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Background Atopic dermatitis (AD) is a chronic inflammatory skin disease with a multifactorial genesis including genetic predispositions and environmental risk and trigger factors. One of the latter possibly is smoking, indicated by an increased prevalence of AD in adults and children that are actively or passively exposed to cigarette smoke. Objectives In this study AD characteristics and its atopic comorbidities are compared in smoking and nonsmoking AD patients. Methods TREATgermany is a non-interventional clinical registry which includes patients with moderate to severe AD in Germany. Baseline data of patients included into TREATgermany from inception in June 2016 to April 2020 in 39 sites across Germany was analyzed comparing AD disease characteristics and comorbidities in smokers versus non-smokers. Results Of 921 patients, 908 (male: 58.7%) with a mean age of 41.9 ± 14.4 reported their smoking status. The objective Scoring of Atopic Dermatitis (oSCORAD) did not differ between smokers (n=352; 38.8%) and nonsmokers, however lesions' intensity of oozing/crusts and excoriations as well as patient global assessment scores (PGA) of AD severity were higher in smoking as opposed to nonsmoking patients. Smokers reported a lower number of weeks with well-controlled AD and more severe pruritus than nonsmokers. Total IgE levels were more elevated in smokers and they displayed a younger age at initial diagnosis of bronchial asthma. After adjustment for potential confounders, the increased intensity of oozing/crusts, the reduced number of weeks with well-controlled AD and the greater pruritus remained different in smokers compared to nonsmokers. In addition, smoking patients with adult-onset AD showed a 2.5 times higher chance of involvement of the feet. Conclusions German registry data indicate that AD patients who smoke have a higher disease burden with a different distribution pattern of lesions in adult-onset AD.

BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by unrelenting pruritus and recurrent eczematous lesions. It affects up to 15% of children and adolescents and up to 5% of adults, and confers a high and multifactorial burden to patients, families and society. With increasing awareness of this substantial burden, AD has become a priority for healthcare systems. AIM The Atopic Dermatitis Quality of Care (ADQoC) initiative set out to describe good practices for addressing the challenges that impede the management of AD. METHODS The initiative carried out a literature review and surveyed 32 expert care centres, catalogued findings, and analysed and elucidated global challenges to AD care along with good practice implementations that can address them. RESULTS The four challenges to quality care for AD are: (i) misconceptions about AD; (ii) delayed referral and access to AD specialists; (iii) poor patient access to AD treatments and poor adherence to medications; and (iv) managing the complexity of AD and its comorbidities. The initiative highlighted 5 of 10 good practice implementations as high priority for any AD care centre to focus on: (i) clinical assessment and diagnosis; (ii) a structured multidisciplinary care team; (iii) monitoring and evaluating care quality; (iv) patient education and communication; and (v) collaboration and exchange with patient groups. CONCLUSION These implementations can provide benefits for patients, healthcare providers and the healthcare system. They directly contribute to the efficacy of treatment, improved healthcare provider efficiency, improved education for patients and healthcare providers, and improved costs to healthcare systems. The initiative was launched on https://atopicdermatitiscare.kpmg.co.uk/ to provide an easy-to-use educational platform.

