Atopic Dermatitis

Overview

Atopic Dermatitis (AD) is a common inflammatory skin condition also known as eczema. Patients with AD often experience itchy skin, red and brown blotches of skin, swollen or dry patches, and anxiety due to the condition. It also makes the skin more vulnerable to environmental irritants and allergens. Treatments, including topical medications, phototherapy, immunosuppressant drugs, and steroids, are currently targeted only to relieve symptoms

Epidemiology evidence suggests that AD affects 15 to 20 percent of children and 1 to 3 percent of adults globally. In Singapore, it is estimated to affect 20 percent of children and 11 percent of adults.

Our Approach

As part of the National Atopic Dermatitis Research Programme, we aim to get deeper insights into this complex skin condition through our multidisciplinary approach.

The exact cause of AD, which belongs to a spectrum of atopic disorders, is unknown. There is a known genetic component, as it runs in families with skin conditions. Mutations in the gene Filaggrin, which encodes a protein necessary for forming the skin barrier, often result in AD.

The holistic approach to AD research in SRIS involves leading researchers, dermatologists, and industry partners to focus on the underlying causes of AD to discover effective novel therapeutics.

With comprehensive data to identify biomarkers and drug targets to treat AD, we aim to understand the skin barrier, microbiome, and host immunity interaction. Our prime focus of interest is to innovate a series of next-generation diagnostic tools and patient-specific engagement tools. Our program, encompassing clinical, genomic, and imaging data collected from patients, facilitates us to understand AD pathogenesis in Asian populations.

Burden of Atopic Dermatitis in Singapore

We aim to collect comprehensive data on the epidemiology and disease burden of AD in Singapore. This will enable us to better understand the pathogenesis of Asian AD through a systems biology approach utilising cohort-based studies. To do this, we will engage with a strong network of clinicians and scientists within Singapore and globally to ensure the regional interest and global significance of our work.

AD researchers discussion

Selected theme publications

1. Olsson M, Bajpai R, Wee LWY, Yew YW, Koh MJA, Thng S, Car J, Järbrink K. The cost of childhood atopic dermatitis in a multi-ethnic Asian population: a cost-of-illness study. Br J Dermatol. 2020 May;182(5):1245-1252. doi: 10.1111/bjd.18442. Epub 2019 Oct 23. PMID: 31420964.

2. Xu X, van Galen LS, Koh MJA, Bajpai R, Thng S, Yew YW, Ho VPY, Alagappan U, Järbrink KSA, Car J. Factors influencing quality of life in children with atopic dermatitis and their caregivers: a cross-sectional study. Sci Rep. 2019 Nov 5;9(1):15990. doi: 10.1038/s41598-019-51129-5. PMID: 31690745; PMCID: PMC6831568.

Causes of Atopic Dermatitis

We use cutting-edge technologies to investigate and characterise the pathogenic mechanisms of Asian AD. We study the skin barrier, skin microbiome, immunology, and itch to conduct in-depth clinical and experimental research on AD, with a strong emphasis on translating our results. Given our focus on Asian AD patients, we aim to develop regional significance and, therefore, appropriate pathophysiological in vitro AD models and animal models to validate and translate novel findings.

AD lab gloves

Selected theme publications

1. Chng KR, Tay AS, Li C, Ng AH, Wang J, Suri BK, Matta SA, McGovern N, Janela B, Wong XF, Sio YY, Au BV, Wilm A, De Sessions PF, Lim TC, Tang MB, Ginhoux F, Connolly JE, Lane EB, Chew FT, Common JE, Nagarajan N. Whole metagenome profiling reveals skin microbiome-dependent susceptibility to atopic dermatitis flare. Nat Microbiol. 2016 Jul 11;1(9):16106. doi: 10.1038/nmicrobiol.2016.106. PMID: 27562258.

2. Liew WC, Sundaram GM, Quah S, Lum GG, Tan JSL, Ramalingam R, Common JEA, Tang MBY, Lane EB, Thng STG, Sampath P. Belinostat resolves skin barrier defects in atopic dermatitis by targeting the dysregulated miR-335:SOX6 axis. J Allergy Clin Immunol. 2020 Sep;146(3):606-620.e12. doi: 10.1016/j.jaci.2020.02.007. Epub 2020 Feb 21. PMID: 32088305.

DEVELOPING NOVEL TECHNOLOGIES TO CHARACTERISE AND TREAT ATOPIC DERMATITIS

We are developing and validating diagnostic tests to identify skin genetic and functional alterations in AD. We aim to study skin barrier function and the underlying tissue as well as the cellular structure using novel in-house tools such as confocal Raman imaging of molecular components. We are also improving the utility of current imaging techniques by generating machine learning tools to detect and score AD patients.

AD under microscope

Selected theme publications

1. Wong XFCC, Denil SLIJ, Foo JN, Chen H, Tay ASL, Haines RL, Tang MBY, McLean WHI, Sandilands A, Smith FJD, Lane EB, Liu J, Common JEA. Array-based sequencing of filaggrin gene for comprehensive detection of disease-associated variants. J Allergy Clin Immunol. 2018 Feb;141(2):814-816. doi: 10.1016/j.jaci.2017.10.001. Epub 2017 Oct 19. PMID: 29056476; PMCID: PMC5792052.

2. Yew YW, Unnimadhava Kurup Soudamini Amma D, Kuan AHY, Li X, Dev K, Ebrahim Attia AB, Bi R, Moothanchery M, Balasundaram G, Aguirre J, Ntziachristos V, Olivo M, Thng STG. Raster-scanning optoacoustic mesoscopy imaging as an objective disease severity tool in atopic dermatitis patients. J Am Acad Dermatol. 2021 Apr;84(4):1121-1123. doi: 10.1016/j.jaad.2020.06.045. Epub 2020 Jun 17. PMID: 32561371.

IMPROVING EDUCATION AND MANAGEMENT OF ATOPIC DERMATITIS

We aim to translate novel findings and technologies identified within the themes for the benefit of our patients. Strategies will include the development of new drug targets for clinical trials in AD patients. We aim to create novel methods to engage patients in their therapy and disease management through digital technologies. Mobile applications will be  co-developed with clinical trials and will improve compliance and patient self-care and  remotely monitor patients.

atopic dermatitis digital technologies

Selected theme publications

1. Yew YW, Dinish US, Choi ECE, Bi R, Ho CJH, Dev K, Li X, Attia ABE, Wong MKW, Balasundaram G, Ntziachristos V, Olivo M, Thng STG. Investigation of morphological, vascular and biochemical changes in the skin of an atopic dermatitis (AD) patient in response to dupilumab using raster scanning optoacoustic mesoscopy (RSOM) and handheld confocal Raman spectroscopy (CRS). J Dermatol Sci. 2019 Sep;95(3):123-125. doi: 10.1016/j.jdermsci.2019.07.003. Epub 2019 Jul 12. PMID: 31558224.

2. van Galen LS, Xu X, Koh MJA, Thng S, Car J. Eczema apps conformance with clinical guidelines: a systematic assessment of functions, tools and content. Br J Dermatol. 2020 Feb;182(2):444-453. doi: 10.1111/bjd.18152. Epub 2019 Jul 15. PMID: 31179535.

3. Tham EH, Koh E, Common JEA, Hwang IY. Biotherapeutic Approaches in Atopic Dermatitis. Biotechnol J. 2020 Oct;15(10):e1900322. doi: 10.1002/biot.201900322. Epub 2020 Apr 6. PMID: 32176834.

Contact Us

For more information on the National Atopic Dermatitis Programme, please contact Steven Thng or John Common.