Category Archives: Eczema

Morningstar: LEO Pharma Receives Positive CHMP Opinion of Anzupgo (delgocitinib cream) for the Treatment of Adults with Moderate to Severe Chronic Hand Eczema (CHE)

LEO Pharma has received a positive opinion from the European Medicines Agencys Committee for Medicinal Products for Human Use for delgocitinib cream (Anzupgo), a topical treatment for adults with moderate to severe chronic hand eczema. If approved, delgocitinib cream will be the first specific topical treatment for adults with CHE who do not respond to or cannot use topical corticosteroids. The positive opinion is supported by data from the DELTA phase 3 trials, which demonstrated significant efficacy and safety with delgocitinib cream compared to a vehicle control.

In Sudbury, Ontario, there is a significant shortage of dermatologists, leading to wait times of up to 6 months for appointments. This shortage has driven more individuals to use online platforms for skin care. Clinicians report seeing patients from various regions including Timmins and Ottawa due to the scarcity of local specialists, emphasizing that Canada's dermatology services are insufficient, with wait times often exceeding 1 year and up to 2 years in some regions.

The US FDA approved deuruxolitinib (Leqselvi), an oral Janus kinase inhibitor, for the treatment of adults with severe alopecia areata. Deuruxolitinib, taken as 8 mg tablets twice daily, demonstrated significant efficacy in 2 phase 3 trials (THRIVE-AA1 and THRIVE-AA2), which included 1,220 patients. By 24 weeks, over 30% of patients achieved 80% or more scalp hair coverage, and up to 25% had nearly complete hair restoration (90% coverage).

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Earlier this summer, Penn State Health conducted a sun safety educational assembly at an elementary school, aiming to instill sun protection habits in third and fourth graders. During the assembly, Penn State Health staff, including dermatology professionals, emphasized the importance of regular sunscreen application. The initiative is part of a broader effort by Penn State Dermatology to address skin cancer prevention. According to their 2021 Community Health Needs Assessment, Lebanon, the city the elementary school is local to, has a high incidence of cancer. The team measures the event's effectiveness through pre- and post-tests administered to students and plans to evaluate long-term retention of sun safety practices.

Researchers at Northwestern Medicine have identified increased immune cell activity in Merkel cell carcinoma (MCC) tumors, which could be used to predict patient responses to treatment and guide the development of new targeted therapies. The study, published in Cancer Discovery, highlights the potential of using immune cell activity as a biomarker to improve treatment outcomes for MCC patients. The study found that specialized CD8 T-cells and V-delta-1-gamma-delta T-cells are key players in the anti-tumor immune response. These findings suggest that enhancing these immune cell activities could improve responses to existing therapies or lead to the development of new treatment strategies.

Have you seen any dermatology headlines this week that we may have missed? Share with us by emailing our team atDTEditor@mmhgroup.com.

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Derm In The News: July 21-27 - Dermatology Times

Positive results from 2 phase 3 clinical trials evaluating the efficacy and safety of nemolizumab in adolescent and adult patients with moderate to severe atopic dermatitis have recently been announced, according to a press release from pharmaceutical company Galderma.1

Nemolizumab for Atopic Dermatitis Shows Positive Results in Phase 3 Trials / - stock.adobe.com

Results from the ARCADIA 1 (NCT03985943) and ARCADIA 2 (NCT03989349) trials showed that the therapy met the co-primary endpoints of an Investigator's Global Assessment (IGA) success score of 0 or 1 with a 2 or more point improvement from baseline at 16 weeks and at least 75% improvement in Eczema Area and Severity Index score. Nemolizumab also met its key secondary endpoints, including proportion of participants with Peak Pruritus Numerical Rating Scale (PP-NRS) score improvement of at least 4 points, PP-NRS score below 2, and Sleep Disturbance Numerical Rating Scale score improvement of at least 4 points.

READ MORE:Chronic Hand Eczema Treatment Shows Positive Results in Phase 3 Trials

Data from the 2 clinical trials were detailed in a study published in The Lancet.2

As a practicing dermatologist, Im excited about the potential of nemolizumab for atopic dermatitis patients, Jonathan Silverberg, lead investigator on the clinical trial program, said in a release.1 These phase III data demonstrate that, by blocking the activity of IL-31, nemolizumab could effectively address itch, skin lesions and sleep disturbance. Many patients complain that chronic itch negatively impacts their overall quality of life. Reducing itch within just one week of treatment could significantly ease the burden of disease.

The 2 clinical trials were identical 48-week randomized, double-blind, placebo-controlled phase 3studies evaluating the efficacy and safety of nemolizumab administered subcutaneously every 4 weeks compared to placebo in adult and adolescent participants aged 12 years or older with moderate to severe atopic dermatitis, associated pruritus, and inadequate response to topical steroids.

The study cohort included 1728 across both trials who were enrolled between August 2019 and November 2022. Of the patients, 1142 were in the nemolizumab plus topical corticosteroids with or without topical calcineurin inhibitors (TCS-TCI) group, and 586 were in the placebo plus TCS-TCI group. ARCADIA 1 included 500 men and 441 females, while ARCADIA 2 included 381 males and 406 females. The mean age ranged from 33 to 35 across both trials.

Investigators found that more patients in the nemolizumab plus TCSTCI group had IGA success at 16 weeks compared to placebo. Patients receiving the therapy also had significantly improved skin lesions, itch as early as week 1, and sleep by week 16 compared to placebo. The safety profile was similar between groups, with most adverse events being mild to moderate in severity.

Galderma said in the release that the FDA has accepted the companys Biologics License Application (BLA) for nemolizumab for the treatment of adolescents and adults with moderate-to-severe atopic dermatitis based on the data from the trials. A decision on the BLA is expected by the end of the year. The company also said that it is awaiting decisions from the European Medicines Agency, Health Canada, and the Access Consortiumon applications for both atopic dermatitis and prurigo nodularis.

Publication of the phase III ARCADIA program results for the first time in The Lancet reinforces both the robustness of our trial design and the potential of nemolizumab as an effective treatment option for patients living with atopic dermatitis, Baldo Scassellati Sforzolini, global head of R&D at Galderma, said in a release.1 We are working closely with regulators in the U.S., Europe, and elsewhere to bring nemolizumab to those in need as soon as possible.

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Nemolizumab for Atopic Dermatitis Shows Positive Results in Phase 3 Trials - Drug Topics

The following scenario is all too familiar to many: you experience a sudden, intense itch. That itch turns into an angry, scaly red rash, and then that begins to spread. No, it's not poison ivy nor chickenpox. You have atopic dermatitis, better known as eczema.

