Clinical Edge Journal Scan Commentary: Atopic Dermatitis September 2021

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/*-->*/ Jonathan Silverberg, MD, PHD, MPH
George Washington University School of Medicine and Health Sciences
Washington, DC
So many comorbidities, so little time

 

Atopic dermatitis (AD) is a complex disease with varying degrees of itch, pain, eczematous skin lesions and quality of life impact. Research over the past decade uncovered myriad associations of AD with comorbid health disorders. There are well-established associations of AD with atopic comorbidities in children and adults, including asthma, hay fever, food allergies and less commonly eosinophilic esophagitis. AD is also associated with higher rates of mental health disorders, including depression, anxiety and attention deficit (hyperactivity) disorder.

AD patients also have multiple risk factors for hypertension, including chronic sleep deprivation and limitations on physical activity from itch. Yousaf et al conducted a systematic literature review and meta-analysis of 19 studies and found significantly increased likelihood of hypertension in patients with AD compared to healthy controls, particularly moderate-to-severe AD. Though, the odds of hypertension were lower in patients with AD compared to psoriasis.

Sleep disturbances (SD) are also common in AD patients. Manjunath et al conducted a cross-sectional, dermatology practice-based study to examine clinical differences in geriatric vs younger adult AD patients. Geriatric age was not associated with any significant differences of AD severity. However, geriatric AD patients had significantly more nights of SD, particularly trouble staying asleep, and increased fatigue than younger adults. In general, having good sleep hygiene and getting adequate sleep are important for overall health and longevity. SD therefore warrant particular attention in clinical management of AD as they are often modifiable with improved AD control.

Likewise, the myriad comorbidities associated with AD may lead to poorer health outcomes, such as hospitalization. Edigin et al conducted a longitudinal study of 23,410 adults hospitalized in the United States with AD. Hospitalizations rates increased between 1998 and 2018 owing to comorbid health disorders, but not AD itself.

Together, these results highlight the importance of holistic management of AD patients, including atopic and non-atopic comorbidities. However, many questions remain about how and when to best screen for various comorbidities. Generally, more severe AD is one of the strongest predictors of atopic and mental health comorbidities, as well as sleep disturbances and hypertension as shown in the abovementioned studies. Additionally, geriatric AD patients warrant closer monitoring of SD. Of course, screening patients for these comorbidities can take up precious time in a busy clinical practice. Though, it is a worthwhile investment of time and will improve patients’ health outcomes and the quality of care you provide for patients.

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George Washington University School of Medicine and Health Sciences
Washington, DC

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George Washington University School of Medicine and Health Sciences
Washington, DC

Dr. Silverberg scans the journals, so you don’t have to!
Dr. Silverberg scans the journals, so you don’t have to!

/*-->*/ Jonathan Silverberg, MD, PHD, MPH
George Washington University School of Medicine and Health Sciences
Washington, DC
So many comorbidities, so little time

 

Atopic dermatitis (AD) is a complex disease with varying degrees of itch, pain, eczematous skin lesions and quality of life impact. Research over the past decade uncovered myriad associations of AD with comorbid health disorders. There are well-established associations of AD with atopic comorbidities in children and adults, including asthma, hay fever, food allergies and less commonly eosinophilic esophagitis. AD is also associated with higher rates of mental health disorders, including depression, anxiety and attention deficit (hyperactivity) disorder.

AD patients also have multiple risk factors for hypertension, including chronic sleep deprivation and limitations on physical activity from itch. Yousaf et al conducted a systematic literature review and meta-analysis of 19 studies and found significantly increased likelihood of hypertension in patients with AD compared to healthy controls, particularly moderate-to-severe AD. Though, the odds of hypertension were lower in patients with AD compared to psoriasis.

Sleep disturbances (SD) are also common in AD patients. Manjunath et al conducted a cross-sectional, dermatology practice-based study to examine clinical differences in geriatric vs younger adult AD patients. Geriatric age was not associated with any significant differences of AD severity. However, geriatric AD patients had significantly more nights of SD, particularly trouble staying asleep, and increased fatigue than younger adults. In general, having good sleep hygiene and getting adequate sleep are important for overall health and longevity. SD therefore warrant particular attention in clinical management of AD as they are often modifiable with improved AD control.

Likewise, the myriad comorbidities associated with AD may lead to poorer health outcomes, such as hospitalization. Edigin et al conducted a longitudinal study of 23,410 adults hospitalized in the United States with AD. Hospitalizations rates increased between 1998 and 2018 owing to comorbid health disorders, but not AD itself.

