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The successful management of chronic diseases such as atopic dermatitis relies greatly on adherence to treatment. The likelihood of adherence requires much more than a simple transfer of knowledge: a change in individuals’ behaviour towards health is needed. One of the critical components of this change is therapeutic patient education. This form of education is an evolving concept: it aims to empower patients and their caregivers with the knowledge and skills to be able to manage disease autonomously. Despite the obvious challenges, this Darwinist approach to healthcare should be embraced in medicine, and in particular in the care of atopic dermatitis patients, in order to ensure an improvement in patients’ (and their caregivers’) quality of life.

Skin barrier dysfunction precedes eczema development. We tested whether daily use of emollient in the first year could prevent eczema in high-risk children. We did a multicentre, pragmatic, parallel-group, randomised controlled trial in 12 hospitals and four primary care sites across the UK. Families were approached via antenatal or postnatal services for recruitment of term infants (at least 37 weeks' gestation) at high risk of developing eczema (ie, at least one first-degree relative with parent-reported eczema, allergic rhinitis, or asthma, diagnosed by a doctor). Term newborns with a family history of atopic disease were randomly assigned (1:1) to application of emollient daily (either Diprobase cream or DoubleBase gel) for the first year plus standard skin-care advice (emollient group) or standard skin-care advice only (control group). The randomisation schedule was created using computer-generated code (stratified by recruiting centre and number of first-degree relatives with atopic disease) and participants were assigned to groups using an internet-based randomisation system. The primary outcome was eczema at age 2 years (defined by UK working party criteria) with analysis as randomised regardless of adherence to allocation for participants with outcome data collected, and adjusting for stratification variables. This trial is registered with ISRCTN, ISRCTN21528841. Data collection for long-term follow-up is ongoing, but the trial is closed to recruitment. 1394 newborns were randomly assigned to study groups between Nov 19, 2014, and Nov 18, 2016; 693 were assigned to the emollient group and 701 to the control group. Adherence in the emollient group was 88% (466 of 532) at 3 months, 82% (427 of 519) at 6 months, and 74% (375 of 506) at 12 months in those with complete questionnaire data. At age 2 years, eczema was present in 139 (23%) of 598 infants with outcome data collected in the emollient group and 150 (25%) of 612 infants in the control group (adjusted relative risk 0·95 [95% CI 0·78 to 1·16], p=0·61; adjusted risk difference –1·2% [–5·9 to 3·6]). Other eczema definitions supported the results of the primary analysis. Mean number of skin infections per child in year 1 was 0·23 (SD 0·68) in the emollient group versus 0·15 (0·46) in the control group; adjusted incidence rate ratio 1·55 (95% CI 1·15 to 2·09). We found no evidence that daily emollient during the first year of life prevents eczema in high-risk children and some evidence to suggest an increased risk of skin infections. Our study shows that families with eczema, asthma, or allergic rhinitis should not use daily emollients to try and prevent eczema in their newborn. National Institute for Health Research Health Technology Assessment.

