Search

Atopic dermatitis (AD) is a chronic inflammatory skin disease with the highest disease burden among non-fatal dermatoses. Severe itching and frequent recurrence seriously affect the patients′ psychological and social functions, resulting in a significant decline in the patients′ quality of life. Using effective measurement instrument to assess the quality of life is an effective way to evaluate the quality of life of AD patients, and to improve patients′ care experience and the clinical outcomes. Here, we review the patient-reported quality-of-life measurement instruments, including generic instruments, dermatology-specific instruments, and disease-specific instruments used in AD. The generic instruments can be used to compare the quality of life of patients with AD and non-skin diseases, while the dermatology-specific instruments can be used to compare the quality of life of patients with different skin diseases. Dermatology-specific instruments and disease-specific instruments used in AD may have greater discriminatory power and higher specificity and sensitivity for subtle changes. How to choose the appropriate scale in clinical practice and research depends on the research question and the applicable population.

Abstract Introduction Patients with atopic dermatitis (AD) are uniquely susceptible to a number of serious viral skin complications, including eczema herpeticum (EH), caused by herpes simplex virus. This study explored the associations between biomarkers of epithelial barrier dysfunction, type 2 immunity, Staphylococcus aureus infection, and S. aureus-specific immunoglobulin responses in a cohort of AD subjects with and without a history of EH (EH+ and EH−, respectively). Methods A total of 112 subjects with AD (56 EH+, 56 EH−), matched by age and AD severity, were selected from a registry of over 3000 AD subjects. Logistic regression was used to test the association between history of S. aureus skin infection and history of EH, while controlling for a number of confounders. Results Compared to those without a history of S. aureus skin infection, subjects with a history of S. aureus skin infection were found to have more than sixfold increased odds of having a history of EH (6.60, 95% confidence interval [CI]: 2.00–21.83), after adjusting for history of other viral skin infections (molluscum contagiosum virus, human papillomavirus), serum total IgE, and IgG against the S. aureus virulence factor SElX. Conclusions These findings indicate an important relationship between S. aureus skin infections and EH.

Abstract The JAK-STAT signaling pathway mediates important cellular processes such as immune response, carcinogenesis, cell differentiation, division and death. Therefore, drugs that interfere with different JAK-STAT signaling patterns have potential indications for various medical conditions. The main dermatological targets of JAK-STAT pathway inhibitors are inflammatory or autoimmune diseases such as psoriasis, vitiligo, atopic dermatitis and alopecia areata; however, several dermatoses are under investigation to expand this list of indications. As JAK-STAT pathway inhibitors should gradually occupy a relevant space in dermatological prescriptions, this review presents the main available drugs, their immunological effects, and their pharmacological characteristics, related to clinical efficacy and safety, aiming to validate the best dermatological practice.

Jiaoquan Chen,&ast; Nanji Yu,&ast; Weihong Wu, Shanshan Ou, Quan Chen, Huilan Zhu Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, 510095, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Huilan Zhu, Department of Dermatology Guangzhou Institute of Dermatology, 56 Hengfu Road, Guangzhou, 510095, People’s Republic of China, Email zhlhuilan@126.comBackground: Although dupilumab is an effective treatment approach for chronic actinic dermatitis (CAD) in some cases, its effectiveness and safety in CAD have not been sufficiently assessed.Purpose: Evaluation of the effectiveness and safety of dupilumab in patients with recalcitrant CAD was performed.Methods: We retrospectively reviewed the medical records of CAD patients treated with dupilumab. Data regarding demographics were collected, and disease severity scores were assessed using the following: Clinical Severity Score of CAD (CSS-CAD), Atopic Dermatitis Control Tool (ADCT), Dermatology Life Quality Index (DLQI), and Numeric Rating Scale (NRS)-itch scores.Results: After 12 weeks of treatment, there was a significant decrease in disease severity scores of 16 CAD patients. Only one patient achieved a good response and most of the patients (62.5%, 10/16) had no significant symptom improvement after 4 weeks of treatment. However, after 12 weeks of treatment, 43.75% (7/16) of the patients reached excellent response (> 75% improvement of CSS-CAD), 31.25% (5/16) good response (50%– 75% improvement of CSS-CAD), 6.25% (1/16) partial response (25%– 50% improvement of CSS-CAD), and only 18.75% (3/16) no response (< 25% improvement of CSS-CAD). One patient complained of injection site reaction at the first injection.Conclusion: This study supports dupilumab as an effective and safe treatment option for patients with recalcitrant CAD. Patients may require at least 4 weeks of treatment before the partial response is noted.Keywords: chronic actinic dermatitis, dupilumab, photodermatitis, atopic dermatitis

Abstract Introduction Atopic dermatitis (AD) can require long-term therapy. Few real-world studies have evaluated long-term effectiveness from the patients’ perspective. The aim of this study was to evaluate patient-reported outcomes (PROs) during long-term dupilumab treatment. Methods Adults with moderate-to-severe AD who initiated dupilumab through the US manufacturer patient support program and participated in RELIEVE-AD (a prospective patient survey study with a 12-month follow-up) were recontacted 30–36 months post-initiation regardless of current dupilumab use. The online questionnaire consisted of PROs, including the Atopic Dermatitis Control Tool (ADCT), use of concomitant AD therapies, satisfaction with current therapy, global change in itch relative to before dupilumab initiation, non-itch skin symptoms (skin pain/soreness, hot/burning feeling, and sensitivity to touch), flares, Dermatology Life Quality Index, sleep problems, and the AD-specific Work Productivity and Activity Impairment Questionnaire. Results Of 698 patients who initiated dupilumab (baseline) and were recontacted, 425 completed the 30–36-month survey. Significant reductions from baseline were reported in concomitant AD therapy use (P

