Une fondation pour les professionnels de santé Une fondation pour les patients atteints de dermatite atopique

Fondation pour la Dermatite AtopiqueRecherche et Education

Les missions

Les membres fondateurs

Pierre Fabre DermocosmétiqueLaboratoires A-Derma Laboratoires Dermatologiques AvènePierre Fabre DermatologieLaboratoires Dermatologiques DucrayLaboratoires Klorane Pierre Fabre Médicament

Le Conseil d’Administration

Collège de Professeurs

Professeur Yves De Prost (Paris)

Professeur François Bernard Michel (Montpellier)

Professeur Jean Revuz (Paris)

Conseil Scientifi que

Professeur Carle Paul(Hôpital Larrey - Toulouse)

Professeur Jean-François Nicolas(Centre Hospitalier - Lyon Sud)

Professeur Jean-François Stalder(Hôtel Dieu - Nantes)

La Fondation pour la Dermatite Atopique est une

fondation d’entreprise Pierre Fabre exclusivement

dédiée à l’eczéma atopique

Les projets de recherche fondamentale ou clinique peuvent faire l’objet d’un soutien fi nancier après validation par le Conseil Scientifi que de la Fondation.

Comme toutes les maladies chroniques, la dermatite atopique est diffi cile à prendre en charge. Le découragement gagne souvent enfants et parents qui ne comprennent pas toujours comment tirer le meilleur parti des traitements disponibles. L’éducation thérapeutique met en œuvre des moyens adaptés pour apporter les connaissances nécessaires, un savoir-faire et un savoir-être précieux.

La Fondation pour la Dermatite Atopique aide le développement des centres d’éducation thérapeutique.

Une fondation pour la recherche

Une fondation pour l’éducation thérapeutique

Les missions

Aider la recherchedans le domaine de la dermatite atopique

Aider la recherche

PO SCORADORIGINAL ARTICLE SKIN AND EYE DISEASES

Patient-Oriented SCORAD (PO-SCORAD): a new self-assessment scale in atopic dermatitis validated in EuropeJ.-F. Stalder1, S. Barbarot1, A. Wollenberg2, E. A. Holm3, L. De Raeve4, S. Seidenari5, A. Oranje6,M. Deleuran7, F. Cambazard8, A. Svensson9, D. Simon10, E. Benfeldt11, T. Reunala12,J. Mazereeuv13, F. Boralevi14, B. Kunz15, L. Misery16, C. G. Mortz17, U. Darsow18, C. Gelmetti19,T. Diepgen20, J. Ring18,21, M. Moehrenschlager21, U. Gieler22 & A. Taı̈eb14, for the PO-SCORADInvestigators Group*

Department of Dermatology, Nantes University Hospital, Nantes, France; Department of Dermatology and Allergy, Ludwig-Maximilian Univer-

sity, Munich, Germany; Skin Clinic in Ballerup, ‘‘Helsehuset’’, Ballerup, Denmark; Department of Dermatology UZ Brussels, Vrije Universiteit

Brussel, Brussel, Belgium; Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy; University Hospital

Rotterdam and Erasmus University, Rotterdam, the Netherlands; Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark;

Jean Monet Faculty, Saint-Etienne, France; Department of Dermatology, Skane University Hospital, Malmö, Sweden; Department of

Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Dermato-allergology, Copenhagen

University Hospital Gentofte, Hellerup, Denmark; Medical School, Tampere University, Tampere, Finland; Department of Dermatology and

Paul Sabatier University, Larrey Hospital, Toulouse, France; Department of Dermatology and Pediatric Dermatology, St André Hospital,

Bordeaux, France; Dermatologikum Hamburg, Hamburg, Germany; Department of Dermatology, Brest University Hospital, Brest, France;

Department of Dermatology and Allergy centre, Odense University Hospital, Odense, Denmark; Deptartment of Dermatology and Allergy

Biederstein, Technische Universität München and Division of Environmental Dermatology and Allergy, Helmholtz Center/Tum, Munich, Ger-

many; Department of Anesthesia, Intensive care and Dermatologic Sciences, Fondazione Ca’ Granda ‘‘Ospedale Maggiore Policlinico’’, Milan,

Italy; University Hospital Heidelberg, Department of Social Medicine, Center of Occupational & Environmental Dermatology, Heidelberg,

Germany; Hochgebirgsklinik Davos-Wolfgang, Christine-Kuehne Centre for Allergy Research and Education (CK-CARE), Davos, Switzerland;

Department of Psychosomatic Medicine-Psychodermatology, University of Giessen, Giessen, Germany

To cite this article: Stalder J-F, Barbarot S, Wollenberg A, Holm EA, De Raeve L, Seidenari S, Oranje A, Deleuran M, Cambazard F, Svensson A, Simon D,

Benfeldt E, Reunala T, Mazereeuv J, Boralevi F, Kunz B, Misery L, Mortz CG, Darsow U, Gelmetti C, Diepgen T, Ring J, Moehrenschlager M, Gieler U, Taı̈eb A,

for the PO-SCORAD Investigators Group. Patient-Oriented SCORAD (PO-SCORAD): a new self-assessment scale in atopic dermatitis validated in Europe. Allergy

2011; 66: 1114–1121.

