Atopic Dermatitis

Key clinical point: Tralokinumab was effective and safe in a real-world cohort of patients with moderate-to-severe atopic dermatitis (AD) who had failed prior systemic therapy.

Major finding: At last review (24 weeks of maximum follow-up), 59% of patients were still on tralokinumab therapy and showed a decrease in the median Numeric Rating Scale Peak Pruritus Score over the past 7 days (from 5 at baseline to 2) but without any change in the median Investigator Global Assessment score. Treatment-related adverse events were mostly mild in severity.

Study details: Findings are from an observational, prospective cohort study including 37 patients aged ≥15 years with moderate-to-severe AD who had failed prior therapy with immunosuppressants, biologics, or a Janus kinase inhibitor and received subcutaneous tralokinumab.

Disclosures: This study did not receive any funding. DJ Hijnen declared serving as an investigator for and receiving consulting fees from various sources.

Source: Schlösser AR et al. Tralokinumab for moderate-to-severe atopic dermatitis patients: First daily practice results. Clin Exp Dermatol. 2023 (Jan 26). Doi: 10.1093/ced/llad038

Key clinical point: Tralokinumab was effective and safe in a real-world cohort of patients with moderate-to-severe atopic dermatitis (AD) who had failed prior systemic therapy.

Major finding: At last review (24 weeks of maximum follow-up), 59% of patients were still on tralokinumab therapy and showed a decrease in the median Numeric Rating Scale Peak Pruritus Score over the past 7 days (from 5 at baseline to 2) but without any change in the median Investigator Global Assessment score. Treatment-related adverse events were mostly mild in severity.

Study details: Findings are from an observational, prospective cohort study including 37 patients aged ≥15 years with moderate-to-severe AD who had failed prior therapy with immunosuppressants, biologics, or a Janus kinase inhibitor and received subcutaneous tralokinumab.

Disclosures: This study did not receive any funding. DJ Hijnen declared serving as an investigator for and receiving consulting fees from various sources.

Source: Schlösser AR et al. Tralokinumab for moderate-to-severe atopic dermatitis patients: First daily practice results. Clin Exp Dermatol. 2023 (Jan 26). Doi: 10.1093/ced/llad038

Key clinical point: Tralokinumab was effective and safe in a real-world cohort of patients with moderate-to-severe atopic dermatitis (AD) who had failed prior systemic therapy.

Major finding: At last review (24 weeks of maximum follow-up), 59% of patients were still on tralokinumab therapy and showed a decrease in the median Numeric Rating Scale Peak Pruritus Score over the past 7 days (from 5 at baseline to 2) but without any change in the median Investigator Global Assessment score. Treatment-related adverse events were mostly mild in severity.

Study details: Findings are from an observational, prospective cohort study including 37 patients aged ≥15 years with moderate-to-severe AD who had failed prior therapy with immunosuppressants, biologics, or a Janus kinase inhibitor and received subcutaneous tralokinumab.

Disclosures: This study did not receive any funding. DJ Hijnen declared serving as an investigator for and receiving consulting fees from various sources.

Source: Schlösser AR et al. Tralokinumab for moderate-to-severe atopic dermatitis patients: First daily practice results. Clin Exp Dermatol. 2023 (Jan 26). Doi: 10.1093/ced/llad038

Key clinical point: Tralokinumab was effective and safe in a real-world cohort of patients with moderate-to-severe atopic dermatitis (AD) who had failed prior systemic therapy.

Major finding: At last review (24 weeks of maximum follow-up), 59% of patients were still on tralokinumab therapy and showed a decrease in the median Numeric Rating Scale Peak Pruritus Score over the past 7 days (from 5 at baseline to 2) but without any change in the median Investigator Global Assessment score. Treatment-related adverse events were mostly mild in severity.

Study details: Findings are from an observational, prospective cohort study including 37 patients aged ≥15 years with moderate-to-severe AD who had failed prior therapy with immunosuppressants, biologics, or a Janus kinase inhibitor and received subcutaneous tralokinumab.

Disclosures: This study did not receive any funding. DJ Hijnen declared serving as an investigator for and receiving consulting fees from various sources.

Source: Schlösser AR et al. Tralokinumab for moderate-to-severe atopic dermatitis patients: First daily practice results. Clin Exp Dermatol. 2023 (Jan 26). Doi: 10.1093/ced/llad038

Key clinical point: Tralokinumab was effective and safe in a real-world cohort of patients with moderate-to-severe atopic dermatitis (AD) who had failed prior systemic therapy.

Major finding: At last review (24 weeks of maximum follow-up), 59% of patients were still on tralokinumab therapy and showed a decrease in the median Numeric Rating Scale Peak Pruritus Score over the past 7 days (from 5 at baseline to 2) but without any change in the median Investigator Global Assessment score. Treatment-related adverse events were mostly mild in severity.

Study details: Findings are from an observational, prospective cohort study including 37 patients aged ≥15 years with moderate-to-severe AD who had failed prior therapy with immunosuppressants, biologics, or a Janus kinase inhibitor and received subcutaneous tralokinumab.

Disclosures: This study did not receive any funding. DJ Hijnen declared serving as an investigator for and receiving consulting fees from various sources.

Source: Schlösser AR et al. Tralokinumab for moderate-to-severe atopic dermatitis patients: First daily practice results. Clin Exp Dermatol. 2023 (Jan 26). Doi: 10.1093/ced/llad038

Key clinical point: Tralokinumab was effective and safe in a real-world cohort of patients with moderate-to-severe atopic dermatitis (AD) who had failed prior systemic therapy.

Major finding: At last review (24 weeks of maximum follow-up), 59% of patients were still on tralokinumab therapy and showed a decrease in the median Numeric Rating Scale Peak Pruritus Score over the past 7 days (from 5 at baseline to 2) but without any change in the median Investigator Global Assessment score. Treatment-related adverse events were mostly mild in severity.

Study details: Findings are from an observational, prospective cohort study including 37 patients aged ≥15 years with moderate-to-severe AD who had failed prior therapy with immunosuppressants, biologics, or a Janus kinase inhibitor and received subcutaneous tralokinumab.