Abstract Background Cost-of-illness studies are widely used for healthcare decision-making in chronic conditions. Our aim was to assess the cost-of-illness of adult atopic dermatitis (AD) from the societal perspective in Hungary. Methods We conducted a multicentre, cross-sectional questionnaire survey between February 2018 and January 2021. Data was collected from consecutive AD patients aged ≥ 18 years and their physicians at dermatology departments in Hungary. We calculated direct and indirect costs, including costs for treatments, outpatient visits, hospital admissions, informal care, travel costs and productivity loss. To assess indirect costs, the Work Productivity and Activity Impairment (WPAI) questionnaire was used to collect data, and costs were estimated with the human capital approach. Generalized linear model was used to analyse predictors of total, direct and indirect costs. Results Altogether 218 patients completed the survey (57.8% female) with an average age of 31.3 (SD = 11.7). Patients’ average Dermatology Life Quality Index (DLQI) score was 13.5 (SD = 8.5). According to Eczema Area and Severity Index (EASI) score, 2.3% (n = 5), 21.2% (n = 46), 54.4% (n = 118) and 22.1% (n = 48) had clear, mild, moderate, and severe AD, respectively. We found that the average total, direct medical, direct non-medical and indirect annual costs per patients were €4,331, €1,136, €747, and €2450, respectively, with absenteeism and presenteeism being the main cost drivers, accounting for 24% and 29% of the total cost of AD. A one-year longer disease duration led to, on average, 1.6%, and 4.2% increase in total and direct non-medical costs, respectively. Patients with worse health-related quality of life (higher DLQI score) had significantly higher total, direct medical, direct non-medical costs, and indirect costs. Conclusions Our results indicate a substantial economic burden of AD from a societal perspective, mainly driven by productivity losses.

Li Liu,&ast; Jie Chen,&ast; Kangheng Tang, Feng Li, Si Li, Xiaojie Ding Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaojie Ding, Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, 1st Maoyuan South Road, Shunqing District, Nanchong, Sichuan Province, 637000, People’s Republic of China, Tel +8615881788808, Fax +8681715881788808, Email pfkdxj@126.comAbstract: Psoriasis and atopic dermatitis are relatively common in clinical practice, but it is rare for the two diseases to co-occur in the same patient. Dupilumab, an anti-IL-4/IL-13 monoclonal antibody, has been approved for treating moderate to severe AD. In addition to its therapeutic effects, dupilumab may induce new cutaneous adverse reactions. We report a rare case of pustular psoriasis induced during the treatment of atopic dermatitis with dupilumab. This case demonstrates the need for caution while treating patients with moderate to severe atopic dermatitis and staying vigilant for the emergence of new symptoms, especially with biological agents.Keywords: psoriasis, atopic dermatitis, dupilumab, case report

Silmara Cestari,1 Priscila Correia,2 Delphine Kerob3 1Department of Dermatology, Sírio Libanês Hospital, São Paulo, Brazil; 2Scientific Expertise, L’Oréal Brazil, Rio de Janeiro, Brazil; 3Medical Direction, La Roche-Posay Laboratoire Dermatologique, Levallois-Perret, FranceCorrespondence: Priscila Correia, Scientific Expertise, L’Oréal Brazil, Rio de Janeiro, Brazil, Email priscila.correia@loreal.comIntroduction: Atopic dermatitis (AD) is a chronic relapsing disease with a pathophysiology including skin barrier damage, microbiome disbalance and inflammation. Classically, emollients maintaining a healthy microbiome are recommended as the basis of any AD severity management.Objective: To assess the benefit of a light balm containing vitamin E, tocopherol and glycerine and enriched with Aqua posae filiformis and microresyl (Emollient+) in subjects with mild AD over a period of 168 days.Materials and Methods: For this open-label study, subjects above 3 years of age with mild and stable AD for at least 6 months before inclusion and with a SCORAD score of < 25 were eligible. Assessments took place at baseline, D14, D28, D84 and D168, and included SCORAD, flare frequency, severity of clinical signs and symptoms, skin hydration status using a Corneometer and local tolerance. QoL was assessed using the DLQI or CDLQI questionnaire. Subjects used Emollient+ at least once daily.Results: Overall, 56 subjects were included in this study. The mean age was 25.0± 20.0 years (45% children); 69.6% were females. Except for erythema in the paediatric population, all clinical parameters had significantly (all p < 0.05) improved at D28. At D168, SCORAD, signs and symptoms had significantly (all p < 0.05) improved in the global, adult and paediatric population at D168 compared to baseline. So did flares, skin hydration and QoL. The regimen was very well tolerated.Conclusion: Emollient+ is highly beneficial and well tolerated in mild AD with early benefits in improving AD signs and symptoms and skin hydration as well as the QoL of subjects as soon as D28.Clinicaltrials.gov identifier: NCT05783453.Keywords: atopic dermatitis, emollients, long term use

Background: Atopic dermatitis (AD) is a chronic skin inflammatory disease characterized by mild to severe itching, relapses, and mostly appears in infants and children. Although there have been current advances in the management of AD, satisfactory treatment has not been achieved. Purpose: To evaluate the treatment of patients with AD in order to provide better management. Methods: A retrospective study of newly diagnosed AD patients at the Allergy and Immunology Division of the Outpatient Unit, Dermatology and Venereology Clinic, Prof. Dr. R.D. Kandou Hospital Manado from 2019-2021. Result: Antihistamines were the most widely prescribed medication, administered to 108 patients of all patients’ visits, and 94 (87%) of them were given cetirizine (the most widely prescribed type). Emollients were used adequately; they included petroleum jelly in 82 patients (90.1%) and urea 10% cream in 9 patients (9.9%). Conclusion: There were 108 AD patients in Dermatology and Venereology Clinic, Prof. Dr. R.D. Kandou Hospital Manado from 2019-2021. Treatment with antihistamine and emollient therapy gave satisfactory results.

