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Atopic dermatitis has a well-known association with mental health comorbidities. This article reviews the mental health interventions currently available to patients and caregivers, including the use of multidisciplinary clinics and peer support programmes. Future research is needed to understand the efficacy of these interventions, the optimal formats and the accessibility of mental health resources. Atopic dermatitis (AD) is associated with high levels of psychosocial burden, often resulting in poor mental health outcomes. Despite this association, few studies have evaluated the efficacy of mental health interventions within this population. Utilization of multidisciplinary and peer-led support, in addition to equipping patients with psychological tools, may be beneficial in improving mental health outcomes. Future research is needed to determine which interventions and formats are desired by, effective in and accessible to patients and caregivers with AD. [ABSTRACT FROM AUTHOR]

Janus kinase (JAK) refers to a family of tyrosine kinases that are involved in the production of proinflammatory mediators in response to various extracellular signals. The JAK–signal transducer and activator of transcription (STAT) pathway is an appealing target in many inflammatory illnesses as this pathway modulates immune cell activation and T-cell-mediated inflammation in response to several cytokines. The practical considerations of prescription for topical and oral JAK inhibitors (JAKis) in atopic dermatitis, vitiligo and psoriasis have been covered in prior publications. Currently, the US Food and Drug Administration has approved the topical JAKi ruxolitinib for atopic dermatitis and nonsegmental vitiligo. None of the remaining first- or second-generation topical JAKis have been approved for topical application in any dermatological indications so far. For this review, the PubMed database was searched using 'topical' and 'JAK inhibitor' or 'Janus kinase inhibitor' or the names of individual drug molecules as the keyword in the title with no date limits. The description of topical JAKi usage in dermatology from the literature was evaluated in each abstract. The current review concentrates on emphasizing the rising use of topical JAKis in both approved and off-label dermatological applications for both old and novel conditions. Currently, the Food and Drug Administration has approved the topical Janus kinase inhibitor (JAKi) ruxolitinib for atopic dermatitis and nonsegmental vitiligo. None of the remaining first- or second-generation topical JAKis have been approved for topical application in any dermatological indications so far. The current review concentrates on emphasizing the rising use of topical JAKis in both approved and off-label dermatological applications for both old and novel conditions. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) in people with skin of colour can appear psoriasiform, lichenoid, scaly or papular, with a violaceous colour and there is a higher prevalence of post-inflammatory dyspigmentation compared with affected individuals of White ethnicities, which can limit the use of current severity assessment tools. Greater participation from patients of different ethnicities in clinical trials is needed; with adequate representation, future studies may be able to better characterize potential differences in AD between different ethnic groups, as well as differences in treatment response. Recent advances in atopic dermatitis (AD) present the condition as a heterogeneous disease of distinct endotypes across ethnic groups. AD in people with skin of colour may appear psoriasiform, lichenoid, scaly or papular, with a violaceous colour and there is a higher prevalence of post-inflammatory dyspigmentation compared with affected individuals of White ethnicity. These differences in clinical presentation may limit the use of AD assessment tools in people with skin of colour, leading to the potential for misdiagnosis and underestimation of severity, particularly in relation to assessment of erythema. Recent targeted therapies for AD have been studied in multiple ethnic groups; however, ethnicity-based subgroup analysis is often not performed. Further research is required to understand whether treatment responses or safety may differ among ethnic groups. [ABSTRACT FROM AUTHOR]

Background Almost 50% of patients with skin psoriasis have concomitant nail involvement. The comparative effectiveness of the available biologics for nail psoriasis (NP) is still an area of contention because of limited data on nails. Objectives We conducted a systematic review and network meta-analysis (NMA) to compare the efficacy of biologics in achieving complete resolution of NP. Methods We identified studies in PubMed, EMBASE and Scopus. The eligibility criteria included randomized controlled trial (RCTs) or cohort studies for psoriasis or psoriatic arthritis with at least two arms of active comparator of biologic reporting at least one efficacy outcome of interest: that is the Nail Psoriasis Severity Index (NAPSI), the modified NAPSI or the Physician's Global Assessment of Fingernail Psoriasis with a score of 0. Results Fourteen studies comprising seven treatments met the inclusion criteria, and were included in the NMA. The NMA showed the odds of complete NP resolution were superior with ixekizumab [risk ratio (RR) 1.4, 95% confidence interval (CI) 0.73–3.10] compared with the treatment of reference (adalimumab). Brodalumab (RR 0.92, 95% CI 0.14–7.40), guselkumab (RR 0.81, 95% CI 0.40–1.80), infliximab (RR 0.90, 95% CI 0.19–4.60) and ustekinumab (RR 0.33, 95% CI 0.08–1.60) demonstrated worse therapeutic effect compared with adalimumab. According to the surface under the cumulative ranking curve, ixekizumab 80 mg every 4 weeks had the highest probability of being the best treatment. Conclusions The interleukin-17A inhibitor ixekizumab has the highest rate of complete nail clearance and it can be considered the best-ranked therapy from the present evidence. This study is relevant to daily practice as it facilitates the decision when choosing between the wide variety of available biologics in patients for whom clearance of nail symptoms is the first concern. [ABSTRACT FROM AUTHOR]

