Flares Of Dermatitis Research Articles

50865 Efficacy of Step-up Abrocitinib Treatment in Combination With Topical Medicated Therapy for Treating Atopic Dermatitis Flares: A Post Hoc Analysis of the JADE REGIMEN Trial

50865 Efficacy of Step-up Abrocitinib Treatment in Combination With Topical Medicated Therapy for Treating Atopic Dermatitis Flares: A Post Hoc Analysis of the JADE REGIMEN Trial

From flare to care: Dermatologists' impact on pediatric atopic dermatitis hospital admissions.

Atopic dermatitis (AD) is a common chronic skin disease in the pediatric population; however, rates of admissions for flares in patients established with dermatology compared to those that are not established have not been fully assessed in prior studies. We reviewed electronic medical records of patients hospitalized (billing codes 99221-99223, 99217) with diagnoses encompassing AD, eczema, and dermatitis (ICD-10 codes L20.8-L20.9, L30.8-L30.9) between January 1, 2011, and December 31, 2021, at University Hospitals (UH) in Cleveland, Ohio. Patients were considered established with dermatology if they had been seen by a dermatology provider within 6 months prior to admission. Statistical analysis was performed using chi-square goodness of fit. A total of 95 patient encounters met criteria for inclusion. Fifteen (15.8%) patients were established with dermatology at the time of admission and 80 (84.2%) were not. The chi-square value (x2 = 44.74) was greater than the critical value of 10.828 at one degree of freedom (p < .001). There were 8 patients who had more than one admission for atopic dermatitis flares; 2 of these patients were established with dermatology prior to their first admission, and 4 were established at the time of the second admission. The majority of patients admitted with AD flare were not established with dermatology. Many of these patients lived in a low socioeconomic area and missed follow-up appointments. Increasing access to dermatologic care for patients with atopic dermatitis, especially in lower-income areas, could aid in decreasing atopic dermatitis-related hospitalizations.

Towards a patient-centred definition for atopic dermatitis flare: a qualitative study of adults with atopic dermatitis.

The term 'flare' is used across multiple diseases, including atopic dermatitis (AD), to describe increased disease activity. While several definitions of an AD flare have been proposed, no single definition of AD flare is widely accepted and it is unclear what the term 'AD flare' means from the patient perspective. To understand AD flares from the adult patient perspective and to explore how adults with AD define an AD flare. Participants were adults with AD recruited from the National Eczema Association Ambassadors programme, a volunteer patient-engagement programme. They participated in online focus groups to discuss how they describe AD flares from their perspective, how they define its start and stop, and how they relate to existing definitions of flare. Using a grounded theory approach, transcripts were analysed and coded using an iterative process to identify concepts to support a patient-centred conceptual framework of 'flare'. Six 90-min focus groups of 3-8 participants each were conducted with 29 US adults (≥ 18 years of age) with AD who had at least one self-reported AD flare in the past year. When participants were presented with examples of previously published definitions of AD flare, participants found them problematic and unrelatable. Specifically, they felt that flare is hard to quantify or put on a numerical scale, definitions cannot solely be about skin symptoms and clinical verbiage does not resonate with patients' lived experiences. Concepts identified by patients as important to a definition of flare were changes from patient's baseline/patient's normal, mental/emotional/social consequences, physical changes in skin, attention needed/all-consuming focus, itch-scratch-burn cycle and control/loss of control/quality of life. Figuring out the trigger that initiated a flare was an underlying concept of the experience of flare but was not considered a contributor to the definition. The results highlight the complexity and diversity of AD flare experiences from the adult patient perspective. Previously published definitions of AD flares did not resonate with patients, suggesting a need for a patient-centred flare definition to support care conversations and AD management.

Association Between Short-Term Exposure to Environmental Air Pollution and Atopic Dermatitis Flare in Patients Treated With Dupilumab.

Association Between Short-Term Exposure to Environmental Air Pollution and Atopic Dermatitis Flare in Patients Treated With Dupilumab.

IL-31-dependent neurogenic inflammation restrains cutaneous type 2 immune response in allergic dermatitis.

Despite robust literature associating IL-31 with pruritic inflammatory skin diseases, its influence on cutaneous inflammation and the interplay between inflammatory and neurosensory pathways remain unmapped. Here, we examined the consequences of disrupting Il31 and its receptor Il31ra in a mouse model of house dust mite (HDM)-induced allergic dermatitis. Il31-deficient mice displayed a deficit in HDM dermatitis-associated scratching, consistent with its well-established role as a pruritogen. In contrast, Il31 deficiency increased the number and proportion of cutaneous type 2 cytokine-producing CD4+ T cells and serum IgE in response to HDM. Furthermore, Il4ra+ monocytes and macrophages capable of fueling a feedforward type 2 inflammatory loop were selectively enriched in Il31ra-deficient HDM dermatitis skin. Thus, IL-31 is not strictly a proinflammatory cytokine but rather an immunoregulatory factor that limits the magnitude of type 2 inflammatory responses in skin. Our data support a model wherein IL-31 activation of IL31RA+ pruritoceptors triggers release of calcitonin gene-related protein (CGRP), which can mediate neurogenic inflammation, inhibit CD4+ T cell proliferation, and reduce T cell production of the type 2 cytokine IL-13. Together, these results illustrate a previously unrecognized neuroimmune pathway that constrains type 2 tissue inflammation in the setting of chronic cutaneous allergen exposure and may explain paradoxical dermatitis flares in atopic patients treated with anti-IL31RA therapy.

