Peter Lio

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.

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.

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 …

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 …

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 …

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 …

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 …

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.

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 …

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…

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.

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 …

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

ImportanceInconsistent reporting of outcomes in clinical trials of rosacea is impeding and likely preventing accurate data pooling and meta-analyses. There is a need for standardization of outcomes assessed during intervention trials of rosacea.ObjectiveTo develop a rosacea core outcome set (COS) based on key domains that are globally relevant and applicable to all demographic groups to be used as a minimum list of outcomes for reporting by rosacea clinical trials, and when appropriate, in clinical practice.Evidence ReviewA systematic literature review of rosacea clinical trials was conducted. Discrete outcomes were extracted and augmented through discussions and focus groups with key stakeholders. The initial list of 192 outcomes was refined to identify 50 unique outcomes that were rated through the Delphi process Round 1 by 88 panelists (63 physicians from 17 countries and 25 patients with rosacea in …

Background Atopic dermatitis (AD) is associated with patient burden, but few studies describe the anatomic distribution of the disease or the impact of number of lesion locations. Objectives To describe lesion locations and assess the relationship between the number of lesion locations (disease extent) and disease burden in patients with AD. Methods This cross‐sectional study included adults with dermatologist‐ or dermatology practitioner‐diagnosed AD enroled in the CorEvitas AD Registry (2020–2021) who initiated systemic therapy within 12 months prior to or at enrolment or had moderate‐to‐severe AD (vIGA‐AD® ≥3 and EASI ≥12) at enrolment. Thirteen areas of lesion involvement were assessed using a body map, and numbers of lesion locations were categorised as: 0, 1, 2–3, 4–6 and ≥7. Demographics, disease characteristics, PROs by number of lesion locations were descriptively compared …

BackgroundLAVOLTA (L)I, LII, and ACOUSTICS were randomized, placebo-controlled, Phase 3 trials of lebrikizumab, a monoclonal antibody targeting interleukin-13, in patients with uncontrolled asthma. Failure to demonstrate efficacy may have been related to patient selection in those trials.ObjectiveTo assess the efficacy in a well-defined subpopulation of patients with elevated blood eosinophil counts and a minimum number of prior asthma exacerbations. An additional analysis in a subpopulation of patients with elevated fractional exhaled nitric oxide (FeNO) and prior exacerbations was performed.MethodsAdult (LI and LII) and adolescent patients (12-17 years weighing ≥40kg, ACOUSTICS) with uncontrolled asthma received lebrikizumab (125mg, N=832 or 37.5mg, N=829) or placebo (N=833) subcutaneously every 4 weeks. Post-hoc analysis of the annualized adjusted exacerbation rate (AER) was …

Itch and sleep loss due to itch are prevalent symptoms of moderate-to-severe atopic dermatitis, significantly impairing patients’ quality of life and wellbeing. First-line topical therapy is insufficient for most patients and there is an unmet need for effective treatments that provide symptom relief and quality of life improvement. In two randomized, placebo-controlled, phase III trials, significantly more patients treated with the novel monoclonal antibody lebrikizumab had ≥ 3-point improvement in Pruritus Numeric Rating Scale by week 16 vs. patients treated with placebo. In addition, significantly more patients treated with lebrikizumab achieved ≥ 1-point improvement in Sleep-Loss Scale score by week 16 vs. placebo. Onset of itch relief was rapid, occurring within the first few days of treatment.

Skin cancer trends continue to rise with the majority of cases attributable to ultraviolet radiation exposure. Studies show that regular sunscreen use reduces the risk of both melanoma and non-melanoma skin cancers. However, limitations and flaws exist with the current generation of sunscreens– both chemical filters and physical blockers. Innovative sun protection solutions are needed on the market to assuage patient concerns regarding the safety of sunscreens, broad spectrum and visible light coverage, and their potential impact on the environment. This narrative review aims to highlight promising new filter technologies that may have better safety profiles and provide comparable or superior sun protection to current available sunscreens.

In the TRuE-AD1/2 studies, patients aged≥ 12 years with atopic dermatitis (Investigator’s Global Assessment [IGA] 2/3; 3%–20% affected body surface area) were randomized (2: 2: 1) to twice-daily 0.75%/1.5% ruxolitinib cream or vehicle for an 8-week, double-blind period followed by a 44-week long-term safety (LTS) period of as-needed ruxolitinib cream. This analysis examines associations between Week 8 responder status to 1.5% ruxolitinib cream with LTS outcomes. At Week 8, 57.0%(244/428) of LTS-evaluable patients applying 1.5% ruxolitinib cream achieved IGA–Treatment Success (IGA-TS; IGA 0/1 with≥ 2-grade improvement from baseline); 66.6%(285/428) achieved≥ 75% improvement in Eczema Area and Severity Index from baseline (EASI-75); 45.8%(196/428) achieved Itch numerical rating scale 0/1 (NRS 0/1). For patients with≥ 2 visits (every 4 weeks) during LTS, mean percentages of visits with clear/almost clear skin were 83.2% vs 59.7%, 82.2% vs 54.9%, and 77.3% vs 70.1% for Week 8 IGA-TS, EASI-75, and Itch NRS 0/1 responders vs nonresponders, respectively. Mean percentages of visits with clear/almost clear skin were similar regardless of time to achieve IGA-TS (83.4%/77.4%/81.9% for those achieving at Week 2/4/8), EASI-75 (80.7%/78.8%/81.6%), and Itch NRS 0/1 (75.8%/70.7%/72.8%). During LTS, mean (SD) cumulative treatment-free days due to complete clearance were 149.2 (86.43) vs 104.0 (89.10), 146.4 (88.43) vs 95.9 (83.55), and 142.6 (87.58) vs 124.4 (91.47) for Week 8 IGA-TS, EASI-75, and Itch NRS 0/1 responders vs nonresponders, respectively. Percentage of treatment-free days between study …

"Epithelia Under Attack: The Skin, Gut, and Respiratory Barriers" by Krishna Patel and Peter Lio Home Search Browse Collections My Account About DC Network Digital Commons Network™ Skip to main content DigitalCommons@KCU Home About FAQ My Account < Previous Next > Home Research@KCU STUDENTPUB 719 Student Publications Epithelia Under Attack: The Skin, Gut, and Respiratory Barriers Authors Krishna Patel, Kansas City University Peter Lio, Northwestern University Document Type Article Publication Title The Dermatology Digest Publication Date 2-26-2024 ISSN 2996-4458 Recommended Citation Patel K, Lio P. Epithelia Under Attack: The Skin, Gut, and Respiratory Barriers. The Dermatology Digest. 2024; . Link to Full Text Share COinS Search Enter search terms: Select context to search: Advanced Search Notify me via email or RSS Browse Collections Disciplines Authors Author Corner …

Previous analyses have demonstrated the validity and reliability of the Atopic Dermatitis Control Tool (ADCT) in assessing patient-perceived control of atopic dermatitis (AD). We evaluated levels of agreement between patient and clinician assessments of AD control using the ADCT and clinician global assessment of control, respectively, providing further support to the measurement properties of the ADCT.