Disclosures: This study did not receive any funding. DJ Hijnen declared serving as an investigator for and receiving consulting fees from various sources.

Source: Schlösser AR et al. Tralokinumab for moderate-to-severe atopic dermatitis patients: First daily practice results. Clin Exp Dermatol. 2023 (Jan 26). Doi: 10.1093/ced/llad038

Key clinical point: Children born by cesarean section or instrumental vaginal delivery are at a greater risk of developing atopic dermatitis (AD) compared with those born by uncomplicated vaginal delivery.

Major finding: Children aged <1 year born by instrumental vaginal delivery (adjusted hazard ratio [aHR] 1.10; 95% CI 1.07-1.13), emergency cesarean section (aHR 1.12; 95% CI 1.10-1.15), and elective caesarean section (aHR 1.13; 95% CI 1.10-1.16) were at a higher risk for AD compared with those born by uncomplicated vaginal delivery, with the risk being similar in children aged ≥1 year.

Study details: This prospective population-based study included 1,399,406 children aged ≤5 years with available information on the mode of delivery and mother's identity.

Disclosures: This study was supported by the Swedish Research Council, Swedish Heart-Lung Foundation, and Stiftelsen Frimurare Barnhuset i Stockholm. The authors declared no conflicts of interest.

Source: Mubanga M et al. Mode of delivery and offspring atopic dermatitis in a Swedish nationwide study. Pediatr Allergy Immunol. 2023;34(1):e13904 (Jan 11). Doi: 10.1111/pai.13904

Key clinical point: Children born by cesarean section or instrumental vaginal delivery are at a greater risk of developing atopic dermatitis (AD) compared with those born by uncomplicated vaginal delivery.

Major finding: Children aged <1 year born by instrumental vaginal delivery (adjusted hazard ratio [aHR] 1.10; 95% CI 1.07-1.13), emergency cesarean section (aHR 1.12; 95% CI 1.10-1.15), and elective caesarean section (aHR 1.13; 95% CI 1.10-1.16) were at a higher risk for AD compared with those born by uncomplicated vaginal delivery, with the risk being similar in children aged ≥1 year.

Study details: This prospective population-based study included 1,399,406 children aged ≤5 years with available information on the mode of delivery and mother's identity.

Disclosures: This study was supported by the Swedish Research Council, Swedish Heart-Lung Foundation, and Stiftelsen Frimurare Barnhuset i Stockholm. The authors declared no conflicts of interest.

Source: Mubanga M et al. Mode of delivery and offspring atopic dermatitis in a Swedish nationwide study. Pediatr Allergy Immunol. 2023;34(1):e13904 (Jan 11). Doi: 10.1111/pai.13904

Key clinical point: Children born by cesarean section or instrumental vaginal delivery are at a greater risk of developing atopic dermatitis (AD) compared with those born by uncomplicated vaginal delivery.

Major finding: Children aged <1 year born by instrumental vaginal delivery (adjusted hazard ratio [aHR] 1.10; 95% CI 1.07-1.13), emergency cesarean section (aHR 1.12; 95% CI 1.10-1.15), and elective caesarean section (aHR 1.13; 95% CI 1.10-1.16) were at a higher risk for AD compared with those born by uncomplicated vaginal delivery, with the risk being similar in children aged ≥1 year.

Study details: This prospective population-based study included 1,399,406 children aged ≤5 years with available information on the mode of delivery and mother's identity.

Disclosures: This study was supported by the Swedish Research Council, Swedish Heart-Lung Foundation, and Stiftelsen Frimurare Barnhuset i Stockholm. The authors declared no conflicts of interest.

Source: Mubanga M et al. Mode of delivery and offspring atopic dermatitis in a Swedish nationwide study. Pediatr Allergy Immunol. 2023;34(1):e13904 (Jan 11). Doi: 10.1111/pai.13904

Key clinical point: Dupilumab with or without concomitant topical corticosteroids (TCS) was safe and provided rapid and sustained improvements in atopic dermatitis (AD) signs and symptoms in patients with erythrodermic AD.

Major finding: At week 16, dupilumab without and with concomitant TCS vs placebo provided significant improvements in the percentage of AD-affected body surface area (P = .02 and P < .001, respectively), Eczema Area and Severity Index score (P = .002 and P < .001, respectively), and Peak Pruritus Numerical Rating Scale score (P < .001 and P = .002, respectively), with improvements observed from week 1. Most treatment-emergent adverse events were mild or moderate in severity.

Study details: This post hoc analysis of six multicenter randomized trials included 209 patients with erythrodermic AD who were randomly assigned to receive dupilumab or placebo (both with or without concomitant TCS).

Disclosures: This study was funded by Sanofi-Regeneron Pharmaceuticals Inc. Some authors reported ties with various organizations, including Sanofi/Regeneron. Four authors declared being employees of or holding stock or stock options in Sanofi/Regeneron.

Source: Paller AS et al. Efficacy and safety of dupilumab in patients with erythrodermic atopic dermatitis: A post hoc analysis of 6 randomized clinical trials. JAMA Dermatol. 2023 (Feb 1). Doi: 10.1001/jamadermatol.2022.6192

Key clinical point: Dupilumab with or without concomitant topical corticosteroids (TCS) was safe and provided rapid and sustained improvements in atopic dermatitis (AD) signs and symptoms in patients with erythrodermic AD.

Major finding: At week 16, dupilumab without and with concomitant TCS vs placebo provided significant improvements in the percentage of AD-affected body surface area (P = .02 and P < .001, respectively), Eczema Area and Severity Index score (P = .002 and P < .001, respectively), and Peak Pruritus Numerical Rating Scale score (P < .001 and P = .002, respectively), with improvements observed from week 1. Most treatment-emergent adverse events were mild or moderate in severity.

Study details: This post hoc analysis of six multicenter randomized trials included 209 patients with erythrodermic AD who were randomly assigned to receive dupilumab or placebo (both with or without concomitant TCS).

