Atopic dermatitis (AD) is one of the most frequently encountered chronic inflammatory skin condition in the UK.^1,2 It affects both, children and adults; however, the paediatric population is predominantly affected.^3,4 The overall prevalence of diagnosed AD in European paediatric population was found to be the lowest in Germany (8.4%), while the highest prevalence was observed in the Southern European countries of Spain (18.6%) and Italy (17.6%). Figure 1 depicts the prevalence of AD in children, across different regions of the globe.⁵ The Global Burden of Disease 2017 data highlights that this chronic condition is highly prevalent in Asian countries, particularly in the high-income territories.⁶

The burden of this disease is substantially high⁷ and the quality of life of AD patients may be significantly reduced.^7,8 Several studies have highlighted the need for psychological support for patients with AD as well as their caregivers to help them cope with the disturbed sleep, disruption of daily life activities, depression, anxiety, and difficulty in maintaining social life.^7,8 Also, AD patients are always prone to infections owing to the defective skin barrier, dysregulated immune system, and altered skin microbiome, which may cause complications in these patients.^9-11 Health care utilization is significantly increased in AD patients, which also results in significant financial burden.¹² Recent developments have promulgated the role of keratinocytes, as a component of the innate and adaptive immune system, in regulating the release of several key molecules triggering inflammatory reactions and immune responses in AD. A better understanding of the pathogenesis would help formulate appropriate treatments to improve the quality of life in these patients and to prevent allergic disorders associated with AD.¹³

AD has been found to be genetically inheritable.^14,15 AD patients express distinct immune and barrier signs, as detected by RNA-sequencing tape strip profiling, which is a minimally invasive technique. Recent studies propose the use of this technique as an alternative to the regular biopsies for detection of AD (both lesional and non-lesional) biomarkers, although further studies are warranted to establish this fact.^16,17 With the development of more targeted therapies, AD biomarkers are valuable sources to understand patient-specific molecular dysregulations differing between the several AD subtypes,¹⁷ contributing to more tailored treatment and may help to predict which patients are most likely to benefit from the specific targeted therapies.¹⁸

A short time ago, treatment for AD mainly targeted emollients, topical steroids, and topical calcineurin inhibitors. Patients who were severely affected by the disease were encouraged to take systemic immunosuppressants. Novel therapeutic strategies, including biologics, aiming at different molecular events involved in the development of AD, have been developed recently.^19,20 These options mainly target the type 2 immune pathway and have been found to control the disease effectively and are well-tolerated.^1,2,21 The emerging systemic therapies include monoclonal antibodies targeting IL-4,²² IL-¹³,23 IL-31,²⁴ IL-33, thymic stromal lymphopoietin,^9,25 and OX40.²⁶ Latest advances on some probiotic preparations have been shown to be beneficial in decreasing allergic symptoms of AD in children; yet further studies with larger sample sizes are warranted to elude the robustness of this evidence.²⁷ Treatment of a pregnant patient for AD, using systemic drugs, may pose a challenge as it can affect the unborn child. Recent studies advocate that treatment with topical agents should be considered in pregnancy.^28,29 The European task force on atopic dermatitis recommends the use of UV radiations in addition to topical corticosteroids. It also adds that moderate sun exposure may be used in such patients.²⁹ Although there have been many promising treatment options for AD, which particularly affects the high-income countries of Asia, further planned prospective studies involving the long-term follow-up of AD patients and cost-effective analyses are warranted to aid clinical decisions in the application of these novel drugs for its treatment.

