image: The left-hand image presents a detailed flowchart outlining the selection criteria for all Atopic Dermatitis (AD) patients included in the study. This comprehensive cross-sectional epidemiological investigation spanned 205 hospitals in 30 provinces across China, including two dedicated pediatric hospitals, and successfully enrolled 16,838 AD patients between August 2021 and September 2022. In contrast, the image on the right provides a visual representation of the therapeutic distribution among patients, categorized by the severity of their condition. The authors highlight a notable observation: the adoption rate of treatments endorsed by international guidelines was disappointingly low within this cohort. AD: Atopic Dermatitis, TCS: Topical corticosteroids, TCI: Topical calcineurin inhibitor.
Credit: Beijing Zhongke Journal Publising Co. Ltd.
This report represents the first large-scale, nationwide study in China focusing on the severity, risk factors, and comorbidities of Atopic Dermatitis (AD). The cross-sectional epidemiological study encompassed 205 hospitals across 30 provinces in China, including two pediatric specialty hospitals, and enrolled a total of 16,838 AD patients from August 2021 to September 2022. The findings from this study are instrumental in guiding the design of treatment strategies in clinical settings, facilitating proactive monitoring of changes and trends in AD clinical characteristics and patient management, and providing a baseline for future large-scale, controlled cohort studies.
AD, a chronic inflammatory skin disease marked by recurrent pruritic eczematous lesions, is traditionally prevalent among children (up to 25% prevalence). However, adult cases are increasingly recognized. Current research primarily focuses on pediatric AD, with limited studies on adult cases and a lack of comprehensive analysis across all ages, hindering our understanding of AD's clinical manifestations, treatment responses, and management in adults. This study aims to enhance our understanding of AD across age groups, supporting the development of unified, effective management strategies.
This study began by analyzing demographic and clinical characteristics. Severe AD prevalence increased with age, peaking at 26.73% among patients with onset age ≥60 years. Males showed a steeper rise in severe AD incidence with age compared to females, while fewer males had mild AD with later onset. Rural AD patients were underrepresented in the cohort, but no significant difference in AD severity was found between urban and rural populations. AD severity distribution remained consistent across education levels. Northern China had a higher prevalence of severe AD, while western China had a lower prevalence. Overall, patients with severe AD had higher EASI scores, highlighting regional and demographic disparities in disease severity.
In this study, 29.02% of AD patients had a single comorbidity, and 10.03% had multiple comorbidities. Among atopic comorbidities, allergic rhinitis was most prevalent, followed by food allergy, asthma, chronic urticaria, and drug allergy. Severe AD patients had a higher incidence of asthma and food allergy. Allergic rhinitis was more common in moderate AD, and chronic urticaria in mild AD. Regarding non-atopic metabolic comorbidities, hypertension was most frequent, followed by diabetes and coronary heart disease. Severe AD patients had a higher prevalence of these conditions. Hypertension and diabetes were identified as potential AD exacerbating factors.
The study found that 1,953 patients (11.6%) experienced one or more exacerbating factors, with seasonal changes in spring, summer, or winter significantly affecting severe AD patients. Food triggers included fish, shellfish, lamb, beef, chili peppers, and alcohol. Environmental factors such as sunlight, humidity, dryness, sweating, showering, skin friction, dust, and pollen exacerbated severe AD, while stress, emotional issues, and sleep disorders were psychological triggers.
In this study, the authors found that the top six treatments for AD patients included topical glucocorticoids (32.26%), oral antihistamines (28.66%), moisturizers (19.58%), topical calcineurin inhibitors (TCI) (5.99%), glycyrrhizin (5.82%), and dupilumab (5.80%). The authors emphasized that the utilization rate of treatments recommended by international guidelines was relatively low among this study population.
This study highlights allergic rhinitis and hypertension as the predominant atopic and metabolic non-atopic comorbidities, with AD severity strongly associated with chronic urticaria, food allergy, and diabetes. AD severity is exacerbated by dietary triggers, seasonal variations, and psychological stress. Cross-sectional analysis suggests severe AD may stem from inadequate use of potent therapies. Improved AD management necessitates tackling these exacerbating factors and boosting systemic immunotherapeutic approaches.
See the article:
Associations of demographics, aggravating factors, comorbidities, and treatments with atopic dermatitis severity in China: A national cross-sectional study
Journal
Chinese Medical Journal
Article Title
Associations of demographics, aggravating factors, comorbidities, and treatments with atopic dermatitis severity in China: A national cross-sectional study
Article Publication Date
3-Mar-2024