Abrocitinib, an oral selective Janus kinase 1 inhibitor, was effective and well tolerated in adults with moderate-to-severe atopic dermatitis in a phase 2b trial. We aimed to assess the efficacy and safety of abrocitinib monotherapy in adolescents and adults with moderate-to-severe atopic dermatitis. In this multicentre, double-blind, randomised phase 3 trial (JADE MONO-1), patients (aged ≥12 years) with moderate-to-severe atopic dermatitis (Investigator Global Assessment score ≥3, Eczema Area and Severity Index [EASI] score ≥16, percentage of body surface area affected ≥10%, and Peak Pruritus Numerical Rating Scale score ≥4) with a bodyweight of 40 kg or more, were enrolled at 69 sites in Australia, Canada, Europe, and the USA. Patients were randomly assigned (2:2:1) to oral abrocitinib 100 mg, abrocitinib 200 mg, or placebo once daily for 12 weeks. Randomisation was done using an interactive response technology system, stratified by baseline disease severity and age. Patients, investigators, and the funder of the study were masked to study treatment. The coprimary endpoints were the proportion of patients who had achieved an Investigator Global Assessment response (score of 0 [clear] or 1 [almost clear] with a ≥2-grade improvement from baseline), and the proportion of patients who achieved at least a 75% improvement in EASI score from baseline (EASI-75) score, both assessed at week 12. Efficacy was assessed in the full analysis set, which included all randomised patients who received at least one dose of study medication. Safety was assessed in all randomised patients. This study is registered with ClinicalTrials.gov, NCT03349060. Between Dec 7, 2017, and March 26, 2019, 387 patients were enrolled: 156 were assigned to abrocitinib 100 mg, 154 to abrocitinib 200 mg, and 77 to placebo. All enrolled patients received at least one dose of study treatment and thus were evaluable for 12-week efficacy. Of the patients with available data for the coprimary endpoints at week 12, the proportion of patients who had achieved an Investigator Global Assessment response was significantly higher in the abrocitinib 100 mg group than in the placebo group (37 [24%] of 156 patients vs six [8%] of 76 patients; p=0·0037) and in the abrocitinib 200 mg group compared with the placebo group (67 [44%] of 153 patients vs six [8%] of 76 patients; p<0·0001). Of the patients with available data for the coprimary endpoints at week 12, compared with the placebo group, the proportion of patients who had achieved an EASI-75 response was significantly higher in the abrocitinib 100 mg group (62 [40%] of 156 patients vs nine [12%] of 76 patients; p<0·0001) and abrocitinib 200 mg group (96 [63%] of 153 patients vs nine [12%] of 76 patients; p<0·0001). Adverse events were reported in 108 (69%) of 156 patients in the abrocitinib 100 mg group, 120 (78%) of 154 patients in the abrocitinib 200 mg group, and 44 (57%) of 77 patients in the placebo group. Serious adverse events were reported in five (3%) of 156 patients in the abrocitinib 100 mg group, five (3%) of 154 patients in the abrocitinib 200 mg group, and three (4%) of 77 patients in the placebo group. No treatment-related deaths were reported. Monotherapy with oral abrocitinib once daily was effective and well tolerated in adolescents and adults with moderate-to-severe atopic dermatitis. Pfizer.

Evidence is accumulating that early consumption is more beneficial than is delayed introduction as a strategy for primary prevention of food allergy. However, allergic reactions caused by early introduction of such solid foods have been a problematic issue. We investigated whether or not early stepwise introduction of eggs to infants with eczema combined with optimal eczema treatment would prevent egg allergy at 1 year of age. In this randomised, double-blind, placebo-controlled trial, we enrolled infants 4–5 months of age with eczema from two centres in Japan. Exclusion criteria were being born before 37 weeks of gestational age, experience of ingestion of hen's eggs or egg products, history of immediate allergic reaction to hen's eggs, history of non-immediate allergic reaction to a particular type of food, and complications of any severe disease. Infants were randomly assigned (block size of four; stratified by institution and sex) to early introduction of egg or placebo (1:1). Participants in the egg group consumed orally 50 mg of heated egg powder per day from 6 months to 9 months of age and 250 mg per day thereafter until 12 months of age. We aggressively treated participants' eczema at entry and maintained control without exacerbations throughout the intervention period. Participants and physicians were masked to assignment, and allocation was concealed. The primary outcome was the proportion of participants with hen's egg allergy confirmed by open oral food challenges at 12 months of age, assessed blindly by standardised methods, in all randomly allocated participants who received the intervention. This trial is registered with the University Hospital Medical Information Network Clinical Trials Registry, number UMIN000008673. Between Sept 18, 2012, and Feb 13, 2015, we randomly allocated 147 participants (73 [50%] to the egg group and 74 [50%] to the placebo group). This trial was terminated on the basis of the results of the scheduled interim analysis of 100 participants, which showed a significant difference between the two groups (four [9%] of 47 participants had an egg allergy in the egg group vs 18 [38%] of 47 in the placebo group; risk ratio 0·222 [95% CI 0·081–0·607]; p=0·0012). In the primary analysis population, five (8%) of 60 participants had an egg allergy in the egg group compared with 23 (38%) of 61 in the placebo group (risk ratio 0·221 [0·090–0·543]; p=0·0001). The only difference in adverse events between groups was admissions to hospital (six [10%] of 60 in the egg group vs none in the placebo group; p=0·022). 19 acute events occurred in nine (15%) participants in the egg group versus 14 events in 11 (18%) participants in the placebo group after intake of the trial powder. Introduction of heated egg in a stepwise manner along with aggressive eczema treatment is a safe and efficacious way to prevent hen's egg allergy in high-risk infants. In this study, we developed a practical approach to overcome the second wave of the allergic epidemic caused by food allergy. Ministry of Health, Labour and Welfare, and National Centre for Child Health and Development, Japan.