Together, these results highlight the importance of holistic management of AD patients, including atopic and non-atopic comorbidities. However, many questions remain about how and when to best screen for various comorbidities. Generally, more severe AD is one of the strongest predictors of atopic and mental health comorbidities, as well as sleep disturbances and hypertension as shown in the abovementioned studies. Additionally, geriatric AD patients warrant closer monitoring of SD. Of course, screening patients for these comorbidities can take up precious time in a busy clinical practice. Though, it is a worthwhile investment of time and will improve patients’ health outcomes and the quality of care you provide for patients.

/*-->*/ Jonathan Silverberg, MD, PHD, MPH
George Washington University School of Medicine and Health Sciences
Washington, DC
So many comorbidities, so little time

 

Atopic dermatitis (AD) is a complex disease with varying degrees of itch, pain, eczematous skin lesions and quality of life impact. Research over the past decade uncovered myriad associations of AD with comorbid health disorders. There are well-established associations of AD with atopic comorbidities in children and adults, including asthma, hay fever, food allergies and less commonly eosinophilic esophagitis. AD is also associated with higher rates of mental health disorders, including depression, anxiety and attention deficit (hyperactivity) disorder.

AD patients also have multiple risk factors for hypertension, including chronic sleep deprivation and limitations on physical activity from itch. Yousaf et al conducted a systematic literature review and meta-analysis of 19 studies and found significantly increased likelihood of hypertension in patients with AD compared to healthy controls, particularly moderate-to-severe AD. Though, the odds of hypertension were lower in patients with AD compared to psoriasis.

Sleep disturbances (SD) are also common in AD patients. Manjunath et al conducted a cross-sectional, dermatology practice-based study to examine clinical differences in geriatric vs younger adult AD patients. Geriatric age was not associated with any significant differences of AD severity. However, geriatric AD patients had significantly more nights of SD, particularly trouble staying asleep, and increased fatigue than younger adults. In general, having good sleep hygiene and getting adequate sleep are important for overall health and longevity. SD therefore warrant particular attention in clinical management of AD as they are often modifiable with improved AD control.

Likewise, the myriad comorbidities associated with AD may lead to poorer health outcomes, such as hospitalization. Edigin et al conducted a longitudinal study of 23,410 adults hospitalized in the United States with AD. Hospitalizations rates increased between 1998 and 2018 owing to comorbid health disorders, but not AD itself.

Together, these results highlight the importance of holistic management of AD patients, including atopic and non-atopic comorbidities. However, many questions remain about how and when to best screen for various comorbidities. Generally, more severe AD is one of the strongest predictors of atopic and mental health comorbidities, as well as sleep disturbances and hypertension as shown in the abovementioned studies. Additionally, geriatric AD patients warrant closer monitoring of SD. Of course, screening patients for these comorbidities can take up precious time in a busy clinical practice. Though, it is a worthwhile investment of time and will improve patients’ health outcomes and the quality of care you provide for patients.

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Atopic dermatitis: Inadequate disease control and QoL impairments among patients receiving topical therapy

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Key clinical point: Almost a fifth of patients with atopic dermatitis (AD) receiving topical therapy had an uncontrolled disease and reported impairment in work productivity along with a lower quality of life (QoL).

Major finding: Overall, physicians identified 24.5% of patients as having uncontrolled disease. Patients with uncontrolled vs controlled disease had higher impairment in QoL (Dermatology Life Quality Index, 8.8 vs 6.0; P = .0003) and work productivity (Work Productivity and Activity Impairment, 23.5 vs 16.2; P = .0488).

Study details: Findings are from a retrospective, point-in-time study including 394 adults and 144 adolescent patients with moderate-to-severe AD who received topical therapy for at least 1 month.

Disclosures: This study was funded by Incyte Corporation. JH Lofland and VN Joish declared being employees and shareholders of Incyte Corporation. Three of the other authors declared being employees of Adelphi Real World.

Source: Anderson P et al. Dermatol Ther (Heidelb). 2021 Jul 15. doi: 10.1007/s13555-021-00580-2.

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Key clinical point: Almost a fifth of patients with atopic dermatitis (AD) receiving topical therapy had an uncontrolled disease and reported impairment in work productivity along with a lower quality of life (QoL).

