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: [email protected]
*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: [email protected]
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: [email protected]
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: [email protected]
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: [email protected]
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: [email protected]
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: [email protected].
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: [email protected]
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
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Poster et BD :«Comment appliquer ta crème en images»
Poster et BD :
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Application médicale téléchargeable gratuitement en 18 langues Comment expliqu
er la maladie
à Hugo et à ses camarades ?
Avec la collaboration
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Docteur Jacques ROB
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Pédiatre - Allergolog
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Vous êtes instituteur
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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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