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Atopic dermatitis (AD) is a chronic, inflammatory disease characterized by sensitive and dry skin, eczematous lesions and intense pruritus. Patients with moderate-to-severe AD often require systemic treatments if their symptoms are insufficiently controlled with topical treatments or phototherapy. While numerous systemic therapies are currently available for moderate-to-severe AD, more data evaluating patient satisfaction with various characteristics of these treatments are needed to help guide physicians and their patients with joint treatment decision-making. This study aims to investigate patient satisfaction with AD treatments according to the degree and speed of itch improvement and the degree of skin clearance. A cross-sectional, web-based survey was used to evaluate patient preferences for characteristics associated with systemic AD therapies. Respondents were required to have a physician-confirmed diagnosis of AD (currently moderate or severe), to be aged ≥18 years, to be a US resident, and to read and understand English. Assessments included worst itch experienced in the past 24 h (using a scale from 0 to 10, with 0 defined as no itch and 10 defined as the worst imaginable itch), time to noticeable itch reduction following initiation of their current treatment (1–6 days, 7–13 days or ≥14 days) and the amount of body surface area still affected by AD (≤2%, 3–10% or >10%; patient-assessed). Patient satisfaction with itch improvement, speed of itch improvement and skin clearance with their current treatment was also assessed and classified into three categories: satisfied, dissatisfied or neither. P values were determined by Chi-square tests (or Fisher's exact test where appropriate). Of the 213 individuals recruited by physicians to participate in the survey, 200 respondents fulfilled the eligibility criteria, consented to participate and completed surveys. A total of 186 respondents indicated that they were currently receiving treatment for their AD; treatments included over-the-counter creams, ointments or medicines (26.9%, n = 50), prescription creams (72.0%, n = 134), oral corticosteroids (16.7%, n = 31) or dupilumab (11.3%, n = 21). Treatment satisfaction differed based on the patient's itch level within the past 24 h (P < 0.001): 85.2% (n = 23) of the 27 patients reporting the lowest levels of itch (0–1) indicated they were satisfied with their current treatment, whereas only 7.1% (n = 1) of the 14 patients reporting the worst levels of itch (8–10) were satisfied with their current treatment. Among the 73 respondents who experienced the fastest itch reduction (within 1–6 days), 65.8% (n = 48) were satisfied with their treatment. For the 36 respondents experiencing itch reduction ≥14 days post treatment, 13.9% (n = 5) were satisfied with their treatment (P < 0.001). Of the 75 respondents with the highest degree of skin clearance (≤2% of body surface area still affected), 65.3% (n = 49) were satisfied with their treatment. Among the 21 respondents with the lowest degree of skin clearance (>10% of body surface area still affected), 14.3% (n = 3) were satisfied with their treatment (P < 0.001). Safety was not evaluated, which may limit the findings in this analysis. In patients with moderate-to-severe AD, the majority of respondents experiencing the lowest levels of itch, the fastest onset of itch improvement and the highest degree of skin clearance also reported satisfaction with their current treatment. These findings underscore the stringent thresholds for both the degree and speed of symptom improvement required to achieve patient satisfaction. This highlights patients' desire for treatments offering both rapid and extensive itch reduction and skin clearance and may help broaden physicians' understanding of patient preferences and inform treatment decisions. [ABSTRACT FROM AUTHOR]

Background Hair dye products constitute an important source of allergen exposure, and contribute importantly to allergic contact dermatitis in consumers and hairdressers. Objectives To evaluate the presence of potent contact sensitizers in oxidative hair dye products intended for home use on the US market. Methods Ingredient labels of 107 hair dyes from 10 major brands were examined and used to assess the prevalence of hair dye substances known to be potent contact sensitizers. Results One hundred and six of 107 (99%) products contained at least one potent sensitizer, and the average product contained six (range 0-11). p-Phenylenediamine ( PPD) was found in 83 products (78%), but resorcinol (89%), m-aminophenol (75%), p-aminophenol (60%) and toluene-2,5-diamine (21%) were also frequently identified. Conclusions Potent contact sensitizers were almost universally included in the hair dyes investigated in the United States. Although PPD is a common allergen, resorcinol and m-aminophenol were found more frequently. In total, 30 potent sensitizers were found. Clinicians should consider other allergens in addition to PPD when evaluating patients with suspected hair dye allergy. [ABSTRACT FROM AUTHOR]