Keywords

atopic dermatitis (MesH); eczema score;

patient-oriented; SCORing of Atopic

Dermatitis index; self-assessment score.

Correspondence

Pr. Jean-François Stalder, Service de

Dermatologie, CHU de Nantes, Hôtel Dieu,

44035 Nantes, France.

Tel.: +33-2-40-08-31-15

Fax: +33-2-40-08-31-17

E-mail: jean-francois.stalder@univ-nantes.fr

*The PO-SCORAD investigator group is

listed in the Acknowledgments section

Accepted for publication 12 February 2011

DOI:10.1111/j.1398-9995.2011.02577.x

Edited by: Hans-Uwe Simon

Abstract

Background: Patient-oriented medicine is an emerging concept, encouraged by the World

Health Organization, to greater involvement of the patient in the management of chronic

diseases. The Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD) index is a

self-assessment score allowing the patient to comprehensively evaluate the actual course

of atopic dermatitis (AD), using subjective and objective criteria derived mainly from the

SCORAD, a validated AD severity clinical assessment tool.

Objectives: To validate the PO-SCORAD index in a large European population of

patients exhibiting all forms of AD severity by assessing its correlation with the

SCORAD index.

Patients/methods: Four hundred and seventy-one patients (185 adults, 286 children) con-

sulting for AD in hospitals from 9 European countries were recruited. The investigators

and the patients used the SCORAD and PO-SCORAD scales, respectively, to assess AD

severity at inclusion (D0) and 28 ± 7 days later (D28).

Results: Patient-Oriented SCORing Atopic Dermatitis and SCORAD scores were signifi-

cantly correlated at D0 [r = 0.67 (95% CI: 0.62; 0.72), P < 0.0001]. Consistency was con-

firmed at D28, with a stronger linear correlation between both scales [r = 0.79 (95% CI:

0.75; 0.83), P < 0.0001]. Absolute changes from baseline in SCORAD and PO-SCORAD

scores were also significantly correlated [r= 0.71 (95% CI: 0.64; 0.76), P < 0.0001].

Although no specific intervention was investigated, AD improved over the study, with a

decrease of PO-SCORAD and SCORAD scores from D0 to D28 by )19.19% and )24.39%,respectively. The consistency of the correlations was similar in the adult and children groups.

Conclusions: This study validated the use of PO-SCORAD to self-assess AD severity

and demonstrated its good correlation with SCORAD.

Allergy

1114 Allergy 66 (2011) 1114–1121 ª 2011 John Wiley & Sons A/S

Etude sur les récepteurs à l’histamine

Etude sur la corticophobie

Experimental dermatology • Original article CEDClinical and Experimental Dermatology

CPD

Association between copy-number variations of the humanhistamine H4 receptor gene and atopic dermatitis in a Chinesepopulation

B. Chen,1 T. Ye,1,2,3 Y. Shao,1,2,3 J. Zhang,1,2,3 Q. Zhong,1,2,3 X. Hu,1,2,3 W. Zhang4 and B. Yu1,2,3

Dermatology Department and Shenzhen Key Discipline of Dermatology, Peking University Shenzhen Hospital, Shenzhen, China; Shenzhen Key

Laboratory for Translational Medicine of Dermatology and Biomedical Research Institute, Shenzhen PKU-HKUST Medical Center, Shenzhen, China

doi:10.1111/ced.12117

Summary Background. Atopic dermatitis (AD) is a chronic, relapsing allergic skin disease.The histamine H4 receptor (HRH4) has been shown to be associated with a number

of autoimmune disorders, including AD.

Aim. To explore a possible association between copy-number variations (CNVs) of

the HRH4 gene and the risk of AD in a Chinese population.

Methods. Genomic DNA and RNA were collected from 541 patients with AD and

613 healthy controls, and the CNVs and mRNA levels of HRH4 were examined.

ELISA was used to measure the levels of IgE in all participants.

Results. Amplifications of HRH4 copy numbers were associated with the risk of

developing AD (P < 0.05, OR = 1.85, 95% CI 1.30–2.63), whereas deletions of HRH4copy numbers were not associated with disease risk for AD (P = 0.30, OR = 0.82,95% CI 0.57–1.19). HRH4 mRNA levels were much higher in samples with HRH4copy-number amplifications than in those without such amplifications (P < 0.05). IgElevels were associated with amplifications (P < 0.05, OR = 1.96, 95% CI 1.19–3.25),but not with deletions (P = 0.63, OR = 0.87, 95% CI 0.49–1.54) of HRH4 copynumbers.

