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Atopic Dermatitis [AD] is a chronic relapsing inflammatory dermatological disease characterized by itch, dry skin, localized or disseminated eczematous lesions and hyperpigmentation of skin. There are several exogeneous and endogenous risk factors for development of AD. The endogenous factors include genetic factors, atopy, skin hyperreactivity and exogeneous factors such as food, dust, pollen, epidermal, fungal, bacterial, and vaccine-associated factors. The management of AD includes topical treatments such as topical corticosteroids, topical capsaicin, topical calcineurin inhibitors and phosphodiesterase inhibitors. Systemic therapies such as corticosteroids, immunosuppressants, biologicals, gabapentinoids and antidepressants are provided to patients with inadequate systemic therapies have wide range of side effects limiting their use in many patients. Therefore, there is a need for innovative treatment options. This led to development of Janus kinase inhibitors. First generation JAK inhibitors includes Tofacitinib, Baricitinib, Ruxolitinib, Oclacitinib. Second generation drugs such as Upadacitinib and Abrocitinib are more specific towards the JAK isoforms. This review addresses the importance of Abrocitinb for the treatment of Atopic Dermatitis. Abrocitinib an oral once daily treatment for moderate to severe atopic dermatitis developed by Pfizer. Studies shows that Abrocitinib is better alternative in non- responders to Dupilumab therapy or patients with contraindications to the Dupilumab. The patient’s adherence to medication will also be better with oral route rather than injections. Abrocitinib will be widely accepted because of its clinical benefits such as reduction in itching and more convenient oral route of administration.

Introduction: Atopic dermatitis (AD) is a chronic, relapsing–remitting illness. In moderate-to-severe instances, recommendations urge patient-centered systemic therapy. Existing standards lack long-term treatment success requirements. A treat-to-target methodology was proposed for systemic therapy patients that requires global improvements to prompt decisions about treatment. Methods: We conducted an observational study between May 2021 and June 2022 in three Ecuadorian patients with severe AD who were treated with dupilumab to assess the clinical evolution and behavior of the subdomains evaluated by clinimetric tools. Results: Patients A and C satisfied disease-domain response criteria to dupilumab at 12 and 24 weeks, but B did not complete the algorithm objectives. Nonetheless, patient A improved AD severity, itching, bleeding, desquamation, sleep, daily activities, mood, emotions, sexual troubles, clothing, and sports subdomains. Patient B experienced reduced symptomatology, AD aggravation, daily activities impact, and work/study impairment. Patient C improved from severe to mild desquamation, itching, exudate, lichenification, and rough/dry skin. Sleep, shame, and study subdomains improved the most. Conclusion: We provide a new operational construct for analyzing current patient-reported outcome measures (PROMs) and clinician-reported outcome measures (CROMs) based on subdomains to widen our understanding of the state of disease activity and make clinical decisions when the treat-to-target strategy is not attained.

Background Most children with atopic dermatitis(AD) suffer from sleep disturbance, but reliable and valid assessment tools are lacking. Objectives To test PROMIS (Patient Reported Outcomes Measurement Information System) sleep measures in pediatric AD and to develop an algorithm to screen, assess and intervene to reduce sleep disturbance. Methods A cross-sectional study was conducted with AD children ages 5-17 years and one parent(n=61), who completed sleep, itch, and AD-specific questionnaires; clinicians assessed disease severity. All children wore actigraphy watches for 1-week-objective sleep assessment. Results PROMIS sleep disturbance parent-proxy-reliability was high (Cronbach's α=0.90) and differentiated among Patient Oriented Eczema Measure (POEM)-determined disease severity groups (mean±SD in mild vs. moderate vs. severe was 55.7±7.5 vs. 59.8±10.8 vs. 67.1±9.5, p Limitations This was a local sample. Conclusions Sleep disturbance in pediatric AD should be screened using the POEM sleep question, with further assessment using the PROMIS sleep disturbance measure or objective sleep monitoring if needed.

Atopic dermatitis (AD) is a chronic and relapsing multifactorial inflammatory skin disease that also affects dogs. The oral and gut microbiota are associated with many disorders, including allergy. Few studies have addressed the oral and gut microbiota in dogs, although the skin microbiota has been studied relatively well in these animals. Here, we studied the AD-associated oral and gut microbiota in 16 healthy and 9 AD dogs from a purebred Shiba Inu colony. We found that the diversity of the oral microbiota was significantly different among the dogs, whereas no significant difference was observed in the gut microbiota. Moreover, a differential abundance analysis detected the Family_XIII_AD3011_group (Anaerovoracaceae) in the gut microbiota of AD dogs; however, no bacterial taxa were detected in the oral microbiota. Third, the comparison of the microbial co-occurrence patterns between AD and healthy dogs identified differential networks in which the bacteria in the oral microbiota that were most strongly associated with AD were related to human periodontitis, whereas those in the gut microbiota were related to dysbiosis and gut inflammation. These results suggest that AD can alter the oral and gut microbiota in dogs.

Additional long-term treatments are needed for moderate-to-severe atopic dermatitis (AD). An ongoing, open-label, 5-year extension trial, ECZTEND (NCT03587805), assesses tralokinumab plus optional topical corticosteroids in participants from previous tralokinumab parent trials (PTs) with moderate-to-severe AD.To evaluate the safety and efficacy of up to 2 years tralokinumab treatment in a post hoc interim analysis.Safety analyses included adults from completed PTs enrolled in ECZTEND, regardless of tralokinumab exposure duration. Efficacy analyses included adult participants treated with tralokinumab in ECZTEND for ≥1 year and subgroup analyses of those on tralokinumab for 2 years (1 year from PT, 1 year in ECZTEND). Primary end point was the number of adverse events with additional efficacy end points.Participants on tralokinumab had an exposure-adjusted rate of 237.8 adverse events/100 patient-years' exposure (N = 1174) in the safety analysis set. Exposure-adjusted incidence rates of common adverse events were comparable to PTs, although at lower rates. With 2 years of tralokinumab, improvements in extent and severity of AD were sustained, with Eczema Area and Severity Index (EASI-75) in 82.5% of participants (N = 345).Possible selection bias; no placebo arm; some participants experienced treatment gaps between PTs and ECZTEND.Over 2 years, tralokinumab was well tolerated and maintained long-term control of AD signs and symptoms.

IntroductionAtopic dermatitis (AD) is a chronic inflammatory skin disorder with limited treatment options for adolescents with moderate-to-severe disease. Lebrikizumab, a monoclonal antibody targeting interleukin (IL)-13, demonstrated clinical benefit in previous Phase 3 trials: ADvocate1 (NCT04146363), ADvocate2 (NCT04178967), and ADhere (NCT04250337). We report 52-week safety and efficacy outcomes from ADore (NCT04250350), a Phase 3, open-label study of lebrikizumab in adolescent patients with moderate-to-severe AD. The primary endpoint was to describe the proportion of patients who discontinued from study treatment because of adverse events (AEs) through the last treatment visit.MethodsAdolescent patients (N = 206) (≥ 12 to