Background: Patient adherence to topical antipsoriatic drugs is often poor, leading to poor efficacy. Use of long‐term support delivered by dermatological nurses to patients treated with topical drugs may improve outcome. Aim: To evaluate whether regular support from dermatological nurses improves outcome and treatment adherence in patients with psoriasis receiving topical medications. Methods: We conducted a randomized controlled trial (RCT) (clinicaltrials.gov registration NCT04220554), in which patients received once‐daily topical medications (containing corticosteroids and/or calcipotriol) for as long as their psoriasis was visible. The patients were randomly allocated to standard care by the dermatologist either with (n = 51) or without (n = 52) support from dermatological nurses. The nurse support intervention consisted of a structured dermatological consultation at baseline and Week 1, followed by contact with a nurse each month (in the outpatient clinic or by telephone). The primary outcome was severity of psoriasis, which was measured by the Lattice System Physician's Global Assessment (LS‐PGA) and assessed by intention‐to‐treat analyses using linear mixed regression models for longitudinal data. Secondary outcomes were quality of life (measured by the Dermatology Life Quality Index; DLQI) and good adherence (defined as use of ≥ 80% of recommended doses). Results: In total, 92 patients (89%) completed the 48‐week trial period. The intervention group improved more than the nonintervention group from baseline to Week 24 in LS‐PGA (2.21 vs. 1.28, P = 0.001) and in DLQI at Week 12 (6.50 vs. 1.55, P < 0.001). Differences between the two groups in favour of the intervention were observed throughout the study period. More participants in the intervention group had good adherence compared with the nonintervention group (36% vs. 14%, P < 0.001). Conclusion: Regular, continued patient support from dermatological nurses increased the efficacy of psoriasis treatment, improved quality of life and enhanced long‐term adherence to topical antipsoriatic drugs. However, there is still room for more improvement. [ABSTRACT FROM AUTHOR]

Summary: Pruritus is a hallmark of atopic dermatitis (AD), which affects disease severity and patient quality of life. In AD uncontrolled with first‐line topical therapies or in moderate to severe AD, systemic therapies are used; however, there is a paucity of head‐to‐head trials comparing the effectiveness of these therapies. The aim of this study was to compare the effectiveness of systemic therapies in relieving pruritus in moderate to severe AD in adults, using a meta‐analysis. The PubMed, EMBASE, Medline and CINAHL databases were searched from inception up to 31 May 2020 for randomized, placebo‐controlled trials investigating the effectiveness of systemic therapies on pruritus with moderate to severe AD in patients aged ≥ 16 years. In total, 26 studies (n = 5190 participants) were identified. Compared with placebo, there was a large and statistically significant (P < 0.001 for all) reduction in pruritus [standard mean difference (SMD); 95% CI] with dupilumab every 2 weeks (−0.88; −1.13 to −0.63), dupilumab every 2 weeks plus topical corticosteroids (−0.77; −0.91 to −0.62), dupilumab once weekly (−0.99; −1.29 to −0.68), dupilumab once weekly plus topical corticosteroids (−0.70; −0.81 to −0.59). There was also a large and statistically significant reduction with ciclosporin (−1.30; −2.34 to −0.26; P = 0.01) and a large, although not statistically significant reduction with azathioprine (−0.85; −2.07 to 0.35). There was a small reduction with both mepolizumab (−0.27; −0.89 to 0.35) and interferon‐γ (−0.31; −0.75 to 0.12). Of the investigational drugs, nemolizumab 2.0 mg/kg was the most effective (−8.13; −9.31 to −6.94). The majority of systemic therapies were superior to placebo in reducing pruritus. In particular, the dupilumab studies consistently showed large improvements in pruritus, while nemolizumab showed the strongest antipruritic effects. However, future head‐to‐head trials are required for conclusive evidence. [ABSTRACT FROM AUTHOR]

