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Background: Response to abrocitinib treatment for moderate-to-severe atopic dermatitis (AD) has not been evaluated across racial and ethnic subpopulations., Objective: To assess the efficacy and safety of abrocitinib on the basis of patient race, ethnicity, and Fitzpatrick skin type (FST)., Methods: Data were pooled post hoc from patients treated with abrocitinib 200 mg, 100 mg, or placebo in 3 monotherapy trials (NCT02780167, NCT03349060, and NCT03575871). Race and ethnicity were self-reported; FST was determined by study investigators. Evaluations through Week 12 include the following: (1) Investigator's Global Assessment of clear or almost-clear skin; (2) greater than or equal to 75% improvement in Eczema Area and Severity Index or SCORing AD; (3) a greater-than-or-equal-to 4-point improvement in Peak Pruritus Numerical Rating Scale score; (4) least squares mean changes in Dermatology Life Quality Index and Patient-Oriented Eczema Measure scores; and (5) treatment-emergent adverse events., Results: The sample comprised 628 White, 204 Asian, and 83 Black patients; 37 were Hispanic or Latino; 624 had FST I to III and 320 had FST IV to VI. Treatment with either abrocitinib dose was associated with greater proportions of patients achieving Investigator's Global Assessment of clear or almost-clear skin, ≥ 75% improvement in Eczema Area and Severity Index, ≥ 75% improvement in SCORing AD, and a ≥ 4-point improvement in Peak Pruritus Numerical Rating Scale, or greater score changes from baseline in Dermatology Life Quality Index and Patient-Oriented Eczema Measure vs placebo regardless of race, ethnicity, or FST. Dose-response was most prominent in White patients. In Black patients, the effects of the 2 doses were similar. Treatment-emergent adverse events were more common in White and Black than in Asian patients., Conclusion: Abrocitinib was more efficacious than placebo across the racial and ethnic groups and ranges of phototypes analyzed. Studies with increased representation of populations of color are warranted to elucidate potential variations in response across diverse populations., Trial Registration: Clinicaltrials.gov Identifier: NCT02780167 (phase 2b), NCT03349060 (phase 3 MONO-1), and NCT03575871 (phase 3 MONO-2)., Competing Interests: Disclosures Dr Alexis has received grants made to the institution from AbbVie, Almirall, Amgen, Arcutis, Bristol Myers Squibb, Cara Therapeutics, Castle, Dermavant, Galderma, LEO Pharma, Novartis, Valeant (Bausch Health), and Vyne; is an advisory board member or consultant for Pfizer Inc, AbbVie, Allergan, Almirall, Alphyn, Amgen, Apogee, Arcutis, Bausch Health, Beiersdorf, Bristol Myers Squibb, Cara Therapeutics, Canfield, Castle, Cutera, Dermavant, Eli Lilly and Company, EPI Health, Galderma, Incyte, Janssen, LEO Pharma, L'Oreal, Ortho, Sanofi Regeneron, Swiss-American, UCB, VisualDx, and Vyne; and has served as a speaker for Pfizer Inc, Bristol Myers Squibb, Regeneron, and Sanofi-Genzyme. Dr Silverberg served as an investigator for Celgene, Eli Lilly and Company, F. Hoffmann-LaRoche, Menlo Therapeutics, Realm Therapeutics, Regeneron, and Sanofi; as a consultant for Pfizer Inc, AbbVie, Anacor, AnaptysBio, Arena Pharmaceuticals, Dermavant, Dermira, Eli Lilly and Company, Galderma, GlaxoSmithKline, Glenmark, Incyte, Kiniksa Pharmaceuticals, LEO Pharma, Menlo Therapeutics, Novartis, Realm Therapeutics, Regeneron, and Sanofi; and as a speaker for Regeneron and Sanofi. Dr Rice is an advisory board member for Pfizer Inc, Biotech, Cassiopeia, and Medscape; a consultant for Pfizer Inc, Brickell Biotech, Cassiopeia, Dermira, Regeneron, and Sanofi; has received funding from AbbVie, Anacor Pharmaceuticals, Celgene, Galderma, Merck & Co, Regeneron, and Sanofi-Genzyme; and has been a speaker for Pfizer Inc, Dermira, the International Hyperhidrosis Society, PRIME, Regeneron, and Sanofi. Dr Armstrong has served as a research investigator and/or scientific advisor for Pfizer Inc, AbbVie, Boehringer Ingelheim, BMS, Dermavant, Dermira, Eli Lilly and Company, EPI Health, Incyte, Janssen, LEO Pharma, Novartis, Ortho Dermatologics, Regeneron, Sanofi, Sun, and UCB. Dr Desai is a consultant for AbbVie, Allergan, Eli Lilly and Company, Galderma, LEO Pharma, OrthoDermatologics, Scientis, and UCB. Dr Fonacier has received grants made to the institution from Pfizer Inc, AstraZeneca, Regeneron, and Shire and serves as a consultant for Pfizer Inc, AbbVie, Eli Lilly and Company, and Regeneron. Dr Kabashima received consulting fees or advisory board honoraria from Pfizer Inc, AbbVie, Chugai Pharmaceutical, Eli Lilly and Company, Japan Tobacco Inc, Kao, LEO Pharma, Maruho, Pola Pharma, Sanofi, and Taiho Pharmaceutical and has received research grants from AbbVie, Eli Lilly and Company, Japan Tobacco Inc, Kose, Kyorin Pharmaceutical, Kyowa Kirin, LEO Pharma, Ono Pharmaceutical, Pola Pharmaceutical, Procter & Gamble Company, Sanofi, and Tanabe Mitsubishi. Drs Biswas, Chan, and Levenberg are employees and shareholders of Pfizer Inc. Dr Rojo Cella is a former employee and shareholder of Pfizer Inc., (Copyright © 2023. Published by Elsevier Inc.)