According to the National Eczema Association, more than 31 million people in the United States alone experience this genetic skin condition. Everyone from Adele to Suni Lee has dealt with it and recently, it gained media attention thanks to the 2023 documentary "Under My Skin: Untold Stories of Life with Eczema," as well as the 2016 HBO series "The Night Of," in which John Turturro's character, John Stone, has an intense case of eczema. While his flare-ups famously landed him in the hospital, the common ailment can typically be managed with some simple tips.

To better understand eczema and what causes it, we spoke with dermatologist Craig Austin, MD, New York City dermatologist and founder of Cane + Austin, to get the lowdown. Keep reading for everything you need to know.

Craig Austin, MD, is a New York City dermatologist and founder of Cane + Austin.

Eczema is a common, chronic inflammatory skin condition where an overactive immune system leads to an impaired skin barrier that can cause dry, itchy skin and even skin infections. "Medically, it's called atopic dermatitis," says Dr. Austin. "It's usually an itch that rashes rather than a rash that itches."

What makes the skin condition more complicated, however, is that it manifests itself differently for everyone. It can appear as early as infancy and usually shows up on the face, elbows, and knees. From there, it can eventually spread to other parts of the body and can be quite painful if left untreated. Dermatologists typically diagnose eczema by its appearance and occasionally by biopsies to exclude any other issues.

Eczema's cause is unknown, though the British Journal of Dermatology found that it may begin as an autoimmune condition. Genetics, as well as a family history of allergies, can also play a role. If someone in your family has eczema, you're more likely to develop it at some point during your life.

The tricky part about this skin condition is that there are many potential causes that can trigger flare-ups, such as genetics, your environment, stress, or even allergies. "Once your skin is dry, it breaks down easily to form a rash," Dr. Austin says.

Environmental factors like cold, dry air, overexposure to water, air pollutants, low humidity, smoking, irritating soaps or perfumes, stress, and diet can all contribute to eczema.

Again, though eczema rashes can occur anywhere on the body, Dr. Austin says that it's more common on flexural areas (elbows, backs of knees, neck, etc.) and arms and legs. "It probably occurs on the extremities more due to the lack of circulation to these areas, thus resulting in drier skin."

Unfortunately, eczema can go beyond seriously intense itching; sufferers are more at risk for skin infections. "A person with eczema who develops a cold sore due to herpes simplex virus is more susceptible to having it spread all over the skin," says Dr. Austin. Those with this condition are also vulnerable to erythroderma, an inflammatory disease that causes much of the body to become red. This will lead to loss of bodily fluids and electrolytes.

"These are serious issues which all need to be regulated in a hospital under supervision of doctors," he says.

The best course of action when treating any serious skin condition, but especially severe eczema, is with a dermatologist's help. They can equip you with prescription-strength steroids to alleviate rashes quickly. Another option is over-the-counter hydrocortisone cream, but make sure you don't use it for longer than five days to a week.

Otherwise, gentle exfoliation and deep hydration are essential when dealing with these rashes; exfoliate to remove the dull, dry skin, then moisturize the tender skin underneath with a rich cream. Some of the best products for eczema on the market are available at the drugstore.

Jessica Harrington is the senior beauty editor at PS, where she writes about hair, makeup, skin care, piercings, tattoos, and more. As a New York City-based writer and editor with a degree in journalism and over eight years of industry experience, she loves to interview industry experts, keep up with the latest trends, and test new products.

Emily Orofino was a former editor for PS Beauty.

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What Is Eczema and How Can You Treat it? - POPSUGAR

Atopic dermatitis (eczema) comes with an increased risk of mental health issues like depression or anxiety. That can be due to feelings of shame or embarrassment about their condition or sleep problems caused by itch, for instance. But, many with atopic dermatitis dont receive the mental health support they need, according to a new study from the National Eczema Association (NEA).

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Our data really does indicate that many individuals even with milder disease, or even clearer skin are dealing with mental health issues, says senior study author Wendy Smith Begolka, who is the chief strategy officer at the National Eczema Association, where she oversees research, medical, and community affairs. So theres certainly an opportunity to talk about mental health alongside treatment in a more holistic way, broader than whats just on the skin.

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This link between eczema symptoms and worsened mental health can be a vicious cycle, says Peter Lio, MD, a clinical assistant professor of dermatology and pediatrics at Northwestern University in Chicago, who was not affiliated with the study. For instance, patients may worry whether their treatment is working, about a current or future flare-up, or about their ongoing symptoms and stresses like these are known to exacerbate eczema, he says.

Theres a huge psychological component associated with atopic dermatitis and it really isnt addressed often, says Dr. Lio. When your skin is causing you trouble, youre itchy, youre uncomfortable, youre ashamed of how you look and youre not sleeping well thats going to make anybody feel pretty miserable. And when youre feeling stressed and anxious, thats been shown to further increase inflammation and worsen the skin.

Right now, mental health support isnt part of the standard treatment for eczema, which often includes options like topical ointments, systemic drugs, medications like antibiotics or antifungals, and self-care strategies like using a humidifier and avoiding tight or scratchy fabrics or lengthy showers in hot water.

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These conversations could be as simple as doctors asking patients how theyre faring, if theyre sleeping well, or are under any distress, says Begolka. For patients, this may involve starting the conversation by telling their healthcare provider how theyre feeling, she adds.

Our [patient] community did feel they could tell the correlation between the increasing severity of their atopic dermatitis and their mental health. They have a strong sense of when something is off, she says. If youre feeling it, try to have that strength and comfort to be able to raise that with your healthcare provider so they can work to address it in a variety of ways.

Sixty-four percent of adults and caregivers of young patients in the study werent referred by their providers to mental health resources. But when patients were referred, the most common resources were counseling (23 percent), cognitive behavioral therapy (13 percent), and peer and social support groups (12 percent).

Never feel like you have to go at this alone, says Begolka. We recognize this is a disease that has a lot of nuance, its a multidimensional burden, and we have a number of resources that can be helpful to support not only healthcare providers but patients throughout their journey.

If youd like to seek mental health help, either through counseling given by a mental health professional or a support group, Begolka recommends the following resources:

More research is still needed to pinpoint the most effective mental health interventions for people with eczema, to recognize the current barriers to referring patients to mental health care, and to better understand the role organizations like the NEA or NAMI have in helping to connect patients and doctors to resources, notes Begolka.

Lio adds that it can be tricky for dermatologists to open up the lines of communication for mental health help for their patients. While they can offer suggestions or make referrals, issues like proximity to counseling services, insurance policies, and wait times can get in the way, he says. Some dermatologists may feel out of place recommending mental health assistance to patients, too, he says.

