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Barbara Honig from Dermatologist Nation, Maria Macias from AI Unite Commented on a Post
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Topical JAK Inhibitors for Atopic Dermatitis

Atopic dermatitis (AD), also known as atopic eczema, is a chronic, pruritic, relapsing inflammatory dermatological condition. Early disease management includes moisturizers, avoiding the factors that trigger AD, and patient education. Treatment mainly aims at reducing itch and inflammation, eliminating flare-ups, and reducing side effects.

Topical agents are considered as a primary treatment for mild to moderate AD and include topical corticosteroids (TCS), topical calcineurin inhibitors (TCI), and phosphodiesterase 4 (PDE4) inhibitor. More recently, the first topical selective Janus kinase (JAK)1/JAK2 inhibitor has been approved for use in patients with mild to moderate disease.

  • How will the availability of a topical selective JAK impact your use of TCS, TCI, or PDE4 in mild to moderate AD patients?
  • In which types of patients do you foresee the greatest utility of a topical selective JAK in the treatment of mild to moderate AD patients?

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  • from Dermatologist Nation September 25, 2022
    I don't think topical JAKs have been a game changer in mild to moderate AD - unfortunately in part because most insurance plans don't seem to cover them well without Show More
  • from AI Unite March 25, 2022
    The use of topical JAKs will be a game changer. The ability to decrease itch within as little as 12 hours is impressive. Patients and parents are most frustrated by Show More

Managing Atopic Dermatitis in Skin of Color

Despite the recent significant advances in both topical and oral dermatologic therapy, atopic dermatitis (AD) remains a difficult-to-treat skin disease and can be particularly challenging in patients with skin of ..... see more

Source : https://www.dermatologytimes.com/view/managing-atopic-dermatitis-in-skin-of-color


Discussion: All dermatologists should strive to incorporate EASI, BSA, IGA, Patient-Oriented Eczema Measures, and Dermatology Life Quality Index [scores] in their clinical assessments, because what we do in research can easily translate to clinical practice."

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  • from Dermatologist Nation September 21, 2022
    I agree with Dr Honig that one of the key features of AD that is vexing for skin of color patients is dyspigmentation, both hypo- and hyperpigmentation. It will Show More
  • from Dermatologist Nation September 16, 2022
    More recent and clinically effective steroid-sparing agents, both topical like opzelura and biologics or oral JAKs, are particularly useful in treating AD in skin of color because there is no Show More
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Type 2 Inflammation Contributes to Skin Barrier Dysfunction in Atopic Dermatitis

JID Innov. 2022 Sep; 2(5): 100131. Skin barrier dysfunction, a defining feature of atopic dermatitis (AD), arises from multiple interacting systems. In AD, skin inflammation is caused by host-environment interactions ..... see more

Source : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9428921/


Conclusion: Targeting type 2 cytokines in AD has a broad range of beneficial effects on the components of the skin barrier, including lipids, proteins, skin pH, corneocyte structure, TJs, sweat glands, and the microbiome, reinforcing the notion that AD is a systemic type 2 inflammatory disease.

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Optical coherence tomography for monitoring biologic therapy in psoriasis and atopic dermatitis: A case series

Biologic therapies are increasingly used to treat chronic inflammatory skin diseases such as psoriasis and atopic dermatitis. In clinical practice, scores based on evaluation of objective and subjective symptoms are ..... see more

Source : https://www.frontiersin.org/articles/10.3389/fmed.2022.995883/abstract


Discussion: Imaging parameters may enable objective quantification of inflammation in psoriasis or atopic dermatitis in selected representative skin areas. OCT may reveal persistent subclinical inflammation in atopic dermatitis beyond clinical remission.

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Dupilumab in children aged 6 months to younger than 6 years with uncontrolled atopic dermatitis: a randomised, double-blind, placebo-controlled, phase 3 trial

Dupilumab significantly improved atopic dermatitis signs and symptoms versus placebo in children younger than 6 years. Dupilumab was well tolerated and showed an acceptable safety profile, similar to results in ..... see more

Source : https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01539-2/fulltext


Conclusion: Dupilumab significantly improved atopic dermatitis signs and symptoms versus placebo in children younger than 6 years. Dupilumab was well tolerated and showed an acceptable safety profile, similar to results in older children and adults.

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Biological therapy for young children with atopic dermatitis

Atopic dermatitis is a common inflammatory skin disease that might lead to severe and persistent disease during infancy. Atopic dermatitis is associated with poor school performance, psychiatric disease, and allergic ..... see more

Source : https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01742-1/fulltext?rss=yes


Discussion: Oral medication can be challenging to use in children. Accordingly, there is a need for systemic therapies that are efficacious and have a favourable safety profile.

