Workstreams

There is currently significant variation in how the burden of atopic dermatitis is captured across epidemiological studies. For instance, population-based versus hospital-based populations, varying study sizes from hundreds to hundreds of thousands of patients, diagnostic criteria, availability of meta-data, measures of severity and QoL outcomes. Additionally, trend and longitudinal data are rarely found. Therefore, the GADA international consensus exercise aims to align research methodology for epidemiological studies. We plan to form consensus on the core criteria for the design of future epidemiological studies of AD that focus on disease burden, and to develop guidelines for the conduct of such studies. 

The key criteria that will be addressed are: 

• Case definition (self-report via questionnaire, dermatologist diagnosis); 
• Prevalence measure (point, period, lifetime prevalence); 
• Ethnicity; and 
• Disease severity as well as the quality of life assessed by patients/physicians, and determination of co-morbidities in a validated and standardised way. 
   

It is challenging to collect useful data without a data entry tool and standardisation, especially for studies conducted in mid- and low-resource countries. To facilitate AD registers and epidemiological fieldwork, a standardised data entry platform (including image acquisition) is being developed for both web and mobile browser/app-based use. It aims to integrate physician and patient data entry alongside satellite-based (e.g. UV and pollution exposure) parameters to aid in our understanding of how ecological factors affect AD in real life. Moreover, with the aid of machine learning/AI in the patient-facing app, there is potential to use these exterior parameters to contribute to severity/flare prediction. 

GADA has teamed up with the Lebanese registry for Atopic Dermatitis (LebRAD) project led by Dr. Jinane El Khoury Okais, Lebanese American University (LAU) and supported by Rita Iskandar and Marwa Hallal. LebRAD aims to link AD patient data among multiple public and university hospitals through the creation of a national registry and GADA is building the LebRAD data entry platform. The plan is to make the GADA registry platform available to others who would like to run an AD patient register. 

How to get involved? 

• Web and App feedback once released; 
• Assist in raising awareness of the tools, once they are released; and 
• Recruitment of patients to be involved within your own clinics as well as consideration for use in any fieldwork studies being performed. 
   

Core LebRAD team members
 

Atopic dermatitis is ranked 15th among non-fatal diseases and 1st among all skin diseases globally measured by the disability-adjusted life-years (DALYs). Evidence has shown an increasing trend of AD in adolescents and children. Currently, there is no sustainable resource providing long-term data on the prevalence and incidence of atopic dermatitis. This living systematic review aims to provide robust epidemiological data regularly updating the AD burden maps on the GADA website.

This is broken down into key research goals: 

• To develop and maintain a ‘living’ global atlas of the burden of atopic dermatitis; 
• To fill gaps in the currently available epidemiological data; and 
• To provide recommendations for governments, policy-makers, health professionals and patient organizations based on best evidence.
   

The skin microbiome is altered in AD and interacts with host immune pathways to mediate skin inflammation in the disease. However, the underlying mechanisms of microbiome–host interactions in AD remain poorly understood. 

GADA-omics aims to create a global map of the skin microbiome-metabolome and host immune profile in atopic dermatitis and healthy skin. This project would be the first to profile the skin microbiome, metabolome, lipidome, and immune marker signatures associated with clinical AD phenotypes. The identified AD host-microbiome interactions will also be linked to different geographical regions and environmental exposures to explore the ways in which external factors impact the AD skin microbiome.

Currently, we are actively seeking funding to cover staff resources and sample processing expenses. We believe that with your support, GADA-omics can make a meaningful difference in understanding immunometabolism interactions in AD skin. 
 

Patients of different ancestry often present to health services with different features of some of the most common skin diseases. Evidence has shown that most image examples are based on western European (fairer) skin types. This results in many patients feeling unsure about receiving the right diagnosis or being able to confidently describe what is going on. 

The Skin Images and Nomenclature in Diverse Populations (SkIN DP) looks to address this challenge. The need for this project is supported by feedback from our patient representatives and studies investigating US dermatology residents’ confidence in diagnosing skin conditions in darker skin types. 

To address this health inequity, it is cruical to improve trainees’ technical skills and patient health literacy. SkIN DP will investigate the relationship between ancestry and presentation of common skin disease. It will also look to understand how patients of different ancestry describe their skin condition.

SkIN DP is supported by the Dowager Countess Eleanor Peel Trust and the NHS England Topol Digital Health Fellowship. A multi-site mixed method (qualitative and quantitative) study has been adopted which involves patient questionnaires and acquisition of real-world images of skin disease. To date, there have been 46 patients recruited. If you and your hospital are interested in joining the GADA-SkIN DP project, please let us know!
 

Evidence suggests AD may worsen during pregnancy; however, there are no large clinical studies exploring the therapeutic options for AD during conception or pregnancy, nor information on the effects of treatments on the unborn child and lactation. This produces great challenges for women of childbearing age with AD as clinicians may be overly restrictive for treatments due to the lack of scientific knowledge. These challenges translate into greater difficulty with shared decision making between the clinician and patient. 

We are conducting a mixed methods study to explore patients’ lived experiences and to understand the burden of AD in this population. We also aim to obtain some data for this patient population from the LebRAD registry. 

This project will be conducted in close collaboration with Global Skin and the International Eczema Council and their wider networks.

How to get involved?

• Patient recruitment: help recruit patients for semi-structured interviews; and 
• Contribute to quantitative data collection (i.e. through online survey or link your study etc.).