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Background: Atopic dermatitis (AD) patients display an altered skin microbiome which may not only be an indicator but also a driver of inflammation. We aimed to investi- gate associations among AD patients' skin microbiome, clinical data, and response to systemic therapy in patients of the TREATgermany registry. Methods: Skin swabs of 157 patients were profiled with 16S rRNA gene amplicon sequencing before and after 3 months of treatment with dupilumab or cyclosporine. For comparison, 16s microbiome data from 258 population-­based healthy controls were used. Disease severity was assessed using established instruments such as the Eczema Area and Severity Index (EASI). Results: We confirmed the previously shown correlation of Staphylococcus aureus abundance and bacterial alpha diversity with AD severity as measured by EASI. Therapy with Dupilumab shifted the bacterial community toward the pattern seen in healthy controls. The relative abundance of Staphylococci and in particular S. aureus significantly decreased on both lesional and non-­lesional skin, whereas the abundance of Staphylococcus hominis increased. These changes were largely independent from the degree of clinical improvement and were not observed for cyclosporine. Conclusions: Systemic treatment with dupilumab but not cyclosporine tends to re- store a healthy skin microbiome largely independent of the clinical response indicat- ing potential effects of IL-­4RA blockade on the microbiome.

Background: Previous studies demonstrated that birch pollen-related foods can cause late eczematous responses in birch pollen-sensitized patients with atopic dermatitis (AD). However, suitable markers to predict birch pollen-related food allergy in patients with AD are still lacking. Objective: We evaluated the correlation of the results from ImmunoCAP® fluorescence enzyme immunoassay (FEIA) singleplex and ImmunoCAP® immuno solid-phase allergen chip (ISAC) multiplex system in AD patients and investigated the diagnostic validity of allergen microarray analysis, measuring specific IgE (sIgE) with ImmunoCAP® ISAC to predict birch pollen-related food allergy in patients with AD. Methods: A total of 19 children and adults with AD, existing IgE-mediated birch pollen sensitization, and suspected birch pollen-related food allergy underwent a double-blind placebo-controlled food challenge (DBPCFC) in the clinical routine. Total and sIgE levels to birch pollen, Bet v 1, Bet v 2, and birch pollen-related foods (apple, carrot, celery, and hazelnut) were determined prior to the DBPCFC by ImmunoCAP®-FEIA. Additionally, allergen microarray ImmunoCAP® ISAC analysis was performed. Data were analyzed retrospectively. Results: Twelve out of 19 patients (63% responders) experienced an allergic reaction upon DBPCFC. Overall, 7 patients (37%) developed a significant deterioration of AD with a median increase of 12.4 points in the scoring of atopic dermatitis (SCORAD) index (range 10.0–15.7). Oral allergy syndrome was the predominant immediate-type symptom (n = 11/12 responders). There were no differences in sensitization frequencies regarding allergens of the pathogenesis-related protein family 10 between responders and non-responders. In all patients, correlation of IgE levels determined with ImmunoCAP® ISAC and ImmunoCAP®-FEIA, respectively, was significant with high correlation coefficients regarding birch pollen allergen extract, rBet v 1, and rBet v 2 (rs > 0.8, p < 0.001) and lower but also significant correlation coefficients regarding food allergens (rs < 0.8, p < 0.05–Conclusion: ImmunoCAP® ISAC microarray allows displaying a differentiated sensitization profile in birch pollen-sensitized patients with AD. However, IgE-mediated sensitization against birch pollen-related allergens revealed by the allergen multiplex system does not predict late eczematous reactions upon DBPCFC with birch pollen-related foods.

Atopic dermatitis (AD) is a relapsing chronic inflammatory skin disease with a significant public health burden.To conduct a survey in order to gain information on current problems on the care and treatment of AD patients from a wide range of care providers, as well as information on ways of improving AD guidelines.An online survey was conducted via professional associations, focussing on AD health care professionals with regards to current gaps in knowledge of AD management and experience based on the German guidelines (GL).In total, 542 respondents treated a median of 200 AD patients yearly. The most frequent problems in the management of AD concerned emollients (50%), largely due to patient costs and the inability to prescribe emollients/moisturizers. Barriers to prescribing biologics included cost. Respondents stated that the GL lacks information regarding patient education (27%) and use of basic emollients (27%). Consideration should be given to feasibility issues (32%) and the addition of care pathways (41%) to improve the GL.In this survey, we identified inadequate basic AD care mainly due to patient costs and lack of time for counselling as real-life challenges. These issues remain to be addressed in future guidelines.

Background Atopic dermatitis (AD) is a chronic inflammatory skin disease with a multifactorial genesis including genetic predispositions and environmental risk and trigger factors. One of the latter possibly is smoking, indicated by an increased prevalence of AD in adults and children that are actively or passively exposed to cigarette smoke. Objectives In this study AD characteristics and its atopic comorbidities are compared in smoking and nonsmoking AD patients. Methods TREATgermany is a non-interventional clinical registry which includes patients with moderate to severe AD in Germany. Baseline data of patients included into TREATgermany from inception in June 2016 to April 2020 in 39 sites across Germany was analyzed comparing AD disease characteristics and comorbidities in smokers versus non-smokers. Results Of 921 patients, 908 (male: 58.7%) with a mean age of 41.9 ± 14.4 reported their smoking status. The objective Scoring of Atopic Dermatitis (oSCORAD) did not differ between smokers (n=352; 38.8%) and nonsmokers, however lesions' intensity of oozing/crusts and excoriations as well as patient global assessment scores (PGA) of AD severity were higher in smoking as opposed to nonsmoking patients. Smokers reported a lower number of weeks with well-controlled AD and more severe pruritus than nonsmokers. Total IgE levels were more elevated in smokers and they displayed a younger age at initial diagnosis of bronchial asthma. After adjustment for potential confounders, the increased intensity of oozing/crusts, the reduced number of weeks with well-controlled AD and the greater pruritus remained different in smokers compared to nonsmokers. In addition, smoking patients with adult-onset AD showed a 2.5 times higher chance of involvement of the feet. Conclusions German registry data indicate that AD patients who smoke have a higher disease burden with a different distribution pattern of lesions in adult-onset AD.