Background Work-related hand eczema (WRHE) is a common occupational disease in Europe, associated with impaired quality of life and a substantial socioeconomic burden. As skin protection behaviour critically influences disease course, mobile health interventions may help establish and maintain routines. The smartphone app ‘ Mein Hautschutz im Alltag ’ (MiA; German for ‘ My Skin Protection in Everyday Life ’) was developed to support patients with WRHE, but its clinical effectiveness has not yet been evaluated. Methods This quasi-randomised controlled trial will enrol 286 adults with WRHE attending a 3-week inpatient programme at a specialised dermatology clinic. Participants are allocated in clusters based on admission date to either care as usual (control) or care as usual plus an individual goal-setting interview and a 6-month access to the MiA app (intervention). The primary outcome is change in skin protection behaviour from baseline to 6 months post-discharge. Secondary outcomes include clinical and self-rated skin condition, action control, and quality of life. Analyses will follow the intention-to-treat principle using linear mixed models. Discussion This is the first systematic evaluation of the MiA app’s effectiveness in patients with WRHE in a quasi-randomised controlled trial. By combining a structured goal-setting interview with the MiA app, the intervention aims to support the long-term adoption and maintenance of protective behaviours in both occupational and private settings. Key limitations include the quasi-random allocation by admission date (no true randomisation), lack of allocation concealment and blinding, reliance on self-reported primary outcomes, and a 6-month follow-up. Despite these constraints, the pragmatic design aims to generate decision-relevant, real-world evidence for WRHE care. Trial registration German Clinical Trial Registry DRKS00036627. Registered on April 14, 2025.

The role of clothing in the management of eczema (also called atopic dermatitis or atopic eczema) is poorly understood. This trial evaluated the effectiveness and cost-effectiveness of silk garments (in addition to standard care) for the management of eczema in children with moderate to severe disease. This was a parallel-group, randomised, controlled, observer-blind trial. Children aged 1 to 15 y with moderate to severe eczema were recruited from secondary care and the community at five UK medical centres. Participants were allocated using online randomisation (1:1) to standard care or to standard care plus silk garments, stratified by age and recruiting centre. Silk garments were worn for 6 mo. Primary outcome (eczema severity) was assessed at baseline, 2, 4, and 6 mo, by nurses blinded to treatment allocation, using the Eczema Area and Severity Index (EASI), which was log-transformed for analysis (intention-to-treat analysis). A safety outcome was number of skin infections. Three hundred children were randomised (26 November 2013 to 5 May 2015): 42% girls, 79% white, mean age 5 y. Primary analysis included 282/300 (94%) children (n = 141 in each group). The garments were worn more often at night than in the day (median of 81% of nights [25th to 75th centile 57% to 96%] and 34% of days [25th to 75th centile 10% to 76%]). Geometric mean EASI scores at baseline, 2, 4, and 6 mo were, respectively, 9.2, 6.4, 5.8, and 5.4 for silk clothing and 8.4, 6.6, 6.0, and 5.4 for standard care. There was no evidence of any difference between the groups in EASI score averaged over all follow-up visits adjusted for baseline EASI score, age, and centre: adjusted ratio of geometric means 0.95, 95% CI 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 units, which is not clinically important. Skin infections occurred in 36/142 (25%) and 39/141 (28%) of children in the silk clothing and standard care groups, respectively. Even if the small observed treatment effect was genuine, the incremental cost per quality-adjusted life year was £56,811 in the base case analysis from a National Health Service perspective, suggesting that silk garments are unlikely to be cost-effective using currently accepted thresholds. The main limitation of the study is that use of an objective primary outcome, whilst minimising detection bias, may have underestimated treatment effects. Silk clothing is unlikely to provide additional benefit over standard care in children with moderate to severe eczema. Current Controlled Trials ISRCTN77261365.