Core outcome sets are critically important outcomes that should be measured in clinical trials. Their absence in atopic dermatitis is a form of research waste and impedes combining evidence to inform patient care. Here, we articulate the rationale for core outcome sets in atopic dermatitis and review the work of the international Harmonising Outcome Measures for Eczema group from its inception in Munich, 2010. We describe core domain determination (what should be measured), to instrument selection (how domains should be measured), culminating in the complete core outcome measurement set in Tokyo, 2019. Using a "road map," Harmonising Outcome Measures for Eczema includes diverse research methods including Delphi and nominal group techniques informed by systematic reviews of properties of candidate instruments. The 4 domains and recommended instruments for including in all clinical trials of atopic dermatitis are patient symptoms, measured by Patient-Oriented Eczema Measure and peak Numerical Rating Scale 11 for itch intensity over 24 hours, clinical signs measured using the Eczema Area and Severity Index, quality of life measured by the Dermatology Life Quality Index series for adults, children, and infants, and long-term control measured by either Recap of atopic eczema or Atopic Dermatitis Control Tool. Published version Details of funding for each of the consensus meetings is outlined in the published meeting reports. The following additional funding sources contributed to facilitating the HOME COS development: National Institute for Health and Care Research Senior Investigator award to Prof Hywel Williams (RE 2374) funded travel costs to enable UK patients to participate in HOME meetings; National Institute for Health and Care Research Programme Grant for Applied Research RP-PG-0407-10177 ‘‘Setting Priorities and Reducing Uncertainties for the Prevention and Treatment of Skin Disease (SPRUSD)’’ was used to support completion of the some of the systematic reviews, the cost of meetings and patient and public involvement (Prof Kim Thomas); NIH NIAMS A Community-based Assessment of Skin Care, Allergies, and Eczema: The CASCADE Trial grant number 5 R01 AR071057-05 and Oregon Clinical and Translational Research Institute (OCTRI) assisted with outcome evaluations and associated travel costs (Prof Eric Simpson); Laura Howells received a PhD studentship from the British Skin Foundation (Ref: 8016) for studies that informed this work.

BACKGROUND: Abrocitinib efficacy by prior dupilumab response status in patients with moderate-to-severe atopic dermatitis (AD) has not previously been assessed in phase 3 studies.OBJECTIVE: Examine efficacy and safety of abrocitinib among patients who received prior dupilumab.METHODS: Patients with moderate-to-severe AD received abrocitinib 200 mg or 100 mg once-daily in JADE EXTEND (phase 3 extension) after dupilumab in double-blind, placebo-controlled phase 3 JADE COMPARE.RESULTS: Among prior dupilumab responders, ≥75% improvement in Eczema Area and Severity Index (EASI-75) was achieved in 93.5% and 90.2% of patients who received 12 weeks of abrocitinib 200 mg and 100 mg, respectively; ≥4-point improvement in Peak Pruritus Numerical Rating Scale (PP-NRS4) was achieved in 89.7% and 81.6%, respectively. Among prior dupilumab nonresponders, EASI-75 was achieved with abrocitinib 200 mg and 100 mg in 80.0% and 67.7% and PP-NRS4 in 77.3% and 37.8%, respectively. Most common adverse events among abrocitinib-treated patients were nasopharyngitis, nausea, acne, and headache. Conjunctivitis occurred less frequently with abrocitinib in comparison to prior dupilumab.LIMITATIONS: Short-term, 12-week analysis; no placebo arm.CONCLUSION: Efficacy and safety profile of abrocitinib in JADE EXTEND supports the role of abrocitinib as a treatment for patients with moderate-to-severe AD, regardless of prior dupilumab response status.

Introduction: Atopic dermatitis (AD), is the most common chronic inflammatory disease of skin among children globally with increasing prevalence. It tends to cause psychological, functional, and social disabilities in the afflicted patients and their families, overloading them with time-consuming disease treatments along with dietary changes, household responsibilities, and the burden of the financial impact of the disease. Aim: This literature review discusses the importance of the role of parents in controlling pediatric atopic dermatitis. Methods: A total of 4109 articles were found via an online search of the MEDLINE/PubMed, Embase, the Cochrane, ScienceDirect medical literature databases and were screened for relevance for this disease. Results:Understanding atopic dermatitis, including its causes, chronicity, regular flaring nature and the therapeutic waysis very important for the management of the disease. Parents of children affected with AD should ensure that their children show good compliance with their treatment plans. However, parents also experience anxiety and psychological pain because of responsibility and the issue of uncertainty about their childrens disease. Complete support and cooperation from parents and family members as primary caregivers for the management of disease plays a significant contribution in the successful treatment of childhood AD. Conclusion:In order to improve long-term treatment outcomes in childhood AD, Parental support and therapeutic education is crucial in dealing with the symptoms of AD and its chronicity. &nbsp

The skin, as the body’s outermost layer of cells, plays a crucial dual role in protecting against foreign pathogens while providing a habitat for commensal microbes. Despite the skin’s harsh conditions, which include desiccation, acidity, and scarce nutrients, the skin hosts a diverse community of bacteria, fungi, and viruses. Prior work associating fluctuations in the skin microbiome with health and disease has been limited by our limited understanding of the skin microbiome composition and functions. One way to characterise skin microbial diversity is through metagenomics. A previous investigation of the skin microbiome found that more than half of the sequenced skin metagenomic reads did not align to reference genomes, complicating the analysis of skin metagenomic datasets. To address this issue, we combined bacterial cultivation and metagenomic sequencing to create the Skin Microbial Genome Collection (SMGC), the most comprehensive catalogue of prokaryotic, eukaryotic, and viral genomes from the skin. The SMGC allows for the classification of a median of 85% of skin metagenomic sequencing reads, providing a comprehensive view of skin microbial diversity. Using the SMGC, we investigated the skin microbiome in atopic dermatitis, a prevalent inflammatory skin condition characterized by recurring episodes of red, itchy, and swollen skin. Atopic dermatitis flares have been associated with the proliferation of various staphylococcal species, with only S. aureus strains cultured from atopic dermatitis inducing inflammation in a mouse model. Our extensive genomic survey of the skin microbiome in atopic dermatitis, supported by cultured isolates from the same samples, identified Staphylococcus strains and genomic loci associated with higher disease severity. Our work also showed that the Staphylococcus strains found in AD are influenced by factors such as geography and strain sharing within households. Additionally, our examination of the mobilome of multiple Staphylococcus species colonising the same individuals revealed widespread inter-species transfer of genetic material, highlighting the fluid nature of staphylococcal genetic composition. In conclusion, our work shows how novel genomic approaches and the integration of sequencing data can be used to characterise the skin microbiome at an unparalleled resolution, allowing for new insights into how skin microbes vary in health and disease.

Background: The ECHO® (Extension for Community Healthcare Outcomes) project is a model of distance medical education developed in the United States to support health professionals in the management of patients with complex diseases. Since 2019, it has been implemented in atopic dermatitis (AD) in Argentina. The program consists of the periodic presentation of clinical cases by videoconference, virtual classes, and a permanently available open chat between professionals in charge of patients with AD and a group of experts. Objective: The objective of this study was to analyze the impact of the ECHO Project AD on the medical knowledge and medical skills of Argentinian health professionals when treating patients with AD. Methods: A survey was carried out among the participants in order to evaluate the impact of the program on the care of patients with AD. Results: ECHO Project AD revealed a significant improvement in the management of patients with AD. The program contributed to the interpretation and use of severity scores, use of phototherapy, and management and prescription of both classic and innovative topical and systemic treatments. Study limitations: The reduced number of participants and the short period of time. The answers of the survey may be biased by the enthusiasm of the participants. Conclusions: The ECHO project is an educational tool that enhances the medical skills of doctors and institutions, in which a climate of a partnership comes first and the participants look forward to learning from experiences, successes, and mistakes from one another, producing a scientific hub in constant evolution.

