AD and household mould in Indigenous communities
Poor housing conditions may be a factor in social determinants of AD outcomes in Canada’s Indigenous communities (1,400 words, 7 minutes)
Poor housing conditions in many of Canada’s Indigenous communities and the prevalence of household mould may be contributing to the burden of atopic dermatitis (AD), Dr. Jordanna Roesler reported during a presentation at the 3rd annual Indigenous Skin Spectrum Summit.
Dr. Roesler said AD is associated with significant burden and comorbidities. People with barriers to care and disparities in social and environmental determinants of health have poorer outcomes. Many rural Indigenous homes have poor living conditions and mould-promoting environments, including poor ventilation and excessive dampness.
Dr. Roesler is a dermatology resident at the University of British Columbia and a member of Dene First Nation. She has served as the vice president of Indigenous Health for the UBC Medical Undergraduate Society.
She said that household mould is known to have complex immunomodulatory effects and has also been shown to impair the development of the immune system. Dr. Roesler noted mould can generate reactive oxygen species by associating with specific components and metabolites, such as mycotoxins. However, the relationship between mould exposure and AD is not yet fully understood.
She noted that the impact of visible household mould on AD severity was demonstrated in the RHINE study (The Science of the Total Environment Dec. 2022; 20:853:158609), a longitudinal study based in northern Europe. Dr. Roesler said the study investigated the association between home environmental exposures and AD diagnoses in children throughout their development. Exposure during childhood to household water damage and visible mould was significantly associated with parent-reported AD after ten years. The finding was dose-dependent based on the years of exposure.
Other studies have reported similar associations, said Dr. Roesler.
Visible mould remains a significant concern in the homes of many rural Indigenous communities, she said, noting a 2015 report from Statistics Canada that found the percentage of Indigenous homes with mould was three times higher than that of the general population. According to the 2018 report of the First Nations Regional Health Survey, 41.7% of Indigenous rural homes reported household mould. AD prevalence was significantly higher among Indigenous peoples living in homes with mould, but this link was not further explored.
Bottom line: Dermatologists should be aware of the impacts of social determinants of health, including the potential relationship between mould exposure and AD. Further studies are required to research the effects of mould on AD in indigenous communities.
From the literature on atopic dermatitis
Assessment of racial and ethnic differences of atopic dermatitis severity and treatment patterns in a diverse outpatient cohort in the United States: a retrospective observational study
Researchers conducted this study to examine racial or ethnic differences in severity and treatment patterns in a diverse outpatient patient cohort of 833 atopic dermatitis (AD) patients.
They found no significant associations between highest-reported body surface area (BSA; Fisher’s exact test, p=0.19 and p=0.44) or physician’s global assessment (PGA; p=0.63 and p=0.57) with race or ethnicity. There was also no association of race or ethnicity with gender or age as predictors of BSA or PGA.
The authors note that Asian and multiracial/other patients were more likely than White or Black patients to use topical calcineurin inhibitors (Chi-square, p=0.01). Dupilumab use differed by race (Multiracial/other=35.0%; White=20.1%; Asian=15.7%; Black=13.6%; Chi-square, p=0.03), but not ethnicity (p=0.88). Use of oral corticosteroids (Chi-square, p=0.74), immunosuppressants (p=0.98), GABAergics (p=0.16), or NBUVB (p=0.42) did not differ by race. Researchers found no interactions of race or ethnicity with gender or age as predictors of treatment use. Similar treatment patterns were observed across racial or ethnic groups.
Do socioeconomic factors impact atopic dermatitis outcomes? A single-centre study
The authors of this paper hypothesized that spatially-derived factors correlate with atopic dermatitis (AD) severity and patient-reported outcome (PRO) in a pediatric cohort from Chicago.
In a single-site, cross-sectional study, they enrolled children with AD and caregivers from Feb. 2018 to April 2019. Researchers used self- and physician-assessed severity measures and geocoded patient addresses.
Among 216 children aged five to 17 years of age, 111 (51.4%) lived in urban, 104 (48.1%) suburban, and one (0.5%) in rural areas. Race was self-classified as White in 31.0%, Black in 24.5%, other or mixed in 25.0%, and Asian in 19.4%; 24.5% were Hispanic. Median deprivation index (DI) was 0.32 (range 0.03-0.72), with higher scores indicating more deprivation. DI correlated with insurance type, family income, ethnicity, race, and parental education and weakly with selected PRO T-scores. However, the researchers found no correlations between AD severity scores and DI, race, ethnicity, income, education, or insurance type.