Background: The relationship between atopic dermatitis (AD) severity, sleep disturbance (SD), and health-related outcomes is not fully elucidated., Objective: The aim of the study was to determine the prevalence of SD in adult AD and its relationship with AD severity and health outcomes among the US population., Methods: A cross-sectional, US population-based survey study of 2893 adults was performed., Results: Among adults meeting the UK Diagnostic Criteria for AD, 255 (40.7%) reported 1 or more, 67 (11.1%) reported 3 to 4, and 57 (9.5%) reported 5 to 7 nights of SD in the past week; 475 (79.7%) reported at least some trouble sleeping in the past 3 days. Moderate and severe Patient-Oriented Scoring AD, Patient-Oriented Eczema Measure, and Numeric Rating Scale-itch and Numeric Rating Scale-skin pain scores were associated with more severe SD compared with those without AD. More frequent and severe SDs were associated with higher Dermatology Life Quality Index, lower 12-item Short-Form Health Survey, and higher Hospital Anxiety and Depression Scale (HADS) scores. Significant mediation by SD severity was observed between Patient-Oriented Eczema Measure and Numeric Rating Scale-itch with Dermatology Life Quality Index, 12-item Short-Form Health Survey physical and mental component scores, HADS-anxiety and HADS-depression scores, diagnosed anxiety, and heart disease., Conclusions: Atopic dermatitis and AD severity are associated with SDs. Sleep disturbances considerably impact quality of life and other health outcomes in adults with AD., (Copyright © 2021 American Contact Dermatitis Society. All Rights Reserved.)

Background: Abrocitinib efficacy by prior dupilumab response status in patients with moderate-to-severe atopic dermatitis 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 atopic dermatitis 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 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 was achieved in 89.7% and 81.6%, respectively. Among prior dupilumab nonresponders, ≥75% improvement in Eczema Area and Severity Index was achieved with abrocitinib 200 mg and 100 mg in 80.0% and 67.7% and ≥4-point improvement in Peak Pruritus Numerical Rating Scale 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 atopic dermatitis, regardless of prior dupilumab response status., Competing Interests: Conflicts of interest Dr Shi is a stockholder of Learn Health and has served as an advisory board member or investigator and/or received research funding from Pfizer Inc, Sanofi-Genzyme, Regeneron, AbbVie, Eli Lilly, Novartis, SUN Pharma, LEO Pharma, Menlo Therapeutics, Dermira, Burt’s Bees, Galderma, Kiniksa Pharmaceuticals, UCB, Altus Lab, MYOR, Polyfin, GpSkin, and Skin Actives Scientific. Dr Bhutani is an investigator for Pfizer Inc, AbbVie, Galderma, Mindera, and Regeneron. She has served as a consultant and/or advisory board member for Pfizer Inc, AbbVie, Arcutis, Boehringer Ingelheim, Bristol Myers Squibb, Janssen, LEO Pharma, Eli Lilly, Novartis, Sun, and UCB. Dr Fonacier has been a consultant and advisory board member for Pfizer Inc, Regeneron, AbbVie, and Eli Lilly and has received research and educational grants (made to NYU Langone Hospital–Long Island) from Pfizer Inc, Regeneron, AstraZeneca, and Shire. Dr Deleuran has been a consultant, advisory board member, and/or speaker for Pfizer Inc, AbbVie, Eli Lilly, LEO Pharma, Regeneron, Incyte Biosciences International Sàrl, Sanofi-Genzyme, and Pierre Fabre. Dr Shumack has been an investigator, advisory board member, and/or speaker for Pfizer Inc, AbbVie, Eli Lilly, LEO Pharma, Sanofi, and Novartis. Drs Cameron and Yin are former employees of Pfizer Inc and may hold stock options. Drs Zhang, Chan, and Valdez are employees and shareholders of Pfizer Inc., (Copyright © 2022 American Academy of Dermatology, Inc. All rights reserved.)

