Atopic Dermatitis

COEUR D’ALENE, IDAHO – Topical corticosteroids applied to the dry skin of children with atopic dermatitis proved as effective for clinical improvement as the soak and smear technique favored by many physicians, according to a randomized, investigator-blinded clinical trial.

"The use of corticosteroid application to prehydrated, wet skin is not more efficacious than corticosteroid application to dry skin in pediatric patients with atopic dermatitis," Dr. Richard J. Antaya reported at the annual meeting of the Society for Pediatric Dermatology. "This study suggests that 2 weeks of using either soak and smear or standard topical corticosteroid application techniques results in considerable improvement in atopic dermatitis severity," he said.

Eczema Area and Severity Index (EASI) scores improved to a similarly impressive extent – close to 85% after 2 weeks – regardless of which application method was used, added Dr. Antaya, professor of dermatology, pediatrics, and nursing and director of pediatric dermatology at Yale University in New Haven, Conn.

The study included 47 patients aged 4 months to 16 years with atopic dermatitis and a mean baseline EASI score of 15.5. All were assigned to 2 weeks of twice-daily topical steroid therapy. Those younger than age 2 years received a prescription for a 1-lb jar of hydrocortisone 2.5% ointment; older patients received 1-lb jars of triamcinolone 0.1% ointment, and, for the more sensitive face and intertriginous areas, hydrocortisone 2.5% ointment. Patients were randomized to twice-daily application of their medication to affected dry skin or to a single daily soak and smear session and one application of the medication to dry skin.

Soak and smear entails a 10-minute soak in lukewarm plain water to boost skin hydration, followed by steroid application to the wet skin. Data from several studies conducted in adults concluded that soak and smear is more effective than was conventional steroid application to dry skin. For example, a retrospective study of 28 adults referred to a tertiary dermatologic center for highly refractory atopic dermatitis or other eczematous dermatoses showed 26 of the 28 were clear or at least 90% improved after several days to 2 weeks of soak and smear sessions (Arch. Dermatol. 2005;141:1556-9).

In Dr. Antaya’s pediatric atopic dermatitis study, assessment of EASI scores was performed by a dermatologist blinded to the treatment arm. The profound and similar improvement in EASI scores in the two treatment groups was accompanied by essentially equal improvements in measures of sleep quality, itch, and overall disease impact.

Also, there was no difference in EASI score improvement between the two groups when patients were stratified according to baseline atopic dermatitis severity.

No differences between the groups were noted in treatment days missed or development of folliculitis. Neither group showed any evidence of hypothalamic-pituitary-adrenal axis suppression, he added.

Dr. Antaya attributed the marked improvement in atopic dermatitis seen in both study groups to the fact that, at the study outset, caregivers received education aimed at alleviating steroid phobia. Also, the 1-lb jars of medication encouraged treatment compliance, he noted.

Dr. Antaya reported having no financial conflicts with regard to this study.

[email protected]

COEUR D’ALENE, IDAHO – Topical corticosteroids applied to the dry skin of children with atopic dermatitis proved as effective for clinical improvement as the soak and smear technique favored by many physicians, according to a randomized, investigator-blinded clinical trial.

"The use of corticosteroid application to prehydrated, wet skin is not more efficacious than corticosteroid application to dry skin in pediatric patients with atopic dermatitis," Dr. Richard J. Antaya reported at the annual meeting of the Society for Pediatric Dermatology. "This study suggests that 2 weeks of using either soak and smear or standard topical corticosteroid application techniques results in considerable improvement in atopic dermatitis severity," he said.

Eczema Area and Severity Index (EASI) scores improved to a similarly impressive extent – close to 85% after 2 weeks – regardless of which application method was used, added Dr. Antaya, professor of dermatology, pediatrics, and nursing and director of pediatric dermatology at Yale University in New Haven, Conn.

The study included 47 patients aged 4 months to 16 years with atopic dermatitis and a mean baseline EASI score of 15.5. All were assigned to 2 weeks of twice-daily topical steroid therapy. Those younger than age 2 years received a prescription for a 1-lb jar of hydrocortisone 2.5% ointment; older patients received 1-lb jars of triamcinolone 0.1% ointment, and, for the more sensitive face and intertriginous areas, hydrocortisone 2.5% ointment. Patients were randomized to twice-daily application of their medication to affected dry skin or to a single daily soak and smear session and one application of the medication to dry skin.

Soak and smear entails a 10-minute soak in lukewarm plain water to boost skin hydration, followed by steroid application to the wet skin. Data from several studies conducted in adults concluded that soak and smear is more effective than was conventional steroid application to dry skin. For example, a retrospective study of 28 adults referred to a tertiary dermatologic center for highly refractory atopic dermatitis or other eczematous dermatoses showed 26 of the 28 were clear or at least 90% improved after several days to 2 weeks of soak and smear sessions (Arch. Dermatol. 2005;141:1556-9).

In Dr. Antaya’s pediatric atopic dermatitis study, assessment of EASI scores was performed by a dermatologist blinded to the treatment arm. The profound and similar improvement in EASI scores in the two treatment groups was accompanied by essentially equal improvements in measures of sleep quality, itch, and overall disease impact.

Also, there was no difference in EASI score improvement between the two groups when patients were stratified according to baseline atopic dermatitis severity.

No differences between the groups were noted in treatment days missed or development of folliculitis. Neither group showed any evidence of hypothalamic-pituitary-adrenal axis suppression, he added.

Dr. Antaya attributed the marked improvement in atopic dermatitis seen in both study groups to the fact that, at the study outset, caregivers received education aimed at alleviating steroid phobia. Also, the 1-lb jars of medication encouraged treatment compliance, he noted.

Dr. Antaya reported having no financial conflicts with regard to this study.

[email protected]

COEUR D’ALENE, IDAHO – Topical corticosteroids applied to the dry skin of children with atopic dermatitis proved as effective for clinical improvement as the soak and smear technique favored by many physicians, according to a randomized, investigator-blinded clinical trial.

"The use of corticosteroid application to prehydrated, wet skin is not more efficacious than corticosteroid application to dry skin in pediatric patients with atopic dermatitis," Dr. Richard J. Antaya reported at the annual meeting of the Society for Pediatric Dermatology. "This study suggests that 2 weeks of using either soak and smear or standard topical corticosteroid application techniques results in considerable improvement in atopic dermatitis severity," he said.

Eczema Area and Severity Index (EASI) scores improved to a similarly impressive extent – close to 85% after 2 weeks – regardless of which application method was used, added Dr. Antaya, professor of dermatology, pediatrics, and nursing and director of pediatric dermatology at Yale University in New Haven, Conn.