Abstract Introduction This real-world, cross-sectional study compared sociodemographic, clinical and treatment characteristics, and patient-reported outcomes (PROs) among racial/ethnic groups in patients with atopic dermatitis (AD) who are candidates for systemic therapy. Methods This study included adults with dermatologist- or dermatology practitioner-diagnosed AD enrolled in the CorEvitas AD Registry (July 2020–July 2021). All patients initiated systemic therapy within 12 months prior to or at enrollment or had moderate-to-severe AD (vIGA-AD® ≥ 3 and Eczema Area and Severity Index [EASI] ≥ 12) at enrollment. Patients were categorized into five mutually exclusive racial/ethnic groups: non-Hispanic White, Black, Asian, Other/Multiracial, and Hispanic (any race). Patient, clinical, and treatment characteristics were captured at enrollment. Differences in means or proportions of characteristics among racial/ethnic groups were descriptively summarized using effect sizes. Adjusted prevalence ratios and mean differences were estimated (White race/ethnicity group as the reference category) with 95% confidence intervals (CI). Results Among 1288 patients, 64% (n = 822) were White, 13% (n = 167) Black, 10% (n = 129) Asian, 8% (n = 97) Hispanic, and 6% (n = 73) Other/Multiracial. In adjusted analyses, statistically more severe EASI lichenification was noted among Black compared with White patients at the head and neck (mean difference, 0.21, [95% CI 0.06, 0.36]; p = 0.01), trunk (0.32, [0.17, 0.47]; p

Abstract Introduction Atopic dermatitis (AD) is heterogeneous in distribution pattern and clinical features. This analysis assessed the effect of dupilumab on the extent and severity of AD across various signs (erythema, edema/papulation, excoriation, lichenification) in different anatomical regions (head and neck, trunk, upper extremities, lower extremities) in patients aged 6 months to 5 years. Methods In LIBERTY AD PRESCHOOL, a double-blind, placebo-controlled, phase III clinical trial, children aged 6 months to 5 years with moderate-to-severe AD were randomized 1:1 to subcutaneous dupilumab or placebo with concomitant low-potency topical corticosteroids (TCS) every 4 weeks for 16 weeks. Changes in AD signs across anatomical regions were assessed using unweighted Eczema Area and Severity Index (EASI) body region scores. Results Overall, 162 patients were randomized to dupilumab (n = 83) or placebo (n = 79). A significant improvement in least squares mean EASI area score was seen by week 2 in all four anatomical regions (P

Background. Atopic dermatitis is an inflammatory skin disease characterized by recurrent lesions and intense pruritus. Nowadays there is a stepwise approach to the treatment of atopic dermatitis, which is defined by disease intensity and complications such as secondary skin infections. However, the current management of atopic dermatitis may not always lead to the expected outcome due to not only immune dysregulation of both adaptive and innate immunity but also imbalance of the skin microbiome. Aims. The aim of the study was to evaluate changes in the composition of the skin microbiome in both lesional and non-lesional skin in patients with atopic dermatitis during standard treatment. Materials and methods. Twenty patients with atopic dermatitis and twenty six healthy controls over 18 years old were included into the study. All microbiome samples were obtained from lesional and non-lesional skin sites of atopic dermatitis patients before and after therapy. Whereas samples from healthy controls were taken once from a flexor surface of the elbow. Species identification of clinical isolates were identified using MALDI Biotyper Sirius (Bruker Daltonics). Results. At baseline, the prevalence of S. aureus colonization among patients with atopic dermatitis was 34.20% in lesional skin and 32.50% in non-lesional skin. After treatment, there was a significant decrease in the prevalence of S. aureus carriage in both lesional and non-lesional skin areas (р 0.05). However, no significant difference was observed in the proportion of all other staphylococci (р 0.1). Interestingly, S. aureus was not found in healthy controls. Conclusions. The results of the study demonstrated the effectiveness of standard therapy for managing patients with atopic dermatitis as it had a positive impact on the skin microbial community and showed a decrease in S. aureus proportion after the treatment.

The aromatic hydrocarbon receptor (AhR) is a cytoplasmic receptor and transcription factor that regulates a wide range of biological and toxicological effects by binding to specific ligands. Among the effects there is detoxification of xenobiotics, maintenance of tissue homeostasis, regulation of the immune response. The structure and functions of AhR are described in the review. The mechanisms of skin homeostasis with the participation of the aromatic hydrocarbon receptor such as the effect on oxidative reactions and participation in maintaining the barrier function of the epidermis are demonstrated in details. The role of AhR in the pathogenesis of atopic dermatitis is discussed. The participation of AhR in the implementation of immune mechanisms of this disease as well as in the regulation of the production of key proteins of the skin barrier is shown. The data on the therapeutic value of its pharmacological modulation including the results of clinical studies of the topical ligand AhR Tapinarof are presented. The role of the aromatic hydrocarbon receptor in the realization of the effect of phototherapy of atopic dermatitis is demonstrated.

Resumen: El prurito es el síntoma principal en múltiples enfermedades dermatológicas y sistémicas. La dermatitis atópica, la psoriasis, la dermatitis de contacto, la urticaria, el liquen simple crónico, la micosis fungoides, las cicatrices, las enfermedades autoinmunes, la enfermedad renal o hepática crónica, entre otras, asocian prurito que puede requerir un manejo terapéutico distinto. Aunque los antihistamínicos parecen ser la primera línea de tratamiento, en realidad su papel queda limitado a la urticaria y reacciones por fármacos, ya que los mecanismos fisiopatológicos de cada una de las entidades tratadas a lo largo de este manuscrito serán distintas. En estos últimos años han aparecido nuevas moléculas para el tratamiento del prurito, con perfiles de eficacia y seguridad muy atractivos para su uso en práctica clínica. Sin duda, es un momento crucial para el desarrollo de la dermatología en el campo del prurito, y una oportunidad para ser más exigentes con los objetivos a alcanzar en estos pacientes. Abstract: Pruritus is the main symptom of many dermatologic and systemic diseases. Atopic dermatitis, psoriasis, contact dermatitis, urticaria, lichen simplex chronicus, mycosis fungoides, scars, autoimmune diseases, kidney or liver diseases among others are all associated with itch that may require different approaches to management. Although antihistamines seem to be the first line of therapy, in reality their role is limited to urticaria and drug-induced reactions. In fact, the pathophysiologic mechanisms of each of the conditions covered in this review will differ. Recent years have seen the emergence of new drugs whose efficacy and safety profiles are very attractive for the management of pruritus in clinical practice. Clearly we are at a critical moment in dermatology, in which we have the chance to be more ambitious in our goals when treating patients with pruritus.

