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Anthony Bewley,1 Ignasi Figueras-Nart,2 Jainzhong Zhang,3 Mariana Guerreiro,4 Nicole Tietz,4 Sami Chtourou,4 Frederick Durand,4 Ulrike Blume-Peytavi5 1Department of Dermatology, The Royal London Hospital & Queen Mary University, London, UK; 2Department of Dermatology, University Hospital de Bellvitge, Barcelona, Spain; 3Department of Dermatology, Peking University People’s Hospital, Beijing, People’s Republic of China; 4Eli Lilly and Company Ltd, Indianapolis, IN, USA; 5Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Berlin, GermanyCorrespondence: Anthony Bewley, Department of Dermatology, The Royal London Hospital & Queen Mary University, London, UK, Tel +44 020 7767 3200, Email anthony.bewley@nhs.netPurpose: Alopecia areata (AA) is an autoimmune disease characterized by hair loss that has significant psychosocial implications. This study aims to describe the patient-reported burden of severe AA, coping mechanism and information needs using data from the multinational AA Patient Satisfaction and Unmet Need Survey.Patients and Methods: Participants with current or previous ≥ 50% scalp hair loss (n = 747) were recruited from 11 countries and completed a web-based survey that assessed demographics, clinical characteristics, disease burden and psychosocial impact. Data were stratified according to sex, current age, disease duration and current severity of scalp hair loss.Results: The mean (SD) age of participants was 43.8 (7.1) years, 55.3% were women, and 63.5% reported AA symptoms within 6 months of diagnosis. Most participants had black or brown hair (88.4%), reported a disease duration of 2 years or more (75.6%) and had current scalp hair loss of ≥ 50% (87.4%). Severe hair loss also extended to eyebrow (46.9%), eyelash (48.7), beard (61.5%) and body hair (73.2%). Participants commonly reported comorbidities such as anxiety (26.1%), depression (18.1%) and sleep problems (28.1%). The Dermatology Life Quality Index revealed a severe impact on quality of life; 86.2% of participants scored > 10. Mental health/mood was significantly affected; 55.8% of participants reported a substantial impact. Long-term effects included decreased self-esteem (32.9%), poor mental health (28.1%) and challenges in day-to-day activities (27.2%). Information needs were centered around treatment expectations, mental health, and available treatment options. More severe symptoms and a greater daily impact were reported by women and those with a longer disease duration.Conclusion: The study emphasizes the substantial burden, including impaired quality of life and psychological well-being, of severe AA on the lives of surveyed participants. The findings highlight the importance of comprehensive disease management strategies that address both physical and psychosocial aspects of AA.Plain language summary: Alopecia areata (AA) is a disease that results in hair loss and can greatly affect quality of life and well-being. The authors wanted to understand how this condition affects people’s lives and what they need to cope with it. A survey was completed by adults from 11 different countries who had current or past severe AA. The participants were asked about their demographics, their experiences with the condition and how it impacted their daily lives. The results showed that AA has a severe impact on their quality of life, including their mental health and daily activities. Participants also experienced decreased self-esteem and faced challenges in their relationships and daily routines, and many reported feeling anxious, depressed, and having trouble sleeping. Participants found different ways to cope with their condition and expressed a need for realistic expectations about treatment results, information about mental health, and treatment options. The study also found that women and those with a longer duration of AA tended to have more severe symptoms and the impact on their lives was greater. Overall, this study shows that current or previous episodes of severe AA had a significant impact on people’s lives, including their mental health and daily activities. It emphasizes the need for information about the condition and treatment options with realistic expectations. The findings help to better understand the experiences of people with AA and may aid the provision of appropriate support and information.Keywords: burden of disease, quality of life, disease management

