Key clinical point: Although food allergy (FA) is common among pediatric patients with atopic dermatitis (AD), immunoglobulin E (IgE) mediates the majority of instances and very few patients report food-triggered AD (FTAD), cautioning against unnecessary dietary restrictions.

Major finding: IgE-mediated FA was common in the overall cohort (55%) irrespective of the severity of AD (mild, 60%; moderate, 45%; severe, 57%), whereas FTAD was rare (3%) and diagnosed in only 2%, 6%, and 4% of patients with mild, moderate, and severe AD, respectively. In patients with AD only, more patients developed IgE-mediated FA vs FTAD (29% vs 5%).

Study details: Findings are from a retrospective study including 372 pediatric patients with AD, of which 29% had moderate AD and 18% had severe AD.

Disclosures: This study was funded by University of Wisconsin-Madison. The authors declared no conflicts of interest.

Source: Li JC et al. Prevalence of food allergy diagnosis in pediatric patients with atopic dermatitis referred to allergy and/or dermatology subspecialty clinics. J Allergy Clin Immunol Pract. 2022 (Jun 8). Doi: 10.1016/j.jaip.2022.05.028

Key clinical point: Although food allergy (FA) is common among pediatric patients with atopic dermatitis (AD), immunoglobulin E (IgE) mediates the majority of instances and very few patients report food-triggered AD (FTAD), cautioning against unnecessary dietary restrictions.

Major finding: IgE-mediated FA was common in the overall cohort (55%) irrespective of the severity of AD (mild, 60%; moderate, 45%; severe, 57%), whereas FTAD was rare (3%) and diagnosed in only 2%, 6%, and 4% of patients with mild, moderate, and severe AD, respectively. In patients with AD only, more patients developed IgE-mediated FA vs FTAD (29% vs 5%).

Study details: Findings are from a retrospective study including 372 pediatric patients with AD, of which 29% had moderate AD and 18% had severe AD.

Disclosures: This study was funded by University of Wisconsin-Madison. The authors declared no conflicts of interest.

Source: Li JC et al. Prevalence of food allergy diagnosis in pediatric patients with atopic dermatitis referred to allergy and/or dermatology subspecialty clinics. J Allergy Clin Immunol Pract. 2022 (Jun 8). Doi: 10.1016/j.jaip.2022.05.028

Key clinical point: Although food allergy (FA) is common among pediatric patients with atopic dermatitis (AD), immunoglobulin E (IgE) mediates the majority of instances and very few patients report food-triggered AD (FTAD), cautioning against unnecessary dietary restrictions.

Major finding: IgE-mediated FA was common in the overall cohort (55%) irrespective of the severity of AD (mild, 60%; moderate, 45%; severe, 57%), whereas FTAD was rare (3%) and diagnosed in only 2%, 6%, and 4% of patients with mild, moderate, and severe AD, respectively. In patients with AD only, more patients developed IgE-mediated FA vs FTAD (29% vs 5%).

Study details: Findings are from a retrospective study including 372 pediatric patients with AD, of which 29% had moderate AD and 18% had severe AD.

Disclosures: This study was funded by University of Wisconsin-Madison. The authors declared no conflicts of interest.

Source: Li JC et al. Prevalence of food allergy diagnosis in pediatric patients with atopic dermatitis referred to allergy and/or dermatology subspecialty clinics. J Allergy Clin Immunol Pract. 2022 (Jun 8). Doi: 10.1016/j.jaip.2022.05.028

Key clinical point: Age, sex, body mass index (BMI), onset age of atopic dermatitis (AD), smoking habits, presence of palmar hyperlinearity, and other atopic diseases determine the disease severity in patients with AD.

Major finding: Compared with patients with mild AD, those with severe AD were usually older (P  =  .020) and male (P  =  .002) with an early onset age of AD (<2 years; P  =  .004), higher BMI (P < .000), history of smoking (P  =  .012), concomitant asthma (P  =  .001), palmar hyperlinearity (P  =  .013), hand dermatitis (P  =  .020), history of contact allergy (P  =  .042), and higher immunoglobulin E levels (P < .0001).

Study details: Findings are from a single-center, cross-sectional observational study including 502 Finnish patients with AD, of which 146, 231, and 125 patients had mild, moderate, and severe AD, respectively.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Salava A et al. Factors associated with severity of atopic dermatitis - a Finnish cross-sectional study. J Eur Acad Dermatol Venereol. 2022 (Jun 29). Doi: 10.1111/jdv.18378

Key clinical point: Age, sex, body mass index (BMI), onset age of atopic dermatitis (AD), smoking habits, presence of palmar hyperlinearity, and other atopic diseases determine the disease severity in patients with AD.

Major finding: Compared with patients with mild AD, those with severe AD were usually older (P  =  .020) and male (P  =  .002) with an early onset age of AD (<2 years; P  =  .004), higher BMI (P < .000), history of smoking (P  =  .012), concomitant asthma (P  =  .001), palmar hyperlinearity (P  =  .013), hand dermatitis (P  =  .020), history of contact allergy (P  =  .042), and higher immunoglobulin E levels (P < .0001).

Study details: Findings are from a single-center, cross-sectional observational study including 502 Finnish patients with AD, of which 146, 231, and 125 patients had mild, moderate, and severe AD, respectively.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Salava A et al. Factors associated with severity of atopic dermatitis - a Finnish cross-sectional study. J Eur Acad Dermatol Venereol. 2022 (Jun 29). Doi: 10.1111/jdv.18378

Key clinical point: Age, sex, body mass index (BMI), onset age of atopic dermatitis (AD), smoking habits, presence of palmar hyperlinearity, and other atopic diseases determine the disease severity in patients with AD.

