Nav: Home

Racial differences uncovered in debilitating itchy skin condition

June 14, 2018

An international team led by Johns Hopkins Medicine researchers has conducted what is believed to be the largest detailed published study of people with a poorly understood skin condition known as prurigo nodularis (PN). Such studies collect information on a whole subset of people at once and at a particular point in time.

Results of their analysis were highlighted in an oral presentation at the International Investigative Dermatology Conference in May 2018 and were published on May 4 by the Journal of the American Academy of Dermatology. Their results provide some of the first published reliable information from a racially diverse population about who likely develops this chronic disease, which is characterized by intensely itchy nodules that develop on the arms and legs that can generalize throughout the body.

The prevalence of PN remains unknown as the condition has been understudied compared with other inflammatory skin diseases, and its origins, causes and treatment are still largely unexplored. However, says study leader Shawn Kwatra, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, PN's impact is significant.

"These are patients whose lives have been devastated by an unbearable, persistent itch that dramatically reduces quality of life on par with the most severe diseases treated by our specialty," he says.

Besides the immense discomfort from itching and scratching, Kwatra explains, PN interferes with sleep and affects social interactions with people who may be (needlessly) afraid of contracting this noninfectious disease. Despite its severe impact, he adds, PN has been largely ignored by scientists.

To learn more about it, he and his colleagues conducted a detailed study of data from 909 adults with PN over a five-year period. There were 475 females and 434 males. Of the participants, nearly half were African American, about 42% were white, and about 3% were Asian.

In addition to demographic information, the investigators extracted details of the patient group's comorbidities, or other medical problems these patients had at the same time as PN. The majority of patients, nearly half, were between 51 and 65 years old. The findings also suggest that the condition disproportionately affects African-Americans between ages 50 and 65 as compared with the general population.

PN was more prevalent in African-Americans, but not whites, with HIV infection. African-Americans with PN in the patient group were 10.5 times more likely to have HIV than race-matched controls with atopic dermatitis and eight times more likely to have HIV than African-American patients with psoriasis who were treated during this time period.

PN patients were also 2.8, 4.7 and 9.9 times more likely to have diabetes, chronic kidney disease and hepatitis C than patients with atopic dermatitis, respectively. Further, patients with PN were nearly three times more likely to have clinical depression compared with patients with atopic dermatitis and 2.4 times more likely to have depression than patients with psoriasis.

The team suggests their information may be used not only in the clinical care of PN patients, but forms a basis for ongoing translational studies to develop novel treatments for the disorder, which has no FDA-approved therapy or consistently effective treatment.Kwatra cautions that such associations do not demonstrate that PN causes these disorders, or vice versa. More research will be necessary to tease out whether and why these various conditions are linked, he says, which could eventually lead to a better understanding of the mechanism of PN and better targeted treatments.

However, he adds, knowing the connections between PN and various health conditions could lead physicians to give patients more thorough evaluations to check for other conditions once they're diagnosed with PN.

Current systemic treatments for PN include phototherapy, neuroactive agents such as gabapentin and pregabalin, and systemic immunosuppressants such as methotrexate and cyclosporine. As PN is associated with dermatologic conditions such as atopic dermatitis in African-Americans, as well as many systemic conditions, further study is needed to determine the exact prevalence.

Additional authors from Johns Hopkins include Emily Boozalis, Shivani Patel, M.D., Sewon Kang, M.D., and Olive Tang.

Kwatra is supported by a grant from the Skin of Color Society, investigating racial differences in itch.
-end-


Johns Hopkins Medicine

Related Atopic Dermatitis Articles:

