搜索结果：Dermatitis : contact, atopic, occupational, drug

Despite known dermatologic risks from sustained mouthpiece contact, the prevalence, clinical presentation, care-seeking patterns, and hygiene practices related to mouthpiece-associated dermatitis and cheilitis in brass musicians remain poorly understood. To characterize mouthpiece-related dermatitis/cheilitis symptoms, performance impact, care-seeking behavior, and hygiene practices among brass musicians. Brass musicians aged ≥15 completed an anonymous 18-item survey. Quantitative data were analyzed with descriptive statistics and logistic regression. Open-ended responses underwent thematic analysis. Of 228 respondents, 48.2% (95% confidence interval [CI]: 41.8-54.7) reported any mouthpiece-related symptoms and 28.1% (95% CI 22.6-34.3) reported definite symptoms. The most common symptoms were redness (67.6%), lip swelling (53.7%), and dryness (52.8%), with impacts on performance quality (47.2%) and the need for playing breaks (46.2%). 80.0% of respondents indicated hygiene familiarity, but only 38.1% cleaned their mouthpiece at least weekly. Symptom reporting varied by age (P = 0.010) and professional level (P = 0.002), though multivariable estimates were imprecise. Qualitative themes highlighted physical and mental symptoms, mouthpiece materials, and self-management. Mouthpiece-related dermatitis and cheilitis are prevalent among brass musicians, frequently impacting performance, yet care-seeking remains limited and symptoms are often self-managed outside formal health care settings.

Background: Contact dermatitis due to food exposure is underrecognized.Objectives: To characterize relevant allergens associated with food sources and analyze patient and clinical characteristics associated with food-related allergen exposure in patients with a currently relevant positive patch test reaction (PPTR).Methods: We retrospectively analyzed North American Contact Dermatitis Group data from 2001 to 2018, identifying relevant allergens linked to food sources. Patients with currently relevant PPTRs were divided into food-related and non-food-related exposure groups for comparison.Results: Among 43,722 patients, 867 (2.0%) had at least one currently relevant food-related PPTR, accounting for 936 PPTR reactions. The most common allergens were nickel (411, 43.9%), Balsam of Peru (BOP, 287, 30.7%), and fragrance mix 1 (FM1, 60, 6.4%). Carvone (24/139 [17.3%]) and sodium metabisulfite (10/87 [11.5%]) showed the highest food-related proportions. Among 867 food-related patients, the most commonly affected areas were generalized (30.22%) and the hand (19.26%). Patients having food-related PPTR were significantly less likely to involve the hand (OR, 0.59; P < 0.0001) and face (OR, 0.43; P < 0.0001) as compared with nonfood-related patients. Food exposure was associated with a higher likelihood of anogenital dermatitis (P &#x2264; 0.01 for nickel sulfate, BOP or FM1).Conclusion: Nickel, BOP, and FM1 were the most common food-related allergens. Common sites of dermatitis in patients with food-related PPTR were generalized, anogenital areas, and hands, although involvement of the hands and face was significantly less likely compared with nonfood-related cases.

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) and morbilliform drug eruption (MDE) are 2 distinct drug eruptions that can appear clinically similar at presentation. Given the significant morbidity of DRESS, there is a need for objective markers that can aid in early recognition.Objective: The purpose of this study is to explore the diagnostic potential of routine hematological data on or near the date of rash onset.Methods: We use machine learning as an exploratory method to identify any early hematological patterns capable of differentiating DRESS from MDE.Results: We found that lymphocyte count, pan-immune inflammation value, neutrophil-to-lymphocyte ratio, and platelet levels were strong discriminators of DRESS from MDE at initial presentation.Conclusions: These findings highlight the potential of hematologic profiles to enhance early diagnostic accuracy.