BACKGROUND■ AD is a chronic skin disease that can be a serious burden, affecting sleep, daily activities, and social relationships1■ Lebrikizumab is a monoclonal antibody that binds with high affinity and slow off-rate to IL-13, thereby blocking the downstream effects of IL-13 with high potency2■ Integrated safety data for lebrikizumab treatment in moderate-to-severe AD has been previously published in Phase 2 and 3 clinical trials3-6■ Conjunctivitis and keratitis are events of special interest in moderate-to-severe AD and are reported more frequently in lebrikizumab-treated patients7

BACKGROUND■ Lebrikizumab 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 potency1

ImportancePatient values and preferences can inform atopic dermatitis (AD) care. Systematic summaries of evidence addressing patient values and preferences have not previously been available.ObjectiveTo inform American Academy of Allergy, Asthma & Immunology (AAAAI)/American College of Allergy, Asthma and Immunology (ACAAI) Joint Task Force on Practice Parameters AD guideline development, patient and caregiver values and preferences in the management of AD were systematically synthesized.Evidence ReviewPaired reviewers independently screened MEDLINE, Embase, PsycINFO, and CINAHL databases from inception until March 20, 2022, for studies of patients with AD or their caregivers, eliciting values and preferences about treatment, rated risk of bias, and extracted data. Thematic and inductive content analysis to qualitatively synthesize the findings was used. Patients, caregivers, and …

Acne Vulgaris is a common inflammatory skin disorder characterized by skin eruptions, pustules, papules, and cysts. Treatment of acne vulgaris can often lead to the formation of many different scar types with the most common being atrophic. Scarring is a known sequela of acne vulgaris and can often reduce a patient’s quality of life and self-image. There are multiple modalities to treat acne scars. However, epidemiologic data on acne scarring is scarce and lacks uniformity. In this review, we analyze recent treatment modalities that have shown efficacy in reducing or preventing acne scarring. Many of these therapies can be integrated concomitantly into a patient’s treatment plan in order to improve outcomes and patient satisfaction. Among the therapies discussed, efficacy seems promising for 0.3% Adapalene, Adapalene 0.3/Benzoyl peroxide 2.5%, Isotretinoin, DA-5520, and Epidermal Growth Factor. This review summarizes clinical evidence surrounding integrative therapies for scarring reduction and prevention in the treatment of acne vulgaris.

Within a continually evolving healthcare climate, developments in the delivery of educational opportunities have come to the forefront of continuing medical education. The evolution of technology in medical education has allowed for platforms such as podcasts, simulations, gaming, and social media to gain traction as a way for providers to meet continuing education requirements while gaining knowledge and expanding their skillset. These novel methods of communicating information with healthcare providers have gained popularity but lack representation in the literature. With the growing adoption of integrative medicine, these modalities are important to discuss as they are methodologies by which healthcare providers can access information that may not be available on conventional scientific and educational platforms.

Lower incidence but higher mortality in COVID-19 hospitalizations among systemic sclerosis patients - PMC Back to Top Skip to main content NIH NLM Logo Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation Search PMC Full-Text Archive Search in PMC Advanced Search User Guide Journal List JAAD Int v.11; 2023 Jun PMC9822550 Other Formats PubReader PDF (98K) Actions Cite Collections Share Permalink Copy RESOURCES Similar articles Cited by other articles Links to NCBI Databases Journal List JAAD Int v.11; 2023 Jun PMC9822550 As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Logo of jdin JAAD Int. 2023 Jun; 11: 8–10. Published online 2023 Jan 7. doi: 10.1016/j.jdin.…

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by eczematous morphology and intense pruritus. Previous clinical trials have demonstrated that upadacitinib (UPA) was superior to placebo (PBO) in the treatment of moderate-to-severe AD. Here, we analyse the efficacy and safety of UPA across 52 weeks in adolescent and adult subgroups from three phase 3 studies. Patients were randomized to UPA 15 mg (UPA15), UPA 30 mg (UPA30) or PBO orally once daily, either alone or with concomitant topical corticosteroids. After 16 weeks, patients in the PBO group were randomized to the UPA15 or UPA30 groups. For both adolescent and adult subgroups at 52 weeks, the proportion of responders in the UPA15 and UPA30 groups was: ≥70% and 83% for EASI75, ≥31% and 47% for vIGA-AD 0/1 and ≥37% and 61% for Worst Pruritus Numeric Rating Scale improvement ≥4. Children …

Aim New topical agents have been developed for the treatment of atopic dermatitis (AD) in recent years. This systematic review is intended to synthesize the clinical trial literature and concisely report the updated safety and adverse effects of topical medications used to treat atopic dermatitis in children. Methods A systematic search of Cochrane Library, Embase, PubMed and ClinicalTrials.gov from inception to March 2022 was conducted for trials of topical medications used to treat AD in patients <18 years (PROSPERO #CRD42022315355). Included records were limited to English‐language publications and studies of ≥3 weeks duration. Phase 1 studies and those that lacked separate paediatric safety reporting were excluded. Results A total of 5005 records were screened; 75 records met inclusion criteria with 15 845 paediatric patients treated with tacrolimus, 12 851 treated with pimecrolimus, 3539 with …

Background: Topical steroid withdrawal syndrome (TSWS) is a debilitating condition characterized by red, itchy, burning skin that occurs after cessation of topical corticosteroids use. Lack of established diagnostic criteria and a limited understanding of disease pathophysiology makes diagnosis of TSWS challenging. While there have been increasing reports and clinical cases to date (1-3) it lacks formal recognition as a disease entity due to its heterogeneity in time to onset, morphology, distribution, and response to intervention. The aim of this study is to develop a definition of TSWS that is reinforced with validated diagnostic criteria and reaches consensus among international experts. A 3-round modified Delphi approach will be conducted with diagnostic items generated using expert interviews and literature review. Examples include “rank degree of importance of the presented diagnostic items: skin flushing bright …

Atopic dermatitis (AD) is a common, chronic and recurring inflammatory skin disorder characterized by an intensely pruritic, eczematous dermatitis. The etiology of AD is thought to involve a combination of environmental, genetic, and immunologic factors. Emerging research has investigated factors that may impact individual risk for developing AD, disease severity, and treatment response. One component is the gut microbiome, which is considered to play an essential role in maintaining the homeostasis of several organ systems. The gut microbiome has been described as a major regulator of the “gut–skin axis,” yet some studies have yielded conflicting evidence regarding the strength of the association of gut microbiota dysbiosis with AD. This review discusses recent insights into the role of the gut microbiome in AD pathogenesis and its interplay among other complex systems that govern the current assessments of and treatments for AD.

The origin of dermoscopy can be traced back to the middle of the 17^th^ century. Early contributions from Pierre Borel led to later refinement of the technique by physicians in the 19^th^ and 20^th^ centuries. In the 21^st^ century, the popularity of dermoscopy has risen rapidly. Evidence-based approaches, improvements in technique, and growing indications led to its near complete integration within the field of dermatology. This article not only serves to explore the major contributors and events that took place during the evolution of dermoscopy, but also serves to review dermoscopy's growing indications and modernization.