Abstract: Despite the chronic and increasingly prevalent nature of actinic keratosis (AK) and existing evidence supporting assessment of the entire cancerization field during clinical management, a standardized definition of the AK field to aid in the understanding and characterization of the disease is lacking. The objective of this review was to present and appraise the available evidence describing the AK cancerization field, with the aim of determining a precise definition of the AK field in terms of its molecular (including genetic and immunological), histological and clinical characteristics. Eight European dermatologists collaborated to conduct a review and expert appraisal of articles detailing the characteristics of the AK field. Articles published in English before August 2016 were identified using PubMed and independently selected for further assessment according to predefined preliminary inclusion and exclusion criteria. In addition, a retrospective audit of patients with AK was performed to define the AK field in clinical terms. A total of 32 review articles and 47 original research articles provided evidence of sun‐induced molecular (including genetic and immunological) and histological skin changes in the sun‐exposed area affected by AK. However, the available literature was deemed insufficient to inform a clinical definition of the AK field. During the retrospective audit, visible signs of sun damage in 40 patients with AK were assessed. Telangiectasia, atrophy and pigmentation disorders emerged as ‘reliable or very reliable’ indicators of AK field based on expert opinion, whereas ‘sand paper’ was deemed a ‘moderately reliable’ indicator. This literature review has revealed a significant gap of evidence to inform a clinical definition of the AK field. Therefore, the authors instead propose a clinical definition of field cancerization based on the identification of visible signs of sun damage that are reliable indicators of field cancerization based on expert opinion. [ABSTRACT FROM AUTHOR]

Patients with solar urticaria were observed to show a more complete response than patients with either symptomatic dermographism {63% [95% confidence interval (CI) 44-79-81-21] vs. 27-3% [95% CI 0-97-53-63], I P i = 0-046} or cold urticaria [63% (95% CI 44-79-81-21) vs. 22-7% (95% CI 5-20-40-20), I P i = 0-005]. The response of patients with symptomatic dermographism was significantly poorer than that of patients with either solar urticaria [45-5% (95% CI 16-07-74-93) vs. 81-5% (95% CI 66-85-96-15), I P i = 0-026] or cholinergic urticaria [45-5% (95% CI 16-07-74-93) vs. 90% (95% CI 71-41-100-00), I P i = 0-031]. While a good response in 12 patients led to omalizumab withdrawal, due to relapse, treatment was reinitiated in half of those patients, again achieving a good response. [Extracted from the article]

Background: Moderate-to-severe atopic dermatitis (AD) can be difficult to manage in paediatric patients, and there are few licensed treatments available for this age group. Dupilumab is approved for the treatment of AD in children older than 6 months., Objectives: To assess the effectiveness and safety of dupilumab in a real-world cohort of paediatric patients with AD in Spain., Methods: A multicentre, retrospective real-world study on the effectiveness and safety of dupilumab in patients aged 2-18 years with moderate-to-severe AD was conducted. Demographic and clinical characteristics were analysed, and effectiveness (Eczema Area and Severity Index, Investigator's Global Assessment, Dermatology Life Quality Index, Numerical Rating Scale itch), safety and drug survival measures were assessed. A comparison of our results with other real-world outcomes and with clinical trials was made., Results: Data from 243 patients from 19 centres were collected, with a mean follow-up of 85 weeks. Dupilumab exhibited significant effectiveness, with marked reductions in severity scores from week 4. By week 16, 79.4% of patients achieved ≥ 75% improvement in Eczema Area and Severity Index (EASI) score (EASI 75) and 40.5% achieved ≥ 90% improvement in EASI score (EASI 90). Mean percentage reduction in EASI was 79.7%. Increasing improvements were observed until week 52, with 85.8% and 49.6% of patients