Major finding: Overall, physicians identified 24.5% of patients as having uncontrolled disease. Patients with uncontrolled vs controlled disease had higher impairment in QoL (Dermatology Life Quality Index, 8.8 vs 6.0; P = .0003) and work productivity (Work Productivity and Activity Impairment, 23.5 vs 16.2; P = .0488).

Study details: Findings are from a retrospective, point-in-time study including 394 adults and 144 adolescent patients with moderate-to-severe AD who received topical therapy for at least 1 month.

Disclosures: This study was funded by Incyte Corporation. JH Lofland and VN Joish declared being employees and shareholders of Incyte Corporation. Three of the other authors declared being employees of Adelphi Real World.

Source: Anderson P et al. Dermatol Ther (Heidelb). 2021 Jul 15. doi: 10.1007/s13555-021-00580-2.

Key clinical point: Almost a fifth of patients with atopic dermatitis (AD) receiving topical therapy had an uncontrolled disease and reported impairment in work productivity along with a lower quality of life (QoL).

Major finding: Overall, physicians identified 24.5% of patients as having uncontrolled disease. Patients with uncontrolled vs controlled disease had higher impairment in QoL (Dermatology Life Quality Index, 8.8 vs 6.0; P = .0003) and work productivity (Work Productivity and Activity Impairment, 23.5 vs 16.2; P = .0488).

Study details: Findings are from a retrospective, point-in-time study including 394 adults and 144 adolescent patients with moderate-to-severe AD who received topical therapy for at least 1 month.

Disclosures: This study was funded by Incyte Corporation. JH Lofland and VN Joish declared being employees and shareholders of Incyte Corporation. Three of the other authors declared being employees of Adelphi Real World.

Source: Anderson P et al. Dermatol Ther (Heidelb). 2021 Jul 15. doi: 10.1007/s13555-021-00580-2.

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Atopic dermatitis: Rapid improvement in skin pain with baricitinib

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Key clinical point: Baricitinib monotherapy improved clinically burdensome symptom of skin pain on the first day itself after the first dose in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: By day 2, skin pain numerical rating scale scores changed significantly from baseline with baricitinib vs placebo in BREEZE-AD1 (baricitinib 4 mg, 11.9%; 2 mg, 6.4%; 1 mg, 6.2%; all P less than .05), BREEZE-AD2 (baricitinib 4 mg, 12.6%; 2 mg, 5.6%; 1 mg, 6.9%; all P less than .05), and BREEZE-AD7 (baricitinib 4 mg, 6.9%; 2 mg, 7.9%; both P less than .05).

Study details: Findings are from an analysis of 3 phase 3 trials (BREEZE-AD1, BREEZE-AD2, and BREEZE-AD7) including 1,568 patients with moderate-to-severe AD with inadequate response to existing topical therapies who were randomly assigned to baricitinib or placebo with or without topical corticosteroids.

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

Source: Thyssen JP et al. Dermatol Ther (Heidelb). 2021 Jul 18. doi: 10.1007/s13555-021-00577-x.

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Key clinical point: Baricitinib monotherapy improved clinically burdensome symptom of skin pain on the first day itself after the first dose in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: By day 2, skin pain numerical rating scale scores changed significantly from baseline with baricitinib vs placebo in BREEZE-AD1 (baricitinib 4 mg, 11.9%; 2 mg, 6.4%; 1 mg, 6.2%; all P less than .05), BREEZE-AD2 (baricitinib 4 mg, 12.6%; 2 mg, 5.6%; 1 mg, 6.9%; all P less than .05), and BREEZE-AD7 (baricitinib 4 mg, 6.9%; 2 mg, 7.9%; both P less than .05).

Study details: Findings are from an analysis of 3 phase 3 trials (BREEZE-AD1, BREEZE-AD2, and BREEZE-AD7) including 1,568 patients with moderate-to-severe AD with inadequate response to existing topical therapies who were randomly assigned to baricitinib or placebo with or without topical corticosteroids.

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

Source: Thyssen JP et al. Dermatol Ther (Heidelb). 2021 Jul 18. doi: 10.1007/s13555-021-00577-x.

Key clinical point: Baricitinib monotherapy improved clinically burdensome symptom of skin pain on the first day itself after the first dose in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: By day 2, skin pain numerical rating scale scores changed significantly from baseline with baricitinib vs placebo in BREEZE-AD1 (baricitinib 4 mg, 11.9%; 2 mg, 6.4%; 1 mg, 6.2%; all P less than .05), BREEZE-AD2 (baricitinib 4 mg, 12.6%; 2 mg, 5.6%; 1 mg, 6.9%; all P less than .05), and BREEZE-AD7 (baricitinib 4 mg, 6.9%; 2 mg, 7.9%; both P less than .05).