With AtopicHealth1, the first national care study on atopic dermatitis (AD) was conducted in 2010. At that time, about one third of the patients undergoing treatment by dermatologists showed severe limitations in quality of life, which indicated an insufficient quality of care. The aim of the present study was to characterise the current care of patients with AD undergoing dermatological treatment in comparison between different severity grades, as well as in comparison to 2010 and to psoriasis.The Germany-wide multicentre cross-sectional study "AtopicHealth2" recorded clinical data, quality of life (DLQI), therapies, preventive behaviour and patient-defined treatment benefit (PBI). Patients with an indication for systemic therapy were considered moderately to severely affected for subgroup analyses, the others mildly affected.Between 2017 and 2019, 1291 patients (median age 41 years, 56.5% female) were enrolled by 111 centres. Compared with 2010, there were no improvements in quality of life (DLQI 8.5 in both studies), severity (SCORAD 45.4 vs. 42.3 in 2010) or treatment benefit (PBI 2.2 vs. 2.4 in 2010). Moderately to severely affected patients were more likely to show impaired quality of life (45.4% vs. 23.6%) and less likely to have relevant treatment benefits (PBI 1: 21.3% vs. 13.2%) than mildly affected patients. In contrast to psoriasis, patients with AD revealed higher quality of life limitations (DLQI 8.5 vs. 6.1) and lower treatment benefit (PBI 2.2 vs. 2.8).Compared to 2010, there is no improvement in the quality of care for AD in Germany. Compared to psoriasis, patients with AD show higher burden and lower treatment benefit, which underlines the need for therapeutic innovations.HINTERGRUND: Mit AtopicHealth1 wurde 2010 die erste nationale Versorgungsstudie zur AD durchgeführt. Damals zeigte etwa ein Drittel der Patienten, die sich in einer Behandlung bei Dermatologen befanden, starke Einschränkungen der Lebensqualität, was auf eine unzureichende Versorgungsqualität hindeutete. Ziel der vorliegenden Studie war die Charakterisierung der aktuellen Versorgung von Patienten mit Neurodermitis in dermatologischer Behandlung im Schweregradvergleich sowie im Vergleich zu 2010 und zu Psoriasis.Die deutschlandweite multizentrische Querschnittstudie „AtopicHealth2“ erfasste klinische Daten, Lebensqualität (DLQI), Therapien, präventives Verhalten und patientendefinierten Behandlungsnutzen (PBI). Patienten mit einer Indikation für Systemtherapie wurden für Subgruppenanalysen als mittelschwer bis schwer, die anderen als leicht betroffen angesehen.Zwischen 2017 und 2019 wurden 1291 Patienten durch 111 Zentren eingeschlossen, mittleres Alter 41 Jahre, 56,5 % weiblich. Im Vergleich zu 2010 fanden sich keine Verbesserungen hinsichtlich Lebensqualität (jeweils DLQI 8,5), Schweregrad (SCORAD 45,4 vs. 42,3 in 2010) und Therapienutzen (PBI 2,2 vs. 2,4 in 2010). Mittelschwer bis schwer betroffene Patienten zeigten häufiger Lebensqualitätseinbuße (45,4 % vs. 23,6 %) und seltener relevante Therapienutzen (PBI 1: 21,3 % vs. 13,2 %) als leichter betroffene. Verglichen mit Psoriasis offenbarten die Patienten mit Neurodermitis höhere Lebensqualitätseinschränkungen (DLQI 8,5 vs. 6,1) und einen geringeren Behandlungsnutzen (PBI 2,2 vs. 2,8).Im Vergleich zu 2010 zeigt sich keine verbesserte Versorgungsqualität von Neurodermitis in Deutschland. Im Vergleich zur Psoriasis weisen Patienten mit Neurodermitis höhere Belastungen und geringere therapeutische Nutzen auf, was den Bedarf an therapeutischen Innovationen unterstreicht.

The coronavirus disease 2019 (COVID-19) pandemic is caused by rapid spread of different strains of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The severity of infection ranges from mild, or even asymptomatic, to very severe. Signs and symptoms include fatigue, fever, exanthemas, upper respiratory illness, loss of smell and taste, pneumonia, severe acute respiratory syndrome, and multi-organ failure. Risk factors for a severe or lethal course include age, male gender, obesity, diabetes, cardiovascular disease, and immune suppression1 .

TREATgermany is a multicenter academic registry for the long-term observation of patients with moderate-to-severe atopic dermatitis (AD). Eligibility criteria, study procedures, and baseline characteristics including previous treatments have already been described (1). AD is associated with psychosocial disorders such as depression, anxiety, and suicidal ideation (2-4).