achieving EASI 75 and EASI 90, respectively. Forty-three patients developed adverse events (AEs) (43 of 243, 17.7%). The most frequent AEs were ocular surface diseases (20 of 243, 8.2%), injection site reactions (8 of 243, 3.3%) and facial redness (7 of 243, 2.9%). Drug survival was high (96.9% and 93.1% after 1 and 2 years of follow-up, respectively), with only 19 patients (7.8%) interrupting treatment: 7 (2.9%) owing to AEs; 2 (0.82%) owing to secondary failure; 5 (2.1%) were lost to follow-up; and 5 (2.1%) entered remission and stopped treatment., Conclusions: Real-world use of dupilumab in paediatric AD demonstrated sustained effectiveness, high drug survival and acceptable safety profiles. Longer-term studies are crucial for AE surveillance and understanding how to manage disease remission., Competing Interests: Conflicts of interest H.I. has received consultancy/speaker honoraria and/or participated in clinical trials sponsored by AbbVie, Amgen, Boehringer Ingelheim, Novartis, Pfizer, Leo Pharma, Sanofi and UCB. E.R. has received consultancy/speaker honoraria and/or participated in clinical trials sponsored by AbbVie, Amgen, AstraZeneca, Bayer, Biogen, Cantabria, Celgene, Galderma, Leo Pharma, Lilly, Pierre Fabre, Pfizer and Sanofi. A.V. has received consultancy/speaker’s honoraria from and/or participated in clinical trials sponsored by AbbVie, Almirall, Amgen, Amryt, Boehringer Ingelheim, Bristol Myers Squibb, Galderma, Janssen, Leo Pharma, Lilly, Novartis, Pfizer, Pierre Fabre, Sandoz, Sanofi and Viatris. A.M.-S. has received consultancy/speaker’s honoraria from and/or participated in clinical trials sponsored by AbbVie, Almirall, Amgen, Amryt, Janssen, Leo Pharma, Leti, Lilly, MSD, Mylan, Novartis, Pfizer, Pierre Fabre, Sanofi and UCB. M.M.-C. has participated as an investigator in clinical trials sponsored by Sanofi, AbbVie, Lilly, Leo Pharma, Pfizer, Almirall, Galderma and Novartis and has received speaker and consultant fees from Sanofi, Lilly, Leo Pharma, AbbVie and Galderma. M.C. has participated as an investigator in clinical trials and has received consultant fees from Sanofi and AbbVie. C.N.L. has received speaker honoraria from Sanofi. C.P. has received consultancy/speaker honoraria and/or participated in clinical trials sponsored by AbbVie, Sanofi, Novartis and Leo Pharma. A.E. has received consultancy/speaker honoraria and/or participated in clinical trials sponsored by AbbVie, Viñas, Leo Pharma, Sanofi, Novartis and Pfizer. M.V. has received consultancy/speaker’s honoraria from and/or participated in clinical trials sponsored by AbbVie, Almirall, Amgen, Biogen, Celgene, Gebro, Janssen, Leo Pharma, Lilly, Merck-Serono, MSD, Mylan, Novartis, Pfizer, Sanofi and UCB. J.P.-M. has received consultancy/speaker honoraria and/or participated in clinical trials sponsored by AbbVie, Sanofi, Celgene, Janssen-Cilag, Almirall, Lilly and Novartis. L.C.-B. has received consultancy/speaker honoraria and/or participated in clinical trials sponsored by Sanofi, Leo Pharma, AbbVie, Lilly, Almirall, Novartis, Amgen and Pfizer. M.B.-C. has received consultancy/speaker honoraria and/or participated in clinical trials sponsored by Sanofi, AbbVie, Lilly and Almirall. I.F. has received consultancy/speaker’s honoraria from and/or participated in clinical trials sponsored by AbbVie, Almirall, Amgen, AstraZeneca, Celgene, Celldex, Galderma, Galapagos, Gebro, L’Oreal, Leo Pharma, Eli-Lilly, MSD, Novartis, Pfizer, Regeneron, Sanofi and Sobi. G.M.-N. has been a Medical Advisor for AbbVie, Leo Pharma, Lilly, Sanofi and Novartis and has participated in educational activities for Almirall, Avène, AbbVie, Laboratorio Reig Jofre, Leo Pharma, Lilly, Meda, Novartis, Sanofi and Uriage. F.C. has received consultancy/speaker honoraria and/or participated in clinical trials sponsored by AbbVie, Novartis, Pfizer, Leo Pharma, Mylan, Sanofi and UCB. A.A.