Is Food-Triggered Atopic Dermatitis a Form of Systemic Contact Dermatitis?

Food allergy in atopic dermatitis is mediated by complex immune interactions between genetics, diet, environment, and the microbiome. When contact between inflamed skin and food antigens occurs, contact hypersensitivity can develop. Consequently, systemic contact dermatitis (SCD) can occur after ingestion of allergenic foods or food additives in the setting of a Th2 response with CLA-positive T cells, triggering dermatitis where skin resident memory lymphocytes reside. This phenomenon explains food-triggered dermatitis. Atopy patch tests (APTs) detect sensitization to food proteins responsible for SCD, which in turn can be confirmed by oral food challenge with delayed interpretation. We summarize the literature on using APTs to identify foods for oral challenge with dermatitis as an outcome. In dermatitis patients at risk for Th2 skewing based on a history of childhood-onset flexural dermatitis, shared decision …

MethodsWe systematically identified randomized controlled trials addressing systemic treatments for AD from inception to July 8, 2023 from MEDLINE, EMBASE, CENTRAL, Web of Science, and GREAT. We performed Bayesian random-effects network meta-analyses on AD severity, itch severity, sleep disturbance, AD-related quality of life, AD exacerbations, and adverse events. We used GRADE to rate the certainty of the evidence. A multidisciplinary panel including patient partners determined thresholds for patient-important benefits and harms.ResultsWe analyzed 154 trials enrolling 29,831 patients (pediatrics and adults) and evaluated 78 unique interventions over a median 13 weeks (range 1–52). High-dose upadacitinib was among the most effective in improving multiple patient-important outcomes, but among the most harmful. High-dose abrocitinib and low-dose upadacitinib were of intermediate …

Topical corticosteroids (TCSs) are the most widely used treatment for atopic dermatitis (AD), but they can have adverse effects such as skin atrophy, telangiectasias, and hypopigmentation, especially with prolonged use of higher potency steroids. Many patients also have a fear of using TCSs, known as “corticophobia.” With the development of biologics and Janus kinase inhibitors, a nonsteroidal approach to the treatment of AD may be possible and may be preferred by certain patients. Given what is known about these nonsteroidal therapies, we propose a structured treatment ladder and action plan that can guide clinicians and patients on the use of these therapies for the treatment of AD. The ladder divides nonsteroidal medication classes into treatments for exacerbation versus maintenance therapies in an escalating order of increasing potential for adverse effects, both real and perceived. This treatment …

Atopic dermatitis (AD) has a complex pathogenesis that leads to the characteristic itchy, eczematous skin findings. Treatment of AD is aimed at alleviating symptoms, preventing exacerbations and infections, and minimizing long-term risks. Treatment depends on the extent and severity of the AD but almost always includes topical therapies as a first line and often in addition to other treatments. These topicals include a variety of moisturizers and non-pharmacologic preparations, steroids, crisaborole, and calcineurin inhibitors, as well as a topical Janus kinase (JAK) inhibitor. Each has strengths and weaknesses in terms of efficacy, accessibility, and safety/tolerability. Given the heterogeneity of AD, it is important to be able to call upon a variety of topical therapies to meet individual needs.

Clinics in Dermatology

ConclusionsAI-powered language models perform adequately on dermatology CME questions but do not consistently achieve the passing score required to receive credit. AI developers may wish to target procedural questions to push AI's performance into the passing range. AI is still a valuable resource for CME. Limitations of this study include a relatively small number of questions (N= 100) and categories of questions (N= 10). The external validity of ChatGPT and Claude's performance may vary considering the number of questions asked.