Einleitung: TREATgermany ist ein Forschungsregister, das deutschlandweit Informationen zu Erkrankungsschwere, Therapieverlauf und Patient Reported Outcomes bei erwachsenen Patienten mit moderater bis schwerer Neurodermitis (AD) dokumentiert. Im Beitrag wird der Zusammenhang der globalen Einschätzung der Erkrankungsschwere der AD durch Ärzte und Patienten zur Baselinevisite und deren Abhängigkeit von Erkrankungssymptomen untersucht. Methoden: Skalen: Globale Einschätzung der Schwere der AD (0 (abgeheilt) - 5 (sehr schwer)) durch Patienten (PGA) und Ärzte (IGA). Symptome: NRS für Schmerzen, Juckreiz und Schlafstörungen der letzten 3 Tage (0 (kein Auftreten des Symptoms) - 10 (schwerst-vorstellbares Auftreten)). Statistik: Stata 15, Wilcoxon-Vorzeichen-Rang-Test. + TREATgermany wird durch Sanofi, LEO, Galderma und Lilly finanziell unterstützt. Ergebnisse: 2016-2020 wurden 1.025 Patienten (Alter 42±15 Jahre; 42% Frauen) in 38 Zentren eingeschlossen. PGA und IGA lagen im Median bei beiden Geschlechtern bei 3 (moderat). Frauen (F) litten stärker unter den erfragten Symptomen als Männer (M) (Mediane: Schmerzen: 4 vs 3, Juckreiz: 7 vs 6, Schlafstörungen: 5 vs 4). PGA und IGA stimmten bei 38,4% der Patienten überein. 30,2 bzw. 31,4% der Frauen sowie 35,1 bzw. 26,5% der Männer schätzten ihre AD leichter bzw. schwerer ein als der Arzt (F: p = 0,9; M: p = 0,002). 50,3% der Patienten litten stark unter Schmerzen, Juckreiz oder Schlafstörungen (mind. 1 Wert ≥7), 14,2% unter allen 3 Symptomen. Je 38,0 bzw. 46,2% dieser Patienten schätzten ihre AD schwerer ein als der Arzt (M 33,8 vs 39,7%; F 42,5 vs 52,0%). Fazit: Arzt- und Patientenbeurteilung der AD stimmen geschlechtsspezifisch insbesondere bei schwerem Symptomerleben nicht immer überein. Dies zeigt den Bedarf an individualisierter Behandlung der AD, die Patientenpräferenzen im Fokus hat.

Since the introduction of active vaccination against SARS-CoV-2 infection, there has been a debate about the risk of developing severe allergic or anaphylactic reactions among individuals with a history of allergy. Indeed, rare cases of severe allergic reactions have been reported in the United Kingdom and North America. By february 2021 a rate of 4,5 severe allergic reactions occurred among 1 million patients vaccinated with the mRNA-based COVID-19 vaccines, which is higher than the generally expected rate of severe allergic reactions to vaccinations of around 1 in 1 million.

BACKGROUND: The human skin offers diverse ecosystems for microbial symbionts. However, the factors shaping skin-microbiome interactions are still insufficiently characterized. This contrasts to the broader knowledge about the factors influencing the gut microbiota. OBJECTIVES: We aimed to investigate major patterns of associations of host traits, lifestyle, and environmental factors with skin bacteria in two German populations. METHODS: This is a cross-sectional study with 647 participants from two population-based German cohorts, PopGen (n=294) and KORA FF4 (n=353), totaling 1794 skin samples. The V1-V2 regions of the 16S rRNA gene were sequenced. Associations were tested with two bacterial levels, community (beta-diversity) and 16S rRNA gene amplicon sequence variants (ASVs). RESULTS: We validated known associations of the skin microbiota with skin microenvironment, age, body mass index (BMI) and sex. These factors were associated with beta diversity and abundance of ASVs in PopGen, which was largely replicated in KORA FF4. Most intriguingly, dietary macronutrients and total dietary energy were associated with several ASVs. ASVs were also associated with smoking, alcohol consumption, skin pH, skin type, transepidermal water loss, education, and several environmental exposures, including hours spent outdoors. Associated ASVs included members of the genera Propionibacterium, Corynebacterium, and Staphylococcus. DISCUSSION: We expand the current understanding of factors associated with the skin bacterial community. We show the association of diet with the skin bacteria. Finally, we hypothesize that the skin microenvironment and the host physiology would shape the skin bacterial community at greater extent in comparison to a single skin physiological feature, lifestyle and environmental exposition.