Interleukin 31 (IL-31) is a neurocytokine that stimulates sensory neurons involved in pruritus. It contributes to skin barrier inflammation, dysfunction, and remodeling. As the immune and nervous systems are interrelated, IL-31 has a key role in the treatment of atopic dermatitis (AD) and prurigo nodularis (PN). Nemolizumab is a humanized monoclonal antibody that blocks the a subunit of the IL-31 receptor, modulates the neuroimmune response, and rapidly alleviates itching by directly blocking signaling. It reduces inflammation and lesion severity in AD and PN by restoring epithelial function and promoting skin barrier integrity. This review synthesizes the latest information on the functions of IL-31 and presents the current evidence, including clinical trial results, on the use of nemolizumab in the treatment of AD and PN.

Background The European Prospective Observational Study in Patients Eligible for Systemic Therapy for Atopic Dermatitis (EUROSTAD) is an ongoing observational study aiming to describe characteristics of patients with atopic dermatitis (AD) treated with systemic therapy over time and the management of their disease in a real-world setting. Methods Data from patients enrolled in EUROSTAD between March 2017 and April 2019 were analyzed for systemic therapy use and treatment change over 12 months. Results 288 patients reported taking systemic medications; 42.7% received cyclosporine, 35.3% dupilumab, 28.1% methotrexate, 25.4% oral corticosteroids, 6.8% azathioprine, 6.1% injectable corticosteroids, and 3.4% mycophenolate. The median duration of treatment was 1.1 months for oral systemic corticosteroids, 3.2 months for injectable corticosteroids, 4.8 months for cyclosporine, 7.3 months for methotrexate, and 14.9 months for dupilumab. The most frequent reasons for stopping treatment included lack of efficacy, patient decision, adverse events, and disease well controlled. Conclusion The 12-month interim EUROSTAD study analysis highlights the current trends and outcomes of systemic treatments for moderate-to-severe AD. Among all systemic treatments for AD, dupilumab was the least likely to be discontinued, whereas cyclosporine and corticosteroids, whilst effective, were primarily limited to episodic flare management consistent with treatment guidelines.

Atopic dermatitis (AD) is a common presenting complaint by children and their caretakers to their primary care providers. On testing, children with AD frequently exhibit positive food-specific IgE levels in the absence of immediate allergic reactions. Misinterpretation of these false positive tests can lead to unnecessary food avoidance, which can have tremendous psychosocial, economic and nutritional consequences and, in some cases, facilitate the development of an immediate hypersensitivity to the food. We present a child with persistent AD who underwent broad testing that led to unnecessary food avoidance resulting in Vitamin D deficiency, growth failure and the development of an IgE-mediated food allergy. This case underscores the need for caution by primary care clinicians in using food avoidance diets as a treatment for AD and the importance of limiting allergy testing to foods only when the clinical history indicates an immediate hypersensitivity reaction.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder that affects a substantial number of children and has a significant negative impact on affected patients and their caregivers/families. Recent studies have led to significant evolutions in the understanding of AD pathogenesis, epidemiology, and treatment. The first point of contact for many patients with new-onset AD is usually with their primary care provider or pediatrician. This underscores the importance for pediatricians to understand the basic pathophysiology and current standards of care for AD. This article provides up-to-date information and reviews the basic principles of AD pathophysiology, diagnosis, and management. In addition, the article highlights recent advances in scientific research regarding the mechanisms involved in the pathogenesis of atopic dermatitis that have resulted in the discovery of novel therapeutic targets and the development of targeted biologic therapies with the potential to revolutionize AD therapy.

Introduction: The comparative efficacy of targeted systemic therapies for moderate to severe atopic dermatitis (AD) has not been systematically assessed using recent phase 3 data. This network meta-analysis assesses the comparative efficacy of targeted systemic therapies without the addition of topical corticosteroids (TCS) and/or topical calcineurin inhibitors (TCI) in adults with moderate to severe AD. Methods: The systematic literature review searched through 17 May 2021 for phase 3/4 trials with upadacitinib, interleukin-4 (IL-4), interleukin-13 (IL-13), or JAK inhibitors compared with placebo or active intervention for adults and adolescents with moderate to severe AD with inadequate response to TCS/TCI or for whom TCS/TCI was medically inadvisable, without restrictions on year or region. Researchers assessed data using PRISMA guidelines. The proportion of patients achieving trial co-primary endpoints [Investigator Global Assessment (IGA) score of 0 or 1 (clear or almost clear) and reduction of ≥ 2 points from baseline; proportion of patients achieving Eczema Area and Severity Index (EASI) improvement ≥ 75% from baseline (EASI-75)]; EASI improvement ≥ 90% from baseline (EASI-90); and ≥ 4-point improvement on Pruritus Numerical Rating Scale from baseline (ΔNRS ≥ 4) were evaluated using Bayesian network meta-analysis. Results: Of 3415 initially identified records, network meta-analysis (NMA) ultimately included 6 records representing 9 unique studies. Two upadacitinib trials were also included. Eleven clinical trials including 6254 patients were analyzed. Upadacitinib 30 mg daily was the most efficacious therapy across all endpoints at the primary endpoint (week 12 or 16) and at earlier timepoints, followed by upadacitinib 15 mg daily and abrocitinib 200 mg daily. Discussion: Many factors need to be considered for treatment selection for AD. These findings can help healthcare providers when personalizing a patient’s treatment. Conclusion: Upadacitinib 30 mg daily, upadacitinib 15 mg daily, and abrocitinib 200 mg daily may be the most efficacious targeted systemic therapies over 12–16 weeks of therapy in AD.

Background. Atopic dermatitis is the most common inflammatory skin disease in childhood, affecting almost 20 % of children. Food allergies affect one of three children with atopic dermatitis, and allergies to peanuts, eggs and milk are the predominant food allergies in the world. The purpose was to assess the prevalence of food allergies in the group of patients with atopic dermatitis, to determine the association of food allergies with anamnestic and clinical parameters of atopic dermatitis. Materials and me­thods. Children with atopic dermatitis (n = 116) were included in the study from September 2020 to August 2021 in Kyiv, Ukraine. Food sensitization was established by determining specific immunoglo­bulin E (sIgE) to food allergens using immunochemiluminescent method on the ImmunoCAP 100 system (Thermo Fisher Scientific Inc., Phadia, Sweden). Results. The average age of children in the main group (59 boys and 57 girls) was 6.8 years. All 116 patients at the time of examination had manifestations of atopic dermatitis in the form of erythematous itchy rash. The number of children with food allergy was 23 (19.8 %). Among food allergens, positive sIgE were found: in 14 patients (12 %) — to milk, in 13 (11.2 %) — to eggs, in 5 (4.3 %) — to fish, and in 4 people (3.4 %) — to hazelnuts. Food sensitization was significantly more common in children with moderate-to-severe atopic dermatitis than in the group of patients with mild atopic dermatitis (χ2 = 7.555, p < 0.05). Children with food sensitization had an earlier onset of atopic dermatitis — the average age of manifestations onset was 8 months, and in the group of children without food allergy, it was 18 months. Children with a parental history of atopic diseases were significantly more likely to have concomitant food allergy (χ2 = 12.831, p < 0.05). Conclusions. Given the significant association between early onset as well as moderate-to-severe atopic dermatitis and food sensitization, it is likely that food sensitization occurs primarily through an inflamed skin barrier in eczematous skin, which could potentially lead to clinical food allergy.

