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Corticosteroid exposure and cumulative effects in patients with eczema: Results from a patient survey

Barta, Kelly; Fonacier, Luz S; Hart, Mary; Lio, Peter; Tullos, Kathryn; Sheary, Belinda; Winders, Tonya A
BACKGROUND:Individuals with eczema may have substantial lifetime corticosteroid exposure, increasing the risk of corticosteroid-related side effects. OBJECTIVE:To conduct a patient survey evaluating corticosteroid exposure and its cumulative effects in individuals with eczema. METHODS:The multinational online survey was conducted between November 5, 2020, and January 11, 2021. Participants were aged 18 years or older and a patient (n = 1889) or a caregiver of a child (n = 271) diagnosed with having eczema by a medical professional. RESULTS:All participants reported using corticosteroids. Average duration of topical corticosteroid (TCS) use was 15.3 years in adults and 3.6 years in children; 75% used TCS 1 to 2 times a day and 50% applied TCS 15 to 30 days/mo. Frequency and duration could not be determined by varying prescription TCS potencies. Oral corticosteroid use was reported by 36% of the participants (23% for eczema), with a lifetime average of 8.4 courses in adults and 8.1 courses in children. Corticosteroids for non-eczema atopic conditions were reported by 49% of the participants. In participants using TCS, 83% of adults and 64% of children experienced worsening symptoms over time. Development of new symptoms and conditions increased with a greater number of corticosteroid treatments and longer duration of TCS use but may have been owing to eczema progression. Symptoms consistent with topical steroid withdrawal syndrome after TCS discontinuation were reported by many participants. CONCLUSION/CONCLUSIONS:Reported substantial corticosteroid exposure throughout their lifetime eczema experience placed participants at risk of negative outcomes. Corticosteroids are a critical component of eczema treatment for many patients. However, careful corticosteroid prescribing practices and monitoring are needed to avoid side effects. When possible, corticosteroid-sparing strategies should be explored.
PMID: 36191848
ISSN: 1534-4436
CID: 5361652

Contact Dermatitis of a Surgical Wound

Kahwash, Basil M; Fonacier, Luz
PMID: 36357052
ISSN: 2213-2201
CID: 5357482

Epidemiology and Burden of Sleep Disturbances in Atopic Dermatitis in US Adults

Silverberg, Jonathan Ian; Chiesa-Fuxench, Zelma; Margolis, David; Boguniewicz, Mark; Fonacier, Luz; Grayson, Mitchell; Simpson, Eric; Ong, Peck
BACKGROUND:The relationship between atopic dermatitis (AD) severity, sleep disturbance (SD), and health-related outcomes is not fully elucidated. OBJECTIVE:The aim of the study was to determine the prevalence of SD in adult AD and its relationship with AD severity and health outcomes among the US population. METHODS:A cross-sectional, US population-based survey study of 2893 adults was performed. RESULTS:Among adults meeting the UK Diagnostic Criteria for AD, 255 (40.7%) reported 1 or more, 67 (11.1%) reported 3 to 4, and 57 (9.5%) reported 5 to 7 nights of SD in the past week; 475 (79.7%) reported at least some trouble sleeping in the past 3 days. Moderate and severe Patient-Oriented Scoring AD, Patient-Oriented Eczema Measure, and Numeric Rating Scale-itch and Numeric Rating Scale-skin pain scores were associated with more severe SD compared with those without AD. More frequent and severe SDs were associated with higher Dermatology Life Quality Index, lower 12-item Short-Form Health Survey, and higher Hospital Anxiety and Depression Scale (HADS) scores. Significant mediation by SD severity was observed between Patient-Oriented Eczema Measure and Numeric Rating Scale-itch with Dermatology Life Quality Index, 12-item Short-Form Health Survey physical and mental component scores, HADS-anxiety and HADS-depression scores, diagnosed anxiety, and heart disease. CONCLUSIONS:Atopic dermatitis and AD severity are associated with SDs. Sleep disturbances considerably impact quality of life and other health outcomes in adults with AD.
PMID: 33675326
ISSN: 2162-5220
CID: 5383832

Capturing total steroid burden in patients with atopic dermatitis and asthma

Fonacier, Luz; Banta, Erin; Mawhirt, Stephanie; Noor, Irum; Feldman, Eleanor; Armstrong Martin, Robert; Akerman, Meredith; Sani, Sonam
PMID: 36065113
ISSN: 1539-6304
CID: 5332372

Phase 3 Efficacy and Safety of Abrocitinib in Adults with Moderate-to-Severe Atopic Dermatitis After Switching from Dupilumab (JADE EXTEND)