-M. has received consultancy/speaker honoraria and/or participated in clinical trials sponsored by AbbVie, Almirall, Amgen, Janssen, Leo Pharma, Lilly, Mylan, Novartis, Pfizer and Sanofi. J.M. has received consultancy/speaker’s honoraria from and/or participated in clinical trials sponsored by AbbVie, Almirall, Amgen, Boehringer Ingelheim, Celgene, Gebro, Janssen, Leo Pharma, Lilly, Novartis, Pfizer, Sanofi and UCB. X.S. has received consultancy/speaker honoraria from AbbVie, Sanofi and Lilly. S.B. has received speaker and consultant fees from Sanofi, AbbVie, Janssen, Lilly, Almirall and Novartis. L.P. has received consultancy/speaker’s honoraria from and/or participated in clinical trials sponsored by AbbVie, Almirall, Amgen, Baxalta, Biogen, Boehringer Ingelheim, Celgene, Gebro, Janssen, Leo Pharma, Lilly, Merck-Serono, MSD, Mylan, Novartis, Pfizer, Regeneron, Roche, Sandoz, Samsung-Bioepis, Sanofi and UCB. E.B. has received consultancy/speaker’s honoraria from and/or participated in clinical trials sponsored by AbbVie, Almirall, Galderma, Isdin, Leo Pharma, Leti, Lilly, Novartis, Pierre Fabre, Pfizer, Regeneron, Roche-Possay, Sanofi and Viatris., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Abrocitinib, a selective JAK 1 inhibitor, was recently approved in Europe. Despite its approval, real-world data on its efficacy and safety in treating moderate-to-severe atopic dermatitis (AD) remains limited., Objectives: This study aimed to evaluate the short-term effectiveness and safety of abrocitinib in a real-life setting for patients with moderate-to-severe AD., Methods: We conducted a retrospective multicenter study involving adult patients with moderate-to-severe AD who started abrocitinib treatment between May 1, 2023, and September 30, 2023, in 15 Spanish hospitals. Treatment doses were 100 or 200 mg daily, based on clinical assessment. Data collection included patient demographics, AD history, comorbidities, previous treatments, and disease severity indicators such as SCORing atopic dermatitis (SCORAD), Eczema Area and Severity Index (EASI), body surface area, and Peak Pruritus NRS scores at baseline, 4, 12, and 24 weeks. Quality of life was measured using the Dermatology Life Quality Index (DLQI), and safety was assessed by monitoring adverse reactions and various biochemical parameters., Results: The cohort comprised 76 patients with an average age of 33.93 years; 57.89% were male. Before abrocitinib, 36.84% were naïve to advanced therapies. The baseline mean scores were SCORAD 47.04, EASI 21.79, and DLQI 15.01. At Week 24, there were significant improvements: EASI was reduced to 2.81, and 70.58% of the patients achieved EASI 75. However, 18.42% discontinued treatment mainly due to inefficacy or adverse effects. The safety profile was favorable, with 22.37% reporting mild adverse events (AEs) and one serious case of cutaneous lymphoma., Conclusions: This first Spanish series assessing abrocitinib in real-world conditions reveals a significant improvement in AD symptoms and quality of life in a range of severity and prior treatment failures. Abrocitinib was well-tolerated, with few serious AEs, highlighting its potential as an effective treatment option for AD., (© 2024 The Author(s). International Journal of Dermatology published by Wiley Periodicals LLC on behalf of the International Society of Dermatology.)

Interleukin (IL)-9 is present in atopic dermatitis (AD) lesions and is considered to be mainly produced by skin-homing T cells expressing the cutaneous lymphocyte-associated antigen (CLA). However, its induction by AD-associated triggers remains unexplored. Circulating skin-tropic CLA + and extracutaneous/systemic CLA - memory T cells cocultured with autologous lesional epidermal cells from AD patients were activated with house dust mite (HDM) and staphylococcal enterotoxin B (SEB). Levels of AD-related mediators in response to both stimuli were measured in supernatants, and the cytokine response was associated with different clinical characteristics. Both HDM and SEB triggered heterogeneous IL-9 production by CLA + and CLA - T cells in a clinically homogenous group of AD patients, which enabled patient stratification into IL-9 producers and non-producers, with the former group exhibiting heightened HDM-specific and total IgE levels. Upon allergen exposure, IL-9 production depended on the contribution of epidermal cells and class II-mediated presentation; it was the greatest cytokine produced and correlated with HDM-specific IgE levels, whereas SEB mildly induced its release. This study demonstrates that both skin-tropic and extracutaneous memory T cells produce IL-9 and suggests that the degree of allergen sensitization reflects the varied IL-9 responses in vitro, which may allow for patient stratification in a clinically homogenous population.