Source:
1. Plant A, Ardern-Jones MR. Clin Med (Lond). 2021;21(3):177-81. 2. Cork MJ, et al. Journal of Dermatological Treatment. 2020;31(8):801-9. 3. NHS.Available from: https://www.nhs.uk/conditions/atopic-eczema/. 4. Kowalska-Olędzka E, etal. Journal of Drug Assessment. 2019;8(1):126-8. 5. Silverberg JI, et al. Ann Allergy Asthma Immunol. 2021;126(4):417-28.e2. 6. Urban K, et al. JAAD International. 2021;2:40-50. 7. Ražnatović Ðurović M, et al. Ital J Dermatol Venerol. 2021;156(1):29-35. 8. Capozza K, et al. Dermatitis. 2020;31(3):223-7. 9. Wang V, et al. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2021;126(1):3-12. 10. Ong PY,Leung DY. Clin Rev Allergy Immunol. 2016;51(3):329-37. 11. Cai SC, et al. Br J Dermatol. 2012;166(1):200-3. 12. Sandhu JK, et al. Pediatr Dermatol. 2019;36(3):303-10. 13. Chieosilapatham P, et al. Clin Exp Immunol. 2021;204(3):296-309. 14. Brown SJ. J InvestDermatol. 2021;141(1):19-22. 15. Mucha S, et al. Journal of Allergy and Clinical Immunology. 2020;145(4):1208-18. 16. He H, et al. J Allergy Clin Immunol. 2021;147(1):199-212. 17. Renert-Yuval Y, Thyssen, J. P., Bissonnette,R., Bieber, T., Kabashima, K., Hijnen, D., & Guttman-Yassky, E. Journal of Allergy and Clinical Immunology. 2021;147(4):1174–90.e1. 18. Bakker DS, et al. J Allergy Clin Immunol. 2021;147(1):189-98. 19. Ramamoorthy R. Journal of Skin and Sexually Transmitted Diseases.0. 20. Katoh N. J Dermatol. 2021;48(2):152-7. 21. Puar N, et al. Ann Allergy Asthma Immunol. 2021;126(1):21-31. 22. Hajar T, et al. An Bras Dermatol. 2018;93(1):104-7. 23. Furue K, et al. Immunology. 2019;158(4):281-6. 24. Ruzicka T, et al. N Engl J Med. 2017;376(9):826-35. 25. Newsom M, et al. Drugs. 2020;80(11):1041-52. 26. Guttman-Yassky E, et al. J Allergy Clin Immunol. 2019;144(2):482-93.e7. 27. Tan-Lim CSC, et al. Pediatr Allergy Immunol. 2021;32(1):124-36. 28. Napolitano M, et al. Dermatol Ther. 2021;34(1):e14475. 29. Vestergaard C, et al. Journal of the European Academy of Dermatology and Venereology. 2019;33(9):1644-59.

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Here are a few highlights on the relation between physical activity and incidence of psoriasis based on three aspects:

· The Effect of Sports on Psoriasis

· The Impact of Psoriasis on Sport Activities

· The Importance of Sports in Psoriasis

Sports may improve the quality of life of patients with psoriasis. Sport activities seem to be a notable, non-pharmacological source for promoting a healthier lifestyle in psoriasis patients. Yet, the impact of different types of sport activities on psoriasis needs further research.

Source:
1. Custurone P, Macca L, Bertino L, Di Mauro D, Trimarchi F, Vaccaro M, et al. Mutual Influence of Psoriasis and Sport. Medicina (Kaunas). 2021;57(2):161. 2. Do YK, Lakhani N, Malhotra R, Halstater B, Theng C, Østbye T. Association between psoriasis and leisuretime physical activity: findings from the National Health and Nutrition Examination Survey. J Dermatol. 2015;42(2):148-53. 3. Schwarz PEH, Pinter A, Melzer N, Barteczek P, Reinhardt M. ERAPSO: Revealing the High Burden of Obesity in German Psoriasis Patients. Dermatol Ther (Heidelb). 2019;9(3):579-87. 4. Frankel HC, Han J, Li T, Qureshi AA. The association between physical activity and the risk of incident psoriasis. Arch Dermatol. 2012;148(8):918-24. 5. Balato N, Megna M, Palmisano F, Patruno C, Napolitano M, Scalvenzi M, et al. Psoriasis and sport: a new ally? J Eur Acad Dermatol Venereol. 2015;29(3):515-20. 6. Torres T, Alexandre JM, Mendonça D, Vasconcelos C, Silva BM, Selores M. Levels of physical activity in patients with severe psoriasis: a cross-sectional questionnaire study. Am J Clin Dermatol. 2014;15(2):129-35. 7. Nyunt WW, Low WY, Ismail R, Sockalingam S, Min AK. Determinants of health-related quality of life in psoriasis patients in Malaysia. Asia PacJ Public Health. 2015;27(2):15. 8. Leino M, Mustonen A, Mattila K, Koulu L, Tuominen R. Perceived impact of psoriasis on leisure-time activities. Eur J Dermatol. 2014;24(2):224-8. 9. Jenner N, Campbell J, Plunkett A, Marks R. Cost of psoriasis: a study on the morbidity and financial effects of having psoriasis in Australia. Australas J Dermatol. 2002;43(4):255-61. 10. Wilson PB. Cardiorespiratory Fitness Among Individuals With Psoriasis in the General Population. J Phys Act Health. 2016;13(7):771- 5. 11. Gyldenløve M, Storgaard H, Holst JJ, Vilsbøll T, Knop FK, Skov L. Patients with psoriasis are insulin resistant. J Am Acad Dermatol. 2015;72(4):599-605. 12. Kim HN, Han K, Park YG, Lee JH. Metabolic syndrome is associated with an increased risk of psoriasis: A nationwide population-based study. Metabolism. 2019;99:19-24. 13. Wilson PB. Prevalence of weight loss attempts and behaviors used by individuals with psoriasis in the United States population. J Dermatolog Treat. 2017;28(6):515-9.