The study included 47 patients aged 4 months to 16 years with atopic dermatitis and a mean baseline EASI score of 15.5. All were assigned to 2 weeks of twice-daily topical steroid therapy. Those younger than age 2 years received a prescription for a 1-lb jar of hydrocortisone 2.5% ointment; older patients received 1-lb jars of triamcinolone 0.1% ointment, and, for the more sensitive face and intertriginous areas, hydrocortisone 2.5% ointment. Patients were randomized to twice-daily application of their medication to affected dry skin or to a single daily soak and smear session and one application of the medication to dry skin.

Soak and smear entails a 10-minute soak in lukewarm plain water to boost skin hydration, followed by steroid application to the wet skin. Data from several studies conducted in adults concluded that soak and smear is more effective than was conventional steroid application to dry skin. For example, a retrospective study of 28 adults referred to a tertiary dermatologic center for highly refractory atopic dermatitis or other eczematous dermatoses showed 26 of the 28 were clear or at least 90% improved after several days to 2 weeks of soak and smear sessions (Arch. Dermatol. 2005;141:1556-9).

In Dr. Antaya’s pediatric atopic dermatitis study, assessment of EASI scores was performed by a dermatologist blinded to the treatment arm. The profound and similar improvement in EASI scores in the two treatment groups was accompanied by essentially equal improvements in measures of sleep quality, itch, and overall disease impact.

Also, there was no difference in EASI score improvement between the two groups when patients were stratified according to baseline atopic dermatitis severity.

No differences between the groups were noted in treatment days missed or development of folliculitis. Neither group showed any evidence of hypothalamic-pituitary-adrenal axis suppression, he added.

Dr. Antaya attributed the marked improvement in atopic dermatitis seen in both study groups to the fact that, at the study outset, caregivers received education aimed at alleviating steroid phobia. Also, the 1-lb jars of medication encouraged treatment compliance, he noted.

Dr. Antaya reported having no financial conflicts with regard to this study.

[email protected]

COEUR D’ALENE, IDAHO – Vitamin D insufficiency or outright deficiency is extremely common among pediatric atopic dermatitis patients, and it correlates with worse skin disease severity.

Unfortunately, vitamin D supplementation in such patients didn’t outperform placebo in improving their atopic dermatitis severity scores in a double-blind, randomized, prospective clinical trial, Dr. Irene Lara-Corrales reported at the annual meeting of the Society for Pediatric Dermatology.

In the first phase of this two-part study, 77 atopic dermatitis patients aged 1-18 years, with a mean age of 7.4 years and free of potentially confounding comorbid medical conditions, had their serum vitamin D level checked. Only 27 patients, or 35%, had a normal level, defined as greater than 72.5 nmol/L, or 30 ng/mL.

Thirty-six patients were categorized as vitamin D insufficient based upon a serum level of 32.5-72.5 nmol/L, or 15-29 ng/mL. The remaining 14 patients were vitamin D deficient, with a serum level below 32.5 nmol/L or 15 ng/mL, according to Dr. Lara-Corrales of the Hospital for Sick Children in Toronto.

Mean baseline atopic dermatitis severity scores using the SCORAD (Scoring Atopic Disease) system were 19.0 in the group with normal serum vitamin D and significantly worse at 28.8 in those who were vitamin D insufficient and 24.6 in patients who were vitamin D deficient.

In phase II of the study, 41 patients from phase I who had low vitamin D levels were randomized and double blinded to either 2,000 IU of vitamin D administered as cholecalciferol drops or to placebo drops for 3 months. The study hypothesis was that SCORAD ratings would improve markedly with vitamin D supplementation, based upon mounting evidence that serum vitamin D plays a key role in skin immune function.

But the hypothesis did not prevail. Although serum vitamin D levels did indeed increase significantly in response to 3 months of daily oral vitamin D supplementation, and recipients showed a hefty mean 15.35-point improvement in SCORAD scores, the placebo-treated controls demonstrated a near-identical mean 15.13-point SCORAD improvement as well.

Dr. Lara-Corrales noted that the study was completed only recently and that substantial collected data have yet to be analyzed. That includes information on sun exposure, nutritional intake, sunscreen use, and exposure to breast milk in early childhood, which may prove useful in interpreting the study results.

The Society for Pediatric Dermatology and the Canadian Dermatology Foundation supported the study. Dr. Lara-Corrales reported having no financial conflicts.

[email protected]

COEUR D’ALENE, IDAHO – Vitamin D insufficiency or outright deficiency is extremely common among pediatric atopic dermatitis patients, and it correlates with worse skin disease severity.

Unfortunately, vitamin D supplementation in such patients didn’t outperform placebo in improving their atopic dermatitis severity scores in a double-blind, randomized, prospective clinical trial, Dr. Irene Lara-Corrales reported at the annual meeting of the Society for Pediatric Dermatology.

In the first phase of this two-part study, 77 atopic dermatitis patients aged 1-18 years, with a mean age of 7.4 years and free of potentially confounding comorbid medical conditions, had their serum vitamin D level checked. Only 27 patients, or 35%, had a normal level, defined as greater than 72.5 nmol/L, or 30 ng/mL.

Thirty-six patients were categorized as vitamin D insufficient based upon a serum level of 32.5-72.5 nmol/L, or 15-29 ng/mL. The remaining 14 patients were vitamin D deficient, with a serum level below 32.5 nmol/L or 15 ng/mL, according to Dr. Lara-Corrales of the Hospital for Sick Children in Toronto.

Mean baseline atopic dermatitis severity scores using the SCORAD (Scoring Atopic Disease) system were 19.0 in the group with normal serum vitamin D and significantly worse at 28.8 in those who were vitamin D insufficient and 24.6 in patients who were vitamin D deficient.

In phase II of the study, 41 patients from phase I who had low vitamin D levels were randomized and double blinded to either 2,000 IU of vitamin D administered as cholecalciferol drops or to placebo drops for 3 months. The study hypothesis was that SCORAD ratings would improve markedly with vitamin D supplementation, based upon mounting evidence that serum vitamin D plays a key role in skin immune function.

But the hypothesis did not prevail. Although serum vitamin D levels did indeed increase significantly in response to 3 months of daily oral vitamin D supplementation, and recipients showed a hefty mean 15.35-point improvement in SCORAD scores, the placebo-treated controls demonstrated a near-identical mean 15.13-point SCORAD improvement as well.

Dr. Lara-Corrales noted that the study was completed only recently and that substantial collected data have yet to be analyzed. That includes information on sun exposure, nutritional intake, sunscreen use, and exposure to breast milk in early childhood, which may prove useful in interpreting the study results.

The Society for Pediatric Dermatology and the Canadian Dermatology Foundation supported the study. Dr. Lara-Corrales reported having no financial conflicts.

[email protected]

COEUR D’ALENE, IDAHO – Vitamin D insufficiency or outright deficiency is extremely common among pediatric atopic dermatitis patients, and it correlates with worse skin disease severity.