Study details: Findings are from an analysis of 3 phase 3 trials (BREEZE-AD1, BREEZE-AD2, and BREEZE-AD7) including 1,568 patients with moderate-to-severe AD with inadequate response to existing topical therapies who were randomly assigned to baricitinib or placebo with or without topical corticosteroids.

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

Source: Thyssen JP et al. Dermatol Ther (Heidelb). 2021 Jul 18. doi: 10.1007/s13555-021-00577-x.

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Abrocitinib emerges as a potential treatment option for moderate-to-severe atopic dermatitis

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Key clinical point: Preliminary evidence from a meta-analysis suggests that abrocitinib was significantly beneficial with a tolerable adverse event profile in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: At 12 weeks, patients treated with abrocitinib achieved a significantly higher Investigator’s Global Assessment response vs those treated with placebo (risk ratio [RR], 3.52; P less than .00001). Treatment-emergent adverse effects were mostly mild and manageable, with a higher risk in the abrocitinib vs placebo group (RR, 1.17; P = .002).

Study details: Findings are from a meta-analysis of 4 randomized controlled trials, which assessed clinical outcomes in 1,175 patients with moderate-to-severe AD with inadequate response to topical medications who received abrocitinib 100 or 200 mg and 334 control participants who received placebo.

Disclosures: The study did not receive any funding. No conflict of interests was reported.

Source: Meher BR et al. J Dermatol Treat. 2021 Jul 27. doi: 10.1080/09546634.2021.1961997.

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Key clinical point: Preliminary evidence from a meta-analysis suggests that abrocitinib was significantly beneficial with a tolerable adverse event profile in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: At 12 weeks, patients treated with abrocitinib achieved a significantly higher Investigator’s Global Assessment response vs those treated with placebo (risk ratio [RR], 3.52; P less than .00001). Treatment-emergent adverse effects were mostly mild and manageable, with a higher risk in the abrocitinib vs placebo group (RR, 1.17; P = .002).

Study details: Findings are from a meta-analysis of 4 randomized controlled trials, which assessed clinical outcomes in 1,175 patients with moderate-to-severe AD with inadequate response to topical medications who received abrocitinib 100 or 200 mg and 334 control participants who received placebo.

Disclosures: The study did not receive any funding. No conflict of interests was reported.

Source: Meher BR et al. J Dermatol Treat. 2021 Jul 27. doi: 10.1080/09546634.2021.1961997.

Key clinical point: Preliminary evidence from a meta-analysis suggests that abrocitinib was significantly beneficial with a tolerable adverse event profile in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: At 12 weeks, patients treated with abrocitinib achieved a significantly higher Investigator’s Global Assessment response vs those treated with placebo (risk ratio [RR], 3.52; P less than .00001). Treatment-emergent adverse effects were mostly mild and manageable, with a higher risk in the abrocitinib vs placebo group (RR, 1.17; P = .002).

Study details: Findings are from a meta-analysis of 4 randomized controlled trials, which assessed clinical outcomes in 1,175 patients with moderate-to-severe AD with inadequate response to topical medications who received abrocitinib 100 or 200 mg and 334 control participants who received placebo.

Disclosures: The study did not receive any funding. No conflict of interests was reported.

Source: Meher BR et al. J Dermatol Treat. 2021 Jul 27. doi: 10.1080/09546634.2021.1961997.

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Atopic dermatitis tied to increased risk for hypertension

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Key clinical point: Patients with atopic dermatitis (AD), particularly those with a moderate-to-severe form of the disease, had significantly higher odds of hypertension than healthy controls.

Major finding: Overall, odds of hypertension was significantly higher in patients with AD than healthy controls (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.04-1.30), particularly in those with moderate-to-severe AD (OR, 2.33; 95% CI, 1.10-4.94). Hypertension was mainly reported as an adverse event from cyclosporine A (pooled prevalence, 7.8%).

Study details: Findings are from a meta-analysis of 19 studies involving 269,861 adults with AD and 718,873 healthy controls, including 52,530 children with AD and 340,356 children as healthy controls.

Disclosures: The study did not report any source of funding. No conflict of interests was reported.

Source: Yousaf M et al. Br J Dermatol. 2021 Jul 28. doi: 10.1111/bjd.20661.