Chronic kidney disease-associated pruritus (CKD-aP) is one of the most common and disabling comorbidities in patients with advanced CKD. In addition, it is associated with an increased risk of mortality, poorer quality of life, sleep disorders, mental health disorders, and increased use of health care resources. The clinical presentation of CKD-aP is very heterogeneous, making it difficult to diagnose and treat. Currently, there are no national guidelines on the management of CKD-aP. The aim of this document is to provide national consensus recommendations for the diagnostic and therapeutic management of CKD-aP. The document was prepared in three phases: a diagnostic and therapeutic management algorithm was proposed by a small group of nephrology specialists; the proposal was validated by a larger group of nephrologists; and a second validation by a multidisciplinary group that also included dermatology specialists. The diagnostic and therapeutic management algorithm attempts to cover the current need of a lack of specific guidelines for the adequate management of CKD-aP. At the same time, it introduces the use of difelikefalin, the first and only drug specifically approved for CKD-aP, with a good safety and efficacy profile., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Background: Undifferentiated autoinflammatory diseases are characterized by recurrent or persistent fever, usually combined with other inflammatory manifestations, and negative or inconclusive genetic studies for monogenic autoinflammatory disorders., Aims: To define and characterize disease phenotypes in adult patients diagnosed in an adult reference center with undifferentiated autoinflammatory diseases, and to analyze the efficacy of the drugs used in order to provide practical diagnostic and therapeutic recommendations., Methods: Retrospective study (2015-2022) of patients with undifferentiated autoinflammatory diseases among all patients visited in our reference center. Demographic, clinical, laboratory features and detailed therapeutic information was collected., Results: Of the 334 patients with a suspected autoinflammatory disease, 134 (40%) patients (61% women) were initially diagnosed with undifferentiated autoinflammatory diseases. Mean age at disease onset and at diagnosis was 28.7 and 37.7 years, respectively. In 90 (67.2%) patients, symptoms started during adulthood. Forty-four (32.8%) patients met diagnostic/classification criteria for adult periodic fever with aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome. In the remaining patients, four additional phenotypes were differentiated according to the predominant manifestations: a) Predominantly fever phenotype (n = 18; 13.4%); b) Predominantly abdominal/pleuritic pain phenotype (n = 9; 6.7%); c) Predominantly pericarditis phenotype (n = 18; 13.4%), and d) Complex syndrome phenotype (n = 45; 33.6%). Prednisone (mainly on demand), colchicine and anakinra were the drugs commonly used. Overall, complete responses were achieved with prednisone in 41.3%, colchicine in 40.2%, and anakinra in 58.3% of patients in whom they were used. By phenotypes, prednisone on demand was more effective in adult PFAPA syndrome and colchicine in patients with the abdominal/pleuritic pain pattern and PFAPA syndrome. Patients with complex syndrome achieved complete responses with prednisone (21.9%), colchicine (25.7%) and anakinra (44.4%), and were the group more often requiring additional immunosuppressive drugs., Conclusions: The analysis of the largest single-center series of adult patients with undifferentiated autoinflammatory diseases identified and characterized different disease phenotypes and their therapeutic approaches. This study is expected to contribute to increase the awareness of physicians for an early identification of these conditions, and to provide the best known therapeutic options., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: José Hernández-Rodríguez reports financial support was provided by Hospital Clínic de Barcelona. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Competing Interests: Conflicts of interest Dr Figueras-Nart has received honoraria as consultancy/speakers for AbbVie, Celgene, La Roche-Posay, Leo Pharma, Lilly, Novartis, Pierre-Fabre, Sanofi, Sobi, Vifor Pharma, Amgen, Pfizer, and Galderma. Dr Notario has received consultancy/speakers honoraria and/or participated in clinical trials sponsored by AbbVie, Almirall, Celgene, Cebro, IQVIA, Janssen, Leo Pharma, Lilly, MSD, Novartis, and Pfizer. Dr Bauer-Alonso has received compensation for presentation for Novartis, Sanofi, AbbVie, Leo Pharma, Galderma, Pierre-Fabre, and L’Oreal. Dr Bonfill-Ortí has received honoraria as consultancy/speakers for AbbVie, Leo Pharma, Lilly, Novartis, Sanofi, Galderma, Roche, and Sun Pharma. Dr Moreno-Vílchez has no conflicts of interest to declare.

Alopecia areata (AA) is a chronic autoimmune disease that causes non-scarring hair loss. Data are lacking on the epidemiology and clinical and economic burden of AA in Spain. To estimate the prevalence and incidence of AA in Spain and describe sociodemographic and clinical characteristics, treatment patterns, healthcare resource utilization (HCRU) and associated costs. This was an observational, retrospective, descriptive study based on the Health Improvement Network (THIN®) database (Cegedim Health Data, Spain). Patients with ICD9-Code 704.01 for AA, registered between 2014 and 2021, were identified. Prevalence (%) and incidence rates per 1,000 patient-years (IR) of AA were calculated and clinical characteristics, treatment characteristics and HCRU/costs were assessed. A total of 5,488 patients with AA were identified. The point prevalence of AA in 2021 was 0.44 (95% confidence interval [CI]: 0.43-0.45) overall, 0.48 (0.47-0.49) in adults, and 0.23 (0.21-0.26) in children ≤12 years. The 2021 IR for AA in adults was 0.55 (0.51-0.60). Of 3,351 adults with AA, 53.4% were female, mean (standard deviation [SD]) age was 43.1 (14.7) years, and 41.6% experienced comorbidities. Among adults, 2.7% used systemic treatment (0.5% immunosuppressants, 2.5% oral corticosteroids, 0.3% both). Laboratory tests and health care professional visits were the principal drivers of cost, which was €821.2 (1065.6)/patient in the first year after diagnosis. The epidemiology of AA in Spain is comparable with that reported for other countries, being more prevalent among adults. There is a significant burden of comorbidities and cost for patients, with limited use of systemic treatments, suggesting an unmet treatment need in this population.