On November 30, 2022, OpenAI (San Francisco, CA) released ChatGPT, a large language model artificial intelligence (AI), with the ability to engage in sophisticated dialog. Features include answering direct prompts, garnering follow-up questions, and even admitting to mistakes in generated responses. 1 The use of ChatGPT in the field of pediatric dermatology has not been fully explored, although the American Academy of Dermatology (AAD) released a viewpoint on the feature stating that while useful, it cannot replace clinical decision making. 2 Since ChatGPT's full potential is unrealized, we provide a viewpoint on the potential effect of AI on anxiety levels in parents of children with atopic dermatitis (AD). On June 15, 2023, we compared the answers to commonly asked questions in AD (encountered by our authors in pediatric dermatology clinic) between ChatGPT-3.5 and the most updated version of Google …

Background The anatomic layers of the skin are well-defined, and a functional model of the skin barrier has recently been described. Barrier disruption plays a key role in several skin conditions, and moisturization is recommended as an initial treatment in conditions such as atopic dermatitis. This review aimed to analyze the skin barrier in the context of the function model, with a focus on the mechanisms by which moisturizers support each of the functional layers of the skin barrier to promote homeostasis and repair. Summary The skin barrier is comprised of four interdependent layers–physical, chemical, microbiologic, and immunologic–which maintain barrier structure and function. Moisturizers target disruption affecting each of these four layers through several mechanisms and were shown to improve transepidermal water loss in several studies. Occlusives, humectants, and emollients occlude the surface of the …

3. Szeto MD, Kokoska RE, Maghfour J, et al. An analysis of public sunscreen distribution in the United States during the COVID-19 pandemic. J Am Acad Dermatol. 2022; 86 (5): e241-e243. https://doi. org/10.1016/j. jaad. 2022.01. 020 4. Ilsley B. New sunscreen dispensers, CU Anschutz Medical Campus News. May 10, 2018. Accessed March 3, 2022. https://news. cuanschutz. edu/news-stories/new-sunscreen-dispensers 5. Esper TL. Supply chain management amid the coronavirus pandemic. J Public Policy Mark. 2021; 40 (1): 101-102. https://doi. org/10.1177/0743915620932150 https://doi. org/10.1016/j. jaad. 2022.09. 031

Background Dermatological conditions, especially when severe, can lead to sleep disturbances that affect a patient’s quality of life. However, limited research exists on the efficacy of treatments for improving sleep parameters in skin conditions. Objective The objective was to perform a systematic review of the literature on dermatological conditions and the treatments available for improving sleep parameters. Methods A literature review was performed using the PubMed, Ovid MEDLINE, Embase, Cochrane, and ClinicalTrials.gov databases from 1945 to 2021. After filtering based on our exclusion criteria, studies were graded using the SORT (Strength of Recommendation Taxonomy) algorithm, and only those receiving a grade of “2” or better were included. Results In total, 25 treatment studies (n=11,025) assessing sleep parameters related to dermatological conditions were found. Dupilumab appeared to be the best-supported and most effective treatment for improving sleep in atopic dermatitis (AD) but had frequent adverse effects. Topical treatments for AD were mostly ineffective, but procedural treatments showed some promise. Treatments for other conditions appeared efficacious. Conclusions The evaluation of sleep parameter changes in dermatological treatments is predominantly restricted to AD. Systemic interventions such as dupilumab and procedural interventions were the most efficacious. Sleep changes in other dermatoses were limited by a paucity of available studies. The inclusion of a sleep assessment component to a broader range of …

# Background Trace Elements (TEs) have a multitude of important functions in the skin, including maintaining structural integrity, mitigating oxidative damage, and accelerating wound healing. TEs have been used as primary or additional treatment in dermatologic disorders. Though TEs are vital to homeostasis, consumption over a threshold can lead to toxicity. # Objective This review aims to discuss the role of trace elements in the treatment of dermatological conditions as well as the potential side effects and toxicities of such therapies. # Methods This review was conducted by doing an extensive literature search of multiple sources, including PubMed, Cochrane Library, and MedLine. # Results Thermal Spring Water and Dead Sea Mud take advantage of the positive roles of trace elements in dermatology. In wound healing and collagen synthesis, zinc and copper have vital roles. Selenium inhibits tyrosinase at the cutaneous level. Silica supports the connective tissue matrix, but excess supplementation can have detrimental side effects. Topical strontium may be used to reduce pruritus. # Conclusion Trace minerals are imperative for healthy skin function. The lack of trace minerals may lead to premature graying, increased inflammation, and systemic evidence of oxidative damage.

Introduction (contexte de la recherche)Un algorithme relatif à la stratégie treat-to-target a récemment été développé pour guider l’utilisation des thérapies systémiques en vue du contrôle de la maladie chez l’adulte atteint d’une DA. Cet algorithme a mis en avant des critères visant à définir un objectif cible initial acceptable à 3 mois ainsi qu’un objectif cible optimal à 6 mois.ObjectifLes objectifs de cette analyse sont d’utiliser l’algorithme lié à la stratégie treat-to-target pour évaluer l’efficacité de l’upadacitinib (UPA), chez des patients adultes atteints d’une DA modérée à sévère, traités par UPA 15 mg ou 30 mg par voie orale en monothérapie 1 fois par jour ; à partir des données poolées des études de phase III, randomisées, contrôlées en double aveugle vs placebo : Measure Up 1 (MU1, NCT03569293) et Measure Up 2 (MU2, NCT03607422) ; ainsi que de déterminer la proportion de patients atteints d’une DA …

Atopic dermatitis (AD) is a chronic, inflammatory skin disease characterized by intense itch and eczematous skin lesions that can impact individuals at any age across any area of the body. There is a need for safe treatments for AD that provide rapid itch relief and skin clearance and that are suitable for long-term use. Upadacitinib is a selective, reversible oral Janus kinase 1 (JAK1) inhibitor, which is approved in multiple countries for the treatment of adolescents and adults with moderate-to-severe AD. The current analysis assessed the long-term safety for up to 4 years of upadacitinib 15 and 30 mg in adolescents and adults with moderate-to-severe AD, using integrated data from three ongoing global pivotal phase 3 studies. The Measure Up 1, Measure Up 2, and AD Up studies are ongoing pivotal phase 3, randomized, placebo-controlled, multicenter studies evaluating the safety and efficacy of upadacitinib …

Hidradenitis suppurativa (HS) is a multifactorial inflammatory disorder. Previous studies have ascertained an association between anemia and HS; however, they were limited by low sample size and lack of demographic information. The objective of this study is to address the concerns of prior research and identify specific subgroups and subtypes of anemia present in HS patients and evaluate how these subgroups impact hospital outcomes. We analyzed HS hospitalizations using the National Inpatient Sample from the years 2016 to 2019. HS was associated with the nutritional anemia, aplastic anemia, and acute posthemorrhagic anemia subgroups. Within these subgroups, HS was specifically associated with iron deficiency anemia, anemia of chronic disease, and other anemia subtypes. HS patients also displayed a lower risk of having aplastic anemia, also described as anemia from bone marrow failure. Our …

The purpose of this article is to review the diagnosis of atopic dermatitis along with various disease mimickers. Traditionally, atopic dermatitis is a clinical diagnosis with distinctive history, morphology, and distribution of pruritic eczematous lesions aiding in determining the condition and treatment. However, multiple other conditions may mimic atopic dermatitis, requiring further workup. We review diagnostic mimickers of atopic dermatitis and divide them into four major categories: immunodeficiencies, malignancies, nutritional deficiencies, and systemic disease. In addition, we organize a workup to be considered if there is a high suspicion for something other than atopic dermatitis. Although there are multiple other conditions that can mimic atopic dermatitis, there are gaps in not only considering them, but also in recognizing when to proceed with further workup and what to include.

