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The sensitivity, specificity, and positive and negative likelihood ratios were 57.7%, 72.3%, 2.08, and 0.59, respectively. (ROC curves were not plotted for case patients aged 2 years or younger because of the small numbers.)There was significant correlation of serum TARC levels with the SCORAD index (r ¼ 0.538; 95% confidence interval [CI], 0.36-0.68), QOL indices (Infants' Dermatitis QOL: r ¼ 0.823; 95% CI, 0.40-0.96; Children's Dermatology Life Quality Index: r ¼ .380; 95% CI, 0.16-0.57), peripheral eosinophils, and LDH in children older than 2 years but not in the younger age groups (Table II). The correlation with IgE was not significant. In the same age group, for SCORAD index, the correlation was highest with LDH (r ¼ 0.582; 95% CI, 0.40-0.72), followed by serum TARC (r ¼ 0.538; 95% CI, 0.36-0.68), peripheral eosinophils (r ¼ 0.397; 95% CI, 0.19-0.57), and serum IgE (r ¼ 0.331; 95% CI, 0.11-0.52). In concurrence with previous studies, our results suggest that TARC correlates with the severity of AD and QOL indices. 1,5 The sensitivity and specificity were lower than those previously reported (83%-85% and 92%-96%, respectively), possibly due to choosing control individuals with diseases mimicking AD and the use of different enzyme-linked immunosorbent assay systems. 2,4

It has recently been revealed that mutation of the IL36RN gene contributes to the development of generalized pustular psoriasis (GPP). The IL36RN gene encodes interleukin (IL)‐36 receptor antagonist (IL‐36Ra), which has antagonistic roles against IL‐36α, ‐36β, and ‐36γ. Previously, sanger sequencing performed in 62 Chinese GPP patients to identify IL36RN mutations revealed a new variant, c.245C>T (p.Pro82Leu), in a single heterozygous state in a patient with adult‐onset GPP with psoriasis vulgaris. Since this p.Pro82Leu variant was not found in the psoriasis vulgaris or control groups in their study, they speculated that this variant might lead to exacerbated inflammatory responses. Meanwhile, Sorting Intolerant From Tolerant and PolyPhen‐2, pathogenicity prediction tools, predict this variant as tolerated and benign. To date, its pathogenicity is unknown. We experienced a patient with GPP harboring the p.Pro82Leu variant, and investigated mRNA and protein expressions of IL‐36Ra. Polymerase chain reaction conducted on hair follicle samples obtained from the scalp of the patient with GPP harboring the p.Pro82Leu using primers to detect mRNA of exons 2 and 5 in IL36RN demonstrated mRNA expression of IL36RN. Immunohistochemical staining revealed IL‐36Ra expression in the keratinocytes of the patient with GPP harboring the p.Pro82Leu as in those of a GPP patient without the mutation (positive control). Furthermore, quantitative analysis of the immunofluorescent staining by ImageJ revealed that the expression level of IL‐36Ra in the keratinocytes of the patient with GPP harboring p.Pro82Leu was higher than that in the healthy control and not lower than that in the GPP patients without the mutation. Our results indicate no aberrant splicing in this variant. In addition, according to the 1000 Genomes Project, this variant could be a founder mutation. Considering these factors together, this variant is unlikely to be associated with the development of GPP.

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Dupilumab was approved for treating adult patients with atopic dermatitis (AD) refractory to topical therapy in Japan in April 2018, and self‐injection of dupilumab has been available since May 2019. Subcutaneous self‐injection of medication has benefits for patients and the healthcare system. However, anxiety about self‐injection, lack of confidence, and the complicated procedure could prevent initiating self‐injection. In this study, we assessed the experience of AD patients treated with dupilumab before and after introducing self‐injection, utilizing the Self‐Injection Assessment Questionnaire (SIAQ). Adult AD patients who received dupilumab by self‐injection and had been treated for more than 3 months after initiating self‐injection in our hospital from March 1, 2020, to June 19, 2021, were included in this study. Patients rated their perceptions about self‐injections using the SIAQ before the first self‐injection and 3 months after initiating self‐injection. Data were collected retrospectively from their charts. Data on 36 patients were analyzed. The mean age was 34.1 ± 11.5 years. Twenty patients used a prefilled auto‐injector, and the others used a prefilled syringe. Scores on self‐confidence and satisfaction with self‐injection significantly improved after introducing self‐injection. Feelings about injections improved in patients over 40 years and in those who felt anxious about self‐injection. A strong correlation in scores between satisfaction with self‐injection and the ease of use was observed. The results were not affected by clinical severity, gender, or device. Our results could encourage patients who dither to introduce self‐injection of dupilumab due to anxiety and/or lack of self‐confidence about self‐injection to initiate self‐injection.

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