Conclusions. CNVs of the HRH4 gene are associated with AD in a Chinese

population.

Introduction

Atopic dermatitis (AD) is a chronic relapsing allergic

skin disease characterized by typically distributed

eczematous skin lesions and intense pruritus. AD affects

15–20% of children and 2–10% of adults.1,2 The

aetiology of AD remains unclear, but it is recognized to

be a complex genetic disorder. Family and twin studies

also support a significant genetic predisposition to AD.3

Up to now, genetic studies have indicated that AD is

associated with the Nod-like receptor (NLR) family

genes, such as C3 and CD14.4–6

Histamine plays an important role in allergic and

autoimmune diseases. Four histamine receptor sub-

types, HRH1–4, have been identified. Of these, HRH1and HRH2 are recognized as the main histamine recep-

tor subtypes affecting inflammation and other immune

responses, and have been used for treatment of AD and

other immune and inflammatory diseases.7,8 HRH4 is

the most recently described histamine receptor, which

was independently cloned and characterized by several

Correspondence: Dr Bo Yu, Dermatology Department, Peking University

Shenzhen Hospital, no. 1120, Lianhua Road, Futian District, Shenzhen

Guangdong 518036, China

E-mail: yubomd@hotmail.com

Conflict of interest: none declared.

The first two authors have contributed equally to this study, and should

be considered joint first authors.

Accepted for publication 4 November 2012

ª The Author(s)CED ª 2013 British Association of Dermatologists � Clinical and Experimental Dermatology, 38, 295–301 295

histamine H4 receptor gene and atopic dermatitis in a Chinesepopulation

B. Chen,1 T. Ye,1,2,3

Dermatology Department and

Laboratory for Translational Medicine of Dermatology and

doi:10.1111/ced.12117

Summary

Introduction

Atopic dermatitis (AD) is a chronic relapsing allergic

skin disease characterized by typically distributed

eczematous skin lesions and intense pruritus. AD affects

15–20% of children and 2

Correspondence: Dr Bo Yu, Dermatology Department, Peking University

Shenzhen Hospital, no. 1120, Lianhua Road, Futian District, Shenzhen

Guangdong 518036, China

E-mail: yubomd@hotmail.com

CLINICAL AND LABORATORY INVESTIGATIONSBJD

British Journal of Dermatology

Topical corticosteroid phobia in atopic dermatitis: a studyof its nature, origins and frequencyH. Aubert-Wastiaux, L. Moret,* A. Le Rhun,* A.M. Fontenoy,* J.M. Nguyen,* C. Leux,* L. Misery,� P. Young,�M. Chastaing,� N. Danou,§ P. Lombrail,* F. Boralevi,– J.P. Lacour,** J. Mazereeuw-Hautier,�� J.-F. Stalder andS. Barbarot

Department of Dermatology, CHU Hôtel-Dieu, 1 place Alexis Ricordeau, 44035 Nantes Cedex 1, France

*PIMESP (Pôle d’Information Médicale et de Santé Publique), CHU Hôtel-Dieu, Nantes, France

�Department of Dermatology, CHU Morvan, Brest, France�Dermatologist, Rouen, France§Dermatologist, Paris, France

–Pediatric Dermatology Unit, Hôpital Pellegrin-Enfants, CHU Bordeaux, Bordeaux, France**Department of Dermatology, CHU Archet, Nice, France

��Department of Dermatology, CHU Larrey, Toulouse, France

CorrespondenceHélène Aubert-Wastiaux.

E-mail: helene.aubert.wastiaux@gmail.com

Accepted for publication28 May 2011

Funding sourcesThis study was sponsored by the Foundation for

Atopic Dermatitis, Pierre Fabre Laboratoire

(Toulouse, France), which provided funds to cover

logistic expenses (e.g. printing the questionnaires),

but had no access to the data collected and played

no role in their analysis, the writing of the

manuscript or the decision to submit it for

publication.

Conflicts of interestNone declared.