Disclosures: This study was funded by Sanofi-Regeneron Pharmaceuticals Inc. Some authors reported ties with various organizations, including Sanofi/Regeneron. Four authors declared being employees of or holding stock or stock options in Sanofi/Regeneron.

Source: Paller AS et al. Efficacy and safety of dupilumab in patients with erythrodermic atopic dermatitis: A post hoc analysis of 6 randomized clinical trials. JAMA Dermatol. 2023 (Feb 1). Doi: 10.1001/jamadermatol.2022.6192

Key clinical point: Dupilumab with or without concomitant topical corticosteroids (TCS) was safe and provided rapid and sustained improvements in atopic dermatitis (AD) signs and symptoms in patients with erythrodermic AD.

Major finding: At week 16, dupilumab without and with concomitant TCS vs placebo provided significant improvements in the percentage of AD-affected body surface area (P = .02 and P < .001, respectively), Eczema Area and Severity Index score (P = .002 and P < .001, respectively), and Peak Pruritus Numerical Rating Scale score (P < .001 and P = .002, respectively), with improvements observed from week 1. Most treatment-emergent adverse events were mild or moderate in severity.

Study details: This post hoc analysis of six multicenter randomized trials included 209 patients with erythrodermic AD who were randomly assigned to receive dupilumab or placebo (both with or without concomitant TCS).

Disclosures: This study was funded by Sanofi-Regeneron Pharmaceuticals Inc. Some authors reported ties with various organizations, including Sanofi/Regeneron. Four authors declared being employees of or holding stock or stock options in Sanofi/Regeneron.

Source: Paller AS et al. Efficacy and safety of dupilumab in patients with erythrodermic atopic dermatitis: A post hoc analysis of 6 randomized clinical trials. JAMA Dermatol. 2023 (Feb 1). Doi: 10.1001/jamadermatol.2022.6192

The U.S. Food and Drug Administration today expanded the indication for Pfizer’s oral Janus kinase (JAK) inhibitor for atopic dermatitis (AD), abrocitinib (Cibinqo), to include adolescents aged 12 through 17 years.

Abrocitinib, taken once daily, previously was approved only for treating adults aged 18 and older.

It joins upadacitinib (Rinvoq), previously the only oral JAK inhibitor to be approved for use by adolescents aged 12 through 17 with refractory moderate to severe AD.

The indication has been expanded for teens whose disease is not adequately controlled with other systemic drugs, including biologics, or those for whom use of those drugs is not advised.

Prescribing information was updated to reflect data from JADE TEEN, a phase 3, randomized, placebo-controlled trial that supported the indication for adolescents. That trial evaluated both the 100-mg and 200-mg doses of abrocitinib in comparison with placebo in 285 adolescents aged 12-18 who had moderate to severe AD and who were also receiving background therapy with topical medications.

The most common toxicities that were reported in at least 1% of patients treated with abrocitinib for up to 16 weeks included nasopharyngitis, nausea, and headache.

Efficacy measures included improvements in itch, skin clearance, and disease severity using the Investigator Global Assessment (IGA), the Peak Pruritus Numerical Rating Scale (PP-NRS), and the Eczema Area and Severity Index (EASI), according to the Pfizer statement announcing the expanded approval.

Select JADE TEEN findings include the following:

• IGA response rate of 0 or 1 at week 12: 39% with abrocitinib 100 mg; 46% with abrocitinib 200 mg; and 24% with placebo.
• EASI-75 response rate at week 12: 64%, 71%, and 41%, respectively.
• Proportion of participants achieving PP-NRS with at least a 4-point decrease from baseline at week 2: 13%, 25%, and 8%, respectively.

Data included in the prescribing information now encompass five randomized, placebo-controlled clinical trials and a long-term extension study with more than 1,600 patients treated with abrocitinib, according to the statement from Pfizer.

In a 2021 story, when JADE TEEN trial results were presented, Lawrence Eichenfield, MD, professor of dermatology and pediatrics, University of California, San Diego, and Rady Children’s Hospital, San Diego, told this news organization that he welcomed oral JAKs as a weapon against atopic dermatitis.

He noted that moderate to severe AD can have a tremendous impact on adolescents. “Traditionally, we have treated it with intermittent topical corticosteroids, but this has left a significant percentage of patients without long-term disease control,” he said.

Abrocitinib is not recommended for use with other JAK inhibitors, biologic immunomodulators, or other immunosuppressants.

AD, one of the most common inflammatory skin diseases, affects approximately 5%-10% of adults in the United States and approximately 11% of children. About one in three adults and one in three children and adolescents aged 17 and younger with AD have moderate to severe disease.

JAK inhibition is thought to modulate multiple cytokines involved in AD, including interleukin (IL)–4, IL-13, IL-31, IL-22, and thymic stromal lymphopoietin.

Prescribing information includes a warning that use of abrocitinib should be avoided by patients with an active, serious infection, including localized infections. A boxed warning is included in the labels of JAK inhibitors regarding the risk of serious infections, mortality, major cardiovascular events, and thrombosis.

Treatment risks and benefits should be carefully considered for patients with chronic or recurrent infections or those who have lived in or traveled in areas of endemic tuberculosis or endemic mycoses, the information states.

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

The U.S. Food and Drug Administration today expanded the indication for Pfizer’s oral Janus kinase (JAK) inhibitor for atopic dermatitis (AD), abrocitinib (Cibinqo), to include adolescents aged 12 through 17 years.

Abrocitinib, taken once daily, previously was approved only for treating adults aged 18 and older.

It joins upadacitinib (Rinvoq), previously the only oral JAK inhibitor to be approved for use by adolescents aged 12 through 17 with refractory moderate to severe AD.

The indication has been expanded for teens whose disease is not adequately controlled with other systemic drugs, including biologics, or those for whom use of those drugs is not advised.

Prescribing information was updated to reflect data from JADE TEEN, a phase 3, randomized, placebo-controlled trial that supported the indication for adolescents. That trial evaluated both the 100-mg and 200-mg doses of abrocitinib in comparison with placebo in 285 adolescents aged 12-18 who had moderate to severe AD and who were also receiving background therapy with topical medications.