Einleitung: Atopische Dermatitis (AD) geht als chronische Hauterkrankung nicht nur mit lebenslangen, sondern auch mit für Betroffene schwer abzuschätzenden, individuellen Krankheitsverläufen und Begleitsymptomatik einher. Der Beitrag untersucht den Zusammenhang objektiver Erkrankungsschwere mit subjektivem Erleben von Fatigue bei Patient*innen mit moderater bis schwerer AD aus dem Register TREATgermany zur Baselinevisite. Methoden: Im Register werden Informationen von Betroffenen und Ärzt*innen u.a. zur klinischen Erkrankungsschwere (Eczema Area and Severity Index, EASI) und der Schwere von Fatigue-Symptomen (Fatigue Severity Scale, FSS) erfasst. Statistik: SPSS 25, t-Test, lineare Regression. Ergebnisse: 2016-2019 wurden 808 Betroffene mit moderater bis schwerer AD (44,6±14,5 Jahre, 39% Frauen) in deutschlandweit 37 Kliniken und Praxen eingeschlossen. Die Patient*innen wiesen einen EASI-Score (0-72) von 15,7±12,6 auf, von denen 21,7% deutliche Fatigue-Ausprägungen angaben (Cut-Off = 5). Frauen (F) und Männer (M) waren ähnlich betroffen (p = 0,057). Betroffene mit deutlichem Fatigue-Erleben wiesen eine signifikant höhere Krankheitsschwere (19,5±13,9) auf, als diejenigen, die niedrigere FSS-Scores berichteten (14,6±12,1; p

Chronic obstructive pulmonary disease (COPD) is a frequent diagnosis in older individuals and contributor to global morbidity and mortality. Given the link between lung disease and aging, we need to understand how molecular indicators of aging relate to lung function and disease. Using data from the population-based KORA (Cooperative Health Research in the Region of Augsburg) surveys, we associated baseline epigenetic (DNA methylation) age acceleration with incident COPD and lung function. Models were adjusted for age, sex, smoking, height, weight, and baseline lung disease as appropriate. Associations were replicated in the Normative Aging Study. Of 770 KORA participants, 131 developed incident COPD over 7 years. Baseline accelerated epigenetic aging was significantly associated with incident COPD. The change in age acceleration (follow-up - baseline) was more strongly associated with COPD than baseline aging alone. The association between the change in age acceleration between baseline and follow-up and incident COPD replicated in the Normative Aging Study. Associations with spirometric lung function parameters were weaker than those with COPD, but a meta-analysis of both cohorts provide suggestive evidence of associations. Accelerated epigenetic aging, both baseline measures and changes over time, may be a risk factor for COPD and reduced lung function.

Background The Atopic Dermatitis (AD) TREATgermany registry was initiated by the German Society for Dermatology (DDG) in 2011 to evaluate the ‘real‐life’ situation of health care for patients with AD. Objectives Interim data analysis on baseline characteristics as well as current and prescribed systemic treatments of the TREATgermany registry patients. Methods Patients (≥18 years) with moderate‐to‐severe AD [objective (o)SCORAD > 20], or with current or previous anti‐inflammatory systemic treatment for AD within 24 months, were included and are followed up over at least 24 months. To assess clinical signs, the eczema area severity index (EASI, 0–72), the oSCORAD (0–83) and the Investigator Global Assessment (IGA; 6‐point scale) were used. The disease severity was globally scored by the patients [Patient Global Assessment (PGA); six‐step Likert scale]. Disease symptoms were assessed by the patient‐oriented eczema measure (POEM, 0–28) and numeric rating scales (NRS, 0–10). Health‐related quality of life was measured using the dermatological life quality index (DLQI, 0–30). Results A total of 612 patients were recruited across 32 sites between 06/2016 and 01/2019 (mean age: 42.6 ± 14.2 years; mean oSCORAD: 40.8 ± 16.3). The mean POEM score was 16.3 ± 7.5. Pruritus was rated highest among subjective symptoms (NRS: 5.4 ± 2.7). The mean DLQI value was 11.3 ± 7.5. The frequency of arterial hypertension was lower (20.8%) compared with the general population, whilst this was higher for depression (10%). More than 60% of the patients had received systemic glucocorticosteroids, and 36.8% had received cyclosporine A prior to inclusion. Dupilumab was the leading substance documented as either ‘current’ (12.1%) or ‘prescribed’ (31.4%) at baseline. Conclusions These ‘real‐life’ data clearly demonstrate the substantial disease burden. Most of TREATgermany patients were already treated with or prescribed dupilumab at baseline. Moreover, current findings indicate the urgent need for further alternative agents in order to achieve a perceptible improvement of quality of life of patients with moderate‐to‐severe AD.