The treatment of refractory periorbital dermatitis.

Refractory periorbital dermatitis has a chronic course with exacerbations leading to discomfort and cosmetic issues, yet characterization of treatment options is limited. The objective was to present comprehensive demographic data and medical management of a series of patients with refractory periorbital dermatitis. Retrospective review identified patients treated at a single institution from January 2010 to August 2020. Descriptive analyses were performed. Demographic data and treatment history were reviewed and data including medication, use, date of use and discontinued use, reason for discontinuation (if applicable), refractory status, formulation, concentration, and dose frequency were extracted. Descriptive analyses. Forty-five patients were included. The average age at first diagnosis was 60.3 years (sd 14.9). 82.2% were women and 84.4% identified as Caucasian. Triamcinolone cream was most frequently used followed by tobramycin-dexamethasone, tacrolimus, and neomycin-polymyxin-dexamethasone. Less than 30% of patients on triamcinolone were refractory. 13.3% of patients used topical hydrocortisone, with over 80% of these patients experiencing refractory episodes of persistent irritation and erythema. Most patients were refractory during initial use or the first recurrence of periorbital dermatitis flare. By better characterizing the diverse treatment regimens in a unique subset of refractory patients, we hope to better inform potential courses of medical management for periorbital dermatitis.

Treatments for atopic dermatitis.

Atopic dermatitis usually develops in childhood, but can occur in adults. Management involves drug and non-drug treatments to clear the skin. Not all patients with atopic dermatitis have allergies. Most patients have trigger factors that can be avoided. All patients should use soap substitutes and bath oils. Moisturisers are important for improving the condition of the skin. Topical corticosteroids are the main drug treatment. The choice of corticosteroid depends largely on the site of the atopic dermatitis. Topical calcineurin inhibitors can be considered for sensitive sites such as the face where potent topical corticosteroids are potentially harmful. Adjunctive treatments given during flares of dermatitis include bleach baths and wet dressings. Antihistamines may help to relieve itch. Phototherapy may be considered by a specialist for adults if there is inadequate response to treatment. Severe cases of atopic dermatitis may require systemic treatment. Immunosuppressants, such as ciclosporin, have been used and now dupilumab and upadacitinib are available for severe chronic atopic dermatitis.

389 Association between short-term exposure to environmental air pollution and atopic dermatitis flare under treatment with dupilumab

389 Association between short-term exposure to environmental air pollution and atopic dermatitis flare under treatment with dupilumab

Association between short-term exposure to environmental air pollution and atopic dermatitis flare in patients treated with dupilumab

BackgroundThe magnitude of short/medium-term air pollution exposure on atopic dermatitis (AD) flare has not been fully investigated. The aim of the study was to investigate the association of short/medium-term exposure to airborne pollution on AD flares in patients treated with dupilumab. MethodsObservational case-crossover study. Patients with moderate-to-severe AD under treatment with dupilumab were included. The exposure of interest was the mean concentrations of coarse and fine particulate matter (PM10, PM2.5), nitrogen dioxide, and oxides (NO2, NOx). Different intervals were considered at 1 to 60 days before the AD flare and control visit, defined as the visit with the highest Eczema Area and Severity Index scores >8 and ≤7, respectively. A conditional logistic regression analysis adjusted for systemic treatments was employed to estimate the incremental odds (%) of flare every 10 μg/m3 pollutant concentration. ResultsData on 169 of 528 patients with AD having 1130 follow-up visits and 5840 air pollutant concentration measurements were retrieved. The mean age was 41.4 ± 20.3 years; 94 (55%) men. The incremental odds curve indicated a significant positive trend of AD flare for all pollutants in all time windows. At 60 days, every 10 μg/m3 PM10, PM2.5, NOx, and NO2 increase concentration was associated with 82%, 67%, 28%, and 113% odds of flare, respectively. ConclusionsIn patients treated with dupilumab, acute air pollution exposure is associated with an increased risk for AD flare with a dose-response relationship.

Quality of Life and Avoiding Triggers of Atopic Dermatitis Flares: A Qualitative Study.

Quality of Life and Avoiding Triggers of Atopic Dermatitis Flares: A Qualitative Study.

Quality of Life and Avoiding Triggers of Atopic Dermatitis Flares: A Qualitative Study.

Quality of Life and Avoiding Triggers of Atopic Dermatitis Flares: A Qualitative Study.

Comparative Genomic and Metagenomic Investigations of the Corynebacterium tuberculostearicum Species Complex Reveals Potential Mechanisms Underlying Associations To Skin Health and Disease.