Background Atopic dermatitis (AD) is one of the most common inflammatory skin diseases worldwide and Staphylococcus aureus colonization and secondary infections occur in the majority of AD patients. Allergic sensitizations against microbial antigens have been discussed as possible trigger factors of AD. Recently, we reported IgE sensitization against fibronectin-binding protein 1 (FBP1), an essential virulence component in S. aureus, in a subgroup of patients suffering from AD. To expand these findings by investigating delayed-type immune reactions, the objective of this study was to detect and phenotypically characterize FBP1-specific T cells as possible trigger factors in AD. Methods Immunodominant T-cell epitopes were mapped by proliferation testing of patient-derived FBP1-specific T-cell lines after stimulation with single 15mer peptides, which were derived from different functional domains of the FBP1 sequence. Major histocompatibility complex class II tetramers carrying immunodominant epitopes successfully stained T helper cells in 8 out of 8 HLA-matched, IgE-sensitized AD patients. Results Cytokine profiling of multimer-sorted cells revealed that predominantly the type 2 cytokines IL-13 and IL-4 were secreted by these cells. In contrast, IL-17, the marker cytokine for response to extracellular pathogens, was scarcely detectable. Conclusions We demonstrate that FBP1 contains immunodominant peptides that induce a specific pro-inflammatory T helper cell response with increased Th2 levels that can drive an allergic inflammation in sensitized AD patients.

The coronavirus disease 2019 (COVID-19) pandemic is caused by rapid spread of different strains of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The severity of infection ranges from mild, or even asymptomatic, to very severe. Signs and symptoms include fatigue, fever, exanthemas, upper respiratory illness, loss of smell and taste, pneumonia, severe acute respiratory syndrome, and multi-organ failure. Risk factors for a severe or lethal course include age, male gender, obesity, diabetes, cardiovascular disease, and immune suppression1 .

The increased permeability of the skin barrier towards environmental factors such as allergens is considered a key factor in the pathogenesis of atopic dermatitis (AD). Strengthening the skin barrier through basic skin therapy represents the basis of any therapy for AD. It is well known that genetic factors as well as the skin inflammation itself contribute to the weakening of the barrier; here, recent studies have led to a deeper understanding of the complex structures of the epidermis. The possibility of counteracting the disease preventively by the use of basic skin therapy from birth on has been studied intensively in recent years. This article summarizes recent findings on the effects of basic skin therapy as a primary and secondary preventive measure.

For the treatment of moderate to severe atopic dermatitis (AD), two groups of modern systemic therapies with a total of five drugs are currently approved in Germany: biologics (dupilumab, tralokinumab) and "small molecules" (abrocitinib, baricitinib, upadacitinib). The growing armamentarium of therapy options, especially with more than one drug per substance group, makes it challenging for practitioners to select the appropriate treatment for the individual patient. In this review article, the preconditions and requirements of each drug group as well as the corresponding substances are presented comparatively. On the one hand, direct therapeutic effects on the severity of the disease are considered and, on the other hand, the spectrum of potential adverse drug reactions are discussed. In particular, short- and long-term effects, the safety profile and the patient's concomitant diseases represent key factors for shared decision-making with regard to select the optimum personalized therapy option.Für die Therapie der moderaten bis schweren atopischen Dermatitis (AD) stehen mittlerweile zwei Gruppen an modernen Systemtherapien zur Verfügung, die aktuell fünf Substanzen umfassen: Biologika (Dupilumab, Tralokinumab) und „small molecules“ (Abrocitinib, Baricitinib, Upadacitinib). Das wachsende Armamentarium an neuen Therapieoptionen stellt die Behandler zunehmend vor neue Herausforderungen im Hinblick auf die Auswahl des passenden Präparates für den individuellen Fall. In diesem Übersichtsbeitrag werden die Therapievoraussetzungen und -bedingungen sowohl der jeweiligen Medikamentengruppen sowie auch der Einzelsubstanzen komparativ dargestellt. Hierbei wird zum einen der direkte Effekt auf die Erkrankungsschwere betrachtet und ferner das Spektrum an möglichen unerwünschten Arzneimittelwirkungen diskutiert. Insbesondere kurz- und langfristige Wirkungen, das Sicherheitsprofil sowie die Begleiterkrankungen können als Entscheidungsfaktoren für eine patientenindividuelle Therapieauswahl zugrunde gelegt werden.

Hintergrund: Eltern von schulpflichtigen Kindern mit Nahrungsmittelallergien und dem Risiko anaphylaktischer Reaktionen wunschen sich einen

In chronic skin diseases such as atopic dermatitis (AD), therapeutic failure due to poor patient adherence to treatment is commonly reported. Therapeutic patient education (TPE) is an approach to improve self-management and adherence. Several studies demonstrated that TPE programmes have positive effects on disease management resulting in decreased disease severity and improved quality of life in AD patients. Various healthcare professionals (dermatologists, nurses, psychologists, dieticians) have been involved. TPE performed by trained dermatology nurses are highly efficient and improve various health-related outcomes. The aim of this position paper is to analyse the aims, modalities and efficacy of TPE in AD, to identify specific roles of dermatology nurses, to assess qualification requirements, and to propose practical recommendations. Potential activities of nurses in ongoing and future TPE programmes for AD patients will be discussed.