The most common toxicities that were reported in at least 1% of patients treated with abrocitinib for up to 16 weeks included nasopharyngitis, nausea, and headache.

Efficacy measures included improvements in itch, skin clearance, and disease severity using the Investigator Global Assessment (IGA), the Peak Pruritus Numerical Rating Scale (PP-NRS), and the Eczema Area and Severity Index (EASI), according to the Pfizer statement announcing the expanded approval.

Select JADE TEEN findings include the following:

• IGA response rate of 0 or 1 at week 12: 39% with abrocitinib 100 mg; 46% with abrocitinib 200 mg; and 24% with placebo.
• EASI-75 response rate at week 12: 64%, 71%, and 41%, respectively.
• Proportion of participants achieving PP-NRS with at least a 4-point decrease from baseline at week 2: 13%, 25%, and 8%, respectively.

Data included in the prescribing information now encompass five randomized, placebo-controlled clinical trials and a long-term extension study with more than 1,600 patients treated with abrocitinib, according to the statement from Pfizer.

In a 2021 story, when JADE TEEN trial results were presented, Lawrence Eichenfield, MD, professor of dermatology and pediatrics, University of California, San Diego, and Rady Children’s Hospital, San Diego, told this news organization that he welcomed oral JAKs as a weapon against atopic dermatitis.

He noted that moderate to severe AD can have a tremendous impact on adolescents. “Traditionally, we have treated it with intermittent topical corticosteroids, but this has left a significant percentage of patients without long-term disease control,” he said.

Abrocitinib is not recommended for use with other JAK inhibitors, biologic immunomodulators, or other immunosuppressants.

AD, one of the most common inflammatory skin diseases, affects approximately 5%-10% of adults in the United States and approximately 11% of children. About one in three adults and one in three children and adolescents aged 17 and younger with AD have moderate to severe disease.

JAK inhibition is thought to modulate multiple cytokines involved in AD, including interleukin (IL)–4, IL-13, IL-31, IL-22, and thymic stromal lymphopoietin.

Prescribing information includes a warning that use of abrocitinib should be avoided by patients with an active, serious infection, including localized infections. A boxed warning is included in the labels of JAK inhibitors regarding the risk of serious infections, mortality, major cardiovascular events, and thrombosis.

Treatment risks and benefits should be carefully considered for patients with chronic or recurrent infections or those who have lived in or traveled in areas of endemic tuberculosis or endemic mycoses, the information states.

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

The U.S. Food and Drug Administration today expanded the indication for Pfizer’s oral Janus kinase (JAK) inhibitor for atopic dermatitis (AD), abrocitinib (Cibinqo), to include adolescents aged 12 through 17 years.

Abrocitinib, taken once daily, previously was approved only for treating adults aged 18 and older.

It joins upadacitinib (Rinvoq), previously the only oral JAK inhibitor to be approved for use by adolescents aged 12 through 17 with refractory moderate to severe AD.

The indication has been expanded for teens whose disease is not adequately controlled with other systemic drugs, including biologics, or those for whom use of those drugs is not advised.

Prescribing information was updated to reflect data from JADE TEEN, a phase 3, randomized, placebo-controlled trial that supported the indication for adolescents. That trial evaluated both the 100-mg and 200-mg doses of abrocitinib in comparison with placebo in 285 adolescents aged 12-18 who had moderate to severe AD and who were also receiving background therapy with topical medications.

The most common toxicities that were reported in at least 1% of patients treated with abrocitinib for up to 16 weeks included nasopharyngitis, nausea, and headache.

Efficacy measures included improvements in itch, skin clearance, and disease severity using the Investigator Global Assessment (IGA), the Peak Pruritus Numerical Rating Scale (PP-NRS), and the Eczema Area and Severity Index (EASI), according to the Pfizer statement announcing the expanded approval.

Select JADE TEEN findings include the following:

• IGA response rate of 0 or 1 at week 12: 39% with abrocitinib 100 mg; 46% with abrocitinib 200 mg; and 24% with placebo.
• EASI-75 response rate at week 12: 64%, 71%, and 41%, respectively.
• Proportion of participants achieving PP-NRS with at least a 4-point decrease from baseline at week 2: 13%, 25%, and 8%, respectively.

Data included in the prescribing information now encompass five randomized, placebo-controlled clinical trials and a long-term extension study with more than 1,600 patients treated with abrocitinib, according to the statement from Pfizer.

In a 2021 story, when JADE TEEN trial results were presented, Lawrence Eichenfield, MD, professor of dermatology and pediatrics, University of California, San Diego, and Rady Children’s Hospital, San Diego, told this news organization that he welcomed oral JAKs as a weapon against atopic dermatitis.

He noted that moderate to severe AD can have a tremendous impact on adolescents. “Traditionally, we have treated it with intermittent topical corticosteroids, but this has left a significant percentage of patients without long-term disease control,” he said.

Abrocitinib is not recommended for use with other JAK inhibitors, biologic immunomodulators, or other immunosuppressants.

AD, one of the most common inflammatory skin diseases, affects approximately 5%-10% of adults in the United States and approximately 11% of children. About one in three adults and one in three children and adolescents aged 17 and younger with AD have moderate to severe disease.

JAK inhibition is thought to modulate multiple cytokines involved in AD, including interleukin (IL)–4, IL-13, IL-31, IL-22, and thymic stromal lymphopoietin.

Prescribing information includes a warning that use of abrocitinib should be avoided by patients with an active, serious infection, including localized infections. A boxed warning is included in the labels of JAK inhibitors regarding the risk of serious infections, mortality, major cardiovascular events, and thrombosis.

Treatment risks and benefits should be carefully considered for patients with chronic or recurrent infections or those who have lived in or traveled in areas of endemic tuberculosis or endemic mycoses, the information states.

