Defining and measuring “eczema control”: An international qualitative study to explore the views of those living with and treating atopic eczema

Background Atopic eczema (also known as eczema) is a chronic, inflammatory skin condition that often afflicts patients’ health and wellbeing. The Harmonising Outcome Measures for Eczema (HOME) initiative recommends that “long-term control of eczema” is measured in all clinical trials 3 months or longer in duration. However, little has been published on what eczema control means to those living with or treating atopic eczema. Objectives To i) develop understanding of what eczema control means to patients, carers and clinicians and ii) explore the feasibility and acceptability of different ways of measuring eczema control in the long-term. Methods Online focus groups explored patients/carers experiences in the UK, USA, the Netherlands, France, Sweden and Japan, and an international online survey gathered views of clinicians. The Framework Method was used to analyse the focus groups and thematic analysis was used to analyse survey data. All findings were integrated into a theoretical framework to create overarching themes that cut across these diverse groups. Results Eight focus groups with patients (16 years+) and eight groups with carers of children took place (N=97). Sixty-two people took part in the survey. Eczema control was described as a multifaceted construct involving changes in disease activity, the treatment and management of the condition, and psychological, social and physical functioning. Patient /carer measurement allows personal accounts and frequent measurement, whilst clinician measurement was deemed less subjective. The burden on patients/carers and issues for analysing and interpreting data should be considered. Conclusions This study formed the basis of judging the content validity and feasibility of measurement instruments/methods to assess control of eczema in clinical trials. This online approach to an international qualitative study is an example of how core outcome set developers with limited resources can engage with multiple stakeholder groups on an international basis to inform consensus meeting discussions

Report from the fifth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative)

This is the report from the fifth meeting of the Harmonising Outcome Measures for Eczema initiative (HOME V). The meeting was held on 12–14 June 2017 in Nantes, France, with 81 participants. The main aims of the meeting were (i) to achieve consensus over the definition of the core domain of long-term control and how to measure it and (ii) to prioritize future areas of research for the measurement of the core domain of quality of life (QoL) in children. Moderated whole-group and small-group consensus discussions were informed by presentations of qualitative studies, systematic reviews and validation studies. Small-group allocations were performed a priori to ensure that each group included different stakeholders from a variety of geographical regions. Anonymous whole-group voting was carried out using handheld electronic voting pads according to predefined consensus rules. It was agreed by consensus that the long-term control domain should include signs, symptoms, quality of life and a patient global instrument. The group agreed that itch intensity should be measured when assessing long-term control of eczema in addition to the frequency of itch captured by the symptoms domain. There was no recommendation of an instrument for the core outcome domain of quality of life in children, but existing instruments were assessed for face validity and feasibility, and future work that will facilitate the recommendation of an instrument was agreed upon. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international group working together to develop a core outcome set (COS) for clinical trials in eczema (synonymous with atopic eczema and atopic dermatitis). HOME is coordinated from the Centre of Evidence Based Dermatology, University of Nottingham, U.K. Participation in HOME is open to anyone with an interest in outcomes for eczema. A COS is the agreed upon minimum set of instruments that should be included in all clinical trials for a particular condition. Use of a COS does not preclude using other instruments; other domains and instruments can also be included to meet the specific requirements of individual trials. COS initiatives are active across many fields of medicine and should enable better synthesis of trial data and reduce selective outcome reporting bias. The HOME initiative follows the best current guidance on developing a COS. Four core domains have been identified: clinician-reported signs; patient-reported symptoms; quality of life; and long-term control. The core outcome measurement instruments for clinician-reported signs and patient-reported symptoms have been established: the Eczema Area and Severity Index (EASI) for measuring clinician reported signs was agreed on at the HOME III meeting, and the Patient-Oriented Eczema Measure (POEM) was chosen to measure patient-reported symptoms at the HOME IV meeting. This is a report from the fifth consensus meeting of the HOME initiative (HOME V), which was held on 12–14 June 2017 in Nantes, France. The local organizers were Sebastien Barbarot and Jean-Francois Stalder of Nantes University Hospital, France

Systemic treatment of hand eczema

Alitretinoin (9-cis-retinoic acid) is the only drug licensed for the treatment of severe chronic hand eczema in adults. Alitretinoin is strongly recommended as second line treatment for severe chronic hand eczema refractory to topical steroids according to the European guidelines on the diagnosis, prevention and treatment of hand eczema. The strong evidence is based on placebo-controlled trials, the comparative advantage over other systemic treatments needs further evaluation. Alitretinoin is more effective in the hyperkeratotic subtype of hand eczema than in recurrent vesicular hand eczema. Cyclosporine is licensed to treat atopic dermatitis and is used off-label for the treatment of severe chronic hand eczema. The evidence for cyclosporine in the treatment of hand eczema is scarce, only one RCT has been done. A daily practice study showed that cyclosporine is a treatment option to be considered in patients with recurrent vesicular hand eczema. Azathioprine and methotrexate are also used off-label to treat hand eczema in daily practice and may be considered if first and second line therapy has been insufficient or contra-indicated. Dupilumab is a monoclonal antibody inhibiting interleukin (IL) 4 and IL-13 signalling. It has been registered for the treatment of moderate to severe atopic dermatitis and has now become widely available. Hand eczema is common in patients with atopic dermatitis. In an observational prospective open label study we aim to evaluate the effectiveness of dupilumab on atopic hand eczema in patients treated for atopic dermatitis. The main study outcomes are response to treatment, measured with a Physician Global Assessment using the Photograpic guide and severity of hand eczema with the Hand Eczema Severity Index (HECSI). Enrolment started as of January 2018. The results of an interim analysis after 16 weeks of treatment with dupilumab will be presented

Bulleuze contactallergische reactie bij de productie van coatings

A 50 year old, healthy man developed a severe bullous allergic reaction after producing coatings. This was probably caused by a proven contact allergy for two compounds he frequently worked with; 1,6-hexanediol diacrylate (HDDA) and glycidyl methacrylate (GMA). Contact allergies to both compounds are not uncommon, but a severe bullous eruption as in this case has, to the best of our knowledge, not been described before. Multiple positive patch test reactions can be explained by the impurity of industrially used acrylates, through which cosensitization can occur. Careful handling of the chemicals and wearing of protective clothing and gloves can prevent sensitization and can provide protection after sensitization

Allergisch contacteczeem veroorzaakt door canvas sneakers: de zoektocht naar het allergeen

Thiurams, dithiocarbamates and mercaptobenzothiazoles are the main groups of allergenic rubber accelerators that can cause allergic contact dermatitis to shoes. In this case report, pruritis, erythema and erythematous papules developed on the dorsal side of the feet after wearing canvas sneakers. After patch testing including a rubber additives series a contact allergy to a thiuram compound was suspected. Eventually after patch testing with extracts from shoe materials and further chemical analysis with thin-layer chromatography and gas chromatography- mass spectrometry the culprit allergen was identified as a newly formed compound dimethylthiocarbamylbenzothiazol sulfide (DMTBS). DMTBS is formed during the vulcanization process of the rubber materials of the canvas sneakers