Einleitung: TREATgermany ist ein Forschungsregister, das deutschlandweit Informationen zu Erkrankungsschwere, Therapieverlauf und Patient Reported Outcomes bei erwachsenen Patienten mit moderater bis schwerer Neurodermitis (AD) dokumentiert. Im Beitrag wird der Zusammenhang der globalen Einschätzung der Erkrankungsschwere der AD durch Ärzte und Patienten zur Baselinevisite und deren Abhängigkeit von Erkrankungssymptomen untersucht. Methoden: Skalen: Globale Einschätzung der Schwere der AD (0 (abgeheilt) - 5 (sehr schwer)) durch Patienten (PGA) und Ärzte (IGA). Symptome: NRS für Schmerzen, Juckreiz und Schlafstörungen der letzten 3 Tage (0 (kein Auftreten des Symptoms) - 10 (schwerst-vorstellbares Auftreten)). Statistik: Stata 15, Wilcoxon-Vorzeichen-Rang-Test. + TREATgermany wird durch Sanofi, LEO, Galderma und Lilly finanziell unterstützt. Ergebnisse: 2016-2020 wurden 1.025 Patienten (Alter 42±15 Jahre; 42% Frauen) in 38 Zentren eingeschlossen. PGA und IGA lagen im Median bei beiden Geschlechtern bei 3 (moderat). Frauen (F) litten stärker unter den erfragten Symptomen als Männer (M) (Mediane: Schmerzen: 4 vs 3, Juckreiz: 7 vs 6, Schlafstörungen: 5 vs 4). PGA und IGA stimmten bei 38,4% der Patienten überein. 30,2 bzw. 31,4% der Frauen sowie 35,1 bzw. 26,5% der Männer schätzten ihre AD leichter bzw. schwerer ein als der Arzt (F: p = 0,9; M: p = 0,002). 50,3% der Patienten litten stark unter Schmerzen, Juckreiz oder Schlafstörungen (mind. 1 Wert ≥7), 14,2% unter allen 3 Symptomen. Je 38,0 bzw. 46,2% dieser Patienten schätzten ihre AD schwerer ein als der Arzt (M 33,8 vs 39,7%; F 42,5 vs 52,0%). Fazit: Arzt- und Patientenbeurteilung der AD stimmen geschlechtsspezifisch insbesondere bei schwerem Symptomerleben nicht immer überein. Dies zeigt den Bedarf an individualisierter Behandlung der AD, die Patientenpräferenzen im Fokus hat.

Allergic diseases are characterized by a complex complex chronic pathophysiology. Therapeutic patient education (TPE) programs are an important part of health care for allergic patients. These programs aim to increase the patient's adherence to evidence-based treatment and improve their ability to cope with the disease. TPE led by a multiprofessional team covers the complex pathogenesis of the disease, trigger factors, nursing and dietary issues, and the broad variety of treatment options available including psychological and behavioral aspects.Regarding atopic dermatitis (AD), randomized, controlled studies have demonstrated the beneficial effects of delivering structured group training to children, their caregivers, and adult patients with AD. Such intervention achieved substantial improvements in quality of life and objective clinical disease parameters. Besides AD, training programs have also been developed and evaluated for patients with anaphylaxis and asthma. This article provides an overview of the multitude of TPE concepts and their impact on subjective and objective outcomes. It focuses on AD but also sheds light on other allergic diseases such as anaphylaxis and asthma.

atopic dermatitis (AD) patients are commonly sensitized to house dust mite (HDM). The current consensus-based European guideline underlines the impact of allergens inducing AD flares and the importance of allergen reduction in AD patients1,2 . With regard to preventive measures in patients with AD, the use of mattress encasings aiming to reduce skin contacts to mite allergens in bed may be considered in HDM-sensitized patients.

Since the introduction of active vaccination against SARS-CoV-2 infection, there has been a debate about the risk of developing severe allergic or anaphylactic reactions among individuals with a history of allergy. Indeed, rare cases of severe allergic reactions have been reported in the United Kingdom and North America. By february 2021 a rate of 4,5 severe allergic reactions occurred among 1 million patients vaccinated with the mRNA-based COVID-19 vaccines, which is higher than the generally expected rate of severe allergic reactions to vaccinations of around 1 in 1 million.

BACKGROUND: As an evidence resource for the currently planned European Academy of Allergy and Clinical Immunology (EAACI) clinical practice guideline "systemic treatment of atopic dermatitis (AD)," we critically appraised evidence on systemic treatments for moderate-to-severe AD.METHODS: We systematically identified randomized controlled trials (RCTs) investigating the safety and efficacy of systemic treatments for AD up to February 2020. Primary efficacy outcomes were clinical signs, AD symptoms and health-related quality of life. Primary safety outcomes included cumulative incidence rates for (serious) adverse events. Trial quality was assessed applying the Cochrane Risk of Bias Tool 2.0. Meta-analyses were conducted where appropriate.RESULTS: 50 RCTs totalling 6681 patients were included. Trial evidence was identified for apremilast, azathioprine (AZA), baricitinib, ciclosporin A (CSA), corticosteroids, dupilumab, interferon-gamma, intravenous immunoglobulins (IVIG), mepolizumab, methotrexate (MTX), omalizumab, upadacitinib and ustekinumab. Meta-analyses were indicated for the efficacy of baricitinib [EASI75 RD 0.16, 95% CI (0.10;0.23)] and dupilumab [EASI75, RD 0.37, 95% CI (0.32;0.42)] indicating short-term (ie 16-week treatment) superiority over placebo. Furthermore, efficacy analyses of AZA and CSA indicated short-term superiority over placebo; however, nonvalidated scores were used and can therefore not be compared to EASI.CONCLUSION: The most robust, replicated high-quality trial evidence is present for the efficacy and safety of dupilumab for up to 1 year in adults. Robust trial evidence was further revealed for AZA, baricitinib and CSA. Methodological restrictions led to limited evidence-based conclusions for all other systemic treatments. Head-to-head trials with novel systemic treatments are required to clarify the future role of conventional therapies.

