PracticeUpdate: Dermatology - Vol 1 - No.1 - 2017

EDITOR’S PICKS 4

Increased risk of cutaneous and systemic infections in atopic dermatitis Take-home message • This large cohort study using The Health Improvement Network, which is representative of the general UK population, revealed that multiple cutaneous and noncutaneous infections are more common in people with atopic dermatitis (AD) compared with those without. In particular, people with AD had a 55% increased odds of impetigo, 27% increased odds of streptococcal throat infections, a threefold increased odds of molluscum contagiosum, and a twofold increased odds of otitis media. • Individuals with AD are likely to be at increased risk for both cutaneous and noncutaneous infections, highlighting the need for infectious screening and prevention programs aimed at this patient population. Abstract Atopic dermatitis (AD, also known as atopic eczema or eczema), is characterized by skin barrier and immunologic dysfunction. Viral and bacterial super-infection of cutaneous lesions including eczema herpeticum and staphylococcus aureus in patients with severe disease is well documented (Ong and Leung, 2016, Weidinger and Novak, 2016). Whether the general population of patients with AD has an increased risk of these and other types of infections due to an impaired skin bar- rier and/or immunologic dysfunction is unclear. Increased risk of cutaneous and systemic infections in atopic dermatitis – A cohort study. J Invest Dermatol 2017 Feb 12;[EPub Ahead of Print], SM Langan, K Abuabara, SE Henrickson, et al. Journal of Investigative Dermatology

COMMENT By Mark A Bechtel MD T his manuscript suggests a potential link between immune dysfunction in atopic dermatitis and increased susceptibility to cutaneous and non-cu- taneous infections. It is becoming increasingly clear from a research perspective that atopic dermatitis is impacted by both skin barrier and immunologic dys- function. The role of genetic abnormalities in filaggrin and its impact on skin barrier function and atopic der- matitis has been elucidated. Genetic abnormalities in the regulation of the innate and adaptive immune sys- tem and its role in increased risk of infection in atopic dermatitis require further investigation. Dermatologists are fully aware of the increased inci- dence of molluscum contagiosum and Staph aureus infections in our atopic patients. The increased inci- dence of non-cutaneous infections, such as otitis media and streptococcal pharyngitis in atopic patients may be a surprise to many dermatologists. A greater insight into the genetic abnormalities impacting immune dysfunc- tion in atopic dermatitis is critical in determining which patients are at greater risk of developing infections. This will help in developing screening and prevention strategies. Modification in our care and therapeutic management could be necessary. Prevention strategies to diminish the risk of cutaneous and non-cutaneous infections will be important in the future care of our atopic patients.

Dr Bechtel is Professor of Medicine – Clinical and the Director of the Division of Dermatology, Ohio State University College of Medicine, Ohio.

Burden of skin disease report: implications for dermatology

Journal of the American Academy of Dermatology

Abstract The most recent American Academy of Der- matology burden of skin disease report builds on the prior report in 2004 in providing strong evidence of the serious nature of skin disease. With nearly 85 million Americans treated for at least 1 skin condition in 2013 at a direct cost of $75 billion, and an additional indirect cost of $11 billion, the findings of this study highlight the impact of skin disease on patients and our health care system and cannot be ignored. Burden of skin disease report: implications for dermatology. J Am Acad Dermatol 2017 Mar 01;[EPub Ahead of Print], K Edison, B Brod.

Take-home message • This commentary on the recent American Academy of Dermatology (AAD) burden of skin disease report summarises the salient features of the study and its implications for dermatologists. Importantly, the burden of skin disease study revealed that skin disease is serious, highly prevalent, and potentially deadly. Skin disease leads to a direct cost of US$11 billion in lost productivity, as well as significant costs for over-the-counter skin treatment products purchased by patients (US$10 billion). • Given the results of the updated report, the AAD is emphasising three key areas that need attention. There is a need for research on additional prevention and early detection strategies; research is needed into the role of dermatologists in the treatment of skin disease; and data registries are important for future research on outcomes.

PRACTICEUPDATE DERMATOLOGY