasis patients. Median headache onset was 8 h in AD and 1.8 days in psoriasis. No serious drug-related adverse event was recorded. No pigmentary change was documented; however, without standardized colorimetry or photography, its absence cannot be confirmed. Tapinarof-containing treatment was associated with clinically meaningful improvement in AD and plaque psoriasis in routine practice, although frequent concomitant therapy, observed-case long-term analyses, and retrospective ascertainment limit causal and safety inferences.
Atopic dermatitis is commonly associated with depressive symptoms and fatigue, which significantly impact quality of life. While clinical trials suggest beneficial effects of dupilumab on mental health, real-world evidence remains limited. This longitudinal cohort study analysed data from adult patients treated with dupilumab in the TREATgermany registry. Subgroups were defined by baseline Center for Epidemiologic Studies Depression Scale (CES D) scores ≥16 (clinically significant depressive symptoms) and Fatigue Severity Scale (FSS) scores >4 (significant fatigue). Clinical severity (Eczema Area and Severity Index [EASI], objective Scoring Atopic Dermatitis [oSCORAD]), quality of life (DLQI), psychological symptoms, treatment needs and benefits (PNQ, PBI) and drug survival were assessed over 12 months. Among 633 patients, those with elevated baseline CES-D (n=309) or FSS (n=281) scores reported greater disease burden measured by DLQI, while EASI and oSCORAD did not differ between subgroups. Both CES-D and FSS scores decreased markedly within the first 3 months. Sleep and social functioning needs were more frequently reported in high-burden subgroups and more often fulfilled after 12 months. Drug survival was comparable across subgroups. Dupilumab treatment was associated with significant improvements in depressive symptoms, fatigue and skin severity. Patients with higher baseline mental health burden showed comparable improvements in patient relevant domains, supporting the broad relevance of dupilumab in real-world atopic dermatitis care.
Early-stage mycosis fungoides (MF) often presents diagnostic challenges because of its clinical overlap with atopic dermatitis (AD). In clinical practice, we encountered a subset of patients with severe AD who fulfilled the MF diagnostic criteria yet remained clinically indistinguishable from AD and presented refractoriness to advanced therapies. We termed this ambiguous entity "mycosis fungoides-like AD" (mfAD) and sought to determine whether it represents malignant transformation or a distinct inflammatory endotype of AD. Skin biopsies were obtained from 7 patients with AD and 11 patients with mfAD. We performed paired single-cell RNA sequencing and single-cell T-cell receptor sequencing analyses. Publicly available MF and AD datasets were integrated for comparative analysis. Spatial transcriptomic profiling was used to contextualize single-cell findings within the tissue architecture. Comparative transcriptomic analysis revealed that T cells in mfAD were aligned with those in AD and lacked genomic instability. High-resolution profiling showed that mfAD was characterized by oligoclonal Th22 expansion rather than a single dominant malignant clone. Notably, all patients with mfAD achieved rapid clinical remission with selective JAK1 inhibition, indicating the therapeutic response characteristics of inflammatory dermatoses. Our findings demonstrate that mfAD is not a true malignancy, but rather a Th22-driven inflammatory endotype of AD. These results redefine mfAD as an inflammatory subtype within the AD spectrum, providing a mechanistic explanation for both the "pseudo-monoclonality" that leads to MF misdiagnosis and the failure of dupilumab. This study establishes a rationale for the use of JAK inhibitors in precision medicine for this patient population.