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

Atopic dermatitis (AD) is one of the most common chronic, inflammatory skin diseases encountered by dermatologists. AD is characterized by pruritus and a chronic course of exacerbations and remissions. AD is thought to involve the interplay of genetic predisposition, immune dysregulation, and environmental factors. It is also associated with other allergic conditions, including asthma. 

Although AD typically presents with pruritus as the hallmark symptom in all patients, the appearance of skin lesions may vary among different skin types. In individuals with light-colored skin, AD often appears as erythematous patches and plaques. It also more commonly affects the flexor surfaces of the skin. In individuals with darker skin tones, AD may more often result in follicularly centered papules, lichenification, and pigmentary changes. Lesions may also present on extensor surfaces rather than the typical flexure surfaces. Erythema in darker skin types may appear reddish-brown, have a violaceous hue, or be an ashen gray or darker brown color rather than bright red. Because erythema is more difficult to detect in darker skin types, clinicians may mistakenly minimize the severity of AD. 

Clinical severity may also differ between ethnicities. Black patients have an increased tendency toward hyperlinearity of the palms, periorbital dark circles, Dennie-Morgan lines, and diffuse xerosis. Compared with White patients, Black patients with AD are also more likely to develop prurigo nodularis and lichenification. In contrast, Asian patients with AD often experience psoriasiform features, with lesions having more well-defined borders and increased scaling and lichenification.

Beyond differences in clinical appearance, AD may appear molecularly and histologically distinct in ethnic skin. One study suggests that Black patients with AD may have decreased Th1 and Th17 but share similar upregulation of Th2 and Th22 as seen in White patients. Another study showed that Asian patients may have higher Th17 and Th22 and lower Th1/interferon compared with White patients. 

Regardless of skin type, treatment goals remain the same. Treatment goals aim to repair and improve the function of the skin barrier while preventing and managing flares. Clinical studies have shown that skincare regimens incorporating ceramide-containing moisturizers may improve AD by increasing the lipid content in the skin. This may offer clinical benefit in patients with skin of color. However, some treatments often used for AD may lead to other skin issues in skin in color. For example, long-term use of topical steroids may worsen hypopigmentation in darker skin types. Management strategies should take into account the unique clinical and genetic features of AD among different patient demographic groups. 

William D. James, MD, Professor, Department of Dermatology, University of Pennsylvania, Philadelphia.

Disclosure: William D. James, MD, has disclosed the following relevant financial relationships:
Received income in an amount equal to or greater than $250 from: Elsevier.

Image Quizzes are fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.

Atopic dermatitis (AD) is one of the most common chronic, inflammatory skin diseases encountered by dermatologists. AD is characterized by pruritus and a chronic course of exacerbations and remissions. AD is thought to involve the interplay of genetic predisposition, immune dysregulation, and environmental factors. It is also associated with other allergic conditions, including asthma. 

Although AD typically presents with pruritus as the hallmark symptom in all patients, the appearance of skin lesions may vary among different skin types. In individuals with light-colored skin, AD often appears as erythematous patches and plaques. It also more commonly affects the flexor surfaces of the skin. In individuals with darker skin tones, AD may more often result in follicularly centered papules, lichenification, and pigmentary changes. Lesions may also present on extensor surfaces rather than the typical flexure surfaces. Erythema in darker skin types may appear reddish-brown, have a violaceous hue, or be an ashen gray or darker brown color rather than bright red. Because erythema is more difficult to detect in darker skin types, clinicians may mistakenly minimize the severity of AD. 

Clinical severity may also differ between ethnicities. Black patients have an increased tendency toward hyperlinearity of the palms, periorbital dark circles, Dennie-Morgan lines, and diffuse xerosis. Compared with White patients, Black patients with AD are also more likely to develop prurigo nodularis and lichenification. In contrast, Asian patients with AD often experience psoriasiform features, with lesions having more well-defined borders and increased scaling and lichenification.

Beyond differences in clinical appearance, AD may appear molecularly and histologically distinct in ethnic skin. One study suggests that Black patients with AD may have decreased Th1 and Th17 but share similar upregulation of Th2 and Th22 as seen in White patients. Another study showed that Asian patients may have higher Th17 and Th22 and lower Th1/interferon compared with White patients. 

Regardless of skin type, treatment goals remain the same. Treatment goals aim to repair and improve the function of the skin barrier while preventing and managing flares. Clinical studies have shown that skincare regimens incorporating ceramide-containing moisturizers may improve AD by increasing the lipid content in the skin. This may offer clinical benefit in patients with skin of color. However, some treatments often used for AD may lead to other skin issues in skin in color. For example, long-term use of topical steroids may worsen hypopigmentation in darker skin types. Management strategies should take into account the unique clinical and genetic features of AD among different patient demographic groups. 

William D. James, MD, Professor, Department of Dermatology, University of Pennsylvania, Philadelphia.

Disclosure: William D. James, MD, has disclosed the following relevant financial relationships:
Received income in an amount equal to or greater than $250 from: Elsevier.

Image Quizzes are fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.

Atopic dermatitis (AD) is one of the most common chronic, inflammatory skin diseases encountered by dermatologists. AD is characterized by pruritus and a chronic course of exacerbations and remissions. AD is thought to involve the interplay of genetic predisposition, immune dysregulation, and environmental factors. It is also associated with other allergic conditions, including asthma. 

Although AD typically presents with pruritus as the hallmark symptom in all patients, the appearance of skin lesions may vary among different skin types. In individuals with light-colored skin, AD often appears as erythematous patches and plaques. It also more commonly affects the flexor surfaces of the skin. In individuals with darker skin tones, AD may more often result in follicularly centered papules, lichenification, and pigmentary changes. Lesions may also present on extensor surfaces rather than the typical flexure surfaces. Erythema in darker skin types may appear reddish-brown, have a violaceous hue, or be an ashen gray or darker brown color rather than bright red. Because erythema is more difficult to detect in darker skin types, clinicians may mistakenly minimize the severity of AD. 

Clinical severity may also differ between ethnicities. Black patients have an increased tendency toward hyperlinearity of the palms, periorbital dark circles, Dennie-Morgan lines, and diffuse xerosis. Compared with White patients, Black patients with AD are also more likely to develop prurigo nodularis and lichenification. In contrast, Asian patients with AD often experience psoriasiform features, with lesions having more well-defined borders and increased scaling and lichenification.