Sleep disturbance is highly prevalent in atopic dermatitis (AD), yet its contribution to memory deficits remains underexplored. To characterize sleep disturbance and memory dysfunction in adults with AD, examine their relationship with disease severity, and identify predictors of impaired memory. A cross-sectional study was conducted among adult patients with AD . Sleep and memory were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Everyday Memory Questionnaire-Revised (EMQ-R). Associations were analyzed using multivariate models. Seventy-eight patients participated. Poor sleep quality was reported in 77%, and 64% exhibited memory dysfunction. Sleep latency increased with disease severity (mild: 32 &#xb1; 13 minutes; moderate: 49 &#xb1; 34 minutes; severe: 63 &#xb1; 33 minutes; P <0.001), while sleep duration decreased (mild: 6.7 &#xb1; 1.2 hours; moderate: 5.5 &#xb1; 1.8 hours; severe: 4.5 &#xb1; 1.9 hours; P <0.001). EMQ-R global scores were highest in severe AD (35 &#xb1; 11 vs. moderate: 19 &#xb1; 11; mild: 7.9 &#xb1; 7.9; P <0.001). Higher PSQI scores were strongly associated with greater memory dysfunction (&#x3b2; = 1.7), poorer retrieval (&#x3b2; = 1.1), and impaired attention tracking (&#x3b2; = 0.7), all P <0.001. Poor sleep quality (adjusted odds ratio [AOR] = 4.4) and daytime dysfunction (AOR = 3.1) independently predicted memory impairment. Sleep and memory disturbances were associated with increasing atopic dermatitis severity in adults, supporting the relevance of routine sleep evaluation when addressing memory performance.

Atopic dermatitis is a chronic inflammatory disease characterized by pruritus, which significantly impacts patients' quality of life. Controlling pruritus in these patients remains a challenge, even with the new treatments available. Recent advances have improved our understanding of the pathophysiology of pruritus in atopic dermatitis. This review aims to facilitate the comprehension of these advancements and propose a practical approach, both diagnostic and therapeutic, to optimize the management of these patients.

Atopic dermatitis (AD) is a common, recurrent skin disease in children, associated with an imbalance in the skin microbiome. Topical corticosteroids (TCS) cream is the first-line drug for treating AD. However, its long-term use is prone to the development of adverse reactions. Crisaborole, a nonsteroidal medication, is effective and well-tolerated for long-term maintenance treatment and flare reduction in adult and pediatric patients with mild-to-moderate AD. However, the effect of crisaborole on the skin microbiome remains unknown. The study aimed to compare the effects of topical crisaborole treatment and TCS treatment on microbial abundance and diversity in AD lesions. A cross-sectional study was conducted involving 30 children with mild-to-moderate AD and 10 healthy controls. Patients with AD were divided into three groups (untreated, TCS, and crisaborole; n = 10 each) based on baseline status. Skin samples were collected directly from the healthy child, the untreated lesions, and after a 2-week treatment period. The skin microbiome was analyzed using 16S rRNA gene sequencing. Compared to the untreated AD group, both TCS and crisaborole treatments significantly reduced the relative abundances of Staphylococcus and Pseudomonas, while increasing the abundances of Streptococcus and Cutibacterium (formerly Propionibacterium). Alpha diversity of the skin microbiome was significantly increased after both treatments. However, the microbial profile of the crisaborole group was more distinct from the healthy control group than the TCS group was. Furthermore, the crisaborole group showed significant enrichment of taxa from the phylum Actinobacteria, including the genus Cutibacterium and species acnes. Although the efficacy of crisaborole in treating mild-to-moderate AD in children is not equivalent to that of TCS, crisaborole could still remarkably improve the clinical symptoms of patients and partially restore the microbial diversity on the skin surface of children with AD.

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease that significantly impairs quality of life. In recent years, treatment has advanced from broad immunosuppressants to targeted biologics and small-molecule therapies that modulate type 2 inflammation and itch signaling. Dupilumab, tralokinumab, lebrikizumab, and nemolizumab are now FDA-approved biologics with demonstrated efficacy and favorable long-term safety, while oral Janus kinase inhibitors (JAKis) such as abrocitinib, upadacitinib, and baricitinib often provide rapid disease control but carry black-box warnings. Comparative trials highlight faster itch relief with JAKis but durable disease control and safety advantages with biologics. The expanding treatment landscape necessitates individualized therapy selection. Key clinical considerations include patient age, pregnancy status, infection, malignancy, or thromboembolic risk, comorbid conditions, and history of adverse effects. Equally important are patient-centered preferences such as dosing frequency, route of administration, storage logistics, and willingness to self-inject. Access and affordability also influence care, with many manufacturers offering copay support and patient assistance programs. Future directions emphasize head-to-head comparative studies, biomarker development for precision treatment, and equitable access to advanced therapies. This narrative review synthesizes current evidence on biologics and JAKis in AD, outlining efficacy, safety, and practical decision-making factors to guide dermatologists in aligning therapies with both clinical context and patient priorities.