The aim of this study was to investigate the effects on gene expression in canine fibroblasts after incubation with a medium enriched with atopic dermatitis canine serum (CAD) compared with healthy canine serum (CTRL) and fetal bovine serum (FBS). Differential Expression and Pathway analysis (iDEP94) in R package (v0.92) was used to identify differentially expressed genes (DEGs) with a False Discovery Rate of 0.01. DEGs from fibroblasts incubated with CAD serum were significantly upregulated and enriched in the extracellular matrix (ECM) and focal adhesion signalling but downregulated in the oxidative phosphorylation pathway. Genes involved in profibrotic processes, such as TGFB1, INHBA, ERK1/2, and the downward regulated genes (collagens and integrins), were significantly upregulated after fibroblasts were exposed to CAD serum. The observed downregulation of genes involved in oxidative phosphorylation suggests metabolic dysregulation toward a myofibroblast phenotype responsible for fibrosis. No differences were found when comparing CTRL with FBS. The DEGs identified in fibroblasts incubated with CAD serum suggest activation of signalling pathways involved in gradual differentiation through a myofibroblast precursors that represent the onset of fibrosis. Molecular and metabolic knowledge of fibroblast changes can be used to identify biomarkers of the disease and new potential pharmacological targets.

IntroductionWhile the efficacy of dupilumab for the treatment of adults with moderate-to-severe atopic dermatitis (AD) has been demonstrated in several clinical trials, patients in such trials may not necessarily reflect the real-world clinical practice setting. This study evaluated the real-world effectiveness of dupilumab in adults with moderate-to-severe AD based on physician global assessment, percent body surface area affected, and patient-reported itch.MethodsFrom Modernizing Medicine's Electronic Medical Assistant dermatology-specific electronic medical records, adults (≥ 18years) were identified with a diagnosis of AD and ≥ 1 dupilumab prescription (index event) between 1 April 2017 and 31 January 2019. Three cohorts were identified based on 3-month pre-index (1) Investigator Global Assessment (IGA) score ≥ 3, (2) an itch severity numerical rating scale (NRS) score ≥ 3, and (3) body surface area (BSA) affected ≥ 10%. Changes from pre-index on the outcome within each cohort were evaluated at 4months post-index. Patients were also stratified for evaluation of outcomes by baseline demographic (sex, age) and prior AD treatments (topical therapy only or no treatment, any systemic therapy).ResultsMore than 70% of the 435 AD patients with baseline IGA score ≥ 3 improved to an IGA score of ≤ 2 at month 4 post-dupilumab initiation, including 42.8% who achieved IGA 0/1 (clear/minimal). Among 112 patients with a pre-index itch severity NRS ≥ 3, scores were reduced from mean (SD) 7.0 (2.4) pre-index to 2.8 (2.8) at month 4 (p

Atopic dermatitis (AD) is the most common inflammatory skin disorder. Despite the high disease burden, the therapeutic options are limited and their efficacy in controlling AD might be partially satisfactory.Most of the key mediators in AD pathogenesis act through the JAK/STAT signaling pathway, which represents a valid therapeutic target. The first generation of JAK inhibitors, namely tofacitinib and ruxolitinib, inhibit multiple JAKs, whereas newer JAK inhibitors show more selective inhibitory effects for specific JAKs. The aim of this review was to discuss the role of the JAK/STAT pathway in AD and its inhibition, with a special focus on pharmacodynamic properties.JAK inhibitors have different selectivity for various JAK molecules, which influences their pharmacodynamics, efficacy, and safety profile. Since many key cytokines in AD signal through JAK1, the selective JAK1 inhibition may be effective, avoiding the concomitant inhibition of JAK2- and JAK3-dependent pathways could be associated with additional safety issues. Therefore, selective JAK1 inhibitors may represent promising therapeutic agents for AD, as they might prevent off-target effects of JAK inhibitors, especially related to the hematologic profile.

Although Western medicine and ideas about atopic dermatitis (AD) have become popular in many Asian countries, local beliefs about the disease and its treatment often prevail. The multi- racial background of these countries as well as the influence of the diverse religions (such as Taoism and Ramadan) in these regions often lead to diverse belief systems about the causes of AD (such as the Chi concept, also known as the balance of yin and yang) and the types of treatment (e.g. herbal remedies, topical versus concoctions, and decoctions). In addition, many of the cultural practices are preserved among the Southeast Asian minorities residing in the United Kingdom and North America. Eastern treatments typically take a holistic approach to AD and emphasize the psychosomatic component of the disorder. This overview provides a summary of the difference between Conventional, Complementary, Alternative, and Integrative Medicine in terms of epidemiology, aetiology, therapy, and prognosis in children with AD. There are a number of similarities in genetic and environmental factors in epidemiology and aetiology; however, differences exist in terms of the concept of management. Complementary and alternative medicine, traditional Chinese medicine, and integrative medicine usage are not only prevalent among the Asian population but are also becoming more popular and accepted in Western societies.

BACKGROUND Dupilumab has been demonstrated to be an effective treatment for patients with moderate-to-severe atopic dermatitis (AD) in clinical trials. However, evidence of real-world experience with dupilumab in a broader population is limited to date. METHODS Adult patients with moderate-to-severe AD, defined as an Eczema Area Severity Index (EASI) score of 24 or higher, treated with dupilumab at ten Italian academic centers, were included in the study. Physician-reported outcome measures (EASI), patient-reported outcome measures (pruritus and sleep score, Dermatology Life Quality Index, DLQI) and serological markers [immunoglobulin (Ig) E and eosinophil count] after 16 weeks were analyzed. RESULTS We enrolled 543 patients with moderate-to-severe AD. Two patients (0.4%) discontinued treatment. The median ± interquartile percentage change from baseline to 16 weeks of treatment in the EASI score was -87.5±22.0 (p

Background: Dysbiosis and colonization with Staphylococcus aureus is considered to play an important role in the pathogenesis of atopic dermatitis (AD). Recovering this dysbiosis may improve AD symptoms. Omiganan is a synthetic indolicidin analogue antimicrobial peptide with activity against S aureus and could be a viable new treatment option for AD.Objective: To explore the tolerability, clinical efficacy, and pharmacodynamics of omiganan in mild to moderate AD.Methods: Eighty patients were randomized to omiganan 1%, 1.75%, or 2.5% or vehicle twice daily for 28 days on all lesions. Weekly visits included clinical scores and microbiological and pharmacodynamic assessments of 1 target lesion.Results: In all omiganan treatment groups, dysbiosis was recovered by reducing Staphylococcus species abundance and increasing diversity. A reduction of cultured S aureus was observed in all omiganan treatment groups, with a significant reduction for omiganan 2.5% compared to vehicle (-93.5%; 95% CI, -99.2 to -28.5%; P = .02). No significant clinical improvement was observed.Conclusion: Topical administration of omiganan twice daily for up to 28 days in patients with mild to moderate AD led to a recovery of dysbiosis but without clinical improvement. Therefore, a monotreatment that selectively targets the microbiome does not appear to be a successful treatment strategy in mild to moderate AD.

Atopic dermatitis (AD) is a pruritic, inflammatory skin disease associated with various comorbidities. However, comprehensive analyses of real-world comorbidities in adult patients with AD are limited.To characterize the real-world comorbidities associated with adult AD in an ambulatory population.We queried the MarketScan Commercial Claims and Encounters database from January 1, 2017 to December 31, 2017. Multivariable logistic regressions were performed to compare comorbidities in adult patients with AD versus age- and sex-matched controls.A total of 39,779 patients with AD and 353,743 controls were identified. Increased odds of psychiatric conditions, including anxiety (odds ratio [OR] 1.44) and mood disorders (OR 1.31), were observed in patients with AD. Patients with AD had higher likelihoods of autoimmune diseases, including vitiligo (OR 4.44) and alopecia areata (OR 6.01). Adult AD was also associated with infections, including impetigo (OR 9.72), methicillin-resistant Staphylococcus aureus (OR 3.92), and cellulitis (OR 2.52). Patients with AD were more likely to have systemic conditions, including lymphoid/hematopoietic malignancy (OR 1.91), atherosclerosis (OR 1.69), and metabolic syndrome (OR 1.47). For all the above, P .001.Retrospective analysis of health care claims data.Adult AD is associated with various psychiatric and systemic comorbidities, emphasizing the systemic nature of AD and the need for the collaborative management of these patients.