Major finding: Compared with patients with mild AD, those with severe AD were usually older (P  =  .020) and male (P  =  .002) with an early onset age of AD (<2 years; P  =  .004), higher BMI (P < .000), history of smoking (P  =  .012), concomitant asthma (P  =  .001), palmar hyperlinearity (P  =  .013), hand dermatitis (P  =  .020), history of contact allergy (P  =  .042), and higher immunoglobulin E levels (P < .0001).

Study details: Findings are from a single-center, cross-sectional observational study including 502 Finnish patients with AD, of which 146, 231, and 125 patients had mild, moderate, and severe AD, respectively.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Salava A et al. Factors associated with severity of atopic dermatitis - a Finnish cross-sectional study. J Eur Acad Dermatol Venereol. 2022 (Jun 29). Doi: 10.1111/jdv.18378

Key clinical point: A 52-week long treatment with difamilast ointment was well tolerated and reduced the severity of atopic dermatitis (AD) in Japanese adult and pediatric patients.

Major finding: Overall, 72.3% of adult patients and 89.0% of pediatric patients experienced treatment-emergent adverse events (TEAE) of mostly mild or moderate severity, and only 7.8% of adult patients and 3.5% of pediatric patients discontinued treatment due to TEAE. At week 52, 55.4% of adult patients and 73.5% of pediatric patients achieved ≥75% improvement in the Eczema Area and Severity Index.

Study details: Findings are from a long-term, open-label, phase 3 study including 166 adult (15-70 years) and 200 pediatric (2-14 years) patients with AD who initiated a 52-week treatment with 0.3% or 1% difamilast ointment.

Disclosures: This study was supported by Otsuka Pharmaceutical Co., Ltd. Three authors declared being employees of Otsuka Pharmaceutical, and the other author declared receiving consulting fees, funding, grant support, and honoraria from several sources, including Otsuka Pharmaceutical.

Source: Saeki H et al. Difamilast ointment in Japanese adult and pediatric patients with atopic dermatitis: A phase III, long-term, open-label study. Dermatol Ther (Heidelb). 2022;12:1589-1601 (Jun 18). Doi: 10.1007/s13555-022-00751-9

Key clinical point: A 52-week long treatment with difamilast ointment was well tolerated and reduced the severity of atopic dermatitis (AD) in Japanese adult and pediatric patients.

Major finding: Overall, 72.3% of adult patients and 89.0% of pediatric patients experienced treatment-emergent adverse events (TEAE) of mostly mild or moderate severity, and only 7.8% of adult patients and 3.5% of pediatric patients discontinued treatment due to TEAE. At week 52, 55.4% of adult patients and 73.5% of pediatric patients achieved ≥75% improvement in the Eczema Area and Severity Index.

Study details: Findings are from a long-term, open-label, phase 3 study including 166 adult (15-70 years) and 200 pediatric (2-14 years) patients with AD who initiated a 52-week treatment with 0.3% or 1% difamilast ointment.

Disclosures: This study was supported by Otsuka Pharmaceutical Co., Ltd. Three authors declared being employees of Otsuka Pharmaceutical, and the other author declared receiving consulting fees, funding, grant support, and honoraria from several sources, including Otsuka Pharmaceutical.

Source: Saeki H et al. Difamilast ointment in Japanese adult and pediatric patients with atopic dermatitis: A phase III, long-term, open-label study. Dermatol Ther (Heidelb). 2022;12:1589-1601 (Jun 18). Doi: 10.1007/s13555-022-00751-9

Key clinical point: A 52-week long treatment with difamilast ointment was well tolerated and reduced the severity of atopic dermatitis (AD) in Japanese adult and pediatric patients.

Major finding: Overall, 72.3% of adult patients and 89.0% of pediatric patients experienced treatment-emergent adverse events (TEAE) of mostly mild or moderate severity, and only 7.8% of adult patients and 3.5% of pediatric patients discontinued treatment due to TEAE. At week 52, 55.4% of adult patients and 73.5% of pediatric patients achieved ≥75% improvement in the Eczema Area and Severity Index.

Study details: Findings are from a long-term, open-label, phase 3 study including 166 adult (15-70 years) and 200 pediatric (2-14 years) patients with AD who initiated a 52-week treatment with 0.3% or 1% difamilast ointment.

Disclosures: This study was supported by Otsuka Pharmaceutical Co., Ltd. Three authors declared being employees of Otsuka Pharmaceutical, and the other author declared receiving consulting fees, funding, grant support, and honoraria from several sources, including Otsuka Pharmaceutical.

Source: Saeki H et al. Difamilast ointment in Japanese adult and pediatric patients with atopic dermatitis: A phase III, long-term, open-label study. Dermatol Ther (Heidelb). 2022;12:1589-1601 (Jun 18). Doi: 10.1007/s13555-022-00751-9

Key clinical point: Acne caused by upadacitinib in adolescents and adults with moderate-to-severe atopic dermatitis (AD) is typically mild or moderate in severity and may not be considered a significant safety risk.

Major finding: Acne of mostly mild or moderate severity was reported by a higher proportion of patients receiving 15 mg upadacitinib (9.8%) and 30 mg upadacitinib (15.2%) vs placebo (2.2%), with no intervention required in 40.5% and 46.6% of patients receiving 15 and 30 mg upadacitinib, respectively. The improvement in quality-of-life scores was proportional to the decrease in AD severity and was similar in patients with or without acne.