Unfortunately, vitamin D supplementation in such patients didn’t outperform placebo in improving their atopic dermatitis severity scores in a double-blind, randomized, prospective clinical trial, Dr. Irene Lara-Corrales reported at the annual meeting of the Society for Pediatric Dermatology.

In the first phase of this two-part study, 77 atopic dermatitis patients aged 1-18 years, with a mean age of 7.4 years and free of potentially confounding comorbid medical conditions, had their serum vitamin D level checked. Only 27 patients, or 35%, had a normal level, defined as greater than 72.5 nmol/L, or 30 ng/mL.

Thirty-six patients were categorized as vitamin D insufficient based upon a serum level of 32.5-72.5 nmol/L, or 15-29 ng/mL. The remaining 14 patients were vitamin D deficient, with a serum level below 32.5 nmol/L or 15 ng/mL, according to Dr. Lara-Corrales of the Hospital for Sick Children in Toronto.

Mean baseline atopic dermatitis severity scores using the SCORAD (Scoring Atopic Disease) system were 19.0 in the group with normal serum vitamin D and significantly worse at 28.8 in those who were vitamin D insufficient and 24.6 in patients who were vitamin D deficient.

In phase II of the study, 41 patients from phase I who had low vitamin D levels were randomized and double blinded to either 2,000 IU of vitamin D administered as cholecalciferol drops or to placebo drops for 3 months. The study hypothesis was that SCORAD ratings would improve markedly with vitamin D supplementation, based upon mounting evidence that serum vitamin D plays a key role in skin immune function.

But the hypothesis did not prevail. Although serum vitamin D levels did indeed increase significantly in response to 3 months of daily oral vitamin D supplementation, and recipients showed a hefty mean 15.35-point improvement in SCORAD scores, the placebo-treated controls demonstrated a near-identical mean 15.13-point SCORAD improvement as well.

Dr. Lara-Corrales noted that the study was completed only recently and that substantial collected data have yet to be analyzed. That includes information on sun exposure, nutritional intake, sunscreen use, and exposure to breast milk in early childhood, which may prove useful in interpreting the study results.

The Society for Pediatric Dermatology and the Canadian Dermatology Foundation supported the study. Dr. Lara-Corrales reported having no financial conflicts.

[email protected]

The monoclonal antibody dupilumab, which blocks the action of the type 2 helper T-cell (Th2) cytokines interleukin-4 and interleukin-13, produced rapid and significant improvement in all signs, symptoms, and biomarkers of atopic dermatitis in four industry-sponsored randomized clinical trials. The data were reported online July 9 in the New England Journal of Medicine.

In particular, once-weekly subcutaneous injections of dupilumab quickly yielded substantial reductions in pruritus, "a major contributor to reduced quality of life experienced by patients with atopic dermatitis," said Dr. Lisa A. Beck of the department of dermatology, University of Rochester (N.Y.) Medical Center, and her associates.

These findings "extend the potential benefit of this new biologic therapy beyond asthma to a second atopic disorder" and suggest that the treatment may be beneficial for other atopic disorders as well, they noted (N. Engl. J. Med. 2014;371:130-9 [doi:10.1056/NEJMoa1314768]).

The four double-blind, placebo-controlled trials involved a total of 207 adults aged 18 years and older in the United States and Europe who had poorly controlled moderate to severe atopic dermatitis of at least 2 years’ duration. Two studies assessed 4 weeks of monotherapy with dupilumab, one assessed 12 weeks of monotherapy, and the fourth assessed 4 weeks of dupilumab added to topical glucocorticoids.

In all four studies, dupilumab induced rapid, dose-dependent improvements in an investigator’s global assessment score, a measure of the percentage of affected body-surface area, scores on the Eczema Area and Severity Index, and scores on both the 5-D pruritus scale and an additional numerical-rating scale of pruritus. In the 12-week trial, for example, 85% of patients given dupilumab achieved at least a 50% reduction in EASI scores, and mean scores on the pruritus rating scale declined by 56%.

Adverse events in all study groups were generally mild and transient: Nasopharyngitis and headache were reported more frequently in the active-treatment groups than in the placebo groups. However, serious adverse events and adverse events leading to treatment withdrawal – chiefly skin infections and exacerbations of the underlying dermatitis – were more common in the placebo groups and were related to lack of efficacy.

This study was funded by Regeneron Pharmaceuticals and Sanofi, which also performed data analysis and assisted with writing the report. Dr. Beck reported other ties to Regeneron; her associates reported ties to numerous industry sources.

The monoclonal antibody dupilumab, which blocks the action of the type 2 helper T-cell (Th2) cytokines interleukin-4 and interleukin-13, produced rapid and significant improvement in all signs, symptoms, and biomarkers of atopic dermatitis in four industry-sponsored randomized clinical trials. The data were reported online July 9 in the New England Journal of Medicine.

In particular, once-weekly subcutaneous injections of dupilumab quickly yielded substantial reductions in pruritus, "a major contributor to reduced quality of life experienced by patients with atopic dermatitis," said Dr. Lisa A. Beck of the department of dermatology, University of Rochester (N.Y.) Medical Center, and her associates.

These findings "extend the potential benefit of this new biologic therapy beyond asthma to a second atopic disorder" and suggest that the treatment may be beneficial for other atopic disorders as well, they noted (N. Engl. J. Med. 2014;371:130-9 [doi:10.1056/NEJMoa1314768]).

The four double-blind, placebo-controlled trials involved a total of 207 adults aged 18 years and older in the United States and Europe who had poorly controlled moderate to severe atopic dermatitis of at least 2 years’ duration. Two studies assessed 4 weeks of monotherapy with dupilumab, one assessed 12 weeks of monotherapy, and the fourth assessed 4 weeks of dupilumab added to topical glucocorticoids.

In all four studies, dupilumab induced rapid, dose-dependent improvements in an investigator’s global assessment score, a measure of the percentage of affected body-surface area, scores on the Eczema Area and Severity Index, and scores on both the 5-D pruritus scale and an additional numerical-rating scale of pruritus. In the 12-week trial, for example, 85% of patients given dupilumab achieved at least a 50% reduction in EASI scores, and mean scores on the pruritus rating scale declined by 56%.

Adverse events in all study groups were generally mild and transient: Nasopharyngitis and headache were reported more frequently in the active-treatment groups than in the placebo groups. However, serious adverse events and adverse events leading to treatment withdrawal – chiefly skin infections and exacerbations of the underlying dermatitis – were more common in the placebo groups and were related to lack of efficacy.

This study was funded by Regeneron Pharmaceuticals and Sanofi, which also performed data analysis and assisted with writing the report. Dr. Beck reported other ties to Regeneron; her associates reported ties to numerous industry sources.