Background: Atopic dermatitis (AD) is characterized by intense itch and symptoms that adversely impact quality of life (QoL). Upadacitinib is a selective Janus kinase-1 inhibitor approved for moderate-to-severe AD. We assessed the effect of once daily oral upadacitinib (15 or 30 mg) on patient-reported outcomes for adults and adolescents during the double-blind, placebo-controlled periods of Measure Up 1 (NCT03569293), Measure Up 2 (NCT03607422), and AD Up (NCT03568318). Assessments included itch (Worst Pruritus Numerical Rating Scale); skin pain and symptom severity (AD Symptom Scale); symptom frequency (Patient Oriented Eczema Measure); and sleep, daily activities, and emotional state (AD Impact Scale). Post-hoc analysis of 2240 adults and 344 adolescents randomized patients was performed. By week 2, more patients receiving upadacitinib achieved a clinically relevant response in itch …

Background: Lichen planopilaris (LPP) is a chronic, progressive cicatricial alopecia that usually affects middle-aged women, with symptoms ranging from mild to severe pain and pruritus. Current management is aimed at alleviating symptoms and halting disease progression. However, large-scale controlled studies evaluating the efficacy of treatments for LPP are limited, and response to therapeutic regimens is variable and inconsistent. Objectives: To describe dermatology treatment patterns for LPP using a United States (US) electronic medical record database.Methods: The sample consisted of patients in the Explorys database, comprised of encounter data from over 40 healthcare delivery networks in the US. Adult patients with a dermatology encounter within the first year following a new diagnosis of LPP were included. The frequency of LPP treatments prescribed by a dermatologist within 1 year following …

BackgroundThe contribution of psychological disorders to the burden of skin disease has been poorly explored in adolescent patients. The review aims to provide insights into the psychological, social, occupational, and social medias' association with acne, atopic dermatitis (AD), and aesthetics in adolescent patients.MethodsThe project used a modified Delphi process comprising face-to-face discussions followed up online. The systematic literature search results informed the 14 draft statements. During an expert panel meeting, the draft statements underwent the panel's evaluation at a workshop, followed by a plenary discussion adopting five statements using evidence from the literature coupled with the panel's opinions and experiences. Results: Studies reported an association between poor sleep, social impairment, and mental health disorders, including body dysmorphic disorder (BDD) with acne or AD in adolescents with acne or AD. Education for patients and parents may improve self-management skills and self-responsibility, promoting better outcomes for acne and AD. The use of certain types of social media can contribute to unrealistic expectations regarding the outcomes of cosmetic procedures. Social media use may also be associated with, and potentially contribute to unrealistic appearance expectations and certain mental health conditions. However, social media use may have benefits, such as connection, diversity, social support, increased self-esteem, safe identity experimentation, and an increased opportunity for self-disclosure. Conclusions: The association with negative life events, BDD, suicidal ideation, depression, and …

Atopic dermatitis affects millions worldwide and is effectively managed by topical treatments, including topical calcineurin inhibitors, pimecrolimus and tacrolimus. In 2005 and 2011, the FDA released reviews associating topical calcineurin inhibitors with a theoretical cancer risk, albeit an uncertain association. We systematically reviewed the risk of cancer in patients with atopic dermatitis exposed to topical calcineurin inhibitors. We systematically identified randomized controlled trials, comparative, and non-comparative non-randomized studies from database inception to 6 June 2022, from MEDLINE, EMBASE, GREAT, LILACS, ICTRP, FDA, EMA, company registers and relevant citations. We included studies in any language addressing the risk of cancer in patients with atopic dermatitis exposed to topical calcineurin inhibitors for greater than 3 weeks. We excluded split-body studies. We conducted a Bayesian …

IntroductionAtopic dermatitis (AD) is a pruritic inflammatory skin disease. Ruxolitinib cream is a topical formulation of ruxolitinib, a Janus kinase (JAK) 1/JAK2 inhibitor. Here, we describe durability of disease control with as-needed ruxolitinib cream monotherapy using long-term pooled data from 2 phase 3 studies (TRuE-AD1 [NCT03745638]/TRuE-AD2 [NCT03745651]).MethodsPatients (≥12 years; AD ≥2 years, Investigator's Global Assessment [IGA] score ≥2, 3%–20% affected BSA) were initially randomized (2:2:1) to twice-daily 0.75% or 1.5% ruxolitinib cream or vehicle for an 8-week, double-blinded period followed by a 44-week long-term safety (LTS) period. In the LTS period, patients applied ruxolitinib cream as needed to active lesions, stopping 3 days after clearance, and resuming upon recurrence. Disease control was evaluated every 4 weeks in the LTS period.ResultsPatients initially randomized to 1.5 …

We used publicly available images to determine ChatGPT’s diagnostic accuracy and potential to aid in primary care diagnostics of dermatological conditions. We found a lower diagnostic accuracy with publicly available images than with patient images, demonstrating that digital transparency and image retrieval play no role in ChatGPT’s diagnostic accuracy.

# Background Topical steroid withdrawal syndrome (TSWS) is a condition characterized by erythema, burning and/or itching, and several more distinctive features after cessation of topical and/or systemic corticosteroids. There is limited data on this phenomenon and it lacks consensus on diagnosis, incidence, and pathophysiology. # Objective To further characterize TSWS from a clinical standpoint via a retrospective chart review. # Methods Using a diagnostic code for adverse reactions to topical steroids which has been used to demarcate this diagnosis otherwise lacking a formal diagnosis code, the charts of 69 patients were analyzed. # Results The average age for diagnosis of topical steroid withdrawal was 35 years. TSWS occurred in a greater proportion in females than males, similar to previously described data. The most frequent location of involvement was the anterior neck. TSWS occurred the most in patients with a history of atopic dermatitis classified as severe. # Limitations Due to the nature of a chart review, comprehensive notes were not available for every patient. # Conclusion Topical steroid withdrawal syndrome is an important entity for clinicians to consider. Several common features identified may help guide the diagnosis, however, more work needs to be done to better characterize this condition.

BackgroundAtopic dermatitis (AD) is a common skin condition with multiple topical treatment options, but uncertain comparative effects. ObjectiveWe sought to systematically synthesize the benefits and harms of AD prescription topical treatments. MethodsFor the 2023 American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters AD guidelines, we searched MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, ICTRP, and GREAT databases to September 5, 2022, for randomized trials addressing AD topical treatments. Paired reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects network meta-analyses addressed AD severity, itch, sleep, AD-related quality of life, flares, and harms. The Grading of Recommendations Assessment, Development and Evaluation approach informed certainty of evidence ratings. We classified topical corticosteroids (TCS) using 7 groups—group 1 being most potent. This review is registered in the Open Science Framework (https://osf.io/q5m6s). ResultsThe 219 included trials (43,123 patients) evaluated 68 interventions. With high-certainty evidence, pimecrolimus improved 6 of 7 outcomes—among the best for 2; high-dose tacrolimus (0.1%) improved 5—among the best for 2; low-dose tacrolimus (0.03%) improved 5—among the best for 1. With moderate- to high-certainty evidence, group 5 TCS improved 6—among the best for 3; group 4 TCS and delgocitinib improved 4—among the best for 2; ruxolitinib improved 4—among the best for 1; group 1 TCS improved 3—among the best …

Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by dry, itchy, and inflamed skin. While the pathophysiology of AD is not completely understood, the microbiome of the skin appears to play a critical role in its pathogenesis. While there are a number of ways to manipulate the microbiome, topical probiotics–which can be defined as live microorganisms that confer health benefits–are increasingly being studied for AD. In this systematic review, we examine 12 published articles and 4 clinical trials that evaluate the effects of more than 9 different bacterial strains on AD. While the results of these studies are promising, there are a several important limitations and significant heterogeneity between studies. Further investigation is warranted to confirm the benefits of this potential therapeutic modality.