Study details: Findings are from a post hoc integrated analysis of 3 phase 3 trials including 2583 patients with moderate-to-severe AD who were randomly assigned to receive upadacitinib (15 or 30 mg) or placebo as monotherapy or with concomitant topical corticosteroids.

Disclosures: This study was funded by AbbVie, Inc. Five authors declared being employees or stockholders of AbbVie. The other authors reported ties with various sources, including AbbVie.

Source: Mendes-Bastos P et al. Characterization of acne associated with upadacitinib treatment in patients with moderate-to-severe atopic dermatitis: A post hoc integrated analysis of 3 phase 3 randomized, double-blind, placebo-controlled trials. J Am Acad Dermatol. 2022 (Jun 14). Doi: 10.1016/j.jaad.2022.06.012

Key clinical point: Acne caused by upadacitinib in adolescents and adults with moderate-to-severe atopic dermatitis (AD) is typically mild or moderate in severity and may not be considered a significant safety risk.

Major finding: Acne of mostly mild or moderate severity was reported by a higher proportion of patients receiving 15 mg upadacitinib (9.8%) and 30 mg upadacitinib (15.2%) vs placebo (2.2%), with no intervention required in 40.5% and 46.6% of patients receiving 15 and 30 mg upadacitinib, respectively. The improvement in quality-of-life scores was proportional to the decrease in AD severity and was similar in patients with or without acne.

Study details: Findings are from a post hoc integrated analysis of 3 phase 3 trials including 2583 patients with moderate-to-severe AD who were randomly assigned to receive upadacitinib (15 or 30 mg) or placebo as monotherapy or with concomitant topical corticosteroids.

Disclosures: This study was funded by AbbVie, Inc. Five authors declared being employees or stockholders of AbbVie. The other authors reported ties with various sources, including AbbVie.

Source: Mendes-Bastos P et al. Characterization of acne associated with upadacitinib treatment in patients with moderate-to-severe atopic dermatitis: A post hoc integrated analysis of 3 phase 3 randomized, double-blind, placebo-controlled trials. J Am Acad Dermatol. 2022 (Jun 14). Doi: 10.1016/j.jaad.2022.06.012

Key clinical point: Acne caused by upadacitinib in adolescents and adults with moderate-to-severe atopic dermatitis (AD) is typically mild or moderate in severity and may not be considered a significant safety risk.

Major finding: Acne of mostly mild or moderate severity was reported by a higher proportion of patients receiving 15 mg upadacitinib (9.8%) and 30 mg upadacitinib (15.2%) vs placebo (2.2%), with no intervention required in 40.5% and 46.6% of patients receiving 15 and 30 mg upadacitinib, respectively. The improvement in quality-of-life scores was proportional to the decrease in AD severity and was similar in patients with or without acne.

Study details: Findings are from a post hoc integrated analysis of 3 phase 3 trials including 2583 patients with moderate-to-severe AD who were randomly assigned to receive upadacitinib (15 or 30 mg) or placebo as monotherapy or with concomitant topical corticosteroids.

Disclosures: This study was funded by AbbVie, Inc. Five authors declared being employees or stockholders of AbbVie. The other authors reported ties with various sources, including AbbVie.

Source: Mendes-Bastos P et al. Characterization of acne associated with upadacitinib treatment in patients with moderate-to-severe atopic dermatitis: A post hoc integrated analysis of 3 phase 3 randomized, double-blind, placebo-controlled trials. J Am Acad Dermatol. 2022 (Jun 14). Doi: 10.1016/j.jaad.2022.06.012

Key clinical point: Dupilumab was more effective than topical corticosteroids (TCS) and cyclosporine in reducing the severity of atopic dermatitis (AD) and transepidermal water loss (TEWL), both in eczematous lesions and nonlesioned skin.

Major finding: At week 16, a higher proportion of patients receiving dupilumab vs cyclosporine or TCS achieved 50% improvement in the Eczema Area and Severity Index (EASI-50; 81.8% vs 28.6% or 40.0% respectively; P  =  .004). TEWL reduced with both dupilumab (P < .001) and TCS (P  =  .047) in eczematous lesions and with dupilumab in nonlesioned skin (P  =  .006) with dupilumab treatment being associated with achievement of EASI-50 (odds ratio 10.67; P  =  .026) and 50% improvement in TEWL (P  =  .004).

Study details: Findings are from a prospective, observational study including 46 patients with AD who received TCS (n = 10), cyclosporine (n = 14), or dupilumab (n = 22).

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Montero-Vilchez T et al. Dupilumab improves skin barrier function in adults with atopic dermatitis: A prospective observational study. J Clin Med. 2022;11(12):3341 (Jun 10). Doi:  10.3390/jcm11123341

Key clinical point: Dupilumab was more effective than topical corticosteroids (TCS) and cyclosporine in reducing the severity of atopic dermatitis (AD) and transepidermal water loss (TEWL), both in eczematous lesions and nonlesioned skin.

Major finding: At week 16, a higher proportion of patients receiving dupilumab vs cyclosporine or TCS achieved 50% improvement in the Eczema Area and Severity Index (EASI-50; 81.8% vs 28.6% or 40.0% respectively; P  =  .004). TEWL reduced with both dupilumab (P < .001) and TCS (P  =  .047) in eczematous lesions and with dupilumab in nonlesioned skin (P  =  .006) with dupilumab treatment being associated with achievement of EASI-50 (odds ratio 10.67; P  =  .026) and 50% improvement in TEWL (P  =  .004).