Beyond differences in clinical appearance, AD may appear molecularly and histologically distinct in ethnic skin. One study suggests that Black patients with AD may have decreased Th1 and Th17 but share similar upregulation of Th2 and Th22 as seen in White patients. Another study showed that Asian patients may have higher Th17 and Th22 and lower Th1/interferon compared with White patients. 

Regardless of skin type, treatment goals remain the same. Treatment goals aim to repair and improve the function of the skin barrier while preventing and managing flares. Clinical studies have shown that skincare regimens incorporating ceramide-containing moisturizers may improve AD by increasing the lipid content in the skin. This may offer clinical benefit in patients with skin of color. However, some treatments often used for AD may lead to other skin issues in skin in color. For example, long-term use of topical steroids may worsen hypopigmentation in darker skin types. Management strategies should take into account the unique clinical and genetic features of AD among different patient demographic groups. 

William D. James, MD, Professor, Department of Dermatology, University of Pennsylvania, Philadelphia.

Disclosure: William D. James, MD, has disclosed the following relevant financial relationships:
Received income in an amount equal to or greater than $250 from: Elsevier.

Image Quizzes are fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.

I love registries! With large numbers of participants, registries can be very helpful to identify rare side effects and to assess the efficacy and safety of medications in populations that may not be fully represented in clinical trials. I also love dupilumab; it was revolutionary in the management of patients with AD.

Vittrup and colleagues have created a registry of 347 participants treated with dupilumab. This does not yet have the large number of participants needed to identify new issues that wouldn't have been detected in clinical trials, but the study is informative about real-life use. The dramatic improvement in the Eczema Area and Severity Index (EASI) score is consistent with the high efficacy of dupilumab. The high rate of treatment persistence is also consistent with dupilumab being a very effective and safe treatment (because if the drug wasn't working well or was causing a severe problem, patients would probably stop the treatment). Though the study reported persistent head and neck involvement, the residual involvement may be quite minimal.

The EASI-75 and Investigator Global Assessment response rates reported in dupilumab trials underestimate the value of this drug. With a 2-year persistence rate of nearly 90%, it's clear that dupilumab is making a huge difference in the lives of patients with AD.

Fatigue is a fascinating issue in AD. We might wonder if all the inflammation in patients with AD would directly cause fatigue. Almost certainly all the itching in AD adversely affects sleep and would cause tremendous fatigue. It surprised me that most of the children in the study by Rangel and colleagues were reported as having no or mild fatigue; severe fatigue was very uncommon. It leaves me wondering whether the assessments of fatigue fully capture what's happening. Also, since the fatigue score was reported by the parents, I (as the parent of a child with AD) am wondering whether the parents were projecting, with the score more reflective of the parents' fatigue than with that of the child; alternatively, perhaps the child's hyperactivity leaves parents thinking there is no fatigue when there actually is (and possibly even causing the perceived hyperactivity).

The lack of a control group without AD is another major limitation in our ability to interpret the study findings. Is fatigue more common or less common in children with AD than in children without AD? I cannot tell from these findings. Does fatigue warrant, as the authors suggest, more attention in clinical practice? I don't know. If we are already treating our patients based on patients' global impressions of how they are doing — combined, of course, with our observations of their objective disease severity — I'm not sure how asking about fatigue would change anything, even if future studies were to definitively show that AD is associated with fatigue.

I hate new drugs (well, maybe not hate, but I worry about unknown long-term risks). Clinical trials that help a drug get approved can tell us a lot about a drug's efficacy, but these studies are generally limited in what they tell us about a drug's safety. Clinical trials are generally not powered enough (not enough participants and not followed for long enough) to be informative about rare risks. I love long-term studies of new drugs in large numbers of people because those studies can be very reassuring about the risks of medications. Studying nearly 10,000 patients for 5 years is quite reassuring, confirming my impression that dupilumab has a remarkable, excellent safety profile (Owji et al). Blocking interleukin 4 and interleukin 13 seems to be very specific to AD. Finding no association to cancer is what I would have expected; being able to share this information with patients is likely to be reassuring to them.

Oh, lord help me, another study that claims we should change our disease management because they've identified an increased risk for something. When you compare 70,000 patients with 270,000 controls, you have huge power to detect statistically significant associations of no clinical consequence. Let's assume for the moment that the detected association the authors found between AD and juvenile idiopathic arthritis (JIA) is real. The odds ratio is 2; the odds ratio for smoking causing cancer is on the order of 100.

In this study, over 99% of individuals in both AD and control groups did not have JIA. The difference between rates of JIA in patients with AD compared with controls was 0.3%! The authors conclude "it is important to inquire actively about symptoms not directly linked to the patients' skin disease"; based on the findings of this study, I would conclude that we don't need to worry about JIA in patients with AD even if there is a (marginally) higher prevalence of JIA in this group.

I love registries! With large numbers of participants, registries can be very helpful to identify rare side effects and to assess the efficacy and safety of medications in populations that may not be fully represented in clinical trials. I also love dupilumab; it was revolutionary in the management of patients with AD.

Vittrup and colleagues have created a registry of 347 participants treated with dupilumab. This does not yet have the large number of participants needed to identify new issues that wouldn't have been detected in clinical trials, but the study is informative about real-life use. The dramatic improvement in the Eczema Area and Severity Index (EASI) score is consistent with the high efficacy of dupilumab. The high rate of treatment persistence is also consistent with dupilumab being a very effective and safe treatment (because if the drug wasn't working well or was causing a severe problem, patients would probably stop the treatment). Though the study reported persistent head and neck involvement, the residual involvement may be quite minimal.

The EASI-75 and Investigator Global Assessment response rates reported in dupilumab trials underestimate the value of this drug. With a 2-year persistence rate of nearly 90%, it's clear that dupilumab is making a huge difference in the lives of patients with AD.