The monoclonal antibody dupilumab, which blocks the action of the type 2 helper T-cell (Th2) cytokines interleukin-4 and interleukin-13, produced rapid and significant improvement in all signs, symptoms, and biomarkers of atopic dermatitis in four industry-sponsored randomized clinical trials. The data were reported online July 9 in the New England Journal of Medicine.

In particular, once-weekly subcutaneous injections of dupilumab quickly yielded substantial reductions in pruritus, "a major contributor to reduced quality of life experienced by patients with atopic dermatitis," said Dr. Lisa A. Beck of the department of dermatology, University of Rochester (N.Y.) Medical Center, and her associates.

These findings "extend the potential benefit of this new biologic therapy beyond asthma to a second atopic disorder" and suggest that the treatment may be beneficial for other atopic disorders as well, they noted (N. Engl. J. Med. 2014;371:130-9 [doi:10.1056/NEJMoa1314768]).

The four double-blind, placebo-controlled trials involved a total of 207 adults aged 18 years and older in the United States and Europe who had poorly controlled moderate to severe atopic dermatitis of at least 2 years’ duration. Two studies assessed 4 weeks of monotherapy with dupilumab, one assessed 12 weeks of monotherapy, and the fourth assessed 4 weeks of dupilumab added to topical glucocorticoids.

In all four studies, dupilumab induced rapid, dose-dependent improvements in an investigator’s global assessment score, a measure of the percentage of affected body-surface area, scores on the Eczema Area and Severity Index, and scores on both the 5-D pruritus scale and an additional numerical-rating scale of pruritus. In the 12-week trial, for example, 85% of patients given dupilumab achieved at least a 50% reduction in EASI scores, and mean scores on the pruritus rating scale declined by 56%.

Adverse events in all study groups were generally mild and transient: Nasopharyngitis and headache were reported more frequently in the active-treatment groups than in the placebo groups. However, serious adverse events and adverse events leading to treatment withdrawal – chiefly skin infections and exacerbations of the underlying dermatitis – were more common in the placebo groups and were related to lack of efficacy.

This study was funded by Regeneron Pharmaceuticals and Sanofi, which also performed data analysis and assisted with writing the report. Dr. Beck reported other ties to Regeneron; her associates reported ties to numerous industry sources.

Adolescents with eczema were significantly more likely to report suicidal ideation than those who did not have eczema, based on data from a population-based study of more than 3,000 adolescents. The findings were published in the Journal of Investigative Dermatology.

Data from previous studies have shown an increased suicide risk in patients with skin disorders, but the impact of eczema on adolescents in particular has not been well studied, wrote Dr. Jon A. Halvorsen of the department of dermatology at the University of Oslo and his colleagues (J. Invest. Dermatol. 2014;134:1847-54).

The researchers reviewed survey data from 3,556 adolescents aged 18-19 years collected as part of the Oslo section of the Youths 2004 study.

The overall prevalence of eczema was 10% (12% in girls and 7% in boys). The overall incidence of suicidal ideation was 11%, but 16% of adolescents with eczema reported suicidal ideation vs. 9% of those with no eczema (odds ratio, 1.87). The association was even stronger in adolescents who reported eczema with itching (OR, 3.57), compared with those who did not report itching (OR, 1.06).

"The risk of suicidal ideation increased nearly fourfold in this group," the researchers noted. "Our data suggest that itch is a major predictor of psychological problems and may be a greater risk factor for these problems than chronic eczema without itch."

In addition, adolescents with eczema were significantly more likely than those without eczema to report mental health problems (assessed by the Strengths and Difficulties Questionnaire) and mental distress (assessed by the Hopkins Symptom Checklist 10) and these associations were even more significant in adolescents who reported eczema with itch, compared with those who had eczema without itch.

The study was limited by the use of self-reports, but its strengths include a large sample size with high participation, the researchers said. The results suggest that "both treatment of eczema and psychological support in this high-risk group may help to reduce suicide and mental health problems in this vulnerable population," they added.

The researchers reported no financial conflicts.

[email protected]

Adolescents with eczema were significantly more likely to report suicidal ideation than those who did not have eczema, based on data from a population-based study of more than 3,000 adolescents. The findings were published in the Journal of Investigative Dermatology.

Data from previous studies have shown an increased suicide risk in patients with skin disorders, but the impact of eczema on adolescents in particular has not been well studied, wrote Dr. Jon A. Halvorsen of the department of dermatology at the University of Oslo and his colleagues (J. Invest. Dermatol. 2014;134:1847-54).

The researchers reviewed survey data from 3,556 adolescents aged 18-19 years collected as part of the Oslo section of the Youths 2004 study.

The overall prevalence of eczema was 10% (12% in girls and 7% in boys). The overall incidence of suicidal ideation was 11%, but 16% of adolescents with eczema reported suicidal ideation vs. 9% of those with no eczema (odds ratio, 1.87). The association was even stronger in adolescents who reported eczema with itching (OR, 3.57), compared with those who did not report itching (OR, 1.06).

"The risk of suicidal ideation increased nearly fourfold in this group," the researchers noted. "Our data suggest that itch is a major predictor of psychological problems and may be a greater risk factor for these problems than chronic eczema without itch."

In addition, adolescents with eczema were significantly more likely than those without eczema to report mental health problems (assessed by the Strengths and Difficulties Questionnaire) and mental distress (assessed by the Hopkins Symptom Checklist 10) and these associations were even more significant in adolescents who reported eczema with itch, compared with those who had eczema without itch.

The study was limited by the use of self-reports, but its strengths include a large sample size with high participation, the researchers said. The results suggest that "both treatment of eczema and psychological support in this high-risk group may help to reduce suicide and mental health problems in this vulnerable population," they added.

The researchers reported no financial conflicts.

[email protected]

Adolescents with eczema were significantly more likely to report suicidal ideation than those who did not have eczema, based on data from a population-based study of more than 3,000 adolescents. The findings were published in the Journal of Investigative Dermatology.

Data from previous studies have shown an increased suicide risk in patients with skin disorders, but the impact of eczema on adolescents in particular has not been well studied, wrote Dr. Jon A. Halvorsen of the department of dermatology at the University of Oslo and his colleagues (J. Invest. Dermatol. 2014;134:1847-54).

The researchers reviewed survey data from 3,556 adolescents aged 18-19 years collected as part of the Oslo section of the Youths 2004 study.

The overall prevalence of eczema was 10% (12% in girls and 7% in boys). The overall incidence of suicidal ideation was 11%, but 16% of adolescents with eczema reported suicidal ideation vs. 9% of those with no eczema (odds ratio, 1.87). The association was even stronger in adolescents who reported eczema with itching (OR, 3.57), compared with those who did not report itching (OR, 1.06).