Study details: Findings are from a prospective, observational study including 46 patients with AD who received TCS (n = 10), cyclosporine (n = 14), or dupilumab (n = 22).

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Montero-Vilchez T et al. Dupilumab improves skin barrier function in adults with atopic dermatitis: A prospective observational study. J Clin Med. 2022;11(12):3341 (Jun 10). Doi:  10.3390/jcm11123341

Key clinical point: Dupilumab was more effective than topical corticosteroids (TCS) and cyclosporine in reducing the severity of atopic dermatitis (AD) and transepidermal water loss (TEWL), both in eczematous lesions and nonlesioned skin.

Major finding: At week 16, a higher proportion of patients receiving dupilumab vs cyclosporine or TCS achieved 50% improvement in the Eczema Area and Severity Index (EASI-50; 81.8% vs 28.6% or 40.0% respectively; P  =  .004). TEWL reduced with both dupilumab (P < .001) and TCS (P  =  .047) in eczematous lesions and with dupilumab in nonlesioned skin (P  =  .006) with dupilumab treatment being associated with achievement of EASI-50 (odds ratio 10.67; P  =  .026) and 50% improvement in TEWL (P  =  .004).

Study details: Findings are from a prospective, observational study including 46 patients with AD who received TCS (n = 10), cyclosporine (n = 14), or dupilumab (n = 22).

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Montero-Vilchez T et al. Dupilumab improves skin barrier function in adults with atopic dermatitis: A prospective observational study. J Clin Med. 2022;11(12):3341 (Jun 10). Doi:  10.3390/jcm11123341

Key clinical point: Patients with moderate-to-severe atopic dermatitis (AD) who did not achieve Investigator's Global Assessment (IGA) 0/1 response with abrocitinib at week 12, still achieved clinically meaningful improvements in AD severity, itch, and quality of life.

Major finding: At week 12, a higher proportion of IGA nonresponders receiving 200 and 100 mg abrocitinib vs placebo achieved ≥ 75% improvement in the Eczema Area and Severity Index (41.0% and 27.0% vs 9.4%, respectively), ≥4-point improvement in itch (42.8% and 35.2% vs 18.2%, respectively), and ≥4-point improvement in Dermatology Life Quality Index (67.6% and 75.0% vs 49.5%, respectively) scores.

Study details: Findings are from a post hoc analysis of 1 phase 2b and 2 phase 3 (JADE Mono-1 and JADE Mono-2) trials including 548 patients with moderate-to-severe AD who were randomly assigned to receive abrocitinib (200 or 100 mg) or placebo and did not achieve IGA 0/1 response.

Disclosures: This study was funded by Pfizer Inc. Five authors declared being current or former employees and shareholders of Pfizer. The other authors reported ties with various sources, including Pfizer.

Source: Blauvelt A et al. Abrocitinib monotherapy in Investigator’s Global Assessment nonresponders: Improvement in signs and symptoms of atopic dermatitis and quality of life. J Dermatolog Treat. 2022 (Jul 6). Doi: 10.1080/09546634.2022.2059053

Key clinical point: Patients with moderate-to-severe atopic dermatitis (AD) who did not achieve Investigator's Global Assessment (IGA) 0/1 response with abrocitinib at week 12, still achieved clinically meaningful improvements in AD severity, itch, and quality of life.

Major finding: At week 12, a higher proportion of IGA nonresponders receiving 200 and 100 mg abrocitinib vs placebo achieved ≥ 75% improvement in the Eczema Area and Severity Index (41.0% and 27.0% vs 9.4%, respectively), ≥4-point improvement in itch (42.8% and 35.2% vs 18.2%, respectively), and ≥4-point improvement in Dermatology Life Quality Index (67.6% and 75.0% vs 49.5%, respectively) scores.

Study details: Findings are from a post hoc analysis of 1 phase 2b and 2 phase 3 (JADE Mono-1 and JADE Mono-2) trials including 548 patients with moderate-to-severe AD who were randomly assigned to receive abrocitinib (200 or 100 mg) or placebo and did not achieve IGA 0/1 response.

Disclosures: This study was funded by Pfizer Inc. Five authors declared being current or former employees and shareholders of Pfizer. The other authors reported ties with various sources, including Pfizer.

Source: Blauvelt A et al. Abrocitinib monotherapy in Investigator’s Global Assessment nonresponders: Improvement in signs and symptoms of atopic dermatitis and quality of life. J Dermatolog Treat. 2022 (Jul 6). Doi: 10.1080/09546634.2022.2059053

Key clinical point: Patients with moderate-to-severe atopic dermatitis (AD) who did not achieve Investigator's Global Assessment (IGA) 0/1 response with abrocitinib at week 12, still achieved clinically meaningful improvements in AD severity, itch, and quality of life.

Major finding: At week 12, a higher proportion of IGA nonresponders receiving 200 and 100 mg abrocitinib vs placebo achieved ≥ 75% improvement in the Eczema Area and Severity Index (41.0% and 27.0% vs 9.4%, respectively), ≥4-point improvement in itch (42.8% and 35.2% vs 18.2%, respectively), and ≥4-point improvement in Dermatology Life Quality Index (67.6% and 75.0% vs 49.5%, respectively) scores.

Study details: Findings are from a post hoc analysis of 1 phase 2b and 2 phase 3 (JADE Mono-1 and JADE Mono-2) trials including 548 patients with moderate-to-severe AD who were randomly assigned to receive abrocitinib (200 or 100 mg) or placebo and did not achieve IGA 0/1 response.

