What the Eczema Area and Severity Index score tells us about the severity of atopic dermatitis: an interpretability study

Leshem, Yael Anne; Hajar, Tamar; Hanifin, Jon M.; Simpson, Eric L.

doi:10.1111/bjd.13662

Cited by 232 publications

(242 citation statements)

References 12 publications

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“…Post hoc subgroup analysis for primary outcome according to baseline eczema severity Eczema Area and Severity Index scores according to group and baseline eczema severity (almost clear or mild EASI scores and moderate or severe EASI scores) 44 are shown in Table 16. There was no evidence that the clothing was more or less effective depending on the severity of eczema at baseline.…”

Section: Results: Clinical Findingsmentioning

confidence: 99%

Randomised controlled trial of silk therapeutic garments for the management of atopic eczema in children: the CLOTHES trial

Kim

Bradshaw

Sach

et al. 2017

Health Technol Assess

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Background: Atopic eczema (AE) is a chronic, itchy, inflammatory skin condition that affects the quality of life of children and their families. The role of specialist clothing in the management of AE is poorly understood.Objectives: To assess the effectiveness and cost-effectiveness of silk garments for the management of AE in children with moderate to severe disease.Design: Parallel-group, observer-blind, randomised controlled trial of 6 months’ duration, followed by a 2-month observational period. A nested qualitative study evaluated the beliefs of trial participants, health-care professionals and health-care commissioners about the use of silk garments for AE.Setting: Secondary care and the community in five UK centres.Participants: Children aged 1–15 years with moderate or severe AE.Interventions: Participants were randomised (1 : 1 using online randomisation) to standard care or standard care plus 100% silk garments made from antimicrobially protected knitted sericin-free silk [DermaSilkTM (AlPreTec Srl, San Donà di Piave, Italy) or DreamSkinTM (DreamSkin Health Ltd, Hatfield, UK)]. Three sets of garments were supplied per participant, to be worn for up to 6 months (day and night). At 6 months the standard care group received the garments to use for the remaining 2-month observational period.Main outcome measures: Primary outcome – AE severity using the Eczema Area and Severity Index (EASI) assessed at 2, 4 and 6 months, by nurses blinded to treatment allocation. EASI scores were log-transformed for analysis. Secondary outcomes – patient-reported eczema symptoms (Patient Oriented Eczema Measure); global assessment of severity (Investigator Global Assessment); quality of life of the child (Atopic Dermatitis Quality of Life, Child Health Utility – 9 Dimensions), family (Dermatitis Family Impact Questionnaire) and main carer (EuroQoL-5 Dimensions-3 Levels); use of standard eczema treatments (e.g. emollients, topical corticosteroids); and cost-effectiveness. The acceptability and durability of the clothing, and adherence to wearing the garments, were assessed by parental/carer self-report. Safety outcomes – number of skin infections and hospitalisations for AE.Results: A total of 300 children were randomised (26 November 2013 to 5 May 2015): 42% female, 79% white, mean age 5 years. The primary analysis included 282 out of 300 (94%) children (n = 141 in each group). Garments were worn for at least 50% of the time by 82% of participants. Geometric mean EASI scores at baseline, 2, 4 and 6 months were 8.4, 6.6, 6.0, 5.4 for standard care and 9.2, 6.4, 5.8, 5.4 for silk clothing, respectively. There was no evidence of difference between the groups in EASI score averaged over all follow-up visits adjusted for baseline EASI score, age and centre (ratio of geometric means 0.95, 95% confidence interval 0.85 to 1.07; p = 0.43). This confidence interval is equivalent to a difference of –1.5 to 0.5 in the original EASI scale units. Skin infections occurred in 39 out of 141 (28%) and 36 out of 142 (25%) participants for sta...