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Key clinical point: Patients with atopic dermatitis (AD), particularly those with a moderate-to-severe form of the disease, had significantly higher odds of hypertension than healthy controls.

Major finding: Overall, odds of hypertension was significantly higher in patients with AD than healthy controls (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.04-1.30), particularly in those with moderate-to-severe AD (OR, 2.33; 95% CI, 1.10-4.94). Hypertension was mainly reported as an adverse event from cyclosporine A (pooled prevalence, 7.8%).

Study details: Findings are from a meta-analysis of 19 studies involving 269,861 adults with AD and 718,873 healthy controls, including 52,530 children with AD and 340,356 children as healthy controls.

Disclosures: The study did not report any source of funding. No conflict of interests was reported.

Source: Yousaf M et al. Br J Dermatol. 2021 Jul 28. doi: 10.1111/bjd.20661.

Key clinical point: Patients with atopic dermatitis (AD), particularly those with a moderate-to-severe form of the disease, had significantly higher odds of hypertension than healthy controls.

Major finding: Overall, odds of hypertension was significantly higher in patients with AD than healthy controls (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.04-1.30), particularly in those with moderate-to-severe AD (OR, 2.33; 95% CI, 1.10-4.94). Hypertension was mainly reported as an adverse event from cyclosporine A (pooled prevalence, 7.8%).

Study details: Findings are from a meta-analysis of 19 studies involving 269,861 adults with AD and 718,873 healthy controls, including 52,530 children with AD and 340,356 children as healthy controls.

Disclosures: The study did not report any source of funding. No conflict of interests was reported.

Source: Yousaf M et al. Br J Dermatol. 2021 Jul 28. doi: 10.1111/bjd.20661.

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Comorbidities account for higher incidence of hospitalization in patients with AD

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Key clinical point: Over 20 years of evidence indicates an increased incidence of hospitalizations among patients with atopic dermatitis (AD) in the United States, mainly attributed to increased burden of medical comorbidities rather than AD itself, highlighting the need for increased screening and management of comorbidities.

Major finding: The number of hospitalizations among patients with AD increased from 1.0 to 2.3 per 100,000 persons from 1998 to 2018 (adjusted P-trend less than .0001). However, the proportion of hospitalizations with AD as the principal diagnosis reduced from 11.5% in 1998 to 3.7% in 2018 (adjusted P-trend = .001). A higher proportion of patients reported Charlson Comorbidity Index score of 3 or higher in 2018 vs 1998 (27.8% vs 10.5%; adjusted P-trend less than .0001).

Study details: Findings are from a longitudinal study including 23,410 adults hospitalized with any form of AD between 1998 and 2018.

Disclosures: The study did not report any source of funding. No conflict of interests was reported.

Source: Edigin E et al. J Am Acad Dermatol. 2021 Jul 9. doi: 10.1016/j.jaad.2021.06.882.

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Key clinical point: Over 20 years of evidence indicates an increased incidence of hospitalizations among patients with atopic dermatitis (AD) in the United States, mainly attributed to increased burden of medical comorbidities rather than AD itself, highlighting the need for increased screening and management of comorbidities.

Major finding: The number of hospitalizations among patients with AD increased from 1.0 to 2.3 per 100,000 persons from 1998 to 2018 (adjusted P-trend less than .0001). However, the proportion of hospitalizations with AD as the principal diagnosis reduced from 11.5% in 1998 to 3.7% in 2018 (adjusted P-trend = .001). A higher proportion of patients reported Charlson Comorbidity Index score of 3 or higher in 2018 vs 1998 (27.8% vs 10.5%; adjusted P-trend less than .0001).

Study details: Findings are from a longitudinal study including 23,410 adults hospitalized with any form of AD between 1998 and 2018.

Disclosures: The study did not report any source of funding. No conflict of interests was reported.

Source: Edigin E et al. J Am Acad Dermatol. 2021 Jul 9. doi: 10.1016/j.jaad.2021.06.882.

Key clinical point: Over 20 years of evidence indicates an increased incidence of hospitalizations among patients with atopic dermatitis (AD) in the United States, mainly attributed to increased burden of medical comorbidities rather than AD itself, highlighting the need for increased screening and management of comorbidities.