Jeremy Moss from Dermatologist Nation, Barbara Honig from Dermatologist Nation Commented on a Post
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Navigating the treatment paradigms for atopic dermatitis

Atopic dermatitis (AD) symptoms fluctuate between stable disease and acute flare-ups. The step-up guidelines to better manage acute flare-ups, and worsening disease severity, include topical therapies for mild-to-moderate AD and systemic therapies for moderate-severe AD. Choosing different therapies is only one potential factor to improve patient outcomes. Non-adherence to treatment also limits patient outcomes for a variety of reasons, including lack of trust/understanding about disease management, inconvenience, and fear of side effects, among others.

Given an increasing range of therapeutic options for moderate AD, which include novel topical therapies, it may be useful to revisit the step-up paradigm.

  • What are the key factors to consider for mild-to-moderate AD treatment choices after disease flare-ups?
  • For moderate AD patients, when is a transition to additional/newer topical treatments preferable to oral therapies?

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  • from Dermatologist Nation September 15, 2022
    The key factors to determine therapies for patients are extent of disease, symptom severity, quality of life issues, patient desire for certain types of therapies, and access/affordability issues. With Show More
  • from Dermatologist Nation August 29, 2022
    AD is a chronic autoimmune skin condition that fluctuates due to multiple environmental triggers and stressors. I have all AD patients optimize OTC care with mild cleansers and emollients, and Show More
Barbara Honig from Dermatologist Nation, Jeremy Moss from Dermatologist Nation Commented on a Post
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The Patient Journey for Atopic Dermatitis

Atopic dermatitis (AD), also known as eczema, is chronic inflammatory skin condition caused by heterogenous factors and manifesting across a range of severities from mild to moderate and severe. AD patients experience periods of flare (worsening of disease symptoms) and periods of remission (fewer symptoms or periods of clear skin). The flare symptoms, including dry skin, rash, skin redness, and pruritis, take a significant toll on the QoL, mental health, and activities of daily life for AD patients. These repeated flare cycles also challenge HCPs to adjust treatment options. For many mild to moderate AD patients, this cycle is a life-long, frustrating journey occurring when standard of care (SOC) topical therapy fails to manage symptoms, or their use is limited by tolerability issues.

SOC treatments for mild to moderate AD include topical forms of corticosteroid, calcineurin inhibitors, and a phosphodiesterase 4 (PDE4) inhibitor. The recent approval of a topical Janus kinase (JAK) inhibitor holds promise that new treatment options could reduce unmet need and improve the patient journey.

  • In mild to moderate AD patients, which QoL factors do you commonly discuss, particularly when flares occur?
  • How might a topical JAK inhibitor improve the patient journey for mild to moderate AD patients?

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  • from Dermatologist Nation September 14, 2022
    Opzelura seems to be working well in my mild to moderate AD patients who stop responding to topical steroids - works relatively fast and reduces pruritus well
  • from Dermatologist Nation September 05, 2022
    I agree with the idea that topical JAKs are an excellent addition to the therapeutic armamentarium for treating AD. I am using Opzelura with a great deal of success Show More
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A Topic Dermatitis-like Genodermatosis: Disease Diagnosis and Management

Eczema is a classical characteristic not only in atopic dermatitis but also in various genodermatosis. Patients suffering from primary immunodeficiency diseases such as hyper-immunoglobulin E syndromes, Wiskott-Aldrich syndrome, immune dysregulation, ..... see more

Source : https://www.mdpi.com/2075-4418/12/9/2177/html


Conclusion: A topic dermatitis-like lesions can frequently present in patients with genetic diseases. In this review, three main categories including immunological disorders, metabolic diseases, and rare syndromes are discussed. We have presented the diagnostic clues that simplify the differential diagnosis, especially for immunological...

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Case 3: 12-Year-Old-Female With Atopic Dermatitis

Joshua Zeichner, MD: Here we have a 12-year-old female patient who presented to her dermatologist with dry, itchy patches on her arms and legs. see more

Source : https://www.contemporarypediatrics.com/view/case-3-12-year-old-female-with-atopic-dermatitis


Discussion: "Here we have a 12-year-old female patient who presented to her dermatologist with dry, itchy patches on her arms and legs...Since her diagnosis 3 years ago, she stopped playing soccer and going to the pool in the summer and has been diagnosed with mild depression."

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Dr Jason Ezra Hawkes on Diagnostic Challenges, Strategies in Atopic Dermatitis

The lack of biomarkers to distinguish atopic dermatitis (AD) from other similar conditions such as psoriasis can impede diagnosis, but there are several clinical features that primary care providers and ..... see more

Source : https://www.ajmc.com/view/dr-jason-ezra-hawkes-on-diagnostic-challenges-strategies-in-atopic-dermatitis


Discussion: "Even though we know a lot about eczema, we just really don't have consistent biomarkers of disease, which makes it challenging to make a diagnosis. Sometimes it's a little trial and error, and this is one thing that we're going to have to work on over time, especially because biopsies don't distinguish consistently between eczema...

