Fourteenth Issue
July 13, 2022
We’ve all learned about atopic dermatitis from a scientific perspective: it is a pruritic inflammatory skin condition that causes Th2 lymphocytic overproduction of IL-4, IL-5, and IL-13 cytokines, leading to high levels of IgE. But putting all the science aside, what does having atopic dermatitis (AD) actually mean in terms of disease burden and overall treatment experience in adult patients? Scientists sought to discover just this.
A 32-item survey was disseminated to adults with atopic dermatitis, reaching 1065 respondents. In addressing their AD symptoms over the past month, 3% reported no impact, 18% reported low impact, 28% reported moderate impact, 21% high impact and 30% significant impact on daily life. A proportional odds model found that higher impact scores were associated with greater disease burden, or disease impact on quality of life; moderate AD was 4.13 more likely than mild disease and severe AD was 13.63 more likely than mild disease to impact disease burden. Additionally, the amount of time spent managing AD symptoms was associated with increased burden of disease, with 11-20 hours having an odds ratio of 2.67 compared to 0-4 hours (95% CI 1.77-4.03), and >21 hours spent managing AD having an odds ratio 5.34 compared to 0-4 hours (95% CI 3.22-8.85). 40% of patients experienced mild mood changes as a result of disease, while 30% and 9% reported moderate and severe mood changes, respectively. This study was limited by selection bias and recall bias; additionally, those with more severe disease were more likely to have participated in the survey.
Main takeaway: Factors that impact disease burden in atopic dermatitis include disease severity, time spent managing disease, and impact on mood. Finding ways to manage disease and deeper understanding of patient experience are necessary to improving patient outcomes.
A 32-item survey was disseminated to adults with atopic dermatitis, reaching 1065 respondents. In addressing their AD symptoms over the past month, 3% reported no impact, 18% reported low impact, 28% reported moderate impact, 21% high impact and 30% significant impact on daily life. A proportional odds model found that higher impact scores were associated with greater disease burden, or disease impact on quality of life; moderate AD was 4.13 more likely than mild disease and severe AD was 13.63 more likely than mild disease to impact disease burden. Additionally, the amount of time spent managing AD symptoms was associated with increased burden of disease, with 11-20 hours having an odds ratio of 2.67 compared to 0-4 hours (95% CI 1.77-4.03), and >21 hours spent managing AD having an odds ratio 5.34 compared to 0-4 hours (95% CI 3.22-8.85). 40% of patients experienced mild mood changes as a result of disease, while 30% and 9% reported moderate and severe mood changes, respectively. This study was limited by selection bias and recall bias; additionally, those with more severe disease were more likely to have participated in the survey.
Main takeaway: Factors that impact disease burden in atopic dermatitis include disease severity, time spent managing disease, and impact on mood. Finding ways to manage disease and deeper understanding of patient experience are necessary to improving patient outcomes.
Vitamin D pretreatment significantly improves actinic keratosis response to blue light therapy
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Forgot to take your vitamins? It could be riskier than you think! Photodynamic light therapy (PDT) is a mainstay in the treatment of actinic keratoses (AK); this treatment incorporates 5-aminolevulinic acid (ALA), a prodrug, which is then converted to protoporphyrin IX (PpIX) in the skin, and later activated by red or blue light.
In this prospective, nonrandomized trial, participants were assigned to either a control or interventional group. Both groups had measurements of baseline serum vitamin D3 levels taken and AK lesions counted. The intervention group was given oral vitamin D3 capsules before therapy, then both groups underwent PDT treatment, with follow-up at 3-6 months for evaluation.
Primary outcomes measured the difference in percent decrease in AK lesions between participants treated with vitamin D3 and the control group. Results showed that oral high-dose vitamin D3 pretreatment increased the mean rate of facial AK clearance to 72.5% (p < .05) compared to the control group clearance rate of 54.4%. In addition, researchers found that vitamin D3-deficient participants had a lower mean rate of AK clearance following treatment (40.9%) than patients with normal serum vitamin D3 levels (62.6%), suggesting that normal levels of vitamin D3 are helpful for optimal treatment response. Self-reported side effects and pain levels during and after PDT treatment were similar between groups. Limitations of the study include non-randomization and evaluation of AKs by two dermatologists, potentially leading to variability.
Main takeaway: Researchers found that high-dose oral vitamin D3 pretreatment before photodynamic therapy significantly improved clearance rates of actinic keratoses compared to a control group. Vitamin D3 is an inexpensive and well-tolerated supplementation that shows promise as a therapeutic intervention.
In this prospective, nonrandomized trial, participants were assigned to either a control or interventional group. Both groups had measurements of baseline serum vitamin D3 levels taken and AK lesions counted. The intervention group was given oral vitamin D3 capsules before therapy, then both groups underwent PDT treatment, with follow-up at 3-6 months for evaluation.
Primary outcomes measured the difference in percent decrease in AK lesions between participants treated with vitamin D3 and the control group. Results showed that oral high-dose vitamin D3 pretreatment increased the mean rate of facial AK clearance to 72.5% (p < .05) compared to the control group clearance rate of 54.4%. In addition, researchers found that vitamin D3-deficient participants had a lower mean rate of AK clearance following treatment (40.9%) than patients with normal serum vitamin D3 levels (62.6%), suggesting that normal levels of vitamin D3 are helpful for optimal treatment response. Self-reported side effects and pain levels during and after PDT treatment were similar between groups. Limitations of the study include non-randomization and evaluation of AKs by two dermatologists, potentially leading to variability.
Main takeaway: Researchers found that high-dose oral vitamin D3 pretreatment before photodynamic therapy significantly improved clearance rates of actinic keratoses compared to a control group. Vitamin D3 is an inexpensive and well-tolerated supplementation that shows promise as a therapeutic intervention.
a. CLEC12B mRNA expression increased in light-pigmented donors compared to dark-pigmented donors.
b. Staining of CLEC12B on human skin. Brown-melanin. Red-CLEC12B.
b. Staining of CLEC12B on human skin. Brown-melanin. Red-CLEC12B.
Skin pigmentation is highly variable, and regulation of pigmentation is complex. Pigmentation largely depends on the amount of melanin made by melanocytes in the skin, that is later transferred to surrounding keratinocytes. But what are the processes that regulate melanin production and transfer? Better understanding of this pathway can provide insight into how to treat pigmentary disorders.
In this study, the authors looked at the gene expression profiles of normal pigmented skin and amelanotic skin from patients with vitiligo. Through transcriptome and protein analysis, they found that CLEC12B is highly expressed by melanocytes, and there was decreased expression in vitiligo skin. It is well known that C-type lectin receptors, such as CLEC12B, play important roles in inflammation and immunity, but these new data suggest that CLEC12B may play additional roles in pigmentation. The authors found that CLEC12B expression varies with skin pigmentation. In light-pigmented skin, CLEC12B expression was significantly higher than in dark-pigmented skin. Additionally, they found that CLEC12B plays a role in regulating melanogenesis. When the authors silenced CLEC12B, they observed increased pigmentation in melanocytes. When the authors overexpressed CLEC12B, they observed a reduction in melanin content. Finally, the authors found that CLEC12B likely acts through SHP1 and SHP2 to further regulate additional melanocyte molecules. These studies identify CLEC12B as an important melanocytic gene in the regulation of skin pigmentation.
Main Takeaway: The authors identified CLEC12B as an important melanocytic gene in the regulation of skin pigmentation. This study provides valuable insight into melanocyte biology and regulation, potentially bringing to light ideas for the development of novel pigmentary disorder therapies.
*genes are italicized, proteins are not