Hair dyes, such as p-phenylenediamine (PPD), are a frequent cause of potentially severe allergic contact dermatitis. Our group previously described the synthesis, safety profile, and hair dye properties of novel hair dye alternatives: hexyl-2,5-diaminobenzoate (PPD6) and hexyl 2-amino-5-((4-aminophenyl)amino)benzoate (PPD7). Our objective was to test the allergenicity of PPD6 and PPD7 with patch tests in individuals with proven contact allergy to PPD. This prospective cohort study at the University of Minnesota conducted patch testing to PPD6 and PPD7 on 8 subjects. Both in vitro and in chemico tests with PPD6 and PPD7 (DPRA and skin penetration) were done on patients with current or previously relevant positive patch test reactions to PPD or PTD. PPD6 and 7 derivatives were supplied in powder form and diluted to 1% and 2% for testing, with reading and photodocumentation on days 2 and 4. None of the subjects (0/8) reacted to PPD6, while most (5/8) of the subjects reacted to PPD7 and/or to the commercially available PTD (2/8) and ME-PPD (5/8). Further studies with larger cohorts are needed using the PPD6 as hair dye in PPD-allergic individuals. PPD6 may be a hypoallergenic alternative for permanent dark hair dye in patients with contact allergy to PPD.

The role of ultraviolet radiation in atopic dermatitis (AD) is paradoxical, and the relationships between distinct skin phenotypes and AD risk are poorly understood. It is unclear whether skin functional sun reactivity or baseline skin pigmentation is associated with AD susceptibility. To disentangle the independent associations of sun-reactive phototype and pigmentary phenotype with the prevalence of AD in a representative US population. This cross-sectional study analyzed data from 2656 participants in the National Health and Nutrition Examination Survey. We used multivariate logistic regression to calculate odds ratios for AD, adjusting for a comprehensive set of covariates. A multiple imputation sensitivity analysis was performed. After full adjustment, less sun-sensitive phototypes were associated with significantly lower odds of AD compared with the most sensitive phototypes. In contrast, the association between pigmentary phenotype and AD was fully attenuated after adjusting for race. Multiple imputation analysis confirmed the robustness of these findings. An individual's functional sun-reactive phototype, but not their constitutional pigmentary phenotype, is independently associated with the risk of AD.

Background: Some patients with atopic dermatitis (AD) have an inadequate response or intolerance to dupilumab. Stapokibart, a novel anti-IL-4R&#x3b1; antibody, is a potential alternative.Objective: To assess the real-world effectiveness and safety of switching from dupilumab to stapokibart in moderate-to-severe AD.Methods: This retrospective study included 85 patients (67 mild and 18 moderate-to-severe after dupilumab) who switched to stapokibart for &#x2265;16 weeks. Efficacy and safety were evaluated over 16 weeks.Results: Stapokibart led to rapid and significant improvements in all patients. By week 16, the Eczema Area and Severity Index (EASI) scores dramatically decreased, and high rates of EASI-90 (89.6% mild and 88.9% moderate-to-severe) were achieved. The mild group showed faster and deeper remission (e.g., EASI-100: 71.6% vs 50.0%). Disease control and quality of life improved significantly. The most common adverse event (AE) was injection site reaction (2.4%); no serious AEs or discontinuations occurred.Conclusion: Switching to stapokibart is an effective and safe strategy for patients with an inadequate response to dupilumab, inducing rapid and profound clinical improvement. It is a valuable sequential treatment for AD.

