Suzanne H. Keddie

Background: Atopic dermatitis (AD) affects around 20% of children and up to 10% of adults. Its fluctuating course, severe pruritus, and impact on sleep, mental health, and daily functioning highlight the need for innovative approaches to diagnosis and disease management. Digital health technologies have rapidly expanded to fill this gap, yet their clinical readiness remains uncertain. Objectives: This scoping review aims to map AI-driven digital tools for AD, classify their functionalities, assess methodologies, and identify challenges and opportunities for real-world implementation. Methods: A comprehensive search of MEDLINE (Ovid), Embase (Ovid), Web of Science, and Scopus was conducted from database inception to December 2024 using controlled vocabulary and free-text terms related to “atopic dermatitis,” “eczema,” “artificial intelligence,” “digital applications,” and “digital tools.” Two reviewers independently screened studies and extracted data, with conflicts resolved by a senior reviewer. Eligible studies included primary research on diagnostic, symptom-tracking, predictive, teledermatology, or language-based tools. Methodological quality was assessed using a 20-item standardised framework. Descriptive statistics and summary tables were used to synthesise findings. Results: 52 studies met inclusion criteria with some having multiple applications: diagnostic tools (n=32), symptom-tracking tools (n=8), predictive models (n=16), teledermatology tools (n=3), and Natural Language Processing/Large Language Models (NLP/LLM)-based applications (n=2). While most studies reported methodological transparency (96%) and data partitioning for model development and evaluation (96%); external validation (21%), code availability (21%), skin colour reporting (27%) and multi-expert labelling (38%) were limited. Despite several Convolutional Neural Network (CNN) based diagnostic models achieving >90% accuracy, few tools underwent real-world testing or clinical integration. Conclusions: AI-driven tools for AD show strong promise. However, limited validation, insufficient amounts of variation in skin type in source data, and real-world evaluation restrict clinical translation. Collaborative efforts to strengthen methodologies, improve dataset representativeness, and evaluate tools in clinical settings are essential for effective implementation.

Background: Patients with immune‐mediated inflammatory diseases (IMIDs) of the skin face challenges beyond visible signs. Despite their significant psychosocial burden, the global impact of skin IMIDs on work productivity has not been systematically reviewed. Objective: To evaluate the global burden of skin IMIDs on work productivity. Methods: We conducted a systematic review and meta‐analysis. Eight electronic databases (PubMed, Web of Science Core Collection, Embase, SciELO, KCI Korean Journal Database, Global Index Medicus, Informit and Google Scholar) were searched from inception to June 2024. We included quantitative studies reporting work‐related outcomes in adults (≥18 years) with alopecia areata, atopic dermatitis, hidradenitis suppurativa, psoriasis or vitiligo. For the meta‐analysis, studies had to report Work Productivity and Activity Impairment (WPAI), Work Limitations Questionnaire (WLQ) or sick leave duration. Two reviewers independently screened and extracted data. Risk of bias was assessed using validated tools. Data were pooled using frequentist and Bayesian approaches to ensure estimations robustness across heterogeneous designs and sample sizes. Results: Across 100 studies with a cumulative sample of 306,619 participants worldwide, skin IMIDs were consistently associated with impaired work functioning. Notably, the mean WPAI overall work impairment was 28.96 (95% CI 25.61; 32.31), and participants averaged 16.74 days of sick leave per year (95% CI 7.39; 26.1). Findings suggest that occupational impairment was influenced by psychosocial factors, thereby highlighting broader societal and economic consequences. Conclusion: Skin IMIDs substantially reduce work functioning and productivity worldwide, representing an underrecognized burden on individuals, employers and health systems. Better multidisciplinary strategies are needed to prevent occupational disadvantage and mitigate the economic and social impact of these chronic conditions.

On 24 May 2025, the Seventy-Eighth World Health Assembly (WHA78) adopted a resolution recognizing skin diseases as a global public health priority. This reflects a collective commitment from WHO member states to strengthen policies, secure resources and improve care for those affected by skin diseases. This milestone comes a decade after the launch of the Grand Challenges in Global Skin Health initiative (GSHi).