Einleitung: Atopische Dermatitis (AD) geht als chronische Hauterkrankung nicht nur mit lebenslangen, sondern auch mit für Betroffene schwer abzuschätzenden, individuellen Krankheitsverläufen und Begleitsymptomatik einher. Der Beitrag untersucht den Zusammenhang objektiver Erkrankungsschwere mit subjektivem Erleben von Fatigue bei Patient*innen mit moderater bis schwerer AD aus dem Register TREATgermany zur Baselinevisite. Methoden: Im Register werden Informationen von Betroffenen und Ärzt*innen u.a. zur klinischen Erkrankungsschwere (Eczema Area and Severity Index, EASI) und der Schwere von Fatigue-Symptomen (Fatigue Severity Scale, FSS) erfasst. Statistik: SPSS 25, t-Test, lineare Regression. Ergebnisse: 2016-2019 wurden 808 Betroffene mit moderater bis schwerer AD (44,6±14,5 Jahre, 39% Frauen) in deutschlandweit 37 Kliniken und Praxen eingeschlossen. Die Patient*innen wiesen einen EASI-Score (0-72) von 15,7±12,6 auf, von denen 21,7% deutliche Fatigue-Ausprägungen angaben (Cut-Off = 5). Frauen (F) und Männer (M) waren ähnlich betroffen (p = 0,057). Betroffene mit deutlichem Fatigue-Erleben wiesen eine signifikant höhere Krankheitsschwere (19,5±13,9) auf, als diejenigen, die niedrigere FSS-Scores berichteten (14,6±12,1; p

This guideline is an update from August 2020 the S2k-guideline "Atopic dermatitis" published in 2015. The reason for updating this chapter of the guideline were the current developments in the field of systemic therapy of atopic dermatitis. The agreed recommendations for systemic treatment in atopic dermatitis of the present guideline are based on current scientific data. Due to the approval of dupilumab for the treatment of moderate to severe atopic dermatitis, which cannot be treated sufficiently with topical drugs alone, this part of the guideline has now been adapted and newly consented. The indication for systemic therapy and the therapeutic response to topical and systemic treatment should be recorded and documented in a suitable form in clinic and practice. A standardized documentation of the indication for system therapy in atopic dermatitis can be recommended and is also part of the updated chapter of this guideline.

Allergic diseases are characterized by a complex complex chronic pathophysiology. Therapeutic patient education (TPE) programs are an important part of health care for allergic patients. These programs aim to increase the patient's adherence to evidence-based treatment and improve their ability to cope with the disease. TPE led by a multiprofessional team covers the complex pathogenesis of the disease, trigger factors, nursing and dietary issues, and the broad variety of treatment options available including psychological and behavioral aspects.Regarding atopic dermatitis (AD), randomized, controlled studies have demonstrated the beneficial effects of delivering structured group training to children, their caregivers, and adult patients with AD. Such intervention achieved substantial improvements in quality of life and objective clinical disease parameters. Besides AD, training programs have also been developed and evaluated for patients with anaphylaxis and asthma. This article provides an overview of the multitude of TPE concepts and their impact on subjective and objective outcomes. It focuses on AD but also sheds light on other allergic diseases such as anaphylaxis and asthma.

Clinical practice guidelines are systematically developed decision aids for specific medical conditions. In Germany, national dermatology guidelines are developed chiefly under the aegis of the German Dermatological Society in collaboration with the Professional Association of German Dermatologists. European and international dermatological guidelines also exist and are developed by a range of organisations, such as the European Centre for Guidelines Development, which was founded by the European Dermatology Forum in 2018. In the years 2019 and 2020, new or updated German national guidelines were published on topics such as pathological scars (hypertrophic scars and keloids), cutaneous lupus erythematosus, pyoderma grangrenosum, anal pruritus, anal eczema, anal canal and anal rim carcinomas, as well as the prevention of HPV-associated neoplasms through vaccination, syphilis and the systemic treatment of neurodermitis. A new European guideline on lichen planus closes a gap in the spectrum of guidelines available in Germany. Key recommendations and relevant changes in the guidelines are presented in this article., Medizinische Leitlinien sind systematisch entwickelte Entscheidungshilfen für die angemessene Vorgehensweise bei speziellen gesundheitlichen Problemen. Dermatologische Leitlinien in Deutschland werden führend von der Deutschen Dermatologischen Gesellschaft in Kooperation mit dem Berufsverband Deutscher Dermatologen herausgegeben. Darüber hinaus werden auch europäische und internationale dermatologische Leitlinien erstellt, u. a. durch das im Jahr 2018 vom European Dermatology Forum gegründete European Centre for Guidelines Development. In den Jahren 2019 und 2020 wurden unter anderem deutsche Leitlinien zu den Themen pathologische Narben (hypertrophe Narben und Keloide), kutaner Lupus erythematodes, Pyoderma gangraenosum, analer Pruritus, Analekzem, Analkanal- und Analrandkarzinome, Impfprävention HPV(humane Papillomviren)-assoziierter Neoplasien sowie Syphilis und Systemtherapie bei Neurodermitis überarbeitet oder neu erstellt. Auf der europäischen Ebene schließt die Leitlinie zum Lichen planus eine in Deutschland noch bestehende Lücke der vorhandenen Leitlinien. Schlüsselempfehlungen und wesentliche Neuerungen in den Leitlinien werden hier vorgestellt.

Die vorliegende Leitlinie ist eine Aktualisierung vom August 2020 zu Systemtherapeutika der 2015 publizierten AWMF-S2k-Leitlinie Neurodermitis. Anlass fur die Aktualisierung dieses Kapitels der Leitlinie waren die aktuellen Entwicklungen zur Systemtherapie der Neurodermitis. In der vorliegenden Leitlinie sind die wissenschaftliche Datenlage und die konsentierten Empfehlungen zur Systemtherapie bei Neurodermitis aufgefuhrt. Aufgrund der Neuzulassung von Dupilumab fur die Behandlung mittelschwer bis schwer ausgepragter Neurodermitis, die mit topischen Medikamenten alleine nicht ausreichend behandelbar ist, wurde dieser Teil der Leitlinie jetzt angepasst und neu konsentiert. Die Indikation zur Systemtherapie und das therapeutische Ansprechen auf die topische und systemische Behandlung sollen in Klinik und Praxis in geeigneter Form erfasst und dokumentiert werden. Eine standardisierte Dokumentation der Indikation zur Systemtherapie bei Neurodermitis kann empfohlen werden und ist ebenfalls Bestandteil des hier vorliegenden aktualisierten Kapitels der Leitlinie.