Atopic dermatitis (AD) is one of the most common childhood dermatological diseases. Its characteristic clinical feature is intractable pruritus, which causes an urge to scratch the skin, and the occurrence of skin lesions which are typical in their morphology and location. It is characterised by its chronicity, difficulty of treatment and numerous psychosocial consequences which affect not only the patient, but also all family members. The child’s severe pruritus and visible skin lesions result in sleep disturbances, chronic fatigue, difficulties in intra- and extra-familial relationships or problems in the family’s financial situation. The effectiveness of treatment provided is highly dependent on the parents’ commitment, knowledge and skills, as well as their mental condition. Caring for a child with AD is demanding and disrupts many aspects concerning the quality of family life. This article addresses the impact of AD on child and family functioning and the burden of the disease.

Abstract Introduction Upadacitinib, an oral selective Janus kinase (JAK) inhibitor, is used to treat moderate-to-severe atopic dermatitis (AD). Acne is the most common treatment-emergent adverse event in patients with AD treated with upadacitinib. In this post hoc analysis, we describe the acne events in Japanese patients with AD who received upadacitinib during the Rising Up study. Methods In this phase 3, double-blind, 3-year trial evaluating the safety and efficacy of upadacitinib 15 mg or 30 mg in Japanese patients with moderate-to-severe AD, patients were randomized 1:1:1 to receive upadacitinib 15 mg, 30 mg, or placebo for up to 16 weeks. At week 16, placebo-treated patients were re-randomized 1:1 to receive upadacitinib 15 mg or 30 mg. The incidence, characteristics, and management of treatment-emergent acne events up to the 52-week cutoff date were summarized. Results Among 272 patients in this analysis, the incidence of acne was higher in patients receiving upadacitinib compared with patients who received placebo. The rate of acne was higher in patients receiving upadacitinib 30 mg (32.4%) compared with those taking upadacitinib 15 mg (17.3%) during the long-term treatment period. All cases of acne were mild or moderate; no cases led to study drug discontinuation. The mean (range) of acne onset was 135.4 (7–465) days after starting study drug. Most acne occurred on the face; inflammatory papules were the most common morphology. Risk factors for acne included relevant concomitant medications (e.g., corticosteroids) started before acne onset and family and personal history of acne. Acne was generally managed with topical treatments. Conclusion Mild or moderate acne reported in Japanese patients with AD receiving upadacitinib occurred in a dose-dependent manner and had a variable onset time. Acne was readily managed with topical treatments. Patients and clinicians should be aware of the risk of acne associated with upadacitinib treatment for AD. Trial Registration ClinicalTrials.gov identifier, NCT03661138.

Abstract Introduction IL-13 is the primary upregulated cytokine in atopic dermatitis (AD) skin and is the pathogenic mediator driving AD pathophysiology. Lebrikizumab, tralokinumab and cendakimab are therapeutic monoclonal antibodies (mAb) that target IL-13. Methods We undertook studies to compare in vitro binding affinities and cell-based functional activities of lebrikizumab, tralokinumab and cendakimab. Results Lebrikizumab bound IL-13 with higher affinity (as determined using surface plasma resonance) and slower off-rate. It was more potent in neutralizing IL-13-induced effects in STAT6 reporter and primary dermal fibroblast periostin secretion assays than either tralokinumab or cendakimab. Live imaging confocal microscopy was employed to determine the mAb effects on IL-13 internalization into cells via the decoy receptor IL-13Rα2, using A375 and HaCaT cells. The results showed that only the IL-13/lebrikizumab complex was internalized and co-localized with lysosomes, whereas IL-13/tralokinumab or IL-13/cendakimab complexes did not internalize. Conclusion Lebrikizumab is a potent, neutralizing high-affinity antibody with a slow disassociation rate from IL-13. Additionally, lebrikizumab does not interfere with IL-13 clearance. Lebrikizumab has a different mode of action to both tralokinumab and cendakimab, possibly contributing to the clinical efficacy observed by lebrikizumab in Ph2b/3 AD studies.

Abstract Objectives Atopic dermatitis (AD) is a common chronic inflammatory skin disorder in Japan. Dupilumab, a fully human monoclonal antibody, targets a shared subunit of the interleukin (IL)‐4 and IL‐13 receptors. Post‐marketing surveillance of the safety and effectiveness of dupilumab in adult AD patients was conducted in Japan, where the drug is also allowed for use in older adolescents (i.e., ≥15 years), and interim results are reported here. Methods This observational, multicenter study enrolled Japanese patients with AD who initiated dupilumab between July 2018–June 2020 (UMIN‐CTR Trials Registry: UMIN000032807). Baseline demographics, clinical history, medication data and dupilumab safety and effectiveness data were collected. Results By the data cut‐off date of March 26, 2021, information from 600 patients has been collected. All the available safety and 1‐year effectiveness data are presented. The mean (standard deviation) age was 42.0 (15.9) years, the majority (69.1%) were male, and asthma was present in 12.2%. Adverse drug reactions (ADRs) were observed in 98 patients (16.4%), including conjunctivitis (n = 40; 6.7%), conjunctivitis allergic (n = 30; 5.0%), blepharitis (n = 5; 0.8%), headache and eye pruritus (n = 4; 0.7% each) and eosinophilia (n = 3; 0.5%). Six patients experienced asthma, all of whom had a history of, or concurrent, asthma. Disease severity improved remarkably at 4 months in most patients, which was maintained up to 1 year. Conclusion Dupilumab appears to be a safe and effective treatment for patients aged ≥15 years with moderate‐to‐severe AD in routine clinical practice in Japan. Dupilumab was well tolerated, with no new safety signals and no new‐onset asthma.