Background: Epidemiological studies of atopic dermatitis lack standardization in key areas, including how the burden is collected and reported, diagnostic criteria, sociodemographic factors and measurement of disease severity. Therefore, direct cross-study comparisons, recognition of population differences and pooled analyses are challenging or not possible. Consequently, the burden of atopic dermatitis remains difficult to assess and address. The Epidemiological Study Designs for Atopic Dermatitis Research (EPISTAR) initiative aims to reach consensus on which domain items should be recommended for future population-based epidemiological studies on atopic dermatitis and how they should be assessed. Methods: In phase 1, a steering group consisting of experts from dermatology and epidemiology as well as patient representatives will generate an initial list of items constituting key variables to measure. This list will be created by reviewing the existing literature, prioritizing evidence from systematic reviews where available. Phase 2 will include an international consensus exercise, conducted through eDelphi methodology. Phase 3 will involve an online consensus conference. In each Delphi round, international participants from diverse stakeholder groups will be invited to assess each item by rating their level of agreement with the item and methods by which it can be measured. Items that reach consensus will be removed after each round. Data analysis will follow predefined consensus criteria, with raw numbers, means and frequencies reported. Discussion: This harmonized approach has the potential to transform the field of atopic dermatitis epidemiology by addressing gaps in data quality and comparability, facilitating meta-analyses, and ultimately informing evidence-based policy and clinical guidelines.

Background: Atopic dermatitis (AD) has the highest burden of all skin diseases globally. While numerous systematic reviews and meta-analyses have attempted to estimate the burden of AD at country, regional and global levels, the variability in research methodology often leads to the exclusion of significant portions of data or the aggregation of data representing disparate factors. As a result, improving the understanding of the burden of AD requires a thorough review of the methodologies currently in use. Objectives: To identify and map the research methodology used in population-based epidemiological studies of AD in terms of the case definitions used, the severity assessment method, measures of frequency and key sociodemographic factors. Methods: A systematic literature search was conducted, covering an 18-month period from 1 January 2023 to 31 July 2024. Original, population-based studies were included if they reported the prevalence and/or incidence of AD. Abstract screening and data extraction were done in duplicate and in a blinded manner. Descriptive analyses stratified by geographical region and age group are presented in tabular and graphical form. Results: A total of 111 studies from 48 countries were included. Data on AD prevalence used various diagnostic criteria, with studies defining cases by a physician diagnosis (n = 86/111; 77.5%), validated questionnaires (n = 15/111; 13.5%) and other methods (n = 10/111; 9.0%), with considerable heterogeneity between geographical regions. Nineteen studies (17.1%) reported the severity distribution. Geographical regions with the fewest studies on AD were the South-East Asian (n = 5/120; 4.2%) and African (n = 4/120; 3.0%) regions. Conclusions: Recent population-based epidemiological studies on AD are highly heterogeneous, limiting meaningful comparisons across studies. Future research should aim to address this variability and fill key geographical gaps in the global burden data.

Background Respiratory syncytial virus (RSV) is an important cause of acute respiratory infection (ARI) in older adults. Vaccines that protect against severe RSV infection are now available. Aim We aimed to describe the incidence, presentation, severity and clinical outcomes of RSV-associated ARI in hospitalised older adults using a new Hospital-based ARI Sentinel Surveillance (HARISS) system in England in the winter prior to RSV vaccine introduction. Methods Adults aged ≥65 years from seven hospitals admitted for ≥24 hours with symptomatic ARI were included. Three groups were identified: RSV positive; influenza positive; negative for RSV, influenza and SARS-CoV-2. We estimated the hospitalisation rate of RSV-associated ARI compared to influenza-associated ARI and assessed clinical outcomes using Poisson regression and mortality using Cox regression across groups. Results This surveillance study included 2743 adults. During the 2023/4 season the hospitalisation rate for RSV-associated ARI was 58.3 per 100,000, compared to 114.6 per 100,000 for influenza-associated ARI. Hospitalisation rates increased with age. Exacerbation of chronic illness including lung disease, heart disease or frailty was a frequent cause of admission in RSV-associated ARI, with a combined incidence of 33.1 per 100,000. The majority of adults with RSV-associated ARI had at least one comorbidity (81%); a high proportion with immunosuppression (26%). Symptoms and clinical outcomes including mortality were similar between RSV- and influenza-associated ARI; 30-day mortality 10.6% vs 8.7% (adjusted hazard ratio 0.85,95% confidence interval 0.6-1.2). Conclusion In England, RSV infection is a common cause of hospitalisation in older adults. Symptoms at presentation, severity and clinical outcomes, including mortality, are comparable to influenza.