Major finding: The number of hospitalizations among patients with AD increased from 1.0 to 2.3 per 100,000 persons from 1998 to 2018 (adjusted P-trend less than .0001). However, the proportion of hospitalizations with AD as the principal diagnosis reduced from 11.5% in 1998 to 3.7% in 2018 (adjusted P-trend = .001). A higher proportion of patients reported Charlson Comorbidity Index score of 3 or higher in 2018 vs 1998 (27.8% vs 10.5%; adjusted P-trend less than .0001).

Study details: Findings are from a longitudinal study including 23,410 adults hospitalized with any form of AD between 1998 and 2018.

Disclosures: The study did not report any source of funding. No conflict of interests was reported.

Source: Edigin E et al. J Am Acad Dermatol. 2021 Jul 9. doi: 10.1016/j.jaad.2021.06.882.

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Methylation on golli-MBP locus serves as an indicator of atopic dermatitis severity in children

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Key clinical point: Reduced DNA methylation of golli-myelin basic protein (MBP) locus could serve as an important biomarker to determine the severity of atopic dermatitis (AD) in pediatric patients.

Major finding: Loss of DNA methylation and higher golli-MBP mRNA expression were observed in pediatric patients with AD (both P less than .0001). The score in the intensity of symptoms increased with decreasing methylation levels in cg27400313, the differentially methylated CpG cluster of MBP gene (P = .012).

Study details: The study used a discovery cohort of 24 pediatric patients with AD and 24 control participants to screen for DNA methylation. The results were further validated in an additional cohort of 224 pediatric patients with AD and 44 control participants.

Disclosures: The study was supported by grants from Ministry of Health and Welfare and Chang Gung Memorial Hospital. The authors declared no conflict of interests.

Source: Chen KD et al. J Invest Dermatol. 2021 Jul 19. doi: 10.1016/j.jid.2021.06.025.

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Key clinical point: Reduced DNA methylation of golli-myelin basic protein (MBP) locus could serve as an important biomarker to determine the severity of atopic dermatitis (AD) in pediatric patients.

Major finding: Loss of DNA methylation and higher golli-MBP mRNA expression were observed in pediatric patients with AD (both P less than .0001). The score in the intensity of symptoms increased with decreasing methylation levels in cg27400313, the differentially methylated CpG cluster of MBP gene (P = .012).

Study details: The study used a discovery cohort of 24 pediatric patients with AD and 24 control participants to screen for DNA methylation. The results were further validated in an additional cohort of 224 pediatric patients with AD and 44 control participants.

Disclosures: The study was supported by grants from Ministry of Health and Welfare and Chang Gung Memorial Hospital. The authors declared no conflict of interests.

Source: Chen KD et al. J Invest Dermatol. 2021 Jul 19. doi: 10.1016/j.jid.2021.06.025.

Key clinical point: Reduced DNA methylation of golli-myelin basic protein (MBP) locus could serve as an important biomarker to determine the severity of atopic dermatitis (AD) in pediatric patients.

Major finding: Loss of DNA methylation and higher golli-MBP mRNA expression were observed in pediatric patients with AD (both P less than .0001). The score in the intensity of symptoms increased with decreasing methylation levels in cg27400313, the differentially methylated CpG cluster of MBP gene (P = .012).

Study details: The study used a discovery cohort of 24 pediatric patients with AD and 24 control participants to screen for DNA methylation. The results were further validated in an additional cohort of 224 pediatric patients with AD and 44 control participants.

Disclosures: The study was supported by grants from Ministry of Health and Welfare and Chang Gung Memorial Hospital. The authors declared no conflict of interests.

Source: Chen KD et al. J Invest Dermatol. 2021 Jul 19. doi: 10.1016/j.jid.2021.06.025.

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Sleep disturbance and geriatric age in atopic dermatitis: Is there a link?

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Key clinical point: Geriatric patients experienced more profound sleep disturbance (SD) despite having similar severity of atopic dermatitis (AD) as younger adult patients with AD.

Major finding: Geriatric age was not associated with severity of AD as measured by Eczema Area and Severity Index score (adjusted odds ratio [aOR], 1.47; P = .3269). However, geriatric patients with AD spent an increased number of nights with SD from eczema (aOR, 2.14; P = .0142), experienced fatigue (aOR, 1.81; P = .0313), and had trouble staying asleep (aOR, 2.26; P = .0030).

Study details: Findings are from a cross-sectional, dermatology practice-based study conducted between 2014 and 2019 and included adults diagnosed with AD.

Disclosures: This study was supported by Agency for Healthcare Research and Quality, the Dermatology Foundation, and an unrestricted research grant from Galderma. The authors declared no conflict of interests.