"The risk of suicidal ideation increased nearly fourfold in this group," the researchers noted. "Our data suggest that itch is a major predictor of psychological problems and may be a greater risk factor for these problems than chronic eczema without itch."

In addition, adolescents with eczema were significantly more likely than those without eczema to report mental health problems (assessed by the Strengths and Difficulties Questionnaire) and mental distress (assessed by the Hopkins Symptom Checklist 10) and these associations were even more significant in adolescents who reported eczema with itch, compared with those who had eczema without itch.

The study was limited by the use of self-reports, but its strengths include a large sample size with high participation, the researchers said. The results suggest that "both treatment of eczema and psychological support in this high-risk group may help to reduce suicide and mental health problems in this vulnerable population," they added.

The researchers reported no financial conflicts.

[email protected]

DENVER – A sodium hypochlorite wash significantly improved symptoms and quality of life for children who had atopic dermatitis with bacterial colonization, in a small study.

Staphylococcus aureus colonization occurs in the lesional and nonlesional skin of many atopic dermatitis patients, and bleach baths at a concentration of approximately 0.005% sodium hypochlorite are a common treatment, but not always an easy or convenient one, Dr. Benjamin R. Bohaty noted in a poster at the annual meeting of the American Academy of Dermatology.

Courtesy Dr. Adelaide Hebert and Dr. Amy Paller

In an open-label study, Dr. Bohaty of the University of Texas Health Science Center in Houston and his colleagues tested a gel cleanser containing a dilute concentration of 0.006% sodium hypochlorite wash that could be used in the bath or shower. The product is designed to be lathered onto the skin and rinsed off after 1-2 minutes. The study population included 40 children, average age 9 years, with a diagnosis of moderate to severe atopic dermatitis and S. aureus colonization. The children were instructed to use the wash once daily for 6 weeks, and they were assessed at three office visits during this period.

At 2 weeks and 6 weeks, the patients had improved an average of 34% and 44% from baseline, respectively, on the Eczema Area and Severity Index, and 23% and 34% from baseline on the Investigator’s Global Assessment scale score.

Courtesy Dr. Adelaide Hebert and Dr. Amy Paller

The average improvement in pruritus visual analog scale score was 31% at 2 weeks and 37% at 6 weeks.

Quality of life measures also improved during the study period. The average change in the Children’s Dermatology Life Quality Index was 41% at 2 weeks, dropping to 32% at 6 weeks, but both were significant improvements from baseline. The average improvement in the Family Dermatology Life Quality Index score was 13% at 2 weeks and 43% at 6 weeks, compared with baseline.

The significant decreases and lack of reported adverse events suggest that the wash is "a simple alternative to bleach baths," Dr. Bohaty reported.

The product is available in the United States under the label CLn Skin Care, a trademark of TopMD Skin Care, which funded the trial through research grants to the universities of the investigators.

[email protected]

DENVER – A sodium hypochlorite wash significantly improved symptoms and quality of life for children who had atopic dermatitis with bacterial colonization, in a small study.

Staphylococcus aureus colonization occurs in the lesional and nonlesional skin of many atopic dermatitis patients, and bleach baths at a concentration of approximately 0.005% sodium hypochlorite are a common treatment, but not always an easy or convenient one, Dr. Benjamin R. Bohaty noted in a poster at the annual meeting of the American Academy of Dermatology.

Courtesy Dr. Adelaide Hebert and Dr. Amy Paller

In an open-label study, Dr. Bohaty of the University of Texas Health Science Center in Houston and his colleagues tested a gel cleanser containing a dilute concentration of 0.006% sodium hypochlorite wash that could be used in the bath or shower. The product is designed to be lathered onto the skin and rinsed off after 1-2 minutes. The study population included 40 children, average age 9 years, with a diagnosis of moderate to severe atopic dermatitis and S. aureus colonization. The children were instructed to use the wash once daily for 6 weeks, and they were assessed at three office visits during this period.

At 2 weeks and 6 weeks, the patients had improved an average of 34% and 44% from baseline, respectively, on the Eczema Area and Severity Index, and 23% and 34% from baseline on the Investigator’s Global Assessment scale score.

Courtesy Dr. Adelaide Hebert and Dr. Amy Paller

The average improvement in pruritus visual analog scale score was 31% at 2 weeks and 37% at 6 weeks.

Quality of life measures also improved during the study period. The average change in the Children’s Dermatology Life Quality Index was 41% at 2 weeks, dropping to 32% at 6 weeks, but both were significant improvements from baseline. The average improvement in the Family Dermatology Life Quality Index score was 13% at 2 weeks and 43% at 6 weeks, compared with baseline.

The significant decreases and lack of reported adverse events suggest that the wash is "a simple alternative to bleach baths," Dr. Bohaty reported.

The product is available in the United States under the label CLn Skin Care, a trademark of TopMD Skin Care, which funded the trial through research grants to the universities of the investigators.

[email protected]

DENVER – A sodium hypochlorite wash significantly improved symptoms and quality of life for children who had atopic dermatitis with bacterial colonization, in a small study.

Staphylococcus aureus colonization occurs in the lesional and nonlesional skin of many atopic dermatitis patients, and bleach baths at a concentration of approximately 0.005% sodium hypochlorite are a common treatment, but not always an easy or convenient one, Dr. Benjamin R. Bohaty noted in a poster at the annual meeting of the American Academy of Dermatology.

Courtesy Dr. Adelaide Hebert and Dr. Amy Paller

In an open-label study, Dr. Bohaty of the University of Texas Health Science Center in Houston and his colleagues tested a gel cleanser containing a dilute concentration of 0.006% sodium hypochlorite wash that could be used in the bath or shower. The product is designed to be lathered onto the skin and rinsed off after 1-2 minutes. The study population included 40 children, average age 9 years, with a diagnosis of moderate to severe atopic dermatitis and S. aureus colonization. The children were instructed to use the wash once daily for 6 weeks, and they were assessed at three office visits during this period.

At 2 weeks and 6 weeks, the patients had improved an average of 34% and 44% from baseline, respectively, on the Eczema Area and Severity Index, and 23% and 34% from baseline on the Investigator’s Global Assessment scale score.

Courtesy Dr. Adelaide Hebert and Dr. Amy Paller

The average improvement in pruritus visual analog scale score was 31% at 2 weeks and 37% at 6 weeks.

Quality of life measures also improved during the study period. The average change in the Children’s Dermatology Life Quality Index was 41% at 2 weeks, dropping to 32% at 6 weeks, but both were significant improvements from baseline. The average improvement in the Family Dermatology Life Quality Index score was 13% at 2 weeks and 43% at 6 weeks, compared with baseline.