Atopic dermatitis (AD) is a complex disease with elevated risk of respiratory comorbidities.1,2 Severely affected patients are often treated with immune-modulating systemic drugs.3,4 On March 11th 2020, the World Health Organization declared the 2019 novel coronavirus severe acute respiratory syndrome (SARS-Cov-2) epidemic to be a pandemic. The number of cases worldwide is increasing exponentially and poses a major health threat, especially for those who are elderly, immuno-compromised, or have comorbidities. This also applies to AD patients on systemic immune-modulating treatment. In these days of uncertainty, reallocation of medical resources, curfew, hoarding, and shutdown of normal social life, patients, caregivers and doctors ask questions regarding the continuation of systemic immune-modulating treatment of AD patients. The ETFAD decided to address some of these questions here.

Background: Clinical registries may provide high-quality evidence on the use and effectiveness of therapeutic interventions under real-life conditions. Adults with moderate-to-severe atopic eczema (atopic dermatitis [AD]) are enrolled into TREATgermany and prospectively followed over at least 2years. This paper analyses the association between dermatological quality of life and work limitations.Materials and Methods: Treatment modalities and abroad set of physician- and patient-reported outcome measures are documented using validated instruments to assess clinical disease severity (EASI [Eczema Area and Severity Index], objective SCORAD [objective-SCORing Atopic Dermatitis]), quality of life (DLQI [Dermatology Life Quality Index]), symptoms (POEM [Patient-oriented Eczema Measure]), global disease severity, as well as patient satisfaction and work limitations including presenteeism (WLQ [Work Limitation Questionnaire]). From 06/2016 until 12/2017, 241 individuals (mean age 43 +/- 15years, 38.6% female) were enrolled at 19recruitment centers;69% of the patients were employed.Results: Employed persons had DLQI and WLQ scores of 10.6 +/- 6.9points and 17.7 +/- 18.1%, respectively. Mean presenteeism was substantial accounting for 9.2%. With coefficients of 0.39 and 0.33 WLQ and presenteeism scores significantly correlate with DLQI (p

Background In patients with subarachnoid hemorrhage (SAH), vasospasm remains one of the major complications. The application of intravenous magnesium sulfate (MgSO4) has been under discussion to prevent cerebral ischemia. Our aim was to examine the impact of early MgSO4 administration on local cerebral microcirculation during microsurgical clipping of SAH-related aneurysms. Methods The non-invasive laser-Doppler spectrophotometry system “Oxygen-to-See (O2C)” was used in 14 consecutive patients (11 female, 3 male, median age 56.5±9.7 yrs) with aneurysmatic SAH. A subdural probe measured capillary venous oxygenation (SO2), relative hemoglobin content (rHb), blood cell velocity (velo) and blood flow (flow) in 7 mm tissue depth. Data samples were recorded as baseline immediately before intraoperative application of MgSO4 10% 50 mg/kg body weight and 10 min thereafter. The continuous MgSO4 infusion rate depended on blood pressure (mean arterial pressure > 60-65 mmHg) and lasted a maximum of 60 min. Results MgSO4 was administered 2.8 (min. 1.6, max. 15.5) hours after onset of symptoms. Median flow increased significantly by 20.8% (5–68%, p = 0.001). Velo increased 4.9% (1–17%), rHb decreased 1.5% (3–34%) and SO2 decreased 9.4% (8–38%) by trend compared to the baseline values. FiO2 correlated positively with velo (rs = 0.712, p = 0.004), whereas arterial HCO3 correlated negatively with SO2 (rs = −0.599, p = 0.024). Of 14 patients, 2 had symptomatic vasospasm. Conclusions Our data suggest an increased cerebral blood flow after early intraoperative administration of MgSO4 in patients with SAH. Using a non-invasive laser-Doppler spectrophotometry system, this technique is feasible for continuous real-time monitoring of cerebral microcirculation. Trial registration DRKS (German Clinical Trial Registry), DRKS00013047 , retrospectively registered on September 21st, 2017.

