MDedge Dermatology

About one-third of U.S. adults struggled with medical debt during the pandemic, according to data from a Commonwealth Fund survey released July 16.

Despite the passage of four major relief bills in 2020 and 2021 and federal efforts to offset pandemic- and job-related coverage loss, many people continued to face financial challenges, especially those with a low income and those who are Black or Latino.

The survey, which included responses from 5,450 adults, revealed that 10% of adults aged 19-64 were uninsured during the first half of 2021, a rate lower than what was recorded in 2020 and 2019 in both federal and private surveys. However, uninsured rates were highest among those with low income, those younger than 50 years old, and Black and Latino adults.

For most adults who lost employee health insurance, the coverage gap was relatively brief, with 54% saying their coverage gap lasted 3-4 months. Only 16% of adults said coverage gaps lasted a year or longer.

“The good news is that this survey is suggesting that the coverage losses during the pandemic may have been offset by federal efforts to help people get and maintain health insurance coverage,” lead author Sara Collins, PhD, Commonwealth Fund vice president for health care coverage, access, and tracking, said in an interview.

“The bad news is that a third of Americans continue to struggle with medical bills and medical debt, even among those who have health insurance coverage,” Dr. Collins added.

Indeed, the survey found that about one-third of insured adults reported a medical bill problem or that they were paying off medical debt, as did approximately half of those who were uninsured. Medical debt caused 35% of respondents to use up most or all of their savings to pay it off.

Meanwhile, 27% of adults said medical bills left them unable to pay for necessities such as food, heat, or rent. What surprised Dr. Collins was that 43% of adults said they received a lower credit rating as a result of their medical debt, and 35% said they had taken on more credit card debt to pay off these bills.

“The fact that it’s bleeding over into people’s financial security in terms of their credit scores, I think is something that really needs to be looked at by policymakers,” Dr. Collins said.

When analyzed by race/ethnicity, the researchers found that 55% of Black adults and 44% of Latino/Hispanic adults reported medical bills and debt problems, compared with 32% of White adults. In addition, 47% of those living below the poverty line also reported problems with medical bills.

According to the survey, 45% of respondents were directly affected by the pandemic in at least one of three ways – testing positive or getting sick from COVID-19, losing income, or losing employer coverage – with Black and Latinx adults and those with lower incomes at greater risk.

George Abraham, MD, president of the American College of Physicians, said the Commonwealth Fund’s findings were not surprising because it has always been known that underrepresented populations struggle for access to care because of socioeconomic factors. He said these populations were more vulnerable in terms of more severe infections and disease burden during the pandemic.

“[This study] validates what primary care physicians have been saying all along in regard to our patients’ access to care and their ability to cover health care costs,” said Dr. Abraham, who was not involved with the study. “This will hopefully be an eye-opener and wake-up call that reiterates that we still do not have equitable access to care and vulnerable populations are disproportionately affected.”

He believes that, although people are insured, many of them may contend with medical debt when they fall ill because they can’t afford the premiums.

“Even though they may have been registered for health coverage, they may not have active coverage at the time of illness simply because they weren’t able to make their last premium payments because they’ve been down, because they lost their job, or whatever else,” Dr. Abraham explained. “On paper, they appear to have health care coverage. But in reality, clearly, that coverage does not match their needs or it’s not affordable.”

For Dr. Abraham, the study emphasizes the need to continue support for health care reform, including pricing it so that insurance is available for those with fewer socioeconomic resources.

Yalda Jabbarpour, MD, medical director of the Robert Graham Center for Policy Studies, Washington, said high-deductible health plans need to be “reined in” because they can lead to greater debt, particularly among vulnerable populations.

“Hopefully this will encourage policymakers to look more closely at the problem of medical debt as a contributing factor to financial instability,” Dr. Jabbarpour said. “Federal relief is important, so is expanding access to comprehensive, affordable health care coverage.”

Dr. Collins said there should also be a way to raise awareness of the health care marketplace and coverage options so that people have an easier time getting insured.

A version of this article first appeared on Medscape.com.

About one-third of U.S. adults struggled with medical debt during the pandemic, according to data from a Commonwealth Fund survey released July 16.

Despite the passage of four major relief bills in 2020 and 2021 and federal efforts to offset pandemic- and job-related coverage loss, many people continued to face financial challenges, especially those with a low income and those who are Black or Latino.

The survey, which included responses from 5,450 adults, revealed that 10% of adults aged 19-64 were uninsured during the first half of 2021, a rate lower than what was recorded in 2020 and 2019 in both federal and private surveys. However, uninsured rates were highest among those with low income, those younger than 50 years old, and Black and Latino adults.

For most adults who lost employee health insurance, the coverage gap was relatively brief, with 54% saying their coverage gap lasted 3-4 months. Only 16% of adults said coverage gaps lasted a year or longer.

“The good news is that this survey is suggesting that the coverage losses during the pandemic may have been offset by federal efforts to help people get and maintain health insurance coverage,” lead author Sara Collins, PhD, Commonwealth Fund vice president for health care coverage, access, and tracking, said in an interview.

“The bad news is that a third of Americans continue to struggle with medical bills and medical debt, even among those who have health insurance coverage,” Dr. Collins added.

Indeed, the survey found that about one-third of insured adults reported a medical bill problem or that they were paying off medical debt, as did approximately half of those who were uninsured. Medical debt caused 35% of respondents to use up most or all of their savings to pay it off.

Meanwhile, 27% of adults said medical bills left them unable to pay for necessities such as food, heat, or rent. What surprised Dr. Collins was that 43% of adults said they received a lower credit rating as a result of their medical debt, and 35% said they had taken on more credit card debt to pay off these bills.

“The fact that it’s bleeding over into people’s financial security in terms of their credit scores, I think is something that really needs to be looked at by policymakers,” Dr. Collins said.

When analyzed by race/ethnicity, the researchers found that 55% of Black adults and 44% of Latino/Hispanic adults reported medical bills and debt problems, compared with 32% of White adults. In addition, 47% of those living below the poverty line also reported problems with medical bills.

According to the survey, 45% of respondents were directly affected by the pandemic in at least one of three ways – testing positive or getting sick from COVID-19, losing income, or losing employer coverage – with Black and Latinx adults and those with lower incomes at greater risk.

George Abraham, MD, president of the American College of Physicians, said the Commonwealth Fund’s findings were not surprising because it has always been known that underrepresented populations struggle for access to care because of socioeconomic factors. He said these populations were more vulnerable in terms of more severe infections and disease burden during the pandemic.

“[This study] validates what primary care physicians have been saying all along in regard to our patients’ access to care and their ability to cover health care costs,” said Dr. Abraham, who was not involved with the study. “This will hopefully be an eye-opener and wake-up call that reiterates that we still do not have equitable access to care and vulnerable populations are disproportionately affected.”

He believes that, although people are insured, many of them may contend with medical debt when they fall ill because they can’t afford the premiums.

“Even though they may have been registered for health coverage, they may not have active coverage at the time of illness simply because they weren’t able to make their last premium payments because they’ve been down, because they lost their job, or whatever else,” Dr. Abraham explained. “On paper, they appear to have health care coverage. But in reality, clearly, that coverage does not match their needs or it’s not affordable.”

For Dr. Abraham, the study emphasizes the need to continue support for health care reform, including pricing it so that insurance is available for those with fewer socioeconomic resources.

Yalda Jabbarpour, MD, medical director of the Robert Graham Center for Policy Studies, Washington, said high-deductible health plans need to be “reined in” because they can lead to greater debt, particularly among vulnerable populations.