Fatigue is a fascinating issue in AD. We might wonder if all the inflammation in patients with AD would directly cause fatigue. Almost certainly all the itching in AD adversely affects sleep and would cause tremendous fatigue. It surprised me that most of the children in the study by Rangel and colleagues were reported as having no or mild fatigue; severe fatigue was very uncommon. It leaves me wondering whether the assessments of fatigue fully capture what's happening. Also, since the fatigue score was reported by the parents, I (as the parent of a child with AD) am wondering whether the parents were projecting, with the score more reflective of the parents' fatigue than with that of the child; alternatively, perhaps the child's hyperactivity leaves parents thinking there is no fatigue when there actually is (and possibly even causing the perceived hyperactivity).

The lack of a control group without AD is another major limitation in our ability to interpret the study findings. Is fatigue more common or less common in children with AD than in children without AD? I cannot tell from these findings. Does fatigue warrant, as the authors suggest, more attention in clinical practice? I don't know. If we are already treating our patients based on patients' global impressions of how they are doing — combined, of course, with our observations of their objective disease severity — I'm not sure how asking about fatigue would change anything, even if future studies were to definitively show that AD is associated with fatigue.

I hate new drugs (well, maybe not hate, but I worry about unknown long-term risks). Clinical trials that help a drug get approved can tell us a lot about a drug's efficacy, but these studies are generally limited in what they tell us about a drug's safety. Clinical trials are generally not powered enough (not enough participants and not followed for long enough) to be informative about rare risks. I love long-term studies of new drugs in large numbers of people because those studies can be very reassuring about the risks of medications. Studying nearly 10,000 patients for 5 years is quite reassuring, confirming my impression that dupilumab has a remarkable, excellent safety profile (Owji et al). Blocking interleukin 4 and interleukin 13 seems to be very specific to AD. Finding no association to cancer is what I would have expected; being able to share this information with patients is likely to be reassuring to them.

Oh, lord help me, another study that claims we should change our disease management because they've identified an increased risk for something. When you compare 70,000 patients with 270,000 controls, you have huge power to detect statistically significant associations of no clinical consequence. Let's assume for the moment that the detected association the authors found between AD and juvenile idiopathic arthritis (JIA) is real. The odds ratio is 2; the odds ratio for smoking causing cancer is on the order of 100.

In this study, over 99% of individuals in both AD and control groups did not have JIA. The difference between rates of JIA in patients with AD compared with controls was 0.3%! The authors conclude "it is important to inquire actively about symptoms not directly linked to the patients' skin disease"; based on the findings of this study, I would conclude that we don't need to worry about JIA in patients with AD even if there is a (marginally) higher prevalence of JIA in this group.

I love registries! With large numbers of participants, registries can be very helpful to identify rare side effects and to assess the efficacy and safety of medications in populations that may not be fully represented in clinical trials. I also love dupilumab; it was revolutionary in the management of patients with AD.

Vittrup and colleagues have created a registry of 347 participants treated with dupilumab. This does not yet have the large number of participants needed to identify new issues that wouldn't have been detected in clinical trials, but the study is informative about real-life use. The dramatic improvement in the Eczema Area and Severity Index (EASI) score is consistent with the high efficacy of dupilumab. The high rate of treatment persistence is also consistent with dupilumab being a very effective and safe treatment (because if the drug wasn't working well or was causing a severe problem, patients would probably stop the treatment). Though the study reported persistent head and neck involvement, the residual involvement may be quite minimal.

The EASI-75 and Investigator Global Assessment response rates reported in dupilumab trials underestimate the value of this drug. With a 2-year persistence rate of nearly 90%, it's clear that dupilumab is making a huge difference in the lives of patients with AD.

Fatigue is a fascinating issue in AD. We might wonder if all the inflammation in patients with AD would directly cause fatigue. Almost certainly all the itching in AD adversely affects sleep and would cause tremendous fatigue. It surprised me that most of the children in the study by Rangel and colleagues were reported as having no or mild fatigue; severe fatigue was very uncommon. It leaves me wondering whether the assessments of fatigue fully capture what's happening. Also, since the fatigue score was reported by the parents, I (as the parent of a child with AD) am wondering whether the parents were projecting, with the score more reflective of the parents' fatigue than with that of the child; alternatively, perhaps the child's hyperactivity leaves parents thinking there is no fatigue when there actually is (and possibly even causing the perceived hyperactivity).

The lack of a control group without AD is another major limitation in our ability to interpret the study findings. Is fatigue more common or less common in children with AD than in children without AD? I cannot tell from these findings. Does fatigue warrant, as the authors suggest, more attention in clinical practice? I don't know. If we are already treating our patients based on patients' global impressions of how they are doing — combined, of course, with our observations of their objective disease severity — I'm not sure how asking about fatigue would change anything, even if future studies were to definitively show that AD is associated with fatigue.

I hate new drugs (well, maybe not hate, but I worry about unknown long-term risks). Clinical trials that help a drug get approved can tell us a lot about a drug's efficacy, but these studies are generally limited in what they tell us about a drug's safety. Clinical trials are generally not powered enough (not enough participants and not followed for long enough) to be informative about rare risks. I love long-term studies of new drugs in large numbers of people because those studies can be very reassuring about the risks of medications. Studying nearly 10,000 patients for 5 years is quite reassuring, confirming my impression that dupilumab has a remarkable, excellent safety profile (Owji et al). Blocking interleukin 4 and interleukin 13 seems to be very specific to AD. Finding no association to cancer is what I would have expected; being able to share this information with patients is likely to be reassuring to them.

Oh, lord help me, another study that claims we should change our disease management because they've identified an increased risk for something. When you compare 70,000 patients with 270,000 controls, you have huge power to detect statistically significant associations of no clinical consequence. Let's assume for the moment that the detected association the authors found between AD and juvenile idiopathic arthritis (JIA) is real. The odds ratio is 2; the odds ratio for smoking causing cancer is on the order of 100.