Hand and foot eczema is a frequent chronic dermatological condition. The persistent itching, pain, and blistering can impair hand and foot function, leading to difficulties in performing tasks requiring fine motor skills. In addition, the impact on the quality of life for affected patients is significant, as the symptoms can be extremely uncomfortable and disruptive to daily activities. By incorporating digital health apps and educational programs into the management of hand and foot eczema, patients may receive ongoing support, optimize their clinical outcomes, and ultimately enhance their overall quality of life. The purpose of this study was to evaluate the effect of a smartphone app combined with educational training on the clinical outcomes and mental health of patients with chronic hand and foot eczema during a 60-week study period. Patients in the intervention group participated in an educational program focused on chronic hand and foot eczema at baseline and had in-person visits at weeks 0, 12, 24, 36, and 60, as well as access to our study smartphone app. The app allowed patients to upload pictures of their hands and feet and answer questions about pain severity, itching, mood, and quality of life. A chat function was also available for patients to contact their dermatologist. The control group received only the in-person study visits described above. A total of 87 patients were included in the study and randomized to the intervention (n=43) or control (n=44) groups. In total, 23 patients from the intervention group and 34 patients from the control group completed the study. Throughout the 60-week study period, a significant reduction in Hand Eczema Severity Index (HECSI) was consistently observed in all patients (week 60: linear regression coefficient [Coef]=-1.108; P≤.001). A trend toward a greater improvement of the HECSI in the intervention group compared to the control group was noticed (week 60: Coef=0.597; P=.05). Subgroup analysis revealed that patients who used the app with a usage frequency of less than 20% demonstrated a significant reduction in the HECSI from week 0 to week 60 (week 60: Coef=-1.275; P=.04) and a significant reduction in the Dermatology Life Quality Index (week 60: Coef=-1.246; P=.04) compared to the control group. We were able to demonstrate a significant correlation between the HECSI calculated based on pictures uploaded by patients through the app and the HECSI assessed during personal visits (ρ=0.885; P<.001), despite the potentially lower image quality of the pictures uploaded through the app. This study provides further evidence that digital health apps can provide valuable support in improving patient clinical outcomes and management, especially as the app-based assessment of hand and feed images appears to be reliable. Deutsches Register Klinischer Studien DRKS00020963; https://drks.de/search/de/trial/DRKS00020963.

People suffer from several kinds of skin disorders caused by infections, allergies, genetic make-up, auto immune disorders, side effects of medications etc., Certain skin disorders such as scabies, psoriasis and eczema make them depressed since they are not getting cured even after many treatments which are highly expensive. There are alternative therapies which are supported by scientific evidences to improve such conditions. There are many medicinal plants which cure many ailments of the human beings, making it very difficult to parse out what and how actually work. This research has been taken to find out the efficiency of Naringi crenulata and Phyllanthus reticulatus in healing and curing eczema associated with scabies. This is a case study of an elderly female who visited one of the tribal healers from the indigenous malasar community in the study area Velliangiri hills reported with eczema associated with scabies.

Background: Eczema of hand and foot is one of the most common dermatological conditions encountered in the outpatient clinic. Both endogenous and exogenous factors can cause eczema identification and elimination of the triggering factor becomes essential. Aims and Objectives: The primary objective of the study was to assess the diagnostic outcomes of patch testing in hand and foot eczema and to study the distribution of clinical patterns and aetiologies causing hand and foot eczema. Materials and Methods: Thirty patients diagnosed with hand and foot eczema had a patch test using Indian standard battery series. This prospective observational study was carried out over 18 months at a tertiary care hospital in Chromepet, Chennai, Tamil Nadu, India. Data entry was done on Microsoft Excel and data analysis was done using SPSS 22 version. P < 0.005 was considered to be significant throughout the study. Patients diagnosed with hand and foot eczema had patch test done using indian standard battery series. The patients were followed up at 48 and 72 h, respectively, and the results were interpreted using international contact dermatitis research group (ICDRG) grading. Results: The study population comprised predominantly of 18 (60%) males and 12 (40%) females with 16 (53.3%) of the entire study population being 41-60 years. Hand eczema was the most common presentation: 19 (63.3%) patients, with itching reported in 29 (96.75%) patients and dryness in 24 (80%) patients, bilateral involvement was observed in 25 (83.3%) cases. The most common exposure was to gloves in 15 (50%) patients followed by detergents in 9 (30%) patients. Hyperkeratotic hand and foot eczema was the most frequent morphological finding documented in 6 patients (20%). Of the 30 patients who had patch testing done, 9 patients (30%) had one positive antigen, 3 had (10%) had three positive antigens, 1 patient (3.3%) had two positive antigens and 17 (56.7%) patients had no positive antigens. The most common antigen was potassium dichromate (25%). Conclusion: Hand and foot eczema remains a challenging dermatological condition due to its chronicity and multifactorial aetiology. Hand eczema is more prevalent than foot eczema and comprises a major part of occupational dermatoses. Patch test being a non-invasive tool helps in ascertaining the causative allergen and plays a significant role in the management of eczema, as avoidance of the allergen forms the cornerstone in the treatment of eczema.