“Hopefully this will encourage policymakers to look more closely at the problem of medical debt as a contributing factor to financial instability,” Dr. Jabbarpour said. “Federal relief is important, so is expanding access to comprehensive, affordable health care coverage.”

Dr. Collins said there should also be a way to raise awareness of the health care marketplace and coverage options so that people have an easier time getting insured.

A version of this article first appeared on Medscape.com.

About one-third of U.S. adults struggled with medical debt during the pandemic, according to data from a Commonwealth Fund survey released July 16.

Despite the passage of four major relief bills in 2020 and 2021 and federal efforts to offset pandemic- and job-related coverage loss, many people continued to face financial challenges, especially those with a low income and those who are Black or Latino.

The survey, which included responses from 5,450 adults, revealed that 10% of adults aged 19-64 were uninsured during the first half of 2021, a rate lower than what was recorded in 2020 and 2019 in both federal and private surveys. However, uninsured rates were highest among those with low income, those younger than 50 years old, and Black and Latino adults.

For most adults who lost employee health insurance, the coverage gap was relatively brief, with 54% saying their coverage gap lasted 3-4 months. Only 16% of adults said coverage gaps lasted a year or longer.

“The good news is that this survey is suggesting that the coverage losses during the pandemic may have been offset by federal efforts to help people get and maintain health insurance coverage,” lead author Sara Collins, PhD, Commonwealth Fund vice president for health care coverage, access, and tracking, said in an interview.

“The bad news is that a third of Americans continue to struggle with medical bills and medical debt, even among those who have health insurance coverage,” Dr. Collins added.

Indeed, the survey found that about one-third of insured adults reported a medical bill problem or that they were paying off medical debt, as did approximately half of those who were uninsured. Medical debt caused 35% of respondents to use up most or all of their savings to pay it off.

Meanwhile, 27% of adults said medical bills left them unable to pay for necessities such as food, heat, or rent. What surprised Dr. Collins was that 43% of adults said they received a lower credit rating as a result of their medical debt, and 35% said they had taken on more credit card debt to pay off these bills.

“The fact that it’s bleeding over into people’s financial security in terms of their credit scores, I think is something that really needs to be looked at by policymakers,” Dr. Collins said.

When analyzed by race/ethnicity, the researchers found that 55% of Black adults and 44% of Latino/Hispanic adults reported medical bills and debt problems, compared with 32% of White adults. In addition, 47% of those living below the poverty line also reported problems with medical bills.

According to the survey, 45% of respondents were directly affected by the pandemic in at least one of three ways – testing positive or getting sick from COVID-19, losing income, or losing employer coverage – with Black and Latinx adults and those with lower incomes at greater risk.

George Abraham, MD, president of the American College of Physicians, said the Commonwealth Fund’s findings were not surprising because it has always been known that underrepresented populations struggle for access to care because of socioeconomic factors. He said these populations were more vulnerable in terms of more severe infections and disease burden during the pandemic.

“[This study] validates what primary care physicians have been saying all along in regard to our patients’ access to care and their ability to cover health care costs,” said Dr. Abraham, who was not involved with the study. “This will hopefully be an eye-opener and wake-up call that reiterates that we still do not have equitable access to care and vulnerable populations are disproportionately affected.”

He believes that, although people are insured, many of them may contend with medical debt when they fall ill because they can’t afford the premiums.

“Even though they may have been registered for health coverage, they may not have active coverage at the time of illness simply because they weren’t able to make their last premium payments because they’ve been down, because they lost their job, or whatever else,” Dr. Abraham explained. “On paper, they appear to have health care coverage. But in reality, clearly, that coverage does not match their needs or it’s not affordable.”

For Dr. Abraham, the study emphasizes the need to continue support for health care reform, including pricing it so that insurance is available for those with fewer socioeconomic resources.

Yalda Jabbarpour, MD, medical director of the Robert Graham Center for Policy Studies, Washington, said high-deductible health plans need to be “reined in” because they can lead to greater debt, particularly among vulnerable populations.

“Hopefully this will encourage policymakers to look more closely at the problem of medical debt as a contributing factor to financial instability,” Dr. Jabbarpour said. “Federal relief is important, so is expanding access to comprehensive, affordable health care coverage.”

Dr. Collins said there should also be a way to raise awareness of the health care marketplace and coverage options so that people have an easier time getting insured.

A version of this article first appeared on Medscape.com.

Adult women with acne describe significant impacts on their lived experience of acne, including concerns about appearance, mental and emotional health consequences, and disruption to their personal and professional lives, results from a qualitative study demonstrated.

“Nearly 50% of women experience acne in their 20s, and 35% experience acne in their 30s,” the study’s corresponding author, John S. Barbieri, MD, MBA, formerly of the department of dermatology at the University of Pennsylvania, Philadelphia, told this news organization. “While several qualitative studies have examined acne in adolescence, the lived experience of adult female acne has not been explored in detail and prior studies have included relatively few patients. As a result, we conducted a series of semistructured interviews among adult women with acne to examine the lived experience of adult acne and its treatment.”

For the study, published online July 28, 2021, in JAMA Dermatology, Dr. Barbieri and colleagues conducted voluntary, confidential phone interviews with 50 women aged between 18 and 40 years with moderate to severe acne who were recruited from the University of Pennsylvania Health System and from a private dermatology clinic in Cincinnati. They used free listing and open-ended, semistructured interviews to elicit opinions from the women on how acne affected their lives; their experience with acne treatments, dermatologists, and health care systems; as well as their views on treatment success.

The mean age of the participants was 28 years and 48% were white (10% were Black, 8% were Asian, 4% were more than one race, and the rest abstained from answering this question; 10% said they were Hispanic).

More than three-quarters (78%) reported prior treatment with topical retinoids, followed by spironolactone (70%), topical antibiotics (43%), combined oral contraceptives (43%), and isotretinoin (41%). During the free-listing part of interviews, where the women reported the first words that came to their mind when asked about success of treatment and adverse effects, the most important terms expressed related to treatment success were clear skin, no scarring, and no acne. The most important terms related to treatment adverse effects were dryness, redness, and burning.

In the semistructured interview portion of the study, the main themes expressed were acne-related concerns about appearance, including feeling less confident at work; mental and emotional health, including feelings of depression, anxiety, depression, and low self-worth during acne breakouts; and everyday life impact, including the notion that acne affected how other people perceived them. The other main themes included successful treatment, with clear skin and having a manageable number of lesions being desirable outcomes; and interactions with health care, including varied experiences with dermatologists. The researchers observed that most participants did not think oral antibiotics were appropriate treatments for their acne, specifically because of limited long-term effectiveness.

“Many patients described frustration with finding a dermatologist with whom they were comfortable and with identifying effective treatments for their acne,” the authors wrote. “In contrast, those who thought their dermatologist listened to their concerns and individualized their treatment plan reported higher levels of satisfaction.”

In an interview, Dr. Barbieri, who is now with the department of dermatology at Brigham and Women’s Hospital, Boston, said that he was surprised by how many patients expressed interest in nonantibiotic treatments for acne, “given that oral antibiotics are by far the most commonly prescribed systemic treatment for acne.”

Moreover, he added, “although I have experienced many patients being hesitant about isotretinoin, I was surprised by how strong patients’ concerns were about isotretinoin side effects. Unfortunately, there are many misconceptions about isotretinoin that limit use of this treatment that can be highly effective and safe for the appropriate patient.”

