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Atopic dermatitis (AD) results from the interaction between dysfunction of the skin barrier, dysregulation of the immune system, and alteration of the skin microbiome. As the most common inflammatory skin disease worldwide and still increasing, it is a real health problem. Vitamin D deficiency is also considered a global problem affecting 13 out of 100 people in Europe. Since vitamin D is involved in the formation of the epidermal barrier, by the synthesis of structural proteins and regulation of keratinocyte proliferation and differentiation, there is a rational to evaluate the relation between vitamin D levels and the prevention or treatment of AD. The authors performed a review of the existing scientific literature on the role of vitamin D in AD. Although studies are scarce not very robust with no consensual results, most studies report lower serum levels of vitamin D in patients with AD. In addition, there seems to be an inverse relationship between plasma levels of vitamin D and clinical severity, a hypothesis that is reinforced by studies that demonstrated a statistically significant benefit of vitamin D supplementation for improving clinical symptoms and signs of AD. Some studies also suggest a possible influence of prenatal vitamin D levels on the onset of AD during childhood. Therefore, vitamin D supplementation may play a relevant role as a complement to the treatment of AD or for its prevention, but more and better scientific evidence is needed to confirm this. [ABSTRACT FROM AUTHOR]

Objective: The use of dupilumab in children with atopic dermatitis (AD) demonstrated clinical efficacy in clinical trials. Nevertheless, real-world evidence is still limited. We aim to provide data on this matter regarding a Portuguese pediatric population. Methods: Retrospective analysis of patients with AD below the age of 18 treated with dupilumab in two Portuguese hospitals. Data regarding previous therapies, activity scores, and adverse reactions were collected. Results: Thirty patients were included in the analysis (19 male patients, 63%), with a median age of 14 years (2-17 years). The median follow-up after starting treatment was 80 weeks. The median baseline Eczema Area and Severity Index (EASI) score was 32.3. Sixty percent of patients achieved EASI-90 and 77% EASI-75 at week 16 (n = 30); 79% EASI-90 and 92% EASI-75 at week 52 (n = 24); 64% EASI-90 and 82% EASI-75 at week 104 (n = 11); and 75% EASI-90 and 100% EASI-75 at week 132 (n = 4). Regarding adverse reactions, four patients (12%) presented facial erythema and two patients had eosinophilia above 2000/µL and conjunctivitis. In five patients (17%), there was a need for a dose increase, with treatment failure occurring in two patients (7%). Conclusion: Our data corroborated the evidence from clinical trials, highlighting the maintained efficacy and adequate safety profile of dupilumab in this age group. [ABSTRACT FROM AUTHOR]

Introduction and Objective: The present study on atopic dermatitis (AD) in Portugal aims to characterize patient needs and discuss measures to improve health care in dermatology, particularly in cases of moderate to severe disease. Methods: The study was conducted in three phases--(1) data collection on the patient access to healthcare and subsequent analysis; (2) critical evaluation of the data in individual interviews with dermatologists and one pediatrician; and lastly, (3) data discussion in consensus meetings to validate the existing care capacity in dermatology, to identify gaps in care for patients with AD and to define mitigation strategies. Results: In Portugal, it is estimated that AD affects ~ 360,000 patients, 70,000 of whom have moderate to severe disease. Healthcare capacity analysis confirmed that the private system plays an important role in the management of AD. It is estimated that 30% of patients rely solely on the Portuguese public health service. Nevertheless, patients with moderate to severe disease can only access advanced targeted therapies from public healthcare providers. Analysis of public care capacity in dermatology shows relevant gaps in the referral system, the geographical coverage of specialized centers, the number of specialists and high waiting times for first appointments. Considering the negative impact of the disease on patients' quality of life, 86% of patients with AD use private settings to better manage their disease. Conclusion: In conclusion, private setting bridges the gaps in public health care capacity in dermatology, and therefore, it is crucial for patients with AD. However, a major limitation is the lack of reimbursement for advanced targeted therapies recommended for moderate to severe AD when they are prescribed in a private setting, thus compromising patient access to these therapies. A possible strategy could be to extend the prescription of these therapies to a private setting based on a reimbursement model similar to that outlined in Act 48/2016 of 22 March. [ABSTRACT FROM AUTHOR]