But Lio and Begolka agree the new research is an important step in normalizing mental health discussions within the eczema community. This is an opportunity for the conversation to occur in a much more standardized way across all atopic dermatitis care, regardless of what healthcare provider is being seen, Begolka says.

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Many With Eczema Don't Get the Mental Health Support They Need, Study Shows - Everyday Health

As she looks ahead to the Paris Olympics, the gold medalist shares how shes overcome the stress of the chronic skin condition

Tim Clayton/Corbis via Getty

U.S. Olympic champion Sunisa 'Suni' Lee is sharing her lifelong struggle with eczema, which she said started when she was child.

My skin was always super dry, super flaky. It was really uncomfortable because it was really itchy," she said, according to CBS News, sharing that her mom took her to a dermatologist to help get the chronic skin condition under control.

"It can be kind of isolating when you deal with eczema and having an eczema flare-up, so I just want people to know that you are not alone and it does not define you."

Evan Frost/Minnesota Public Radio via AP

Lee, who won the gold medal for Team USA in the gymnastics all-around at the Tokyo Summer Olympics, is looking forward to the upcoming gymnastic trials, which will determine who represents the U.S. at the upcomingParis Olympics. Lee, 21, shared her eczema struggle during a panel with pharmaceutical brand Eli Lilly and Company, which is a sponsor of Team USA.

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"Eczema flare ups, they can definitely get in my head," said Lee during the panel. "Being on a competition floor, having so many eyes on you and just trying not to be worried about if people are looking at my skin or like itching myself because the more that I itch myself, the flakier it's going to get, the drier it's going to get."

The National Eczema Association says that anxiety and stress can trigger a flare-up of the itchy, chronic condition something Lee said she experiences.

Related: After Years of Struggling with Severe Eczema, Abby Tai Has Found Healing Through Helping Others 'Conquer' Theirs

Stress is a daily thing that I have to battle," she said, and that "definitely starts to pick up when I have to perform."

"I do have to be out there in a leotard where my skin is fully exposed and everyone can see it, and the insecurity I feel like was just holding me back," she said. "So the more I started to embrace it ... and just went out there and competed with it, I was fine.

Laurence Griffiths/Getty

"When you deal with it and you're constantly looking down at your skin, you probably think, 'Oh, other people are looking at it and staring at it.' But in reality, I don't really think anyone's looking that hard.

The gymnast who said she has a treatment plan in place for her eczema has been open about her other health struggles, sharing that she was diagnosed with an incurable kidney disease that forced her to cut her college gymnastics career short.

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But she said that shes taking steps to protect her mental health: I like to journal and get out everything I feel. I also go to therapy a lot, where I can just say how I feel and just work through all of the mental challenges that I have to go through."

And now, shes looking to the future and competing for her place on Team USA.

Related: Katie Couric Shows Eczema Flare-Up in Vulnerable Photo: 'It Just Flares Up a Lot and Its So Annoying!'

"I have had to deal with so much the past two years. Just feels so good to know that I can be back out there, not even at my best, and I can still be able to perform," she told CBS News.

"I'm so excited."

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Olympian Suni Lee Shares 'Isolating' Eczema Struggle: 'Daily Thing That I Have to Battle' - Yahoo Canada Shine On

Are you finding yourself with itchy, irritated skin that you can't stop scratching? Or have you wondered why your child's eczema is suddenly worse and so hard to control? Mounting evidence suggests that wildfires, which are increasing in intensity and frequency, contribute to skin problems, including eczema flares.

Eczema is a common chronic skin condition that affects about one in 10 people in the US. Its hallmarks are inflamed and dry, itchy patches of skin.

Atopic dermatitis is the most common type of eczema. It can run in families, often beginning in childhood. Typically, in the northern hemisphere, it grows worse during the winter season when the weather is cold and drying. Now some experts are seeing that pattern change. At Massachusetts General Hospital, for example, one dermatologist noted an unusual spike last summer in patients with flare-ups of eczema.

In 2023, Canada experienced more than 6,000 wildfires that burned over 16 million hectares of land an area larger than the entire state of Georgia. While far away from the devastation, the smoke reached across the US and more than 2,000 miles to Europe. Poor air quality from these distant wildfires caused eye and throat irritation and difficulty breathing.

In Boston, Dr. Arianne Shadi Kourosh, a dermatologist at Massachusetts General Hospital, also began to notice skin symptoms. Normally the dermatology clinics would see fewer than 20 people during a summer month for eczema, including atopic dermatitis. Suddenly that jumped to 160.

Looking back at summer month records from the last four years, her research showed that the number of visits for these skin complaints tracked with the severity of air pollution. These findings are consistent with other research noting an uptick in eczema flares and psoriasis flares associated with wildfire pollution. But why?

Researchers theorize that airborne pollutants might set off a cascade of effects within the body by activating an oxidative stress pathway. This damages the skin barrier and prompts an inflammatory response. This cascade also may play a role in the development of eczema.

Air pollutants in wildfire smoke may harm multiple organs not just your heart and lungs, but also our skin, it seems. So, when outdoor air quality is bad due to wildfires, limiting your exposure can help reduce health risks. While we can say the same for industrial air pollution, wildfire pollution is likely worse due to its additional toxic particles.

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One surprising effect of wildfires: itchy, irritated skin - Harvard Health

Itchy, bumpy eczema patches have always crept their way onto the crooks of my elbows, between my fingers, and even behind my knees throughout my adolescence and adulthood thus far. It wasnt until I reached my twenties that I also began experiencing flares on some areas of my face, particularly on my cheeks and along my jawline. This feat has made me particularly cautious when it comes to choosing makeup products for my eczema-prone skin, and it has completely altered what I look for when shopping for new foundations, blushes, powders, you name it.

According to Dr. Hope Mitchell M.D, a board-certified dermatologist based in Ohio, Im not alone. Choosing makeup products when you have eczema can feel daunting, but a few thoughtful tips can make a big difference, she says. Its true, opting for fragrance-free or hypoallergenic formulas made with sensitive skin in mind has calmed my flares and kept my skin looking smoother, patch- and itch-free. But it took some time to get there. Here, I spoke with multiple experts to define eczema, share tips on how to choose the right makeup products for the skin condition, and application tips. Let this be your eczema-friendly makeup guide, one that Ive yearned for since my very first flare-up.