In an accompanying editorial, dermatologists Diane M. Thiboutot, MD and Andrea L. Zaenglein, MD, with Penn State University, Hershey, and Alison M. Layton, MB, ChB, with the Harrogate Foundation Trust, Harrogate, North Yorkshire, England, wrote that the findings from the study “resonate with those recently reported in several international studies that examine the impacts of acne, how patients assess treatment success, and what is important to measure from a patient and health care professional perspective in a clinical trial for acne.”

A large systematic review on the impact of acne on patients, conducted by the Acne Core Outcomes Research Network (ACORN), found that “appearance-related concerns and negative psychosocial effects were found to be a major impact of acne,” they noted. “Surprisingly, only 22 of the 473 studies identified in this review included qualitative data gathered from patient interviews. It is encouraging to see the concordance between the concerns voiced by the participants in the current study and those identified from the literature review, wherein a variety of methods were used to assess acne impacts.”

For his part, Dr. Barbieri said that the study findings “justify the importance of having a discussion with patients about their unique lived experience of acne and individualizing treatment to their specific needs. Patient reported outcome measures could be a useful adjunctive tool to capture these impacts on quality of life.”

This study was funded by grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Barbieri disclosed that he received partial salary support through a Pfizer Fellowship in Dermatology Patient Oriented Research grant to the Trustees of the University of Pennsylvania. Dr. Thiboutot reported receiving consultant fees from Galderma and Novartis outside the submitted work. Dr. Layton reported receiving unrestricted educational presentation, advisory board, and consultancy fees from Galderma Honoraria; unrestricted educational presentation and advisory board honoraria from Leo; advisory board honoraria from Novartis and Mylan; consultancy honoraria from Procter and Gamble and Meda; grants from Galderma; and consultancy and advisory board honoraria from Origimm outside the submitted work.

[email protected]

Adult women with acne describe significant impacts on their lived experience of acne, including concerns about appearance, mental and emotional health consequences, and disruption to their personal and professional lives, results from a qualitative study demonstrated.

“Nearly 50% of women experience acne in their 20s, and 35% experience acne in their 30s,” the study’s corresponding author, John S. Barbieri, MD, MBA, formerly of the department of dermatology at the University of Pennsylvania, Philadelphia, told this news organization. “While several qualitative studies have examined acne in adolescence, the lived experience of adult female acne has not been explored in detail and prior studies have included relatively few patients. As a result, we conducted a series of semistructured interviews among adult women with acne to examine the lived experience of adult acne and its treatment.”

For the study, published online July 28, 2021, in JAMA Dermatology, Dr. Barbieri and colleagues conducted voluntary, confidential phone interviews with 50 women aged between 18 and 40 years with moderate to severe acne who were recruited from the University of Pennsylvania Health System and from a private dermatology clinic in Cincinnati. They used free listing and open-ended, semistructured interviews to elicit opinions from the women on how acne affected their lives; their experience with acne treatments, dermatologists, and health care systems; as well as their views on treatment success.

The mean age of the participants was 28 years and 48% were white (10% were Black, 8% were Asian, 4% were more than one race, and the rest abstained from answering this question; 10% said they were Hispanic).

More than three-quarters (78%) reported prior treatment with topical retinoids, followed by spironolactone (70%), topical antibiotics (43%), combined oral contraceptives (43%), and isotretinoin (41%). During the free-listing part of interviews, where the women reported the first words that came to their mind when asked about success of treatment and adverse effects, the most important terms expressed related to treatment success were clear skin, no scarring, and no acne. The most important terms related to treatment adverse effects were dryness, redness, and burning.

In the semistructured interview portion of the study, the main themes expressed were acne-related concerns about appearance, including feeling less confident at work; mental and emotional health, including feelings of depression, anxiety, depression, and low self-worth during acne breakouts; and everyday life impact, including the notion that acne affected how other people perceived them. The other main themes included successful treatment, with clear skin and having a manageable number of lesions being desirable outcomes; and interactions with health care, including varied experiences with dermatologists. The researchers observed that most participants did not think oral antibiotics were appropriate treatments for their acne, specifically because of limited long-term effectiveness.

“Many patients described frustration with finding a dermatologist with whom they were comfortable and with identifying effective treatments for their acne,” the authors wrote. “In contrast, those who thought their dermatologist listened to their concerns and individualized their treatment plan reported higher levels of satisfaction.”

In an interview, Dr. Barbieri, who is now with the department of dermatology at Brigham and Women’s Hospital, Boston, said that he was surprised by how many patients expressed interest in nonantibiotic treatments for acne, “given that oral antibiotics are by far the most commonly prescribed systemic treatment for acne.”

Moreover, he added, “although I have experienced many patients being hesitant about isotretinoin, I was surprised by how strong patients’ concerns were about isotretinoin side effects. Unfortunately, there are many misconceptions about isotretinoin that limit use of this treatment that can be highly effective and safe for the appropriate patient.”

In an accompanying editorial, dermatologists Diane M. Thiboutot, MD and Andrea L. Zaenglein, MD, with Penn State University, Hershey, and Alison M. Layton, MB, ChB, with the Harrogate Foundation Trust, Harrogate, North Yorkshire, England, wrote that the findings from the study “resonate with those recently reported in several international studies that examine the impacts of acne, how patients assess treatment success, and what is important to measure from a patient and health care professional perspective in a clinical trial for acne.”

A large systematic review on the impact of acne on patients, conducted by the Acne Core Outcomes Research Network (ACORN), found that “appearance-related concerns and negative psychosocial effects were found to be a major impact of acne,” they noted. “Surprisingly, only 22 of the 473 studies identified in this review included qualitative data gathered from patient interviews. It is encouraging to see the concordance between the concerns voiced by the participants in the current study and those identified from the literature review, wherein a variety of methods were used to assess acne impacts.”

For his part, Dr. Barbieri said that the study findings “justify the importance of having a discussion with patients about their unique lived experience of acne and individualizing treatment to their specific needs. Patient reported outcome measures could be a useful adjunctive tool to capture these impacts on quality of life.”

This study was funded by grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Barbieri disclosed that he received partial salary support through a Pfizer Fellowship in Dermatology Patient Oriented Research grant to the Trustees of the University of Pennsylvania. Dr. Thiboutot reported receiving consultant fees from Galderma and Novartis outside the submitted work. Dr. Layton reported receiving unrestricted educational presentation, advisory board, and consultancy fees from Galderma Honoraria; unrestricted educational presentation and advisory board honoraria from Leo; advisory board honoraria from Novartis and Mylan; consultancy honoraria from Procter and Gamble and Meda; grants from Galderma; and consultancy and advisory board honoraria from Origimm outside the submitted work.

[email protected]

Adult women with acne describe significant impacts on their lived experience of acne, including concerns about appearance, mental and emotional health consequences, and disruption to their personal and professional lives, results from a qualitative study demonstrated.

“Nearly 50% of women experience acne in their 20s, and 35% experience acne in their 30s,” the study’s corresponding author, John S. Barbieri, MD, MBA, formerly of the department of dermatology at the University of Pennsylvania, Philadelphia, told this news organization. “While several qualitative studies have examined acne in adolescence, the lived experience of adult female acne has not been explored in detail and prior studies have included relatively few patients. As a result, we conducted a series of semistructured interviews among adult women with acne to examine the lived experience of adult acne and its treatment.”

For the study, published online July 28, 2021, in JAMA Dermatology, Dr. Barbieri and colleagues conducted voluntary, confidential phone interviews with 50 women aged between 18 and 40 years with moderate to severe acne who were recruited from the University of Pennsylvania Health System and from a private dermatology clinic in Cincinnati. They used free listing and open-ended, semistructured interviews to elicit opinions from the women on how acne affected their lives; their experience with acne treatments, dermatologists, and health care systems; as well as their views on treatment success.