The significant decreases and lack of reported adverse events suggest that the wash is "a simple alternative to bleach baths," Dr. Bohaty reported.

The product is available in the United States under the label CLn Skin Care, a trademark of TopMD Skin Care, which funded the trial through research grants to the universities of the investigators.

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Twice-daily application of 0.05% desonide hydrogel significantly improved clinical symptoms of itching and quality of life scores in 100% of patients with mild to moderate atopic dermatitis after 7 days in a small preliminary study.

"Increasingly, researchers and clinicians recognize that disrupted barrier function contributes not only to the xerotic and pruritic manifestations of AD, but also to the inflammatory cascade that underlies the disease," wrote Dr. Leon Kircik of Indiana University, Indianapolis.

Data from previous studies have shown the effectiveness of desonide hydrogel 0.05% for atopic dermatitis in children, but few studies have examined the effectiveness of the gel on itching in particular. In this study, patients applied the gel twice daily, with assessments at baseline, day 3, and day 7 (J. Drugs Dermatol. 2014;13:725-8).

At day 7, all patients achieved the primary endpoint of at least a 50% reduction in pruritus. The average Investigator’s Global Assessment (IGA) scale score was .55 (down from 2.35 at baseline), which translated to a 76% improvement from baseline. The visual analog score decreased by an average of 6.4 points, for an average reduction of 85%. Statistically significant improvements from baseline in both IGA and visual analog scores also were noted at day 3, when the average IGA score improved 27% from baseline, and the mean visual analog score showed a 53% reduction.

The study included 20 atopic dermatitis patients ranging in age from 8 to 68 years, with an average age of 25 years; 60% were black, 40% were white, and 75% were female.

The results suggest that hydrogel is an appropriate option to relieve itchiness in AD patients, and a large, randomized, double-blind controlled trial would be helpful to further study effectiveness, Dr. Kircik said.

Dr. Kircik disclosed receiving funding as an investigator, consultant, or speaker for Bayer Dermatology, manufacturer of the product tested.

[email protected]

Twice-daily application of 0.05% desonide hydrogel significantly improved clinical symptoms of itching and quality of life scores in 100% of patients with mild to moderate atopic dermatitis after 7 days in a small preliminary study.

"Increasingly, researchers and clinicians recognize that disrupted barrier function contributes not only to the xerotic and pruritic manifestations of AD, but also to the inflammatory cascade that underlies the disease," wrote Dr. Leon Kircik of Indiana University, Indianapolis.

Data from previous studies have shown the effectiveness of desonide hydrogel 0.05% for atopic dermatitis in children, but few studies have examined the effectiveness of the gel on itching in particular. In this study, patients applied the gel twice daily, with assessments at baseline, day 3, and day 7 (J. Drugs Dermatol. 2014;13:725-8).

At day 7, all patients achieved the primary endpoint of at least a 50% reduction in pruritus. The average Investigator’s Global Assessment (IGA) scale score was .55 (down from 2.35 at baseline), which translated to a 76% improvement from baseline. The visual analog score decreased by an average of 6.4 points, for an average reduction of 85%. Statistically significant improvements from baseline in both IGA and visual analog scores also were noted at day 3, when the average IGA score improved 27% from baseline, and the mean visual analog score showed a 53% reduction.

The study included 20 atopic dermatitis patients ranging in age from 8 to 68 years, with an average age of 25 years; 60% were black, 40% were white, and 75% were female.

The results suggest that hydrogel is an appropriate option to relieve itchiness in AD patients, and a large, randomized, double-blind controlled trial would be helpful to further study effectiveness, Dr. Kircik said.

Dr. Kircik disclosed receiving funding as an investigator, consultant, or speaker for Bayer Dermatology, manufacturer of the product tested.

[email protected]

Twice-daily application of 0.05% desonide hydrogel significantly improved clinical symptoms of itching and quality of life scores in 100% of patients with mild to moderate atopic dermatitis after 7 days in a small preliminary study.

"Increasingly, researchers and clinicians recognize that disrupted barrier function contributes not only to the xerotic and pruritic manifestations of AD, but also to the inflammatory cascade that underlies the disease," wrote Dr. Leon Kircik of Indiana University, Indianapolis.

Data from previous studies have shown the effectiveness of desonide hydrogel 0.05% for atopic dermatitis in children, but few studies have examined the effectiveness of the gel on itching in particular. In this study, patients applied the gel twice daily, with assessments at baseline, day 3, and day 7 (J. Drugs Dermatol. 2014;13:725-8).

At day 7, all patients achieved the primary endpoint of at least a 50% reduction in pruritus. The average Investigator’s Global Assessment (IGA) scale score was .55 (down from 2.35 at baseline), which translated to a 76% improvement from baseline. The visual analog score decreased by an average of 6.4 points, for an average reduction of 85%. Statistically significant improvements from baseline in both IGA and visual analog scores also were noted at day 3, when the average IGA score improved 27% from baseline, and the mean visual analog score showed a 53% reduction.

The study included 20 atopic dermatitis patients ranging in age from 8 to 68 years, with an average age of 25 years; 60% were black, 40% were white, and 75% were female.

The results suggest that hydrogel is an appropriate option to relieve itchiness in AD patients, and a large, randomized, double-blind controlled trial would be helpful to further study effectiveness, Dr. Kircik said.

Dr. Kircik disclosed receiving funding as an investigator, consultant, or speaker for Bayer Dermatology, manufacturer of the product tested.

[email protected]

Twice-daily application of 0.05% desonide hydrogel significantly improved clinical symptoms of itching and quality of life scores in 100% of patients with mild to moderate atopic dermatitis after 7 days in a small preliminary study.

"Increasingly, researchers and clinicians recognize that disrupted barrier function contributes not only to the xerotic and pruritic manifestations of AD, but also to the inflammatory cascade that underlies the disease," wrote Dr. Leon Kircik of Indiana University, Indianapolis.

Data from previous studies have shown the effectiveness of desonide hydrogel 0.05% for atopic dermatitis in children, but few studies have examined the effectiveness of the gel on itching in particular. In this study, patients applied the gel twice daily, with assessments at baseline, day 3, and day 7 (J. Drugs Dermatol. 2014;13:725-8).

At day 7, all patients achieved the primary endpoint of at least a 50% reduction in pruritus. The average Investigator’s Global Assessment (IGA) scale score was .55 (down from 2.35 at baseline), which translated to a 76% improvement from baseline. The visual analog score decreased by an average of 6.4 points, for an average reduction of 85%. Statistically significant improvements from baseline in both IGA and visual analog scores also were noted at day 3, when the average IGA score improved 27% from baseline, and the mean visual analog score showed a 53% reduction.

The study included 20 atopic dermatitis patients ranging in age from 8 to 68 years, with an average age of 25 years; 60% were black, 40% were white, and 75% were female.