Shi, Vivian Y; Bhutani, Tina; Fonacier, Luz; Deleuran, Mette; Shumack, Stephen; Valdez, Hernan; Zhang, Fan; Chan, Gary L; Cameron, Michael C; Yin, Natalie C
BACKGROUND:Abrocitinib efficacy by prior dupilumab response status in patients with moderate-to-severe atopic dermatitis (AD) has not previously been assessed in phase 3 studies. OBJECTIVE:Examine efficacy and safety of abrocitinib among patients who received prior dupilumab. METHODS:Patients with moderate-to-severe AD received abrocitinib 200 mg or 100 mg once-daily in JADE EXTEND (phase 3 extension) after dupilumab in double-blind, placebo-controlled phase 3 JADE COMPARE. RESULTS:Among prior dupilumab responders, ≥75% improvement in Eczema Area and Severity Index (EASI-75) was achieved in 93.5% and 90.2% of patients who received 12 weeks of abrocitinib 200 mg and 100 mg, respectively; ≥4-point improvement in Peak Pruritus Numerical Rating Scale (PP-NRS4) was achieved in 89.7% and 81.6%, respectively. Among prior dupilumab nonresponders, EASI-75 was achieved with abrocitinib 200 mg and 100 mg in 80.0% and 67.7% and PP-NRS4 in 77.3% and 37.8%, respectively. Most common adverse events among abrocitinib-treated patients were nasopharyngitis, nausea, acne, and headache. Conjunctivitis occurred less frequently with abrocitinib in comparison to prior dupilumab. LIMITATIONS/CONCLUSIONS:Short-term, 12-week analysis; no placebo arm. CONCLUSION/CONCLUSIONS:Efficacy and safety profile of abrocitinib in JADE EXTEND supports the role of abrocitinib as a treatment for patients with moderate-to-severe AD, regardless of prior dupilumab response status.
PMID: 35439608
ISSN: 1097-6787
CID: 5218282

Contact allergens for the allergist

Fonacier, Luz; Frankel, David; Mawhirt, Stephanie
OBJECTIVE:The objective of this article is to provide an overview and describe typically encountered skin contact allergens implicated in allergic contact dermatitis (ACD). DATA SOURCES/METHODS:Published literature obtained through textbooks, online PubMed, and Google Scholar database searches, author photography, and adapted figures were used. STUDY SELECTIONS/METHODS:Studies on the evaluation of ACD and specific skin contact allergens were selected, with a focus on original research articles and clinical reviews. RESULTS:Major classifications of common contact allergens include the following: (1) fragrances, (2) preservatives, (3) excipients, (4) rubber chemicals, (5) textile dyes, (6) topical medications, and (6) metals and other biomedical device components. The dermatitis distribution can aid in identifying the suspected contact allergen culprit. Certain contact allergens have features that are important to consider in the patch testing (PT) interpretation; these include possible irritant reactions, false-negative reactions or missed detection, and delayed reactions. Fragrances, preservatives, and excipients are culprits in personal products and facial or neck dermatitis. Patch testing with fragrances, preservatives, and patient-supplied products requires careful interpretation. Hand or foot dermatitis may be attributed to rubber chemicals or textile dyes. The management of topical corticosteroid contact allergy is guided on the basis of structural group classifications. Metal sensitization has been associated with dermatitis or biomedical device complications. CONCLUSION/CONCLUSIONS:Each skin contact allergen has unique characteristics with regard to the dermatitis clinical presentation and potential PT nuances. These features are critical to recognize in the evaluation of ACD and PT interpretation and clinical relevance, leading to an accurate diagnosis.
PMID: 35346877
ISSN: 1534-4436
CID: 5205952

The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria

Zuberbier, Torsten; Abdul Latiff, Amir Hamzah; Abuzakouk, Mohamed; Aquilina, Susan; Asero, Riccardo; Baker, Diane; Ballmer-Weber, Barbara; Bangert, Christine; Ben-Shoshan, Moshe; Bernstein, Jonathan A; Bindslev-Jensen, Carsten; Brockow, Knut; Brzoza, Zenon; Chong Neto, Herberto Jose; Church, Martin K; Criado, Paulo R; Danilycheva, Inna V; Dressler, Corinna; Ensina, Luis Felipe; Fonacier, Luz; Gaskins, Matthew; Gáspár, Krisztian; Gelincik, Aslı; Giménez-Arnau, Ana; Godse, Kiran; Gonçalo, Margarida; Grattan, Clive; Grosber, Martine; Hamelmann, Eckard; Hébert, Jacques; Hide, Michihiro; Kaplan, Allen; Kapp, Alexander; Kessel, Aharon; Kocatürk, Emek; Kulthanan, Kanokvalai; Larenas-Linnemann, Désirée; Lauerma, Antti; Leslie, Tabi A; Magerl, Markus; Makris, Michael; Meshkova, Raisa Y; Metz, Martin; Micallef, Daniel; Mortz, Charlotte G; Nast, Alexander; Oude-Elberink, Hanneke; Pawankar, Ruby; Pigatto, Paolo D; Ratti Sisa, Hector; Rojo Gutiérrez, María Isabel; Saini, Sarbjit S; Schmid-Grendelmeier, Peter; Sekerel, Bulent E; Siebenhaar, Frank; Siiskonen, Hanna; Soria, Angele; Staubach-Renz, Petra; Stingeni, Luca; Sussman, Gordon; Szegedi, Andrea; Thomsen, Simon Francis; Vadasz, Zahava; Vestergaard, Christian; Wedi, Bettina; Zhao, Zuotao; Maurer, Marcus
This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
PMID: 34536239
ISSN: 1398-9995
CID: 5072122