DOI 10.1111/j.1365-2133.2011.10449.x

Summary

Background Topical corticosteroids remain the mainstay of atopic dermatitis ther-apy. Many atopic dermatitis therapeutic failures appear to be attributable to pooradherence to treatment due to topical corticosteroid phobia.Objectives To assess the facets, origins and frequency of fear of topical corticoste-roid use among patients with atopic dermatitis.Methods A questionnaire comprising 69 items, generated from information gath-ered during interviews with 21 patients and 15 health professionals, was givento consecutive patients consulting at the outpatient dermatology departments offive regional university hospitals or with 53 dermatologists in private practice.Results A total of 208 questionnaires were analysed (including 144 from parentsand 87 from adult patients, 27 of whom were also parents); 80Æ7% of therespondents reported having fears about topical corticosteroids and 36% admittednonadherence to treatment. A correlation was found between topical cortico-steroid phobia and the need for reassurance, the belief that topical corticosteroidspass through the skin into the bloodstream, a prior adverse event, inconsistentinformation about the quantity of cream to apply, a desire to self-treat for theshortest time possible or poor treatment adherence. Topical corticosteroid phobiawas not correlated with atopic dermatitis severity.Conclusion Topical corticosteroid phobia is a genuine and complex phenomenon,common among French patients with atopic dermatitis, that has an importantimpact on treatment compliance.

As defined by the U.K. Working Party’s diagnostic criteria,1 ato-

pic dermatitis (AD) is a relapsing, chronic, inflammatory, cuta-

neous disorder that occurs mainly in childhood and sometimes

persists into adulthood. AD currently affects 10–20% of children

worldwide.2,3 It is a public health concern because of its preva-

lence, cost and impact on quality of life.4,5 Thus, the broad

impact of AD warrants optimization of relevant support services.

Topical corticosteroids (TCS), the mainstay of AD treatment,

are often required for months or years to control the disease.

Although they have long been known to have side-effects,

their efficacy and safety, when used appropriately, are well

established.6–10 Why some patients with AD do not respond

to TCS remains unexplained, but poor adherence to the pre-

scribed regimen may underlie treatment failure. Indeed,

adherence by patients with AD is known to be poor, at

~30%,11 as it is for other chronic diseases.12

What is usually called corticosteroid phobia is frequent.

Corticosteroid phobia is certainly a misnomer because the

term ‘phobia’ defines an irrational fear.13 In fact, corticoste-

roid phobia is the dedicated term to describe all types of fear

about steroid use. In routine clinical practice, it is not unusual

for patients to express fear or anxiety about using TCS and

TCS phobia appears to be common (60–73% of patients),14,15

potentially leading to poor adherence and lack of response to

� 2011 The Authors808 BJD � 2011 British Association of Dermatologists 2011 165, pp808–814

��Department of Dermatology, CHU Larrey, Toulouse, France

CorrespondenceHéHéHelelèlene Aubert-Wastiaux.

E-mail: helene.aubert.wastiaux@gmail.com

Accepted for publication28 May 2011

Funding sourcesThis study was sponsored by the Foundation for

Atopic Dermatitis, Pierre Fabre Laboratoire

(Toulouse, France), which provided funds to cover

logistic expenses (e.g. printing the questionnaires),

but had no access to the data collected and played

no role in their analysis, the writing of the

manuscript or the decision to submit it for

publication.

Conflicts of interestNone declared.

DOI 10.1111/j.1365-2133.2011.10449.x

Summary

Backgroundapy. Many atopic dermatitis therapeutic failures appear to be attributable to pooradherence to treatment due to topical corticosteroid phobia.Objectivesroid use among patients with atopic dermatitis.Methodsered during interviews with 21 patients and 15 health professionals, was givento consecutive patients consulting at the outpatient dermatology departments offive regional university hospitals or with 53 dermatologists in private practice.Resultsand 87 from adult patients, 27 of whom were also parents); 80respondents reported having fears about topical corticosteroids and 36% admittednonadherence to treatment. A correlation was found between topical cortico-steroid phobia and the need for reassurance, the belief that topical corticosteroidspass through the skin into the bloodstream, a prior adverse event, inconsistentinformation about the quantity of cream to apply, a desire to self-treat for theshortest time possible or poor treatment adherence. Topical corticosteroid phobiawas not correlated with atopic dermatitis severity.Conclusioncommon among French patients with atopic dermatitis, that has an importantimpact on treatment compliance.

As defined by the U.K. Working Party’s diagnostic criteria,

pic dermatitis (AD) is a relapsing, chronic, inflammatory, cuta-

neous disorder that occurs mainly in childhood and sometimes

persists into adulthood. AD currently affects 10–20% of children

worldwide.2,3 It is a public health concern because of its preva-

lence, cost and impact on quality of life.

impact of AD warrants optimization of relevant support services.

Topical corticosteroids (TCS), the mainstay of AD treatment,

are often required for months or years to control the disease.