Abstract Atopic patients, multi‐disciplinary specialists, caregivers, and experts from all over the world participated in the International Meeting of the Eczema Foundation in Malta (IMEF). During this 4‐day conference, attendants addressed the challenges pertaining to the management of atopic dermatitis by sharing their experience in the form of presentations, discussion sessions, workshops, and a plenary session. This article aims to report on what we consider to be a successful attempt to unite patients and caregivers in the quest for improved treatment of atopic dermatitis through the implementation of therapeutic patient education.

Abstract Background Treatment responses may differ between patients with severe versus moderate atopic dermatitis (AD). Objectives To assess dupilumab response by baseline AD severity in adolescent and adult patients with moderate‐to‐severe AD. Methods We assessed dupilumab response by baseline AD severity in 1719 patients aged ≥12 years with moderate‐to‐severe AD from five randomized, double‐blind, placebo‐controlled trials. Patients received subcutaneous placebo or dupilumab as monotherapy (300 mg [adults, adolescents] or 200 mg [adolescents] every 2 weeks; 16 weeks), or with concomitant topical corticosteroids (TCS) (adults; 16/52 weeks). Patients were stratified by baseline Investigator's Global Assessment (IGA) score (3 [moderate]/4 [severe]). Results Dupilumab‐treated patients with moderate AD had numerically higher absolute proportions of patients achieving IGA 0/1 (clear/almost clear) than those with severe AD; risk differences (dupilumab vs. placebo) were 18.9–35.5 for moderate AD and 16.4–34.2 for severe AD. For all other endpoints assessed, no meaningful differences or consistent response patterns between moderate and severe subgroups were observed. Conclusions Dupilumab with or without TCS demonstrated similar efficacy in patients with moderate or severe AD.

Background: Research has shown that eczema patients prefer some degree of shared control over treatment decisions, but little is known about factors perceived to be important to facilitate shared decision making (SDM). Objective: To determine factors eczema patients and caregivers consider to be important for SDM, and how often they experience them with their eczema healthcare provider (HCP). Methods: A cross-sectional survey study (64 questions) was conducted, which included factors related to SDM rated by respondents on a Likert scale for importance, and how often these factors were true with their current eczema HCP. Results: Respondents (840, response rate 62.4%) most frequently rated their health literacy and communication skills as important for SDM. Factors which indicated a strong provider-patient relationship, and HCPs who initiate treatment conversations were also deemed beneficial. Low importance was placed on concordant HCP race/ethnicity, however, of those who did rate it as important, 53/91 identified as Black (half of all Black respondents). Limitations: A high proportion of respondents were aware of the term SDM prior to the survey. Conclusions: SDM is more likely to be facilitated when patient education and empowerment are coupled with HCPs who initiate treatment discussions, maintain compassion resilience, and listen to patient perspectives.

Background: The magnitude of short/medium-term air pollution exposure on atopic dermatitis (AD) flare has not been fully investigated. The aim of the study was to investigate the association of short/medium-term exposure to airborne pollution on AD flares in patients treated with dupilumab. Methods: Observational case-crossover study. Patients with moderate-to-severe AD under treatment with dupilumab were included. The exposure of interest was the mean concentrations of coarse and fine particulate matter (PM10, PM2.5), nitrogen dioxide, and oxides (NO2, NOx). Different intervals were considered at 1 to 60 days before the AD flare and control visit, defined as the visit with the highest Eczema Area and Severity Index scores >8 and ≤7, respectively. A conditional logistic regression analysis adjusted for systemic treatments was employed to estimate the incremental odds (%) of flare every 10 μg/m3 pollutant concentration. Results: Data on 169 of 528 patients with AD having 1130 follow-up visits and 5840 air pollutant concentration measurements were retrieved. The mean age was 41.4 ± 20.3 years; 94 (55%) men. The incremental odds curve indicated a significant positive trend of AD flare for all pollutants in all time windows. At 60 days, every 10 μg/m3 PM10, PM2.5, NOx, and NO2 increase concentration was associated with 82%, 67%, 28%, and 113% odds of flare, respectively. Conclusions: In patients treated with dupilumab, acute air pollution exposure is associated with an increased risk for AD flare with a dose-response relationship.

Background: Atopic dermatitis (AD) is common across all ages. Understanding heterogeneous age-related phenotypes may improve AD management. Objective: To determine age-related clinical phenotypes of AD. Methods: A prospective, dermatology practice-based study was performed (n = 380). AD severity was evaluated using questionnaires and full-body examination. Phenotypes were determined using latent class analysis. Results: There were 23 (6.1%) pediatric patients (

Patient A., aged 23, was admitted with a diagnosis of atopic dermatitis with complaints of widespread rashes accompanied by intense itching. Skin manifestations: erythroderma, xeroderma, excoriations, persistent white dermographism. The conclusion of the ophthalmologist: rhegmatogenous retinal detachment, complicated cataract, ophthalmohypertension of the right eye; hemophthalmos, complicated overmature cataract, terminal neovascular glaucoma of the left eye. A diagnosis of Andogsky's syndrome was made. He received treatment: prednisolone 60 mg per day parenterally for 14 days, methotrexate at a dose of 10 mg weekly, Reamberin, folic acid 5 mg weekly, asparcam, aevit, enterosorbents, ointments and creams with corticosteroids and moisturizers. As a result of treatment, hyperemia, infiltration, peeling and itching of the skin decreased. It is recommended to continue taking methotrexate, folic acid, prednisolone (5 mg daily) and asparkam on an outpatient basis; externally moisturizing and softening creams and ointments. The patient has been referred for a medical and social examination and is preparing to be transferred to the treatment with genetically engineered biological drugs.