Lets start with the basics. According to Dr. Dendy Engelman M.D., a board-certified cosmetic dermatologist and Mohs surgeon at Shafer Clinic Fifth Avenue in New York City, eczema is an inflammatory skin condition that manifests as patches of dry, itchy, red, and irritated skin. For those with eczema, choosing cosmetics with nourishing, non-irritating ingredients is crucial for preventing flare-ups and minimizing irritation, she says. While eczema can be triggered by general seasonal allergies, rhinitis, or genetics, it can also flare up if your skin is sensitive to particular skin care or cosmetic ingredients.

According to the experts, its possible for makeup to cause eczema. Look out for increased redness, itching, or a burning sensation in areas where you apply your makeup, says Mitchell. You may also see small bumps, swelling, or dry, flaky patches developing shortly after application.

While this wasnt the case for me personally, the experts recommend to immediately stop using the product you might suspect is causing your eczema flare-up. Engelman also recommends patch-testing the product on another area of your body, like the inner forearm, and waiting 24 to 48 hours to determine if its causing an adverse reaction. If so, soothe the affected area with a calming moisturizer or emollient designed for sensitive skin, or apply over-the-counter hydrocortisone.

No matter the root cause of your eczema, Mitchell warns to avoid scratching the area to prevent further damage and infection. If a flare doesnt improve or gets worse, consult with a dermatologist who can help you identify which ingredients to avoid in the future, she says

Choosing makeup for eczema-prone skin all comes down to the right ingredients. Look for ingredients like ceramides and hyaluronic acid because they help hydrate and protect the skin barrier, says Mitchell. Foundations or skin tints that are hypoallergenic, fragrance-free, and made for sensitive skin also get the green light from the experts especially anything thats approved by the National Eczema Association, like the Tower 28 SunnyDays Tinted SPF 30.

Consistency and format are also important when it comes to choosing makeup for eczema-prone skin. Avoid gel-based products with alcohol, as they can strip your skin of moisture and worsen dryness and itchiness. Opt for liquid, cream, or mousse foundations as well, since powders can highlight texture issues and dryness, says Mitchell.

There are also a handful of makeup ingredients to avoid when you have eczema-prone skin. Steer clear of synthetic preservatives like methylparaben and butylparaben, which are commonly used in cosmetics as these can exacerbate eczema-prone skin, says Engelman. She also shares that chemical colorants, which are often labeled as FD&C or D&C followed by a color and number, can be irritating as well. Because fragrance can exacerbate flare-ups, its important to always opt for fragrance-free makeup whenever possible.

Mitchell also recommends staying away from sulfates, formaldehyde releasers, and lanolin, all of which may cause adverse reactions in sensitive skin. Lastly, be cautious with essential oils and botanical extracts, as they can sometimes lead to irritation, she adds.

Once youve determined what products to use, there are also a few things to be mindful of during application, according to Brielle Pollara, a New Jersey-based makeup artist. The best approach is to start by hydrating the skin really well before applying any makeup, she says. The dermatologists echo this sentiment and share that you should always begin your makeup routine with a rich, hydrating moisturizer like the Embryolisse Crme Concentrate or the Dieux Skin Instant Angel Lipid-Rich Barrier Repair Cream with Ceramides.

Next, apply an eczema-friendly skin tint, like the Ilia Super Serum Skin Tint SPF 40 Skincare Foundation or the CeraVe Hydrating Mineral Sunscreen SPF 30 Face Sheer Tint, which is one of Dr. Mitchells favorites. If you have eczema bumps or patches, Pollara recommends applying your makeup with a brush. Gently pat over the areas with a dense brush to help avoid texture [from showing] underneath the makeup, she says. For blush or bronzer, opt for formulas that are talc and silicone-free, like the Kosas Blush is Life Baked Talc-Free Dimensional + Brightening Blush and the Saie Dew Bronze Soft-Focus Effortless Liquid Bronzer.

To set your makeup, choose a hypoallergenic setting powder to reduce shine without heavy layers, says Mitchell. Personally, I love the Ami Col Skin Melt Talc-Free Loose Setting Powder, and Engelman also recommends the Glo Skin Beauty Pressed Base Powder for a weightless finish.

All in all, applying makeup to eczema-prone skin is possible with the right formulas and techniques. Reading labels carefully, patch-testing, and opting for hypoallergenic and fragrance-free products are the methods that have tamed my eczemas madness. With the right makeup regimen, you too, can kiss those itchy, bumpy patches goodbye albeit, temporarily.

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The Best Makeup For Eczema & How To Apply It - The Zoe Report

There's a simple reason gymnasts wear leotards to compete: they're formfitting, stretchy, and won't get in the way during a front layout. But while they may be functional, they also happen to put quite a bit of skin on display something Olympian Suni Lee struggled with when she first started dealing with eczema.

"It was something that I felt ashamed of, being in a leotard and competing for Team USA," she tells PS. "Our skin is very exposed, cameras are always on us, people are always taking pictures, and it's hard when you're kind of ashamed to be looking at your own body or your skin because you can see that it's rough or flaky."

Lee started experiencing itchy, red skin that was "always uncomfortable" when she was younger, and it wasn't until she'd tried "everything" she could get over the counter before she was officially diagnosed with eczema.

The inflammatory skin disease is characterized by dry, itchy skin. At its core, it's a chronic (but manageable) condition that's caused by an overactive immune system disrupting the skin barrier. Still, certain triggers like specific foods, alcohol, and environmental irritants can cause it to flare. According to the National Eczema Association, it affects over 31 million people in the US alone. Still, it can show up differently on everyone making it hard to treat and even more difficult to talk about.

"I used to have it really bad on my arms, legs, and behind my neck it was swollen and inflamed," Lee says. "It made me not want to be seen anywhere because I knew people were looking at it because it was so inflamed. It has definitely taken a hit to my security levels when I'm competing, because it feels like people are looking at me."

The gymnast has since gotten her eczema under control, which has been immensely helpful for her overall well-being. "My doctors, dermatologists, and I have a really good system we know what works," she says. Lee recently partnered with Eli Lilly and Company, a pharmaceutical company that makes eczema drugs and Team USA's health equity sponsor, to destigmatize the conversation around atopic dermatitis, aka eczema. "I've had my fair share of insecurities with eczema, but it's not something to be ashamed or embarrassed about. And now, I want to share my story to help inspire younger generations to be comfortable in their own skin."