Atopic dermatitis (AD) is characterized by intense itch and symptoms that adversely impact quality of life (QoL). Upadacitinib is a selective Janus kinase-1 inhibitor approved for moderate-to-severe AD. We assessed the effect of once daily oral upadacitinib (15 or 30 mg), with or without concurrent topical corticosteroid treatment, on patient-reported outcomes for adults and adolescents with moderate-to-severe atopic dermatitis during the double-blind, placebo-controlled phase 3 clinical trials, Measure Up 1 (NCT03569293), Measure Up 2 (NCT03607422) and AD Up (NCT03568318). Assessments included itch (Worst Pruritus Numerical Rating Scale), skin pain and symptom severity (AD Symptom Scale), symptom frequency (Patient Oriented Eczema Measure) and sleep, daily activities and emotional state (AD Impact Scale). Post hoc analysis of 2240 adults and 344 adolescents randomized patients was …

2 METHODSOur investigation sourced data from the 2013 to 2018 cycles of the NHANES, which collects nationally representative health data pertaining to the civilian, non-institutionalized population of the United States in 2-year intervals. 7 Non-Hispanic White respondents who underwent the laboratory examination and provided valid responses to items in the dermatology questionnaire and dietary interview were included in the study. Sun protection behaviors were evaluated through the questionnaires: staying in the shade, wearing long-sleeved shirts, and using sunscreen. Participants' engagement in these behaviors was classified as “frequent” when reported as “always” or “most of the time,” as “occasional” when reported as “sometimes” or “rarely,” and as “never” when no engagement was reported. Dietary interview responses were used to measure vitamin D supplementation (μg) over a 30-day period …

BackgroundAtopic dermatitis is a prevalent condition in children and can be effectively managed with medications such as topical calcineurin inhibitors (pimecrolimus or tacrolimus). A key unresolved safety concern is whether use of topical calcineurin inhibitors is associated with cancer. We systematically reviewed the risk of cancer in patients with atopic dermatitis exposed to topical calcineurin inhibitors.MethodsAs part of the 2022 American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters atopic dermatitis guidelines, we searched MEDLINE, Embase, the Latin American and Caribbean Health Sciences Literature database, the Índice Bibliográfico Espanhol de Ciências da Saúde database, the Global Resource of Eczema Trials database, WHO's International Clinical Trials Registry Platform, the US Food and Drug …

Background: Lebrikizumab (LEB) is a novel, high affinity monoclonal antibody that selectively binds to interleukin-13. ADvocate1 (ADv1) and ADvocate2 (ADv2) are two identical phase 3 trials evaluating the efficacy and safety of LEB monotherapy in patients with moderate-to-severe atopic dermatitis. This analysis consists of patients who responded to LEB 250 mg every two weeks (LEB Q2W) at the end of the 16-week induction period and re-randomized 2: 2: 1 to receive LEB Q2W, LEB 250 mg every 4 weeks (LEB Q4W), or placebo Q2W (LEB withdrawal) for 36 additional weeks. Response was defined as achieving IGA (0, 1) with 2: 2-point improvement or EASI75 with no rescue medication use at week 16. Itch was assessed using a validated, 11-point Pruritus Numeric Rating Scale (NRS).Results are presented as percent of patients who reported Pruritus NRS 2: 4-point improvement at week 16 and 52, along with …

Atopic dermatitis (AD) is a pruritic inflammatory skin disease. Ruxolitinib cream (RUX) is a topical formulation of ruxolitinib, a Janus kinase (JAK) 1/JAK2 inhibitor. In two phase 3 studies (TRuE-AD1/TRuE-AD2), 1249 patients with AD ($12 years, Investigator’s Global Assessment [IGA] 2/3, 3% e20% affected body surface area) were randomized to twice-daily 0.75% RUX/1.5% RUX/vehicle for an 8-week, double-blinded, vehicle-controlled period followed by a 44-week double-blinded long-term safety (LTS) period. In the LTS period, patients applied RUX as needed to treat active lesions and stopped after clearance, resuming treatment upon recurrence. IGA, itch (Patient-Oriented Eczema Measure [POEM] question 1) and sleep disturbance (POEM question 2) were evaluated in the LTS period from patients initially randomized to 0.75%(n= 409) or 1.5% RUX (n= 428). Proportions of patients who applied 0.75%/1.5 …

Atopic dermatitis (AD) is a chronic inflammatory skin disease that can significantly decrease quality of life. AD is commonly associated with comorbidities including ocular surface disease (OSD). Conjunctivitis is the most common OSD associated with AD and can increase in incidence with use of monoclonal antibody biologics that target the Type 2 inflammatory pathway. The objective of this review is to raise awareness of comorbid OSD in AD patients that dermatologists may encounter, with a focus on conjunctivitis, and equip dermatologists to address mild ocular concerns. We provide background on the subtypes and pathogenesis of comorbid OSD in AD patients, and describe OSD associated with Type 2 inflammation-inhibiting AD biologics. We also discuss screening and diagnosis, recommended treatment options for dermatologists, and when to refer to an eye care specialist. This multispecialty approach …

Moderate-to-severe atopic dermatitis (AD) is associated with an increased frequency of infections which can lead to hospitalizations. Some treatments used for moderate-to-severe AD can be associated with an increased risk of infection, contributing to a limitation of their long-term use. Dupilumab is a biologic agent that targets the shared signalling pathway for interleukin (IL)-4 and IL-13 and has not been associated with increased risk of overall skin infection rates in clinical trials. To report rates of infection in patients with AD across age groups treated with dupilumab, with a special focus on non-herpetic skin and herpetic infections. We analysed exposure-adjusted infection rates (number of patients per 100 patient-years, nP/100PY) during the study treatment periods for MedDRA terms under the System Organ Class Infections and Infestations (overall infections), including adjudicated skin infections (excluding …

Light therapy encompasses a wide range of treatments in dermatology, ranging from ultraviolet B (UVB) phototherapy to aesthetic lasers and beyond. Using low intensity coherent or non-coherent light in the visible spectrum is often referred to as photobiomodulation therapy (PBT)[1]. Previously, low intensity light treatments have been referred to as low-level light (or laser) therapy (LLLT) and LLLT is sometimes still used interchangeably with PBT; however, PBT is a more encompassing term. PBT has become popular in dermatologic practice for a variety of conditions, including rhytides, scars, burns, vitiligo, and acne vulgaris [2]. The mechanism of light therapy has been characterized in an acne model: the photons produced during PBT are absorbed by tissues and transformed into intracellular energy, which influences cell signaling and growth factor production while reducing oxidative damage in irradiated tissues …

BackgroundAtopic dermatitis (AD) is an inflammatory skin condition with multiple systemic treatments and uncertainty regarding their comparative impact on AD outcomes.ObjectiveWe sought to systematically synthesize the benefits and harms of AD systemic treatments.MethodsFor the 2023 American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters AD guidelines, we searched MEDLINE, EMBASE, CENTRAL, Web of Science, and GREAT databases from inception to November 29, 2022, for randomized trials addressing systemic treatments and phototherapy for AD. Paired reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects network meta-analyses addressed AD severity, itch, sleep, AD-related quality of life, flares, and harms. The Grading of Recommendations …

Systemic sclerosis (SSc) is a connective tissue disorder characterized by fibrosis of the skin and internal organs. As the course of disease can vary, predicting outcomes can be difficult. There is potential to apply machine learning (ML) approaches to predict outcomes among these patients. Our study aims to construct ML models capable of predicting mortality in a nationally representative sample of SSc hospitalizations based on demographic factors and comorbidities. The 2016-2020 National Inpatient Sample (NIS) was reviewed for SSc hospitalizations using ICD-10-CM diagnosis codes M34. 0, M34. 1, M34. 8, and M34. 9. A total of 9 variables were included in the analysis, including patient demographics, income quartile, insurance status, urban-rural classification, and comorbidities of hypertension, diabetes, and obesity identified using the Elixhauser Comorbidity Software Refined. Three models were …