Although they have long been known to have side-effects,

The FASEB Journal • Research Communication

Hornerin is a component of the epidermal cornifiedcell envelopes

Julie Henry,* Chiung-Yueh Hsu,* Marek Haftek,† Rachida Nachat,*Heleen D. de Koning,‡ Isabelle Gardinal-Galera,*,§ Kiyotaka Hitomi,� Stéfana Balica,§

Catherine Jean-Decoster,¶ Anne-Marie Schmitt,¶ Carle Paul,*,§ Guy Serre,*and Michel Simon*,1

*Centre National de la Recherche Scientifique (CNRS)-Toulouse III University UMR5165, InstitutFédératif de Recherche 150 (INSERM-CNRS-Université Paul Sabatier-Centre HospitalierUniversitaire), Toulouse, France; †Lyon I University EA4169, Lyon, France; ‡Department ofDermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;§Department of Dermatology, Toulouse University Hospital, Toulouse, France; �Graduate School ofBioagricultural Sciences, Nagoya University, Naboya, Japan; and ¶Centre Européen de Recherche surla Peau et les Epithéliums de Revêtement, Pierre Fabre Dermo-Cosmétique, Toulouse, France

ABSTRACT A single-nucleotide polymorphism withinthe gene encoding hornerin (HRNR) has recently beenlinked with atopic dermatitis (AD) susceptibility. HRNRshares features with filaggrin, a key protein for keratino-cyte differentiation, but conflicting reports have beenpublished concerning its expression in the epidermis, andits role is still unknown. To analyze HRNR expression andfunction in the epidermis, anti-HRNR antibodies wereproduced and used in Western blot analysis and immuno-histochemical, confocal, and immunoelectron microscopyanalyses of human skin and of cornified cell envelopespurified from plantar stratum corneum. We also testedwhether HRNR was a substrate of transglutaminases. Inthe epidermis, HRNR was detected at the periphery ofkeratohyalin granules in the upper granular layer and atthe corneocyte periphery in the whole cornified layer.Detected in Western blot analysis as numerous bands,HRNR was relatively insoluble and only extracted fromepidermis with urea and/or reducing agents. The pres-ence of HRNR in the purified envelopes was confirmedby immunoelectron microscopy and by Western blotanalysis after V8-protease digestion. HRNR was shown tobe a substrate of transglutaminase 3. These data demon-strate that HRNR is a component of cornified cell enve-lopes of human epidermis. Its reduced expression in ADmay contribute to the epidermal barrier defect observedin the disease.—Henry, J., Hsu, C.-Y., Haftek, M., Nachat,R., de Koning, H. D., Gardinal-Galera, I., Hitomi, K.,Balica, S., Jean-Decoster, C., Schmitt, A.-M., Paul, C.,Serre, G., Simon, M. Hornerin is a component of theepidermal cornified cell envelopes. FASEB J. 25, 000–000(2011). www.fasebj.org

Key Words: atopic dermatitis � skin � keratinocytes � transglu-taminase � terminal differentiation � corneocytes

Differentiation of the epidermis is an orientedprocess during which keratinocytes of the basal layerundergo a series of metabolic and structural changes

throughout their migration to the surface of the skin.Cornification, the later stages of the process, is a realprogrammed cell death, and results in the formation ofcorneocytes. It is the stacking up of these anucleatecells, forming the outermost layer or stratum corneum(also called cornified layer), that enables the epidermisto fulfill one of its main functions: it provides a multiplebarrier between the body and its environment byopposing water loss and the penetration of exogenousmolecules, UV radiation, and pathogens, and by pro-tecting the body, because of its great mechanical resis-tance. Alterations in keratinocyte differentiation areinvolved in the pathophysiology of many skin diseases,e.g., atopic dermatitis (AD; OMIM%603635).

AD is a common chronic inflammatory skin diseaseaffecting 15–20% of children and 1–3% of adults inindustrialized countries. It is often linked with otheratopic conditions, such as asthma and allergic rhinitis.AD results from complex interactions between geneticand environmental factors. The pathogenesis of thedisease is still poorly understood, although immunesystem dysfunctions, as well as defects in the epidermalbarrier, have long been suspected (1–4). A majorbreakthrough was the discovery (5) that loss-of-functionmutations in the gene encoding filaggrin (FLG) onchromosome 1q21 are a major risk factor for AD, withan estimated odds ratio �3 (for a review, see ref. 6).This strengthens the hypothesis of a stratum corneumfailure as a primary event, potentially leading to in-creased penetration of allergens and skin inflammation(1, 2, 7). Indeed, FLG is an essential component of thestratum corneum.

Correspondence: CNRS-UPS UMR5165, CHU Purpan, Pl.du Dr Baylac TSA40031, 31059 Toulouse cedex 9, France.E-mail: michel.simon@udear.cnrs.fr

doi: 10.1096/fj.10-168658This article includes supplemental data. Please visit http://

www.fasebj.org to obtain this information.

10892-6638/11/0025-0001 © FASEB

The FASEB Journal article fj.10-168658. Published online January 31, 2011.