Background: Baricitinib treatment in adults with moderate-to-severe atopic dermatitis (AD) has demonstrated rapid improvements in itch as well as AD sign severity and affected body surface area as assessed by the Eczema Area and Severity Index (EASI) total score, whether administered as monotherapy or in combination with topical corticosteroids (TCS). As EASI clinical signs differ in time course and associated antecedents, the effects of baricitinib on each individual clinical sign are of interest., Objectives: In this post hoc analysis, we aimed to investigate the effects of baricitinib on individual EASI subscores, namely excoriation, oedema/papulation, erythema and lichenification, in both monotherapy and TCS combination therapy trials., Methods: We analysed the percent change from baseline in individual EASI subscores from three phase-III, double-blind, 16-week trials of baricitinib in monotherapy (BREEZE-AD1/BREEZE-AD2) and TCS combination therapy (BREEZE-AD7) cohorts via mixed model repeated measures (MMRM)., Results: Baricitinib 4 mg showed rapid and sustained improvements in all four clinical signs in both cohorts. Significant effects emerged at week 1 for excoriation, oedema/papulation and erythema scores in monotherapy (p < 0.001) and TCS combination therapy (p < 0.001, p < 0.01, p < 0.001), plateaued at week 4, and remained significant versus placebo through week 16. The effect on lichenification scores also emerged early, at week 1 in monotherapy (p < 0.05) and week 2 in combination therapy (p < 0.001), with scores continuously improving without a clear plateau. Effect magnitude was highest in excoriation scores, exhibiting near-maximal reduction in week 1 of monotherapy and remaining highest across all timepoints in combination therapy., Conclusions: Rapid and sustained improvements were observed across clinical signs of inflammation and particularly on excoriation following baricitinib treatment. Our findings suggest that selective inhibition of janus kinases 1 and 2 leads to rapid and sustained control of skin inflammation, and that rapid reductions in itch translate into early disruption of the itch-scratch cycle., (© 2023 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)

Background: Dupilumab has shown to be an effective and safe treatment for patients with moderate-to-severe atopic dermatitis (AD)., Objective: To evaluate the predictive factors of response (PRF) in patients with moderate-to-severe AD treated with dupilumab., Methods: Observational, retrospective and multicentre study conducted on adult patients diagnosed with moderate-to-severe AD treated with dupilumab, with a post-treatment follow-up of at least 16 weeks. The primary endpoints were EASI-75 and the IGA scale at week 52., Results: A total of 198 patients were included in the analysis. Mean age was 38 ± 15.1 years and 116 (58.6%) were men. The most prevalent AD-predominant phenotypes were flexural eczema (45.3%), head-and-neck eczema (18.2%) and erythroderma (17.7%). At week 52, 140 (86.4%) patients achieved EASI-75 and 119 (93.0%) achieved an improvement in ≥2 points from baseline in IGA score. Women were 3.6 times more likely to achieve EASI-75 response than men (Odds ratio: 3.58; p = 0.020). While increased body mass index significantly reduced the probability of obtaining an improvement of ≥2 points in the IGA scale at week 52 (odds ratio: 0.88; p = 0.049)., Conclusions: Dupilumab was an effective treatment in patients with moderate-to-severe AD. Additionally, sex and body mass index were significantly associated with achieving EASI-75 and an improvement of ≥2 points in the IGA scale, respectively, at week 52., (© 2023 Australasian College of Dermatologists.)