Disclosures: This study was funded by Pfizer Inc. Five authors declared being current or former employees and shareholders of Pfizer. The other authors reported ties with various sources, including Pfizer.

Source: Blauvelt A et al. Abrocitinib monotherapy in Investigator’s Global Assessment nonresponders: Improvement in signs and symptoms of atopic dermatitis and quality of life. J Dermatolog Treat. 2022 (Jul 6). Doi: 10.1080/09546634.2022.2059053

Key clinical point: Dupilumab led to clinically meaningful improvements in the severity of atopic dermatitis (AD) and was well tolerated in adolescents and children with moderate-to-severe AD.

Major finding: The mean improvement in the Eczema Area and Severity Index (EASI) was 59.6% at week 12-24 and 77.0% at week 36-48 (both P < .001), with all patients achieving ≥75% improvement in EASI score after a year or more of receiving dupilumab. Adverse events like conjunctivitis (5.6%) and joint pain (2.2%) were reported by 13.5% of patients.

Study details: Findings are from a retrospective observational study including 89 children and adolescents aged < 18 years with moderate-to-severe AD who initiated dupilumab treatment.

Disclosures: This study was funded by Pediatric Dermatology Research Alliance. Some authors declared serving as consultants or receiving research funds from several sources.

Source: Pagan AD et al. Dupilumab improves clinical scores in children and adolescents with moderate-to-severe atopic dermatitis: A real-world, single-center study. J Allergy Clin Immunol Pract. 2022 (Jun 23). Doi: 10.1016/j.jaip.2022.06.014

Key clinical point: Dupilumab led to clinically meaningful improvements in the severity of atopic dermatitis (AD) and was well tolerated in adolescents and children with moderate-to-severe AD.

Major finding: The mean improvement in the Eczema Area and Severity Index (EASI) was 59.6% at week 12-24 and 77.0% at week 36-48 (both P < .001), with all patients achieving ≥75% improvement in EASI score after a year or more of receiving dupilumab. Adverse events like conjunctivitis (5.6%) and joint pain (2.2%) were reported by 13.5% of patients.

Study details: Findings are from a retrospective observational study including 89 children and adolescents aged < 18 years with moderate-to-severe AD who initiated dupilumab treatment.

Disclosures: This study was funded by Pediatric Dermatology Research Alliance. Some authors declared serving as consultants or receiving research funds from several sources.

Source: Pagan AD et al. Dupilumab improves clinical scores in children and adolescents with moderate-to-severe atopic dermatitis: A real-world, single-center study. J Allergy Clin Immunol Pract. 2022 (Jun 23). Doi: 10.1016/j.jaip.2022.06.014

Key clinical point: Dupilumab led to clinically meaningful improvements in the severity of atopic dermatitis (AD) and was well tolerated in adolescents and children with moderate-to-severe AD.

Major finding: The mean improvement in the Eczema Area and Severity Index (EASI) was 59.6% at week 12-24 and 77.0% at week 36-48 (both P < .001), with all patients achieving ≥75% improvement in EASI score after a year or more of receiving dupilumab. Adverse events like conjunctivitis (5.6%) and joint pain (2.2%) were reported by 13.5% of patients.

Study details: Findings are from a retrospective observational study including 89 children and adolescents aged < 18 years with moderate-to-severe AD who initiated dupilumab treatment.

Disclosures: This study was funded by Pediatric Dermatology Research Alliance. Some authors declared serving as consultants or receiving research funds from several sources.

Source: Pagan AD et al. Dupilumab improves clinical scores in children and adolescents with moderate-to-severe atopic dermatitis: A real-world, single-center study. J Allergy Clin Immunol Pract. 2022 (Jun 23). Doi: 10.1016/j.jaip.2022.06.014

Key clinical point: Disease burden of atopic dermatitis (AD) is associated with multiple factors, with the strongest association being with disease severity, time spent managing AD symptoms, and comorbid depression.

Major finding: Disease burden was strongly associated with AD severity (moderate: odds ratio [OR] 4.13; 95% CI 2.94-5.79 or severe: OR 13.63; 95% CI 8.65-21.5 vs mild AD), time spent managing AD symptoms (11-20 hours/week: OR 2.67; 95% CI 1.77-4.03 or ≥21 hours/week: OR 5.34; 95% CI 3.22-8.85 vs 0-4 hours/week), and comorbid depression (OR 1.44; 95% CI 1.04-2.00).

Study details: Findings are from a survey study that analyzed the responses of 1065 adults with mostly moderate or severe AD.

Disclosures: This study was partly supported by National Eczema Association. The authors declared serving as fiscal agents or receiving grants, sponsorships, honoraria, or other compensation from several sources, including the National Eczema Association.

Source: Elsawi R et al. The multidimensional burden of atopic dermatitis among adults: Results from a large national survey. JAMA Dermatol. 2022 (Jun 29). Doi: 10.1001/jamadermatol.2022.1906

Key clinical point: Disease burden of atopic dermatitis (AD) is associated with multiple factors, with the strongest association being with disease severity, time spent managing AD symptoms, and comorbid depression.

Major finding: Disease burden was strongly associated with AD severity (moderate: odds ratio [OR] 4.13; 95% CI 2.94-5.79 or severe: OR 13.63; 95% CI 8.65-21.5 vs mild AD), time spent managing AD symptoms (11-20 hours/week: OR 2.67; 95% CI 1.77-4.03 or ≥21 hours/week: OR 5.34; 95% CI 3.22-8.85 vs 0-4 hours/week), and comorbid depression (OR 1.44; 95% CI 1.04-2.00).