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Section: Results: Clinical Findingsmentioning

confidence: 99%

Randomised controlled trial of silk therapeutic garments for the management of atopic eczema in children: the CLOTHES trial

Kim

Bradshaw

Sach

et al. 2017

Health Technol Assess

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“…Our findings reflect the higher prevalence of ACD in this selected difficult‐to‐treat AD patient group as compared to patients with AD patch tested due to clinical suspicion during routine outpatient care or to screen for contact allergies. The mean EASI of 25 shows that this is indeed a group of severe AD patients,35 which makes it a different subgroup compared to mild AD patients, with therefore different rates of contact sensitization.…”

Section: Discussionmentioning

confidence: 99%

Both children and adult patients with difficult‐to‐treat atopic dermatitis have high prevalences of concomitant allergic contact dermatitis and are frequently polysensitized

Boonstra

Rustemeyer

Middelkamp-Hup

2018

Acad Dermatol Venereol

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BackgroundConcomitant allergic contact dermatitis (ACD) has been described as a possible cause of atopic dermatitis (AD) becoming difficult‐to‐treat. However, contact sensitization in this patient group has barely been studied.ObjectiveTo study the occurrence of ACD in a population of difficult‐to‐treat AD children and adults.MethodsClinical and patch test information of 48 patients with difficult‐to‐treat AD unresponsive to conventional outpatient treatments was gathered retrospectively. We studied prevalence and relevance of common allergens, performed dynamic patch test analysis and assessed occurrence of polysensitization.ResultsIn 48 patients with difficult‐to‐treat AD, 75% (n = 36/48) had a concomitant contact allergy, and 39% (n = 14/36) of these patients were polysensitized. ACD and polysensitization prevalences were equal amongst children and adults. The most frequent and relevant reactions were seen against wool alcohols, surfactants cocamidopropyl betaine and dimethylaminopropylamine, bichromate and fragrance mix I. Dynamic pattern analysis showed these reactions to be mostly allergic and not irritative of nature.ConclusionDifficult‐to‐treat AD patients frequently suffer from concomitant (multiple) contact allergies, and this may be a reason why the AD turns into a difficult‐to‐treat disease. Awareness of this phenomenon is necessary, as pragmatic implementation of allergen avoidance strategies may be helpful in getting disease control in this population.

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“…The molecular basis of APOE single-nucleotide polymorphisms (SNPs) is cysteine-arginine interchanges. 3 APOE SNPs are the main genetic determinant of Alzheimer disease (AD) risk: individuals carrying the e4 allele are at increased risk of AD compared with those carrying the more common e3 allele, whereas the e2 allele decreases the risk. 3 Conversely, in patients with leprosy without dementia, the frequency of the e4 allele was significantly higher, suggesting that this allele is not a risk factor for dementia in elderly patients with leprosy.…”

Section: Supporting Informationmentioning

confidence: 99%

“…Or should one focus on how much they bother a patient? 3,4 The authors chose to use one broad anchor question for all mentioned instruments: 'Would you describe your atopic dermatitis or eczema as mild, moderate, or severe?' In their validation paper of this single question, the authors conclude that it might be an important PRO for assessing the overall burden of disease that accounts for severity, extent, symptom burden and quality of life impact.…”

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confidence: 99%

Interpretability in atopic dermatitis: all about the anchor

Oosterhaven

2018

British Journal of Dermatology

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However, the authors used a strict definition for the 'validated algorithm-based' diagnosis of HS, and the sociodemographic characteristics and comorbidities of the 'validated algorithmbased' HS population were consistent with previous studies, minimizing classification bias.Finally, the authors should be congratulated for the robustness of their study in terms of its design, opening a new methodological avenue in the pharmacoepidemiology field, where diagnostic criteria are lacking. This study confirmed that the prevalence of HS is not more than 0Á7-1%.

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What the Eczema Area and Severity Index score tells us about the severity of atopic dermatitis: an interpretability study

Cited by 232 publications

References 12 publications

Randomised controlled trial of silk therapeutic garments for the management of atopic eczema in children: the CLOTHES trial

Randomised controlled trial of silk therapeutic garments for the management of atopic eczema in children: the CLOTHES trial

Both children and adult patients with difficult‐to‐treat atopic dermatitis have high prevalences of concomitant allergic contact dermatitis and are frequently polysensitized

Interpretability in atopic dermatitis: all about the anchor

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