We present the case of a 63-year-old woman who developed dermatomyositis after hematopoietic stem cell transplantation. Anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibodies were positive and pulmonary involvement was severe and progressive. In addition, we also report that the patient's sister and donor also developed dermatomyositis. She had positive anti-PL7 antibodies and negative anti-MDA5 antibodies. The occurrence of autoimmune diseases after allogeneic hematopoietic stem cell transplantation is infrequent and difficult to interpret due to the reconstitution of the immune system and the multifactorial origin of most of these diseases. To our knowledge, this is the first described case of a hematopoietic progenitor transplant donor and recipient developing dermatomyositis. These findings make us wonder whether the dermatomyositis in this case is due to a shared genetic predisposition or to the donor's disease developing in the recipient., (© 2023 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Background: Tralokinumab was recently approved for the treatment of moderate-to-severe atopic dermatitis (AD) and is the first selective interleukin (IL)-13 inhibitor that specifically neutralizes IL-13 with high affinity., Objectives: To determine the real-life short-term effectiveness and safety of tralokinumab treatment in patients with moderate-to-severe AD., Methods: A multicentre retrospective study was conducted including adult patients with moderate-to-severe AD who started tralokinumab treatment from 1 April to 30 June 2022 in 16 Spanish hospitals. Demographic and disease characteristics, severity and quality of life scales were collected at the baseline visit and at weeks 4 and 16., Results: Eighty-five patients were included. Twenty-seven patients (32%) were non-naive to advanced therapy (biological or Janus kinase inhibitors inhibitors). All included patients had severe disease with baseline Eczema Area and Severity Index (EASI) scores of 25.4 (SD 8.1), Dermatology Life Quality Index (DLQI) 15.8 (5.4) and peak pruritus numerical rating scale (PP-NRS) 8.1 (1.8) and 65% had an Investigator's Global Assessment (IGA) of 4. At week 16, there was improvement on all scales. The mean EASI decreased to 7.5 (SD 6.9, 70% improvement), SCORing Atopic Dermatitis improved 64% and PP-NRS, 57%. Also, 82%, 58% and 21% of the patients achieved EASI 50, 75 and 90, respectively. The percentage of EASI 75 responders was significantly higher among the naive vs. non-naive groups (67% vs. 41%). The safety profile was acceptable., Conclusions: Patients, with a long history of disease and prior multidrug failure, showed a good response to tralokinumab, confirming clinical trial results., Competing Interests: Conflicts of interest: J.J.P.-R. has received honoraria for research from Novartis, AbbVie and Sanofi and for lecturing and other financial benefit from AbbVie, Almirall, Galderma, Janssen, Gebro-Pharma, Leo Pharma, Novartis, Lilly, Novartis, Pfizer, Sanofi and UCB. P.H. has been an investigator, speaker, and/or consultant for: AbbVie, Almirall, Amgen, Bristol Myers Squibb, Janssen, Lilly, Galderma, LEO Pharma, Novartis, Pfizer, Regeneron, Sanofi Genzyme and UCB Pharma. R.R.-V. has received honoraria for research from AbbVie, and lecturing and other financial benefits from Sanofi, AbbVie, Leo, MSD, Pfizer, Lilly, UCB, Janssen and Almirall. M.E.-G. has been an investigator and/or speaker for AbbVie, Lilly, Galderma, Leo Pharma, Pfizer, UCB Pharma and Sanofi Genzyme. M.G.-G. has received honoraria for research from Sanofi and AbbVie, and lecturing and other financial benefits from Sanofi, AbbVie, Leo Pharma, MSD, Pfizer, Celgene, Janssen, UCB Pharma, Lilly and Almirall. I.F.N. has been an investigator, speaker, and/or advisor for: AbbVie, Amgen, Lilly, Galderma, Pierre Fabre, Leo Pharma, Novartis, Regeneron and Sanofi Genzyme. J.M. has received speaker and consultancy fees from AbbVie, Leo Pharma, Novartis, Sanofi, UCB, Janssen, AMGEN and Lilly, and has participated as principal investigator in clinical trials sponsored by AbbVie, AMGEN and Novartis. P.d.l.C. has received consulting fees; payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events; support for attending meetings and/or travel; participation on a Data safety monitoring board or advisory board from AbbVie, Pfizer, UCB, Leo Pharma, Almirall S.A., Lilly, Sanofi, MSD, BMS, Novartis and Janssen. E.S.-B. has been an investigator, speaker, and/or advisor for: AbbVie, Amgen, Sanofi and Lilly. M.M.-C. has participated as an investigator in clinical trials sponsored by Sanofi, AbbVie, Lilly, Leo Pharma, Pfizer, Almirall, Galderma and Novartis and has received speaker and consultant fees from, Leo Pharma, AbbVie and Galderma. G.M.