Background: Early exposure to allergens through a defect skin barrier has been proposed as a mechanism for inducing sensitization and development of allergic diseases. We hypothesized that early-onset, severe atopic dermatitis (AD) is associated with development of aeroallergen sensitization and allergic rhinitis. Methods: We included 368 children from the Copenhagen Prospective Studies on Asthma in Childhood2000 (COPSAC2000) at-risk mother-child cohort. AD was diagnosed prospectively based on Hanifin&Rajka's criteria and severity assessed using the Scoring Atopic Dermatitis (SCORAD) index. Early-onset AD was defined as debut ≤1 year, late-onset as debut from 1–6 years. Aeroallergen sensitization and allergic rhinitis were diagnosed at ages 6–7 and 12 years. Associations between early-onset and late-onset AD and allergy endpoints were calculated using general estimating equations (GEE) models to compute the overall odds ratios (OR) for both time points. Results: Early-onset AD (yes/no) and severity (SCORAD) were associated with development of aeroallergen sensitization during childhood; GEE OR = 1.68 [1.08; 2.62], p =.02 and 1.08 [1.03; 1.12], p sensitization =.03 and p-interactionrhinitis

Given the role of the interaction between gut microbiome with dermatological diseases, namely “gut-skin axis”, the present author proved that gut restoration should alleviate canine atopic dermatitis (CAD), which was the purpose of the study. A 4-week, open-label, non-controlled case series involved 8 -owned dogs with CAD which had received no previous treatment. Evaluations included Canine Atopic Dermatitis Extent and Severity Index version 4 (CADESI-04 scores), Visual Analog Scale (VAS) pruritus scores and Polycheck in vitro allergen specific tests. Faecal samples were analysed by dual indexing one-step PCR and 16S rRNA targeted metagenomics for detecting gut microbiota alterations before and after fecal microbiota transplantation (FMT) capsule treatment twice daily for 4 weeks. All cases were presenting pruritus and all of those dogs showed elevated IgE levels. CADESI scores decreased on days 28 (4-21) compared to day 0 initial values (50-128). Similarly, decreased VAS scores were detected on days 28 (0-2) in contrast to prior values (6-10). Regarding epidermal barrier functioning epidermal hydration (55-100 vs. 4-24) and pH (6.-7.8 vs. 4.2-5.7) values were elevated after FMT treatment in contrast to prior ranges, respectively. Alpha diversity revaled both richness and diversity of gut microbiota were improved for all cases on day 28. Furthermore at the end of trial Firmicutes: Bacteroidetes ratio was 8, the benchmark detected for healthy dogs. The present study supports a potential benefit of FMT capsule treatment against CAD. This safe and tolerant treatment modality directed against CAD shifted the gut microbiome composition towards a healthy state for all 8 dogs enrolled.

Atopic dermatitis (AD) and psoriasis represent two of the most common inflammatory skin diseases in developed countries. A hallmark of both diseases is T cell infiltration into the skin. However, it is still not clarified to what extent these infiltrating T cells are antigen-specific skin-homing T cells or unspecific heterogeneous bystander cells. To elucidate this, T cells from lesional skin and from blood of 10 AD and 11 psoriasis patients were compared by receptor (TCR) sequencing. Therefore, peripheral blood mononuclear cells (PBMC) were cell-sorted according to expression of the cutaneous leukocyte antigen (CLA) into skin-homing (CLA+) and non-skin-homing (CLA-) subfractions. Aeroallergen-specific T cell lines were grown from AD patients’ s PBMC in parallel. Intra-individual comparison of TCRB CDR3 regions revealed that clonally expanded T cells in skin lesions of both AD and psoriasis patients corresponded to skin-homing circulating T cells. However, in psoriasis patients, these T cell clones were also detectable to a larger extent among CLA- circulating T cells. Up to 28% of infiltrating cells were identified as allergen-specific by overlapping TCR sequences. Our data shows that in line with the systemic nature of psoriasis, T cells infiltrating psoriatic skin lesions do not exclusively home to the skin and are therefore not specific to antigens that are exclusively encountered at the skin. T cells driving AD skin inflammation appear to home nearly exclusively to the skin and are, to a certain extent, specific to aeroallergens. One Sentence Summary In contrast to psoriasis, T cells driving atopic dermatitis are predominantly skin-homing and are to a certain extent allergen-specific Key Message / Significance Statement T cells that encounter their cognate antigen proliferate clonally and share the same T cell receptor (TCR). Here we describe that clonally expanded T cells from lesional skin in patients with psoriasis and atopic dermatitis (AD) can also be detected within the circulation. While in AD these are mostly homing to the skin, psoriasis-driving T cells do not appear to be exclusively skin-directed. The fact that several co-morbidities are associated with psoriasis matches this observation. In contrast, AD is commonly accompanied by allergic sensitizations. Here we demonstrate that allergen-specific T cells do indeed infiltrate lesional skin and allow a concrete estimate of their frequency.

Background: Hand eczema is common in patients with atopic dermatitis (AD), but few studies have described the characteristics of these patients in large, representative populations from different geographic regions and occupational settings. Objective: To describe the epidemiological, clinical, and allergy profile of patients with hand eczema who underwent patch testing and compare patients with and without AD. Methods: Analysis of data from the Spanish Contact Dermatitis Registry, a multicenter registry of patients who undergo patch testing in Spain. Results: We included 1466 patients with hand eczema who were patch tested between January 2018 and June 2020. Those with AD were younger and had had symptoms for longer before testing. They were also more likely to have been exposed to occupational triggers (38% vs 53% for patients without AD). The only profession for which significant differences were found was hairdressing. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, cobalt chloride, potassium dichromate, fragrance mixes I and II, and formaldehyde. The most common diagnoses were allergic contact dermatitis (24% vs 31% in patients with and without AD, P=.0224) and irritant contact dermatitis (18% and 35% respectively, P