International audience; Background: Surgery is a radical treatment for hidradenitis suppurativa (HS) and may be considered as the only one potentially curative. Objectives: To characterize HS recurrence in patients after surgery and assess the risk factors of recurrence. Methods: We conducted a monocentric retrospective cohort study. All consecutive patients who had surgery (January 1, 2012 to March 31, 2017) were included. We estimated the rate of recurrence of HS lesions after surgery (

International audience; Atopic dermatitis (AD) is a highly pruritic, chronic inflammatory skin disease. The diagnosis is made using evaluated clinical criteria. Disease activity and burden are best measured with a composite score, assessing both objective and subjective symptoms, such as SCORing Atopic Dermatitis (SCORAD). AD management must take into account clinical and pathogenic variabilities, the patient's age and also target flare prevention. Basic therapy includes hydrating and barrier-stabilizing topical treatment universally applied, as well as avoiding specific and unspecific provocation factors. Visible skin lesions are treated with anti-inflammatory topical agents such as corticosteroids and calcineurin inhibitors (tacrolimus and pimecrolimus), which are preferred in sensitive locations. Topical tacrolimus and some mid-potency corticosteroids are proven agents for proactive therapy, which is defined as the long-term intermittent anti-inflammatory therapy of frequently relapsing skin areas. Systemic anti-inflammatory or immunosuppressive treatment is a rapidly changing field requiring monitoring. Oral corticosteroids have a largely unfavourable benefit-risk ratio. The IL-4R-blocker dupilu-mab is a safe, effective and licensed, but expensive, treatment option with potential ocular side-effects. Other biologicals targeting key pathways in the atopic immune response, as well as different Janus kinase inhibitors, are among emerging treatment options. Dysbalanced microbial colonization and infection may induce disease exacerbation and can justify additional antimicrobial treatment. Systemic antihistamines (H1R-blockers) only have limited effects on AD-related itch and eczema lesions. Adjuvant therapy includes UV irradiation, preferably narrowband UVB or UVA1. Coal tar may be useful for atopic hand and foot eczema. Dietary recommendations should be patient-specific, and elimination diets should only be advised in case of proven food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Psychosomatic counselling is recommended to address stress-induced exacerbations. Efficacy-proven 'Eczema school' educational programmes and therapeutic patient education are recommended for both children and adults.

Background The Atopic Dermatitis (AD) TREATgermany registry was initiated by the German Society for Dermatology (DDG) in 2011 to evaluate the ‘real‐life’ situation of health care for patients with AD. Objectives Interim data analysis on baseline characteristics as well as current and prescribed systemic treatments of the TREATgermany registry patients. Methods Patients (≥18 years) with moderate‐to‐severe AD [objective (o)SCORAD > 20], or with current or previous anti‐inflammatory systemic treatment for AD within 24 months, were included and are followed up over at least 24 months. To assess clinical signs, the eczema area severity index (EASI, 0–72), the oSCORAD (0–83) and the Investigator Global Assessment (IGA; 6‐point scale) were used. The disease severity was globally scored by the patients [Patient Global Assessment (PGA); six‐step Likert scale]. Disease symptoms were assessed by the patient‐oriented eczema measure (POEM, 0–28) and numeric rating scales (NRS, 0–10). Health‐related quality of life was measured using the dermatological life quality index (DLQI, 0–30). Results A total of 612 patients were recruited across 32 sites between 06/2016 and 01/2019 (mean age: 42.6 ± 14.2 years; mean oSCORAD: 40.8 ± 16.3). The mean POEM score was 16.3 ± 7.5. Pruritus was rated highest among subjective symptoms (NRS: 5.4 ± 2.7). The mean DLQI value was 11.3 ± 7.5. The frequency of arterial hypertension was lower (20.8%) compared with the general population, whilst this was higher for depression (10%). More than 60% of the patients had received systemic glucocorticosteroids, and 36.8% had received cyclosporine A prior to inclusion. Dupilumab was the leading substance documented as either ‘current’ (12.1%) or ‘prescribed’ (31.4%) at baseline. Conclusions These ‘real‐life’ data clearly demonstrate the substantial disease burden. Most of TREATgermany patients were already treated with or prescribed dupilumab at baseline. Moreover, current findings indicate the urgent need for further alternative agents in order to achieve a perceptible improvement of quality of life of patients with moderate‐to‐severe AD.

Atopic dermatitis (AD) is a complex disease with elevated risk of respiratory comorbidities.1,2 Severely affected patients are often treated with immune-modulating systemic drugs.3,4 On March 11th 2020, the World Health Organization declared the 2019 novel coronavirus severe acute respiratory syndrome (SARS-Cov-2) epidemic to be a pandemic. The number of cases worldwide is increasing exponentially and poses a major health threat, especially for those who are elderly, immuno-compromised, or have comorbidities. This also applies to AD patients on systemic immune-modulating treatment. In these days of uncertainty, reallocation of medical resources, curfew, hoarding, and shutdown of normal social life, patients, caregivers and doctors ask questions regarding the continuation of systemic immune-modulating treatment of AD patients. The ETFAD decided to address some of these questions here.

Electrospun polycaprolactone:gelatin (PCL:GT) fibre scaffolds are widely employed in the field of tissue implants. Here, the orientation of fibres plays an important role in regard to implantation due to the impact on the mechanical properties. Likewise, the orientation of collagen fibres in skin tissue is relevant for dermatology. State-of-the-art fibre orientation measurement methods like electron microscopy are time consuming and destructive. In this work, we demonstrate polarimetry as a non-invasive approach and evaluate its potential by measuring the Mueller matrix (MM) of gelatin and collagen containing samples as simple skin tissue phantoms. We demonstrate that it is possible to determine the orientation of PCL:GT fibre scaffolds within one MM measurement. Furthermore, we determine the structural orientation in collagen film samples. Currently, the diagnosis of skin diseases is often performed by image analysis or histopathology respectively, which are either subjective or invasive. The method presented, here, provides an interesting alternative approach for such investigations. Our findings indicate that the orientation of collagen fibres within skin lesions might be detectable by MM measurements in the future, which is of interest for skin diagnostics, and will be further investigated during the next step.