Objective To compare the specificity, sensitivity, variability and consistency among three different diagnostic criteria for atopic dermatitis (AD) in subjects with and without AD. Methods We retrospectively analyzed patients with AD initially diagnosed according to the Hanifin Rajka criteria at our clinic between September 2020 and October 2021. Demographic characteristics, clinical manifestations and the results of laboratory tests were used to analyze the sensitivity and specificity of Williams criteria, Zhang's criteria/Chinese criteria and Chinese diagnostic criteria for childhood AD. Patients with other dermatological diseases visiting our clinic during the same period were used as controls. The sensitivity and specificity of the three diagnostic criteria were compared using McNemar's test, while Kappa values were used to determine the consistency of the diagnostic criteria. Results One hundred and ten patients with AD and 91 patients without AD were included in this analysis. The highest sensitivity and lowest specificity were Chinese diagnostic criteria for childhood AD (83.6%, 59.3%). Both Zhang's criteria/Chinese criteria and Williams criterion displayed the highest specificity (90.1% for both). Both positive and negative predictive values (90.2%, 75.2%) were higher for Zhang's criteria/Chinese criteria than the others. The Williams criteria exhibited the highest false negative rate (29.1%), while the highest false positive rate was found for the Chinese diagnostic criteria for AD in children (40.7%). The Zhang's criteria/Chinese criteria displayed the highest Youden index and Kappa coefficient, with a Kappa coefficient of 0.645 (95% CI: 0.541-0.748, P

Abstract Atopic dermatitis (AD) is a chronic or chronically relapsing inflammatory skin disease which results from a complex, multifaceted interaction between environmental factors in genetically predisposed patients. Epidermal barrier impairment, alteration of the cutaneous microbiota, effect of external antigens, neurosensory dysfunction, and inflammatory and immune dysregulation all play a pivotal role in inducing and maintaining AD lesions. AD significantly impacts the patient’s quality of life and general well-being and is often associated with anxiety and/or depressive symptoms. Classical treatment options include topical corticosteroids and calcineurin inhibitors, phototherapy, and systemic immunosuppression with oral corticosteroids, cyclosporine, methotrexate, and azathioprine in more severe cases. A turning point in facing AD was accomplished when the efficacy and safety of dupilumab, a monoclonal antibody targeting the interleukin (IL)-4 receptor α subunit, led to its approval for the treatment of moderate-to-severe or severe AD in children, adolescents, and adults. Subsequently, a more extensive understanding of AD etiology and pathogenesis has allowed the development of several topical and systemic novel therapy options. Most of these drugs are monoclonal antibodies which interfere with the type 2 inflammatory cascade, especially its key cytokines IL-4 and IL-13, or its downstream Janus kinase signaling pathway. However, considering the relevance of other subtypes of T helper (Th) cells, such as Th1 and Th22, and the important role of specific cytokines (IL-31) in generating pruritus, the horizon of potential therapeutic targets has widened extremely. In this review, we aim to present the most promising systemic agents currently under investigation and illustrate the most significant aspects of their efficacy, safety, and tolerability.

Resumen: La dermatitis atópica (DA) es una enfermedad inflamatoria crónica multifactorial. La dermatitis de contacto alérgica (DCA) y la dermatitis de contacto por proteínas (DCP) son patologías alérgicas que pueden ser comórbidas a la DA y ser causa de algunas de las exacerbaciones. Aunque la DCA tiene una prevalencia similar en pacientes atópicos que en la población general, debemos considerarla una comorbilidad frecuente en la DA por la disrupción de la barrera cutánea. Por ello, se recomienda la realización de pruebas epicutáneas a los pacientes atópicos. Dupilumab podría ser útil para el tratamiento de la DCA mediada por vía Th2 y exacerbar aquellas que ocurren por vía Th1, aunque se precisan más estudios para establecer conclusiones. El mecanismo por el que la exposición a proteínas ambientales produce exacerbaciones en la DA es controvertido, pero es un fenómeno habitual en la práctica clínica diaria. Se recomienda estudio mediante prick test a pacientes con clínica sugestiva y recomendar conductas evitativas ante pacientes sintomáticos y pruebas positivas. Abstract: Atopic dermatitis is a chronic inflammatory disease that is multifactorial in nature. Allergic contact dermatitis and protein contact dermatitis are allergic conditions that may occur in the context of atopic dermatitis and be the cause of exacerbations. Although the prevalence of allergic contact dermatitis is similar in atopic patients and the general population, these 2 conditions are frequently associated because atopic inflammation disrupts the skin barrier. Skin tests are therefore recommended in atopic individuals. Dupilumab could be useful for treating allergic contact dermatitis if it is mediated by type 2 helper T cells but could exacerbate inflammation if mediated by TH1 cells: further study is needed before conclusions can be drawn. Although the mechanism by which exposure to environmental proteins exacerbates atopic dermatitis remains under discussion, such exacerbations are routinely seen in clinical practice. Prick testing is recommended in symptomatic atopic dermatitis. When prick-test findings are positive, patients should be advised to avoid the culprit substances.

AbstractBackground Atopic dermatitis (AD) is a chronic eczematous disease with severe pruritus. Janus kinase (JAK) inhibitors, upadacitinib, baricitinib, and abrocitinib, are systemic treatments for AD. The outcomes of switching from one JAK inhibitor to another have not been examined.Objectives We assessed the outcomes of switching from baricitinib 4 mg to upadacitinib 30 mg in Japanese patients with moderate-to-severe AD.Methods Twenty patients treated with baricitinib 4 mg, showing insufficient response or adverse events, were switched to treatment with upadacitinib 30 mg. We evaluated total eczema area and severity index (EASI), EASI at head and neck, trunk, upper, or lower limbs, EASI of erythema, edema/papulation, excoriation, or lichenification, and peak pruritus numerical-rating scale (PP-NRS) at baseline (start of baricitinib), weeks 0 (time of switching), and 4 and 12 after switching.Results Total EASI, EASI at each anatomical site, EASI of each clinical sign, and PP-NRS were markedly reduced at weeks 4 or 12 compared to week 0. Achievement rates of more than 75% or 90% reduction of EASI from baseline significantly improved after switching.Conclusions Switching from baricitinib 4 mg to upadacitinib 30 mg effectively improved rash and pruritus.