Research published by The Journal of Allergy and Clinical Immunology has shown that those who have eczema are at a higher risk for depression and anxiety, and according to a recent survey conducted by the National Eczema Association, 30 percent of people with atopic dermatitis deal with one or both of these mental health concerns. But ironically, mental and emotional stress is one of the top triggers for eczema flare-ups, which Lee has experienced firsthand. "I get the worst stress eczema flare-ups," she says. "At the 2021 Olympics, I was having a flare-up on my neck that I thankfully got handled right before the competition. But it happens a lot when I'm stressed and I can't sleep. I get really bad flare-ups. So then I'm constantly itching and uncomfortable."

"I was scared to talk about [mental health] for a long time, but when Simone and other athletes started talking about it, it made me feel more comfortable."

It's one of the many reasons Lee prioritizes her mental health. In addition to therapy, two practices that help manage her stress are journaling and visualization. "I'm a very private person and I keep a lot of things, so I don't really share how I totally feel all the time, so I write it all down," she says. "I write down my 'whys,' my goals, my keywords, and I visualize a lot during my routines because it's important to remember them when you're out there and nervous and trying to block everything out."

While navigating her own mental health journey, Lee has been grateful to see fellow athletes open up about theirs ahead of the 2024 Paris Olympics, where she's competing for Team USA next month. "The attitude now is just so much more positive, and it's more focused on the mental health of the athletes because if we're not in the right headspace, you can't expect us to compete the best routines in the way that we're expected to," she says. "Our needs are very important because they're things that are going to help us when we're out there competing."

In the last few years, athletes like Simone Biles, Gabby Douglas, and Naomi Osaka have spoken out about their own mental health experiences, which has helped Lee feel comfortable sharing her story. "I talk to and listen to a bunch of other athletes, and I'm constantly trying to hear and understand how some people do the things they do," she says. "And it's been so helpful because I was scared to talk about it for a long time, but when Simone and other athletes started talking about it, it made me feel more comfortable."

Zo Weiner is a freelance beauty and wellness writer. Her work has appeared in Bustle, Byrdie, Cosmopolitan, PS, GQ, Glamour, Marie Claire, Allure, Self, Brides, and Teen Vogue, among others, and she was the senior beauty editor at Well+Good.

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Olympic Gymnast Suni Lee Shares Her Eczema and Mental Health Journey - POPSUGAR

For people with eczema, learning about the many possible ingredients that can trigger a flare and how to avoid these ingredients when buying moisturizer, shampoo and other everyday products can feel daunting. In an effort to simplify the process, the National Eczema Association (NEA) created the Seal of Acceptance program.

You might recognize that little blue symbol the Seal on some of your favorite skincare and/or household products, but what exactly does it mean? What makes a product qualified to receive the Seal? Here, well give you a deeper look at what it means to obtain the Seal, including who reviews the products and how companies maintain the Seal standards to help you ensure youre using quality products for your life with eczema.

So what exactly is the Seal of Acceptance? Started in 2008, the Seal was created as a way to help consumers find eczema-friendly products. The Seal is a branded label displayed on personal care and household products that have been vetted by NEA. NEA awards the Seal to products that are deemed suitable for people with eczema or sensitive skin, based on sensitivity, toxicity and formulation testing data.

Only products that have applied for and pass the review process are awarded the Seal. NEA does not solicit manufacturers to apply for the Seal.

Brands or product manufacturers must fill out an application form for each product they wish to have evaluated, which includes:

Lets dig into each part of the application and review process to get a better understanding of what they are and how products obtain the Seal.

As you can imagine, evaluation of a products formulation is a big part of the Seal review process. NEA has identified 18 ingredients in its Ecz-clusion list that are known irritants and allergens that cannot be included in a product that applies for the Seal.

For a product to obtain the Seal, it cannot contain any of the following ingredients in any amount:

In addition, products must not include:

These guidelines were set by the Seal Scientific Oversight Committee. This is a panel of leading dermatologists, allergists and eczema experts. In addition to setting the ingredient guidelines, the committee established the criteria and framework for the overall Seal review process based on the most current scientific information.

For a product to obtain the Seal, it must meet the strict standards established by our Scientific Oversight Committee, including a review of ingredients and formulation data, said Christine Anderson, director of Seal of Acceptance and department operations at NEA.

Ingredients are considered in relation to sensitivity and irritation, said Anderson. The concentration levels and the purpose of the ingredient within the formula is taken into consideration as well.

To be considered for the Seal, manufacturers must have completed a clinical testing report for each individual product. Clinical testing is a way in which manufacturers make sure their products are suitable. NEA does not conduct this testing; rather, the testing is completed by an outside company who recruits people to test the formula in a controlled environment. Product manufacturers are solely responsible for identifying and working with companies to obtain this testing.

There are various types of clinical tests. NEA requires at least one of the following tests be completed by the manufacturer for each product formula:

During the testing, NEA requires that the clinical testing report include information regarding the skin tones of individuals involved in the testing process. This is reported using the Fitzpatrick Classification of Skin Types, which represents six skin types classified by pigment and ultraviolet light sensitivity.4 This requirement allows us to assess if a reasonable representation of skin types and tones are taken into consideration during testing.

The product samples are another part of the review process. NEA receives product samples from the manufacturers to ensure there is no fragrance present and to allow for reviewers to use the product as intended. The product samples, along with the clinical testing reports, are then sent to a panel of doctors who are part of the Seal reviewers selected by NEA.

This is the stage where experts weigh in on products. This includes the Seal Scientific Oversight Committee and Seal Review Panel. These doctors are selected by NEA for their expertise in dermatology, specifically eczema and sensitive skin care, and they hold MD, PhD and DO credentials.

The Seal Scientific Oversight Committee works independently of the Seal Review Panel. The Seal Scientific Oversight Committee sets the standards and criteria for the Seal Review Panel to use. The Seal Review Panel is the ultimate decision maker in whether or not a product is accepted to receive the Seal.

When selecting the Seal reviewers, NEA strives for diversity in geography, gender, specialty in medical fields (dermatologists and allergists) and race/ethnicity, while simultaneously prioritizing expertise.

The Seal Review Panel reviews all the materials holistically, including:

Products are reviewed and awarded the Seal on an ongoing basis. When a product is awarded the Seal, NEA enters into a one-year license agreement with the manufacturer allowing them to utilize the Seal logo on accepted products in the U.S. and Canada markets.

Product manufacturers are allowed to renew their license annually. However, to ensure a product still meets our high standards, a manufacturer must:

If there is a change in formula, even a minor one, the manufacturer must restart the application process with new clinical testing.

The Seal was created to help empower you to find products that are suitable for you and your family. The rigorous testing and review requirements help ensure that every product with the Seal has been vetted specifically for eczema and sensitive skin.