JAAD International

BackgroundEmpirical decisions to select therapies for psoriasis (PSO) and atopic dermatitis (AD) can lead to delays in disease control and increased healthcare costs. However, routine molecular testing for AD and PSO are lacking.ObjectiveTo examine 1) how clinicians choose systemic therapies for patients with PSO and AD without molecular testing and 2) to determine how often the current approach leads to patients switching medications.MethodsA 20-question survey designed to assess clinician strategies for systemic treatment of AD and PSO was made available to attendees of a national dermatology conference in 2022.ResultsClinicians participating in the survey (265/414, 64% response rate) ranked “reported efficacy” as the most important factor governing treatment choice (P<.001). However, 62% (165/265) of clinicians estimated that two or more systemic medications were typically required to achieve …

SKIN The Journal of Cutaneous Medicine

Introduction: Tralokinumab, an IL-13 targeted biologic approved in the United States (US) for adult patients with moderate-to-severe atopic dermatitis (AD), improved patient-reported outcomes (PROs) in clinical trials and after 4 weeks of use in the real-world setting. This 6-month interim analysis evaluated the real-world impact of tralokinumab on PROs in adult patients.Methods: This is an interim analysis of an ongoing 52-week patient survey study enrolling US AD patients from the Adbry TM Advocate TM Program. Patients completed the baseline survey close to tralokinumab initiation. Data on demographics and PROs including weekly itch numeric rating scale (NRS), eczema-related weekly sleep NRS, Dermatology Life Quality Index (DLQI), and Treatment Satisfaction Questionnaire for Medication (TSQM-9) were collected. Percent and absolute changes from baseline to 6 months of treatment were calculated. Outcomes are stratified by previous dupilumab use. The percentage of patients experiencing minimal clinically important difference (MCID) was also calculated for itch NRS (3-point reduction) and DLQI (4-point reduction).Results: As of May 2023, 102 patients completed baseline, 1-month, and 6-month surveys. Of these, 59.8% were female, mean age was 44.2 years (SD= 15.7), 82.4% were white, and 85.3% had private insurance. 84.3% were previously treated with topical corticosteroids (TCS) and 52.9% were dupilumab-experienced patients. Over 6 months, there was an improvement in the mean sleep interference NRS (40%), average weekly itch NRS (39%), worst weekly itch NRS (33%), PO-SCORAD (37%), and DLQI (52%). There …

MethodsWe systematically identified randomized controlled trials addressing topical treatments for AD from MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, ICTRP, and GREAT to July 8, 2023. We excluded split-body trials. We performed Bayesian random-effects network meta-analyses on AD severity, itch severity, sleep disturbance, AD-related quality of life, AD exacerbations, and harms. We used GRADE to rate certainty of evidence. A multidisciplinary panel including patient partners determined thresholds for patient-important benefits and harms.ResultsWe analyzed 235 trials enrolling 46,315 patients (pediatrics and adults) and evaluated 69 unique interventions over a median 4 weeks for induction and 16 weeks for maintenance (overall range 1–156). To gain AD control, pimecrolimus improved the most outcomes, while tacrolimus, moderatepotency corticosteroids, delgocitinib, and ruxolitinib had …

British Journal of Dermatology

Introduction/Background Atopic dermatitis (AD) is a chronic disease affecting children and adults and requires long-term treatment. Moderate-to-severe AD causes itching, which considerably impacts sleep. Interleukin (IL)-13 is the key cytokine in the skin of patients with AD. Lebrikizumab (LEB) is a novel monoclonal antibody that binds with high affinity and slow off-rate to IL-13, thereby blocking the downstream effects of IL-13 with high potency. LEB has demonstrated efficacy and maintained improvement in measures of itch and sleep over 52 weeks in previous phase 3 trials. ADhere (NCT04250337) was a 16-week, randomized, double-blinded, placebo-controlled, phase 3 clinical trial, where patients were treated with LEB and topical corticosteroids (TCS) vs placebo and TCS. LEB responders from ADhere at week 16 were defined as having Investigator’s Global Assessment response of 0 or 1 or …

Clinical and Experimental Dermatology

We elaborate on our previously published article by asking ChatGPT to create images for each of the diagnoses previously asked in our article. We assess ChatGPT's internal validity by calculating the accuracy of ChatGPT's responses provided to its own images.