Conclusions• This interim real-world analysis of the ongoing study describes the baseline characteristics of patients who were prescribed tralokinumab in the US

BackgroundPatients with moderate-to-severe atopic dermatitis (AD) experience skin lesions and intense itch that substantially affect quality of life. Patients have choices among systemic AD treatments that offer varied benefit–risk profiles.ObjectiveMeasure patients’ willingness to trade off the risks and benefits of systemic treatments among individuals with a physician-confirmed diagnosis of moderate-to-severe AD.MethodsPatients participated in a discrete choice experiment online survey with a series of choices between hypothetical AD treatments defined by six attributes reflecting benefits and risks of treatments (itch reduction, time until noticeable itch reduction, chance of clear or almost clear skin, risk of serious infection, risk of developing acne, and need for prescription topical steroids). Data were analyzed with a random parameters logit model to quantify preferences and the relative importance of attributes for …

BackgroundTopical anti-inflammatory therapy is a cornerstone of treatment for atopic dermatitis (AD). However, many unmet needs remain with existing therapies. B244 is a live topical biotherapeutic being tested for the reduction of pruritus and improvement of eczema signs in patients with AD. We aimed to assess the safety and efficacy of B244, compared to vehicle, for patients with mild-to-moderate AD and moderate-to-severe pruritus.MethodsIn this randomised, placebo-controlled, double-blind phase 2b trial, adults aged 18–65 years with mild-to-moderate AD and moderate-to-severe pruritus were enrolled across 56 sites in the USA. Patients were randomised 1:1:1 into a low-dose (optical density at 600 nm [OD] 5.0), high-dose (OD 20.0), or vehicle group for the 4-week treatment period and a 4 week follow-up period. Patients were instructed to apply the topical spray twice daily throughout the treatment period …

LAVOLTA (L)I, LII and ACOUSTICS were randomized, placebo-controlled, double-blinded, Phase 3 trials of lebrikizumab, a monoclonal antibody targeting interleukin-13, in patients with uncontrolled asthma (LI, NCT01867125; LII, NCT01868061; ACOUSTICS, NCT01875003). These studies failed to provide consistently significant efficacy results in uncontrolled asthma. This study aims to report pooled safety analysis of lebrikizumab in patients during the 52-week placebo-controlled period from the three clinical trials. Adults in LI and LII, adolescents (12–17 years) in ACOUSTICS, with uncontrolled asthma, prebronchodilator forced expiratory volume in 1 s 40–90% predicted and stable background therapy were randomized 1 : 1 : 1 to lebrikizumab 125 or 37·5 mg or placebo (PBO) subcutaneously once every 4 weeks. Safety analyses were based on all patients who received at least one dose of study drug …

BackgroundIndividuals with eczema may have substantial lifetime corticosteroid exposure, increasing the risk of corticosteroid-related side effects.ObjectiveTo conduct a patient survey evaluating corticosteroid exposure and its cumulative effects in individuals with eczema.MethodsThe multinational online survey was conducted between November 5, 2020, and January 11, 2021. Participants were aged 18 years or older and a patient (n = 1889) or a caregiver of a child (n = 271) diagnosed with having eczema by a medical professional.ResultsAll participants reported using corticosteroids. Average duration of topical corticosteroid (TCS) use was 15.3 years in adults and 3.6 years in children; 75% used TCS 1 to 2 times a day and 50% applied TCS 15 to 30 days/mo. Frequency and duration could not be determined by varying prescription TCS potencies. Oral corticosteroid use was reported by 36% of the participants …

Background: In order to assess the difficulty dermatologists and primary care physicians (PCP) experience in differentiating atopic dermatitis (AD) from psoriasis (PS), and their interest in incorporating a non-invasive genomic test to help guide treatment decisions, we conducted a quantitative market research study including 250 dermatologists and 250 PCP’s. A representative distribution was obtained across four US census regions and included a mix of gender, age, practice ownership and years of practice. PCP’s were split between Family Practice (52%) and Internal Medicine (48%) and saw a minimum of 25 patients a week with dermatologic conditions. Dermatologists (83%) and PCPs (89%) were likely (very or somewhat) to use a test that could distinguish between AD and PS to guide their treatment decisions. PCPs struggle more than dermatologists to differentiate these conditions and demonstrate a more …

Janus kinase inhibitors (JAKis) are promising medications that the Food and Drug Administration recently approved for treatment of atopic dermatitis in January 2022. These medications offer a novel therapeutic mechanism and may be an additional treatment avenue for patients who are currently reliant on conventional immunosuppressants, such as cyclosporine A, methotrexate, or mycophenolate mofetil, or newer medications, such as dupilumab. However, redundant treatment puts patients at risk for excessive toxicity and polypharmacy, whereas abrupt tapering of a preexisting regimen may cause flares of the disease. Thus, transitioning to JAKis should be implemented strategically to retain the therapeutic benefit and minimize the risk of flares. Herein, we outline gradual transition schemas for patients needing to transition to JAKis from conventional immunosuppressants or dupilumab. There is no evidence …

Background: While anemia has been identified as a comorbidity in hidradenitis suppurativa (HS), to our knowledge, no studies have evaluated its effects on HS outcomes. 1–4 We evaluated the impact of anemia on outcomes of HS hospitalizations using a nationally representative sample of inpatient encounters. The National Inpatient Sample database was parsed for hospitalizations with a primary diagnosis of HS using ICD-10-CM code L73. 2. Clinical Classifications Software Refined was used to identify accompanying diagnoses of anemia subgroups: nutritional anemia, hemolytic anemia, aplastic anemia, acute posthemorrhagic anemia, and sickle cell trait/anemia. Multiple linear regression models were constructed to analyze the outcomes of length of stay and cost of care within each anemia subgroups after controlling for age, race, sex, household income, and year. Cost was standardized using the cost-to …

BackgroundRecent data on unmet needs in the treatment of moderate to severe atopic dermatitis (AD) in the US are not available.ObjectiveTo describe disease control, quality of life (QoL), and treatment satisfaction in a United States population with moderate-to-severe AD.MethodsCross-sectional 2021 survey conducted among US patients recruited to an online survey from Kantar e-profiles, their panel partners, and Global Perspectives. Adults with self-reported, physician-diagnosed AD completed the primary survey. Of those reporting moderate to severe AD, a subset, including patients who “strongly disagreed,”“somewhat disagreed,” or were “neutral” on the statement “my eczema is adequately controlled”(“inadequately controlled”) with varying experience with approved biologic treatment (dupilumab), completed a second, enriched survey. Outcome measures evaluated included self-reported disease control and severity and validated measures including Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD), Dermatology Life Quality Index (DLQI), Recap of Atopic Eczema (RECAP), and Treatment Satisfaction Questionnaire for Medication (TSQM-9).ResultsOf 3,285 patients who participated in the primary survey, 1,935 self-reported moderate-to-severe AD, 979 (51%) of whom reported inadequate control. A total of 371 completed the enriched survey, leading to an analytic sample with 87 controlled patients and 284 inadequately controlled patients (178/284 inadequately controlled patients never received dupilumab, 23 previously received it, and 83 were currently receiving it). Mean RECAP, PO-SCORAD, and DLQI scores were …