The mean age of the participants was 28 years and 48% were white (10% were Black, 8% were Asian, 4% were more than one race, and the rest abstained from answering this question; 10% said they were Hispanic).

More than three-quarters (78%) reported prior treatment with topical retinoids, followed by spironolactone (70%), topical antibiotics (43%), combined oral contraceptives (43%), and isotretinoin (41%). During the free-listing part of interviews, where the women reported the first words that came to their mind when asked about success of treatment and adverse effects, the most important terms expressed related to treatment success were clear skin, no scarring, and no acne. The most important terms related to treatment adverse effects were dryness, redness, and burning.

In the semistructured interview portion of the study, the main themes expressed were acne-related concerns about appearance, including feeling less confident at work; mental and emotional health, including feelings of depression, anxiety, depression, and low self-worth during acne breakouts; and everyday life impact, including the notion that acne affected how other people perceived them. The other main themes included successful treatment, with clear skin and having a manageable number of lesions being desirable outcomes; and interactions with health care, including varied experiences with dermatologists. The researchers observed that most participants did not think oral antibiotics were appropriate treatments for their acne, specifically because of limited long-term effectiveness.

“Many patients described frustration with finding a dermatologist with whom they were comfortable and with identifying effective treatments for their acne,” the authors wrote. “In contrast, those who thought their dermatologist listened to their concerns and individualized their treatment plan reported higher levels of satisfaction.”

In an interview, Dr. Barbieri, who is now with the department of dermatology at Brigham and Women’s Hospital, Boston, said that he was surprised by how many patients expressed interest in nonantibiotic treatments for acne, “given that oral antibiotics are by far the most commonly prescribed systemic treatment for acne.”

Moreover, he added, “although I have experienced many patients being hesitant about isotretinoin, I was surprised by how strong patients’ concerns were about isotretinoin side effects. Unfortunately, there are many misconceptions about isotretinoin that limit use of this treatment that can be highly effective and safe for the appropriate patient.”

In an accompanying editorial, dermatologists Diane M. Thiboutot, MD and Andrea L. Zaenglein, MD, with Penn State University, Hershey, and Alison M. Layton, MB, ChB, with the Harrogate Foundation Trust, Harrogate, North Yorkshire, England, wrote that the findings from the study “resonate with those recently reported in several international studies that examine the impacts of acne, how patients assess treatment success, and what is important to measure from a patient and health care professional perspective in a clinical trial for acne.”

A large systematic review on the impact of acne on patients, conducted by the Acne Core Outcomes Research Network (ACORN), found that “appearance-related concerns and negative psychosocial effects were found to be a major impact of acne,” they noted. “Surprisingly, only 22 of the 473 studies identified in this review included qualitative data gathered from patient interviews. It is encouraging to see the concordance between the concerns voiced by the participants in the current study and those identified from the literature review, wherein a variety of methods were used to assess acne impacts.”

For his part, Dr. Barbieri said that the study findings “justify the importance of having a discussion with patients about their unique lived experience of acne and individualizing treatment to their specific needs. Patient reported outcome measures could be a useful adjunctive tool to capture these impacts on quality of life.”

This study was funded by grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Barbieri disclosed that he received partial salary support through a Pfizer Fellowship in Dermatology Patient Oriented Research grant to the Trustees of the University of Pennsylvania. Dr. Thiboutot reported receiving consultant fees from Galderma and Novartis outside the submitted work. Dr. Layton reported receiving unrestricted educational presentation, advisory board, and consultancy fees from Galderma Honoraria; unrestricted educational presentation and advisory board honoraria from Leo; advisory board honoraria from Novartis and Mylan; consultancy honoraria from Procter and Gamble and Meda; grants from Galderma; and consultancy and advisory board honoraria from Origimm outside the submitted work.

[email protected]

Atopic Dermatitis (AD) is complex with heterogeneous symptoms (e.g. skin-pain, sleep disturbance), signs (e.g. lichenification, prurigo nodules, follicular accentuation), and longitudinal course (intermittent, persistent). These disparate signs and symptoms should be addressed in optimize disease control.

Multiple extracellular cytokines are upregulated in skin of AD patients, including interleukins 4, 5, 13, 22, 31 and thymic stromal lymphopoietin, all of which signal intracellularly through Janus Kinase (JAK)-Signal Transducer and Activator of Transcription (STAT) pathways. Differential cytokine expression is proposed to underlie clinical variability. It may be necessary to inhibit signaling of multiple cytokines to achieve adequate control of AD.

Dupilumab is currently the only biologic treatment approved in the United States for moderate-severe AD. Dupilumab revolutionized AD management. However, there remain unmet needs, including the need for faster and more potent efficacy, and oral treatment options. Recently, oral JAK-inhibitors were investigated as treatments for moderate-severe AD. Multiple JAK-inhibitors demonstrated strong and rapid efficacy across multiple clinician-reported and patient-reported outcomes.

• Miao et al. recently conducted a meta-analysis of 10 randomized controlled trials and found that patients receiving JAK inhibitors showed significantly higher efficacy for eczema area and severity index (EASI) and Numeric Rating Scale (NRS)-itch scores and similar rates of adverse-events.
• Kim et al. pooled data from 3 randomized controlled trials of abrocitinib and found significantly higher proportions of clinically meaningful responses for itch in patients receiving abrocitinib 200 mg and 100 mg vs placebo as early as week 2 which continued through week 12.
• Lio et al. performed a post-hoc analysis of a phase 3 study of conducted in North America and found significant improvements for itch severity and sleep disturbance in patients treated with baricitinib 1 mg and 2 mg vs placebo. In particular, patients who achieved improvement of itch or sleep disturbance compared to those who did not were more likely to report having no impact on quality of life impact and improved work productivity.

This new therapeutic class will be an important addition to our therapeutic armamentarium and has potential to transform the AD treatment landscape.

• Many patients prefer taking pills over injections.
• Rapid-onset of efficacy for JAK-inhibitors will certainly be appreciated by patients, especially when trying to control tough flares. It may even guide clinical decision-making. Patients who have a good clinical response to JAK-inhibitors tend to do so within 4-8 weeks. By 8 weeks, if patients have no clinical response, they are likely not going to respond and may benefit from switching to alternative therapies.
• JAK-inhibitors can have robust efficacy, with higher doses of upadacitinib and abrocritinib showing greater efficacy than dupilumab at 12-16 weeks. This makes them attractive options to consider in patients who previously failed dupilumab.
• On the other hand, JAK-inhibitors have laboratory monitoring requirements, including complete blood count, comprehensive metabolic panel, lipid panel, etc.
• JAK-inhibitors warrant adverse-event monitoring for headache, nausea, acne, herpesvirus infections, risk of venous thromboembolism, etc.

Future research is needed to identify patient subsets who will benefit most from JAK-inhibitor therapy and where to position these agents in treatment guidelines.

Atopic Dermatitis (AD) is complex with heterogeneous symptoms (e.g. skin-pain, sleep disturbance), signs (e.g. lichenification, prurigo nodules, follicular accentuation), and longitudinal course (intermittent, persistent). These disparate signs and symptoms should be addressed in optimize disease control.

Multiple extracellular cytokines are upregulated in skin of AD patients, including interleukins 4, 5, 13, 22, 31 and thymic stromal lymphopoietin, all of which signal intracellularly through Janus Kinase (JAK)-Signal Transducer and Activator of Transcription (STAT) pathways. Differential cytokine expression is proposed to underlie clinical variability. It may be necessary to inhibit signaling of multiple cytokines to achieve adequate control of AD.