Contact dermatitis due to personal protective equipment use and hygiene practices during the COVID-19 pandemic: A systematic review of case reports

Sarfraz, Zouina; Sarfraz, Azza; Sarfraz, Muzna; Felix, Miguel; Bernstein, Jonathan A; Fonacier, Luz; Cherrez-Ojeda, Ivan
Background/UNASSIGNED:Prolonged use of personal protective equipment (PPE) may lead to contact dermatitis during the coronavirus disease 19 (COVID-19) pandemic. This paper aims to identify the causative factors of contact dermatitis from PPE and hygiene practices. Methods/UNASSIGNED:The search was conducted adhering to PRISMA 2020 guidelines. A Delphi process was employed to ensure that the aims of this study were met. PubMed and Web of Science databases were systematically searched through September 12, 2021, using search terms: Contact dermatitis, case report, covid-19. The findings were tabulated as author/year, gender, age, presentation, cause, dermatological diagnosis, testing modality, provided treatment, symptom resolution (time in days), prognosis, and follow-up. Results/UNASSIGNED:The mean age of all individuals was 29.75 years, with 75% females. All cases presented with erythema, with 62.5% reporting pruritus and 37.5% reporting burning facial symptoms. Surgical masks and hand-hygiene products (37.5%) were the most commonly reported causative agent with 25% due to KN95/FFP type 2 use. Allergic contact dermatitis (50%) and irritant contact dermatitis (25%) were common diagnoses. Treatments included creams, emollients, and desloratadine, with restriction of irritant-causing factors. The prognosis was generally good among the cases, with 62.5% presenting complete resolution within a week and 12.5% showing moderate improvement at the fourth month after discontinuing use. Conclusion/UNASSIGNED:This study finds pertinent links between PPE use and contact dermatitis during the COVID-19 pandemic. While many cases are bound to go underreported in literature, well-designed, large-scale studies in the future may help promote these associations in a more comprehensive manner.
PMID: 35039780
ISSN: 2049-0801
CID: 5147472

Allergic and Nonallergic Covid-19 Vaccine Adverse Reactions in Hospital Employees [Meeting Abstract]

Jin, H; Diaz, A M; Phillips, M; Akerman, M; Cohan, C; Salvati, S; Wilkenfeld, M; Fonacier, L
Rationale: Allergic and non-allergic adverse reactions (ARs) to Covid-19 vaccine (Cov19V) have been reported. Understanding the characteristics of Cov19V ARs, particularly those that are allergic in nature, may help us to better counsel patients who are at risk of developing a vaccine AR.
Method(s): We performed a retrospective chart review of ARs voluntarily reported to our Occupational Health Services following Cov19V at a multi-site academic medical center between December 2020-June 2021.
Result(s): 464 Cov19V ARs among 71,281 vaccine doses given (0.65%) were reported. 57 ARs (12.3%) were determined to be allergic (10 after the second dose), 356 were nonallergic, and 51 (11.0%) were undetermined. Of the 47 first-dose allergic ARs, 30 (63.8%) received a second dose, 16 did not complete the vaccine series, and 1 had no data. 3 employees received an alternative Cov19V. Of the 356 nonallergic ARs, 110 were following second dose, 2 were following Janssen, and 4 had no data. 228 of first dose reactions (95.0%, 228/240) completed the vaccine series. 22/57 (38.6%) allergic ARs versus 38/356 (10.7%) nonallergic ARs required ER transfer. More allergic ARs were categorized as moderate/severe (80.7%, 46/57) than nonallergic ARs (66.3%, 236/356).
Conclusion(s): Cov19V ARs are extremely uncommon with nonallergic AR more common than allergic. A vast majority of ARs, allergic or nonallergic, are able to receive subsequent Cov19V. Employees with allergic ARs were less likely to receive a second Cov19V and more frequently required emergent medical evaluation compared to those with nonallergic ARs.
ISSN: 1097-6825
CID: 5157442

Atopic Dermatitis and Allergic Contact Dermatitis

Chapter by: Boguniewicz, Mark; Fonacier, Luz; Leung, Donald Y.M.
in: Allergy Essentials by
[S.l.] : Elsevier, 2022
pp. 212-239
ISBN: 9780323931212
CID: 5313532