Adult atopic dermatitis (AD), especially adult-onset type appears to have different clinical manifestations. Dupilumab is an IL-4 receptor antagonist used in patients with moderate and severe atopic dermatitis, aged 12 years and older and it works by inhibiting the IL-4 and IL-13 signaling pathway. The purpose of our study is to retrospectively investigate the side effect profile and drug efficacy of thirteen adult patients who received dupilumab treatment and to evaluate the drug use status and the results during the COVID-19 pandemicour stuAdult atopic dermatitis (AD), especially adult-onset type appears to have different clinical manifestations. Dupilumab is an IL-4 receptor antagonist used in patients with moderate and severe atopic dermatitis, aged 12 years and older and it works by inhibiting the IL-4 and IL-13 signaling pathway. The purpose of our study is to retrospectively investigate the side effect profile and drug efficacy of thirteen adult patients who received dupilumab treatment and to evaluate the drug use status and the results during the COVID-19 pandemicAdult atopic dermatitis (AD), especially adult-onset type appears to have different clinical manifestations. Dupilumab is an IL-4 receptor antagonist used in patients with moderate and severe atopic dermatitis, aged 12 years and older and it works by inhibiting the IL-4 and IL-13 signaling pathway. The purpose of dy is to retrospectively investigate the side effect profile and drug efficacy of thirteen adult patients who received dupilumab treatment and to evaluate the drug use status and the results during the COVID-19 pandemicAdult atopic dermatitis (AD), especially adult-onset type appears to have different clinical manifestations. Dupilumab is an IL-4 receptor antagonist used in patients with moderate and severe atopic dermatitis, aged 12 years and older and it works by inhibiting the IL-4 and IL-13 signaling pathway. The purpose of our study is to retrospectively investigate the side effect profile and drug efficacy of thirteen adult patients who received dupilumab treatment and to evaluate the drug use status and the results during the COVID-19 pandemic.Thirteen patients with clinical and/or histopathological diagnoses of atopic dermatitis who received dupilumab treatment and were subsequently followed up in Bezmialem Vakif University dermatology outpatient clinic between April 2019 and October 2021 were included in our study.Patient files were reviewed, and patients were interviewed in-person or by phone to learn about the COVID-19 contagion.Descriptive statistical analysis was performed with Microsoft Excel, and the data obtained were calculated as mean and percentage.All of our patients responded to the treatment after one course of dupilumab injection and also CRP and LDH levels decreased. Conjunctivitis side effect was found at a slightly higher rate than in previous clinical studies. The treatment was continued during the COVID-19 pandemic in most patients. Meanwhile, four patients had COVID-19 infection, but one of them was not using dupixent at that time.We can conclude that dupilumab is an effective and safe therapy for patients with severe AD also in cases of severe infections.

The efficacy of abrocitinib for atopic dermatitis remains controversial.We conducted a systematic review and meta-analysis to explore the influence of abrocitinib versus placebo on the treatment of atopic dermatitis.We searched PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases up to June 2021 for randomized controlled trials (RCTs) assessing the effect of abrocitinib versus placebo for patients with atopic dermatitis. This meta-analysis was performed using a random-effect model.Four RCTs involving 932 patients were included in the meta-analysis. Overall, compared with the control group for atopic dermatitis, abrocitinib has a remarkably positive impact on IGA response (OR = 6.60; 95% CI: 4.41-9.87;Abrocitinib exerts a favorable effect on the treatment of atopic dermatitis.

Background In the SARS-CoV-2/COVID-19 pandemic, we need to understand the impact of immunomodulatory medications on COVID-19 symptom severity in patients with inflammatory diseases, including the type 2/Th2 polarized skin disease, atopic dermatitis (AD). Objective Because it is believed that type 1/Th1 immunity controls viral infections and that there is a Th1/Th2 counter-regulation, we hypothesized that Th2 targeting with the IL-4Rα-antagonist, dupilumab, in patients with moderate-to-severe AD would rebalance the Th1/Th2 axis, potentially leading to attenuated COVID-19 symptoms. Methods A total of 1237 patients with moderate-to-severe AD in the Icahn School of Medicine at Mount Sinai Department of Dermatology were enrolled in a registry. Patients were screened for COVID-19-related symptoms and assigned a severity score (asymptomatic [0]-fatal [5]). Scores were compared among 3 treatment groups: dupilumab (n = 632), other systemic treatments (n = 107), and limited/no treatment (n = 498). Demographic and comorbid covariates were adjusted by multivariate generalized logistic regression models. Results The dupilumab-treated group showed reduced incidence and severity of COVID-19 symptoms versus other treatment groups. Dupilumab-treated patients were less likely to experience moderate-to-severe symptoms versus patients on other systemics (P = .01) and on limited/no treatment (P = .04), and less likely to experience any symptoms versus patients on other systemics (P = .01). This effect was seen in our entire cohort and in the subgroup of patients with verified COVID-19 or high-risk exposure. Conclusions Patients on dupilumab experienced less severe COVID-19 manifestations and lesser symptoms compared with patients on other systemics and on limited/no treatment. These results suggest that Th2 modulation with dupilumab may have a protective effect on anti-viral immune response in patients with AD.

The aim of this overview is to map the current (2023) practices published in the academic literature for the management of atopic dermatitis.

IntroductionPatients with atopic dermatitis (AD) have an increased risk for infections. This open-label extension study, LIBERTY AD OLE, reports the incidence of infections in adults with moderate-to-severe AD treated with dupilumab for up to 4years.MethodsWe evaluated infections in adults with moderate-to-severe AD treated with dupilumab 300mg weekly (qw) or every 2weeks (q2w; approved regimen) for up to 4years. Topical corticosteroids (TCS) and calcineurin inhibitors (TCI) were permitted. Exposure-adjusted incidence rates (number of patients with at least one event per 100 patient-years [nP/100PY]) are reported.ResultsOverall, 2677 patients were enrolled and treated with dupilumab: 352 (13.1%) completed up to week204; 226 patients (8.4%) switched from qw to q2w during the trial. Rates of overall infections (71.27nP/100PY), serious and/or severe infections (1.39nP/100PY), and infections leading to discontinuation (0.34nP/100PY) were consistent with a previous 3-year analysis of this study and low compared with 1-year results in adults with AD treated with placebo + TCS. The cumulative number of patients with treatment-emergent serious or severe infections, non-herpetic or herpetic infections, and total skin infections decreasedyear-over-year. Limitations included open-label study design with no placebo arm; decreasing sample size at later time points due to sponsor decision to close sites following regulatory approval; qw dosing differs from approved q2w dosing; and patients could use TCS/TCI throughout the study, which may have impacted infection rates.ConclusionsContinuous long-term dupilumab treatment in adults with moderate-to-severe AD is not associated with an increased risk of overall systemic or cutaneous infections.Trial registrationClinicalTrials.gov Identifier: NCT01949311. Video Abstract INFOGRAPHIC.

Atopic dermatitis (AD) is a chronic, inflammatory condition that presents itself in myriad ways, greatly influenced by its multifactorial origins. Populations with skin of color (SOC) exhibit notable variations in clinical, genetic, and endotypic features of this disease. These disparities, coupled with gaps in research, clinical understanding, and education, contribute to racial and ethnic differences in the management of AD. To address these disparities and improve our understanding of AD in SOC populations, we are planning to conduct a comprehensive scoping review.

This scoping systematic review will synthesize emerging technologies for diagnosing, managing, and treating contact dermatitis (CD) and atopic dermatitis (AD). It will examine advancements like teledermatology, AI, ML, mobile health applications, and omics data analysis. It will emphasize the need for further research to refine algorithms, validate their effectiveness in diverse populations, and address ethical and privacy concerns related to patient data.