Atopic dermatitis (AD) is a disease that can have a high impact on quality of life, especially due to itch and skin pain. This paper utilizes expertise from members of the International Society of Atopic Dermatitis (ISAD)/Oriented Patient-Education Network in Dermatology (OPENED) task force to review the epidemiology, pathophysiology and exacerbating factors of itch and pain in atopic dermatitis. General principles of treatment are provided, as well as a more detailed evaluation of topical and systemic therapies. Educational and psychological approaches to itch and pain in atopic dermatitis are proposed, along with expert recommendations for the management of itch and pain in atopic dermatitis.

Summary Background Parents of school-age children with food allergies and potential anaphylactic reactions want their children to have an unburdened and risk-free everyday school life. Thus, particularly in the case of peanut allergy, demands for peanut-free schools are put forward. Results and discussion The position paper of the food allergy working group of the German Society for Allergology and Clinical Immunology (Deutsche Gesellschaft für Allergologie und klinische Immunologie) highlights why the concept of peanut-free schools does not protect peanut allergic children, but rather bears potential disadvantages and risks for all those involved. The focus on peanut as a potential trigger of anaphylactic reactions ignores other relevant triggers. Conclusion In order to address the fears and concerns of patients, parents, and school staff, it is mandatory to develop various coping strategies. These should enable and ensure the safety and participation of food-allergic pupils in classes and other school activities. Therefore, it is important to implement adequate measures for allergen avoidance and emergency treatment for students with confirmed food allergies.

Background: Clinical registries may provide high-quality evidence on the use and effectiveness of therapeutic interventions under real-life conditions. Adults with moderate-to-severe atopic eczema (atopic dermatitis [AD]) are enrolled into TREATgermany and prospectively followed over at least 2years. This paper analyses the association between dermatological quality of life and work limitations.Materials and Methods: Treatment modalities and abroad set of physician- and patient-reported outcome measures are documented using validated instruments to assess clinical disease severity (EASI [Eczema Area and Severity Index], objective SCORAD [objective-SCORing Atopic Dermatitis]), quality of life (DLQI [Dermatology Life Quality Index]), symptoms (POEM [Patient-oriented Eczema Measure]), global disease severity, as well as patient satisfaction and work limitations including presenteeism (WLQ [Work Limitation Questionnaire]). From 06/2016 until 12/2017, 241 individuals (mean age 43 +/- 15years, 38.6% female) were enrolled at 19recruitment centers;69% of the patients were employed.Results: Employed persons had DLQI and WLQ scores of 10.6 +/- 6.9points and 17.7 +/- 18.1%, respectively. Mean presenteeism was substantial accounting for 9.2%. With coefficients of 0.39 and 0.33 WLQ and presenteeism scores significantly correlate with DLQI (p

Atopic eczema is a chronic recurrent inflammatory skin disease characterized by intensive pruritus and a high burden of disease. Based on a genetically determined skin barrier dysfunction, xerosis cutis and a tendency towards microbial skin infections are the leading clinical features. Mild and moderate disease manifestations are common, and usually treated with topical agents only. Treatment concepts are usually based on a combination of (i) topical basic therapy consisting of skin cleansing and barrier stabilizing emollients and (ii) topical anti-inflammatory therapy of visible skin lesions with topical corticosteroids and topical calcineurin inhibitors. Proactive therapy of the commonly affected and usually relapsing areas of skin is an important therapeutic option for long-term maintenance treatment of moderate to severe disease. Patients should be actively involved in planning of treatment, which should be adapted to individual patient factors such as age, involved body areas, type of skin lesions, as well as seasonal and climatic factors. New promising treatment options including topical phosphodiesterase inhibitors and topical Janus kinase inhibitors are currently being evaluated in clinical trials and may become a future treatment option for atopic eczema. This review article summarizes the current topical treatment options and new perspectives in the topical therapy of atopic eczema.

In schweren Fallen einer atopischen Dermatitis (AD) ist eine Systemtherapie indiziert. Bislang waren fur diese Indikation lediglich Ciclosporin und systemische Glukokortikosteroide zugelassen. Daneben liegen mittlerweile positive Erfahrungen aus der Praxis zum (Off‑label‑)Einsatz von weiteren Wirkstoffen, wie Mycophenolsaure, Methotrexat, Alitretinoin, Azathioprin und Ustekinumab, vor. Intensive Forschungsbemuhungen zielen auf ein besseres Verstandnis im Hinblick auf genetische und immunologische Faktoren dieser chronisch-entzundlichen Hauterkrankung ab. Dabei wurden kurzlich fur eine Behandlung mit Mycophenolsaure relevante Genpolymorphismen bei Patienten mit AD identifiziert, die ein Therapieansprechen auf diesen Wirkstoff vorhersagen konnten. Derzeit befindet sich eine Vielzahl vollig neuer Wirksubstanzen in der klinischen Erprobung, die spezifisch in das Entzundungsgeschehen bei AD eingreifen und fur die erste vielversprechende Behandlungseffekte auf den Hautzustand bzw. die Juckreizsymptomatik bei AD beobachtet werden konnten. Als ein herausragendes Ergebnis dieser Entwicklungen wurde im September dieses Jahres in Europa und damit auch in Deutschland erstmals ein Biologikum als „First-line“-Therapie fur die Indikation einer mittelschweren bis schweren AD im Erwachsenenalter zugelassen: Dupilumab ist ein humaner monoklonaler Immunglobulin(Ig)G4-Antikorper und blockiert eine Untereinheit sowohl des Interleukin(IL)-4- als auch des IL-13-Rezeptors, sodass die Wirkung dieser beiden fur die akute Krankheitsphase bei AD entscheidenden Zytokine gehemmt wird. Aber auch das IL-13 selbst, der fur den Juckreiz bei AD relevante IL-31-Rezeptor, der Histamin-4-Rezeptor und Januskinasen stellen neue therapeutische Zielstrukturen klinischer Studien zur Behandlung der AD dar.