Scientists identify single-gene mutations that lead to atopic dermatitis
Researchers have identified mutations in a gene called CARD11 that lead to atopic dermatitis, or eczema, an allergic skin disease.
Study casts doubt about link between eczema, cardiovascular disease
Despite mixed evidence recently about an association between atopic dermatitis and cardiovascular disease, a new study that analyzed more than 250,000 medical records suggests there is no link.
TWEAKing inflammation
Superficially, psoriasis and atopic dermatitis may appear similar but their commonalities are only skin deep.
Vitamin D levels not linked to asthma or dermatitis
Vitamin D supplementation is unlikely to reduce the risk of asthma in children or adults, atopic dermatitis, or allergies according to a new study published in PLOS Medicine by Brent Richards, of McGill University, Canada, and the Lady Davis Institute at the Jewish General Hospital, Canada, and colleagues.
Unraveling the mechanism of skin barrier formation
Scientists have identified the gene responsible for generating acylceramide, the key lipid in forming the skin barrier that protects us from pathogens, allergens and other harmful substances.
Transplanting good bacteria to kill Staph
University of California San Diego School of Medicine researchers screened 10,000 colonies of bacteria found on the epidermis to determine how many had antimicrobial properties and at what rate these are found on healthy and non-healthy skin.
Personalized skin lotions keep disease-causing bacteria at bay
Two new antibiotics that specifically abolished a potentially disease-causing form of Staphylococcus aureus were discovered in the secretions of innocuous bacteria that naturally occupy people's skin, a new study reports.
Are prebiotics or probiotics effective against dermatitis?
Evidence supporting a key role for an altered gut microbiome in the development of atopic dermatitis (AD) would suggest that the use of probiotics or prebiotics to correct microbial imbalances in the gut could help prevent or treat AD.
Review examines diversity in dermatology clinical trials
Racial and ethnic groups can be underrepresented in medical research.
Why air pollutants make some people vulnerable to atopic dermatitis
Researchers announce the results of a study into why air pollutants cause some people to be more susceptible to atopic dermatitis, a kind of skin inflammation.

Related Atopic Dermatitis Reading:

Atopic Dermatitis: Eczema
by Johannes Ring (Author)

This book presents the state of the art in research into atopic dermatitis, or atopic eczema, and provides numerous effective practical management recommendations that are grounded in the immense clinical experience of the author. A scientific evidence-based approach to the subject is adopted, progressing from clinical symptoms in different disease stages, molecular genetics, and pathophysiology through to treatment and prevention. All aspects of patient management are covered, including diagnostics, avoidance strategies, emollient therapy, and acute treatment of eczema and itch. Diverse... View Details


Atopic Dermatitis: New Perspectives on Managing a Chronic Inflammatory Disease
by Integritas Communications

The goal of this eHealth Source™ activity is to educate clinicians on atopic dermatitis pathoetiology, best practices in patient evaluations, and the clinical profiles of treatment options for moderate-to-severe disease, including a biologic therapy recently approved by the US Food and Drug Administration (FDA). With the overall goal of improving outcomes for patients with moderate-to-severe atopic dermatitis, this educational activity integrates published clinical data and the experience of expert faculty to provide actionable recommendations on individualizing care and improving... View Details


Atopic Dermatitis: The Epidemiology, Causes and Prevention of Atopic Eczema
by Hywel C. Williams (Editor)

Atopic dermatitis or eczema is an increasingly common skin disease, but its distribution, frequency, and underlying causes have not yet been systematically reviewed in depth. Atopic Dermatitis takes an original look at the epidemiology of the disorder, its prevalence and possible causes. This unique volume draws on international experts from dermatology, epidemiology, pediatrics, and immunology. As an allergic disease, atopic dermatitis has much in common with other allergies and this comprehensive resource sheds new light on the mechanisms that underlie the allergic response. This... View Details


Atopic Dermatitis, An Issue of Dermatologic Clinics, 1e (The Clinics: Dermatology)
by Jonathan I. Silverberg MD PhD (Author), Nanette Silverberg MD (Author)

This issue of Dermatologic Clinics, guested edited by Drs.Jonathan I. Silverberg and Nanette Silverberg, is devoted to Atopic Dermatitis. Articles in this outstanding issue include: How to Define Atopic Dermatitis; Public Health Burden and Epidemiology of Atopic Dermatitis; Long-term Course of Atopic Dermatitis; Allergic and Non-Allergic Comorbidities of Atopic Dermatitis; Patient-burden of Atopic Dermatitis; Assessment of Atopic Dermatitis Severity in Clinical Practice; An Update on the Pathophysiology of Atopic Dermatitis; Long-term Treatment of Atopic Dermatitis; Special Considerations for... View Details


Atopic Dermatitis and Eczematous Disorders
by Donald Rudikoff (Editor), Steven R Cohen (Editor), Noah Scheinfeld (Editor)

It is estimated that around 15% of the population suffer from atopic dermatitis or eczematous disorders at some point in their lifetime, causing a significant percentage of visits to dermatologists, primary care physicians, and allergists. Despite much current research interest, the pathophysiology of these disorders and their optimum treatment remain uncertain.