Study details: Findings are from a survey study that analyzed the responses of 1065 adults with mostly moderate or severe AD.

Disclosures: This study was partly supported by National Eczema Association. The authors declared serving as fiscal agents or receiving grants, sponsorships, honoraria, or other compensation from several sources, including the National Eczema Association.

Source: Elsawi R et al. The multidimensional burden of atopic dermatitis among adults: Results from a large national survey. JAMA Dermatol. 2022 (Jun 29). Doi: 10.1001/jamadermatol.2022.1906

Key clinical point: Disease burden of atopic dermatitis (AD) is associated with multiple factors, with the strongest association being with disease severity, time spent managing AD symptoms, and comorbid depression.

Major finding: Disease burden was strongly associated with AD severity (moderate: odds ratio [OR] 4.13; 95% CI 2.94-5.79 or severe: OR 13.63; 95% CI 8.65-21.5 vs mild AD), time spent managing AD symptoms (11-20 hours/week: OR 2.67; 95% CI 1.77-4.03 or ≥21 hours/week: OR 5.34; 95% CI 3.22-8.85 vs 0-4 hours/week), and comorbid depression (OR 1.44; 95% CI 1.04-2.00).

Study details: Findings are from a survey study that analyzed the responses of 1065 adults with mostly moderate or severe AD.

Disclosures: This study was partly supported by National Eczema Association. The authors declared serving as fiscal agents or receiving grants, sponsorships, honoraria, or other compensation from several sources, including the National Eczema Association.

Source: Elsawi R et al. The multidimensional burden of atopic dermatitis among adults: Results from a large national survey. JAMA Dermatol. 2022 (Jun 29). Doi: 10.1001/jamadermatol.2022.1906

INDIANAPOLIS – When adolescents present with acne that is not responding to isotretinoin, make sure to ask if they’re taking the medication when eating fatty food – which is known to increase the drug’s bioavailability, advises James R. Treat, MD, a pediatric dermatologist at Children’s Hospital of Philadelphia.

“We see lots of teenagers who are on a restrictive diet,” which is “certainly one reason they could be failing isotretinoin,” Dr. Treat said at the annual meeting of the Society for Pediatric Dermatology.

Often, patients say that they have been referred to him because they had no response to 20 mg or 30 mg per day of isotretinoin. But after a dose escalation to 60 mg per day, their acne worsened.

If the patient’s acne is worsening with a cystic flare, “tripling the dose of isotretinoin is not something that you should do,” Dr. Treat said. “You should lower the dose and consider adding steroids.” For evidence-based recommendations on managing acne fulminans, he recommended an article published in the Journal of the American Academy of Dermatology in 2017.

Skin picking is another common reason for failure of isotretinoin, as well as with other acne therapies. These patients may have associated anxiety, which “might be a contraindication or at least something to consider before you put them on isotretinoin,” he noted.

In his experience, off-label use of N-acetylcysteine, an antioxidant and cysteine prodrug, has been “extremely effective” for patients with excoriation disorder. In a randomized trial of adults 18-60 years of age, 47% patients who took 1,200-3,000 mg per day doses of N-acetylcysteine for 12 weeks reported that their skin picking was much or very much improved, compared to 19% of those who took placebo (P = .03). The authors wrote that N-acetylcysteine “increases extracellular levels of glutamate in the nucleus accumbens,” and that these results support the hypothesis that “pharmacologic manipulation of the glutamate system may target core symptoms of compulsive behaviors.”

The tumor necrosis factor (TNF)-alpha blocker adalimumab is a reasonable option for patients with severe cystic inflammatory acne who fail isotretinoin, Dr. Treat said. In one published case, clinicians administered adalimumab 40 mg every other week for a 16-year-old male patient who received isotretinoin for moderate acne vulgaris, which caused sudden development of acne fulminans and incapacitating acute sacroiliitis with bilateral hip arthritis. Inflammatory lesions started to clear in 1 month and comedones improved by 3 months of treatment. Adalimumab was discontinued after 1 year and the patient remained clear.

“There are now multiple reports as well as some case series showing TNF-alpha agents causing clearance of acne,” said Dr. Treat, who directs the hospital’s pediatric dermatology fellowship program. A literature review of adalimumab, etanercept, and infliximab for treatment-resistant acne found that all agents had similar efficacy after 3-6 months of therapy. “We see this in our GI population, where TNF-alpha agents are helping their acne also,” he said. “We just have to augment it with some topical medications.”

Certain medications can drive the development of acne, including phenytoin, phenobarbital, lithium, MEK inhibitors, EGFR inhibitors, systemic steroids, and unopposed progesterone contraceptives. Some genetic conditions also predispose patients to acne, including mutations in the NCSTN gene and trisomy 13.

Dr. Treat discussed one of his patients with severe acne who had trisomy 13. The patient failed 12 months of doxycycline and amoxicillin in combination with a topical retinoid. He also failed low- and high-dose isotretinoin in combination with prednisone, as well as oral dapsone at a dose of 1 mg/kg per day for 3 months. He was started on adalimumab, but that was stopped after he flared. The patient is now maintained on ustekinumab monthly at a dose of 45 mg.

“I’ve only had a few patients where isotretinoin truly has failed,” Dr. Treat said. He described one patient with severe acne who had a hidradenitis-like appearance in his axilla and groin. “I treated with isotretinoin very gingerly in the beginning, [but] he flared significantly. I had given him concomitant steroids from the very beginning and transitioned to multiple different therapies – all of which failed.”