In this study, over 99% of individuals in both AD and control groups did not have JIA. The difference between rates of JIA in patients with AD compared with controls was 0.3%! The authors conclude "it is important to inquire actively about symptoms not directly linked to the patients' skin disease"; based on the findings of this study, I would conclude that we don't need to worry about JIA in patients with AD even if there is a (marginally) higher prevalence of JIA in this group.

Key clinical point: The majority of topical and systemic therapies for atopic dermatitis (AD) effectively reduced pruritus, the most common patient-reported symptom.

Major finding: Topical and systemic treatments led to a mean reduction of 3.32 (99% CI 2.32-4.33) and 3.07 (99% CI 2.58-3.56) points in pruritus score, respectively. Wet-wrap therapy using halometasone (−4.75 points) was the most effective topical treatment, and 30 mg upadacitinib (−4.90 points) was the most effective systemic treatment.

Study details: This study analyzed 22 studies that included patients aged ≥ 10 years with AD who received topical or systemic treatments.

Disclosures: No information on the source of funding was provided. Two authors reported ties with various organizations.

Source: Rodriguez-Le Roy Y et al. Efficacy of topical and systemic treatments for atopic dermatitis on pruritus: A systematic literature review and meta-analysis. Front Med (Lausanne). 2022;9:1079323 (Dec 22). Doi: 10.3389/fmed.2022.1079323

Key clinical point: The majority of topical and systemic therapies for atopic dermatitis (AD) effectively reduced pruritus, the most common patient-reported symptom.

Major finding: Topical and systemic treatments led to a mean reduction of 3.32 (99% CI 2.32-4.33) and 3.07 (99% CI 2.58-3.56) points in pruritus score, respectively. Wet-wrap therapy using halometasone (−4.75 points) was the most effective topical treatment, and 30 mg upadacitinib (−4.90 points) was the most effective systemic treatment.

Study details: This study analyzed 22 studies that included patients aged ≥ 10 years with AD who received topical or systemic treatments.

Disclosures: No information on the source of funding was provided. Two authors reported ties with various organizations.

Source: Rodriguez-Le Roy Y et al. Efficacy of topical and systemic treatments for atopic dermatitis on pruritus: A systematic literature review and meta-analysis. Front Med (Lausanne). 2022;9:1079323 (Dec 22). Doi: 10.3389/fmed.2022.1079323

Key clinical point: The majority of topical and systemic therapies for atopic dermatitis (AD) effectively reduced pruritus, the most common patient-reported symptom.

Major finding: Topical and systemic treatments led to a mean reduction of 3.32 (99% CI 2.32-4.33) and 3.07 (99% CI 2.58-3.56) points in pruritus score, respectively. Wet-wrap therapy using halometasone (−4.75 points) was the most effective topical treatment, and 30 mg upadacitinib (−4.90 points) was the most effective systemic treatment.

Study details: This study analyzed 22 studies that included patients aged ≥ 10 years with AD who received topical or systemic treatments.

Disclosures: No information on the source of funding was provided. Two authors reported ties with various organizations.

Source: Rodriguez-Le Roy Y et al. Efficacy of topical and systemic treatments for atopic dermatitis on pruritus: A systematic literature review and meta-analysis. Front Med (Lausanne). 2022;9:1079323 (Dec 22). Doi: 10.3389/fmed.2022.1079323

Key clinical point: Children and adolescents with atopic dermatitis (AD) are at an increased risk of developing juvenile idiopathic arthritis (JIA).

Major finding: Patients with AD vs control individuals had an increased risk for JIA (adjusted odds ratio [aOR] 1.58; 95% CI 1.41-1.77), especially for psoriatic JIA (aOR 2.75; 95% CI 1.64-4.60).

Study details: This population-based register study included 70,584 patients with AD aged <18 years at the time of the first AD diagnosis and 270,783 age- and sex-matched control individuals without AD.

Disclosures: This study did not receive any funding. Some authors declared serving as investigators for or receiving educational grants, speaker honoraria, or consultation honoraria from various organizations.

Source: Keskitalo PL et al. Juvenile idiopathic arthritis in children and adolescents with atopic dermatitis: A Finnish nationwide registry study. J Am Acad Dermatol. 2023 (Jan 3). Doi: 10.1016/j.jaad.2022.12.025

Key clinical point: Children and adolescents with atopic dermatitis (AD) are at an increased risk of developing juvenile idiopathic arthritis (JIA).

Major finding: Patients with AD vs control individuals had an increased risk for JIA (adjusted odds ratio [aOR] 1.58; 95% CI 1.41-1.77), especially for psoriatic JIA (aOR 2.75; 95% CI 1.64-4.60).

Study details: This population-based register study included 70,584 patients with AD aged <18 years at the time of the first AD diagnosis and 270,783 age- and sex-matched control individuals without AD.

Disclosures: This study did not receive any funding. Some authors declared serving as investigators for or receiving educational grants, speaker honoraria, or consultation honoraria from various organizations.

Source: Keskitalo PL et al. Juvenile idiopathic arthritis in children and adolescents with atopic dermatitis: A Finnish nationwide registry study. J Am Acad Dermatol. 2023 (Jan 3). Doi: 10.1016/j.jaad.2022.12.025

Key clinical point: Children and adolescents with atopic dermatitis (AD) are at an increased risk of developing juvenile idiopathic arthritis (JIA).

Major finding: Patients with AD vs control individuals had an increased risk for JIA (adjusted odds ratio [aOR] 1.58; 95% CI 1.41-1.77), especially for psoriatic JIA (aOR 2.75; 95% CI 1.64-4.60).

Study details: This population-based register study included 70,584 patients with AD aged <18 years at the time of the first AD diagnosis and 270,783 age- and sex-matched control individuals without AD.

Disclosures: This study did not receive any funding. Some authors declared serving as investigators for or receiving educational grants, speaker honoraria, or consultation honoraria from various organizations.

Source: Keskitalo PL et al. Juvenile idiopathic arthritis in children and adolescents with atopic dermatitis: A Finnish nationwide registry study. J Am Acad Dermatol. 2023 (Jan 3). Doi: 10.1016/j.jaad.2022.12.025