Introduction L’interleukine (IL)-13 est une cytokine cle de type 2 impliquee dans l’inflammation de la dermatite atopique (DA). Le tralokinumab est un anticorps monoclonal entierement humain qui neutralise specifiquement l’IL-13. Nous rapportons ici les resultats sur l’efficacite et la tolerance du tralokinumab + corticosteroide topique (TCS) dans la DA moderee a severe de l’adulte. Materiel et methodes Dans cette etude randomisee en double aveugle de 32 semaines ( NCT03363854 ), les patients atteints de DA moderee a severe ont ete randomises 2: 1 en 2 bras: 1 bras tralokinumab en injection sous-cutanee 300 mg toutes les 2 semaines (Q2W) + TCS et 1 bras controle (placebo Q2W + TCS). Les criteres principaux d’evaluation etaient l’evaluation globale de l’investigateur: IGA-0/1 et l’EASI-75, a la semaine 16. A S16, les repondeurs au tralokinumab (IGA-0/1 et/ou EASI-75) ont ete re-randomises 1: 1 dans un bras tralokinumab Q2W ou un bras tralokinumab Q4W + TCS pour 16 semaines supplementaires. Les repondeurs au placebo ont continue le placebo et tous les non-repondeurs ont recu du tralokinumab Q2W + TCS. Resultats A l’inclusion, 46,3 % des 380 patients randomises avaient une DA severe (IGA-4); l’EASI moyen etait de 29,4. A S16, les patients traites par tralokinumab ont atteint l’IGA-0/1 et l’EASI-75 plus frequemment que ceux du bras controle, soit pour l’IGA-0/1: 38,9 % vs 26,2 % (p = 0,015) et pour l’EASI-75: 56,0 % vs 35,7 % (p Discussion Le tralokinumab 300 mg Q2W + TCS s’est revele efficace dans le traitement de la DA moderee a severe de l’adulte, avec un profil de tolerance favorable.

Background: Clinical registries may provide high quality evidence on the use and effectiveness of therapeutic interventions under real-life conditions. Adults with moderate-to-severe AD are enrolled into TREATgermany and prospectively followed over at least 2 years. The paper analyses the association between dermatological quality of life and work limitations. Materials and methods: Treatment modalities and a broad set of physician and patient reported outcome measures are documented using validated instruments to assess clinical disease severity (EASI, objective SCORAD), quality of life (DLQI), symptoms (POEM), global disease severity, as well as patient satisfaction and work limitations including presentism (WLQ). From 06/2016 until 12/2017. 241 individuals (mean age 43 +/- 15 years. 38.6% female) were enrolled at 19 recruitment centers. 69% of them were currently employed. Results: Employed persons had DLQI and WLQ scores of 10.4 +/- 6.9 points and 17.7 +/- 18.1%, respectively. Mean presentism was substantial accounting for 9.2%. With coefficients of 0.39 and 0.33 WLQ and presentism scores significantly correlate with DLQI (p < 0.000). Bootstrapped regression models showed that the limitations in coping with work requirements increase by 1.7% as DLQI increases by one point. Lower quality of life due to AD is most strongly associated with limitations in the area of physical and performance requirements in general. Presentism decreases by 0.5% as DLQI increases by one point. Conclusion: Moderate-to-severe AD has substantial adverse economic impact with mean productivity loss of patients of almost 10%. Future analyses from TREATgermany will address the impact of innovative treatment modalities on quality of life and work productivity of patients with moderate-to-severe AD., Hintergrund: Klinische Register tra- gen zur Evidenzbasierung der Gesund- heitsversorgung und zur Umsetzung von Forschungsergebnissen in die Praxis bei. TREATgermany schließt Erwachsene mit moderater bis schwerer Neurodermitis (AD) mit prospektiver Beobachtung über min- destens 2 Jahre ein. Der Beitrag zeigt ers- te Ergebnisse zum Zusammenhang von krankheitsbezogener Lebensqualität und Leistungseinschränkungen im Beruf. Ma- terial und Methoden: Dokumentiert werden objektive und subjektive Outcomes mit vali- dierten Messinstrumenten: klinischer Schwe- regrad (EASI, oSCORAD), Lebensqualität (DLQI), Symptome (POEM), globaler Schweregrad (IGA/PGA), Patientenzufrie- denheit und berufsbezogene Leistungsein- schränkungen (WLQ) inkl. Präsentismus (Produktivitätsverlust bei der Arbeit) so- wie der Therapieverlauf. 06/2016 – 12/2017 wurden 241 Patienten (Alter 43 ± 15 Jahre; 38,6% Frauen) in deutschlandweit 19 Zent- ren eingeschlossen, 69% waren berufstätig. Ergebnisse: Erwerbstätige hatten DLQI- und WLQ-Mittelwerte von 10,4 ± 6,9 Punkten bzw. 17,7 ± 18,1%. Der mittlere Präsentis- mus betrug 9,2%. Mit r = 0,39 und 0,33 kor- relierten die WLQ- und Präsentismus-Scores signifikant mit dem DLQI (p < 0,001). Eine geringere Lebensqualität war am stärks- ten mit körperlichen und allgemeinen Leis- tungseinschränkungen im Beruf assoziiert. Regressionsmodelle zeigten einen Zuwachs von Limitationen bei der Bewältigung von Arbeitsanforderungen um 1,7% und des Prä- sentismus um 0,5% mit der Zunahme des DLQI um einen Punkt. Diskussion: eine mo- derate bis schwere AD hat negative wirt- schaftliche Auswirkungen mit einem mittle- ren Produktivitätsverlust der Patienten von fast 10%. Weitere Analysen sollten den Ein- fluss innovativer Behandlungsmethoden auf Lebensqualität und Arbeitsproduktivität in den Fokus rücken.