Importance of Skin Care in Eczema Patients — Northwestern Scholars Skip to main navigation Skip to search Skip to main content Northwestern Scholars Home Northwestern Scholars Logo Help & FAQ Home Experts Organizations Research Output Grants Core Facilities Research Data Search by expertise, name or affiliation Importance of Skin Care in Eczema Patients Peter Lio, Adelaide A. Hebert * * Corresponding author for this work Research output: Contribution to journal › Editorial › peer-review Overview Original language English (US) Pages (from-to) S4 Journal Journal of Drugs in Dermatology Volume 22 Issue number 10 State Published - Oct 2023 Externally published Yes ASJC Scopus subject areas Medicine(all) Other files and links Link to publication in Scopus Link to the citations in Scopus Cite this APA Author BIBTEX Harvard Standard RIS Vancouver Northwestern Scholars Logo Powered by Pure, …

Association between atopic dermatitis and illicit drug use among US adults - Smith - International Journal of Dermatology - Wiley Online Library Skip to Article Content Skip to Article Information Wiley Online Library Wiley Online Library Search within Search term Advanced Search Citation Search Search term Advanced Search Citation Search Login / Register International Journal of Dermatology Early View International Journal of Dermatology Correspondence Association between atopic dermatitis and illicit drug use among US adults Brandon Smith BA , Brandon Smith BA orcid.org/0000-0003-0231-8947 Drexel University College of Medicine, Philadelphia, PA, USA Search for more papers by this author Priya Engel MPH, Priya Engel MPH California University of Science and Medicine, Colton, CA, USA Search for more papers by this author Sogol Stephanie Javadi BS, Sogol Stephanie Javadi BS David Geffen …

ResultsNicholas D. Brownstone1, Aaron S. Farberg2, 3, Ann P. Quick4, Jennifer J. Siegel4, Matthew S. Goldberg4, Peter A. Lio5

ImportanceAtopic dermatitis onset usually occurs in childhood. Persistence of disease into adolescence and adulthood is common. It is important to evaluate new treatment options in adolescents because of the high unmet need in this population.ObjectiveTo assess the efficacy and safety of upadacitinib to treat moderate-to-severe atopic dermatitis in adolescents.Design, Setting, and ParticipantsPrespecified analysis of adolescents enrolled in 3 randomized, double-blind, placebo-controlled phase 3 clinical trials in more than 20 countries across Europe, North and South America, Oceania, the Middle East, and the Asia-Pacific region from July 2018 through December 2020. Participants were adolescents aged 12 to 17 years with moderate-to-severe atopic dermatitis. Data analysis was performed from April to August 2021.InterventionsPatients were randomized (1:1:1) to once-daily oral upadacitinib 15 mg …

# Relevance Despite advancements in staging, surgical techniques, and other treatments that have improved the ten-year survival rate, the incidence of melanoma continues to rise. It is imperative that patients be educated on the etiology of melanoma and engage in risk-reducing behaviors. # Objective The aims of this study were to: 1) examine the characteristics of YouTube videos on melanoma and 2) evaluate the educational content. Methods: YouTube was searched with the keyword “melanoma.” The top 100 search results with English language titles were included in our analysis of video characteristics and educational content. # Results Most videos about melanoma were presented by physicians (41.5%). When analyzed by content, 43.6% featured general information pertaining to melanoma; 29.8% discussed risk factors; 29.8% discussed prognosis; and 38.3% discussed treatment options. # Conclusion With access to quality health information, patients can make better informed decisions regarding their care.

Atopic patients, multi‐disciplinary specialists, caregivers, and experts from all over the world participated in the International Meeting of the Eczema Foundation in Malta (IMEF). During this 4‐day conference, attendants addressed the challenges pertaining to the management of atopic dermatitis by sharing their experience in the form of presentations, discussion sessions, workshops, and a plenary session. This article aims to report on what we consider to be a successful attempt to unite patients and caregivers in the quest for improved treatment of atopic dermatitis through the implementation of therapeutic patient education.

Lebrikizumab is a monoclonal antibody that binds with high affinity and slow off-rate to interleukin (IL)-13, thereby blocking the downstream effects of IL-13 with high potency. ADvocate1 (NCT04146363) and ADvocate2 (NCT04178967) are identically designed phase 3, randomized, double-blinded, placebo-controlled trials evaluating lebrikizumab for the treatment of moderate-to-severe atopic dermatitis (AD). At Week 16 of both studies, lebrikizumab 250 mg every 2 weeks (Q2W) showed statistically significant improvements in measures of skin clearance and patient reported outcomes. Patients treated with lebrikizumab achieved clinically meaningful improvements in the signs and symptoms of AD with fewer AD flares across multiple definitions than patients treated with placebo. In patients who met the protocol-defined criteria for response to lebrikizumab at Week 16, most patients treated with lebrikizumab …

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by eczematous morphology and intense pruritus. Previous clinical trials have demonstrated that upadacitinib (UPA) was superior to placebo (PBO) in the treatment of moderate-to-severe AD. Here, we analyze the efficacy and safety of UPA across 52 weeks in adolescent and adult subgroups from three phase 3 studies. Patients were randomized to UPA 15 mg (UPA15), UPA 30 mg (UPA30), or PBO orally once daily, either alone or with concomitant topical corticosteroids. After 16 weeks, patients in the PBO group were randomized to the UPA15 or UPA30 groups. At 52 weeks, for both adolescent and adult subgroups: the proportion of responders in the UPA15 and UPA30 groups was: 2: 70% and 83% for EASI75, 2: 31% and 47% for vIGA-AD 0/1, and 2: 37% and 61% for Worst Pruritus Numeric Rating Scale (WP-NRS …

Background Approximately 60% of patients with atopic dermatitis have involvement of the hands adding to the burden of disease. Objective This analysis aims to evaluate the effect of upadacitinib monotherapy on atopic hand eczema in patients with moderate‐to‐severe AD over 16 weeks in the Measure Up 1 and 2 studies. Methods Data from patients (ages 12–75) randomized 1:1:1 to receive upadacitinib 15 mg, 30 mg, or placebo once daily in the Measure Up 1 and 2 studies were analysed for impact on atopic hand eczema assessed using the Hand Eczema Severity Index (HECSI). The percent change from baseline in HECSI score was a prespecified additional endpoint at all visits. The proportion of patients with at least a 75% improvement in HECSI score (HECSI 75) was evaluated post hoc. Results Patients treated with upadacitinib 15 mg or 30 mg experienced greater improvement in HECSI score …

# Relevance Skin microbiome dysbiosis plays a large role in the pathogenesis of atopic dermatitis (AD). The metabolic pathways of the skin microbiome provide a potential target for AD treatment by altering microbial diversity and decreasing inflammation. # Objective This systematic review synthesizes findings of the current literature, which investigate topical prebiotics and metabolites of the skin microbiome’s influence on AD. # Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a search was performed on PubMed, Embase, and Web of Science databases from earliest records to March 2022. After screening based on predetermined inclusion criteria, outcomes were extracted, and risk of bias assessments were performed on the included studies. # Results The search yielded 1,124 publications. Five studies published were found to fit the inclusion criteria. Four studies investigated the efficacy of a topical prebiotic in treating AD, and three indicated improvement of AD severity with topical prebiotic use. The sole study on metabolites suggest that a tryptophan metabolite may decrease AD severity. The most significant risks of bias were found in the selection process, determination of treatment efficacy, and statistical analyses. # Conclusion Current literature suggests that topical prebiotics hold promise in AD as they may beneficially modify the skin microbiome, which can lead to improvements in AD. Metabolites of the skin microbiome demonstrated anti-inflammatory effects that may provide a novel target for AD treatment. However, further investigation with improved and standardized …