Dupilumab is currently the only biologic treatment approved in the United States for moderate-severe AD. Dupilumab revolutionized AD management. However, there remain unmet needs, including the need for faster and more potent efficacy, and oral treatment options. Recently, oral JAK-inhibitors were investigated as treatments for moderate-severe AD. Multiple JAK-inhibitors demonstrated strong and rapid efficacy across multiple clinician-reported and patient-reported outcomes.

• Miao et al. recently conducted a meta-analysis of 10 randomized controlled trials and found that patients receiving JAK inhibitors showed significantly higher efficacy for eczema area and severity index (EASI) and Numeric Rating Scale (NRS)-itch scores and similar rates of adverse-events.
• Kim et al. pooled data from 3 randomized controlled trials of abrocitinib and found significantly higher proportions of clinically meaningful responses for itch in patients receiving abrocitinib 200 mg and 100 mg vs placebo as early as week 2 which continued through week 12.
• Lio et al. performed a post-hoc analysis of a phase 3 study of conducted in North America and found significant improvements for itch severity and sleep disturbance in patients treated with baricitinib 1 mg and 2 mg vs placebo. In particular, patients who achieved improvement of itch or sleep disturbance compared to those who did not were more likely to report having no impact on quality of life impact and improved work productivity.

This new therapeutic class will be an important addition to our therapeutic armamentarium and has potential to transform the AD treatment landscape.

• Many patients prefer taking pills over injections.
• Rapid-onset of efficacy for JAK-inhibitors will certainly be appreciated by patients, especially when trying to control tough flares. It may even guide clinical decision-making. Patients who have a good clinical response to JAK-inhibitors tend to do so within 4-8 weeks. By 8 weeks, if patients have no clinical response, they are likely not going to respond and may benefit from switching to alternative therapies.
• JAK-inhibitors can have robust efficacy, with higher doses of upadacitinib and abrocritinib showing greater efficacy than dupilumab at 12-16 weeks. This makes them attractive options to consider in patients who previously failed dupilumab.
• On the other hand, JAK-inhibitors have laboratory monitoring requirements, including complete blood count, comprehensive metabolic panel, lipid panel, etc.
• JAK-inhibitors warrant adverse-event monitoring for headache, nausea, acne, herpesvirus infections, risk of venous thromboembolism, etc.

Future research is needed to identify patient subsets who will benefit most from JAK-inhibitor therapy and where to position these agents in treatment guidelines.

Atopic Dermatitis (AD) is complex with heterogeneous symptoms (e.g. skin-pain, sleep disturbance), signs (e.g. lichenification, prurigo nodules, follicular accentuation), and longitudinal course (intermittent, persistent). These disparate signs and symptoms should be addressed in optimize disease control.

Multiple extracellular cytokines are upregulated in skin of AD patients, including interleukins 4, 5, 13, 22, 31 and thymic stromal lymphopoietin, all of which signal intracellularly through Janus Kinase (JAK)-Signal Transducer and Activator of Transcription (STAT) pathways. Differential cytokine expression is proposed to underlie clinical variability. It may be necessary to inhibit signaling of multiple cytokines to achieve adequate control of AD.

Dupilumab is currently the only biologic treatment approved in the United States for moderate-severe AD. Dupilumab revolutionized AD management. However, there remain unmet needs, including the need for faster and more potent efficacy, and oral treatment options. Recently, oral JAK-inhibitors were investigated as treatments for moderate-severe AD. Multiple JAK-inhibitors demonstrated strong and rapid efficacy across multiple clinician-reported and patient-reported outcomes.

• Miao et al. recently conducted a meta-analysis of 10 randomized controlled trials and found that patients receiving JAK inhibitors showed significantly higher efficacy for eczema area and severity index (EASI) and Numeric Rating Scale (NRS)-itch scores and similar rates of adverse-events.
• Kim et al. pooled data from 3 randomized controlled trials of abrocitinib and found significantly higher proportions of clinically meaningful responses for itch in patients receiving abrocitinib 200 mg and 100 mg vs placebo as early as week 2 which continued through week 12.
• Lio et al. performed a post-hoc analysis of a phase 3 study of conducted in North America and found significant improvements for itch severity and sleep disturbance in patients treated with baricitinib 1 mg and 2 mg vs placebo. In particular, patients who achieved improvement of itch or sleep disturbance compared to those who did not were more likely to report having no impact on quality of life impact and improved work productivity.

This new therapeutic class will be an important addition to our therapeutic armamentarium and has potential to transform the AD treatment landscape.

• Many patients prefer taking pills over injections.
• Rapid-onset of efficacy for JAK-inhibitors will certainly be appreciated by patients, especially when trying to control tough flares. It may even guide clinical decision-making. Patients who have a good clinical response to JAK-inhibitors tend to do so within 4-8 weeks. By 8 weeks, if patients have no clinical response, they are likely not going to respond and may benefit from switching to alternative therapies.
• JAK-inhibitors can have robust efficacy, with higher doses of upadacitinib and abrocritinib showing greater efficacy than dupilumab at 12-16 weeks. This makes them attractive options to consider in patients who previously failed dupilumab.
• On the other hand, JAK-inhibitors have laboratory monitoring requirements, including complete blood count, comprehensive metabolic panel, lipid panel, etc.
• JAK-inhibitors warrant adverse-event monitoring for headache, nausea, acne, herpesvirus infections, risk of venous thromboembolism, etc.

Future research is needed to identify patient subsets who will benefit most from JAK-inhibitor therapy and where to position these agents in treatment guidelines.

Key clinical point: Janus kinase (JAK) inhibitors were safe and effective in reducing the intensity of signs and symptoms of atopic dermatitis (AD) with significant improvements observed for Eczema Area and Severity Index (EASI) and pruritus numerical rating scale (NRS) scores.

Major finding: Patients receiving JAK inhibitors showed significant improvements in both total EASI score (mean difference [MD], −0.31; 95% confidence interval [CI], −0.46 to −0.17) and pruritus NRS score (MD, −1.15; 95% CI, −1.48 to −0.83). The risk of total adverse events was not significantly different between JAK inhibitor and control groups (risk ratio, 1.02; P = .745).

Study details: Findings are from a meta-analysis of 10 randomized controlled trials including 2583 patients with AD, of which 1,761 were in JAK inhibitor and 822 in control groups.

Disclosures: The study did not report any source of funding. No conflicts of interest were reported.

Source: Miao M et al. J Dermatolog Treat. 2021 Jun 16. doi: 10.1080/09546634.2021.1942422.

Key clinical point: Janus kinase (JAK) inhibitors were safe and effective in reducing the intensity of signs and symptoms of atopic dermatitis (AD) with significant improvements observed for Eczema Area and Severity Index (EASI) and pruritus numerical rating scale (NRS) scores.

Major finding: Patients receiving JAK inhibitors showed significant improvements in both total EASI score (mean difference [MD], −0.31; 95% confidence interval [CI], −0.46 to −0.17) and pruritus NRS score (MD, −1.15; 95% CI, −1.48 to −0.83). The risk of total adverse events was not significantly different between JAK inhibitor and control groups (risk ratio, 1.02; P = .745).

Study details: Findings are from a meta-analysis of 10 randomized controlled trials including 2583 patients with AD, of which 1,761 were in JAK inhibitor and 822 in control groups.

Disclosures: The study did not report any source of funding. No conflicts of interest were reported.

Source: Miao M et al. J Dermatolog Treat. 2021 Jun 16. doi: 10.1080/09546634.2021.1942422.

Key clinical point: Janus kinase (JAK) inhibitors were safe and effective in reducing the intensity of signs and symptoms of atopic dermatitis (AD) with significant improvements observed for Eczema Area and Severity Index (EASI) and pruritus numerical rating scale (NRS) scores.

Major finding: Patients receiving JAK inhibitors showed significant improvements in both total EASI score (mean difference [MD], −0.31; 95% confidence interval [CI], −0.46 to −0.17) and pruritus NRS score (MD, −1.15; 95% CI, −1.48 to −0.83). The risk of total adverse events was not significantly different between JAK inhibitor and control groups (risk ratio, 1.02; P = .745).

Study details: Findings are from a meta-analysis of 10 randomized controlled trials including 2583 patients with AD, of which 1,761 were in JAK inhibitor and 822 in control groups.

Disclosures: The study did not report any source of funding. No conflicts of interest were reported.

Source: Miao M et al. J Dermatolog Treat. 2021 Jun 16. doi: 10.1080/09546634.2021.1942422.

Key clinical point: Analysis of serum biomarker profiles in pediatric patients with atopic dermatitis (AD) indicates the existence of unique endotypes that could predict patients at risk of persistent disease and guide personalized, endotype-driven therapeutic approaches.

Major finding: Distinct biomarker profiles identified Th2/retinol dominant (mean Eczema Area Severity Index [EASI] score: 9.2), skin-homing dominant (mean EASI score: 27.8), Th1/Th2/Th17/IL-1 dominant (mean EASI score: 10.5), and Th1/IL-1/eosinophil inferior (mean EASI score: 12.3) as the 4 distinct pediatric clusters. The clusters were influenced by disease severity and not age, with the skin-homing dominant cluster having more severe AD than other clusters (P less than .001).

Study details: Findings are from an analysis of biomarker profiles of 240 pediatric patients with AD aged 0-17 years compared with previously found profiles in adult patients with AD.

Disclosures: This study was funded by Regeneron and Sanofi-Genzyme pharmaceuticals, Inc. Dr. M de Graaf, Dr. MS de Bruin-Weller, Dr. DS Bakker, Dr. E Knol, and Dr. JL Thijs declared being speaker, principal investigator, consultant, and/or advisory board member for various sources including Sanofi-Genzyme and Regeneron.

Source: Bakker DS et al. J Allergy Clin Immun. 2021 Jul 6. doi: 10.1016/j.jaci.2021.06.029.

Key clinical point: Analysis of serum biomarker profiles in pediatric patients with atopic dermatitis (AD) indicates the existence of unique endotypes that could predict patients at risk of persistent disease and guide personalized, endotype-driven therapeutic approaches.

Major finding: Distinct biomarker profiles identified Th2/retinol dominant (mean Eczema Area Severity Index [EASI] score: 9.2), skin-homing dominant (mean EASI score: 27.8), Th1/Th2/Th17/IL-1 dominant (mean EASI score: 10.5), and Th1/IL-1/eosinophil inferior (mean EASI score: 12.3) as the 4 distinct pediatric clusters. The clusters were influenced by disease severity and not age, with the skin-homing dominant cluster having more severe AD than other clusters (P less than .001).

Study details: Findings are from an analysis of biomarker profiles of 240 pediatric patients with AD aged 0-17 years compared with previously found profiles in adult patients with AD.

Disclosures: This study was funded by Regeneron and Sanofi-Genzyme pharmaceuticals, Inc. Dr. M de Graaf, Dr. MS de Bruin-Weller, Dr. DS Bakker, Dr. E Knol, and Dr. JL Thijs declared being speaker, principal investigator, consultant, and/or advisory board member for various sources including Sanofi-Genzyme and Regeneron.

Source: Bakker DS et al. J Allergy Clin Immun. 2021 Jul 6. doi: 10.1016/j.jaci.2021.06.029.

Key clinical point: Analysis of serum biomarker profiles in pediatric patients with atopic dermatitis (AD) indicates the existence of unique endotypes that could predict patients at risk of persistent disease and guide personalized, endotype-driven therapeutic approaches.

Major finding: Distinct biomarker profiles identified Th2/retinol dominant (mean Eczema Area Severity Index [EASI] score: 9.2), skin-homing dominant (mean EASI score: 27.8), Th1/Th2/Th17/IL-1 dominant (mean EASI score: 10.5), and Th1/IL-1/eosinophil inferior (mean EASI score: 12.3) as the 4 distinct pediatric clusters. The clusters were influenced by disease severity and not age, with the skin-homing dominant cluster having more severe AD than other clusters (P less than .001).

Study details: Findings are from an analysis of biomarker profiles of 240 pediatric patients with AD aged 0-17 years compared with previously found profiles in adult patients with AD.

Disclosures: This study was funded by Regeneron and Sanofi-Genzyme pharmaceuticals, Inc. Dr. M de Graaf, Dr. MS de Bruin-Weller, Dr. DS Bakker, Dr. E Knol, and Dr. JL Thijs declared being speaker, principal investigator, consultant, and/or advisory board member for various sources including Sanofi-Genzyme and Regeneron.

Source: Bakker DS et al. J Allergy Clin Immun. 2021 Jul 6. doi: 10.1016/j.jaci.2021.06.029.

Key clinical point: Higher maternal serum 25-hydroxyvitamin D (25[OH]D) levels during pregnancy may be associated with increased risk for early-onset infant atopic dermatitis (AD).

Major finding: Overall, 26.5% of infants developed AD before 1 year of age. Higher maternal serum 25(OH)D levels during pregnancy were associated with increased risks for AD in infants before 1 year of age with borderline statistical significance, particularly in the first trimester (per ln unit increase, adjusted odds ratio [aOR], 1.93; 95% confidence interval [CI], 0.96-3.88) and the second trimester (per ln unit increase, aOR, 1.72; 95% CI, 0.93-3.19).

Study details: Findings are from the analysis of pregnant women from the MKFOAD birth cohort and their infants (n=456) who received routine child care visits at birth, day 42, and 6 and 12 months after birth.

Disclosures: This study was funded by Shanghai Public Health Three-Year Action Plan, National Key Research and Development Program, Canada-China Clinical Research Program, Collaboration Grant of Children’s Hospital of Fudan University, and Pigeon Maternal and Infant Skin Care Research Institute. The authors declared no conflicts of interest.

Source: Tian Y et al. Pediatr Allergy Immunol. 2021 Jun 23. doi: 10.1111/pai.13582. 

Key clinical point: Higher maternal serum 25-hydroxyvitamin D (25[OH]D) levels during pregnancy may be associated with increased risk for early-onset infant atopic dermatitis (AD).

Major finding: Overall, 26.5% of infants developed AD before 1 year of age. Higher maternal serum 25(OH)D levels during pregnancy were associated with increased risks for AD in infants before 1 year of age with borderline statistical significance, particularly in the first trimester (per ln unit increase, adjusted odds ratio [aOR], 1.93; 95% confidence interval [CI], 0.96-3.88) and the second trimester (per ln unit increase, aOR, 1.72; 95% CI, 0.93-3.19).

Study details: Findings are from the analysis of pregnant women from the MKFOAD birth cohort and their infants (n=456) who received routine child care visits at birth, day 42, and 6 and 12 months after birth.

Disclosures: This study was funded by Shanghai Public Health Three-Year Action Plan, National Key Research and Development Program, Canada-China Clinical Research Program, Collaboration Grant of Children’s Hospital of Fudan University, and Pigeon Maternal and Infant Skin Care Research Institute. The authors declared no conflicts of interest.

Source: Tian Y et al. Pediatr Allergy Immunol. 2021 Jun 23. doi: 10.1111/pai.13582. 

Key clinical point: Higher maternal serum 25-hydroxyvitamin D (25[OH]D) levels during pregnancy may be associated with increased risk for early-onset infant atopic dermatitis (AD).

Major finding: Overall, 26.5% of infants developed AD before 1 year of age. Higher maternal serum 25(OH)D levels during pregnancy were associated with increased risks for AD in infants before 1 year of age with borderline statistical significance, particularly in the first trimester (per ln unit increase, adjusted odds ratio [aOR], 1.93; 95% confidence interval [CI], 0.96-3.88) and the second trimester (per ln unit increase, aOR, 1.72; 95% CI, 0.93-3.19).

Study details: Findings are from the analysis of pregnant women from the MKFOAD birth cohort and their infants (n=456) who received routine child care visits at birth, day 42, and 6 and 12 months after birth.

Disclosures: This study was funded by Shanghai Public Health Three-Year Action Plan, National Key Research and Development Program, Canada-China Clinical Research Program, Collaboration Grant of Children’s Hospital of Fudan University, and Pigeon Maternal and Infant Skin Care Research Institute. The authors declared no conflicts of interest.

Source: Tian Y et al. Pediatr Allergy Immunol. 2021 Jun 23. doi: 10.1111/pai.13582. 

Key clinical point: Dupilumab with or without topical corticosteroids (TCS) was beneficial in adults with moderate-to-severe atopic dermatitis (AD) regardless of any prior use of systemic nonsteroidal immunosuppressants (NSISS).

Major finding: Compared with placebo with/without TCS, dupilumab with/without TCS showed significant improvement in Eczema Area and Severity Index, SCORing AD, Peak Pruritus Numerical Rating Scale, and quality of life in patients with/without prior use of NSISS (P less than .001) by week 16 which continued through week 52 of treatment.

Study details: Findings are from a post hoc analysis of 4 phase 3 clinical trials including 1553 patients with moderate-to-severe AD randomly assigned to placebo or dupilumab as monotherapy for 16 weeks or with concomitant TCS for 16/52 weeks.

Disclosures: This study was funded by Sanofi and Regeneron Pharmaceuticals, Inc. Some of the authors declared receiving grants, honoraria and serving as consultant or speaker or on advisory board for various sources. Some of the authors declared being employees and/or holding stocks/stock options at Sanofi, Regeneron Pharmaceuticals, Inc or Sanofi Genzyme.

Source: Griffiths C et al. Dermatol Ther (Heidelb). 2021 Jun 18. doi: 10.1007/s13555-021-00558-0.

Key clinical point: Dupilumab with or without topical corticosteroids (TCS) was beneficial in adults with moderate-to-severe atopic dermatitis (AD) regardless of any prior use of systemic nonsteroidal immunosuppressants (NSISS).

Major finding: Compared with placebo with/without TCS, dupilumab with/without TCS showed significant improvement in Eczema Area and Severity Index, SCORing AD, Peak Pruritus Numerical Rating Scale, and quality of life in patients with/without prior use of NSISS (P less than .001) by week 16 which continued through week 52 of treatment.

Study details: Findings are from a post hoc analysis of 4 phase 3 clinical trials including 1553 patients with moderate-to-severe AD randomly assigned to placebo or dupilumab as monotherapy for 16 weeks or with concomitant TCS for 16/52 weeks.

Disclosures: This study was funded by Sanofi and Regeneron Pharmaceuticals, Inc. Some of the authors declared receiving grants, honoraria and serving as consultant or speaker or on advisory board for various sources. Some of the authors declared being employees and/or holding stocks/stock options at Sanofi, Regeneron Pharmaceuticals, Inc or Sanofi Genzyme.

Source: Griffiths C et al. Dermatol Ther (Heidelb). 2021 Jun 18. doi: 10.1007/s13555-021-00558-0.

Key clinical point: Dupilumab with or without topical corticosteroids (TCS) was beneficial in adults with moderate-to-severe atopic dermatitis (AD) regardless of any prior use of systemic nonsteroidal immunosuppressants (NSISS).

Major finding: Compared with placebo with/without TCS, dupilumab with/without TCS showed significant improvement in Eczema Area and Severity Index, SCORing AD, Peak Pruritus Numerical Rating Scale, and quality of life in patients with/without prior use of NSISS (P less than .001) by week 16 which continued through week 52 of treatment.

Study details: Findings are from a post hoc analysis of 4 phase 3 clinical trials including 1553 patients with moderate-to-severe AD randomly assigned to placebo or dupilumab as monotherapy for 16 weeks or with concomitant TCS for 16/52 weeks.

Disclosures: This study was funded by Sanofi and Regeneron Pharmaceuticals, Inc. Some of the authors declared receiving grants, honoraria and serving as consultant or speaker or on advisory board for various sources. Some of the authors declared being employees and/or holding stocks/stock options at Sanofi, Regeneron Pharmaceuticals, Inc or Sanofi Genzyme.

Source: Griffiths C et al. Dermatol Ther (Heidelb). 2021 Jun 18. doi: 10.1007/s13555-021-00558-0.

Key clinical point: In real world clinical practice, combination of tacrolimus ointment and dupilumab was an effective and safe treatment option for facial atopic dermatitis (AD).

Major finding: On 16 weeks of treatment, a significant decrease was observed in average scores including Investigator’s Global Assessment, overall Eczema Area and Severity Index (EASI), and head/neck EASI (P less than .0001). Moreover, the rate of improvement in head/neck EASI scores significantly correlated with the rate of improvement in the overall EASI scores (Pearson’s r, 0.61; P less than .01). None of the patients developed herpes simplex, whereas 2 patients developed conjunctivitis.

Study details: Findings are from a retrospective chart review of 109 patients with moderate-to-severe AD who initiated dupilumab, of which 60 patients also used tacrolimus ointment. Of these, 20 patients used tacrolimus ointment without any topical steroids.

Disclosures: This work was supported by grants from Japan Society for the Promotion of Science. The authors did not declare any conflicts of interest.

Source: Matsutani M et al. J Dermatol. 2021 Jun 22. doi: 10.1111/1346-8138.16039.

Key clinical point: In real world clinical practice, combination of tacrolimus ointment and dupilumab was an effective and safe treatment option for facial atopic dermatitis (AD).

Major finding: On 16 weeks of treatment, a significant decrease was observed in average scores including Investigator’s Global Assessment, overall Eczema Area and Severity Index (EASI), and head/neck EASI (P less than .0001). Moreover, the rate of improvement in head/neck EASI scores significantly correlated with the rate of improvement in the overall EASI scores (Pearson’s r, 0.61; P less than .01). None of the patients developed herpes simplex, whereas 2 patients developed conjunctivitis.

Study details: Findings are from a retrospective chart review of 109 patients with moderate-to-severe AD who initiated dupilumab, of which 60 patients also used tacrolimus ointment. Of these, 20 patients used tacrolimus ointment without any topical steroids.

Disclosures: This work was supported by grants from Japan Society for the Promotion of Science. The authors did not declare any conflicts of interest.

Source: Matsutani M et al. J Dermatol. 2021 Jun 22. doi: 10.1111/1346-8138.16039.

Key clinical point: In real world clinical practice, combination of tacrolimus ointment and dupilumab was an effective and safe treatment option for facial atopic dermatitis (AD).

Major finding: On 16 weeks of treatment, a significant decrease was observed in average scores including Investigator’s Global Assessment, overall Eczema Area and Severity Index (EASI), and head/neck EASI (P less than .0001). Moreover, the rate of improvement in head/neck EASI scores significantly correlated with the rate of improvement in the overall EASI scores (Pearson’s r, 0.61; P less than .01). None of the patients developed herpes simplex, whereas 2 patients developed conjunctivitis.

