To Örebro University

The main aim of this study was to evaluate longitudinal associations between atopic dermatitis (AD) in late adolescence and occupational socioeconomic group, labour market participation, income from work, and marital status later in adult life. Using Swedish population-based registry data a total of 205,394 men were included, born between 1952 and 1956 in Sweden and who underwent military conscription examination including assessment of atopic dermatitis (AD) and AD severity. The associations between AD and AD severity in late adolescence and labour market participation, income from work, marital status, and medication for anxiety and depression later in adult life were examined. In this study, men with AD in adolescence, especially those with severe AD, more often had a prescription for antidepressants or anxiolytics at the age of 50-57 years (unadjusted HR 1.55, 95% CI 1.32-1.81). Interestingly, despite increased risk of poorer mental health, AD was not found to be associated with a disadvantage in terms of occupational socioeconomic group, income from work, and unemployment benefits. Individuals with mild AD showed a lower risk of holding routine and lower technical jobs compared with men without AD. Persons with AD in late adolescence seem not to differ regarding registered partnerships and marital status compared with those without AD.

The main aim of this study was to evaluate longitudinal associations between atopic dermatitis (AD) in late adolescence and occupational socioeconomic group, labour market participation, income from work, and marital status later in adult life. Using Swedish population-based registry data a total of 205,394 men were included, born between 1952 and 1956 in Sweden and who underwent military conscription examination including assessment of atopic dermatitis (AD) and AD severity. The associations between AD and AD severity in late adolescence and labour market participation, income from work, marital status, and medication for anxiety and depression later in adult life were examined. In this study, men with AD in adolescence, especially those with severe AD, more often had a prescription for antidepressants or anxiolytics at the age of 50-57 years (unadjusted HR 1.55, 95% CI 1.32-1.81). Interestingly, despite increased risk of poorer mental health, AD was not found to be associated with a disadvantage in terms of occupational socioeconomic group, income from work, and unemployment benefits. Individuals with mild AD showed a lower risk of holding routine and lower technical jobs compared with men without AD. Persons with AD in late adolescence seem not to differ regarding registered partnerships and marital status compared with those without AD.

A previous study indicated that atopic dermatitis (AD) was associated with better cognitive function in males during late adolescence. This association was examined among 2 021 369 males who had a medical examination and cognitive function testing during a military conscription assessment in late adolescence in Sweden. Sibling-comparison analysis to tackle confounding indicated that AD is associated with poorer cognitive function, suggesting AD in childhood is detrimental for the development of cognitive function.

A Swedish translation of the patient-reported outcome measure for assessing long-term control of atopic dermatitis, Recap of atopic eczema (RECAP), has not been validated. Cross-cultural translation and multi-centre validation of the translated RECAP questionnaire were therefore performed. Disease severity was assessed using the validated Investigator Global Assessment Scale for atopic dermatitis (vIGA-ADTM). The Swedish RECAP was completed by 208 individuals aged 16 years or older with a median age of 36 years (interquartile range [IQR] 27-48). The participants considered the questionnaire suitable for assessing eczema control. The median RECAP score (range 0-28) was 12 (IQR 5-19). The mean and median vIGA-ADTM scores (range 0-4) were 2 (standard deviation [SD] 2) and 3 (IQR 2-4), respectively. A correlation between RECAP and the vIGA-ADTM was observed (p < 0.001). There was no significant change in scores for participants who answered the questionnaire twice within 14 days. Over time, improved or worsened eczema, as evaluat-ed by vIGA-ADTM, affected RECAP scores significantly (p < 0.001). The study suggests that RECAP can assess AD control in a Swedish clinical setting and shows -acceptable reliability.

Background: Pediatric atopic dermatitis (AD) is a common chronic disease. For assessing treatment outcomes, the concept of controlled and uncontrolled AD has been introduced.

Objectives: The aim of the study was to estimate healthcare resource use in terms of visits, treatments and costs in children with controlled and uncontrolled AD.