Next, Dr. Treat tried a course of systemic dapsone, and the patient responded nicely. “As an anti-inflammatory agent, dapsone is very reasonable” to consider, he said. “It’s something to add to your armamentarium.”

Dr. Treat disclosed that he is a consultant for Palvella and Regeneron. He has ownership interests in Matinas Biopharma Holdings, Axsome, Sorrento, and Amarin.

INDIANAPOLIS – When adolescents present with acne that is not responding to isotretinoin, make sure to ask if they’re taking the medication when eating fatty food – which is known to increase the drug’s bioavailability, advises James R. Treat, MD, a pediatric dermatologist at Children’s Hospital of Philadelphia.

“We see lots of teenagers who are on a restrictive diet,” which is “certainly one reason they could be failing isotretinoin,” Dr. Treat said at the annual meeting of the Society for Pediatric Dermatology.

Often, patients say that they have been referred to him because they had no response to 20 mg or 30 mg per day of isotretinoin. But after a dose escalation to 60 mg per day, their acne worsened.

If the patient’s acne is worsening with a cystic flare, “tripling the dose of isotretinoin is not something that you should do,” Dr. Treat said. “You should lower the dose and consider adding steroids.” For evidence-based recommendations on managing acne fulminans, he recommended an article published in the Journal of the American Academy of Dermatology in 2017.

Skin picking is another common reason for failure of isotretinoin, as well as with other acne therapies. These patients may have associated anxiety, which “might be a contraindication or at least something to consider before you put them on isotretinoin,” he noted.

In his experience, off-label use of N-acetylcysteine, an antioxidant and cysteine prodrug, has been “extremely effective” for patients with excoriation disorder. In a randomized trial of adults 18-60 years of age, 47% patients who took 1,200-3,000 mg per day doses of N-acetylcysteine for 12 weeks reported that their skin picking was much or very much improved, compared to 19% of those who took placebo (P = .03). The authors wrote that N-acetylcysteine “increases extracellular levels of glutamate in the nucleus accumbens,” and that these results support the hypothesis that “pharmacologic manipulation of the glutamate system may target core symptoms of compulsive behaviors.”

The tumor necrosis factor (TNF)-alpha blocker adalimumab is a reasonable option for patients with severe cystic inflammatory acne who fail isotretinoin, Dr. Treat said. In one published case, clinicians administered adalimumab 40 mg every other week for a 16-year-old male patient who received isotretinoin for moderate acne vulgaris, which caused sudden development of acne fulminans and incapacitating acute sacroiliitis with bilateral hip arthritis. Inflammatory lesions started to clear in 1 month and comedones improved by 3 months of treatment. Adalimumab was discontinued after 1 year and the patient remained clear.

“There are now multiple reports as well as some case series showing TNF-alpha agents causing clearance of acne,” said Dr. Treat, who directs the hospital’s pediatric dermatology fellowship program. A literature review of adalimumab, etanercept, and infliximab for treatment-resistant acne found that all agents had similar efficacy after 3-6 months of therapy. “We see this in our GI population, where TNF-alpha agents are helping their acne also,” he said. “We just have to augment it with some topical medications.”

Certain medications can drive the development of acne, including phenytoin, phenobarbital, lithium, MEK inhibitors, EGFR inhibitors, systemic steroids, and unopposed progesterone contraceptives. Some genetic conditions also predispose patients to acne, including mutations in the NCSTN gene and trisomy 13.

Dr. Treat discussed one of his patients with severe acne who had trisomy 13. The patient failed 12 months of doxycycline and amoxicillin in combination with a topical retinoid. He also failed low- and high-dose isotretinoin in combination with prednisone, as well as oral dapsone at a dose of 1 mg/kg per day for 3 months. He was started on adalimumab, but that was stopped after he flared. The patient is now maintained on ustekinumab monthly at a dose of 45 mg.

“I’ve only had a few patients where isotretinoin truly has failed,” Dr. Treat said. He described one patient with severe acne who had a hidradenitis-like appearance in his axilla and groin. “I treated with isotretinoin very gingerly in the beginning, [but] he flared significantly. I had given him concomitant steroids from the very beginning and transitioned to multiple different therapies – all of which failed.”

Next, Dr. Treat tried a course of systemic dapsone, and the patient responded nicely. “As an anti-inflammatory agent, dapsone is very reasonable” to consider, he said. “It’s something to add to your armamentarium.”

Dr. Treat disclosed that he is a consultant for Palvella and Regeneron. He has ownership interests in Matinas Biopharma Holdings, Axsome, Sorrento, and Amarin.

INDIANAPOLIS – When adolescents present with acne that is not responding to isotretinoin, make sure to ask if they’re taking the medication when eating fatty food – which is known to increase the drug’s bioavailability, advises James R. Treat, MD, a pediatric dermatologist at Children’s Hospital of Philadelphia.

“We see lots of teenagers who are on a restrictive diet,” which is “certainly one reason they could be failing isotretinoin,” Dr. Treat said at the annual meeting of the Society for Pediatric Dermatology.

Often, patients say that they have been referred to him because they had no response to 20 mg or 30 mg per day of isotretinoin. But after a dose escalation to 60 mg per day, their acne worsened.

If the patient’s acne is worsening with a cystic flare, “tripling the dose of isotretinoin is not something that you should do,” Dr. Treat said. “You should lower the dose and consider adding steroids.” For evidence-based recommendations on managing acne fulminans, he recommended an article published in the Journal of the American Academy of Dermatology in 2017.