BackgroundAtopic dermatitis (AD) typically starts in infancy and early childhood. The chronic skin disorder is associated with recurrent flares, pruritus, and genetic predisposition. Daily use of moisturizers that contain lipids, such as ceramides, reduces the rate of AD flares and the need for topical steroid treatment. We aimed to provide insights on AD attenuation to tailor AD prescription therapy, skin care, and maintenance treatment to improve pediatric patients with AD and families.MethodsA panel of 6 pediatric dermatologists and dermatologists who treat neonates, infants, and children developed a consensus paper on AD attenuation for pediatric patients. The modified Delphi process comprised a face-to-face panel meeting and online follow-up to discuss the systematic literature search results and draw from clinical experience and opinion of the panel to adopt and agree on 5 statements. Results: Understanding the functional properties of newborn and infant skin, discussing skincare product use with parents, and recommending tailored prescription and skincare routines can improve newborn, infant, and children’s skin health. Studies on the prophylactic application of moisturizers initiated in early infancy suggest moisturizers may delay rather than prevent AD, especially in high-risk populations and when used continuously. Increasingly there is evidence that moisturizer application reduces the severity of AD and extends the time to flares, which may help attenuate the atopic march. The protective effect of skin care for AD has been observed in studies where its daily use is ongoing; these beneficial effects may be lost in less than 1year after …

British Journal of Dermatology

IntroductionIntegrated safety data for lebrikizumab (LEB) treatment in moderate-to-severe atopic dermatitis (AD) has been previously published. Conjunctivitis and keratitis were identified as adverse events (AEs) of special interest in the AD program. Objectives Further characterize patient-reported conjunctivitis and keratitis AEs in LEB clinical trials for AD. Methods Data from adult and adolescent patients were analyzed in 2 groups: a) LEB 250mg every 2 weeks (LEBQ2W, N=783) vs placebo (PBO, N=404), weeks 0-16 (PC 0-16wk) from 4 clinical trials (ADvocate1, ADvocate2, ADhere, Phase 2b study); and b) patients who received at least one dose of LEB (ALL-LEB, N=1720) from 8 clinical trials (ADvocate1, ADvocate2, ADhere, ADore, ADjoin (ongoing), ARBAN, TREBLE, Phase 2b study). Conjunctivitis and keratitis refer to cluster definitions defined by …

Journal of Integrative Dermatology

The use of complementary and alternative approaches in rosacea, a common, yet poorly understood chronic facial condition with an unknown etiology, has continued to grow. Recent studies have implicated oxidative stress in the pathophysiology of rosacea. As a result, there has been increasing interest in evaluating the effects of using naturally occurring antioxidants as therapeutic agents for managing rosacea. We discuss therapeutic applications of grape seed extract (GSE), vitamin C, azelaic acid, and zinc which have been studied for effects on reducing rosacea.

SKIN The Journal of Cutaneous Medicine

Introduction: The decision to initiate systemic therapy (ST) in patients with atopic dermatitis (AD) is complex, with no criteria that are globally agreed upon. To aid dermatology providers in this decision-making, the “When to Start Systemic Therapy Checklist” was developed. The checklist comprises three components:(A) clinical severity,(B) subjective burden, and (C) lack of treatment response, each with several criteria. Systemic therapy is indicated when at least one criterion in each component is fulfilled. To corroborate the validity of this checklist, we evaluated the agreement between the decision to initiate ST using the checklist, against the reference, CorEvitas AD Registry patients prescribed a ST.Methods: Adults with moderate-to-severe AD from the prospective, longitudinal CorEvitas AD registry were included in this descriptive analysis (July 2020–August 2023). Patients were included if they were initiating ST at enrollment (ST group) or not initiating ST at enrollment (non-ST group) but had vIGA-AD®≥ 3 and Eczema Area Severity Index≥ 12. The checklist criteria were compared against registry outcome measures; when a criterion did not match a measure, either a proxy measure was selected or that part of the questionnaire was excluded. Overall percentage agreement (accord between checklist criteria and ST initiation status [reference standard]) with corresponding 95% confidence intervals (CIs) was calculated.Results: In the ST group (n= 1488), 97.0% of patients met at least one criterion from section A, 94.1% from section B, and 92.1% for either section A or B. In the non-ST group (n= 208), 100% of patients met at least one criterion …

