PeDRA

Pediatric Dermatology Research Alliance

Atopic Derm & Psoriasis

TNF inhibitor-induced psoriasiform dermatitis in children: Clinical and mechanistic analyses

By

Principal Investigators:

Amy Paller, MD
Northwestern University

Jennifer Boles-Scott, MD
Northwestern University

Overview:

Injectable medications that inhibit tumor necrosis factor (TNF) block inflammation in arthritis, inflammatory bowel disease, and psoriasis. However, there are reports of psoriasis or a psoriasis-like skin disease developing, particularly in adults, during treatment with TNF inhibitors. Diagnosis can be challenging and the mechanism of disease, particularly in children, has not been explored.

We plan to study the clinical patterns of TNF-induced versus classic psoriasis in children, with the expectation that their patterns of distribution, appearance, and types of immune markers expressed in the skin will differ. We will use tape strips (a painless, non-invasive technique) to collect superficial skin cells, and will identify markers of their immune system response in skin. We predict that the degree of altered immune expression will correlate with disease severity. Our goal is to better understand TNFi psoriasiform disease and develop a tape strip panel to distinguish TNFi-induced psoriasis from classic psoriasis.

Status:

This project was funded by a 2020 PeDRA Research Grant.

Characterization of Lipoprotein Composition and Function in Pediatric Psoriasis Before and After Treatment

By

Principal Investigator:

Amy Paller, MD
Northwestern University

Overview:

Psoriasis is a chronic inflammatory skin disease associated with early onset cardiovascular disease. Despite studies demonstrating high cholesterol, increased diabetes and higher rate of obesity in psoriasis, these traditional risk factors only explain a fraction of total cardiovascular risk in psoriasis. One-third of the psoriasis patients start developing psoriatic plaques during childhood and studies have shown that the children with psoriasis have similar or higher risk for obesity and future problems with high cholesterol and diabetes. In fact, children have been shown to have abnormal cholesterol as early as age 13 years in psoriasis. However, little is known about how pediatric psoriasis severity affects cholesterol function, including its relationship with proteins involved in inflammation. Importantly, whether treatment of pediatric psoriasis early in the life leads to improvement in cholesterol function and overall lipoprotein composition is unknown. Therefore, the goal of this proposal is to understand the effect of disease activity and psoriasis treatment on cholesterol and metabolic markers in pediatric psoriasis.

Status:

This project was funded as a 2018 PeDRA and NPF Pediatric Psoriasis Challenge Grant and is currently underway.

Understanding Racial/Ethnic Disparities in Health Care Utilization for Childhood Atopic Dermatitis

By


Principal Investigator:

Junko Takeshita, MD, PhD, MSCE
University of Pennsylvania

Overview:

Atopic dermatitis (AD) is a common skin disease that disproportionately affects minority children and is associated with a large financial burden in the U.S. Racial/ethnic disparities in health care use for AD also exist. For example, minority children are more likely than white children to go to the emergency room (ER) for their AD. In order to reduce differences in health care use for AD between white and minority children as well as minimize potentially avoidable and costly ER use, we propose to evaluate racial/ethnic differences in the barriers to routine health care use and reasons for specific health care use patterns among children with AD. We will interview caregivers of white, black, and Hispanic children with AD and identify the factors that affect health care use for AD by race/ethnicity. Our findings will inform future interventions to optimize and reduce racial/ethnic disparities in health care use for childhood AD.

Status:

This study was funded by PeDRA in partnership with the National Eczema Association (NEA) through the 2020 Childhood Eczema Challenge Grant and is currently underway.