While the Seal can help eczema-friendly products be more easily identifiable, eczema is different for everyone and what works for one person might not work for another, said Anderson. Identifying a product with the Seal is an important first step, but it should be followed by trying the product to see how well it works for you.

The Seal of Acceptance Program is intended to provide broad guidance on personal care products suitable for individuals with eczema and/or sensitive skin when used as intended per the product label. Individuals with eczema and/or sensitive skin have the responsibility for identifying ingredients in any product that could potentially irritate their skin and/or trigger potential allergies. Healthcare-related questions should be referred to a physician or other healthcare provider, including questions regarding product ingredients, as well as whether use of the accepted product(s) is suitable.

References:

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Eczema-friendly Products in Seal of Acceptance - National Eczema Association

Introduction

Eosinophils have a wide range of biological functions and play an important role in anti-infection, inflammatory response, anti-tumor, and tissue damage and repair.1,2 Eosinophils enter the blood circulation after maturation in the bone marrow. There are no eosinophils in normal skin tissue, and eosinophils are recruited from peripheral blood to skin tissue only when inflammation occurs.3 Most dermatoses associated with blood eosinophilia (DABE) belong to allergy-related skin diseases, such as atopic eczema, contact dermatitis, urticaria, prurigo, and drug eruption; Second, blood eosinophilia can also be seen in parasitic infections and autoimmune bullous diseases. The skin is also the first and most commonly affected organ of hypereosinophilic syndrome (HES).4,5

It is estimated that for every additional eosinophil in the blood, there is a corresponding increase of 100 eosinophils in the tissue.6 Potential mechanisms leading to eosinophilia are divided into primary intrinsic mechanisms and secondary reactive mechanisms.7,8 The clonal expansion of eosinophils mediated by FIP1L1-PDGFRA (F/P) fusion gene belongs to the primary disease, while the secondary eosinophilia is mainly caused by eosinophilopoietic cytokines (IL-3, IL-5 and GM-CSF).7,9 The continuous increase of eosinophils can secrete a series of cytotoxic mediators, such as eosinophil cationic protein (ECP), eosinophil-derived neurotoxin (EDN), and eosinophil peroxidase (EPO), leading to multiple organ damage and possibly life-threatening.10 However, the evaluation and treatment of dermatoses with blood eosinophilia is challenging because of the significant clinical and histopathological overlap between different DABE diseases.

In this study, we divided DABE patients into three groups according to blood absolute eosinophil count (AEC) levels: mild eosinophilia group, moderate eosinophilia group, and severe eosinophilia group, and summarized the demographics, clinical characteristics, laboratory results, related diagnoses, and treatments, hope to help the differential diagnoses of DABE patients to further optimize disease management.

This is a retrospective cross-sectional study, including all inpatients with AEC greater than or equal to 0.5109/L who visited the Department of Dermatology, Southwest Hospital of Army Military Medical University from January 2018 to January 2023. Since eosinophilia associated with dermatoses is usually not very high, the categorization used for HES does not make sense and important information in the mild to moderate group might have been overlooked.11 According to the degree of elevated blood AEC, patients were divided into the mild eosinophilia group (0.5 AEC109/L < 1.5), moderate eosinophilia group (1.5 AEC109/L < 3), and severe eosinophilia group (AEC109/L 3). Electronic medical records were reviewed for all cases, and data collected included demographics, patient history, clinical manifestations, laboratory results, diagnoses, and treatment. The Ethics Committee of Southwest Hospital of Army Medical University approved this study (KY2023100). Patient consent is not required for this retrospective study. The study conformed to the ethical guidelines of the Declaration of Helsinki.

Statistical analyses were performed using SPSS Statistics (V22; IBM SPSS Corp., Armonk, NY, USA). All tests were considered significant at P < 0.05. The KruskalWallis test was used to analyze variations in the age, duration of eosinophilia, serum total Immunoglobulin.E (IgE) values, and lactate dehydrogenase (LDH) values in different groups. Categorical data were analyzed using chi-square test or Fishers exact test, including sex ratios, medical history ratios, clinical manifestations (prevalence of pruritus, distribution of lesions, ratio of lesion types), diagnostic rates, and drug use rates.

A total of 397 DABE patients (267 males, 67.3%; median 59 years, range:4570 years) were included and grouped according to blood AEC: mild eosinophilia, 0.5 AEC < 1.5 (n = 292, 73.6%); moderate eosinophilia, 1.5 AEC < 3 (n = 70, 17.6%); severe eosinophilia, AEC 3 (n = 35, 8.8%, Table 1).

Table 1 Demographic and Historical Characteristics in the Study Groups

There were statistically significant differences in the age distribution (P = 0.012) and the proportion of atopic history (P < 0.001) among the three groups. The severe eosinophilia group had a higher proportion (23/35, 71.5%) of old patients and a lower proportion (1/35, 2.9%) of atopic history. 18.2% (66/397) of the patients had lesions associated with elevated blood eosinophils due to drug exposure. The proportion of drug sensitization in the severe eosinophilia group (10/35, 32.3%) was higher than that in the other two groups, but the difference was not statistically significant (P = 0.076). The severe group had the shortest duration of eosinophilia compared with the mild and moderate groups (P = 0.005, Table 1).

Almost all DABE patients (383/397, 96.5%) exhibited pruritus symptoms, which were independent of blood eosinophil levels (P = 0.549). Localized skin lesions were more common in the mild eosinophilia group, while generalized skin lesions were observed in the moderate and severe eosinophilia groups (P < 0.001). The morphological spectrum of skin lesions in DABE patients was wide, and the most common lesions were erythema (348/397, 87.7%) and papules (208/397, 52.4%). The incidence of skin vesicles was significantly higher in the moderate eosinophilia group than in the mild and severe groups (P = 0.03, Table 2). The incidence of other lesion types was independent of blood eosinophil levels.

Table 2 Clinical Manifestations in the Study Groups

We selected two blood parameters, serum total IgE and LDH, to analyze their association with blood eosinophilia. Serum total IgE was elevated in 68.4% (132/193) of DABE patients, and LDH levels were elevated in 27.7% (67/242) of DABE patients. In the mild eosinophilia group, the serum total IgE median was significantly lower than those in the other two groups (P < 0.001). In contrast to mild and moderate groups, elevated LDH was more common in the severe group, and their LDH levels were also higher (P < 0.001, Table 3).