-N. has been a medical advisor for AbbVie, Leo Pharma, Lilly, Sanofi and Novartis and undertaken educational activities for Almirall, Avène, AbbVie, Laboratorio Reig Jofre, Leo Pharma, Lilly, Meda, Novartis, Sanofi and Uriage. V.E.-S. has been an investigator, speaker, and/or advisor for AbbVie, Lilly, Leo Pharma, Novartis and Sanofi Genzyme. B.P. has received honoraria as speaker and/or advisor as well as funding to attend conferences for Sanofi, AbbVie, Boheringer Ingelheim, Lilly, Galderma, Leo Pharma, Pierre Fabre, Meda Pharma and FAES Pharma. J.O.d.F. has received speaker and consultancy fees from AbbVie, Leo Pharma, Novartis, Sanofi, Pfizer and Lilly, and has participated as principal investigator in clinical trials sponsored by AbbVie, Sanofi, Pfizer, Leo Pharma, Lilly and Novartis. J.C.A.-H. with funding for research from Novartis, AbbVie and Sanofi, and lecturing and other financial benefits from AbbVie, Almirall, Galderma, Janssen, Gebro-Pharma, Leo Pharma, Novartis, Lilly, Novartis, Pfizer, Sanofi and UCB. A.S. declares they have no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The role of allergen sensitization in IL-31 production by T cells and specifically in the clinical context of atopic dermatitis (AD) has not been characterized., Methods: The response to house dust mite (HDM) in purified memory T cells cocultured with epidermal cells from AD patients (n=58) and control subjects (n=11) was evaluated. AD-associated cytokines from culture supernatants, plasma proteins and mRNA expression from cutaneous lesions were assessed and related with the clinical features of the patients., Results: HDM-induced IL-31 production by memory T cells defined two subsets of AD patients according to the presence or absence of IL-31 response. Patients in the IL-31 producing group showed a more inflammatory profile, and increased HDM-specific (sp) and total IgE levels compared to the IL-31 non-producing group. A correlation between IL-31 production and patient's pruritus intensity, plasma CCL27 and periostin was detected. When the same patients were analyzed based on sp IgE and total IgE levels, an increased IL-31 in vitro response, as well as type 2 markers in plasma and cutaneous lesions, was found in patients with sp IgE levels > 100 kUA/L and total IgE levels > 1000 kU/L. The IL-31 response by memory T cells was restricted to the cutaneous lymphocyte-associated antigen (CLA) + T-cell subset., Conclusion: IgE sensitization to HDM allows stratifying IL-31 production by memory T cells in AD patients and relating it to particular clinical phenotypes of the disease., Competing Interests: AG has received grants from AbbVie, Janssen, Lilly, Novartis and Sanofi, and lecture fees from AbbVie, Almirall, Leo Pharma and Sanofi. ES-B is a consultant for AbbVie, Almirall, Galderma, Genentec, Leo Pharma, Lilly, Novartis, Pfizer, Pierre Fabre and Sanofi. LS-B is a consultant for AbbVie, Janssen, Leo Pharma, Novartis and Sanofi. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Sans-de San Nicolàs, Figueras-Nart, García-Jiménez, Bonfill-Ortí, Guilabert, Curto-Barredo, Bertolín-Colilla, Ferran, Serra-Baldrich, Pujol and Santamaria-Babí.)

Competing Interests: Ignasi Figueras-Nart has received honoraria as speaker and advisor for Abbvie.

Background: The guidelines for the treatment of chronic spontaneous urticaria (CSU) recommend adding omalizumab to the treatment of patients with uncontrolled disease despite four-fold doses of second-generation antihistamines (AH). On the contrary, some studies revealed that omalizumab was effective without concomitant AH and several authors suggest tapering off AH when CSU is controlled with omalizumab., Objectives: The aim of our study was to evaluate the use of AH during treatment with omalizumab in patients with CSU in real clinical practice., Materials & Methods: This was a multicentre cross-sectional and observational study conducted by the Catalan and Balearic Chronic Urticaria Network (XUrCB) based on a cohort of 298 CSU patients treated with omalizumab., Results: In total, 23.5% of our patients decided themselves to stop taking AH during omalizumab treatment. The ratio of patients with CSU without concomitant inducible urticaria and the percentage of patients with a good response to omalizumab (UAS7≤6 and/or UCT ≥12) were higher in those who stopped taking AH., Conclusion: More studies are required to identify the phenotypic characteristics of patients responding to omalizumab as monotherapy in order to avoid overtreating with AH. Our study suggests that patients with CSU without concomitant inducible urticaria and those who achieve a good response to omalizumab tend to be controlled by omalizumab without AH. In order to establish guidelines on how to stop AH, further evidenced-based studies are required.