Clinical registries may provide high-quality evidence on the use and effectiveness of therapeutic interventions under real-life conditions. Adults with moderate-to-severe atopic eczema (atopic dermatitis [AD]) are enrolled into TREATgermany and prospectively followed over at least 2 years. This paper analyses the association between dermatological quality of life and work limitations.Treatment modalities and a broad set of physician- and patient-reported outcome measures are documented using validated instruments to assess clinical disease severity (EASI [Eczema Area and Severity Index], objective SCORAD [objective-SCORing Atopic Dermatitis]), quality of life (DLQI [Dermatology Life Quality Index]), symptoms (POEM [Patient-oriented Eczema Measure]), global disease severity, as well as patient satisfaction and work limitations including presenteeism (WLQ [Work Limitation Questionnaire]). From 06/2016 until 12/2017, 241 individuals (mean age 43 ± 15 years, 38.6% female) were enrolled at 19 recruitment centers; 69% of the patients were employed.Employed persons had DLQI and WLQ scores of 10.6 ± 6.9 points and 17.7 ± 18.1%, respectively. Mean presenteeism was substantial accounting for 9.2%. With coefficients of 0.39 and 0.33 WLQ and presenteeism scores significantly correlate with DLQI (p 0.000). Bootstrapped regression models showed that the limitations in coping with work requirements increase by 1.7% as DLQI increases by one point. Lower quality of life due to AD is most strongly associated with limitations in the area of physical and performance requirements in general. Presenteeism increases by 0.5% as DLQI increases by one point.Moderate-to-severe AD has substantial adverse economic impact with mean productivity loss of patients of almost 10%. Future analyses from TREATgermany will address the impact of innovative treatment modalities on quality of life and work productivity of patients with moderate-to-severe AD.

Das atopische Ekzem ist eine typische multifaktorielle Erkrankung, bei der Umwelt- und Lebensstilfaktoren eine individuell vererbte Disposition in die Manifestation fuhren. Die Heritabilitat des atopischen Ekzems, d. h. der Anteil erblicher Faktoren an der Gesamtvarianz in der Bevolkerung, wird auf 70–80 % geschatzt. Die Moglichkeiten zur Entschlusselung erblicher Risikofaktoren haben sich in den letzten Jahren enorm erweitert. Als Folge konnten eine Vielzahl von Risikogenen identifiziert sowie erste Einblicke in Veranderungen des Epigenoms gewonnen werden. Mit dem wachsenden Verstandnis fur die konstitutionell bedingte Variabilitat entstehen zunehmend Krankheitsmodelle, die zeit- und entwicklungsabhangige Interaktionen zwischen genetischen und umweltbedingten Faktoren einbeziehen. Gleichzeitig rucken starker individualisierte Vorhersage-, Vorbeugungs- und Behandlungsansatze in greifbare Nahe.