Table 3 The Laboratory Results in the Study Groups

Then, we were interested in whether increased blood eosinophilia corresponded to eosinophilic infiltration in the skin and bone marrow. Histopathological examination of skin biopsies showed cutaneous eosinophilic infiltration in 71.9% (105/155) patients. There was no significant difference in skin eosinophil infiltration among the three groups (P = 0.629). The most common histopathologic characteristics are spongiosis and hyperplasia. Bone marrow biopsy histopathology showed that 93.2% (41/44) of DABE patients were accompanied by bone marrow eosinophil infiltration, and most of them were from the moderate or severe eosinophilia groups (Table 3). Screening for the F/P fusion gene, which has been associated with HES, was negative in 2 patients. For the immunophenotype analysis of peripheral blood lymphocytes, no abnormal T and B lymphocytes were found in all 3 patients.

The most common diagnosis in DABE patients was eczema/dermatitis (207/397, 52.1%), followed by drug eruption (66/397, 16.6%), systemic disease (50/397, 12.6%) including HES or tumor, autoimmune bullous diseases (34/397, 8.6%), psoriasis (23/397, 5.8%), and other diseases (17/397, 4.3%). The diagnosis of eczema/dermatitis was dominant in the mild eosinophilia group (P < 0.001), while the diagnosis of systemic disease (HES or tumor) was more common in the severe eosinophilia group (P < 0.001, Table 4).

Table 4 Final Diagnoses in the Study Groups

In this study, we also evaluated the response to therapeutic drugs in three groups with elevated blood eosinophils. Glucocorticoids (370/392, 93.2%) were the most commonly used drug to treat DABE, followed by antihistamines (322/397, 81.1%), immunosuppressants (129/392, 32.5%), antibiotics (14/392, 3.5%), retinoids (14/392, 3.5%), biologics (5/392, 1.3%), other drugs (7/392, 1.8%). In the mild eosinophilia group, the usage rate of antihistamines was significantly higher than that in the moderate and severe groups (P = 0.032), while the usage rate of antibiotics was opposite (P < 0.001, Table 5). There was no statistically significant difference in the usage rate of other drugs among the three groups.

Table 5 Treatment in the Study Groups

An elevated level of blood eosinophils may be the first important clue in a laboratory result. We analyzed in detail the demographics, clinical characteristics, laboratory results, related diagnoses and treatments in DABE patients. Our results demonstrated that blood eosinophil level is associated with different clinical types in DABE patients. Blood eosinophil level plus other information such as age, history of atopy, history of drug sensitization, disease duration, distribution of skin lesions, and abnormal blood parameters may be helpful for further diagnosis.

Our study revealed three distinct patterns: (1) Mild eosinophilia associated with localized skin lesions, atopic history, mildly elevated total serum IgE level, diagnosed with eczema/dermatitis, and frequent antihistamines use. (2) Moderate eosinophilia has the characteristics of both mild group and severe group. (3) The severe eosinophilia group had a high proportion of elderly people without atopic history, but with acute onset, generalized skin lesions, and high blood LDH levels, and the majority of them were diagnosed with systemic diseases (HES or tumor) (Figure 1).

Figure 1 The characteristics of demographics, history, lesion manifestation, examination, and diagnoses in DABE patients with mild, moderate, and severe blood eosinophilia. (-) The laboratory result was negtive. The laboratory result was mildly elevated. The laboratory result was dramatically elevated.

Abbreviations: DABE, dermatoses associated with blood eosinophilia; IgE, immunoglobulin E; LDH, lactate dehydrogenase.

The predominance of eosinophils in eczema is not surprising since T helper 2 (Th2) lymphocytes always induce the recruitment of eosinophils in inflamed areas.12 Dermatological results showed that eosinophil activation and toxic granule protein deposition were involved in the acute and chronic lesions of atopic eczema.13 Cetinkaya et al suggested that transient, mild eosinophilia in children is associated with atopic eczema, whereas persistent, severe eosinophilia may be associated with congenital immune deficiency.14 This is similar to our data, where patients under the age of 18 were mostly clustered in the mild eosinophilia group and were diagnosed with eczema. Our results also show that atopic eczema is often related to mild blood eosinophilia, and this relation is more pronounced when accompanied by atopic history and mildly elevated serum total IgE.15

The skin is one of the organs most commonly affected by adverse drug reactions (ADRs). Eosinophils play a key role in drug-induced lesions.16 The incubation period for drug exposure can vary from days to years. Correspondingly, the duration of drug eruption includes acute exacerbation and chronic relapse. Our study showed that 16.6% (66/397) of the patients had lesions and different degrees of elevated blood eosinophils due to drug exposure. The incidence of drug sensitization was 14.7%, 18.6%, and 28.6% in the mild, moderate, and severe eosinophilia groups, but there was no statistical difference among the three groups. Severe eosinophilia with organ damage of the heart, liver, and kidney is associated with more serious systemic adverse drug reactions, such as drug eruption with eosinophilia and systemic symptoms (DRESS).17 Similar to the study of Yang et al, we suggested that the circulating eosinophil count was positively correlated with the severity of drug eruption, and the circulating eosinophil count could also be a prognostic indicator of drug eruption.18 Therefore, any patient with unexplained eosinophilia must obtain a detailed medication history.

Although eosinophilia is generally considered to be insignificant in psoriasis, our results showed 22 cases of psoriasis with mild eosinophilia, including 14 cases of vulgaris, 5 cases of pustulosa, 3 cases of erythrodermic. Retinoids are the first-line drugs for the treatment of psoriasis. Correspondingly, the use of retinoids is clustered in the mild eosinophilia group. There are no published reports investigating the overall incidence of eosinophilia associated with psoriasis. In psoriasis patients, the number of eosinophils labeled with ECP polyclonal antibody was significantly higher than that in healthy controls.19 Sueki et al reported a case of psoriasis vulgaris in which peripheral blood eosinophilia paralleled with the Psoriasis Area and Severity Index (PASI) score, and improvement in psoriasis was directly correlated with decline in eosinophilia.20 Another study showed that peripheral blood eosinophilia appears to be associated with severe forms of psoriasis, such as generalized pustulosa and erythrodermic forms.6 In conclusion, the combination of mild blood eosinophilia and psoriasis appears to be a relatively common condition. It would be significant to further investigate this association in a larger series of cohorts.

Although parasitic infection is one of the most important causes of eosinophilia,21 only 1% (4/397) of DABE in our study were caused by parasitic infection (including 1 case of hookworm infection, 1 case of insect bite dermatitis, 2 cases of scabies) and both were from the mild eosinophilia group. It was reported that 1.0% of children with eosinophilia had parasitic infections, compared with 4.8% of non-parasitic infections.14 In another study, the frequency of parasitic infections in hypereosinophilia was 5.7%.22 Differences between these studies may be strongly related to various socioeconomic levels. Based on the epidemiological importance of parasitic infection, we suggest that for DABE patients with a history of travel to endemic areas and persistent eosinophilia, it is necessary to develop further stool and dermatoscopy to detect eggs and parasites.