In Atopic Dermatitis & Eczematous Disorders, the authors discuss all clinical aspects and treatment of atopic dermatitis and other eczema variants, including:

Seborrheic dermatitis

... View Details


Atopic Dermatitis. Understanding Atopic Dermatitis as a disease and learning how to cope with it through preventative and curative methods.
by Robert Rymore (Author)

Millions of people are suffering from Atopic Dermatitis. This is another very informative book by Robert Rymore. He continues with his interest in writing medical educational guides. This guide is intended to be a tool, one that will give you information and hopefully some pain relief. Skin is one of the most essential systems of an individual’s body. Our skin covers up the underlying body parts and systems and acts as a protective layer for essential internal elements of the body to function well even in the worst environmental conditions. Skin makes up the whole entity of a human being.... View Details


The Aromatherapy Eczema Treatment: The Professional Aromatherapist’s Guide to Healing Eczema, Itchy Skin Rashes and Atopic Dermatitis with Essential ... Medicine. (The Secret Healer) (Volume 5)
by Mrs Elizabeth Ashley (Author)

Say Goodbye to Eczema....For Good with Aromatherapy and Essential Oils Most people appreciate that the itching and redness of eczema can be used using essential oils, but what if I told you they were capable of so much more?

Imagine if, as a therapist, you were able to pinpoint the emotions that set off these flares? Can you visualise what it would mean to your patient if you were able to isolate the very protagonist causing the eczema breakout and alleviate their pain completely?

Well now you can.
This natural medicine textbook teaches you: How to... View Details


Atopic Dermatitis: A Review for the Primary Care Physician (Dermatology-laboratory and Clinical Research: Public Health in the 21st Century)
by Alexander K. C. Leung (Editor), Kam Lun E. Hon (Editor)

Atopic dermatitis is a chronically relapsing dermatosis characterised by pruritus, erythema, vesiculation, papulation, exudation, excoriation, crusting, scaling and sometimes lichenification. Atopic dermatitis affects 10 to 20 per cent of school-aged children. This book presents research in the study of atopic dermatitis. View Details


Atopic eczema - Atopic dermatitis treated with Homeopathy, Schuessler salts (homeopathic cell salts) and Acupressure: A naturopathic, homeopathic and biochemical guide
by BookRix GmbH & Co. KG

Atopic dermatitis, also named atopic eczema, is a chronic condition with an itchy inflammation of the skin that tends to flare periodically. The itchy patches most often appear on the hands and feet, in the front of the bend of the elbow, behind the knees, on the ankles, wrists, face, neck and upper chest. The cause of atopic dermatitis is the result from a combination of inherited tendencies for sensitive skin, environmental factors and malfunction in the body's immune system.

The chief characteristic of atopic eczema is the itch which can become almost unbearable, leading to... View Details


Atopic Dermatitis in Childhood and Adolescence (Pediatric and Adolescent Medicine, Vol. 15)
by T. Werfel (Editor), J.M. Spergel (Editor), W. Kiess (Editor), W. Kiess (Editor)

Atopic dermatitis is amongst the most common disorders of the skin in young people around the world. This timely book presents the newest insights and novel concepts in relation to all aspects of this skin disorder. Classification, clinical features and differential diagnosis are reviewed in the first chapter, while risk factors, susceptibility and an epidemiological overview are outlined in the next chapter, followed by a detailed discussion of the immunology of the skin and the pathophysiology of dermatitis. Further chapters present exciting new data delineating clinical aspects of current... View Details

Best Science Podcasts 2018

We have hand picked the best science podcasts for 2018. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

The Person You Become
Over the course of our lives, we shed parts of our old selves, embrace new ones, and redefine who we are. This hour, TED speakers explore ideas about the experiences that shape the person we become. Guests include aerobatics pilot and public speaker Janine Shepherd, writers Roxane Gay and Taiye Selasi, activist Jackson Bird, and fashion executive Kaustav Dey.
Now Playing: Science for the People

#479 Garden of Marvels (Rebroadcast)
This week we're learning about botany and the colorful science of gardening. Author Ruth Kassinger joins us to discuss her book "A Garden of Marvels: How We Discovered that Flowers Have Sex, Leaves Eat Air, and Other Secrets of the Way Plants Work." And we'll speak to NASA researcher Gioia Massa about her work to solve the technical challenges of gardening in space.