Genome-wide association study of susceptibility loci for self-reported atopic dermatitis and allergic rhinitis in the Korean population
To identify single nucleotide polymorphisms (SNPs) associated with allergic diseases in the Korean population, researchers obtained 8,840 samples from the Korean Association Resource Consortium dataset of the Korean Genome and Epidemiology Study Ansan-Anseong cohort.
This data determined allergic disease phenotype based on self-reported physician diagnoses. After quality control, 8,823 subjects with 877,242 variants remained for the final analysis.
Researchers analyzed 636 patients with allergic disease and 8,176 controls among the initial subjects. The investigators found three SNPs associated with allergic disease at a level of genome-wide suggestive significance (p<1.0×10-5) in the Korean population. These three were: rs7275360, located in neural cell adhesion molecule 2; rs698195; and rs3750552, located in a family with sequence similarity 189, member A2. These polymorphisms were on chromosomes 21q21.1, 7q31.1, and 9q21.12, respectively.
In their conclusions, the authors write more research is required to confirm the association between these novel SNPs and allergic diseases in the Korean population and other ethnicities.
Safety and efficacy of dupilumab in adult atopic dermatitis in Singapore
For this study, investigators included a retrospective cohort of 51 patients with moderate-to-severe atopic dermatitis (AD) treated with dupilumab at a tertiary skin institute from Jan. 2018 to Feb. 2020. Researchers analyzed outcome measures such as Scoring Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI) and Dermatology Quality of Life Index (DLQI) at baseline and after 16 weeks of treatment. Laboratory tests at the respective time points were also measured.
The authors found that patients treated with dupilumab showed a consistent reduction in body surface area (BSA), SCORAD, EASI, and DLQI scores. Concurrently, serum immunoglobulin E (IgE) and absolute eosinophil count showed a downward trend at four months of treatment. There was a transient increase in mean serum IgE at one month of dupilumab therapy. Also, 42.0% and 35.3% of patients developed eye symptoms and head and neck dermatitis, respectively, but no significant adverse events were reported. Childhood-onset AD was more likely to have improved BSA scores compared to adult-onset AD.
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At the intersection of skin and society
CBC News reports that the BC government and the Council of the Haida Nation have signed an agreement officially recognizing Gwaii’swaii's Aboriginal title.
This agreement comes more than two decades after the nation launched a legal action seeking formal recognition.
The province announced last month that it had reached a proposed deal with the Haida. On April 6, 2024, the nation announced that more than 500 Haida citizens had voted 95% to approve the Gaayhllxid/Gíhlaga Haida Title Lands Agreement.
The deal recognizes the nation’s title throughout Haida Gwaii, an archipelago of more than 150 islands roughly 90 kms from BC's North Coast.
In a press release, BC’s Ministry of Indigenous Relations and Reconciliation, Gaagwiis Jason Alsop, President of the Haida Nation, said that reaching the agreement has not been easy. “It’s really a monumental stride, building on the work of past leaders of the Haida Nation,” said Alsop. “We have always asserted our sovereignty to Haida Gwaii and the surrounding waters. With this agreement in place, we can work toward implementing our title without conflict, based on yahguudang/yahgudáng (respect), with our ownership being properly recognized. Our work will benefit not only the lands, water, people, and all beings of Haida Gwaii but the province and Canada as well. This is a good day.”
More details on the agreement can be found in the press release.
This week
April 22 to 28 is Allergy Awareness Week in the UK.
April 22 to 30 is National Immunization Awareness Week in Canada
April 28 is World Day for Safety and Health at Work
Something to think about in the week ahead. . .
—Julia Child, US celebrity chef and author, (1912-2004)
Next week
Boston University Chobanian & Avedisian School of Medicine researchers have validated a new scale for evaluating post-inflammatory hyperpigmentation.
Save the date for the Atopic Dermatitis Summit
On May 11, 2024, from 10 a.m. to 1 p.m. EDT, Drs. Marissa Joseph and Neil Shear will co-chair the Atopic Dermatitis Summit, a one-day virtual medical education event seeking to provide the highest-quality AD education to help Canadian patients receive the best care possible. The session is developed by the organizers of Skin Spectrum Summit.
You can join your colleagues to learn more about the incidence of and the latest therapies for AD through live Q&As and lectures.
The Summit is a landmark opportunity to learn to:
Effectively communicate about AD with patient and their families
Diagnose AD across all skin phototypes
Prioritize sun protection in the management of AD
Address disparities among Indigenous communities
Understand the interplay between food allergies and AD
Registering for this compelling event is free, but space is limited. Reserve your (virtual) space now at https://tinyurl.com/ADSummit2024
L’Oréal, Procter & Gamble, Dermtek Pharma and other event supporters. Learn more at www.skinspectrum.ca/ad
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