BACKGROUND: Ocular surface diseases (OSDs), including conjunctivitis and blepharitis, are common in atopic dermatitis (AD) patients, but the magnitude and patient characteristics are unclear.OBJECTIVES: To examine the prevalence of OSDs in adults with AD and identify patient characteristics and risk factors.METHODS: We designed a cross-sectional questionnaire-based survey and sent it via a secure public mail to all adult Danes with a hospital diagnosis of AD (ICD-10 code L20.x) registered in the National Patient Register (n=16,718) between 2000-2019 and 7,044 (42%) participated. Primary outcomes were OSDs and severity according to Ocular Surface Disease Index (OSDI). Adjusted odds ratios (aOR) were calculated with 95% confidence intervals (CIs) using logistic regression models.RESULTS: Respondents were mostly females and middle-aged (67.4%, mean [SD] age, 39.0 [15.5] years). Based on Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD) 49% had mild AD, 35% moderate, 10% severe and in 6% AD was inactive. 44.3% reported physician-diagnosed asthma bronchiale and 55.8% rhinitis. The lifetime prevalence of OSDs was 66.6% for conjunctivitis, 63.5% for hordeolum, 11.0% for blepharitis, 9.7% for keratitis, 2.0% for pterygium, 1.5% for symblepharon, 1.1% for keratoconus and 12.7% reported current conjunctivitis. Factors associated with lifetime occurrence of conjunctivitis included mild, moderate, and severe AD (aOR=1.48 [95% CI, 1.02-2.14], aOR=1.73 [95% CI, 1.19-2.53], aOR=2.17 [95% CI, 1.42-3.21]), asthma bronchiale and rhinitis (aOR=1.76 [95% CI, 1.49-2.07]), childhood-onset of AD (aOR=1.34 [95% CI, 1.16-1.56]) and systemic AD treatment (aOR=1.27 [95% CI, 1.08-1.50]). Use of soft and hard contact lenses (aOR=2.15 [95% CI, 1.65-2.80], aOR=3.35 [95% CI, 1.62-6.92]) were associated with lifetime occurrence of keratitis. Moderate and severe AD, asthma bronchiale and rhinitis were also associated with a higher OSDI level.CONCLUSIONS: This study identified important patient factors associated with OSDs. Clinicians should be attentive of ocular signs and symptoms in AD patients and ask about these.

Background: In JADE COMPARE, abrocitinib improved severity of atopic dermatitis (AD) and demonstrated rapid itch relief. Objectives: We examined clinically meaningful improvements in selected patient-reported outcomes (PROs). Methods: JADE COMPARE was a multicentre, phase 3 randomized, double-blind, placebo-controlled trial. Adults with moderate-to-severe AD were randomized 2:2:2:1 to receive 16 weeks of oral abrocitinib 200 or 100 mg once daily, dupilumab 300 mg subcutaneous injection every 2 weeks, or placebo, with background topical therapy. PROs included Dermatology Life Quality Index (DLQI), Patient-Oriented Eczema Measure (POEM), Night Time Itch Scale (NTIS), Pruritus and Symptoms Assessment for Atopic Dermatitis, Patient Global Assessment, SCORing Atopic Dermatitis, and Hospital Anxiety and Depression Scale. Results: At week 16, the proportion of patients achieving POEM scores

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with intense and persistent pruritus. Objectives: To examine associations between AD symptoms and health-related quality of life (HRQoL) in adults (aged ≥18 years) with moderate-to-severe AD. Materials & Methods: Patient chart and survey data from physicians within Europe were derived from the Adelphi AD Disease Specific Programme (Q3 2019-Q2 2020). HRQoL measures included Euro-Qol 5-dimension, 3-level, questionnaire; Dermatology Life Quality Index; and Work Productivity and Activity Impairment—Atopic Dermatitis questionnaire. Data were evaluated using descriptive statistics and generalized linear models. Results: Of 631 patients, 90.1%, 49.3%, 18.5% and 17.7% reported pruritus, sleep disruption, anxiety and depression, respectively. Adjusted analyses indicated an increased frequency of symptoms associated with worse HRQoL and greater work/activity impairments, particularly for patients with pruritus and sleep disruption. Conclusion: Reductions in symptom frequency may have important implications for improving the overall health of patients with moderate-to-severe AD.

Healthy newborn skin care is challenging task. The basic principles of care should be taught to both medical staff and parents. This care is more crucial in children with atopic dermatitis who have abnormal skin acidity due to multifactorial exposure. Significant pH reduction leads to aggravation of the skin process that requires active therapeutic measures. The article presents guidelines for the first infant's skin cleaning, for conducting first and daily bathing, for using cleansing agents and daily care solutions to prevent skin acidity disorders and the development of atopic dermatitis.

In current conditions, traditional antiallergic therapy for atopic dermatitis does not always help to achieve timely remission, so the development of effective therapy methods is a very topical task. The promising direction of probiotics in combination with prebiot-ics, including the original mono-strain synbiotic Lactobacillus rhamnosus LGG® at optimal high concentration of 4 х 109 CFU and prebiotic fructooligosaccharides 800 mg is drawing attention. This article presents data in a clinical case format. This article presents its own data in a clinical case format. The clinical case 1 showed that administration of synbiotic in 1 sachet 1 time per day for 14 days in the composition therapeutic diet during the period of complex antiallergic therapy to a 5-month-old child with a moderate course of atopic dermatitis resulted in a pronounced positive dynamics and achievement of remission on the 10th day after the treatment start against normalization of stool. Prior to this, the child had received only antiallergic therapy, which led to improvement of the skin process, but full clinical remission could not be achieved. Clinical case 2 showed the effectiveness of synbiotic in the composition therapeutic diet during the period of comprehensive antiallergic therapy in a 10-month-old child with a mild course of atopic dermatitis. From day 2 of treatment there was a significant positive dynamics in the skin process. On day 12, remission was achieved: relief of acute inflammatory elements on the face and at the elbows on the background of increased lactobaciUus content from 104 to 106 CFU/g of feces and bifidobacteria from 107 to 109 CFU/g of feces. Clinical case 3 demonstrates the efficacy of synbiotic in 2 sachets once a day for 14 days in a 9-year-old child with atopic dermatitis of moderate severity with a continuously relapsing course. From the 4th day of the beginning of the complex therapy positive dynamics in the skin process was noted, on the 14th day partial remission was achieved: erythematous elements on the back and extremities were eliminated, signs of hyperemia, infiltration and scratching disappeared against the background of stool normalization. Signs of dryness and slight lichenification persisted. Thus, these clinical examples demonstrate a high efficacy of synbiotic treatment in the complex antiallergic therapy of atopic dermatitis in children.

Oki Suwarsa, Maryam Nissa Hazari, Hartati Purbo Dharmadji, Reiva Farah Dwiyana, Raden Mohamad Rendy Ariezal Effendi, Risa Miliawati Nurul Hidayah, Erda Avriyanti, Hendra Gunawan, Endang Sutedja Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, West Java, IndonesiaCorrespondence: Hendra GunawanDepartment of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Hasan Sadikin General Hospital, Pasteur 38, Bandung, West Java, 40161, IndonesiaTel +62 222032426 ext. 3449Fax +62 222032426Email h.gunawan2016@unpad.ac.idBackground: Atopic dermatitis (AD) interferes with quality of life and is influenced by important factors like skin microbiome. The results of the skin microbiome composition and diversity in AD varied in some studies.Purpose: This study aims to determine the composition and diversity of the skin microbiome in Indonesian AD patients.Patients and Methods: Genomic deoxyribonucleic acid (DNA) preparations were obtained from skin swabs of the cubital fossa of 16 subjects, nine of which were having mild AD, three moderate AD, and four healthy individuals. DNA extraction and sequencing of the 16S ribosomal ribonucleic acid (rRNA) gene using next-generation sequencing and bioinformatics analysis were further performed.Results: Firmicutes (p), Bacilli (c), Bacillales (o), Staphylococcaceae (f), and Staphylococcus (g) were dominant in moderate AD. On the contrary, Proteobacteria (p), Gammaproteobacteria (c), Pseudomonadales (o), Moraxellaceae (f), and Acinetobacter (g) were dominant in mild AD. Staphylococcus aureus was found in the highest number in individuals with moderate AD. Interestingly, Ensifer adhaerens was found in mild AD. Microbial diversity was decreased in moderate AD.Conclusion: Metagenomic analysis in this study identified microbes in moderate and mild AD and showed a low diversity of skin microbiomes in moderate AD. Interestingly, this is the first time that the bacteria Ensifer adhaerens was detected on the human skin.Keywords: atopic dermatitis, microbiome, skin microbiome

This article presents a case of the successful use of dupilumab in a 21-year-old patient with severe atopic dermatitis, concomitant bronchial asthma, and allergic rhinitis. The patient was observed in the allergological department of the Krasnoyarsk Clinical Regional Hospital for 2 years. The disease was characterized by constant skin symptoms, frequent exacerbations, resistance to standard therapy, including systemic glucocorticosteroids and immunosuppressors. Considering the above factors, targeted therapy was started with dupilumab, registered in the Russian Federation for use in atopic dermatitis resistant to standard therapy. Against the background of biological therapy (13 injections were carried out), a stable significant decrease in skin syndrome activity was achieved (SCORAD index decreased from 72 to 9 points), and the patients quality of life significantly improved.