A low level of health literacy is a predictor of corticophobia in atopic dermatitis | Anais Brasileiros de Dermatologia

Introduction Methods Patients and setting Questionnaires Statistical analysis Ethics Results Discussion Conclusion Financial support Authors' contributions Conflict of interest Atopic Dermatitis (AD) is a chronic relapsing inflammatory skin disorder with ..... see more

Source : https://www.anaisdedermatologia.org.br/en-a-low-level-health-literacy-avance-S0365059622001969


Conclusion: HL had an inverse correlation with corticophobia. Lower HL was shown to be a predictor of higher corticophobia. The promotion of health literacy is essential for the correct use of TCS and good control of AD.

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  • September 07, 2022
    Key Points • Source: Anais Brasileiros de Dermatologia • Conclusion: “The degree of corticophobia is similar to the values reported in other studies. HL [health literacy] had an inverse correlation with corticophobia. Lower HL Show More

Comorbidities Associated with Vitiligo

Jeffrey D. Dunn, PharmD, MBA: Dr King, you touched on this, but let's take a deeper dive into this as we're trying to establish the clinical consequences of vitiligo. What ..... see more

Source : https://www.ajmc.com/view/comorbidities-associated-with-vitiligo


Discussion: Autoimmune thyroid disease isn’t common, but we see more of other autoimmune skin diseases in our patients with vitiligo. Not infrequently, we see associated atopic dermatitis; eczema; alopecia areata, an autoimmune form of hair loss; or other forms of autoimmune or inflammatory skin disease.

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  • September 07, 2022
    Thanks for your wonderful input, Barbara Honig ! What do others hypothesize is the link between vitiligo and autoimmune disease? How is a Show More
  • from Dermatologist Nation September 06, 2022
    There is no question that autoimmune thyroid disease can be associated with vitiligo. But AD, AA, and psoriasis are seen much more frequently in vitiligo patients - largely because they Show More
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Investigating the association of atopic dermatitis with ischemic stroke and coronary heart disease: A mendelian randomization study

Background: Atopic dermatitis (AD) is the most common chronic skin inflammatory disease. Prior observational studies have reported inconsistent results on the association of AD with ischemic stroke and coronary heart ..... see more

Source : https://www.frontiersin.org/articles/10.3389/fgene.2022.956850/full


Conclusion: Our MR study does not support a causal association of genetically predicted AD with ischemic stroke, large artery stroke, cardioembolic stroke, small vessel stroke, coronary heart disease, and myocardial infarction.

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Association of atopic diseases with atrial fibrillation risk: A systematic review and meta-analysis

BackgroundAtopic diseases and atrial fibrillation (AF) seem to share an underlying inflammatory pathology. To date, some population-based studies have explored the relationship between the two. We aimed to conduct a ..... see more

Source : https://www.frontiersin.org/articles/10.3389/fcvm.2022.877638/full


Conclusion: This meta-analysis demonstrated that patients with atopic diseases have a higher risk of developing AF, particularly those with asthma.

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Association of atopic diseases with atrial fibrillation risk: A systematic review and meta-analysis

BackgroundAtopic diseases and atrial fibrillation (AF) seem to share an underlying inflammatory pathology. To date, some population-based studies have explored the relationship between the two. We aimed to conduct a ..... see more

Source : https://www.frontiersin.org/articles/10.3389/fcvm.2022.877638/full

A Review of Phase 3 Trials of Dupilumab for the Treatment of Atopic Dermatitis in Adults, Adolescents, and Children Aged 6 and Up - Dermatology and Therapy

Atopic dermatitis (AD) is a chronic pruritic skin disease that can have a profound negative impact on patients' quality of life, especially in cases of inadequate disease control. Dupilumab, a ..... see more

Source : https://link.springer.com/article/10.1007/s13555-022-00778-y


Conclusion: In summary, phase 3 clinical trials of dupilumab demonstrate that dupilumab provides a multidimensional benefit in patients ages 6 years and older with moderate-to-severe AD, with rapid and sustained improvements in AD signs and symptoms and an acceptable safety profile.

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  • from Dermatologist Nation September 05, 2022
    This article helps to solidify that dupixent is an excellent first line medicine for moderate to severe AD. It is a go-to medicine in my practice. My experience Show More
  • from Dermatologist Nation September 04, 2022
    Indeed, we should feel very comfortable prescribing dupixent - minimal side effects and no lab monitoring needed - and now also approved for children aged 6 months to 5 years Show More
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Atopic dermatitis and risk of major neuropsychiatric disorders in children: a population-based cohort study - PubMed

The was no substantial impact of AD on the overall risk of many neuropsychiatric conditions in children, but disease severity and age may be important modifying factors. Additional research is ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/36018560/


Conclusion: There was no substantial impact of AD on the overall risk of many neuropsychiatric conditions in children, but disease severity and age may be important modifying factors.