Background: Abrocitinib, an oral selective Janus kinase 1 inhibitor, was effective and well tolerated in adults with moderate-to-severe atopic dermatitis in a phase 2b trial. We aimed to assess the efficacy and safety of abrocitinib monotherapy in adolescents and adults with moderate-to-severe atopic dermatitis.Methods: In this multicentre, double-blind, randomised phase 3 trial (JADE MONO-1), patients (aged ≥12 years) with moderate-to-severe atopic dermatitis (Investigator Global Assessment score ≥3, Eczema Area and Severity Index [EASI] score ≥16, percentage of body surface area affected ≥10%, and Peak Pruritus Numerical Rating Scale score ≥4) with a bodyweight of 40 kg or more, were enrolled at 69 sites in Australia, Canada, Europe, and the USA. Patients were randomly assigned (2:2:1) to oral abrocitinib 100 mg, abrocitinib 200 mg, or placebo once daily for 12 weeks. Randomisation was done using an interactive response technology system, stratified by baseline disease severity and age. Patients, investigators, and the funder of the study were masked to study treatment. The coprimary endpoints were the proportion of patients who had achieved an Investigator Global Assessment response (score of 0 [clear] or 1 [almost clear] with a ≥2-grade improvement from baseline), and the proportion of patients who achieved at least a 75% improvement in EASI score from baseline (EASI-75) score, both assessed at week 12. Efficacy was assessed in the full analysis set, which included all randomised patients who received at least one dose of study medication. Safety was assessed in all randomised patients. This study is registered with ClinicalTrials.gov, NCT03349060.Findings: Between Dec 7, 2017, and March 26, 2019, 387 patients were enrolled: 156 were assigned to abrocitinib 100 mg, 154 to abrocitinib 200 mg, and 77 to placebo. All enrolled patients received at least one dose of study treatment and thus were evaluable for 12-week efficacy. Of the patients with available data for the coprimary endpoints at week 12, the proportion of patients who had achieved an Investigator Global Assessment response was significantly higher in the abrocitinib 100 mg group than in the placebo group (37 [24%] of 156 patients vs six [8%] of 76 patients; p=0·0037) and in the abrocitinib 200 mg group compared with the placebo group (67 [44%] of 153 patients vs six [8%] of 76 patients; p<0·0001). Of the patients with available data for the coprimary endpoints at week 12, compared with the placebo group, the proportion of patients who had achieved an EASI-75 response was significantly higher in the abrocitinib 100 mg group (62 [40%] of 156 patients vs nine [12%] of 76 patients; p<0·0001) and abrocitinib 200 mg group (96 [63%] of 153 patients vs nine [12%] of 76 patients; p<0·0001). Adverse events were reported in 108 (69%) of 156 patients in the abrocitinib 100 mg group, 120 (78%) of 154 patients in the abrocitinib 200 mg group, and 44 (57%) of 77 patients in the placebo group. Serious adverse events were reported in five (3%) of 156 patients in the abrocitinib 100 mg group, five (3%) of 154 patients in the abrocitinib 200 mg group, and three (4%) of 77 patients in the placebo group. No treatment-related deaths were reported.Interpretation: Monotherapy with oral abrocitinib once daily was effective and well tolerated in adolescents and adults with moderate-to-severe atopic dermatitis.Funding: Pfizer. [ABSTRACT FROM AUTHOR]