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Further, randomised controlled trials are warranted to assess the efficacy of these dietary modifications in patients with various skin ailments.

Source:
1. Svoboda SA, Christopher M, Shields BE. Reexamining the Role of Diet in Dermatology. Cutis. 2021;107(6):308-14. 2. Castaldo G, Rastrelli L, Galdo G, Molettieri P, Rotondi Aufiero F, Cereda E. Aggressive weight-loss program with a ketogenic induction phase for the treatment of chronic plaque psoriasis: A proof-of-concept, single-arm, open-label clinical trial. Nutrition. 2020;74:110757. 3. Drago F, De Col E, Agnoletti AF, Schiavetti I, Savarino V, Rebora A, et al. The role of small intestinal bacterial overgrowth in rosacea: A 3-year follow-up. J Am Acad Dermatol. 2016;75(3):e113-e5. 4. Afifi L, Danesh MJ, Lee KM, Beroukhim K, Farahnik B, Ahn RS, et al. Dietary Behaviors in Psoriasis: Patient-Reported Outcomes from a U.S. National Survey. Dermatol Ther (Heidelb). 2017;7(2):227-42. 5. Song MS, Farber D, Bitton A, Jass J, Singer M, Karpati G. Dermatomyositis associated with celiac disease: response to a gluten-free diet. Can J Gastroenterol. 2006;20(6):433-5. 6. Egan CA, Smith EP, Taylor TB, Meyer LJ,Samowitz WS, Zone JJ. Linear IgA bullous dermatosis responsive to a gluten-free diet. Am J Gastroenterol. 2001;96(6):1927-9. 7. Son JH, Chung BY, Kim HO, Park CW. A Histamine-Free Diet Is Helpful for Treatment of Adult Patients with Chronic Spontaneous Urticaria. Ann Dermatol. 2018;30(2):164-72. 8. Maintz L, Benfadal S, Allam JP, Hagemann T, Fimmers R, Novak N. Evidence for a reduced histamine degradation capacity in a subgroup of patients with atopic eczema. J Allergy Clin Immunol. 2006;117(5):1106-12. 9. Korovesi A, Dalamaga M, Kotopouli M, Papadavid E. Adherence to the Mediterranean diet is independently associated with psoriasis risk, severity, and quality of life: a cross-sectional observational study. Int J Dermatol. 2019;58(9):e164-e5. 10. Barrea L, Fabbrocini G, Annunziata G, Muscogiuri G, Donnarumma M, Marasca C, et al. Role of Nutrition and Adherence to the Mediterranean Diet in the Multidisciplinary Approach of Hidradenitis Suppurativa: Evaluation of Nutritional Status and Its Association with Severity of Disease. Nutrients. 2018;11(1). 11. Skroza N, Tolino E, Semyonov L, Proietti I, Bernardini N, Nicolucci F, et al. Mediterranean diet and familial dysmetabolism as factors influencing the development of acne. Scand J Public Health. 2012;40(5):466-74.

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With increasing awareness about the role of dietary modifications in skin care treatment, dermatologists play an imperative role in recommending modified diets to their patients.¹ Gluten-free (GF) diet is becoming immensly popular worldwide. Besides celiac disease and wheat allergic patients, GF diets are frequently adapted by other patients as well, including those with non-celiac gluten sensitivity (NCGS).^2-4

Patients with NCGS

Although these patients do not have celiac disease or wheat allergy, they show intestinal as well as extra-intestinal manifestation on ingestion of gluten. GF diet may prove beneficial for some NCGS patients.¹

GF diets may prove to be beneficial beneficial for patients suffering from various skin ailments, yet, more high-quality studies are warranted to elucidate these benefits in patients without celiac disease and wheat allergy.

Source:
1. Bell KA, Pourang A, Mesinkovska NA, Cardis MA. The effect of gluten on skin and hair: a systematic review. Dermatol Online J. 2021;27(4). 2. Hietikko M, Hervonen K, Salmi T, Ilus T, Zone JJ, Kaukinen K, et al. Disappearance of epidermal transglutaminase and IgA deposits from the papillary dermis of patients with dermatitis herpetiformis after a long-term gluten-free diet. Br J Dermatol. 2018;178(3):e198-e201. 3. Graziano M, Rossi M. An update on the cutaneous manifestations of coeliac disease and non-coeliac gluten sensitivity. Int Rev Immunol. 2018;37(6):291-300. 4. Sapone A, Bai JC, Ciacci C, Dolinsek J, Green PHR, Hadjivassiliou M, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med. 2012;10:13-.

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