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Background: Janus kinase inhibitors (JAKinibs) have the potential to dramatically alter the landscape of atopic dermatitis (AD) management due to their promising efficacy results from phase 3 trials and rapid onset of action. However, JAKinibs are not without risk, and their use is not appropriate for all AD patients, making this a medication class that dermatologists should understand and consider when treating patients with moderate-to-severe AD., Objective: This consensus expert opinion statement from the International Eczema Council (IEC) provides a pragmatic approach to prescribing JAKinibs, including choosing appropriate patients, dosing, clinical and lab monitoring, as well as long-term use., Methods: An international cohort of authors from the IEC with expertise in JAKinibs selected topics of interest and were formed into authorship groups covering 10 subsections. The groups performed topic-specific literature reviews, consulted up-to-date adverse event (AE) data, referred to product labels and provided analysis and expert opinion. The manuscript guidance and recommendations were reviewed by all authors as well as the IEC Research Committee., Results: We recommend JAKinibs be considered for patients with moderate to severe AD seeking the benefits of rapid reduction in disease burden and itch, oral administration, and the potential for flexible dosing. Baseline risk factors should be assessed prior to prescribing JAKinibs, including increasing age, venous thromboembolisms, malignancy, cardiovascular health, kidney/liver function, pregnancy and lactation, and immunocompetence. Patients being considered for JAKinib therapy should be current on vaccinations and we provide a generalized framework for laboratory monitoring, though clinicians should consult individual product labels for recommendations as there are variations among the JAKinib class. Patients who achieve disease control should be maintained on the lowest possible dose, as many of the observed AEs occurred in a dose-dependent manner. Future studies are needed in AD patients to assess the durability and safety of continuous long-term use of JAKinibs, combination medication regimens, and the effects of flexible, episodic treatment over time., Conclusions: The decision to initiate a JAKinib should be shared among patient and provider, accounting for AD severity and personal risk/benefit assessment, including consideration of baseline health risk factors, monitoring requirements and treatment costs., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists.)

Background: Despite previous attempts to classify atopic dermatitis (AD) into subtypes (e.g. extrinsic vs. intrinsic), there is a need to better understand specific phenotypes in adulthood., Objectives: To identify, using machine learning (ML), adult AD phenotypes., Methods: We used unsupervised cluster analysis to identify AD phenotypes by analysing different responses to predetermined variables (age of disease onset, severity, itch and skin pain intensity, flare frequency, anatomical location, presence and/or severity of current comorbidities) in adults with AD from the Danish Skin Cohort., Results: The unsupervised cluster analysis resulted in five clusters where AD severity most clearly differed. We classified them as 'mild', 'mild-to-moderate', 'moderate', 'severe' and 'very severe'. The severity of multiple predetermined patient-reported outcomes was positively associated with AD, including an increased number of flare-ups and increased flare-up duration and disease severity. However, an increased severity of rhinitis and mental health burden was also found for the mild-to-moderate phenotype., Conclusions: ML confirmed the use of disease severity for the categorization of phenotypes, and our cluster analysis provided novel detailed information about how flare patterns and duration are associated with AD disease severity., Competing Interests: Conflicts of interest Outside the submitted work, S.F.T. has been a speaker or advisor for Sanofi, AbbVie, LEO Pharma, Pfizer, Eli Lilly, Novartis, UCB Pharma, Almirall and Janssen Pharmaceuticals; and has received research support from Sanofi, AbbVie, LEO Pharma, Novartis, UCB Pharma and Janssen Pharmaceuticals. Outside of the submitted work, A.E. has received research funding from Pfizer, Eli Lilly, Novartis, Bristol Myers Squibb, AbbVie, Janssen Pharmaceuticals, Boehringer Ingelheim, the Danish National Psoriasis Foundation, the Simon Spies Foundation and the Kgl Hofbundtmager Aage Bang Foundation; and has received honoraria as consultant and/or speaker from Amgen, AbbVie, Almirall, LEO Pharma, Zuellig Pharma, Galápagos, Sun Pharmaceuticals, Samsung Bioepis, Pfizer, Eli Lilly, Novartis, Union Therapeutics, Galderma, Dermavant, UCB, Mylan, Bristol Myers Squibb, McNeil Consumer Healthcare, Horizon Therapeutics, Boehringer Ingelheim and Janssen Pharmaceuticals. Outside of the submitted work, J.P.T. is an advisor for AbbVie, Almirall, Arena Pharmaceuticals, Coloplast, OM Pharma, Aslan Pharmaceuticals, Union Therapeutics, Eli Lilly, LEO Pharma, Pfizer, Regeneron and Sanofi-Genzyme; is a speaker for AbbVie, Almirall, Eli Lilly, LEO Pharma, Pfizer, Regeneron and Sanofi-Genzyme; and has received research grants from Pfizer, Regeneron and Sanofi-Genzyme. J.P.T. is an employee of LEO Pharma. Outside the submitted work I.V. has received research funding from Sanofi/Regeneron Pharmaceuticals, Pfizer and AbbVie; personal honoraria from Pfizer for lecturing; and has been a subinvestigator for LEO Pharma. Outside the submitted work, A.-S.H. has received honoraria from LEO Pharma (speaker) and Coloplast (consultant). L.N. and M.-L.N. declare no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Competing Interests: Conflicts of interest I.V. has received financial support from Sanofi/Regeneron Pharmaceuticals, Pfizer and AbbVie; personal honoraria for lecturing for Pfizer; and has been a subinvestigator for Leo Pharma.