The results suggest that hydrogel is an appropriate option to relieve itchiness in AD patients, and a large, randomized, double-blind controlled trial would be helpful to further study effectiveness, Dr. Kircik said.

Dr. Kircik disclosed receiving funding as an investigator, consultant, or speaker for Bayer Dermatology, manufacturer of the product tested.

[email protected]

Twice-daily application of 0.05% desonide hydrogel significantly improved clinical symptoms of itching and quality of life scores in 100% of patients with mild to moderate atopic dermatitis after 7 days in a small preliminary study.

"Increasingly, researchers and clinicians recognize that disrupted barrier function contributes not only to the xerotic and pruritic manifestations of AD, but also to the inflammatory cascade that underlies the disease," wrote Dr. Leon Kircik of Indiana University, Indianapolis.

Data from previous studies have shown the effectiveness of desonide hydrogel 0.05% for atopic dermatitis in children, but few studies have examined the effectiveness of the gel on itching in particular. In this study, patients applied the gel twice daily, with assessments at baseline, day 3, and day 7 (J. Drugs Dermatol. 2014;13:725-8).

At day 7, all patients achieved the primary endpoint of at least a 50% reduction in pruritus. The average Investigator’s Global Assessment (IGA) scale score was .55 (down from 2.35 at baseline), which translated to a 76% improvement from baseline. The visual analog score decreased by an average of 6.4 points, for an average reduction of 85%. Statistically significant improvements from baseline in both IGA and visual analog scores also were noted at day 3, when the average IGA score improved 27% from baseline, and the mean visual analog score showed a 53% reduction.

The study included 20 atopic dermatitis patients ranging in age from 8 to 68 years, with an average age of 25 years; 60% were black, 40% were white, and 75% were female.

The results suggest that hydrogel is an appropriate option to relieve itchiness in AD patients, and a large, randomized, double-blind controlled trial would be helpful to further study effectiveness, Dr. Kircik said.

Dr. Kircik disclosed receiving funding as an investigator, consultant, or speaker for Bayer Dermatology, manufacturer of the product tested.

[email protected]

Twice-daily application of 0.05% desonide hydrogel significantly improved clinical symptoms of itching and quality of life scores in 100% of patients with mild to moderate atopic dermatitis after 7 days in a small preliminary study.

"Increasingly, researchers and clinicians recognize that disrupted barrier function contributes not only to the xerotic and pruritic manifestations of AD, but also to the inflammatory cascade that underlies the disease," wrote Dr. Leon Kircik of Indiana University, Indianapolis.

Data from previous studies have shown the effectiveness of desonide hydrogel 0.05% for atopic dermatitis in children, but few studies have examined the effectiveness of the gel on itching in particular. In this study, patients applied the gel twice daily, with assessments at baseline, day 3, and day 7 (J. Drugs Dermatol. 2014;13:725-8).

At day 7, all patients achieved the primary endpoint of at least a 50% reduction in pruritus. The average Investigator’s Global Assessment (IGA) scale score was .55 (down from 2.35 at baseline), which translated to a 76% improvement from baseline. The visual analog score decreased by an average of 6.4 points, for an average reduction of 85%. Statistically significant improvements from baseline in both IGA and visual analog scores also were noted at day 3, when the average IGA score improved 27% from baseline, and the mean visual analog score showed a 53% reduction.

The study included 20 atopic dermatitis patients ranging in age from 8 to 68 years, with an average age of 25 years; 60% were black, 40% were white, and 75% were female.

The results suggest that hydrogel is an appropriate option to relieve itchiness in AD patients, and a large, randomized, double-blind controlled trial would be helpful to further study effectiveness, Dr. Kircik said.

Dr. Kircik disclosed receiving funding as an investigator, consultant, or speaker for Bayer Dermatology, manufacturer of the product tested.

[email protected]

WAIKOLOA, HAWAII – The 2014 update of the American Academy of Dermatology guidelines on atopic dermatitis take a strong stance in favor of the use of topical calcineurin inhibitors as topical corticosteroid-sparing agents, even in children less than 2 years old, where the use of the medications remains off-label.

The evidence-based AAD guidelines bestow a Class A, Level of Evidence I recommendation for the use of topical calcineurin inhibitors as topical steroid-sparing agents. The proactive use of topical calcineurin inhibitors as proactively scheduled, short-term, intermittent maintenance therapy to prevent disease flares also gets an A-I recommendation in the guidelines. The report states that there is no need to monitor blood levels of topical calcineurin inhibitors, Dr. Wynnis Tom noted at the Hawaii Dermatology Seminar, sponsored by the Global Academy for Medical Education/Skin Disease Education Foundation.

The guidelines emphasize the importance of having a proactive discussion with the patient and/or parents about the black box warning for topical calcineurin inhibitors, stressing the fact that interim analyses of long-term surveillance studies do not show an increase in malignancies, said Dr. Tom, a member of the working group that developed the AAD guidelines and a pediatric dermatologist at the University of California, San Diego.

The section of the guidelines devoted to topical therapies includes a detailed description of wet wrap therapy, which is useful for quickly reducing atopic dermatitis severity during flares. The use of topical antihistamines gets a strong thumbs-down in the guidelines.

The guidelines go into considerable detail about the importance of fixing the skin barrier. Bathing is recommended as an important component of therapy, with the caveat that there is no good evidence as to the optimal frequency or duration.

"You want to get the crusting off and hydrate the skin; but you do have to be careful of how long the bath lasts, because you don’t want the skin to dry out as the water evaporates," Dr. Tom said. "I find bathing even daily is good, so long as people are using moisturizers afterward. That’s the key part both for treatment and maintenance: liberal use of moisturizers."

The guideline panel determined that while moisturizers are a cornerstone of atopic dermatitis therapy, no one moisturizer product has been shown to be better than the others. And that includes the prescription devices containing ceramides or hydrolipids, which haven’t persuasively been shown to have clinical advantages over inexpensive over-the-counter moisturizers.

The 2014 atopic dermatitis guidelines are the first-ever AAD guidelines to include an entire section devoted to the diagnosis of a dermatologic disorder (J. Am. Acad. Dermatol. 2014;70:338-51). This was deemed necessary because misdiagnosis of atopic dermatitis is a problem, particularly in adults.

The guidelines stress that atopic dermatitis is a clinical diagnosis that requires ruling out conditions including contact dermatitis, cutaneous T-cell lymphoma, psoriasis, photosensitivity reactions, seborrheic dermatitis, and immune deficiency diseases. At this time, no specific biomarkers can be recommended for the diagnosis of atopic dermatitis or assessment of its severity. In particular, according to the guidelines, the popular practice of monitoring immunoglobulin E levels isn’t recommended.