Atopic dermatitis is a common inflammatory disease with a chronic and relapsing course. Although considered a childhood disease, it is now evident that atopic dermatitis is also common in adulthood and in the elderly population. Atopic dermatitis typically manifests with bilateral and symmetrical eczematous lesions on the face, trunk and skin folds. Itch is invariably present and may be very severe, markedly affecting daily life and sleep. In older adults, atopic dermatitis may have a high level of impact on quality of life, frequently burdening an already complex comorbid situation. The full assessment of disease burden (localizations, itch severity, sleep alterations, impact on quality of life, disease history, comorbidities) is crucial to identify the most appropriate treatment. In many cases, moderate-to-severe atopic dermatitis in the elderly population can be successfully and safely treated with biological agents inhibiting the interleukin-4/-13 pathway, whereas the use of Janus kinase inhibitors may pose concerns about the safety profile.

Abstract is missing (Quiz)

AbstractBackground This systematic review evaluated the Chinese herbal medicine (CHM) for treating atopic dermatitis (AD).Methods PubMed, EMBASE, the Cochrane library, the Wanfang database, and China National Knowledge Infrastructure (CNKI) were searched for relevant randomized controlled trials (RCTs) from inception to December 2021. Overall recovery rate, disease/symptom severity scoring, quality of life (QoL), recurrence rate, and incidence of adverse events (AEs) were evaluated. STATA SE 14.0 software was used for statistical analysis.Results 17 RCTs involving 1624 patients were eligible. CHM was associated with a higher overall recovery rate (risk ratio [RR] = 1.15, 95% confidence interval [CI]: 1.05, 1.26, p = .003) and decreased recurrence rate (odds ratio [OR] = 0.19, 95% CI: 0.07, 0.55, p = .002), both confirmed by sensitivity analyses. CHM could decrease scoring atopic dermatitis index (MD = −0.61, 95% CI: −1.12, −0.11, p = .017), however, sensitivity analysis revealed non-robustness. No significant differences were found between the CHM and the control group in Eczema Area and Severity Index, QoL, and the incidence of AEs.Conclusions CHM was effective for treating AD as it could improve the overall recovery rate and decrease the recurrence rate. More studies are required to validate the potential of CHM on disease/symptoms severity and QoL.

Purpose: Although psoriasis and atopic dermatitis (AD) were for decades considered to be opposing diseases, it is now known that these skin conditions can coexist or even overlap in the same individual. Especially when using modern drugs with targeted IL inhibition, the balance between Th1 and Th2 immunity can be disturbed. In line with it, numerous clinical cases of AD have been induced by antipsoriatic biologics (e.g., TNF-alpha, IL-23, or IL-17 inhibitors), and IL-4-/IL-13 inhibition by dupilumab also resulted in paradoxical psoriasis in patients with AD. Materials and methods: Herein, we describe a case of psoriasis vulgaris in a patient with intrinsic AD after systemic treatment with the anti-IL-13 antibody tralokinumab. Results: We present a 36-years-old male patient with a severe course of an intrinsic atopic dermatitis and dyshidrotic hand eczema. He responded well to the therapy with tralokinumab. However, about 7 months after the start of anti-IL-13 treatment the patient developed psoriasiform lesions. The drug was then discontinued. Currently, the patient is receiving topical therapy with topical corticosteroids and calcineurin inhibitors with stable course of psoriasis and AD. Conclusions: This case suggests, that not only a dual IL-4-/IL-13-blockade, but also a selective IL-13-inhibition is able to skew immune responses toward IL-17 cytokine pathway-related disease. However, no clinical scores exist to predict the development of paradoxical psoriasis in patients with AD during therapy with biologics.

Aim: To investigate the efficacy and tolerability of a cream (Rilastil Xerolact PB) containing a mixture of prebiotics and postbiotics, and to validate the PRURISCORE itch scale in the management of atopic dermatitis. Methods: The study is based on 396 subjects of both sexes in three age groups (i.e., infants, children, adults) suffering from mild/moderate Atopic Dermatitis, recruited from 8 European countries and followed for 3 months. Results: The product demonstrated good efficacy combined with good/very good tolerability in all age groups. In particular, SCORAD, PRURISCORE and IGA scores decreased significantly over the course of the study. The PRURISCORE was preferred to VAS by the vast majority of patients. Conclusion: Even though the role of prebiotics and postbiotics was not formally demonstrated since these substances were part of a complex formulation, it can be reasonably stated that prebiotics and postbiotics have safety and standardization features that probiotics do not have. In addition they are authorized by regulatory authorities, whereas topical probiotics are not.

Background Dupilumab facial redness (DFR) is a side effect of dupilumab treatment that has only been recently reported. We previously reported on two patients with DFR who were successfully treated with a topical formulation containing human adipose tissue-derived mesenchymal stem cell-derived exosomes (ASCEs). Objectives The study aimed to evaluate the efficacy and safety of ASCEs in DFR. Participants and methods We performed 12-week prospective study at single center. Twenty adult atopic dermatitis patients diagnosed with DFR were enrolled. They were treated with a topical application of the exosome formulation every week for five consecutive weeks. Results After exosome treatment, both the average investigator global assessment score and clinical erythema assessment scale scores decreased. 19 patients (95%) were satisfied with the treatment. Compared to baseline, erythema index at week 4 were decreased by 31, 27, 13, and 25 units on the forehead, chin, right and left cheek respectively. The analysis of stratum corneum samples revealed the expression of IL-1α and human thymic stromal lymphopoietin was suppressed after exosome treatment, whereas filaggrin and vascular endothelial growth factor expression increased. Conclusions This study suggests topical formulation containing ASCEs can alleviate DFR by downregulating local inflammation and restoring skin barrier function.

