Characteristics of successful and unsuccessful strategies to increase vaccine intention and improve vaccine uptake for U.S. adult populations in the Affordable Care Act era (2010-2025): a systematic r

The clinical phenotypes of atopic dermatitis (AD) can vary, and some individuals display prurigo nodularis (PN)‐like lesions [, , ]. A systematic review and meta‐analysis of > 100 studies of AD showed that common morphologies included follicular (34%), papular lichenoid (22%), nummular (13%), and prurigo lesions (7%) []. PN is a cutaneous disease that is distinct from AD, but prurigo nodules (Pn) can occur secondary to AD (i.e., AD‐associated Pn [AD‐Pn]). Pn present mainly on the extremities as single to multiple excoriated hyperkeratotic, intensely itchy papules and nodules. AD‐Pn more commonly affects adults and individuals of South‐East Asian or African origin []. Studies from Singapore and Thailand have reported a higher prevalence of AD‐Pn compared with European prevalence data (27% vs. 4%, respectively) []. We have previously reported, in our AD registry study performed in Japan, a high prevalence of AD‐Pn in participants with moderate‐to‐severe AD (30.9% in participants with moderate AD and 56.3% in those with severe AD) []. AD‐Pn has traditionally been considered to consist of refractory AD skin eruptions, or a phenotype of AD that is often difficult to treat. Retrospective, single‐center data have described the prevalence, disease burden, and epidemiology of individuals with AD‐Pn in Japan [, ]. A 2014 Japanese university hospital‐based study reported that among 257 individuals with AD, 33 (12.8%) were diagnosed with AD‐Pn []. However, there is scant evidence on the long‐term prognosis of individuals with AD‐Pn, particularly with regard to how the extent of Pn relates to disease severity, mainly because there are very few prospective cohort studies []. The impact of AD‐Pn on overall AD management, therefore, remains unclear [, ]. Access to such information may help clinicians to accurately identify individuals with severe prurigo as appropriate candidates for systemic treatment []. AD‐Pn also deserves close attention in terms of assessing the severity of skin symptoms. For severity assessments of AD, well‐validated instruments are used for measuring signs and symptoms of AD, such as the Eczema Area and Severity Index (EASI) score [] and the Severity Scoring of Atopic Dermatitis (SCORAD) index [], to grade the intensity of lesions. These usually assess the disease severity by the area of skin lesions and the degree of erythema, papules, excoriations, and lichenification. However, these measurements do not easily capture the severity of AD‐Pn, which may affect a smaller body surface area (BSA) by themselves, and the morphology does not match each component of the skin lesions to be assessed. Thus, established measurements for AD cannot specifically assess the severity of AD‐Pn [, ].