Background: Children with atopic dermatitis (AD) may have disturbed sleep, affected self-esteem and decreased quality of life, likely interfering with performance in school., Objectives: To examine the association between hospital-managed paediatric AD, school performance and cognitive function., Methods: In this cross-sectional study we linked data from the Danish national registers and identified three populations between 2001 and 2019. Population 1 comprised children with graduation grades registered from lower secondary school, population 2 comprised adolescents with registration of an upper secondary graduation mean, and population 3 comprised male conscripts with registration of an IQ test score. AD was defined as a hospital diagnostic code (inpatient or outpatient) prior to the exam or conscription date, and was stratified according to severity, activity and atopic comorbidity. Outcomes included graduation mean from lower and upper secondary school, special educational assistance in primary and lower secondary school, and IQ at conscription., Results: In total, 770 611 (12 137 with AD), 394 193 (6261 with AD) and 366 182 (4539 with AD) children and adolescents were included in populations 1 (lower secondary graduation), 2 (upper secondary graduation) and 3 (conscription), respectively. In lower secondary school, children with severe AD had significantly lower overall, written and oral graduation grade means compared with children with mild AD: respectively, difference -0.29 [95% confidence interval (CI) -0.45 to -0.13, P < 0.001], difference -0.26 (95% CI -0.42 to -0.10, P = 0.0016) and difference -0.30 (95% CI -0.49 to -0.11, P = 0.0018). In upper secondary school, adolescents with AD performed similarly to their peers without AD. Young men with AD scored significantly lower IQ test means at conscription examination than male conscripts without AD: difference -0.60 (95% CI -0.87 to -0.32, P < 0.001)., Conclusions: AD, in particular when severe, is associated with lower school performance in childhood and IQ in young men, which can interfere with academic achievements in life. Optimization of treatment of children with AD and specific educational support to children with severe AD could be needed., Competing Interests: Conflicts of interest I.V. has received salary from research funding from Sanofi and Regeneron Pharmaceuticals, Inc., and honoraria for lecturing from Pfizer Denmark. Y.M.F.A. has received research funding from the AP Møller Foundation and the Kgl Hofbundtmager Aage Bang Foundation. L.S. has been a paid speaker for AbbVie, Eli Lilly, Novartis and LEO Pharma; has been a consultant for or has served on advisory boards with AbbVie, Janssen-Cilag, Novartis, Eli Lilly, LEO Pharma, UCB, Almirall and Sanofi; has served as an investigator for AbbVie, Sanofi, Janssen-Cilag, Boehringer Ingelheim, AstraZeneca, Eli Lilly, Novartis, Regeneron and LEO Pharma; and has received research and educational grants from Novartis, Sanofi, Janssen-Cilag and LEO Pharma. J.J.W. is or has been an investigator, consultant or speaker for AbbVie, Almirall, Amgen, Arcutis, Aristea Therapeutics, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Dermavant, DermTech, Dr Reddy’s Laboratories, Eli Lilly, EPI Health, Galderma, Janssen, LEO Pharma, Mindera, Novartis, Pfizer, Regeneron, Samsung Bioepis, Sanofi, Solius, Sun Pharma, UCB and Zerigo Health. T.A. reports consulting fees and honoraria for lectures from Sanofi, LEO Pharma, Lilly, Pfizer and AbbVie; has received support for attending meetings and/or travel support from AbbVie; and has been an investigator for Sanofi, LEO Pharma and AbbVie. S.F.T. has been a consultant and/or served on advisory boards for AbbVie, Almirall, Celgene, Eli Lilly, Janssen, LEO Pharma, Novartis, Pfizer, Roche and Sanofi; has been a speaker for AbbVie, Eli Lilly, LEO Pharma, Novartis, Sanofi and UCB; and has received research support from AbbVie, LEO Pharma, Janssen, Novartis, Sanofi and UCB. A.E. has received research funding from Pfizer, Eli Lilly, the Danish National Psoriasis Foundation and the Kgl Hofbundtmager Aage Bang Foundation; and honoraria as a consultant and/or speaker for AbbVie, Almirall, LEO Pharma, Samsung Bioepis Co Ltd, Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, Bristol Myers Squibb, Mylan, UCB, Union Therapeutics and Janssen Pharmaceuticals. J.P.T. is an advisor for AbbVie, Almirall, Arena Pharmaceuticals, Coloplast, OM Pharma, Aslan Pharmaceuticals, Union Therapeutics, Eli Lilly & Co, LEO Pharma, Pfizer, Regeneron and Sanofi; is a speaker for AbbVie, Almirall, Eli Lilly & Co, LEO Pharma, Pfizer, Regeneron and Sanofi; and has received research grants from Pfizer, Regeneron and Sanofi., (© The Author(s) 2022. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)