Die atopische Dermatitis (AD) ist eine chronisch entzundliche Hauterkrankung mit einer 1‑Jahres-Pravalenz im Erwachsenenalter von 2–3 %. Zur Verbesserung der ambulanten Versorgungssituation dieser Patienten wurde durch die Arbeitsgemeinschaft Neurodermitisschulung im Erwachsenenalter (ARNE) im Rahmen einer nationalen randomisierten, kontrollierten Multicenterstudie mit Wartekontrollgruppendesign ein Programm zur strukturierten Schulung im ambulanten Setting entwickelt und evaluiert. Die Teilnahme an dieser 12-stundigen, interdisziplinar geleiteten Kleingruppenschulung fuhrte bei den Patienten (n = 168) im Vergleich zur Wartekontrollgruppe (n = 147) 1 Jahr nach Teilnahme an der Schulung zu einer signifikant starkeren Verbesserung sowohl der Coping-Strategien im Hinblick auf Juckreiz (erfasst anhand des Juckreiz-Kognitions-Fragebogens, p

Background Dental technicians (DTs) are at increased risk for allergic contact sensitization. Objectives To assess the current spectrum of occupational sensitization in DTs with occupational contact dermatitis (OCD). Methods A retrospective analysis of Information Network of Departments of Dermatology patch test data from the years 2001-2015 concerning DTs with OCD was performed. Results Patients of the study group (226 DTs with OCD) were significantly more often diagnosed with allergic contact dermatitis (37.6% versus 18.5%; p = 0.0002) than patients of the control group (124 DTs without OCD). In the study group, positive reactions were most frequently observed to methacrylates and/or acrylates (n = 67). Of these, 61 patients showed positive reactions to at least one of the five most frequent allergens in this group, namely 2-hydroxyethyl methacrylate, 2-hydroxypropyl methacrylate, methyl methacrylate, ethyl methacrylate, and/or ethylene glycol dimethacrylate. In contrast, no positive reactions to diurethane dimethacrylate (DUDMA) occurred. Among allergens of the German Contact Dermatitis Research Group series 'dental metals', positive reactions were less frequent and were mainly to palladium chloride (n = 6). Conclusions The present data analysis showed that the sensitization spectrum and spectrum of cross-reactivity are largely unchanged as compared with the 1990s. It can be concluded that test recommendations are still valid and useful, except for the methacrylate DUDMA, which could be omitted.

Atopic dermatitis is a chronic inflammatory skin disease with a complex pathogenesis and different exogenous and endogenous trigger factors. One important factor is the sensitization to inhalant and/or food allergens. The detection of total IgE and specific IgE antibodies to inhalant and/or food allergens is one central aspect in diagnosing atopic dermatitis, especially if skin prick tests are not feasible. Many patients are polysensitized, but not all sensitizations are of clinical relevance. The challenge is to identify the sensitizations with clinical relevance and to initiate suitable therapeutic options. In this article we go into detail for the allergens house dust mite, pollen, food, and Malassezia sympodialis. Furthermore, the authors comment on the impact of the detection of specific IgG/IgG4 antibodies in the diagnosis of food allergy in atopic dermatitis. Moreover, new options in the in-vitro diagnostic will be explained briefly and their actual diagnostic significance in patients with atopic dermatitis will be highlighted. These options are the detection of specific IgE antibodies to recombinant allergens and the allergen chip.

SummaryBackground Textile dyes, rubber, elements or textile resins carry the risk of inducing allergic contact sensitization. Objectives To assess clinical data and patch test results for dermatitis patients with suspected textile allergy. Methods A retrospective analysis of Information Network of Departments of Dermatology data of the years 2007–2014 of patients patch tested because of suspected textile allergy was performed. Results Patients of the study group (n = 3207) suffered more frequently from leg, trunk and generalized dermatitis than patients of the control group (n = 95210). Among the allergens of the textile dye series, the highest frequency of positive reactions was observed for p-aminoazobenzene (5.1%) and p-phenylenediamine (PPD) (4.5%), followed by Disperse Orange 3 (3.1%), Disperse Blue 124 (2.3%), Disperse Blue 106 (2.0%), Disperse Red 17 (1.1%), and Disperse Yellow 3 (1.1%), partly with concomitant reactions. Patch testing with the patients' own textiles was performed in 315 patients, with positive reactions in 18 patients. These were mostly elicited by blue or black textiles with tight skin contact. Only 2 of these patients also reacted to textile dyes from the German Contact Dermatitis Research Group series. Conclusions For the comprehensive diagnosis of contact sensitization in patients with suspected textile dermatitis, combined patch testing is indicated, with (i) PPD and a textile dye series and (ii) patients' own clothing.

Purpose of review This review summarizes the mode of action of IL-4 and IL-13 in skin allergy, upcoming therapeutics and depicts key outcomes of the latest clinical trials. Recent findings Atopic dermatitis is considered to be one of the most common inflammatory skin disease in industrialized countries. Accompanied by strong pruritus, atopic dermatitis has a significant impact on quality of life in severely affected individuals. Aside from unspecific immunosuppressant medications, therapeutics targeting the key cytokines IL-4 and IL-13 and their downstream mediators are under development or have been approved just recently with outstanding potential. Summary The recent development of several biologics and small compounds has the potential to revolutionize the treatment of atopic dermatitis, and applying this set of state-of-the-art drugs will provide a unique chance to gain insights into this skin disorder, patient subgroups, and key inflammatory mediators.