Utilization of the Topical Steroid Volume Calculator and its Effect on Atopic Dermatitis Clinical Outcomes

By

Fellow

Stephanie Lee, MD
University of California, San Diego
Rady Children’s Hospital

Mentor

Lawrence Eichenfield, MD
University of California, San Diego
Rady Children’s Hospital

Overview

Topical corticosteroids are the first-line treatment for acute flares of atopic dermatitis, the most common chronic inflammatory dermatologic condition affecting children. Despite evidence of its efficacy, topical corticosteroids are often underutilized by patients leading to subpar therapeutic results. Treatment non-adherence may be due to a variety of factors, including steroid phobia, a lack of full understanding of the regimen, prescriber/family communication issues, and non-specific recommendations about how to utilize medications for both acute and long-term care.
The proposed research project will help establish the clinical efficacy of the topical steroid volume calculator, with hopes that the utilization of the calculator will improve clinical outcomes of patients with atopic dermatitis by providing standardized volumes tailored to each patient. This will be a multi-center project, starting with two centers initially, and with the goal of three to five centers. The calculator is being incorporated into a standardized electronic medical record for ease of use by providers to give clear patient instructions (EPIC). As a result, it can help providers communicate better to their patients specifically how much topical corticosteroids to use to treat
acute flares of atopic dermatitis.

Status

This project was funded through a 2020 PeDRA Research Fellowship Grant.

Discovering the Immune Phenotype of Morphologic Subsets of Atopic Dermatitis at the Single Cell Level

By

Fellow

Carmel Aghdasi
University of California, San Francisco

Mentor

Kelly Cordoro, MD
University of California, San Francisco

Overview

The purpose of this work is to characterize the immunologic signatures and clinical characteristics of a diverse population of pediatric patients with atopic dermatitis. Understanding the unique immune pathogenesis of pediatric atopic dermatitis will drive discovery of targeted therapies appropriate to the unique needs of pediatric patients.

Status

This project was funded through a 2020 PeDRA Research Fellowship Grant.

Studying Topical Adherence in Atopic Dermatitis: What We Can Learn from Positive Outliers

By

Principal Investigator:

Steven Feldman, MD, PhD
Wake Forest University Health Sciences

Overview:

Although topical medications are highly effective treatments for atopic dermatitis, poor treatment adherence can lead to poor treatment outcomes and unnecessary escalation of costly therapy. The purpose of this study is to identify new approaches to help patients use their medicine by using a positive outlier approach: identifying novel strategies that successful patients already use to take their medication correctly. The adherence strategies used by patients who successfully use their topicals may help us identify novel ways to improve other patients’ use of medication and serve as a foundation for future studies to develop and test innovative adherence interventions.

Status:

This project was funded by a 2019 PeDRA Research Grant.

The Relationship between the Cutaneous Microbiome and Skin Barrier in Infantile Atopic Dermatitis

By

Principal Investigator:

Jennifer Schoch, MD
University of Florida

Co-Investigator:

Reesa Monir, MD
University of Florida

Overview:

Infantile atopic dermatitis (i.e. eczema) is a common pediatric skin condition leading to significant complications for patients and parents. Sleep disturbances, behavioral issues, and parental exhaustion are just a few of the negative ramifications. Though advances have been made in disease treatment, preventive interventions lag far behind.

Infancy is a unique, impressionable period of time during which the physical skin barrier, the cutaneous immune system, and the skin microbiome are developing in parallel. These closely intertwined factors are critical to the development of eczema. The skin barrier becomes “leaky” in kids with eczema, making it dry and prone to infection. The skin’s immune system becomes more reactive, leading to itching and inflammation. The collection of microbes that live in and on the skin (the skin microbiome) also changes in kids with eczema. The timeline of these changes and how they are related, however, is unclear.

In this study, we will begin exploration of the relationship between skin structure, cutaneous immunity, and the cutaneous microbiome. We will examine skin pH and the cutaneous microbiome in infants with newly-onset atopic dermatitis, compared to infants without eczema. Infants age three to nine months with newly-onset atopic dermatitis and without atopic dermatitis will be compared, with the goal of identifying how and when various aspects of skin development go awry. Understanding normal and pathologic skin changes is the first step in developing preventative interventions.

Status:

This study was funded through the 2019 PeDRA Research Hot Seat – A PeDRA Shark Tank.

Systemic Treatment of Atopic Dermatitis

By

Principal Investigator:

Wynnis Tom, MD
UCSD

Overview:

This is a prospective, observational study of traditional systemic agents for severe, refractory atopic dermatitis in children. We are comparing the efficacy and safety of oral cyclosporine, azathioprine, mycophenolate mofetil, and methotrexate, guided by consensus-derived dosing and administration protocols.

Status:

Enrollment underway.

Participating Sites: