Atopic Dermatitis

Sleep deprivation can increase emotional distress and mood disorders; reduce quality of life; and lead to cognitive, memory, and performance deficits.¹ Military service predisposes members to disordered sleep due to the rigors of deployments and field training, such as long shifts, shift changes, stressful work environments, and time zone changes. Evidence shows that sleep deprivation is associated with cardiovascular disease, gastrointestinal disease, and some cancers.² We explore multiple mechanisms by which sleep deprivation may affect the skin. We also review the potential impacts of sleep deprivation on specific topics in dermatology, including atopic dermatitis (AD), psoriasis, alopecia areata, physical attractiveness, wound healing, and skin cancer.

Sleep and Military Service

Approximately 35.2% of Americans experience short sleep duration, which the Centers for Disease Control and Prevention defines as sleeping fewer than 7 hours per 24-hour period.³ Short sleep duration is even more common among individuals working in protective services and the military (50.4%).⁴ United States military service members experience multiple contributors to disordered sleep, including combat operations, shift work, psychiatric disorders such as posttraumatic stress disorder, and traumatic brain injury.⁵ Bramoweth and Germain⁶ described the case of a 27-year-old man who served 2 combat tours as an infantryman in Afghanistan, during which time he routinely remained awake for more than 24 hours at a time due to night missions and extended operations. Even when he was not directly involved in combat operations, he was rarely able to keep a regular sleep schedule.⁶ Service members returning from deployment also report decreased sleep. In one study (N=2717), 43% of respondents reported short sleep duration (<7 hours of sleep per night) and 29% reported very short sleep duration (<6 hours of sleep per night).⁷ Even stateside, service members experience acute sleep deprivation during training.⁸

Sleep and Skin

The idea that skin conditions can affect quality of sleep is not controversial. Pruritus, pain, and emotional distress associated with different dermatologic conditions have all been implicated in adversely affecting sleep.⁹ Given the effects of sleep deprivation on other organ systems, it also can affect the skin. Possible mechanisms of action include negative effects of sleep deprivation on the hypothalamic-pituitary-adrenal (HPA) axis, cutaneous barrier function, and immune function. First, the HPA axis activity follows a circadian rhythm.¹⁰ Activation outside of the bounds of this normal rhythm can have adverse effects on sleep. Alternatively, sleep deprivation and decreased sleep quality can negatively affect the HPA axis.¹⁰ These changes can adversely affect cutaneous barrier and immune function.¹¹ Cutaneous barrier function is vitally important in the context of inflammatory dermatologic conditions. Transepidermal water loss, a measurement used to estimate cutaneous barrier function, is increased by sleep deprivation.¹² Finally, the cutaneous immune system is an important component of inflammatory dermatologic conditions, cancer immune surveillance, and wound healing, and it also is negatively impacted by sleep deprivation.¹³ This framework of sleep deprivation affecting the HPA axis, cutaneous barrier function, and cutaneous immune function will help to guide the following discussion on the effects of decreased sleep on specific dermatologic conditions.

Atopic Dermatitis—Individuals with AD are at higher odds of having insomnia, fatigue, and overall poorer health status, including more sick days and increased visits to a physician.¹⁴ Additionally, it is possible that the relationship between AD and sleep is not unidirectional. Chang and Chiang¹⁵ discussed the possibility of sleep disturbances contributing to AD flares and listed 3 possible mechanisms by which sleep disturbance could potentially flare AD: exacerbation of the itch-scratch cycle; changes in the immune system, including a possible shift to helper T cell (T_H2) dominance; and worsening of chronic stress in patients with AD. These changes may lead to a vicious cycle of impaired sleep and AD exacerbations. It may be helpful to view sleep impairment and AD as comorbid conditions requiring co-management for optimal outcomes. This perspective has military relevance because even without considering sleep deprivation, deployment and field conditions are known to increase the risk for AD flares.¹⁶

Psoriasis—Psoriasis also may have a bidirectional relationship with sleep. A study utilizing data from the Nurses’ Health Study showed that working a night shift increased the risk for psoriasis.¹⁷ Importantly, this connection is associative and not causative. It is possible that other factors in those who worked night shifts such as probable decreased UV exposure or reported increased body mass index played a role. Studies using psoriasis mice models have shown increased inflammation with sleep deprivation.¹⁸ Another possible connection is the effect of sleep deprivation on the gut microbiome. Sleep dysfunction is associated with altered gut bacteria ratios, and similar gut bacteria ratios were found in patients with psoriasis, which may indicate an association between sleep deprivation and psoriasis disease progression.¹⁹ There also is an increased association of obstructive sleep apnea in patients with psoriasis compared to the general population.²⁰ Fortunately, the rate of consultations for psoriasis in deployed soldiers in the last several conflicts has been quite low, making up only 2.1% of diagnosed dermatologic conditions,²¹ which is because service members with moderate to severe psoriasis likely will not be deployed.

Alopecia Areata—Alopecia areata also may be associated with sleep deprivation. A large retrospective cohort study looking at the risk for alopecia in patients with sleep disorders showed that a sleep disorder was an independent risk factor for alopecia areata.²² The impact of sleep on the HPA axis portrays a possible mechanism for the negative effects of sleep deprivation on the immune system. Interestingly, in this study, the association was strongest for the 0- to 24-year-old age group. According to the 2020 demographics profile of the military community, 45% of active-duty personnel are 25 years or younger.²³ Fortunately, although alopecia areata can be a distressing condition, it should not have much effect on military readiness, as most individuals with this diagnosis are still deployable.

Physical Appearance—Studies where raters evaluate photographs of sleep-deprived and well-rested individuals have shown that sleep-deprived individuals are more likely to be perceived as looking sad and/or having hanging eyelids, red and/or swollen eyes, wrinkles around the eyes, dark circles around the eyes, pale skin, and/or droopy corners of the mouth.²⁴ Additionally, raters indicated that they perceived the sleep-deprived individuals as less attractive, less healthy, and more sleepy and were less inclined to socialize with them.²⁵ Interestingly, attempts to objectively quantify the differences between the 2 groups have been less clear.^26,27 Although the research is not yet definitive, it is feasible to assume that sleep deprivation is recognizable, and negative perceptions may be manifested about the sleep-deprived individual’s appearance. This can have substantial social implications given the perception that individuals who are viewed as more attractive also tend to be perceived as more competent.²⁸ In the context of the military, this concept becomes highly relevant when promotions are considered. For some noncommissioned officer promotions in the US Army, the soldier will present in person before a board of superiors who will “determine their potential to serve at the recommended rank.” Army doctrine instructs the board members to “consider the Soldier’s overall personal appearance, bearing, self-confidence, oral expression and conversational skills, and attitude when determining each Soldier’s potential.”²⁹ In this context, a sleep-deprived soldier would be at a very real disadvantage for a promotion based on their appearance, even if the other cognitive effects of sleep deprivation are not considered.

Final Thoughts

Although more research is needed, there is evidence that sleep deprivation can negatively affect the skin. Randomized controlled trials looking at groups of individuals with specific dermatologic conditions with a very short sleep duration group (<6 hours of sleep per night), short sleep duration group (<7 hours of sleep per night), and a well-rested group (>7 hours of sleep per night) could be very helpful in this endeavor. Possible mechanisms include the HPA axis, immune system, and skin barrier function that are associated with sleep deprivation. Specific dermatologic conditions that may be affected by sleep deprivation include AD, psoriasis, alopecia areata, physical appearance, wound healing, and skin cancer. The impact of sleep deprivation on dermatologic conditions is particularly relevant to the military, as service members are at an increased risk for short sleep duration. It is possible that improving sleep may lead to better disease control for many dermatologic conditions.

Sleep deprivation can increase emotional distress and mood disorders; reduce quality of life; and lead to cognitive, memory, and performance deficits.¹ Military service predisposes members to disordered sleep due to the rigors of deployments and field training, such as long shifts, shift changes, stressful work environments, and time zone changes. Evidence shows that sleep deprivation is associated with cardiovascular disease, gastrointestinal disease, and some cancers.² We explore multiple mechanisms by which sleep deprivation may affect the skin. We also review the potential impacts of sleep deprivation on specific topics in dermatology, including atopic dermatitis (AD), psoriasis, alopecia areata, physical attractiveness, wound healing, and skin cancer.

Sleep and Military Service

Approximately 35.2% of Americans experience short sleep duration, which the Centers for Disease Control and Prevention defines as sleeping fewer than 7 hours per 24-hour period.³ Short sleep duration is even more common among individuals working in protective services and the military (50.4%).⁴ United States military service members experience multiple contributors to disordered sleep, including combat operations, shift work, psychiatric disorders such as posttraumatic stress disorder, and traumatic brain injury.⁵ Bramoweth and Germain⁶ described the case of a 27-year-old man who served 2 combat tours as an infantryman in Afghanistan, during which time he routinely remained awake for more than 24 hours at a time due to night missions and extended operations. Even when he was not directly involved in combat operations, he was rarely able to keep a regular sleep schedule.⁶ Service members returning from deployment also report decreased sleep. In one study (N=2717), 43% of respondents reported short sleep duration (<7 hours of sleep per night) and 29% reported very short sleep duration (<6 hours of sleep per night).⁷ Even stateside, service members experience acute sleep deprivation during training.⁸

Sleep and Skin

The idea that skin conditions can affect quality of sleep is not controversial. Pruritus, pain, and emotional distress associated with different dermatologic conditions have all been implicated in adversely affecting sleep.⁹ Given the effects of sleep deprivation on other organ systems, it also can affect the skin. Possible mechanisms of action include negative effects of sleep deprivation on the hypothalamic-pituitary-adrenal (HPA) axis, cutaneous barrier function, and immune function. First, the HPA axis activity follows a circadian rhythm.¹⁰ Activation outside of the bounds of this normal rhythm can have adverse effects on sleep. Alternatively, sleep deprivation and decreased sleep quality can negatively affect the HPA axis.¹⁰ These changes can adversely affect cutaneous barrier and immune function.¹¹ Cutaneous barrier function is vitally important in the context of inflammatory dermatologic conditions. Transepidermal water loss, a measurement used to estimate cutaneous barrier function, is increased by sleep deprivation.¹² Finally, the cutaneous immune system is an important component of inflammatory dermatologic conditions, cancer immune surveillance, and wound healing, and it also is negatively impacted by sleep deprivation.¹³ This framework of sleep deprivation affecting the HPA axis, cutaneous barrier function, and cutaneous immune function will help to guide the following discussion on the effects of decreased sleep on specific dermatologic conditions.

Atopic Dermatitis—Individuals with AD are at higher odds of having insomnia, fatigue, and overall poorer health status, including more sick days and increased visits to a physician.¹⁴ Additionally, it is possible that the relationship between AD and sleep is not unidirectional. Chang and Chiang¹⁵ discussed the possibility of sleep disturbances contributing to AD flares and listed 3 possible mechanisms by which sleep disturbance could potentially flare AD: exacerbation of the itch-scratch cycle; changes in the immune system, including a possible shift to helper T cell (T_H2) dominance; and worsening of chronic stress in patients with AD. These changes may lead to a vicious cycle of impaired sleep and AD exacerbations. It may be helpful to view sleep impairment and AD as comorbid conditions requiring co-management for optimal outcomes. This perspective has military relevance because even without considering sleep deprivation, deployment and field conditions are known to increase the risk for AD flares.¹⁶

Psoriasis—Psoriasis also may have a bidirectional relationship with sleep. A study utilizing data from the Nurses’ Health Study showed that working a night shift increased the risk for psoriasis.¹⁷ Importantly, this connection is associative and not causative. It is possible that other factors in those who worked night shifts such as probable decreased UV exposure or reported increased body mass index played a role. Studies using psoriasis mice models have shown increased inflammation with sleep deprivation.¹⁸ Another possible connection is the effect of sleep deprivation on the gut microbiome. Sleep dysfunction is associated with altered gut bacteria ratios, and similar gut bacteria ratios were found in patients with psoriasis, which may indicate an association between sleep deprivation and psoriasis disease progression.¹⁹ There also is an increased association of obstructive sleep apnea in patients with psoriasis compared to the general population.²⁰ Fortunately, the rate of consultations for psoriasis in deployed soldiers in the last several conflicts has been quite low, making up only 2.1% of diagnosed dermatologic conditions,²¹ which is because service members with moderate to severe psoriasis likely will not be deployed.

Alopecia Areata—Alopecia areata also may be associated with sleep deprivation. A large retrospective cohort study looking at the risk for alopecia in patients with sleep disorders showed that a sleep disorder was an independent risk factor for alopecia areata.²² The impact of sleep on the HPA axis portrays a possible mechanism for the negative effects of sleep deprivation on the immune system. Interestingly, in this study, the association was strongest for the 0- to 24-year-old age group. According to the 2020 demographics profile of the military community, 45% of active-duty personnel are 25 years or younger.²³ Fortunately, although alopecia areata can be a distressing condition, it should not have much effect on military readiness, as most individuals with this diagnosis are still deployable.

Physical Appearance—Studies where raters evaluate photographs of sleep-deprived and well-rested individuals have shown that sleep-deprived individuals are more likely to be perceived as looking sad and/or having hanging eyelids, red and/or swollen eyes, wrinkles around the eyes, dark circles around the eyes, pale skin, and/or droopy corners of the mouth.²⁴ Additionally, raters indicated that they perceived the sleep-deprived individuals as less attractive, less healthy, and more sleepy and were less inclined to socialize with them.²⁵ Interestingly, attempts to objectively quantify the differences between the 2 groups have been less clear.^26,27 Although the research is not yet definitive, it is feasible to assume that sleep deprivation is recognizable, and negative perceptions may be manifested about the sleep-deprived individual’s appearance. This can have substantial social implications given the perception that individuals who are viewed as more attractive also tend to be perceived as more competent.²⁸ In the context of the military, this concept becomes highly relevant when promotions are considered. For some noncommissioned officer promotions in the US Army, the soldier will present in person before a board of superiors who will “determine their potential to serve at the recommended rank.” Army doctrine instructs the board members to “consider the Soldier’s overall personal appearance, bearing, self-confidence, oral expression and conversational skills, and attitude when determining each Soldier’s potential.”²⁹ In this context, a sleep-deprived soldier would be at a very real disadvantage for a promotion based on their appearance, even if the other cognitive effects of sleep deprivation are not considered.

Final Thoughts

Although more research is needed, there is evidence that sleep deprivation can negatively affect the skin. Randomized controlled trials looking at groups of individuals with specific dermatologic conditions with a very short sleep duration group (<6 hours of sleep per night), short sleep duration group (<7 hours of sleep per night), and a well-rested group (>7 hours of sleep per night) could be very helpful in this endeavor. Possible mechanisms include the HPA axis, immune system, and skin barrier function that are associated with sleep deprivation. Specific dermatologic conditions that may be affected by sleep deprivation include AD, psoriasis, alopecia areata, physical appearance, wound healing, and skin cancer. The impact of sleep deprivation on dermatologic conditions is particularly relevant to the military, as service members are at an increased risk for short sleep duration. It is possible that improving sleep may lead to better disease control for many dermatologic conditions.

Sleep deprivation can increase emotional distress and mood disorders; reduce quality of life; and lead to cognitive, memory, and performance deficits.¹ Military service predisposes members to disordered sleep due to the rigors of deployments and field training, such as long shifts, shift changes, stressful work environments, and time zone changes. Evidence shows that sleep deprivation is associated with cardiovascular disease, gastrointestinal disease, and some cancers.² We explore multiple mechanisms by which sleep deprivation may affect the skin. We also review the potential impacts of sleep deprivation on specific topics in dermatology, including atopic dermatitis (AD), psoriasis, alopecia areata, physical attractiveness, wound healing, and skin cancer.

Sleep and Military Service

Approximately 35.2% of Americans experience short sleep duration, which the Centers for Disease Control and Prevention defines as sleeping fewer than 7 hours per 24-hour period.³ Short sleep duration is even more common among individuals working in protective services and the military (50.4%).⁴ United States military service members experience multiple contributors to disordered sleep, including combat operations, shift work, psychiatric disorders such as posttraumatic stress disorder, and traumatic brain injury.⁵ Bramoweth and Germain⁶ described the case of a 27-year-old man who served 2 combat tours as an infantryman in Afghanistan, during which time he routinely remained awake for more than 24 hours at a time due to night missions and extended operations. Even when he was not directly involved in combat operations, he was rarely able to keep a regular sleep schedule.⁶ Service members returning from deployment also report decreased sleep. In one study (N=2717), 43% of respondents reported short sleep duration (<7 hours of sleep per night) and 29% reported very short sleep duration (<6 hours of sleep per night).⁷ Even stateside, service members experience acute sleep deprivation during training.⁸

Sleep and Skin

The idea that skin conditions can affect quality of sleep is not controversial. Pruritus, pain, and emotional distress associated with different dermatologic conditions have all been implicated in adversely affecting sleep.⁹ Given the effects of sleep deprivation on other organ systems, it also can affect the skin. Possible mechanisms of action include negative effects of sleep deprivation on the hypothalamic-pituitary-adrenal (HPA) axis, cutaneous barrier function, and immune function. First, the HPA axis activity follows a circadian rhythm.¹⁰ Activation outside of the bounds of this normal rhythm can have adverse effects on sleep. Alternatively, sleep deprivation and decreased sleep quality can negatively affect the HPA axis.¹⁰ These changes can adversely affect cutaneous barrier and immune function.¹¹ Cutaneous barrier function is vitally important in the context of inflammatory dermatologic conditions. Transepidermal water loss, a measurement used to estimate cutaneous barrier function, is increased by sleep deprivation.¹² Finally, the cutaneous immune system is an important component of inflammatory dermatologic conditions, cancer immune surveillance, and wound healing, and it also is negatively impacted by sleep deprivation.¹³ This framework of sleep deprivation affecting the HPA axis, cutaneous barrier function, and cutaneous immune function will help to guide the following discussion on the effects of decreased sleep on specific dermatologic conditions.

Atopic Dermatitis—Individuals with AD are at higher odds of having insomnia, fatigue, and overall poorer health status, including more sick days and increased visits to a physician.¹⁴ Additionally, it is possible that the relationship between AD and sleep is not unidirectional. Chang and Chiang¹⁵ discussed the possibility of sleep disturbances contributing to AD flares and listed 3 possible mechanisms by which sleep disturbance could potentially flare AD: exacerbation of the itch-scratch cycle; changes in the immune system, including a possible shift to helper T cell (T_H2) dominance; and worsening of chronic stress in patients with AD. These changes may lead to a vicious cycle of impaired sleep and AD exacerbations. It may be helpful to view sleep impairment and AD as comorbid conditions requiring co-management for optimal outcomes. This perspective has military relevance because even without considering sleep deprivation, deployment and field conditions are known to increase the risk for AD flares.¹⁶

Psoriasis—Psoriasis also may have a bidirectional relationship with sleep. A study utilizing data from the Nurses’ Health Study showed that working a night shift increased the risk for psoriasis.¹⁷ Importantly, this connection is associative and not causative. It is possible that other factors in those who worked night shifts such as probable decreased UV exposure or reported increased body mass index played a role. Studies using psoriasis mice models have shown increased inflammation with sleep deprivation.¹⁸ Another possible connection is the effect of sleep deprivation on the gut microbiome. Sleep dysfunction is associated with altered gut bacteria ratios, and similar gut bacteria ratios were found in patients with psoriasis, which may indicate an association between sleep deprivation and psoriasis disease progression.¹⁹ There also is an increased association of obstructive sleep apnea in patients with psoriasis compared to the general population.²⁰ Fortunately, the rate of consultations for psoriasis in deployed soldiers in the last several conflicts has been quite low, making up only 2.1% of diagnosed dermatologic conditions,²¹ which is because service members with moderate to severe psoriasis likely will not be deployed.

Alopecia Areata—Alopecia areata also may be associated with sleep deprivation. A large retrospective cohort study looking at the risk for alopecia in patients with sleep disorders showed that a sleep disorder was an independent risk factor for alopecia areata.²² The impact of sleep on the HPA axis portrays a possible mechanism for the negative effects of sleep deprivation on the immune system. Interestingly, in this study, the association was strongest for the 0- to 24-year-old age group. According to the 2020 demographics profile of the military community, 45% of active-duty personnel are 25 years or younger.²³ Fortunately, although alopecia areata can be a distressing condition, it should not have much effect on military readiness, as most individuals with this diagnosis are still deployable.

Physical Appearance—Studies where raters evaluate photographs of sleep-deprived and well-rested individuals have shown that sleep-deprived individuals are more likely to be perceived as looking sad and/or having hanging eyelids, red and/or swollen eyes, wrinkles around the eyes, dark circles around the eyes, pale skin, and/or droopy corners of the mouth.²⁴ Additionally, raters indicated that they perceived the sleep-deprived individuals as less attractive, less healthy, and more sleepy and were less inclined to socialize with them.²⁵ Interestingly, attempts to objectively quantify the differences between the 2 groups have been less clear.^26,27 Although the research is not yet definitive, it is feasible to assume that sleep deprivation is recognizable, and negative perceptions may be manifested about the sleep-deprived individual’s appearance. This can have substantial social implications given the perception that individuals who are viewed as more attractive also tend to be perceived as more competent.²⁸ In the context of the military, this concept becomes highly relevant when promotions are considered. For some noncommissioned officer promotions in the US Army, the soldier will present in person before a board of superiors who will “determine their potential to serve at the recommended rank.” Army doctrine instructs the board members to “consider the Soldier’s overall personal appearance, bearing, self-confidence, oral expression and conversational skills, and attitude when determining each Soldier’s potential.”²⁹ In this context, a sleep-deprived soldier would be at a very real disadvantage for a promotion based on their appearance, even if the other cognitive effects of sleep deprivation are not considered.

Final Thoughts

Although more research is needed, there is evidence that sleep deprivation can negatively affect the skin. Randomized controlled trials looking at groups of individuals with specific dermatologic conditions with a very short sleep duration group (<6 hours of sleep per night), short sleep duration group (<7 hours of sleep per night), and a well-rested group (>7 hours of sleep per night) could be very helpful in this endeavor. Possible mechanisms include the HPA axis, immune system, and skin barrier function that are associated with sleep deprivation. Specific dermatologic conditions that may be affected by sleep deprivation include AD, psoriasis, alopecia areata, physical appearance, wound healing, and skin cancer. The impact of sleep deprivation on dermatologic conditions is particularly relevant to the military, as service members are at an increased risk for short sleep duration. It is possible that improving sleep may lead to better disease control for many dermatologic conditions.

Despite the profound shift in guidelines for preventing peanut allergies in infants after the landmark LEAP study, national surveys in 2021 showed that 70% of parents and caregivers said that they hadn’t heard the new recommendations, and fewer than one-third of pediatricians were following them.

Now, in a 5-year National Institutes of Health–funded study called iREACH, researchers are testing whether a two-part intervention, which includes training videos and a clinical decision support tool, helps pediatricians follow the guidelines and ultimately reduces peanut allergy.

Early results from iREACH, presented at the American Academy of Allergy, Asthma, and Immunology 2023 annual meeting in San Antonio, showed mixed results with a sharp rise in clinician knowledge of the guidelines but only a modest increase in their real-world implementation with high-risk infants.

Raising a food-allergic child while working as a pediatrician herself, Ruchi Gupta, MD, MPH, director of the Center for Food Allergy and Asthma Research at Northwestern University, Chicago, understands the importance and challenge of translating published findings into practice.

During a typical 4- to 6-month well-child visit, pediatricians must check the baby’s growth, perform a physical exam, discuss milestones, field questions about sleep and poop and colic and – if they’re up on the latest guidelines – explain why it’s important to feed peanuts early and often.

“Pediatricians get stuff from every single specialty, and guidelines are always changing,” she told this news organization.

The current feeding guidelines, published in 2017 after the landmark LEAP study, switched from “ ‘don’t introduce peanuts until age 3’ to ‘introduce peanuts now,’ ” said Dr. Gupta.

But the recommendations aren’t entirely straightforward. They require pediatricians to make an assessment when the baby is around 4 months old. If the child is high-risk (has severe eczema or an egg allergy), they need a peanut-specific immunoglobulin E (IgE) test. If the test is negative, the pediatrician should encourage peanut introduction. If positive, they should refer the child to an allergist.

“It’s a little complicated,” Dr. Gupta said.

To boost understanding and adherence, Dr. Gupta’s team created the intervention tested in the iREACH study. It includes a set of training videos, a clinical decision support tool that embeds into the electronic health record (EHR) with pop-ups reminding the physician to discuss early introduction, menus for ordering peanut IgE tests or referring to an allergist if needed, and a caregiver handout that explains how to add peanuts to the baby’s diet. (These resources can be found here.)

The study enrolled 290 pediatric clinicians at 30 local practices, examining 18,460 babies from diverse backgrounds, about one-quarter of whom were from families on public insurance. About half of the clinicians received the intervention, whereas the other half served as the control arm.

The training videos seemed effective. Clinicians’ knowledge of the guidelines rose from 72.6% at baseline to 94.5% after the intervention, and their ability to identify severe eczema went up from 63.4% to 97.6%. This translated to 70.4% success with applying the guidelines when presented various clinical scenarios, up from 29% at baseline. These results are in press at JAMA Network Open.

The next set of analyses, preliminary and unpublished, monitored real-world adherence using natural language processing to pull EHR data from 4- and 6-month well-check visits. It was “AI [artificial intelligence] for notes,” Dr. Gupta said.

For low-risk infants, the training and EHR-embedded support tool greatly improved clinician adherence. Eighty percent of clinicians in the intervention arm followed the guidelines, compared with 26% in the control group.

In high-risk infants, the impact was much weaker. Even after the video-based training, only 17% of pediatric clinicians followed the guidelines – that is, ordered a peanut IgE test or referred to an allergist – compared with 8% in the control group.

Why such a low uptake?

Pediatricians are time-pressed. “How do you add [early introduction] to the other 10 or 15 things you want to talk to a parent about at the 4-month visit?” said Jonathan Necheles, MD, MPH, a pediatrician at Children’s Healthcare Associates in Chicago.

It can also be hard to tell if a baby’s eczema is “severe” or “mild to moderate.” The EHR-integrated support tool included a scorecard for judging eczema severity across a range of skin tones. The condition can be hard to recognize in patients of color. “You don’t get the redness in the same way,” said Dr. Necheles, who worked with Dr. Gupta to develop the iREACH intervention.

Curiously, even though the AI analysis found that less than one-fifth of pediatricians put the guidelines into action for high-risk infants, 69% of them recommended peanut introduction.

One interpretation is that busy pediatricians may be “doing the minimum” – introducing the concept of early introduction and telling parents to try it “but not giving any additional sort of guidance as far as who’s high risk, who’s low risk, who should see the allergist, who should get screened,” said Edwin Kim, MD, allergist-immunologist and director of the Food Allergy Initiative at the University of North Carolina at Chapel Hill.

The ultimate impact of iREACH has yet to be seen. “The end goal is, if pediatricians recommend, will parents follow, and will we reduce peanut allergy?” Dr. Gupta said.

Dr. Gupta consults or serves as an advisor for Genentech, Novartis, Aimmune, Allergenis, and Food Allergy Research & Education; receives research funding from Novartis, Genentech, FARE, Melchiorre Family Foundation, and Sunshine Charitable Foundation; and reports ownership interest from Yobee Care. Dr. Necheles reports no financial disclosures. Dr. Kim reports consultancy with Allergy Therapeutics, Belhaven Biopharma, Duke Clinical Research Institute, Genentech, Nutricia, and Revolo; advisory board membership with ALK, Kenota Health, and Ukko; and grant support from the National Institute of Allergy and Infectious Diseases, Immune Tolerance Network, and Food Allergy Research and Education.

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

Despite the profound shift in guidelines for preventing peanut allergies in infants after the landmark LEAP study, national surveys in 2021 showed that 70% of parents and caregivers said that they hadn’t heard the new recommendations, and fewer than one-third of pediatricians were following them.

Now, in a 5-year National Institutes of Health–funded study called iREACH, researchers are testing whether a two-part intervention, which includes training videos and a clinical decision support tool, helps pediatricians follow the guidelines and ultimately reduces peanut allergy.

Early results from iREACH, presented at the American Academy of Allergy, Asthma, and Immunology 2023 annual meeting in San Antonio, showed mixed results with a sharp rise in clinician knowledge of the guidelines but only a modest increase in their real-world implementation with high-risk infants.

Raising a food-allergic child while working as a pediatrician herself, Ruchi Gupta, MD, MPH, director of the Center for Food Allergy and Asthma Research at Northwestern University, Chicago, understands the importance and challenge of translating published findings into practice.

During a typical 4- to 6-month well-child visit, pediatricians must check the baby’s growth, perform a physical exam, discuss milestones, field questions about sleep and poop and colic and – if they’re up on the latest guidelines – explain why it’s important to feed peanuts early and often.

“Pediatricians get stuff from every single specialty, and guidelines are always changing,” she told this news organization.

The current feeding guidelines, published in 2017 after the landmark LEAP study, switched from “ ‘don’t introduce peanuts until age 3’ to ‘introduce peanuts now,’ ” said Dr. Gupta.

But the recommendations aren’t entirely straightforward. They require pediatricians to make an assessment when the baby is around 4 months old. If the child is high-risk (has severe eczema or an egg allergy), they need a peanut-specific immunoglobulin E (IgE) test. If the test is negative, the pediatrician should encourage peanut introduction. If positive, they should refer the child to an allergist.

“It’s a little complicated,” Dr. Gupta said.

To boost understanding and adherence, Dr. Gupta’s team created the intervention tested in the iREACH study. It includes a set of training videos, a clinical decision support tool that embeds into the electronic health record (EHR) with pop-ups reminding the physician to discuss early introduction, menus for ordering peanut IgE tests or referring to an allergist if needed, and a caregiver handout that explains how to add peanuts to the baby’s diet. (These resources can be found here.)

The study enrolled 290 pediatric clinicians at 30 local practices, examining 18,460 babies from diverse backgrounds, about one-quarter of whom were from families on public insurance. About half of the clinicians received the intervention, whereas the other half served as the control arm.

The training videos seemed effective. Clinicians’ knowledge of the guidelines rose from 72.6% at baseline to 94.5% after the intervention, and their ability to identify severe eczema went up from 63.4% to 97.6%. This translated to 70.4% success with applying the guidelines when presented various clinical scenarios, up from 29% at baseline. These results are in press at JAMA Network Open.

The next set of analyses, preliminary and unpublished, monitored real-world adherence using natural language processing to pull EHR data from 4- and 6-month well-check visits. It was “AI [artificial intelligence] for notes,” Dr. Gupta said.

For low-risk infants, the training and EHR-embedded support tool greatly improved clinician adherence. Eighty percent of clinicians in the intervention arm followed the guidelines, compared with 26% in the control group.

In high-risk infants, the impact was much weaker. Even after the video-based training, only 17% of pediatric clinicians followed the guidelines – that is, ordered a peanut IgE test or referred to an allergist – compared with 8% in the control group.

Why such a low uptake?

Pediatricians are time-pressed. “How do you add [early introduction] to the other 10 or 15 things you want to talk to a parent about at the 4-month visit?” said Jonathan Necheles, MD, MPH, a pediatrician at Children’s Healthcare Associates in Chicago.

It can also be hard to tell if a baby’s eczema is “severe” or “mild to moderate.” The EHR-integrated support tool included a scorecard for judging eczema severity across a range of skin tones. The condition can be hard to recognize in patients of color. “You don’t get the redness in the same way,” said Dr. Necheles, who worked with Dr. Gupta to develop the iREACH intervention.

Curiously, even though the AI analysis found that less than one-fifth of pediatricians put the guidelines into action for high-risk infants, 69% of them recommended peanut introduction.

One interpretation is that busy pediatricians may be “doing the minimum” – introducing the concept of early introduction and telling parents to try it “but not giving any additional sort of guidance as far as who’s high risk, who’s low risk, who should see the allergist, who should get screened,” said Edwin Kim, MD, allergist-immunologist and director of the Food Allergy Initiative at the University of North Carolina at Chapel Hill.

The ultimate impact of iREACH has yet to be seen. “The end goal is, if pediatricians recommend, will parents follow, and will we reduce peanut allergy?” Dr. Gupta said.

Dr. Gupta consults or serves as an advisor for Genentech, Novartis, Aimmune, Allergenis, and Food Allergy Research & Education; receives research funding from Novartis, Genentech, FARE, Melchiorre Family Foundation, and Sunshine Charitable Foundation; and reports ownership interest from Yobee Care. Dr. Necheles reports no financial disclosures. Dr. Kim reports consultancy with Allergy Therapeutics, Belhaven Biopharma, Duke Clinical Research Institute, Genentech, Nutricia, and Revolo; advisory board membership with ALK, Kenota Health, and Ukko; and grant support from the National Institute of Allergy and Infectious Diseases, Immune Tolerance Network, and Food Allergy Research and Education.

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

Despite the profound shift in guidelines for preventing peanut allergies in infants after the landmark LEAP study, national surveys in 2021 showed that 70% of parents and caregivers said that they hadn’t heard the new recommendations, and fewer than one-third of pediatricians were following them.

Now, in a 5-year National Institutes of Health–funded study called iREACH, researchers are testing whether a two-part intervention, which includes training videos and a clinical decision support tool, helps pediatricians follow the guidelines and ultimately reduces peanut allergy.

Early results from iREACH, presented at the American Academy of Allergy, Asthma, and Immunology 2023 annual meeting in San Antonio, showed mixed results with a sharp rise in clinician knowledge of the guidelines but only a modest increase in their real-world implementation with high-risk infants.

Raising a food-allergic child while working as a pediatrician herself, Ruchi Gupta, MD, MPH, director of the Center for Food Allergy and Asthma Research at Northwestern University, Chicago, understands the importance and challenge of translating published findings into practice.

During a typical 4- to 6-month well-child visit, pediatricians must check the baby’s growth, perform a physical exam, discuss milestones, field questions about sleep and poop and colic and – if they’re up on the latest guidelines – explain why it’s important to feed peanuts early and often.

“Pediatricians get stuff from every single specialty, and guidelines are always changing,” she told this news organization.

The current feeding guidelines, published in 2017 after the landmark LEAP study, switched from “ ‘don’t introduce peanuts until age 3’ to ‘introduce peanuts now,’ ” said Dr. Gupta.

But the recommendations aren’t entirely straightforward. They require pediatricians to make an assessment when the baby is around 4 months old. If the child is high-risk (has severe eczema or an egg allergy), they need a peanut-specific immunoglobulin E (IgE) test. If the test is negative, the pediatrician should encourage peanut introduction. If positive, they should refer the child to an allergist.

“It’s a little complicated,” Dr. Gupta said.

To boost understanding and adherence, Dr. Gupta’s team created the intervention tested in the iREACH study. It includes a set of training videos, a clinical decision support tool that embeds into the electronic health record (EHR) with pop-ups reminding the physician to discuss early introduction, menus for ordering peanut IgE tests or referring to an allergist if needed, and a caregiver handout that explains how to add peanuts to the baby’s diet. (These resources can be found here.)

The study enrolled 290 pediatric clinicians at 30 local practices, examining 18,460 babies from diverse backgrounds, about one-quarter of whom were from families on public insurance. About half of the clinicians received the intervention, whereas the other half served as the control arm.

The training videos seemed effective. Clinicians’ knowledge of the guidelines rose from 72.6% at baseline to 94.5% after the intervention, and their ability to identify severe eczema went up from 63.4% to 97.6%. This translated to 70.4% success with applying the guidelines when presented various clinical scenarios, up from 29% at baseline. These results are in press at JAMA Network Open.

The next set of analyses, preliminary and unpublished, monitored real-world adherence using natural language processing to pull EHR data from 4- and 6-month well-check visits. It was “AI [artificial intelligence] for notes,” Dr. Gupta said.

For low-risk infants, the training and EHR-embedded support tool greatly improved clinician adherence. Eighty percent of clinicians in the intervention arm followed the guidelines, compared with 26% in the control group.

In high-risk infants, the impact was much weaker. Even after the video-based training, only 17% of pediatric clinicians followed the guidelines – that is, ordered a peanut IgE test or referred to an allergist – compared with 8% in the control group.

Why such a low uptake?

Pediatricians are time-pressed. “How do you add [early introduction] to the other 10 or 15 things you want to talk to a parent about at the 4-month visit?” said Jonathan Necheles, MD, MPH, a pediatrician at Children’s Healthcare Associates in Chicago.

It can also be hard to tell if a baby’s eczema is “severe” or “mild to moderate.” The EHR-integrated support tool included a scorecard for judging eczema severity across a range of skin tones. The condition can be hard to recognize in patients of color. “You don’t get the redness in the same way,” said Dr. Necheles, who worked with Dr. Gupta to develop the iREACH intervention.

Curiously, even though the AI analysis found that less than one-fifth of pediatricians put the guidelines into action for high-risk infants, 69% of them recommended peanut introduction.

One interpretation is that busy pediatricians may be “doing the minimum” – introducing the concept of early introduction and telling parents to try it “but not giving any additional sort of guidance as far as who’s high risk, who’s low risk, who should see the allergist, who should get screened,” said Edwin Kim, MD, allergist-immunologist and director of the Food Allergy Initiative at the University of North Carolina at Chapel Hill.

The ultimate impact of iREACH has yet to be seen. “The end goal is, if pediatricians recommend, will parents follow, and will we reduce peanut allergy?” Dr. Gupta said.

Dr. Gupta consults or serves as an advisor for Genentech, Novartis, Aimmune, Allergenis, and Food Allergy Research & Education; receives research funding from Novartis, Genentech, FARE, Melchiorre Family Foundation, and Sunshine Charitable Foundation; and reports ownership interest from Yobee Care. Dr. Necheles reports no financial disclosures. Dr. Kim reports consultancy with Allergy Therapeutics, Belhaven Biopharma, Duke Clinical Research Institute, Genentech, Nutricia, and Revolo; advisory board membership with ALK, Kenota Health, and Ukko; and grant support from the National Institute of Allergy and Infectious Diseases, Immune Tolerance Network, and Food Allergy Research and Education.

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

Another study caught my attention this month for having presented a lot of information with no clinically important conclusions. In "Mode of Delivery and Offspring Atopic Dermatitis in a Swedish Nationwide Study," Mubanga and colleagues studied 1.4 million children! With that many participants, they were almost certain to find associations that were statistically significant and clinically irrelevant. They reported that children born by instrumental vaginal delivery, emergency caesarean section, and elective caesarean section were at a higher risk for AD compared with those born by uncomplicated vaginal delivery. They failed to report the absolute magnitude of the associations, which were undoubtedly so small as to be clinically meaningless. Even if the observed association were not due to some hidden bias, the association is not anything that would change treatment in any way.

On the other hand, the small, open label registry analysis, "Experiences From Daily Practice of Upadacitinib Treatment on Atopic Dermatitis With a Focus on Hand Eczema: Results From the BioDay Registry," published by Kamphuis and colleagues, is of much greater value, reporting the effectiveness and safety of upadacitinib on hand eczema. Not surprisingly, there were large improvements in the investigators' assessments of the dermatitis and in patients' quality of life. This small study is informative about efficacy; it is too small, though, to evaluate how frequently rare severe adverse events occur.

The use of probiotics to safely improve skin disease is such an appealing concept, yet it sounds a lot like hocus-pocus to me. Feíto-Rodríguez and colleagues report in the journal Clinical and Experimental Dermatology that a probiotic mixture of Bifidobacterium lactis, Bifidobacterium longum, and Lactobacillus casei improved atopic dermatitis more than did placebo. The findings are not compelling. Differences were small. Rates of being clear or almost clear weren't reported. We can get atopic dermatitis to clear up in a few days with topical triamcinolone (if we can get patients to use it); so far, the effects of probiotics on the presumed gut-immune system-skin axis seem very much underwhelming.

Another study caught my attention this month for having presented a lot of information with no clinically important conclusions. In "Mode of Delivery and Offspring Atopic Dermatitis in a Swedish Nationwide Study," Mubanga and colleagues studied 1.4 million children! With that many participants, they were almost certain to find associations that were statistically significant and clinically irrelevant. They reported that children born by instrumental vaginal delivery, emergency caesarean section, and elective caesarean section were at a higher risk for AD compared with those born by uncomplicated vaginal delivery. They failed to report the absolute magnitude of the associations, which were undoubtedly so small as to be clinically meaningless. Even if the observed association were not due to some hidden bias, the association is not anything that would change treatment in any way.

On the other hand, the small, open label registry analysis, "Experiences From Daily Practice of Upadacitinib Treatment on Atopic Dermatitis With a Focus on Hand Eczema: Results From the BioDay Registry," published by Kamphuis and colleagues, is of much greater value, reporting the effectiveness and safety of upadacitinib on hand eczema. Not surprisingly, there were large improvements in the investigators' assessments of the dermatitis and in patients' quality of life. This small study is informative about efficacy; it is too small, though, to evaluate how frequently rare severe adverse events occur.

The use of probiotics to safely improve skin disease is such an appealing concept, yet it sounds a lot like hocus-pocus to me. Feíto-Rodríguez and colleagues report in the journal Clinical and Experimental Dermatology that a probiotic mixture of Bifidobacterium lactis, Bifidobacterium longum, and Lactobacillus casei improved atopic dermatitis more than did placebo. The findings are not compelling. Differences were small. Rates of being clear or almost clear weren't reported. We can get atopic dermatitis to clear up in a few days with topical triamcinolone (if we can get patients to use it); so far, the effects of probiotics on the presumed gut-immune system-skin axis seem very much underwhelming.

Another study caught my attention this month for having presented a lot of information with no clinically important conclusions. In "Mode of Delivery and Offspring Atopic Dermatitis in a Swedish Nationwide Study," Mubanga and colleagues studied 1.4 million children! With that many participants, they were almost certain to find associations that were statistically significant and clinically irrelevant. They reported that children born by instrumental vaginal delivery, emergency caesarean section, and elective caesarean section were at a higher risk for AD compared with those born by uncomplicated vaginal delivery. They failed to report the absolute magnitude of the associations, which were undoubtedly so small as to be clinically meaningless. Even if the observed association were not due to some hidden bias, the association is not anything that would change treatment in any way.

On the other hand, the small, open label registry analysis, "Experiences From Daily Practice of Upadacitinib Treatment on Atopic Dermatitis With a Focus on Hand Eczema: Results From the BioDay Registry," published by Kamphuis and colleagues, is of much greater value, reporting the effectiveness and safety of upadacitinib on hand eczema. Not surprisingly, there were large improvements in the investigators' assessments of the dermatitis and in patients' quality of life. This small study is informative about efficacy; it is too small, though, to evaluate how frequently rare severe adverse events occur.

The use of probiotics to safely improve skin disease is such an appealing concept, yet it sounds a lot like hocus-pocus to me. Feíto-Rodríguez and colleagues report in the journal Clinical and Experimental Dermatology that a probiotic mixture of Bifidobacterium lactis, Bifidobacterium longum, and Lactobacillus casei improved atopic dermatitis more than did placebo. The findings are not compelling. Differences were small. Rates of being clear or almost clear weren't reported. We can get atopic dermatitis to clear up in a few days with topical triamcinolone (if we can get patients to use it); so far, the effects of probiotics on the presumed gut-immune system-skin axis seem very much underwhelming.

Key clinical point: Patients with atopic dermatitis (AD) have an increased risk of developing food allergy (FA), food sensitivity (FS), and challenge-proven food allergy (CPFA), and vice versa.

Major finding: AD was significantly associated with an increased risk for FS (pooled odds ratio [pOR] 4.17; 95% CI 3.03-5.75), FA (pOR 3.91; 95% CI 3.44-4.45), and CPFA (pOR 4.99; 95% CI 2.20-11.35). A significantly increased risk for AD was observed in individuals with FS (pOR 3.92; 95% CI,2.88-5.33), FA (pOR 4.06; 95% CI 3.54-4.65), and CPFA (pOR 4.93; 95% CI 2.74-8.84).

Study details: Findings are from a meta-analysis of 465 studies involving patients with AD (n = 225,568); reference individuals without AD (n = 1,128,322); individuals with FS, FA, and CPFA (n = 1,357,793); and reference individuals without FS, FA, and CPFA (n = 1,244,596).

Disclosures: This study did not receive any funding. Some authors declared serving as advisors, speakers, or consultants for or receiving speaking or consulting fees from various sources.

Source: Christensen MO et al. Prevalence of and association between atopic dermatitis and food sensitivity, food allergy and challenge-proven food allergy: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2023 (Jan 25). Doi: 10.1111/jdv.18919

Key clinical point: Patients with atopic dermatitis (AD) have an increased risk of developing food allergy (FA), food sensitivity (FS), and challenge-proven food allergy (CPFA), and vice versa.

Major finding: AD was significantly associated with an increased risk for FS (pooled odds ratio [pOR] 4.17; 95% CI 3.03-5.75), FA (pOR 3.91; 95% CI 3.44-4.45), and CPFA (pOR 4.99; 95% CI 2.20-11.35). A significantly increased risk for AD was observed in individuals with FS (pOR 3.92; 95% CI,2.88-5.33), FA (pOR 4.06; 95% CI 3.54-4.65), and CPFA (pOR 4.93; 95% CI 2.74-8.84).

Study details: Findings are from a meta-analysis of 465 studies involving patients with AD (n = 225,568); reference individuals without AD (n = 1,128,322); individuals with FS, FA, and CPFA (n = 1,357,793); and reference individuals without FS, FA, and CPFA (n = 1,244,596).

Disclosures: This study did not receive any funding. Some authors declared serving as advisors, speakers, or consultants for or receiving speaking or consulting fees from various sources.

Source: Christensen MO et al. Prevalence of and association between atopic dermatitis and food sensitivity, food allergy and challenge-proven food allergy: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2023 (Jan 25). Doi: 10.1111/jdv.18919

Key clinical point: Patients with atopic dermatitis (AD) have an increased risk of developing food allergy (FA), food sensitivity (FS), and challenge-proven food allergy (CPFA), and vice versa.

Major finding: AD was significantly associated with an increased risk for FS (pooled odds ratio [pOR] 4.17; 95% CI 3.03-5.75), FA (pOR 3.91; 95% CI 3.44-4.45), and CPFA (pOR 4.99; 95% CI 2.20-11.35). A significantly increased risk for AD was observed in individuals with FS (pOR 3.92; 95% CI,2.88-5.33), FA (pOR 4.06; 95% CI 3.54-4.65), and CPFA (pOR 4.93; 95% CI 2.74-8.84).

Study details: Findings are from a meta-analysis of 465 studies involving patients with AD (n = 225,568); reference individuals without AD (n = 1,128,322); individuals with FS, FA, and CPFA (n = 1,357,793); and reference individuals without FS, FA, and CPFA (n = 1,244,596).

Disclosures: This study did not receive any funding. Some authors declared serving as advisors, speakers, or consultants for or receiving speaking or consulting fees from various sources.

Source: Christensen MO et al. Prevalence of and association between atopic dermatitis and food sensitivity, food allergy and challenge-proven food allergy: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2023 (Jan 25). Doi: 10.1111/jdv.18919

Key clinical point: In patients with moderate-to-severe atopic dermatitis (AD), itch was more closely associated with patient-reported outcome measures than with objective assessments by the physician.

Major finding: Itch severity had a weak positive correlation with objective Scoring Atopic Dermatitis (rho (ρ) 0.44; 95% CI 0.39-0.48), Eczema Area and Severity Index (ρ 0.41; 95% CI 0.36-0.46), and Investigator Global Assessment (ρ 0.46; 95% CI 0.42-0.51) scores, but a strong positive correlation with Patient Global Assessment score (ρ 0.68; 95% CI 0.65-0.71), Patient-Oriented Eczema Measure sum score (ρ 0.66; 95% CI 0.63-0.69), and Dermatology Life Quality Index score (ρ 0.61; 95% CI 0.57-0.65).

Study details: This study analyzed the data of 1134 adult patients with moderate-to-severe AD from the multicenter prospective TREATgermany registry, of which 1121 had provided data on their itch.

Disclosures: TREATgermany is sponsored by AbbVie Deutschland GmbH & Co. KG, Galderma S.A., and others. Some authors reported ties with various organizations, including TREATgermany sponsors.

Source: Weisshaar E et al. Itching in atopic dermatitis: Patient- and physician-reported outcomes in the German atopic dermatitis registry TREATgermany. Acta Derm Venereol. 2023;103:adv00854 (Jan 23). Doi: 10.2340/actadv.v103.4426

Key clinical point: In patients with moderate-to-severe atopic dermatitis (AD), itch was more closely associated with patient-reported outcome measures than with objective assessments by the physician.

Major finding: Itch severity had a weak positive correlation with objective Scoring Atopic Dermatitis (rho (ρ) 0.44; 95% CI 0.39-0.48), Eczema Area and Severity Index (ρ 0.41; 95% CI 0.36-0.46), and Investigator Global Assessment (ρ 0.46; 95% CI 0.42-0.51) scores, but a strong positive correlation with Patient Global Assessment score (ρ 0.68; 95% CI 0.65-0.71), Patient-Oriented Eczema Measure sum score (ρ 0.66; 95% CI 0.63-0.69), and Dermatology Life Quality Index score (ρ 0.61; 95% CI 0.57-0.65).

Study details: This study analyzed the data of 1134 adult patients with moderate-to-severe AD from the multicenter prospective TREATgermany registry, of which 1121 had provided data on their itch.

Disclosures: TREATgermany is sponsored by AbbVie Deutschland GmbH & Co. KG, Galderma S.A., and others. Some authors reported ties with various organizations, including TREATgermany sponsors.

Source: Weisshaar E et al. Itching in atopic dermatitis: Patient- and physician-reported outcomes in the German atopic dermatitis registry TREATgermany. Acta Derm Venereol. 2023;103:adv00854 (Jan 23). Doi: 10.2340/actadv.v103.4426

Key clinical point: In patients with moderate-to-severe atopic dermatitis (AD), itch was more closely associated with patient-reported outcome measures than with objective assessments by the physician.

Major finding: Itch severity had a weak positive correlation with objective Scoring Atopic Dermatitis (rho (ρ) 0.44; 95% CI 0.39-0.48), Eczema Area and Severity Index (ρ 0.41; 95% CI 0.36-0.46), and Investigator Global Assessment (ρ 0.46; 95% CI 0.42-0.51) scores, but a strong positive correlation with Patient Global Assessment score (ρ 0.68; 95% CI 0.65-0.71), Patient-Oriented Eczema Measure sum score (ρ 0.66; 95% CI 0.63-0.69), and Dermatology Life Quality Index score (ρ 0.61; 95% CI 0.57-0.65).

Study details: This study analyzed the data of 1134 adult patients with moderate-to-severe AD from the multicenter prospective TREATgermany registry, of which 1121 had provided data on their itch.

Disclosures: TREATgermany is sponsored by AbbVie Deutschland GmbH & Co. KG, Galderma S.A., and others. Some authors reported ties with various organizations, including TREATgermany sponsors.

Source: Weisshaar E et al. Itching in atopic dermatitis: Patient- and physician-reported outcomes in the German atopic dermatitis registry TREATgermany. Acta Derm Venereol. 2023;103:adv00854 (Jan 23). Doi: 10.2340/actadv.v103.4426

Key clinical point: Children who were hospitalized for atopic dermatitis (AD) exacerbation had significantly higher serum total IgE levels than those hospitalized for AD-associated infectious complications.

Major finding: Children with AD exacerbation vs an infectious complication had significantly higher mean serum total IgE levels (9603 ± 15,873 vs 3167 ± 5486 kU/L; P = .029). The likelihood of AD exacerbation vs an infectious complication was significantly greater in children with an age-adjusted IgE level (serum total IgE level/maximum reference IgE value for their age) of >4.

Study details: This retrospective chart review study included 68 children hospitalized for AD exacerbations (n = 34) or AD-associated infectious complications (n = 34) over a 17-year period.

Disclosures: This study did not report the source of funding. PY Ong declared serving as a consultant for and receiving research funding from various organizations.

Source: Atwal S, Ong PY. Elevated serum total IgE is associated with eczema exacerbation in children hospitalized for atopic dermatitis. Pediatr Dermatol. 2023 (Jan 19). Doi: 10.1111/pde.15245

Key clinical point: Children who were hospitalized for atopic dermatitis (AD) exacerbation had significantly higher serum total IgE levels than those hospitalized for AD-associated infectious complications.

Major finding: Children with AD exacerbation vs an infectious complication had significantly higher mean serum total IgE levels (9603 ± 15,873 vs 3167 ± 5486 kU/L; P = .029). The likelihood of AD exacerbation vs an infectious complication was significantly greater in children with an age-adjusted IgE level (serum total IgE level/maximum reference IgE value for their age) of >4.

Study details: This retrospective chart review study included 68 children hospitalized for AD exacerbations (n = 34) or AD-associated infectious complications (n = 34) over a 17-year period.

Disclosures: This study did not report the source of funding. PY Ong declared serving as a consultant for and receiving research funding from various organizations.

Source: Atwal S, Ong PY. Elevated serum total IgE is associated with eczema exacerbation in children hospitalized for atopic dermatitis. Pediatr Dermatol. 2023 (Jan 19). Doi: 10.1111/pde.15245

Key clinical point: Children who were hospitalized for atopic dermatitis (AD) exacerbation had significantly higher serum total IgE levels than those hospitalized for AD-associated infectious complications.

Major finding: Children with AD exacerbation vs an infectious complication had significantly higher mean serum total IgE levels (9603 ± 15,873 vs 3167 ± 5486 kU/L; P = .029). The likelihood of AD exacerbation vs an infectious complication was significantly greater in children with an age-adjusted IgE level (serum total IgE level/maximum reference IgE value for their age) of >4.

Study details: This retrospective chart review study included 68 children hospitalized for AD exacerbations (n = 34) or AD-associated infectious complications (n = 34) over a 17-year period.

Disclosures: This study did not report the source of funding. PY Ong declared serving as a consultant for and receiving research funding from various organizations.

Source: Atwal S, Ong PY. Elevated serum total IgE is associated with eczema exacerbation in children hospitalized for atopic dermatitis. Pediatr Dermatol. 2023 (Jan 19). Doi: 10.1111/pde.15245

Key clinical point: Dupilumab demonstrated good 4-year drug survival in patients with moderate-to-severe atopic dermatitis (AD); however, early-onset AD (at <18 years of age) was a risk factor for a shorter drug survival.

Major finding: The 1-, 2-, 3-, and 4-year overall dupilumab drug survival rates were 90.5%, 82.9%, 78.8%, and 76.4%, respectively. Early onset of AD may serve as a significant predictor of shorter overall drug survival (hazard ratio, 1.32; P = .04).

Study details: This real-world prospective cohort study included 363 patients with moderate-to-severe AD who had received dupilumab for ≥4 weeks.

Disclosures: This study did not receive any funding. Some authors declared serving as consultants and/or speakers for various organizations.

Source: Pezzolo E et al. Long-term drug survival of dupilumab and associated predictors in moderate to severe atopic dermatitis: A real-world prospective cohort study. J Eur Acad Dermatol Venereol. 2023 (Jan 20). Doi: 10.1111/jdv.18889

Key clinical point: Dupilumab demonstrated good 4-year drug survival in patients with moderate-to-severe atopic dermatitis (AD); however, early-onset AD (at <18 years of age) was a risk factor for a shorter drug survival.

Major finding: The 1-, 2-, 3-, and 4-year overall dupilumab drug survival rates were 90.5%, 82.9%, 78.8%, and 76.4%, respectively. Early onset of AD may serve as a significant predictor of shorter overall drug survival (hazard ratio, 1.32; P = .04).

Study details: This real-world prospective cohort study included 363 patients with moderate-to-severe AD who had received dupilumab for ≥4 weeks.

Disclosures: This study did not receive any funding. Some authors declared serving as consultants and/or speakers for various organizations.

Source: Pezzolo E et al. Long-term drug survival of dupilumab and associated predictors in moderate to severe atopic dermatitis: A real-world prospective cohort study. J Eur Acad Dermatol Venereol. 2023 (Jan 20). Doi: 10.1111/jdv.18889

Key clinical point: Dupilumab demonstrated good 4-year drug survival in patients with moderate-to-severe atopic dermatitis (AD); however, early-onset AD (at <18 years of age) was a risk factor for a shorter drug survival.

Major finding: The 1-, 2-, 3-, and 4-year overall dupilumab drug survival rates were 90.5%, 82.9%, 78.8%, and 76.4%, respectively. Early onset of AD may serve as a significant predictor of shorter overall drug survival (hazard ratio, 1.32; P = .04).

Study details: This real-world prospective cohort study included 363 patients with moderate-to-severe AD who had received dupilumab for ≥4 weeks.

Disclosures: This study did not receive any funding. Some authors declared serving as consultants and/or speakers for various organizations.

Source: Pezzolo E et al. Long-term drug survival of dupilumab and associated predictors in moderate to severe atopic dermatitis: A real-world prospective cohort study. J Eur Acad Dermatol Venereol. 2023 (Jan 20). Doi: 10.1111/jdv.18889

Key clinical point: Coadjuvant treatment with a specific probiotic preparation reduced disease severity in children and adolescents with atopic dermatitis (AD), as evidenced by a decrease in Scoring of Atopic Dermatitis (SCORAD) and Investigator’s Global Assessment (IGA) scores.

Major finding: At 12 weeks, patients receiving the probiotic preparation vs placebo had a significantly higher rate of achieving at least a 1-point improvement in IGA score (90.5% vs 56.7%; P < .002) and lower SCORAD score (13.52 vs 18.96; P = .041).

Study details: This study included 70 patients aged 4-17 years with AD who were randomly assigned to receive the probiotic preparation (containing Bifidobacterium lactis, Bifidobacterium longum, and Lactobacillus casei; n = 35) or placebo (n = 35) daily for 12 weeks.

Disclosures: This study was funded by Biopolis SL. The authors declared no conflicts of interest.

Source: Feíto-Rodríguez M et al. Randomised double blind placebo controlled clinical trial to evaluate the effect of a mixture of probiotic strains on symptom severity and the use of corticosteroids in children and adolescents with atopic dermatitis. Clin Exp Dermatol. 2023 (Jan 13). Doi: 10.1093/ced/llad007

Key clinical point: Coadjuvant treatment with a specific probiotic preparation reduced disease severity in children and adolescents with atopic dermatitis (AD), as evidenced by a decrease in Scoring of Atopic Dermatitis (SCORAD) and Investigator’s Global Assessment (IGA) scores.

Major finding: At 12 weeks, patients receiving the probiotic preparation vs placebo had a significantly higher rate of achieving at least a 1-point improvement in IGA score (90.5% vs 56.7%; P < .002) and lower SCORAD score (13.52 vs 18.96; P = .041).

Study details: This study included 70 patients aged 4-17 years with AD who were randomly assigned to receive the probiotic preparation (containing Bifidobacterium lactis, Bifidobacterium longum, and Lactobacillus casei; n = 35) or placebo (n = 35) daily for 12 weeks.

Disclosures: This study was funded by Biopolis SL. The authors declared no conflicts of interest.

Source: Feíto-Rodríguez M et al. Randomised double blind placebo controlled clinical trial to evaluate the effect of a mixture of probiotic strains on symptom severity and the use of corticosteroids in children and adolescents with atopic dermatitis. Clin Exp Dermatol. 2023 (Jan 13). Doi: 10.1093/ced/llad007

Key clinical point: Coadjuvant treatment with a specific probiotic preparation reduced disease severity in children and adolescents with atopic dermatitis (AD), as evidenced by a decrease in Scoring of Atopic Dermatitis (SCORAD) and Investigator’s Global Assessment (IGA) scores.

Major finding: At 12 weeks, patients receiving the probiotic preparation vs placebo had a significantly higher rate of achieving at least a 1-point improvement in IGA score (90.5% vs 56.7%; P < .002) and lower SCORAD score (13.52 vs 18.96; P = .041).

Study details: This study included 70 patients aged 4-17 years with AD who were randomly assigned to receive the probiotic preparation (containing Bifidobacterium lactis, Bifidobacterium longum, and Lactobacillus casei; n = 35) or placebo (n = 35) daily for 12 weeks.

Disclosures: This study was funded by Biopolis SL. The authors declared no conflicts of interest.

Source: Feíto-Rodríguez M et al. Randomised double blind placebo controlled clinical trial to evaluate the effect of a mixture of probiotic strains on symptom severity and the use of corticosteroids in children and adolescents with atopic dermatitis. Clin Exp Dermatol. 2023 (Jan 13). Doi: 10.1093/ced/llad007

Key clinical point: Upadacitinib can serve as an effective treatment option for atopic dermatitis (AD) and concomitant hand eczema (HE) in daily practice.

Major finding: At week 16, the mean Eczema Area and Severity Index (EASI) score decreased significantly from 17.2 (at baseline) to 4.8 (P < .001) and 50.0%, 40.6%, 59.3%, and 74.1% of patients achieved EASI-75, an Investigator’s Global Assessment score of (almost) clear, Hand Eczema Severity Index-75, and a score of (almost) clear on the photographic guide, respectively. Adverse events were generally mild in severity.

Study details: This multicenter prospective observational study included 38 patients with AD from the BioDay registry who received once-daily upadacitinib over 16 weeks, of which 32 patients had concomitant HE.

Disclosures: The BioDay registry is funded by Sanofi/Regeneron and others. Some authors declared serving as advisors, speakers, or consultants for or receiving consulting fees from various sources, including the registry funders.

Source: Kamphuis E, Loman L, et al. Experiences from daily practice of upadacitinib treatment on atopic dermatitis with a focus on hand eczema: Results from the BioDay registry. Contact Dermatitis. 2023 (Jan 9). Doi: 10.1111/cod.14276

Key clinical point: Upadacitinib can serve as an effective treatment option for atopic dermatitis (AD) and concomitant hand eczema (HE) in daily practice.

Major finding: At week 16, the mean Eczema Area and Severity Index (EASI) score decreased significantly from 17.2 (at baseline) to 4.8 (P < .001) and 50.0%, 40.6%, 59.3%, and 74.1% of patients achieved EASI-75, an Investigator’s Global Assessment score of (almost) clear, Hand Eczema Severity Index-75, and a score of (almost) clear on the photographic guide, respectively. Adverse events were generally mild in severity.

Study details: This multicenter prospective observational study included 38 patients with AD from the BioDay registry who received once-daily upadacitinib over 16 weeks, of which 32 patients had concomitant HE.

Disclosures: The BioDay registry is funded by Sanofi/Regeneron and others. Some authors declared serving as advisors, speakers, or consultants for or receiving consulting fees from various sources, including the registry funders.

Source: Kamphuis E, Loman L, et al. Experiences from daily practice of upadacitinib treatment on atopic dermatitis with a focus on hand eczema: Results from the BioDay registry. Contact Dermatitis. 2023 (Jan 9). Doi: 10.1111/cod.14276

Key clinical point: Upadacitinib can serve as an effective treatment option for atopic dermatitis (AD) and concomitant hand eczema (HE) in daily practice.

Major finding: At week 16, the mean Eczema Area and Severity Index (EASI) score decreased significantly from 17.2 (at baseline) to 4.8 (P < .001) and 50.0%, 40.6%, 59.3%, and 74.1% of patients achieved EASI-75, an Investigator’s Global Assessment score of (almost) clear, Hand Eczema Severity Index-75, and a score of (almost) clear on the photographic guide, respectively. Adverse events were generally mild in severity.

Study details: This multicenter prospective observational study included 38 patients with AD from the BioDay registry who received once-daily upadacitinib over 16 weeks, of which 32 patients had concomitant HE.

Disclosures: The BioDay registry is funded by Sanofi/Regeneron and others. Some authors declared serving as advisors, speakers, or consultants for or receiving consulting fees from various sources, including the registry funders.

Source: Kamphuis E, Loman L, et al. Experiences from daily practice of upadacitinib treatment on atopic dermatitis with a focus on hand eczema: Results from the BioDay registry. Contact Dermatitis. 2023 (Jan 9). Doi: 10.1111/cod.14276

Key clinical point: Dupilumab provides rapid improvement in atopic dermatitis (AD) signs and symptoms and is well tolerated in patients with moderate-to-severe AD in a real-world setting.

Major finding: At week 12, the percentages of patients who achieved ≥75% improvement in the Eczema Area and Severity Index, an Investigator’s Global Assessment score of 0/1 with a ≥2-point reduction from baseline, and a ≥4-point decrease in itch-numerical rating scale score were 59.4%, 33.0%, and 57.0%, respectively. Adverse event rates were lower than those reported in previous phase 3 trials.

Study details: Findings are from a 12-week analysis of the multicenter prospective real-life study PROLEAD including 828 dupilumab-naive adult patients with moderate-to-severe AD who received dupilumab.

Disclosures: This study was funded by Sanofi. Some authors reported ties with various organizations, including Sanofi. Three authors declared being employees of or holding stock or stock options in Sanofi.

Source: Augustin M et al. Dupilumab demonstrates rapid onset of action in improving signs, symptoms and quality of life in adults with atopic dermatitis. Dermatol Ther (Heidelb). 2023 (Feb 4). Doi: 10.1007/s13555-023-00894-3

Key clinical point: Dupilumab provides rapid improvement in atopic dermatitis (AD) signs and symptoms and is well tolerated in patients with moderate-to-severe AD in a real-world setting.

Major finding: At week 12, the percentages of patients who achieved ≥75% improvement in the Eczema Area and Severity Index, an Investigator’s Global Assessment score of 0/1 with a ≥2-point reduction from baseline, and a ≥4-point decrease in itch-numerical rating scale score were 59.4%, 33.0%, and 57.0%, respectively. Adverse event rates were lower than those reported in previous phase 3 trials.

Study details: Findings are from a 12-week analysis of the multicenter prospective real-life study PROLEAD including 828 dupilumab-naive adult patients with moderate-to-severe AD who received dupilumab.

Disclosures: This study was funded by Sanofi. Some authors reported ties with various organizations, including Sanofi. Three authors declared being employees of or holding stock or stock options in Sanofi.

Source: Augustin M et al. Dupilumab demonstrates rapid onset of action in improving signs, symptoms and quality of life in adults with atopic dermatitis. Dermatol Ther (Heidelb). 2023 (Feb 4). Doi: 10.1007/s13555-023-00894-3

Key clinical point: Dupilumab provides rapid improvement in atopic dermatitis (AD) signs and symptoms and is well tolerated in patients with moderate-to-severe AD in a real-world setting.

Major finding: At week 12, the percentages of patients who achieved ≥75% improvement in the Eczema Area and Severity Index, an Investigator’s Global Assessment score of 0/1 with a ≥2-point reduction from baseline, and a ≥4-point decrease in itch-numerical rating scale score were 59.4%, 33.0%, and 57.0%, respectively. Adverse event rates were lower than those reported in previous phase 3 trials.

Study details: Findings are from a 12-week analysis of the multicenter prospective real-life study PROLEAD including 828 dupilumab-naive adult patients with moderate-to-severe AD who received dupilumab.

Disclosures: This study was funded by Sanofi. Some authors reported ties with various organizations, including Sanofi. Three authors declared being employees of or holding stock or stock options in Sanofi.

Source: Augustin M et al. Dupilumab demonstrates rapid onset of action in improving signs, symptoms and quality of life in adults with atopic dermatitis. Dermatol Ther (Heidelb). 2023 (Feb 4). Doi: 10.1007/s13555-023-00894-3