Skin picking is another common reason for failure of isotretinoin, as well as with other acne therapies. These patients may have associated anxiety, which “might be a contraindication or at least something to consider before you put them on isotretinoin,” he noted.

In his experience, off-label use of N-acetylcysteine, an antioxidant and cysteine prodrug, has been “extremely effective” for patients with excoriation disorder. In a randomized trial of adults 18-60 years of age, 47% patients who took 1,200-3,000 mg per day doses of N-acetylcysteine for 12 weeks reported that their skin picking was much or very much improved, compared to 19% of those who took placebo (P = .03). The authors wrote that N-acetylcysteine “increases extracellular levels of glutamate in the nucleus accumbens,” and that these results support the hypothesis that “pharmacologic manipulation of the glutamate system may target core symptoms of compulsive behaviors.”

The tumor necrosis factor (TNF)-alpha blocker adalimumab is a reasonable option for patients with severe cystic inflammatory acne who fail isotretinoin, Dr. Treat said. In one published case, clinicians administered adalimumab 40 mg every other week for a 16-year-old male patient who received isotretinoin for moderate acne vulgaris, which caused sudden development of acne fulminans and incapacitating acute sacroiliitis with bilateral hip arthritis. Inflammatory lesions started to clear in 1 month and comedones improved by 3 months of treatment. Adalimumab was discontinued after 1 year and the patient remained clear.

“There are now multiple reports as well as some case series showing TNF-alpha agents causing clearance of acne,” said Dr. Treat, who directs the hospital’s pediatric dermatology fellowship program. A literature review of adalimumab, etanercept, and infliximab for treatment-resistant acne found that all agents had similar efficacy after 3-6 months of therapy. “We see this in our GI population, where TNF-alpha agents are helping their acne also,” he said. “We just have to augment it with some topical medications.”

Certain medications can drive the development of acne, including phenytoin, phenobarbital, lithium, MEK inhibitors, EGFR inhibitors, systemic steroids, and unopposed progesterone contraceptives. Some genetic conditions also predispose patients to acne, including mutations in the NCSTN gene and trisomy 13.

Dr. Treat discussed one of his patients with severe acne who had trisomy 13. The patient failed 12 months of doxycycline and amoxicillin in combination with a topical retinoid. He also failed low- and high-dose isotretinoin in combination with prednisone, as well as oral dapsone at a dose of 1 mg/kg per day for 3 months. He was started on adalimumab, but that was stopped after he flared. The patient is now maintained on ustekinumab monthly at a dose of 45 mg.

“I’ve only had a few patients where isotretinoin truly has failed,” Dr. Treat said. He described one patient with severe acne who had a hidradenitis-like appearance in his axilla and groin. “I treated with isotretinoin very gingerly in the beginning, [but] he flared significantly. I had given him concomitant steroids from the very beginning and transitioned to multiple different therapies – all of which failed.”

Next, Dr. Treat tried a course of systemic dapsone, and the patient responded nicely. “As an anti-inflammatory agent, dapsone is very reasonable” to consider, he said. “It’s something to add to your armamentarium.”

Dr. Treat disclosed that he is a consultant for Palvella and Regeneron. He has ownership interests in Matinas Biopharma Holdings, Axsome, Sorrento, and Amarin.

Key clinical point: Use of beta-adrenergic receptor blockers is associated with prolonged survival in patients with hepatocellular carcinoma (HCC).

Major finding: Beta-blocker use was associated with better overall survival (hazard ratio 0.69; P  =  .0031), with no significant heterogeneity across studies (I²  =  41%; P  =  .18).

Study details: The data come from a meta-analysis of 3 cohort studies involving 5148 patients with HCC that analyzed the association between the use of beta-blockers (including propranolol) and overall survival of the patients.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Chang H and Lee SH. Beta-adrenergic receptor blockers and hepatocellular carcinoma survival: A systemic review and meta-analysis. Clin Exp Med. 2022 (Jun 23). Doi: 10.1007/s10238-022-00842-z

Key clinical point: Use of beta-adrenergic receptor blockers is associated with prolonged survival in patients with hepatocellular carcinoma (HCC).

Major finding: Beta-blocker use was associated with better overall survival (hazard ratio 0.69; P  =  .0031), with no significant heterogeneity across studies (I²  =  41%; P  =  .18).

Study details: The data come from a meta-analysis of 3 cohort studies involving 5148 patients with HCC that analyzed the association between the use of beta-blockers (including propranolol) and overall survival of the patients.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Chang H and Lee SH. Beta-adrenergic receptor blockers and hepatocellular carcinoma survival: A systemic review and meta-analysis. Clin Exp Med. 2022 (Jun 23). Doi: 10.1007/s10238-022-00842-z

Key clinical point: Use of beta-adrenergic receptor blockers is associated with prolonged survival in patients with hepatocellular carcinoma (HCC).

Major finding: Beta-blocker use was associated with better overall survival (hazard ratio 0.69; P  =  .0031), with no significant heterogeneity across studies (I²  =  41%; P  =  .18).

Study details: The data come from a meta-analysis of 3 cohort studies involving 5148 patients with HCC that analyzed the association between the use of beta-blockers (including propranolol) and overall survival of the patients.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Chang H and Lee SH. Beta-adrenergic receptor blockers and hepatocellular carcinoma survival: A systemic review and meta-analysis. Clin Exp Med. 2022 (Jun 23). Doi: 10.1007/s10238-022-00842-z