Study details: Findings are from a retrospective chart review of 109 patients with moderate-to-severe AD who initiated dupilumab, of which 60 patients also used tacrolimus ointment. Of these, 20 patients used tacrolimus ointment without any topical steroids.

Disclosures: This work was supported by grants from Japan Society for the Promotion of Science. The authors did not declare any conflicts of interest.

Source: Matsutani M et al. J Dermatol. 2021 Jun 22. doi: 10.1111/1346-8138.16039.

Key clinical point: Baricitinib therapy resulted in clinically meaningful improvement in itch severity leading to significantly better quality of life (QoL) in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: By week 16, higher proportion of patients receiving baricitinib 2 mg (25.2%; P less than .0001) and 1 mg (15.9%; P = .0114) vs placebo (5.7%) experienced improvements in itch severity. Higher proportion of patients with vs without itch improvement showed no impact of AD on QoL (P less than .0001).

Study details: Findings are from a post hoc analysis of phase 3 trial, BREEZE-AD5 involving 440 adults with moderate-to-severe AD who received baricitinib 1 mg, 2 mg, or placebo once daily.

Disclosures: This work was funded by Eli Lilly and Company. Some of the authors declared receiving grants, funding, consulting fees, and/or honoraria from and/or serving as board member, speaker, advisor, and/or investigator for various sources including Eli Lilly. Five of the authors declared being employees and shareholders of Eli Lilly.

Source: Lio PA et al. J Dermatolog Treat. 2021 Jun 28. doi: 10.1080/09546634.2021.1914308.

Key clinical point: Baricitinib therapy resulted in clinically meaningful improvement in itch severity leading to significantly better quality of life (QoL) in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: By week 16, higher proportion of patients receiving baricitinib 2 mg (25.2%; P less than .0001) and 1 mg (15.9%; P = .0114) vs placebo (5.7%) experienced improvements in itch severity. Higher proportion of patients with vs without itch improvement showed no impact of AD on QoL (P less than .0001).

Study details: Findings are from a post hoc analysis of phase 3 trial, BREEZE-AD5 involving 440 adults with moderate-to-severe AD who received baricitinib 1 mg, 2 mg, or placebo once daily.

Disclosures: This work was funded by Eli Lilly and Company. Some of the authors declared receiving grants, funding, consulting fees, and/or honoraria from and/or serving as board member, speaker, advisor, and/or investigator for various sources including Eli Lilly. Five of the authors declared being employees and shareholders of Eli Lilly.

Source: Lio PA et al. J Dermatolog Treat. 2021 Jun 28. doi: 10.1080/09546634.2021.1914308.

Key clinical point: Baricitinib therapy resulted in clinically meaningful improvement in itch severity leading to significantly better quality of life (QoL) in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: By week 16, higher proportion of patients receiving baricitinib 2 mg (25.2%; P less than .0001) and 1 mg (15.9%; P = .0114) vs placebo (5.7%) experienced improvements in itch severity. Higher proportion of patients with vs without itch improvement showed no impact of AD on QoL (P less than .0001).

Study details: Findings are from a post hoc analysis of phase 3 trial, BREEZE-AD5 involving 440 adults with moderate-to-severe AD who received baricitinib 1 mg, 2 mg, or placebo once daily.

Disclosures: This work was funded by Eli Lilly and Company. Some of the authors declared receiving grants, funding, consulting fees, and/or honoraria from and/or serving as board member, speaker, advisor, and/or investigator for various sources including Eli Lilly. Five of the authors declared being employees and shareholders of Eli Lilly.

Source: Lio PA et al. J Dermatolog Treat. 2021 Jun 28. doi: 10.1080/09546634.2021.1914308.

Key clinical point: Abrocitinib monotherapy was associated with a rapid and profound relief in atopic dermatitis (AD) itch.

Major finding: A higher proportion of patients receiving abrocitinib 200 mg and 100 mg vs placebo experienced clinically meaningful itch improvement at week 2 (44.2% and 24.9% vs 5.8%), which continued through week 12 (57.3% and 42.9% vs 16.5%; both P less than .05). Mean percentage reductions in itch scores 24 hours after the first dose were greater for abrocitinib 200 mg and 100 mg vs placebo which was maintained through week 12 (−56.1 and −42.3 vs −19.5).

Study details: Findings are from a pooled analysis of 1 phase 2b (NCT02780167) and 2 phase 3 (JADE MONO-1 and JADE MONO-2) trials including 942 patients with moderate-to-severe AD who received abrocitinib 200 mg, abrocitinib 100 mg, or placebo.

Disclosures: This study was sponsored by Pfizer, Inc. Some of the authors declared receiving grants and personal fees and/or serving as consultant, speaker, advisor, and/or principal investigator for various sources including Pfizer. Six of the authors declared being employees and shareholders of Pfizer, Inc.

Source: Kim BS et al. Dermatitis. 2021 Jul 7. doi: 10.1097/DER.0000000000000770.

Key clinical point: Abrocitinib monotherapy was associated with a rapid and profound relief in atopic dermatitis (AD) itch.

Major finding: A higher proportion of patients receiving abrocitinib 200 mg and 100 mg vs placebo experienced clinically meaningful itch improvement at week 2 (44.2% and 24.9% vs 5.8%), which continued through week 12 (57.3% and 42.9% vs 16.5%; both P less than .05). Mean percentage reductions in itch scores 24 hours after the first dose were greater for abrocitinib 200 mg and 100 mg vs placebo which was maintained through week 12 (−56.1 and −42.3 vs −19.5).

Study details: Findings are from a pooled analysis of 1 phase 2b (NCT02780167) and 2 phase 3 (JADE MONO-1 and JADE MONO-2) trials including 942 patients with moderate-to-severe AD who received abrocitinib 200 mg, abrocitinib 100 mg, or placebo.

Disclosures: This study was sponsored by Pfizer, Inc. Some of the authors declared receiving grants and personal fees and/or serving as consultant, speaker, advisor, and/or principal investigator for various sources including Pfizer. Six of the authors declared being employees and shareholders of Pfizer, Inc.

Source: Kim BS et al. Dermatitis. 2021 Jul 7. doi: 10.1097/DER.0000000000000770.

Key clinical point: Abrocitinib monotherapy was associated with a rapid and profound relief in atopic dermatitis (AD) itch.

Major finding: A higher proportion of patients receiving abrocitinib 200 mg and 100 mg vs placebo experienced clinically meaningful itch improvement at week 2 (44.2% and 24.9% vs 5.8%), which continued through week 12 (57.3% and 42.9% vs 16.5%; both P less than .05). Mean percentage reductions in itch scores 24 hours after the first dose were greater for abrocitinib 200 mg and 100 mg vs placebo which was maintained through week 12 (−56.1 and −42.3 vs −19.5).

Study details: Findings are from a pooled analysis of 1 phase 2b (NCT02780167) and 2 phase 3 (JADE MONO-1 and JADE MONO-2) trials including 942 patients with moderate-to-severe AD who received abrocitinib 200 mg, abrocitinib 100 mg, or placebo.

Disclosures: This study was sponsored by Pfizer, Inc. Some of the authors declared receiving grants and personal fees and/or serving as consultant, speaker, advisor, and/or principal investigator for various sources including Pfizer. Six of the authors declared being employees and shareholders of Pfizer, Inc.

Source: Kim BS et al. Dermatitis. 2021 Jul 7. doi: 10.1097/DER.0000000000000770.