BACKGROUND: Atopic dermatitis is considered a childhood illness, and the direct and indirect health care burden of atopic dermatitis in adults is not fully understood. OBJECTIVE: To measure the dir...

BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by unrelenting pruritus and recurrent eczematous lesions. It affects up to 15% of children and adolescents and up to 5% of adults, and confers a high and multifactorial burden to patients, families and society. With increasing awareness of this substantial burden, AD has become a priority for healthcare systems. AIM The Atopic Dermatitis Quality of Care (ADQoC) initiative set out to describe good practices for addressing the challenges that impede the management of AD. METHODS The initiative carried out a literature review and surveyed 32 expert care centres, catalogued findings, and analysed and elucidated global challenges to AD care along with good practice implementations that can address them. RESULTS The four challenges to quality care for AD are: (i) misconceptions about AD; (ii) delayed referral and access to AD specialists; (iii) poor patient access to AD treatments and poor adherence to medications; and (iv) managing the complexity of AD and its comorbidities. The initiative highlighted 5 of 10 good practice implementations as high priority for any AD care centre to focus on: (i) clinical assessment and diagnosis; (ii) a structured multidisciplinary care team; (iii) monitoring and evaluating care quality; (iv) patient education and communication; and (v) collaboration and exchange with patient groups. CONCLUSION These implementations can provide benefits for patients, healthcare providers and the healthcare system. They directly contribute to the efficacy of treatment, improved healthcare provider efficiency, improved education for patients and healthcare providers, and improved costs to healthcare systems. The initiative was launched on https://atopicdermatitiscare.kpmg.co.uk/ to provide an easy-to-use educational platform.

Background Adult-onset atopic dermatitis (AD) diagnosis is very challenging as it presents with clinical heterogeneity and can mimic a broad of differential diagnoses such as mycosis fungoid and psoriasis. Herein, we report a lupus-like presentation of adult-onset AD. Clinical case A 32-year-old man with a history of asthma presented to our department with a – lupus like – malar rash. Cutaneous lupus was suspected, but neither clinical, nor paraclinical or immunological assessment were in favor of the disease, skin biopsy revealed epidermal spongiosis, and eosinophilic infiltrate which, together with the patient's personal history and laboratory abnormalities, allowed the diagnosis of late-onset AD. Treatment with topical corticosteroids on the body and tacrolimus on the face was started, with good improvement. Conclusion Adult AD can simulate cutaneous lupus. Recognition of the clinical mimickers of AD is crucial for an accurate diagnosis.

There is a strong interaction between the immunological and nervous system in the skin. Lesions that are physically disfiguring and chronically relapsing have a high impact on quality of life (QoL) and can result in the emergence of psychiatric disorders. The literature data confirm a higher prevalence of psychiatric disorders in patients with psoriasis, hidradenitis suppurativa (HS) and atopic dermatitis (AD), but such data are compromised by low-quality evidence due to methodological heterogeneity.The primary aim was to analyse the prevalence of psychiatric comorbidities in a group of psoriasis, AD and HS patients compared with a control group. The secondary aims were to evaluate the impact of psychiatric comorbidities on the disease development, severity, flare-ups and QoL.A total of 59 cases and 64 controls were included.Generalized anxiety disorder and depressive disorder with anxious distress were found to be risk factors for AD. Age, smoking and substance-related disorder showed a specific association with HS. Major depressive disorder showed a specific association with dermatology life quality index (DLQI) and all the above disease flare-ups.Atopic dermatitis, psoriasis and HS are associated with psychiatric disorders. A psychodermatological approach improves outcomes in terms of QoL, disease flare-ups and long-term management.

Objective To review recent trends in the development of targeted small molecule drugs (SMDs) for the treatment of immunologically driven disorders, including atopic dermatitis, rheumatoid arthritis, and hereditary angioedema. Data sources Data sources included peer-reviewed published literature from the PubMed database, published abstracts from scientific and medical meetings, and medication information from the Drugs@FDA database. Study selections Articles with primary or retrospective trial results, articles with patient or physician survey results, articles providing expert perspectives, and commentary on chronic immunologic disorders, Food and Drug Administration package inserts, and abstracts from scientific meetings were selected. Results Targeted biological therapies have greatly improved response rates and symptom relief for patients with long-term immunologically driven disorders over the past 2 decades. However, recent advances in the understanding of molecular pathways involved in the pathogenesis of these disorders have led to the development of novel targeted SMDs, such as tofacitinib and berotralstat, that can be delivered orally or topically. Few head-to-head studies that compare the safety and efficacy of biologics to SMDs in immunologically driven disorders exist, although some studies suggest that oral and topical modes of administration are preferred by patients and may improve patient quality of life over time. Conclusion Scientific advances have led to an increase in the development of targeted SMDs for the treatment of chronic immunologic disorders, which may revolutionize the management of these diseases. Head-to-head studies and real-world evidence are needed to fully compare treatment attributes between biologics and SMDs, including safety, efficacy, adherence, impact on quality of life, and cost-effectiveness.

Background There is incomplete understanding of the risk of coronavirus disease 2019 (COVID-19) infection in atopic dermatitis (AD) patients. Objective To evaluate the risk of COVID-19 infection in AD patients in a large, diverse cohort. Methods A case-control study of the All of Us cohort to analyze the association between AD and COVID-19. Comorbidities and risk factors were compared between cases and controls using multivariable analyses. Results In a cohort of 11,752 AD cases with 47,008 matched controls, AD patients were more likely to have a COVID-19 diagnosis (4.2% vs. 2.8%, P

Background Various atopic dermatitis (AD) phenotypes showed an enormously heterogenic risk for subsequent asthma development. Objective We aimed to investigate the association between AD phenotypes and the risk for progression to asthma. Methods We searched PubMed, Embase, and Web of Science databases for relevant publications. Pooled relative risks (RR) with 95% CI were calculated using the CMA-3.0 software. This study has been registered with PROSPERO (CRD42019129273). Results We analyzed 39 publications with 458,810 participants. The RR for asthma in AD was 2.16 (95% CI, 1.88-2.48). The risk in persistent AD (RR, 3.36; 95% CI, 2.83-3.99) was higher than in transient AD (RR, 1.52; 95% CI, 1.34-1.73), and the risk in severe AD (RR, 2.40; 95% CI, 1.96-2.94) was higher than in mild AD (RR, 1.82; 95% CI, 1.03-3.23) or moderate AD (RR, 1.51; 95% CI, 1.30-1.75). The risk for asthma in early-onset AD was slightly higher than in late-onset AD and higher in boys than in girls. Limitations The AD and asthma definitions differed across the included studies. Conclusion Patients with persistent or severe AD were at a higher risk for developing asthma. These findings further elucidate the atopic march and identify target populations for asthma prevention.