Summary: Background: Better understanding of the experience of people living with hidradenitis suppurativa (HS) is essential to identify gaps in current patient care and inform healthcare decision‐making. Aim: To describe the patient experience of individuals with HS, including their path to diagnosis, symptom control, treatments, healthcare utilization, patient needs and impact on quality of life. Methods: The Hidradenitis Suppurativa Patient Experience survey was created, extensively reviewed and disseminated through engaging HS‐related patient organizations, physician groups and social media groups. Results: In total, 537 respondents completed the survey; the mean age was 38 years (range 14–73 years) and 95% (510 of 537) were female. The mean number of treatment types per respondent was 15, and included antibacterial soaps (93.3%; 431 of 462), avoidance of tight clothing (90.9%; 419 of 462), use of oral antibiotics (79.7%; 368 of 462), nonprescription drugs (79.7%; 368 of 462) and topical antibiotics (77.1%; 356 of 262). Pain was poorly controlled in 46% of respondents (184 of 401). HS had a negative impact on the ability to work and attend school for 81% of respondents (337 of 415), with 59% (245 of 415) missing at least 2 days of work a month and 16% (66 of 415) missing > 11 days of work. The mean number of misdiagnoses per respondent was three and the median time to diagnosis was 10 years. Conclusion: Individuals with HS experience a delay in diagnosis and have suboptimal control of the disease. We propose 11 recommendations to improve diagnosis, treatment and quality of life for individuals living with HS. [ABSTRACT FROM AUTHOR]

During dupilumab treatment, Patient 1 presented with injection site reactions, manifesting as local mild erythema, swelling, which resolved without special treatment. Dear Editor, Atopic dermatitis (AD) is one of the most common skin disorders in children, with a prevalence of 25%-30%, and up to 33% of patients develop moderate to severe AD.1 Systemic treatment options may be needed in cases of moderate to severe AD, but none of the currently available medications is a long-term treatment option, as they are all restricted by potential drug toxicity. Off-label use of dupilumab for the treatment of moderate to severe atopic dermatitis in children aged below 6 years of age: a case series. [Extracted from the article]

Summary: Nail changes are visible in a variety of inflammatory dermatoses. The commonest dermatological condition with nail manifestations is chronic plaque psoriasis. This two‐part article reviews the nail signs in psoriasis in Part 1, and the nail changes in cutaneous lichen planus and alopecia areata in Part 2. It provides a brief summary of the salient points in the clinical features, management and prognosis of these entities, with practical recommendations that may be beneficial to all dermatologists. [ABSTRACT FROM AUTHOR]

Summary: Nail involvement is estimated to affect 80–90% of patients with psoriasis at some point in their lives and is often associated with severe disease. Patients with nail involvement experience pain, functional impairment and social stigma, with significant restriction of daily activities and quality of life. Nail psoriasis is also considered a risk factor for the development of psoriatic arthritis (PsA). Management of nail psoriasis is deemed challenging and as a result, it is often left untreated by physicians. Assessing the severity of nail disease can also be difficult in clinical practice. While the Nail Psoriasis Severity Index is used widely in trials, it is time‐consuming and rarely used in the clinic, highlighting the need to develop a simplified disease severity score for nail psoriasis. All patients should be advised to keep their nails short, wear gloves for wet and dirty work, and regularly apply emollient to the nail folds and nail surface. Patients with mild nail psoriasis, without signs of severe cutaneous psoriasis or PsA, may benefit from topical treatment, while systemic treatment is indicated in patients with severe nail involvement. Evidence suggests that all anti‐tumour necrosis factor (TNF)‐α, anti‐interleukin (IL)‐17, and anti‐IL‐12/23 antibodies available for plaque psoriasis and PsA are highly effective treatments for nail psoriasis. This article aims to provide an up‐to‐date review of the therapeutic options currently available for the management of nail psoriasis in patients with or without skin psoriasis. Therapeutic options for the management of nail psoriasis in children will also be discussed. [ABSTRACT FROM AUTHOR]

Summary: Apremilast has been approved as an effective and safe treatment for psoriasis, but clinical trial results may differ from real‐life data. This retrospective cross‐sectional study evaluated the long‐term efficacy and safety of apremilast in a Greek cohort of adult patients with psoriasis who had received at least one dose of apremilast between March 2016 and January 2021. The primary endpoint was the percentage of patients who achieved 75% reduction in Psoriasis Area Severity Index (PASI75) at Week 16. Absolute PASI, PASI90 (90% reduction) and adverse events were also recorded at various timepoints. In total, 102 patients (29.4% women, 70.6% men) with a mean ± SD age 55.94 ± 15.21 years were included. PASI75 and PASI90 were achieved by 20.8% and 1.98% of patients, respectively, at Week 16. According to our results, PASI90 achievement was significantly lower than that reported in clinical trials. The efficacy of apremilast increased gradually until Week 24, with further improvement noted in good responders up to Week 52. [ABSTRACT FROM AUTHOR]