Source: Manjunath J and Silverberg JI. J Am Acad Dermatol. 2021 Jul 29. doi: 10.1016/j.jaad.2021.07.039.

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Key clinical point: Geriatric patients experienced more profound sleep disturbance (SD) despite having similar severity of atopic dermatitis (AD) as younger adult patients with AD.

Major finding: Geriatric age was not associated with severity of AD as measured by Eczema Area and Severity Index score (adjusted odds ratio [aOR], 1.47; P = .3269). However, geriatric patients with AD spent an increased number of nights with SD from eczema (aOR, 2.14; P = .0142), experienced fatigue (aOR, 1.81; P = .0313), and had trouble staying asleep (aOR, 2.26; P = .0030).

Study details: Findings are from a cross-sectional, dermatology practice-based study conducted between 2014 and 2019 and included adults diagnosed with AD.

Disclosures: This study was supported by Agency for Healthcare Research and Quality, the Dermatology Foundation, and an unrestricted research grant from Galderma. The authors declared no conflict of interests.

Source: Manjunath J and Silverberg JI. J Am Acad Dermatol. 2021 Jul 29. doi: 10.1016/j.jaad.2021.07.039.

Key clinical point: Geriatric patients experienced more profound sleep disturbance (SD) despite having similar severity of atopic dermatitis (AD) as younger adult patients with AD.

Major finding: Geriatric age was not associated with severity of AD as measured by Eczema Area and Severity Index score (adjusted odds ratio [aOR], 1.47; P = .3269). However, geriatric patients with AD spent an increased number of nights with SD from eczema (aOR, 2.14; P = .0142), experienced fatigue (aOR, 1.81; P = .0313), and had trouble staying asleep (aOR, 2.26; P = .0030).

Study details: Findings are from a cross-sectional, dermatology practice-based study conducted between 2014 and 2019 and included adults diagnosed with AD.

Disclosures: This study was supported by Agency for Healthcare Research and Quality, the Dermatology Foundation, and an unrestricted research grant from Galderma. The authors declared no conflict of interests.

Source: Manjunath J and Silverberg JI. J Am Acad Dermatol. 2021 Jul 29. doi: 10.1016/j.jaad.2021.07.039.

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Cold atmospheric plasma alleviates AD severity without any safety issues

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Key clinical point: Cold atmospheric plasma (CAP) can potentially improve the clinical severity of atopic dermatitis (AD) by recovering the diversity of skin microbiome and promoting wound healing for damaged skin barriers without any safety issues.

Major finding: At the end of treatment, reduction in Staphylococcus aureus count was significantly higher for the CAP vs sham group (10.14% vs 15.29%; P = .047). In the CAP group, mean modified AD antecubital severity score reduced significantly at week 4 vs baseline (13.12 vs 33.73; P less than .001), whereas reduction in the sham group was not statistically significant (P = .114). No severe adverse events were reported.

Study details: Findings are from a prospective analysis of 22 adults with mild-to-moderate AD having symmetric lesions. For each patient, the symmetric lesions were randomly assigned to either CAP or sham treatment.

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

Source: Kim YJ et al. Sci Rep. 2021 Jul 14. doi: 10.1038/s41598-021-93941-y.

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Key clinical point: Cold atmospheric plasma (CAP) can potentially improve the clinical severity of atopic dermatitis (AD) by recovering the diversity of skin microbiome and promoting wound healing for damaged skin barriers without any safety issues.

Major finding: At the end of treatment, reduction in Staphylococcus aureus count was significantly higher for the CAP vs sham group (10.14% vs 15.29%; P = .047). In the CAP group, mean modified AD antecubital severity score reduced significantly at week 4 vs baseline (13.12 vs 33.73; P less than .001), whereas reduction in the sham group was not statistically significant (P = .114). No severe adverse events were reported.

Study details: Findings are from a prospective analysis of 22 adults with mild-to-moderate AD having symmetric lesions. For each patient, the symmetric lesions were randomly assigned to either CAP or sham treatment.

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

Source: Kim YJ et al. Sci Rep. 2021 Jul 14. doi: 10.1038/s41598-021-93941-y.

Key clinical point: Cold atmospheric plasma (CAP) can potentially improve the clinical severity of atopic dermatitis (AD) by recovering the diversity of skin microbiome and promoting wound healing for damaged skin barriers without any safety issues.