SummaryAim The PETITE study (Sigurgeirsson et al.) aimed to compare safety and efficacy of pimecrolimus 1% cream (PIM) and low-to-medium-potency topical corticosteroids (TCS) in children with mild-to-moderate atopic dermatitis (AD). Setting and design Participants of this 5-year drug-company sponsored multicentre, open-label, parallel-group trial were recruited between April 2004 and October 2005. No details are reported regarding the study sites. Study exposure Infants aged ≥ 3 to < 12 months with mild-to-moderate AD were randomly assigned in a 1 : 1 ratio to receive either PIM or a low- or medium-potency TCS cream/ointment for 5 years. No information on specific TCS products used was provided. The topical treatment was applied twice daily ‘until complete AD clearance or for as long as allowed by the label of the specific TCS’, and was reinitiated at the occurrence of first signs and symptoms of AD flares. In the PIM group, exacerbations not controlled by PIM were treated with short-term TCSs. Outcomes Adverse events (AEs) and serious AEs (SAEs) were recorded ‘during clinic visits’. In a proportion of the patients, various immunological assessments including antibody titres to common vaccine antigens, immunoglobulin levels, B and T lymphocyte cell counts, and T-cell proliferation tests were performed. The children's growth was assessed by measuring height and weight. AD severity was measured using the Investigator Global Assessment (IGA) score and the percentage of the total body surface area affected. No specific information was provided on the number and scheduling of study visits. Primary outcomes were the incidence of AEs ‘of primary clinical interest’ and those with a crude incidence of ≥ 5% in either treatment group. Secondary outcome was ‘long-term efficacy’ defined as IGA ≤ 1 at week 3 and year 5. Results Patients in the PIM group experienced significantly more AEs [bronchitis (P = 0·02), infected eczema (P ≤ 0·001), impetigo (P = 0·045), nasopharyngitis (P = 0·04)]. No significant differences were seen for the other AEs. The overall incidence of SAEs was slightly higher for PIM (20·5% vs. 17·3%; P = 0·046). The proportion of participants with IGA ≤ 1 at year 5 was 88·7% for PIM and 92·3% for TCS, a success rate difference of 3·6% (95% confidence interval 0·8–6·4) favouring TCS. Conclusions Sigurgeirsson et al. conclude that the long-term management of mild-to-moderate AD in children with both TCS and PIM is safe, and that PIM has similar efficacy to TCS. Further, they conclude that their data support the use of PIM as a first-line treatment of mild-to-moderate AD in children.

Die beiden haufigsten chronisch-entzundlichen Dermatosen sind das atopische Ekzem mit einer Pravalenz von 15 % bei Kindern und 5 % bei Erwachsenen und die Psoriasis vulgaris mit einer Lebenszeitpravalenz von 3–5 %. Beide reprasentieren typische multifaktorielle Erkrankungen, deren Manifestation und Progression auf einem Zusammenspiel verschiedener genetischer sowie umweltbedingter Faktoren beruht. Die rasante technologische Entwicklung im Bereich der Molekulargenetik ermoglichte in den letzten Jahren tiefe Einblicke in die genetische Architektur dieser Erkrankungen. Insbesondere mithilfe genomweiter Assoziationsstudien ist es gelungen, eine eindrucksvolle Zahl genetischer Risikofaktoren zu identifizieren und so ein besseres Verstandnis der Pathophysiologie zu erreichen. Die Erkenntnisse aus der genetischen Epidemiologie werden zunehmend auch in klinische Fragestellungen ubersetzt, beispielsweise indem genetische Marker zur Stratifizierung von Patienten und betroffene biologische Prozesse zur Entwicklung neuer Behandlungsansatze genutzt werden. In der weiteren Erforschung der Zusammenhange zwischen genetischer Information und chronisch-entzundlichen Hautkrankheiten wird den neuen Sequenziertechniken und systembiologischen Ansatzen eine wichtige Rolle zukommen.