Contact dermatitis (CD) is a common skin condition caused by contact with an exogenous agent that elicits an inflammatory response. Although history and physical examination can be helpful in distinguishing between irritant CD and allergic CD (ACD), the gold standard for diagnosing ACD is patch testing. Although the actual patch test (PT) procedure and application is relatively straightforward, the decisions involving which allergens to use, interpretation of results, determination of relevant allergens, and subsequent patient management require more skill and expertise. Often, the distribution of the presenting dermatitis can provide insight into the potential causative allergens and should be taken into account when selecting PT allergens. Commercially available PT panels and personal care products can be used for patch testing. Determining the clinical relevance of PT results is a critical component of the PT procedure. Patients must be educated on avoidance of relevant allergens and given guidance on alternative products available for use. Special populations, including children with ACD and occupational CD, and patients with biomedical devices have unique allergen considerations, and PT panels should be directed as such to address all potential allergens., (Published by Elsevier Inc.)

Background: Structured patient-reported outcomes of atopic dermatitis (AD) severity are not standardized in clinical practice., Objectives: To determine the construct validity, internal consistency, cross-cultural validity and floor or ceiling effects of multiple AD severity assessments., Methods: This is a cross-sectional, population-based study of 2893 adults, including 602 adults who met a modified set of U.K. diagnostic criteria for AD. AD severity was assessed using self-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD) and its objective and subjective components, and numerical rating scale (NRS)-itch. Quality of life was assessed using Short-Form (SF)-12 mental and physical health scores, Short-Form Six Dimensions (SF-6D) health utility scores and Dermatology Life Quality Index (DLQI). Mental health was assessed with the Hospital Anxiety and Depression Scale (HADS)., Results: PO-SCORAD, PO-SCORAD objective and subjective subscores, NRS-itch and POEM all had moderate-to-strong correlations with each other and DLQI, fair-to-moderate correlations with HADS-anxiety and HADS-depression, and inverse correlations with SF-12 mental component score and SF-6D (Pearson correlations, P < 0·001). All scores showed good criterion validity as judged by anova and receiver operator characteristics. PO-SCORAD, PO-SCORAD objective subscore and POEM had similarly good internal consistency (Cronbach's alpha = 0·84, 0·82 and 0·86); the PO-SCORAD subjective subscore was less internally consistent (alpha = 0·57). All scores showed potentially poor cross-cultural validity as demonstrated by uniform and nonuniform differential item functioning by age, sex and/or race/ethnicity for multiple items. There were floor effects for POEM, but not for the other assessments., Conclusions: PO-SCORAD, PO-SCORAD objective and subjective subscores, NRS-itch and POEM appear to be valid for assessing AD severity in clinical practice. What's already known about this topic? Few studies have demonstrated the validity of the atopic dermatitis severity assessments Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD), PO-SCORAD subscores, numerical rating scale (NRS)-itch and Patient-Oriented Eczema Measure (POEM). What does this study add? This study demonstrates that PO-SCORAD, PO-SCORAD subscores, NRS-itch and POEM all had good construct validity in the assessment of atopic dermatitis severity in adults. Only POEM demonstrated floor effects. What are the clinical implications of this work? PO-SCORAD, PO-SCORAD subscores, NRS-itch and POEM all appear to have sufficient validity to be used as assessments of atopic dermatitis severity in clinical practice., (© 2019 British Association of Dermatologists.)