Journal of the European Academy of Dermatology and Venereology: JEADV

A large language model artificial intelligence for patient queries in atopic dermatitis A large language model artificial intelligence for patient queries in atopic dermatitis J Eur Acad Dermatol Venereol. 2024 Jan 3. doi: 10.1111/jdv.19737. Online ahead of print. Authors Pranvera Sulejmani 1 , Olivia Negris 1 , Valeria Aoki 2 , Chia-Yu Chu 3 , Lawrence Eichenfield 4 , Laurent Misery 5 , Ana Mosca 6 , Raquel Leão Orfali 2 , Markéta Saint Aroman 7 , Jean-Francois Stalder 8 , Magdalena Trzeciak 9 , Andreas Wollenberg 10 11 , Peter Lio 12 Affiliations 1 Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA. 2 Departamento of Dermatology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil. 3 Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. 4 Departments of Dermatology and Pediatrics…

Annals of Allergy, Asthma & Immunology

BackgroundGuidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology.ObjectiveTo produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD.MethodsA multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group …

Topical corticosteroids, topical steroid-sparing agents, and emollients are all used to treat atopic dermatitis. However, there are no formal guidelines dictating the order and timing in which these topical modalities should be applied. Additionally, the order of application may change drug absorption, efficacy, and distribution. This is especially important for patients with atopic dermatitis. These patients have a dysfunctional skin barrier, which can lead to greater systemic absorption of drugs. Moreover, children already have an increased rate of systemic absorption due to a higher ratio of body surface area to body weight. Thus, the order of application of topical regimens is of the utmost importance in pediatric dermatology. This manuscript presents an updated review of the literature with a focus on guiding clinicians toward the best practices from the available resources.

# Background The integumentary system is one of the many organ systems that changes during pregnancy. Pruritus is an extremely common and distressing dermatologic symptom in pregnancy. # Objective This review aims to discuss the teratogenicity of traditional and integrative treatment for pruritus in pregnancy. # Methods and Materials This review was conducted by doing an extensive literature search of multiple sources, including PubMed, Cochrane Library, and MedLine. # Results Traditional treatments for pruritus in pregnancy include phototherapy, antihistamines, and immunosuppressants. Integrative treatments for pruritus include acupuncture, cupping, and topical vitamin C. # Conclusion Holistic regimens for pruritus are effective and safe in pregnancy. Integrative treatment should be incorporated with conventional treatments to maximize the alleviation of symptoms.

British Journal of Dermatology

Introduction/Background Tralokinumab, an IL-13 targeted biologic approved in the United States (US) for adult patients with moderate-to-severe atopic dermatitis (AD), improved patient-reported outcomes (PROs) in clinical trials and after 4 weeks of use in the real-world setting. Objectives This 6-month interim analysis evaluated the real-world impact of tralokinumab on PROs in adult patients. Methods This is an interim analysis of an ongoing 52-week patient survey study enrolling US AD patients from the AdbryTM AdvocateTM Program. Patients completed the baseline survey close to tralokinumab initiation. Data on demographics and PROs including weekly itch numeric rating scale (NRS), eczema-related weekly sleep NRS, Dermatology Life Quality Index (DLQI), and Treatment Satisfaction Questionnaire for Medication (TSQM-9) were collected. Percent …

SKIN The Journal of Cutaneous Medicine

Methods• Robust gene expression is obtained from lesional PSO, AD, and MF samples collected by non-invasive skin scraping.