Etude sur la fi laggrine

International Guidelines

Therapeutic Patient Education in Atopic

Dermatitis: WorldwideExperiences

Jean-Francois Stalder,M.D.,* Claire Bernier,

M.D.,* Alan Ball, B.A.,* Linda De Raeve,M.D

.,†

Uwe Gieler, M.D.,‡ Mette Deleuran, M.D.,§ Dan

ielle Marcoux, M.D.,¶

Lawrence F. Eichenfield, M.D.,** Peter Lio,

M.D.,†† Sue Lewis-Jones, M.D.,‡‡

Carlo Gelmetti, M.D.,§§ Roberto Takaoka, M.

D.,¶¶ Christine Chiaverini, M.D.,***

Laurent Misery, M.D.,††† Sébastien Barbarot

, M.D.,* and for the Oriented Patient-Educat

ion

Network in Dermatology (OPENED)

*Department of Dermatology, Nantes Univers

ity Hospital, Nantes, France, †Department of D

ermatology UZ

Brussels, Vrije Universiteit Brussel, Brussels,

Belgium, ‡Department of Psychosomatic Medic

ine-

Psychodermatology, University of Giessen, G

iessen, Germany, §Department of Dermatology,

Aarhus University

Hospital, Aarhus, Denmark, ¶Department of D

ermatology, St. JustineUniversity Hospital, M

ontreal, Canada,

**Department of Dermatology, Rady Children

’s Hospital, San Diego, California, ††Departme

nt of Dermatology,

Children’s Memorial Hospital, Chicago, Illino

is, ‡‡Department of Dermatology, Ninewells H

ospital and Medical

School, Dundee, Scotland, §§Department of Ane

sthesia, Intensive Careand Dermatological Sc

iences, Fondazione

Ca’ Granda Ospedale Maggiore Policlinico, M

ilan, Italy, ¶¶Departmentof Dermatology, Unive

rsity of Sao Paulo

Medical School, Sao Paulo, Brazil, ***Depar

tment of Dermatology,Archet Hospital, Nice,

France, †††Department

of Dermatology, University Hospital, Brest, F

rance

Abstract: Therapeutic patient education (

TPE) has proven effective in

increasing treatment adherence and im

proving quality of life (QoL) for

patients with numerous chronic diseas

es, especially atopic dermatitis

(AD). This study was undertaken to iden

tify worldwide TPE experiences

in AD treatment. Experts from 23 hos

pitals, located in 11 countries,

responded to a questionnaire on 10majo

r items. Patients in TPE programs

were mainly children and adolescents

with moderate to severe AD or

markedly affected QoL. Individual and c

ollective approacheswere used.

Depending on the center, the number of

sessions varied fromone to six

(corresponding to 2to 12 hours of educa

tion), and 20 to 200 patients were

followed each year.Each center’s educa

tion team comprisedmultidisci-

plinary professionals (e.g., doctors, nur

ses, psychologists).Evaluations

were based on clinical assessment, Qo

L, a satisfaction index, or some

combination of thethree. When fundin

g was obtained, itcame from

regional health authorities (France), in

surance companies(Germany),

donations (United States), or pharmaceu

tical firms (Japan, Italy). The role

of patient associations was always high

lighted, but their involvement in

the TPE processvaried from one

country to another. Despite

the nonexhaustiveapproach, our findi

ngs demonstrate the increasing

Address correspondence to Jean Francois Sta

lder, M.D., Service

de Dermatologie, CHU de Nantes–Hôtel D

ieu, 44035 Nantes,

France, or e-mail: jfstalder@mac.com.

DOI: 10.1111/pde.12024

© 2013 Wiley Periodicals, Inc.

1

CLINICAL AND LABORATORY INVESTIGA

TIONS

Pediatric Dermatology1–6, 2013

Dermatitis: WorldwideExperiences

Jean-Francois Stalder,M.D.,* Claire Bernier,

M.D.,* Alan Ball, B.A.,* Linda De Raeve,M.D

.,

Danielle Marcoux, M.D.,¶

Sue Lewis-Jones, M.D.,‡‡

Christine Chiaverini, M.D.,***

bastien Barbarot, M.D.,* and for the Oriente

d Patient-Education

Department of Dermatology UZ

Department of Psychosomatic Medicine-

Department of Dermatology, Aarhus Universi

ty

Department of Dermatology, St. Justine Univ

ersity Hospital, Montreal, Canada,

Department of Dermatology, Rady Children’s

Hospital, San Diego, California, ††Department

of Dermatology,

Department of Dermatology, Ninewells Hosp

ital and Medical

Department of Anesthesia, Intensive Care and

Dermatological Sciences, Fondazione

Department of Dermatology, University of Sa

o Paulo

Department of Dermatology, Archet Hospital

, Nice, France, †††Department

of Dermatology, University Hospital, Brest, F

rance

Therapeutic patienteducation (TPE) has

proven effective in

increasing treatment adherence and im

proving quality of life (QoL) for

patients with numerous chronic diseas

es, especially atopic dermatitis

(AD). This study was undertaken to iden

tify worldwide TPE experiences

in AD treatment. Experts from 23 hos

pitals, located in 11 countries,

responded to a questionnaire on 10majo

r items. Patients in TPE programs

were mainly children and adolescents

with moderate to severe AD or

markedly affected QoL. Individual and c

ollective approacheswere used.