Atopic dermatitis (AD) is a chronic inflammatory skin condition that requires a manifold approach to therapy. The goal of therapy is to restore the function of the epidermal barrier and to reduce skin inflammation. This can be achieved with skin moisturization and topical anti-inflammatory agents, such as topical corticosteroids and calcineurin inhibitors. Furthermore, proactive therapy with twice weekly use of both topical corticosteroids and calcineurin inhibitors in previously affected areas has been found to reduce the time to the next eczematous flare. Adjunctive treatment options include wet wrap therapy, anti-histamines, and vitamin D supplementation. Bacterial colonization, in particular Staphylococcus aureus, can contribute to eczematous flares and overt infection. Use of systemic antibiotics in infected lesions is warranted; however, empiric antibiotics use in uninfected lesions is controversial. Local antiseptic measures (i.e., bleach baths) and topical antimicrobial therapies can be considered in patients with high bacterial colonization. Difficult-to-treat AD is a complex clinical problem that may require re-evaluation of the initial diagnosis of AD, especially if the onset of disease occurs in adulthood. It may also necessitate evaluation for contact, food, and inhaled allergens that may exacerbate the underlying AD. There are a host of systemic therapies that have been successful in patients with difficult-to-treat AD, however, these agents are limited by their side effect profiles. Lastly, with further insight into the pathophysiology of AD, new biological agents have been investigated with promising results.

Contact dermatitis is a common disease seen by allergists, dermatologists, and primary care physicians. The gold standard for diagnosing allergic contact dermatitis (ACD) is patch testing and is indicated in any patient with a chronic, pruritic, eczematous, or lichenified dermatitis if underlying or secondary ACD is suspected. Patients with acute generalized dermatitis who have extensive eczema on the back, are on immunosuppressant medications, and have applied topical corticosteroids, topical calcineurin inhibitors, or ultraviolet radiation to the patch test (PT) site may have suppressed PT reactions. The procedure of patch testing is not a difficult one to perform, but the interpretation of the PT needs some critical components, including having an appropriate level of suspicion for the diagnosis of ACD, testing the relevant allergens in their proper vehicle and concentration, and the necessary experience to properly interpret the results. Careful history and physical examination must be correlated with the result of the PT to establish clinical relevance. Once the PT is completed, allergens are identified, and relevance has been established, educating the patient about the avoidance of exposure is critical. The Joint Task Force of the American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma and Immunology has developed updated practice parameters for contact dermatitis and patch testing, and their recommendations will be discussed (Fonacier LF, Bernstein DI, Pacheco K, Holness DL. Contact dermatitis: a practice parameter update 2015. J Allergy Clin Immunol Pract 2015; 3(3S):S1-S40.)., (Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Flexural eczema and atopic dermatitis are frequently synonymized. As respiratory atopy is rarely tested for and found in these patients, systematically equating a flexural distribution of dermatitis with atopic dermatitis may too frequently result in misclassified diagnoses and potentially missed opportunity for intervention toward improving patients' symptoms and quality of life. We present a critical review of the available evidence for the atopic dermatitis diagnosis and discuss the similarities between atopic dermatitis and allergic contact dermatitis. Because neither flexural predilection nor atopy is specific for atopic dermatitis, we conclude that the term atopic dermatitis is a misnomer and propose an etymologic reclassification of atopic dermatitis to "atopy-related" dermatitis. Allergic contact dermatitis can induce an atopic dermatitis-like phenotype, and thus, flexural dermatitis cannot be assumed as atopic without further testing. Patch testing should at least be considered in cases of chronic or recurrent eczema regardless of the working diagnosis.

Summary: Atopic dermatitis, also known simply as eczema, is a long‐term skin condition that causes an itchy rash. Scratching can cause skin to weep, crust, become infected and become thicker. 16.5 million adults in the USA suffer from atopic dermatitis, with 6.6 million reporting moderate to severe symptoms. Those with more severe disease have been found to have worse quality of life and increased risk of depression and anxiety. This US‐based study looked at 2893 adults to see if having atopic dermatitis, and how severe it is, affects the likelihood of also having anxiety or depression. Information was collected by sending out a survey. Modified UK diagnostic criteria were used to screen for patients with atopic dermatitis. Disease severity was self‐reported by patients using tools such as the Patient‐Orientated Eczema Measure and Dermatology Life Quality Index. The Hospital Anxiety and Depression Scale (HADS) was used for measuring anxiety and depression. 602 adults had atopic dermatitis. They had higher HADS scores (meaning higher levels of anxiety and depression) than the 2291 adults without atopic dermatitis. There were more adults with atopic dermatitis who also had a formal diagnosis of anxiety or depression than those without atopic dermatitis. However, many atopic dermatitis patients with high HADS scores had no formal diagnosis of anxiety or depression. Furthermore, patients with more severe atopic dermatitis had higher HADS scores than those with milder disease. The conclusion is that atopic dermatitis increases the likelihood of having anxiety and depression, especially if one has severe disease. This may go undiagnosed. Linked Article: Silverberg et al. Br J Dermatol 2019; 181:554–565 [ABSTRACT FROM AUTHOR]