Background Patients with moderate-to-severe atopic dermatitis (AD) experience skin lesions and intense itch that substantially affect quality of life. Patients have choices among systemic AD treatments that offer varied benefit–risk profiles. Objective Measure patients’ willingness to trade off the risks and benefits of systemic treatments among individuals with a physician-confirmed diagnosis of moderate-to-severe AD. Methods Patients participated in a discrete choice experiment online survey with a series of choices between hypothetical AD treatments defined by six attributes reflecting benefits and risks of treatments (itch reduction, time until noticeable itch reduction, chance of clear or almost clear skin, risk of serious infection, risk of developing acne, and need for prescription topical steroids). Data were analyzed with a random parameters logit model to quantify preferences and the relative importance of attributes for treatment alternatives. Results Respondents (n = 200) placed the highest relative importance on itch reduction, speed of itch reduction, and skin clearance, and were generally willing to accept clinically relevant levels of risk of serious infection and acne in exchange for treatment benefits. Conclusions Patients with moderate-to-severe AD were willing to trade clinically relevant treatment risks for greater or more rapid itch reduction and skin clearance offered by systemic therapies.

Background Baricitinib is an oral selective Janus kinase 1/2 inhibitor approved for moderate-to-severe atopic dermatitis (AD) in adults. Objectives To evaluate absolute Eczema Area and Severity Index (EASI) and SCORing of Atopic Dermatitis (SCORAD) outcomes over 16 weeks and to link disease severity categories to quality of life (QoL) improvements. Methods This post-hoc analysis included patients enrolled in Phase3 monotherapy (BREEZE-AD1/AD2) and topical corticosteroid (TCS) combination therapy (BREEZE-AD7) trials and analyzed baricitinib 2 and 4 mg vs. placebo. Categorical outcomes were analyzed using Fisher’s exact test. Results Significantly more baricitinib-treated patients reached EASI ≤ 7 and SCORAD < 25 as early as week 1 in monotherapy and week 2 in TCS combination therapy, compared to placebo. Significant response vs. placebo was sustained until week 16 for EASI ≤ 7 (AD1/2 [p-value vs. placebo]: 2 mg = 19.9%, 4 mg = 25.4% [p = 0.001] and AD7: 2 mg = 40.4% [p = 0.087], 4 mg = 48.6% [p = 0.003]) and SCORAD < 25 (AD1/2: 2 mg = 12.2%, 4 mg = 19.4% [p = 0.001] and AD7: 2 mg = 30.3% [p = 0.025], 4 mg = 34.2% [p = 0.004]) severity categories. These effects were accompanied by rapid improvements in QoL. Conclusion Baricitinib-treated patients rapidly achieved recommended absolute EASI and SCORAD treatment outcomes which were sustained until week 16. Improvements in QoL were greater than EASI severity categories reflected, indicating that physician-assessed scores do not necessarily correlate with patients’ impression of AD severity.

Background Upadacitinib is an oral Janus kinase (JAK) 1 inhibitor approved in Japan for moderate-to-severe atopic dermatitis (AD), and it provides a high therapeutic efficacy. Objectives We compared the therapeutic effects of upadacitinib on skin rashes of individual anatomical sites, head and neck, upper limbs, lower limbs, and trunk in patients with AD. Methods From August 2021 to December 2022, 65 Japanese patients with moderate-to-severe AD (aged ≥ 12 years) were treated with oral once daily upadacitinib 15 mg plus twice daily topical corticosteroids of moderate-to-strongest classes. Results The eczema area and severity indexes (EASIs) of individual sites decreased significantly at weeks 4, 12, and 24 compared to those at week 0 in parallel to total (whole body) EASI. The achievement rates of EASI 75 at week 24 and of EASI 90 at week 12 of lower limbs were significantly higher than those of trunk. The percent reductions of EASI of lower limbs at weeks 12 and 24 were significantly higher than those of head and neck and of trunk. Conclusions Among the four anatomical sites, the treatment responsiveness to upadacitinib in lower limbs appeared the highest, while those in trunk and in head and neck appeared relatively lower.

Background Differences in atopic dermatitis (AD) disease course and manifestation with age may extend to treatment response. Objective To evaluate response maintenance with continuous-/reduced-dose abrocitinib or withdrawal and response to treatment reintroduction after flare in adolescent and adult participants in JADE REGIMEN (NCT03627767). Methods Adolescents (12–17 years) and adults with moderate-to-severe AD responding to abrocitinib 200-mg induction were randomly assigned to 40-week maintenance with abrocitinib (200 mg/100 mg) or placebo. Patients who experienced flare during maintenance received rescue treatment. Results Of 246 adolescents and 981 adults, 145/246 (58.9%) and 655/981 (66.8%), respectively, responded to induction. Similar proportions of adolescents and adults experienced flare during maintenance with abrocitinib 200 mg (14.9%/16.9%), 100 mg (42.9%/38.9%), and placebo (75.5%/78.0%). From the abrocitinib 200-mg, 100-mg, and placebo arms, respectively, Eczema Area and Severity Index response was recaptured by 28.6%, 25.0%, and 52.9% of adolescents and 34.3%, 33.7%, and 58.0% of adults; Investigator’s Global Assessment response, by 42.9%, 50.0%, and 73.5% of adolescents and 34.3%, 50.6%, and 74.1% of adults. Abrocitinib had a similar safety profile regardless of age; nausea incidence was higher in adolescents. Limitations Adolescents represented 20% of the trial population. Conclusion Abrocitinib was effective in preventing flare in adolescents and adults.Clinicaltrials.gov listing: NCT03627767.

Purpose: The overlap of psoriasis and atopic dermatitis (AD) is rare and treating moderate-to-severe cases can be challenging. Conventional immune-suppressive drugs cannot be used long-term, and no biological drugs are currently approved for treating both conditions. Method: We report the cases of four patients with overlapping features of both psoriasis and AD. Result: After being treated with several systemic drugs, including gold-standard treatments for both psoriasis and AD, they received upadacitinib 15 or 30 mg, achieving complete remission. Upadacitinib is an inhibitor of Janus Kinase 1, currently approved for treating moderate-to-severe AD. Conclusion: To date, very limited data are available regarding the efficacy of upadacitinib in psoriasis. In a phase-3 trial on the efficacy of upadacitinib 15 mg in patients affected by psoriatic arthritis, 52.3% of patients achieved a 75% improvement in Psoriasis Area and Severity Index (PASI75) after one year. Currently, no clinical trials are evaluating the efficacy of upadacitinib in plaque psoriasis.