Summary: Background: There are limited data regarding the long‐term continuation with biological therapy for patients with psoriasis. In particular, the reasons for secukinumab discontinuation have not been thoroughly investigated. Aim: To better ascertain the real‐life continuation of secukinumab in psoriasis, we conducted a retrospective study to evaluate the incidence, causes and factors of secukinumab discontinuation in patients with psoriasis. Methods: All patients treated with secukinumab for psoriasis in the Department of Dermatology (Toulouse University and Larrey Hospital, Toulouse, France), between September 2011 and June 2017, were enrolled in the study. Results: Of the 91 patients in the study, 22 (24.2%) discontinued secukinumab. In 14 (15%) patients, the discontinuation was due to loss of efficacy. Two patients stopped treatment because they planned a pregnancy and five patients stopped because of adverse events. A longer disease duration (P = 0.01) and presence of palmoplantar psoriasis (P = 0.01) seem to be predictive factors for treatment failure. Patients reaching 90 or 100% improvement in Psoriasis Area and Severity Index (PASI90 and PASI100, respectively) at weeks 12–16 had a lower risk of long‐term treatment discontinuation compared with patients who had less complete clearance (P = 0.04). Conclusion: Long‐term persistence of secukinumab appears to be good, as only 24.2% (n = 22) of the patients in this study discontinued secukinumab over the follow‐up period. Loss of efficacy prompted discontinuation in about 14% of patients by the 2‐year follow‐up. Persistence appears to be lower in patients with palmoplantar psoriasis and in patients previously exposed to many systemic treatments. Optimal therapeutic response at 12–16 weeks as defined by reaching PASI90–100 seems to be predictive of long‐term treatment persistence. [ABSTRACT FROM AUTHOR]

The article discusses a study that investigated the use of optical coherence tomography (OCT) imaging as a biomarker response to treatment for nail disease in psoriasis and psoriatic arthritis. The study covered four patients using the Nail Psoriasis Severity Index as outcome measures. Results showed that OCT identifies all common psoriasis nail changes and the findings suggest that OCT imaging may be a useful tool for assessing nail biomarker in psoriasis.

Treatment of ILVEN is challenging, although numerous therapies have been attempted. Inflammatory linear verrucous epidermal naevus (ILVEN) is a rare, chronic skin disorder characterized by pruritic erythematous scaly papules that follow the lines of Blaschko. Several case reports have shown promising results using pulsed dye, ablative CO SB 2 sb and fractional laser treatment; however, treatment remains challenging, with a recurrence rate of 60%-80% after CO SB 2 sb laser treatment. [Extracted from the article]

Click here for the corresponding questions to this CME article. [ABSTRACT FROM AUTHOR]

Prevention of conjunctivitis in patients with atopic dermatitis undergoing treatment with dupilumab: an Italian single-centre experience Atopic dermatitis (AD) is a chronic inflammatory skin disease,1 commonly related to other atopic manifestations such as food allergy, rhinitis, asthma and conjunctivitis.2 A large proportion of patients with AD (31%-56%) develop an episode of conjunctivitis in their lifetime, usually related to the severity of dermatitis.3 Conjunctivitis also appears to be one of the most frequent adverse events (AEs) in patients treated with dupilumab,4 a monoclonal antibody targeting interleukin (IL)-4 and IL-13, which has been approved for the treatment of several type 2 diseases in addition to AD, such as asthma, nasal polyposis and eosinophilic oesophagitis.5 Previous reports of randomized controlled trials (RCTs) revealed that the incidence of conjunctivitis was higher in participants with AD than in those with other type 2 diseases, for whom the incidence of conjunctivitis was comparable to the placebo group. Both patients recovered without needing to discontinue dupilumab therapy but at Week 52 of treatment, one of the two patients relapsed. [Extracted from the article]

The article presents a case study of a 57-year-old man who was presented with a palmoplantar psoriasis affecting all 10 toenails. Information about moderate to severe nail psoriasis with predominant matrix involvement that depicts rapid clinical and ultrasonographic improvement after initiation of apremilast initiation is presented.

The article presents a study conducted on the efficacy of apremilast for the treatment of moderate to severe psoriasis. Topics discussed include after 16 weeks of treatment half of the patients responded to apremilast with 75% reduction in Psoriasis Area and Severity Index; improvement in Mean Dermatology Life Quality Index at 16 weeks; and adverse effects reported by patients such as nausea, vomiting, diarrhoea, abdominal spasm, headaches, dizziness, loss of appetite, lethargy and chest pain.