Depending on the center, the number of

sessions varied fromone to six

(corresponding to 2to 12 hours of educa

tion), and 20 to 200 patients were

followed each year.Each center’s educa

tion team comprisedmultidisci-

plinary professionals (e.g., doctors, nur

ses, psychologists).Evaluations

Jean-Francois Stalder,M.D.,* Claire Bernier,

M.D.,* Alan Ball, B.A.,* Linda De Raeve,M.D

.,

bastien Barbarot, M.D.,* and for the Oriente

d Patient-Education

Department of Dermatology UZ

Department of Dermatology, Aarhus Universi

ty

Department of Dermatology, St. Justine Univ

ersity Hospital, Montreal, Canada,

Department of Dermatology,

Department of Dermatology, Ninewells Hosp

ital and Medical

Department of Anesthesia, Intensive Care and

Dermatological Sciences, Fondazione

Department of Dermatology, University of Sa

o Paulo

Department

Cornification, the later stages of the process, is a realprogrammed cell death, and results in the formation ofcorneocytes. It is the stacking up of these anucleatecells, forming the outermost layer or stratum corneum(also called cornified layer), that enables the epidermisto fulfill one of its main functions: it provides a multiplebarrier between the body and its environment byopposing water loss and the penetration of exogenousmolecules, UV radiation, and pathogens, and by pro-tecting the body, because of its great mechanical resis-tance. Alterations in keratinocyte differentiation areinvolved in the pathophysiology of many skin diseases,

, atopic dermatitis (AD; OMIM%603635).AD is a common chronic inflammatory skin disease

affecting 15–20% of children and 1–3% of adults inindustrialized countries. It is often linked with otheratopic conditions, such as asthma and allergic rhinitis.AD results from complex interactions between geneticand environmental factors. The pathogenesis of thedisease is still poorly understood, although immunesystem dysfunctions, as well as defects in the epidermalbarrier, have long been suspected (1–4). A majorbreakthrough was the discovery (5) that loss-of-functionmutations in the gene encoding filaggrin (FLG) onchromosome 1q21 are a major risk factor for AD, with

�3 (for a review, see ref. 6).This strengthens the hypothesis of a stratum corneumfailure as a primary event, potentially leading to in-creased penetration of allergens and skin inflammation(1, 2, 7). Indeed, FLG is an essential component of the

Correspondence: CNRS-UPS UMR5165, CHU Purpan, Pl.du Dr Baylac TSA40031, 31059 Toulouse cedex 9, France.E-mail: michel.simon@udear.cnrs.fr

This article includes supplemental data. Please visit http://to obtain this information.to obtain this information.

assessment scale in atopic dermatitis validated in Europe, S. Seidenari5, A. Oranje6,

12,, C. Gelmetti19,

, for the PO-SCORAD

Department of Dermatology and Allergy, Ludwig-Maximilian Univer-

Department of Dermatology UZ Brussels, Vrije Universiteit

University Hospital

Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark;

Department of

Department of Dermato-allergology, Copenhagen

Department of Dermatology and

Department of Dermatology and Pediatric Dermatology, St AndreDepartment of Dermatology and Pediatric Dermatology, St AndréDepartment of Dermatology and Pediatric Dermatology, St Andre Hospital,

Department of Dermatology, Brest University Hospital, Brest, France;

Deptartment of Dermatology and Allergy

nchen and Division of Environmental Dermatology and Allergy, Helmholtz Center/Tum, Munich, Ger-

Department of Anesthesia, Intensive care and Dermatologic Sciences, Fondazione Ca’ Granda ‘‘Ospedale Maggiore Policlinico’’, Milan,

University Hospital Heidelberg, Department of Social Medicine, Center of Occupational & Environmental Dermatology, Heidelberg,

Hochgebirgsklinik Davos-Wolfgang, Christine-Kuehne Centre for Allergy Research and Education (CK-CARE), Davos, Switzerland;

: Stalder J-F, Barbarot S, Wollenberg A, Holm EA, De Raeve L, Seidenari S, Oranje A, Deleuran M, Cambazard F, Svensson A, Simon D,