Background: Chronic hand eczema (CHE) significantly impacts quality of life. Published literature on pediatric CHE (P-CHE) in North America including knowledge on epidemiology and standard evaluation and management is limited., Objective: Our objective was to assess diagnostic practices when evaluating patients with P-CHE in the US and Canada, produce data on therapeutic agent prescribing practices for the disorder, and lay the foundation for future studies., Methods: We surveyed pediatric dermatologists to collect data on clinician and patient population demographics, diagnostic methods, therapeutic agent selection, among other statistics. From June 2021 to January 2022, a survey was distributed to members of the Pediatric Dermatology Research Alliance (PeDRA)., Results: Fifty PeDRA members responded stating that they would be interested in participating, and 21 surveys were completed. For patients with P-CHE, providers most often utilize the diagnoses of irritant contact dermatitis, allergic contact dermatitis, dyshidrotic hand eczema, and atopic dermatitis. Contact allergy patch testing and bacterial hand culture are the most used tests for workup. Nearly all utilize topical corticosteroids as first line therapy. Most responders report that they have treated fewer than six patients with systemic agents and prefer dupilumab as first-line systemic therapy., Conclusions: This is the first characterization of P-CHE among pediatric dermatologists in the United States and Canada. This assessment may prove useful in designing further investigations including prospective studies of P-CHE epidemiology, morphology, nomenclature, and management., (© 2023. The Author(s).)

Competing Interests: Conflicts of interest A.E. has received research funding from Pfizer, Eli Lilly, Novartis, Bristol-Myers Squibb, AbbVie, Janssen Pharmaceuticals, the Danish National Psoriasis Foundation, the Simon Spies Foundation, and the Kgl Hofbundtmager Aage Bang Foundation, and honoraria as consultant and/or speaker from AbbVie, Almirall, LEO Pharma, Zuellig Pharma Ltd., Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals. J.P.T. has attended advisory boards for Almirall, Eli Lilly & Co, Pfizer, LEO Pharma, Asana, Regeneron, AbbVie, Union Therapeutics, and Sanofi-Genzyme and received speaker honoraria from LEO Pharma, Regeneron, Almirall, AbbVie, Eli Lilly & Co, and Sanofi-Genzyme. He has also been an investigator for AbbVie, Pfizer, Eli Lilly & Co, LEO Pharma and Sanofi-Genzyme.

Background: Nickel is the most common allergen detected by patch testing in children. There is an increasing number of cases in children who have not had exposure to piercing. Although the clinical relevance of nickel patch test reactions in children is sometimes uncertain, continued vigilance to identify new sources of nickel exposure in this age group is important. Recent case reports have described allergic nickel contact dermatitis in children following exposure to toys, but the magnitude of this problem is unknown., Objective: The aim of this study was to evaluate nickel and cobalt release from children's toys., Methods: We purchased 212 toys in 18 different retail and online stores in the United States and Denmark. Nickel and cobalt release was tested using the dimethylglyoxime and cobalt screening spot tests., Results: A total of 73 toys (34.4%) released nickel, and none released cobalt., Conclusions: Toys are a commonly overlooked source of nickel exposure and sensitization. Therefore, dermatologists, allergists, and pediatricians should consider the role of toys in their evaluation of children with dermatitis, and the parents of children with positive nickel patch test reactions should be told that toys may release nickel and be a potential chemical source in the manifestation of allergic contact dermatitis.

Background: Nickel and cobalt are common causes of metal allergy., Objective: The objective of this study was to investigate nickel and cobalt exposure in belt buckles by testing 701 belts purchased in China and the United States and to consider the prevalence of nickel allergy and its relevance among Chinese patients., Methods: Seven hundred one belt buckles purchased in China and the United States were tested for nickel and cobalt release. Six hundred thirty-one Chinese patients with suspected allergic contact dermatitis were patch tested and interviewed to determine clinical relevance of results. The Chinese and American literature was reviewed to investigate trends in nickel prevalence over the past decades., Results: Sixty percent (n = 219) of belts purchased in China (n = 365) released nickel, and 0.5% (n = 2) released cobalt; 55.7% (n = 187) in the United States (n = 336) released nickel, and 0.9% (n = 3) released cobalt. Belt dermatitis was a significant clinical finding in 34.8% of Chinese nickel-allergic patients. Literature review suggests increasing nickel allergy prevalence in the United States and China., Conclusions: Metallic belt buckles are an important source of nickel exposure to consumers. Belts from lowest socioeconomic vendors were more likely to release nickel. Belts with silver color and dark metallic color were more likely to release nickel and cobalt, respectively. Clinical findings show belt dermatitis in China to be a problem.