Background: Clinical registries may provide high quality evidence on the use and effectiveness of therapeutic interventions under real-life conditions. Adults with moderate-to-severe AD are enrolled into TREATgermany and prospectively followed over at least 2 years. The paper analyses the association between dermatological quality of life and work limitations. Materials and methods: Treatment modalities and a broad set of physician and patient reported outcome measures are documented using validated instruments to assess clinical disease severity (EASI, objective SCORAD), quality of life (DLQI), symptoms (POEM), global disease severity, as well as patient satisfaction and work limitations including presentism (WLQ). From 06/2016 until 12/2017. 241 individuals (mean age 43 +/- 15 years. 38.6% female) were enrolled at 19 recruitment centers. 69% of them were currently employed. Results: Employed persons had DLQI and WLQ scores of 10.4 +/- 6.9 points and 17.7 +/- 18.1%, respectively. Mean presentism was substantial accounting for 9.2%. With coefficients of 0.39 and 0.33 WLQ and presentism scores significantly correlate with DLQI (p < 0.000). Bootstrapped regression models showed that the limitations in coping with work requirements increase by 1.7% as DLQI increases by one point. Lower quality of life due to AD is most strongly associated with limitations in the area of physical and performance requirements in general. Presentism decreases by 0.5% as DLQI increases by one point. Conclusion: Moderate-to-severe AD has substantial adverse economic impact with mean productivity loss of patients of almost 10%. Future analyses from TREATgermany will address the impact of innovative treatment modalities on quality of life and work productivity of patients with moderate-to-severe AD., Hintergrund: Klinische Register tra- gen zur Evidenzbasierung der Gesund- heitsversorgung und zur Umsetzung von Forschungsergebnissen in die Praxis bei. TREATgermany schließt Erwachsene mit moderater bis schwerer Neurodermitis (AD) mit prospektiver Beobachtung über min- destens 2 Jahre ein. Der Beitrag zeigt ers- te Ergebnisse zum Zusammenhang von krankheitsbezogener Lebensqualität und Leistungseinschränkungen im Beruf. Ma- terial und Methoden: Dokumentiert werden objektive und subjektive Outcomes mit vali- dierten Messinstrumenten: klinischer Schwe- regrad (EASI, oSCORAD), Lebensqualität (DLQI), Symptome (POEM), globaler Schweregrad (IGA/PGA), Patientenzufrie- denheit und berufsbezogene Leistungsein- schränkungen (WLQ) inkl. Präsentismus (Produktivitätsverlust bei der Arbeit) so- wie der Therapieverlauf. 06/2016 – 12/2017 wurden 241 Patienten (Alter 43 ± 15 Jahre; 38,6% Frauen) in deutschlandweit 19 Zent- ren eingeschlossen, 69% waren berufstätig. Ergebnisse: Erwerbstätige hatten DLQI- und WLQ-Mittelwerte von 10,4 ± 6,9 Punkten bzw. 17,7 ± 18,1%. Der mittlere Präsentis- mus betrug 9,2%. Mit r = 0,39 und 0,33 kor- relierten die WLQ- und Präsentismus-Scores signifikant mit dem DLQI (p < 0,001). Eine geringere Lebensqualität war am stärks- ten mit körperlichen und allgemeinen Leis- tungseinschränkungen im Beruf assoziiert. Regressionsmodelle zeigten einen Zuwachs von Limitationen bei der Bewältigung von Arbeitsanforderungen um 1,7% und des Prä- sentismus um 0,5% mit der Zunahme des DLQI um einen Punkt. Diskussion: eine mo- derate bis schwere AD hat negative wirt- schaftliche Auswirkungen mit einem mittle- ren Produktivitätsverlust der Patienten von fast 10%. Weitere Analysen sollten den Ein- fluss innovativer Behandlungsmethoden auf Lebensqualität und Arbeitsproduktivität in den Fokus rücken.

Background: Altered quantities, activity, and composition of natural killer (NK) cells in blood as well as expression changes of genes involved in NK-cell function in skin lesions of patients with atopic dermatitis (AD) were recently reported. Objectives: We sought to comprehensively analyze cutaneous NK-cell transcriptomic signatures in AD, and to examine changes under treatment. Methods: We analyzed NK-cell signatures in skin transcriptome data from 57 patients with moderate to severe AD and 31 healthy controls. In addition, changes after 12 weeks of systemic treatment (dupilumab n = 21, cyclosporine n = 8) were analyzed. Deconvolution of leucocyte fractions was conducted. Immunofluorescence staining of NK cells was performed on paraffin-embedded skin sections. Results: Immunofluorescence staining revealed a relatively high abundance of both NK cells and CD3+ CD56+ cells in lesional as compared with nonlesional and healthy skin. Lesional and to a lesser extent nonlesional skin showed a strong upregulation of NK-cell markers together with a dysbalanced expression of inhibitory and activating receptors, which was not reverted under treatment. Digital cytometry showed a decrease in activated and an increase in resting NK cells in both lesional and nonlesional skin, which was reverted by both treatment with dupilumab and cyclosporine. The NK-cell transcriptomic signature remained upregulated after treatment, but there was a shift on the qualitative level, indicating a compositional change in NK-cell subsets toward CD56bright NK cells. Conclusions: Lesional AD skin shows a NK-cell dysregulation, which despite clinical improvement under systemic therapy was only partially reverted, and which may represent a yet underappreciated disease mechanism

Summary Background Hereditary factors may influence individual susceptibility to contact allergy (CA). Objectives To investigate genetic variants with impacts on early inflammatory reactions and T cell functions that possibly increase the risk of CA. Patients and Methods Three hundred and seventy two patients undergoing patch testing were recruited from the Information Network of Departments of Dermatology (IVDK). Of these, 133 were monosensitized and 239 were polysensitized, defined as reacting to three or more unrelated sensitizers. Within the polysensitized individuals, a subgroup with at least one particularly strong patch test reaction (strong reactors; n = 194) was considered. Three hundred and forty-seven blood bank donors served as controls. Fifteen genetic variants in 13 genes were analysed. Results The homozygous variant CXCL11 AA genotype (rs6817952) was significantly more frequent among polysensitized patients (10 of 239 = 4.2%; p = 0.0048; odds ratio 7.49; 95%CI: 1.7–36.1) than among monosensitized patients (2.2%) and in the control group (0.6%). None of the remaining genetic variants investigated were characterized by similarly strong associations. However, the significance was lost after correction for multiple comparisons. Conclusions The homozygous variant CXCL11 genotype is associated with an increased risk of CA. To confirm this exploratory finding, further independent studies are needed.