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Despite multiple therapeutic strategies, a significant proportion of psoriatic patients fail to achieve complete/sustained disease clearance, highlighting the need for effective adjuvant or alternative therapy. Melittin, the main component in bee venom, exhibits valuable anti-inflammatory and immunomodulatory properties in various diseases; meanwhile, its effect on psoriasis has not been explored yet. Our study aims to investigate the anti-psoriatic effect of melittin with possible involvement of phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) and the autophagy pathways. Mice were divided into 5 groups: Control group, Imiquimod (IMQ) group, and groups (3-5) received daily intraperitoneal injections of methotrexate (MTX, 1 mg/kg), melittin (40 mg/kg), or melittin (80 mg/kg), respectively. All groups except the control received topical IMQ for seven days. Melittin 80 demonstrated superior efficacy, significantly reducing the clinical Psoriasis Area and Severity Index score by 60% and epidermal thickening by 58.55%. Mel 80 decreased malondialdehyde by 62.32%, increased glutathione by 1.44-fold, and reduced nuclear factor-kappa B p65, tumor necrosis factor-alpha, interleukin (IL)-1 beta, IL-6, IL-23, and IL-17 levels by 72.10%, 83.70%, 61.54%, and 58.09%, 64.55%, and 55.19%, indicating suppression of the pathogenic IL-23/IL-17 axis. Furthermore, Melittin 80 inhibited PI3K/Akt pathway, decreasing p-Akt and PI3K by 50.88% and 57.30%, leading to downregulation of phosphorylated mammalian target of rapamycin (p-mTOR) by 58.53% and a 3.01-fold increase in Beclin-1, indicating restored autophagy. Epidermal proliferation was reduced, with a 58.80% reduction in Epidermal Growth Factor Receptor and 46.51% reduction in Ki67 expression. These results suggest that melittin may represent a promising antioxidant and anti-inflammatory agent for psoriasis, acting through PI3K/Akt/mTOR pathway inhibition and autophagy restoration.
Atopic dermatitis (AD) is a chronic and relapsing skin disorder that significantly impairs patients' quality of life. Long-term biologic therapy provides durable efficacy for AD, but raises concerns related to costs, safety, and withdrawal-associated relapse. Traditional Chinese medicine (TCM) has a long history in AD treatment and is usually integrated with biologic treatment to achieve complementary benefits and provide comprehensive care for patients with AD. However, high-quality evidence supporting its real-world efficacy remains limited. This study aims to collect real-world data to evaluate the efficacy and safety of TCM integrated with biologics (TCMIB) in moderate to severe AD, thereby providing methodological insights to obtain high-quality evidence and inform future in-depth research on AD treatment. A total of 3500 patients with moderate to severe AD will be classified into 7 groups based on clinical manifestations and receive 16 weeks of treatment followed by 36 weeks of observation. A reduction of 75% or more in eczema area and severity index score from baseline to week 16 is set as the primary outcome. The secondary outcomes include the eczema area and severity index, body surface area, Investigator's Global Assessment scale, Dermatology Life Quality Index, numerical rating scale for pruritus, Patient-Oriented Eczema Measure, Atopic Dermatitis Control Tool, and TCM syndrome scale. Assessments will be performed at baseline, every 2 weeks until week 16, and then every 4 weeks until week 52. Safety assessments include vital signs, concomitant medications, and adverse events. The SAS software (version 9.4) will be used for data analysis, and a P value of less than .05 will be considered statistically significant. This study has been approved by the institutional review boards of Shanghai Skin Disease Hospital and registered on the International Traditional Medicine Clinical Trial Registry (ITMCTR2025000984). Patient recruitment began in June 2025 and is expected to be completed in January 2028. Data analysis will begin in June 2028. The main results of the study are expected to be submitted for publication in peer-reviewed journals in December 2028. The anticipated findings of this protocol are projected to furnish strong evidence on the efficacy and safety of TCMIB for moderate to severe AD, potentially contributing to the standardization of TCMIB and optimization of clinical practice.
Atopic dermatitis (AD) features impaired skin barrier, elevated cutaneous pH, and Staphylococcus aureus overcolonization. Restoring acidic skin pH while suppressing microbial overgrowth represents a promising non-steroidal strategy. To develop a copper-based acidic hydrogel and evaluate its properties, antimicrobial activity, efficacy, and safety. A hydrogel with 0.115% copper ions was prepared from basic copper carbonate, acetic acid (6% w/w), and xanthan gum, formulated at a final pH of ∼3.2, and characterized by rheology and stability testing. Antimicrobial activity was evaluated by a quantitative carrier test against S. aureus, E. coli, and C. albicans. Efficacy was assessed in DNFB-induced AD-like BALB/c mice. Dermal safety was examined in a 14-day study in rabbits. The hydrogel showed gel-like behavior (G' > G″) with 94.6% structural recovery and remained stable over 23 months. It achieved >98% killing of all pathogens within 5 min and >99.6% within 10 min. In mice, treatment dose-dependently reduced ear swelling and dermatitis scores, attenuated epidermal hyperplasia, and decreased mast cell infiltration. In rabbits, only mild, reversible local irritation occurred, without systemic toxicity. This copper-based acidic hydrogel exhibits potent broad-spectrum antimicrobial activity, ameliorates AD-like lesions, and shows a favorable short-term dermal safety profile, supporting further development as a non-steroidal topical option for AD.