BackgroundEczema, or atopic dermatitis (AD), is a chronic relapsing skin disease associated with unpredictable flares of erythema, rash, and pruritus. AD arises from a combination of immune system dysregulation and abnormal skin barrier function. Skin barrier support with proper skincare regimens have a central role in management.MethodsThis was a multi-center, 12-week in-use study of a skincare regimen in children and adults with mild-to-moderate eczema (6-16) on the Patient-Oriented Eczema Measure (POEM), and≥ 2 flares within 3 months prior to screening. The regimen included Itch Relief Gel, Eczema Soothing Lotion, and Flare Relief Cream. Efficacy assessments included POEM, ItchyQuant, Eczema Area and Severity Index (EASI), Quality of Life and digital photography, along with gathering of adverse events and cutaneous tolerability.Results34 subjects completed the study. In 12 weeks, mean POEM scores improved from 9.7 to 5.3, and EASI scores improved by 17.9%(P< 0.05 vs baseline). Additionally, mean ItchyQuant scores showed that pruritus was significantly improved from 5.4 at baseline to 2.7 at week 12 (P< 0.05). The number of flares decreased from 4.2 to 3.2 after 12 weeks of regimen application (P< 0.05 vs 12 weeks before baseline). Quality-of-life measures also showed improvement in both children and adults from baseline (P< 0.05). There were no related adverse events, the regimen was well tolerated, and participants had positive perceptions of the regimen.Conclusions12-week use of this OTC skincare regimen resulted in significant improvements in EASI, POEM, and ItchyQuant scores, a reduced number of …

BackgroundAtopic dermatitis (AD, eczema) is driven by a combination of skin barrier defects, immune dysregulation, and extrinsic stimuli such as allergens, irritants, and microbes. The role of environmental allergens (aeroallergens) in triggering AD remains unclear. ObjectiveWe systematically synthesized evidence regarding the benefits and harms of allergen immunotherapy (AIT) for AD. MethodsAs part of the 2022 American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters AD Guideline update, we searched the MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Global Resource for Eczema Trials, and Web of Science databases from inception to December 2021 for randomized controlled trials comparing subcutaneous immunotherapy (SCIT), sublingual immunotherapy (SLIT), and/or no AIT (placebo or standard care) for guideline panel–defined patient-important outcomes: AD severity, itch, AD-related quality of life (QoL), flares, and adverse events. Raters independently screened, extracted data, and assessed risk of bias in duplicate. We synthesized intervention effects using frequentist and Bayesian random-effects models. The GRADE approach determined the quality of evidence. ResultsTwenty-three randomized controlled trials including 1957 adult and pediatric patients sensitized primarily to house dust mite showed that add-on SCIT and SLIT have similar relative and absolute effects and likely result in important improvements in AD severity, defined as a 50% reduction in SCORing Atopic Dermatitis (risk ratio [95% confidence interval] 1.53 [1.31-1 …

Purpose of ReviewBiologics and small molecule inhibitors (SMIs) are a rapidly growing class of highly efficacious therapies in the treatment of chronic immunologic and allergic conditions. With precision targeting of inflammatory signaling molecules, these new agents selectively modulate the immune system to treat a variety of conditions. Dermatologic diseases, including atopic dermatitis and psoriasis, are of particular interest due to the growing number of new biologics and SMIs in recent years. This review serves to summarize and evaluate the recent literature regarding biologics and SMIs.Recent FindingsCurrently approved biologics for AD achieve clear or almost clear skin in less than 40% of patients treated. Several biologics that are still under investigation for AD have shown better efficacy in phase III trials with similar safety profiles. Recently approved SMIs for AD also demonstrate a high degree of efficacy …

Background Current Guidelines from the National Institute of Allergy and Infectious Disease (NIAID) are based on the Learning Early About Peanut Allergy Study (LEAP Study) results and recommend early introduction of peanuts to children with atopic dermatitis (AD) depending on their disease severity. There is yet to be a widely accepted method of evaluating AD severity among clinicians. Thus, the purpose of this study was to determine the association between AD severity as measured by patient‐oriented scoring of atopic dermatitis(PO‐SCORAD) and Patient Oriented Eczema Measure (POEM) surveys and peanut sensitivity as measured by Immunoglobulin E (IgE) or skin prick test levels. Objectives The primary objective of this study was to determine the association between AD severity as measured by PO‐SCORAD and POEM surveys and peanut sensitivity as measured by IgE or skin prick test levels. The …

BackgroundEmerging treatments for moderate-to-severe atopic dermatitis (AD) may provide greater and faster improvement in AD signs and symptoms than current therapies.ObjectiveTo examine JADE COMPARE (NCT03720470) data using stringent efficacy end points.MethodsAdults with moderate-to-severe AD were randomly assigned 2:2:2:1 to receive oral abrocitinib 200 or 100 mg once daily, subcutaneous dupilumab 300 mg every 2 weeks (600-mg loading dose), or placebo, with medicated topical therapy for 16 weeks. Stringent response thresholds were applied for Eczema Area and Severity Index (EASI), Investigator’s Global Assessment, Dermatology Life Quality Index, Peak Pruritus Numerical Rating Scale, and Night Time Itch Scale severity.ResultsAt week 16, 48.9%, 38.0%, and 38.8% of the abrocitinib 200-mg, 100-mg, and dupilumab groups, respectively, achieved greater than or equal to 90 …

The All of Us research program is supported by the National Institutes of Health, Office of the Director: Regional Medical Centers: 1 OT2 OD026549; 1 OT2 OD026554; 1 OT2 OD026557; 1 OT2 OD026556; 1 OT2 OD026550; 1 OT2 OD 026552; 1 OT2 OD026553; 1 OT2 OD026548; 1 OT2 OD026551; 1 OT2 OD026555; IAA#: AOD 16037; Federally Qualified Health Centers: HHSN 263201600085U; Data and Research Center: 5 U2C OD023196; Biobank: 1 U24 OD023121; The Participant Center: U24 OD023176; Participant Technology Systems Center: 1 U24 OD023163; Communications and Engagement: 3 OT2 OD023205; 3 OT2 OD023206; and Community Partners: 1 OT2 OD025277; 3 OT2 OD025315; 1 OT2 OD025337; 1 OT2 OD025276. In addition, the All of Us research program would not be possible without the partnership of its participants.

Hyperpigmentation involves darkening of skin due to increased production of melanin and encompasses a wide range of dermatologic conditions, including melasma, post-inflammatory hyperpigmentation, maturational hyperpigmentation, and periorbital melanosis. The etiologies of hyperpigmentation may be inherited, acquired, or congenital. There are multiple approaches for treating hyperpigmentation, including conventional therapeutics and complementary and alternative medicines (CAMs). There is a growing body of literature investigating the uses of these alternative therapies in patients with hyperpigmentation, which can be broadly organized into three major groups: 1) minimally invasive treatments, 2) plant-based therapies, and 3) natural antioxidants. CAMs offer relatively low-risk and readily available treatment options for patients seeking to manage hyperpigmentation. The use of these alternative therapies has gained substantial traction in recent years. These therapies may be especially beneficial for patients who have not achieved favorable clinical outcomes using conventional treatments alone. A greater understanding of the various integrative approaches available for treating hyperpigmentation can allow providers to make the most informed recommendations and help ensure the best health outcomes for patients.