Peripheral blood eosinophilia has been reported in 61% of bullous pemphigoid (BP) cases and 46% of pemphigus cases.23,24 In our study, 8.6% (34/397) of DABE patients were diagnosed with autoimmune bullous diseases. Research has shown the strong relation between circulating eosinophil counts and the classic phenotype of BP (vesicles and erosions).25 There was a positive correlation between the severity of BP and peripheral blood eosinophils in the study of Gore Karaali et al.26 Diagnosis of autoimmune bullous disease was mostly in the moderate eosinophilia group through semantic connectivity map analysis.27 Unfortunately, we did not detect these patterns, which may be due to the lack of enough patients with autoimmune bullous disease in our cohort.

In the severe eosinophilia group, DABE patients were more diagnosed with systemic diseases (HES and tumor), and they had a lower proportion with atopic history and a higher proportion of older age. Severe blood eosinophilia was associated with higher levels of IgE and LDH. HES is a diagnosis of exclusion, excluding allergies, infections, rheumatism, and other diseases.28 In various studies, more than 50% of patients with HES develop pleomorphic skin lesions, often delaying diagnosis and treatment.29,30 Khallaayoune et al reported a case diagnosed with BP who showed resistance to conventional treatment and persistent eosinophilia, and finally this patient was considered as BP-associated HES.31 Patients with HES should be carefully examined, especially bone marrow biopsy, F/P fusion gene, and immunophenotyping of peripheral blood lymphocytes. Because HES with the fusion gene is at risk of developing to the malignant end, eventually progressing to eosinophilic leukemia. It is worth noting that some HES patients have allergies, rhinitis, asthma, and other comorbidities at the same time, which is difficult to distinguish from atopic eczema.30

This study could help to better understand the relationship between dermatoses and blood eosinophilia, potentially improving diagnoses and treatments for patients. The level of blood eosinophilia corresponds to different dermatoses, and careful history and targeted examination are crucial for differential diagnosis.

This study was approved by the Ethics Committee of Southwest Hospital of Army Medical University (KY2023100). This retrospective study conformed to the ethical guidelines of the Declaration of Helsinki, and patients privacy and personal identity information are protected. Exemption from informed consent will not have any adverse impact on patients health and rights. Therefore, the patient consent is not required for this retrospective study.

The authors thank all participants in this study for their enthusiastic cooperation.

This research was funded by Natural Science Foundation of China (82073442).

The authors report no conflicts of interest in this work.

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8. Leru PM. Eosinophilic disorders: evaluation of current classification and diagnostic criteria, proposal of a practical diagnostic algorithm. Clin Transl Allergy. 2019;9(1):36. doi:10.1186/s13601-019-0277-4

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13. Kiehl P, Falkenberg K, Vogelbruch M, Kapp A. Tissue eosinophilia in acute and chronic atopic dermatitis: a morphometric approach using quantitative image analysis of immunostaining. Br J Dermatol. 2001;145(5):720729. doi:10.1046/j.1365-2133.2001.04456.x

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15. Crnkovi HT, Bendelja K, imi Klari A, Tomi Raji M, Drkulec V, Aberle N. Family history and cord blood eosinophil count as predictors for atopic manifestations. Cent Eur J Public Health. 2019;27(4):267271. doi:10.21101/cejph.a5601

16. Hoetzenecker W, Ngeli M, Mehra ET, et al. Adverse cutaneous drug eruptions: current understanding. Semin Immunopathol. 2016;38(1):7586. doi:10.1007/s00281-015-0540-2

17. Duong TA, Valeyrie-Allanore L, Wolkenstein P, Chosidow O. Severe cutaneous adverse reactions to drugs. Lancet. 2017;390(10106):19962011. doi:10.1016/S0140-6736(16)30378-6

18. Yang J, Yang X, Li M. Peripheral blood eosinophil counts predict the prognosis of drug eruptions. J Investig Allergol Clin Immunol. 2013;23(4):248255.

19. Kim TY, Park HJ, Kim CW. Eosinophil cationic protein (ECP) level and its correlation with eosinophil number or IgE level of peripheral blood in patients with various skin diseases. J Dermatol Sci. 1997;15(2):8994. doi:10.1016/S0923-1811(97)00614-2

20. Sueki H, Nakada T, Iijima M. A case of psoriasis vulgaris with peripheral blood eosinophilia, parallelling the psoriasis area and severity index (PASI) score. Clin Exp Dermatol. 2004;29(5):549550. doi:10.1111/j.1365-2230.2004.01566.x

21. Rothenberg ME. Eosinophilia. N Engl J Med. 1998;338(22):15921600. doi:10.1056/NEJM199805283382206

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25. Garrido PM, Aguado-Lobo M, Espinosa-Lara P, Soares-Almeida L, Filipe P. Association of peripheral blood and cutaneous eosinophils with bullous pemphigoid disease severity and treatment outcomes. Actas Dermosifiliogr. 2022;113(9):881887. doi:10.1016/j.ad.2022.05.021

26. Gore Karaali M, Koku Aksu AE, Cin M, Leblebici C, Kara Polat A, Gurel MS. Tissue eosinophil levels as a marker of disease severity in bullous pemphigoid. Australas J Dermatol. 2021;62(2):e236e241. doi:10.1111/ajd.13547

27. Radonjic-Hoesli S, Martignoni Z, Cazzaniga S, et al. Characteristics of dermatological patients with blood eosinophilia: a retrospective analysis of 453 patients. J Allergy Clin Immunol Pract. 2022;10(5):12291237.e1228. doi:10.1016/j.jaip.2022.02.018

28. Salomon G, Severino M, Casassa E, et al. Skin manifestations of hypereosinophilic syndrome are polymorphous and difficult to treat: a retrospective cohort study. Ann Dermatol Venereol. 2022;149(2):139141. doi:10.1016/j.annder.2021.12.002

29. Ogbogu PU, Bochner BS, Butterfield JH, et al. Hypereosinophilic syndrome: a multicenter, retrospective analysis of clinical characteristics and response to therapy. J Allergy Clin Immunol. 2009;124(6):13191325.e1313. doi:10.1016/j.jaci.2009.09.022

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31. Khallaayoune M, Sialiti S, Meziane M, Senouci K. Bullous pemphigoid-like rash revealing hypereosinophilic syndrome. BMJ Case Rep. 2021;14(6). doi:10.1136/bcr-2021-242695

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