Atopic dermatitis (AD) (also known as eczema) is a long-term skin disease affecting 13% of children in the United States. These children often have other inflammatory conditions, including asthma, hay fever (allergic rhinitis), and food allergies. Currently, little is known about the use of healthcare resources (hospital visits and admissions and emergency room/urgent care visits) and the associated healthcare costs in children with AD. In this study, we looked at the treatment received for AD, use of healthcare, and associated costs in patients with AD in the United States aged between 6 months and 6 years who were treated for their AD. Patients were split into 3 groups based on received treatments: low-potency topical treatment (LTT) used to treat mild AD, medium-to-high-potency topical treatment (MHTT) for moderate AD, and systemic treatments (ST) for severe AD. Of 23,098 patients studied, 5,452 received LTT, 6,778 received MHTT, and 10,868 received ST. The use of healthcare was similar in children treated with LTT and MHTT, but higher in children treated with ST, including hospital admissions and emergency room/urgent care visits. Healthcare costs per patient were higher in AD patients treated with MHTT and ST, compared to LTT, primarily due to medical expenses. Children had a high number of AD-related inflammatory conditions, with highest burden in the ST group The study showed that patients treated with ST had higher healthcare utilization and costs, suggesting a higher disease burden. To assess healthcare resource utilization and healthcare costs in this patient group. This retrospective, 1-year, cross-sectional, observational study (July 2016-December 2019) of US patients used data from the IQVIA PharMetrics Plus Database. Patients were assigned to cohorts based on treatments received: LTTs, MHTTs, and STs. Overall, 23,098 patients were included (LTT: 5452; MHTT: 6778; ST: 10,868). All-cause health care resource utilization was generally similar for the MHTT and LTT cohorts, but was higher in the ST cohort, including inpatient admissions (1.5% and 1.5% vs 6.5%) and emergency room/urgent care visits (22.0% and 22.0% vs 37.5%). The mean all-cause healthcare costs per patient were higher in the ST and MHTT cohorts vs LTT cohort ($9272.24 and $5671.60 vs $5249.69), with the majority being medical costs ($8135.93 and $4669.39 vs $4221.56). Possibility of selection bias and misclassification if treatments were used for conditions other than atopic dermatitis; exclusion of patients using over-the-counter treatments; neglecting out-of-pocket costs. Patients receiving ST had higher healthcare resource utilization and costs than patients receiving LTT, with medical costs being the main driver.
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This descriptive survey aimed to identify factors influencing home health care advanced practice nurses' ability to visually differentiate between pressure injuries (PIs) and incontinence-associated dermatitis (IAD). The study included 157 home health care advanced practice nurses currently employed at medical institutions nationwide. Data were collected from July 20 to November 5, 2024. Instruments consisted of a PI-IAD knowledge assessment tool (19 items) and a PI-IAD visual differentiation evaluation tool (21 images and related information). Participants achieved an average score of 14.86 ± 2.06 out of 19 on the PI-IAD knowledge scale. The mean score for visual differentiation ability was 13.20 ± 4.15 out of 21. A significant positive correlation was found between PI-IAD knowledge and visual differentiation ability (r = .52, p < .001). Multiple regression analysis identified PI-IAD knowledge, age under 40 years, clinical experience of 10~20, 20~30, or over 30 years, and employment in clinics or general hospitals as significant predictors of visual differentiation ability. These variables explained 39% of the variance (F = 8.81, p < .001). Home health care advanced practice nurses demonstrated difficulty visually distinguishing between pressure injury stages and IAD. Therefore, practice-based educational programs are needed to improve anatomical understanding and visual discrimination skills.