There is no consensus on the impact of meteorological factors and air pollutants on childhood atopic dermatitis (AD). Literature was searched in 3 databases (PubMed, Web of Science, and Embase) up to May 1, 2025, and evaluated by 2 independent reviewers. Cross-sectional studies, cohort studies, or time-series analyses were included, reporting outcomes of meteorological factors, air pollutants, and childhood AD. The Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality scale were used to assess study quality. A random-effects model was applied to estimate pooled risk ratios. From 132 identified literature, 49 studies involving nearly 7,091,746 participants were included. Air pollutants were positively correlated with the risk of childhood AD (odds ratio [OR] [95% confidence interval or CI] = 1.030 [1.005, 1.056] for carbon monoxide [CO]; 1.116 [1.075, 1.264] for nitrogen dioxide [NO2]; 1.059 [1.013, 1.108] for ozone; 1.114 [1.039, 1.260] for particulate matter [PM] with diameter of 10 &#xb5;m [PM10]; 1.041 [1.009, 1.074] for PM with diameter of 2.5 &#xb5;m [PM2.5]). No clear associations were observed between sulfur dioxide, temperature, humidity, and ultraviolet radiation (UVR) and the risk of childhood AD. Subgroup analysis showed that higher temperature and UVR might reduce the risk of AD, increased concentrations of CO, NO2 in developed countries, and PM10, PM2.5, and NO2 might increase the incidence risk in developing countries. Air pollutants represented significant risk factors for childhood AD, underscoring the imperative to prioritize environmental quality improvement for AD prevention.

Conventional systemic therapies, including cyclosporine and methotrexate, have traditionally been used for moderate-to-severe atopic dermatitis (AD). However, their real-world effectiveness and treatment persistence in the era of advanced therapies remain uncertain. To evaluate the effectiveness, safety, and treatment persistence of cyclosporine and methotrexate in routine clinical practice. We conducted a retrospective observational cohort study, including patients with moderate-to-severe AD who initiated cyclosporine or methotrexate as first-line systemic therapy. Disease severity and patient-reported outcomes were assessed at treatment initiation and discontinuation. Outcomes after escalation to advanced therapies were also analyzed. A total of 113 patients were included (mean age 33.7 &#xb1; 13.4 years; 53.1% female). Conventional systemic therapy was associated with modest clinical improvement, with no significant change in Eczema Area and Severity Index [EASI] (-0.66; P = 0.439) but a reduction in pruritus (Numerical Rating Scale [NRS] itch -1.3; P = 0.001). Median treatment duration was 20.5 weeks, and 96% discontinued therapy, mainly due to lack of efficacy (68.8%). After discontinuation, 76.0% escalated to advanced therapies, which achieved significant improvements in EASI (-11.1; P <0.001) and NRS itch (-3.2; P <0.001). In real-world practice, cyclosporine and methotrexate show limited effectiveness and low persistence, whereas advanced therapies provide substantial clinical benefit.

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Real-world evidence on the long-term use of dupilumab in very young children with moderate-to-severe atopic dermatitis (AD) remains limited. Observational data are needed to complement clinical trial findings by describing treatment outcomes in routine clinical practice. This multicenter retrospective study included children aged 6 months to 5 years with moderate-to-severe AD treated with dupilumab through the Italian Named Patient Program. Clinical assessments were performed at baseline and at weeks (W) 16, 24, 36, and 52. Disease severity, quality of life, and symptom burden were evaluated using the Eczema Area and Severity Index (EASI), Children's Dermatology Life Quality Index (c-DLQI), pruritus-numeric rating scale (P-NRS), and sleep-numeric rating scale (S-NRS). EASI-50/75/90 responder rates were calculated at each time point. Safety data were collected throughout treatment. Growth parameters were monitored between baseline and W52. Forty-seven children were included. Dupilumab led to rapid and progressive improvement of AD severity, with mean EASI decreasing from 26.1 at baseline to 2.7 at W52 (-89.7%). Marked improvements were also observed in quality of life (-91.3% in c-DLQI), itch intensity (-82.5% in P-NRS), and sleep disturbance (-82.7% in S-NRS). At W52, EASI-75 and EASI-90 responses were achieved by 79.5% and 59.0% of evaluable patients, respectively. Dupilumab was well tolerated, with treatment-emergent adverse events occurring in 10.6% of patients, all mild or moderate and none leading to discontinuation. Weight- and height-for-age z-scores significantly increased over 52 weeks; no child newly developed values below -2 standard deviations, although 1 child remained below this threshold at W52. Percentile-based analyses yielded consistent results, confirming the absence of negative effects on growth. Dupilumab was effective and well tolerated over 52 weeks in children aged 6 months to 5 years with moderate-to-severe AD, providing sustained skin clearance, symptom relief, and quality-of-life improvement. These findings support dupilumab as a valuable long-term therapeutic option in very young children with uncontrolled AD in clinical practice.

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