Major finding: At the end of treatment, reduction in Staphylococcus aureus count was significantly higher for the CAP vs sham group (10.14% vs 15.29%; P = .047). In the CAP group, mean modified AD antecubital severity score reduced significantly at week 4 vs baseline (13.12 vs 33.73; P less than .001), whereas reduction in the sham group was not statistically significant (P = .114). No severe adverse events were reported.

Study details: Findings are from a prospective analysis of 22 adults with mild-to-moderate AD having symmetric lesions. For each patient, the symmetric lesions were randomly assigned to either CAP or sham treatment.

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

Source: Kim YJ et al. Sci Rep. 2021 Jul 14. doi: 10.1038/s41598-021-93941-y.

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Difamilast ointment shows promise for pediatric atopic dermatitis in phase 3

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Key clinical point: Difamilast 0.3% and 1% ointments demonstrated superiority over vehicle along with a favorable safety profile when applied twice daily for up to 4 weeks in pediatric patients with atopic dermatitis (AD).

Major finding: At week 4, the success rate in investigator global assessment score was significantly higher with difamilast 0.3% (44.6%; P = .0005) and 1% (47.1%; P less than .0001) vs vehicle (18.1%) group. Treatment-emergent adverse effects were mostly mild or moderate in severity, with adverse event profiles similar between treatment and vehicle groups.

Study details: Findings are from a double-blind phase 3 trial including 251 patients aged 2-14 years with mild-to-moderate AD who were randomly assigned to receive difamilast 0.3%, difamilast 1%, or vehicle ointment twice daily for 4 weeks.

Disclosures: This study was funded by Otsuka Pharmaceutical Co., Ltd. Dr. Saeki and Dr. Baba declared receiving consultation fees from Otsuka Pharmaceutical Co., Ltd. Dr. Ito, Dr. Yokota, and Dr. Tsubouchi declared being employees of Otsuka Pharmaceutical Co., Ltd.

Source: Saeki H et al. Br J Dermatol. 2021 Jul 21. doi: 10.1111/bjd.20655.

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Key clinical point: Difamilast 0.3% and 1% ointments demonstrated superiority over vehicle along with a favorable safety profile when applied twice daily for up to 4 weeks in pediatric patients with atopic dermatitis (AD).

Major finding: At week 4, the success rate in investigator global assessment score was significantly higher with difamilast 0.3% (44.6%; P = .0005) and 1% (47.1%; P less than .0001) vs vehicle (18.1%) group. Treatment-emergent adverse effects were mostly mild or moderate in severity, with adverse event profiles similar between treatment and vehicle groups.

Study details: Findings are from a double-blind phase 3 trial including 251 patients aged 2-14 years with mild-to-moderate AD who were randomly assigned to receive difamilast 0.3%, difamilast 1%, or vehicle ointment twice daily for 4 weeks.

Disclosures: This study was funded by Otsuka Pharmaceutical Co., Ltd. Dr. Saeki and Dr. Baba declared receiving consultation fees from Otsuka Pharmaceutical Co., Ltd. Dr. Ito, Dr. Yokota, and Dr. Tsubouchi declared being employees of Otsuka Pharmaceutical Co., Ltd.

Source: Saeki H et al. Br J Dermatol. 2021 Jul 21. doi: 10.1111/bjd.20655.

Key clinical point: Difamilast 0.3% and 1% ointments demonstrated superiority over vehicle along with a favorable safety profile when applied twice daily for up to 4 weeks in pediatric patients with atopic dermatitis (AD).

Major finding: At week 4, the success rate in investigator global assessment score was significantly higher with difamilast 0.3% (44.6%; P = .0005) and 1% (47.1%; P less than .0001) vs vehicle (18.1%) group. Treatment-emergent adverse effects were mostly mild or moderate in severity, with adverse event profiles similar between treatment and vehicle groups.

Study details: Findings are from a double-blind phase 3 trial including 251 patients aged 2-14 years with mild-to-moderate AD who were randomly assigned to receive difamilast 0.3%, difamilast 1%, or vehicle ointment twice daily for 4 weeks.

Disclosures: This study was funded by Otsuka Pharmaceutical Co., Ltd. Dr. Saeki and Dr. Baba declared receiving consultation fees from Otsuka Pharmaceutical Co., Ltd. Dr. Ito, Dr. Yokota, and Dr. Tsubouchi declared being employees of Otsuka Pharmaceutical Co., Ltd.

Source: Saeki H et al. Br J Dermatol. 2021 Jul 21. doi: 10.1111/bjd.20655.

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