The comprehensive guidelines also include a section on phototherapy and systemic agents. In addition, a section on preventing disease flares and the use of adjunctive therapies is slated for release in June.

Dr. Tom reported serving as a financially uncompensated investigator for studies sponsored by Amgen and Anacor. SDEF and this news organization are owned by the same parent company.

[email protected]

WAIKOLOA, HAWAII – The 2014 update of the American Academy of Dermatology guidelines on atopic dermatitis take a strong stance in favor of the use of topical calcineurin inhibitors as topical corticosteroid-sparing agents, even in children less than 2 years old, where the use of the medications remains off-label.

The evidence-based AAD guidelines bestow a Class A, Level of Evidence I recommendation for the use of topical calcineurin inhibitors as topical steroid-sparing agents. The proactive use of topical calcineurin inhibitors as proactively scheduled, short-term, intermittent maintenance therapy to prevent disease flares also gets an A-I recommendation in the guidelines. The report states that there is no need to monitor blood levels of topical calcineurin inhibitors, Dr. Wynnis Tom noted at the Hawaii Dermatology Seminar, sponsored by the Global Academy for Medical Education/Skin Disease Education Foundation.

The guidelines emphasize the importance of having a proactive discussion with the patient and/or parents about the black box warning for topical calcineurin inhibitors, stressing the fact that interim analyses of long-term surveillance studies do not show an increase in malignancies, said Dr. Tom, a member of the working group that developed the AAD guidelines and a pediatric dermatologist at the University of California, San Diego.

The section of the guidelines devoted to topical therapies includes a detailed description of wet wrap therapy, which is useful for quickly reducing atopic dermatitis severity during flares. The use of topical antihistamines gets a strong thumbs-down in the guidelines.

The guidelines go into considerable detail about the importance of fixing the skin barrier. Bathing is recommended as an important component of therapy, with the caveat that there is no good evidence as to the optimal frequency or duration.

"You want to get the crusting off and hydrate the skin; but you do have to be careful of how long the bath lasts, because you don’t want the skin to dry out as the water evaporates," Dr. Tom said. "I find bathing even daily is good, so long as people are using moisturizers afterward. That’s the key part both for treatment and maintenance: liberal use of moisturizers."

The guideline panel determined that while moisturizers are a cornerstone of atopic dermatitis therapy, no one moisturizer product has been shown to be better than the others. And that includes the prescription devices containing ceramides or hydrolipids, which haven’t persuasively been shown to have clinical advantages over inexpensive over-the-counter moisturizers.

The 2014 atopic dermatitis guidelines are the first-ever AAD guidelines to include an entire section devoted to the diagnosis of a dermatologic disorder (J. Am. Acad. Dermatol. 2014;70:338-51). This was deemed necessary because misdiagnosis of atopic dermatitis is a problem, particularly in adults.

The guidelines stress that atopic dermatitis is a clinical diagnosis that requires ruling out conditions including contact dermatitis, cutaneous T-cell lymphoma, psoriasis, photosensitivity reactions, seborrheic dermatitis, and immune deficiency diseases. At this time, no specific biomarkers can be recommended for the diagnosis of atopic dermatitis or assessment of its severity. In particular, according to the guidelines, the popular practice of monitoring immunoglobulin E levels isn’t recommended.

The comprehensive guidelines also include a section on phototherapy and systemic agents. In addition, a section on preventing disease flares and the use of adjunctive therapies is slated for release in June.

Dr. Tom reported serving as a financially uncompensated investigator for studies sponsored by Amgen and Anacor. SDEF and this news organization are owned by the same parent company.

[email protected]

WAIKOLOA, HAWAII – The 2014 update of the American Academy of Dermatology guidelines on atopic dermatitis take a strong stance in favor of the use of topical calcineurin inhibitors as topical corticosteroid-sparing agents, even in children less than 2 years old, where the use of the medications remains off-label.

The evidence-based AAD guidelines bestow a Class A, Level of Evidence I recommendation for the use of topical calcineurin inhibitors as topical steroid-sparing agents. The proactive use of topical calcineurin inhibitors as proactively scheduled, short-term, intermittent maintenance therapy to prevent disease flares also gets an A-I recommendation in the guidelines. The report states that there is no need to monitor blood levels of topical calcineurin inhibitors, Dr. Wynnis Tom noted at the Hawaii Dermatology Seminar, sponsored by the Global Academy for Medical Education/Skin Disease Education Foundation.

The guidelines emphasize the importance of having a proactive discussion with the patient and/or parents about the black box warning for topical calcineurin inhibitors, stressing the fact that interim analyses of long-term surveillance studies do not show an increase in malignancies, said Dr. Tom, a member of the working group that developed the AAD guidelines and a pediatric dermatologist at the University of California, San Diego.

The section of the guidelines devoted to topical therapies includes a detailed description of wet wrap therapy, which is useful for quickly reducing atopic dermatitis severity during flares. The use of topical antihistamines gets a strong thumbs-down in the guidelines.

The guidelines go into considerable detail about the importance of fixing the skin barrier. Bathing is recommended as an important component of therapy, with the caveat that there is no good evidence as to the optimal frequency or duration.

"You want to get the crusting off and hydrate the skin; but you do have to be careful of how long the bath lasts, because you don’t want the skin to dry out as the water evaporates," Dr. Tom said. "I find bathing even daily is good, so long as people are using moisturizers afterward. That’s the key part both for treatment and maintenance: liberal use of moisturizers."

The guideline panel determined that while moisturizers are a cornerstone of atopic dermatitis therapy, no one moisturizer product has been shown to be better than the others. And that includes the prescription devices containing ceramides or hydrolipids, which haven’t persuasively been shown to have clinical advantages over inexpensive over-the-counter moisturizers.

The 2014 atopic dermatitis guidelines are the first-ever AAD guidelines to include an entire section devoted to the diagnosis of a dermatologic disorder (J. Am. Acad. Dermatol. 2014;70:338-51). This was deemed necessary because misdiagnosis of atopic dermatitis is a problem, particularly in adults.

The guidelines stress that atopic dermatitis is a clinical diagnosis that requires ruling out conditions including contact dermatitis, cutaneous T-cell lymphoma, psoriasis, photosensitivity reactions, seborrheic dermatitis, and immune deficiency diseases. At this time, no specific biomarkers can be recommended for the diagnosis of atopic dermatitis or assessment of its severity. In particular, according to the guidelines, the popular practice of monitoring immunoglobulin E levels isn’t recommended.

The comprehensive guidelines also include a section on phototherapy and systemic agents. In addition, a section on preventing disease flares and the use of adjunctive therapies is slated for release in June.

Dr. Tom reported serving as a financially uncompensated investigator for studies sponsored by Amgen and Anacor. SDEF and this news organization are owned by the same parent company.

[email protected]