Materials & Methods: The study utilised administrative data and hospital patient records. An algorithm for the identification of patients with controlled and uncontrolled AD was developed, and an assessment of content validity was performed. The study included 8,922 children, aged 0-17 years, diagnosed with AD between 2015 and 2018 in three Swedish regions, treated in primary and specialist care, at regional and university hospitals.

Results: The proposed algorithm demonstrated adequate content validity. About 13% of children had uncontrolled AD. In dermatology clinics, most patients with uncontrolled disease were 12-17 years old (39%) and 17% had moderate-to-severe AD; 2% had systemic drug treatment and 7% received UVB treatment. Uncontrolled AD was associated with treatment changes and frequent visits in specialist care over several years compared to controlled disease. The mean annual healthcare cost of a child with AD aged 0-17 years in Sweden was estimated at 4,479.5. There was a statistically significant cost difference (around 4000 annually) between patients with uncontrolled AD and those with controlled disease.

Conclusion: AD was associated with high healthcare utilization, especially for children with uncontrolled disease. A high proportion of children with AD might be undertreated, and risk groups, such as adolescents with uncontrolled AD, should be treated more effectively.

BACKGROUND: The use of insulin pumps (continuous subcutaneous insulin infusion [CSII]) in individuals living with type 1 diabetes (T1D) improves disease control. However, adverse skin reactions may hamper compliance. We aimed to assess the relationship of insulin pumps, particularly that of infusion set therapy, used in children and adults with T1D and dermatitis including allergic contact dermatitis (ACD).

METHODS: A systematic search of PubMed, and EMBASE, of full-text studies reporting dermatitis in persons with diabetes using a CSII was conducted from 2020 to 2023. The Newcastle-Ottawa Scale was used to assess study quality. The inventory performed at the Department of Occupational and Environmental Dermatology, Malmö, Sweden (YMDA) was also performed highlighting the diagnostic process.

RESULTS: Among the 391 screened abstracts, 21 studies fulfilled the inclusion criteria. Seven studies included data on children only, four studies were on adults, and nine studies reported data on both children and adults. Participants were exposed to a broad range of pumps. Dermatitis was rarely specified. Up to 60% of those referred to a university hospital due to skin reactions possibly related to insulin pumps had an ACD.

CONCLUSIONS: The review and our findings indicate that there is not sufficient focus on contact allergy in the primary toxicological evaluations of substances used also for insulin pump therapy products and that possible adverse skin reactions are not correctly followed up in the clinical setting.

Use of medical devices (MDs), that is, glucose sensors and insulin pumps, in patients with Type 1 diabetes mellitus (T1D) has proven an enormous advantage for disease control. Adverse skin reactions from these MDs may however hamper compliance. The objective of this study was to systematically review and analyse studies assessing the prevalence and incidence of dermatitis, including allergic contact dermatitis (ACD) related to MDs used in patients with T1D and to compare referral routes and the clinical investigation routines between clinics being part of the European Environmental and Contact Dermatitis Research Group (EECDRG). A systematic search of PubMed, EMBASE, CINAHL and Cochrane databases of full-text studies reporting incidence and prevalence of dermatitis in persons with T1D using MDs was conducted until December 2021. The Newcastle-Ottawa Scale was used to assess study quality. The inventory performed at EECRDG clinics focused on referral routes, patient numbers and the diagnostic process. Among the 3145 screened abstracts, 39 studies fulfilled the inclusion criteria. Sixteen studies included data on children only, 14 studies were on adults and nine studies reported data on both children and adults. Participants were exposed to a broad range of devices. Skin reactions were rarely specified. It was found that both the diagnostic process and referral routes differ in different centres. Further data on the prevalence of skin reactions related to MDs in individuals with T1D is needed and particularly studies where the skin reactions are correctly diagnosed. A correct diagnosis is delayed or hampered by the fact that, at present, the actual substances within the MDs are not declared, are changed without notice and the commercially available test materials are not adequately updated. Within Europe, routines for referral should be made more standardized to improve the diagnostic procedure when investigating patients with possible ACD from MDs.