Rios-Duarte Jorge A, Silverberg Jonathan I
From the *Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia.
†Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Dermatitis. 2023 Mar-Apr;34(2):120-126. doi: 10.1089/derm.2022.29006.jrd. Epub 2023 Jan 19.
Little is known about the relationship of atopic dermatitis (AD) severity, phenotype, and persistence on different types of skin infections. To evaluate the relationship of AD characteristics and skin infections over time in adults. We performed a prospective dermatology practice-based study (n = 559). History of infection was assessed using questionnaires. AD severity was evaluated using Scoring Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), Investigator's Global Assessment (IGA), and Patient-reported Global Assessment (PtGA). At baseline, 160 (21.4%) patients reported history of ≥1 skin infection, including 14.3% with bacterial infections. In multivariable repeated measures logistic regression models, ≥1 cutaneous infection was associated with moderate (adjusted odds ratio [95% confidence interval]: 2.67 [1.67-4.28]) and severe (6.35 [3.36-12.01]) versus mild SCORAD; as well as severe SCORAD-itch; moderate and severe versus clear-mild EASI; moderate and severe versus clear-mild PtGA; mild, moderate, and severe versus clear-almost clear IGA. Cutaneous infections were not associated with ichthyosis, palmar hyperlinearity, nummular eczema, cheilitis, or hand eczema. Specific infections varied by AD severity and body site. Persistent moderate-severe disease was associated with higher odds of skin infection. Skin infections were associated with AD severity but not phenotype, and may be mitigated by improved AD severity.
关于特应性皮炎（AD）的严重程度、表型以及其与不同类型皮肤感染的持续关系，我们所知甚少。为了评估成人AD特征与皮肤感染随时间的关系，我们开展了一项基于皮肤科实践的前瞻性研究（n = 559）。通过问卷评估感染史。使用特应性皮炎评分（SCORAD）、湿疹面积和严重程度指数（EASI）、研究者整体评估（IGA）以及患者报告的整体评估（PtGA）来评估AD的严重程度。在基线时，160名（21.4%）患者报告有≥1次皮肤感染史，其中14.3%有细菌感染史。在多变量重复测量逻辑回归模型中，≥1次皮肤感染与中度（调整后的优势比[95%置信区间]：2.67[1.67 - 4.28]）和重度（6.35[3.36 - 12.01]）AD（与轻度SCORAD相比）相关；也与重度SCORAD瘙痒相关；中度和重度（与轻度 - 轻度EASI相比）相关；中度和重度（与轻度 - 轻度PtGA相比）相关；轻度、中度和重度（与轻度 - 几乎轻度IGA相比）相关。皮肤感染与鱼鳞病、手掌皮肤纹理加深、钱币状湿疹、唇炎或手部湿疹无关。特定感染因AD严重程度和身体部位而异。持续性中重度疾病与皮肤感染的较高几率相关。皮肤感染与AD严重程度相关，但与表型无关，并且可能通过改善AD严重程度而得到缓解。