Benfeldt E, Reunala T, Mazereeuv J, Boralevi F, Kunz B, Misery L, Mortz CG, Darsow U, Gelmetti C, Diepgen T, Ring J, Moehrenschlager M, Gieler U, Taı̈Benfeldt E, Reunala T, Mazereeuv J, Boralevi F, Kunz B, Misery L, Mortz CG, Darsow U, Gelmetti C, Diepgen T, Ring J, Moehrenschlager M, Gieler U, Taı̈Benfeldt E, Reunala T, Mazereeuv J, Boralevi F, Kunz B, Misery L, Mortz CG, Darsow U, Gelmetti C, Diepgen T, Ring J, Moehrenschlager M, Gieler U, Taıeb A,

for the PO-SCORAD Investigators Group. Patient-Oriented SCORAD (PO-SCORAD): a new self-assessment scale in atopic dermatitis validated in Europe. Allergy

Patient-oriented medicine is an emerging concept, encouraged by the World

Health Organization, to greater involvement of the patient in the management of chronic

diseases. The Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD) index is a

self-assessment score allowing the patient to comprehensively evaluate the actual course

of atopic dermatitis (AD), using subjective and objective criteria derived mainly from the

To validate the PO-SCORAD index in a large European population of

patients exhibiting all forms of AD severity by assessing its correlation with the

Four hundred and seventy-one patients (185 adults, 286 children) con-

sulting for AD in hospitals from 9 European countries were recruited. The investigators

and the patients used the SCORAD and PO-SCORAD scales, respectively, to assess AD

Développer l’éducation thérapeutiquedans la dermatite atopique

Développer l’éducation thérapeutique

Collaboration avec plus de 35 centres dans le monde

Développer l’éducation thérapeutique Les outils d’éducation thérapeutiqueLes outils d’éducation thérapeutique

Des dossiers de formation

Les cartes PO SCORAD

La Fondation pour la Dermatite Atopique remercie le Professeur Carlo Gelmetti pour sa collaboration dans la conception et la réalisation de ce document.

FONDATION POUR LA DERMATITE ATOPIQUE : RECHERCHE ET EDUCATION

Siège social : Hôtel-Dieu Saint Jacques - 2, rue Viguerie - 31000 TOULOUSE Tel. : 33 (5) 63 58 88 95

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Un chevalet pédagogique sur la dermatite atopique

Les cartes PO SCORADLes cartes Les cartes

Pour les parents et le corps enseignant

Le PO-SCORAD

Le jeu de l’oie

Conseils simples et réponses aux questions les plus fréquentes des parents

Dr Magali Bourrel BouttazDermatologue . Chambery

Votre enfant est atteint d'eczéma

Mon enfant a de l’ eczéma ?Informations données aux parents

et utiles aux enseignants

Docteur Jacques ROBERT

Pédiatre - Allergologue

Réalisée par la FONDATION POUR LA DERMATITE ATOPIQUE

u2400_Broch_FONDATION_DERM ATOP_8p.indd 1 8/09/09 11:06:41

Poster et BD :«Comment appliquer ta crème en images»

Poster et BD :

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eczéma atopique

po-ScoRaD que f

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Lesccoonnsseeiills

Application médicale téléchargeable gratuitement en 18 langues Comment expliqu

er la maladie

à Hugo et à ses camarades ?

Avec la collaboration

du

Docteur Jacques ROB

ERT

Pédiatre - Allergolog

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Vous êtes instituteur

, institutrice…

FONDATION PO-SCORAD

téléchargeable gratuitement

Site internetSite internet

Les journées de formation ETP DAYorganisées en Italie, France et Belgique

Grisez les zones correspondant à votre eczéma sur le dessin qui vous est fourni.

� SURFACE DE LA PEAURegardez la peau où il n’y a pas d’eczéma

La peau est-elle sèche ?

� ERYTHÈMEExiste-t-il des zones rouges sur les plaques d’eczéma ?

1re ÉTAPE� L’extension de l’eczéma

2e ÉTAPE� Les différents signes à évaluer

� Un peu rouge� Pas du tout � Modérément rouge� Extrêmement

rouge

� Un peu sèche� Pas du tout � Modérément sèche� Extrêmement

sèche

Version papier

Le PO SCORAD

Les experts vous informent

L’éducation thérapeutique

Pour les professionnels de santé

Versions disponibles :

Site internetSite internet

Version papier

S’informer

Pour les patients

Apprendre de façon ludique

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Vous ou votre enfant avez un

eczéma atopique

po-ScoRaD que f

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L’ecz

éma atopique c’est...

uuee c’est...

que faire ?Diminuer l’inflammatio

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inflammation

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La crème à base de cortisone

réduit l’inflammation

L’émollient reconstruit

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Evaluer son eczéma

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