Corynebacterium are a diverse genus and dominant member of the human skin microbiome. Recently, we reported that the most prevalent Corynebacterium species found on skin, including Corynebacterium tuberculostearicum and Corynebacterium kefirresidentii, comprise a narrow species complex despite the diversity of the genus. Here, we apply high-resolution phylogenomics and comparative genomics to describe the structure of the C. tuberculostearicum species complex and highlight genetic traits which are enriched or depleted in it relative to other Corynebacterium. Through metagenomic investigations, we also find that individual species within the complex can associate with specific body sites. Finally, we discover that one species from the complex, C. kefirresidentii, increases in relative abundance during atopic dermatitis flares, and show that most genomes of this species encode a colocalized set of putative virulence genes. IMPORTANCE Corynebacterium are commonly found bacteria on the human skin. In this study, we perform comparative genomics to gain insight into genetic traits which differentiate a phylogenetically related group of Corynebacterium, the Corynebacterium tuberculostearicum species complex, that includes the most prevalent species from the genus in skin microbiomes. After resolving the presence of distinct species within the complex, we applied metagenomic analysis to uncover biogeographic associations of individual species within the complex with specific body sites and discovered that one species, commonly found in the nares of individuals, increases in abundance across multiple body sites during atopic dermatitis flares.

Disseminated Bullous Impetigo in an Adult With Atopic Dermatitis Flare

A man in his mid-20s with a history of atopic dermatitis presented to the emergency department with a 1-week history of a worsening painful and pruritic generalized rash. Examination revealed erythematous erosions on the trunk and limbs with shallow bullae (Figure 1; Supplemental Figure 1, available online at http://www.mayoclinicproceedings.org) and absence of Nikolsky sign.

A LEAP FORWARD IN EVALUATION OF PEANUT ALLERGY IN A CHILD WITH SEVERE ATOPIC DERMATITIS

<h3>Introduction</h3> Children with atopic dermatitis (AD) are at higher risk of peanut allergy. However, children with AD may have more elevated measures of sensitization including serum IgE (sIgE) and skin prick testing (SPT) at baseline without necessarily having clinical allergy. Here we describe the case of a child who despite having AD and significantly elevated sIgE and SPT to peanut, passed an oral food challenge (OFC). <h3>Case Description</h3> Our patient is a 16 month-old who presented for evaluation of severe eczema and food allergy. He introduced peanut in the form of Bamba at home, which coincided with an atopic dermatitis flare, although cutaneous symptoms were not noted to be immediate. An intensive skin care regimen was initiated with clinical improvement. SPT to peanut was positive with a wheal of 7 × 5 mm. His total sIgE was 10,229 kU/L, sIgE to peanut was 39.7 kUA/L and sIgE to Ara h 2 was 1.72 kUA/L. A 5 dose OFC to peanut butter was negative. His parents were instructed to incorporate peanut butter into his diet regularly. <h3>Discussion</h3> Given the importance of early exposure in preventing the development of clinical allergy, it may be worth considering an OFC for children without clear history of immediate type 1 hypersensitivity reactions to peanuts, even with elevated measures of sensitization. Close attention to skin care is also necessary prior to OFC so that a cutaneous reaction to the culprit food is not confused with a background eczema flare that may have occurred without food exposure.

Closing the knowledge gaps in pediatric emergency department management of atopic dermatitis flares: Responding to the challenge.

Closing the knowledge gaps in pediatric emergency department management of atopic dermatitis flares: Responding to the challenge.

Practical algorithm to inform clinical decision-making in the topical treatment of atopic dermatitis.

Atopic dermatitis is a chronic relapsing, inflammatory skin disorder associated with skin barrier dysfunction, the prevalence of which has increased dramatically in developing countries. In this article, we propose a treatment algorithm for patients with mild-to-moderate and severe atopic dermatitis flares in daily clinical practice. An international panel of 15 dermatology and allergy experts from eight countries was formed to develop a practical algorithm for the treatment of patients with atopic dermatitis, with a particular focus on topical therapies. In cases of mild-to-moderate atopic dermatitis involving sensitive skin areas, the topical calcineurin inhibitor pimecrolimus should be applied twice daily at the first signs of atopic dermatitis. For other body locations, patients should apply a topical calcineurin inhibitor, either pimecrolimus or tacrolimus, twice daily at the first signs of atopic dermatitis, such as pruritus, or twice weekly in previously affected skin areas. Emollients should be used regularly. Patients experiencing acute atopic dermatitis flares in sensitive skin areas should apply a topical corticosteroid twice daily or alternate once-daily topical corticosteroid/topical calcineurin inhibitor until symptoms improve. Following improvement, topical corticosteroid therapy should be discontinued and patients switched to a topical calcineurin inhibitor. Maintenance therapy should include the use of pimecrolimus once daily for sensitive areas and tacrolimus for other body locations. This treatment algorithm can help guide clinical decision-making in the treatment of atopic dermatitis.

Patient survey reports association between compression stocking use adherence and stasis dermatitis flare frequency

To the Editor: Compression stocking use for stasis dermatitis is an effective treatment to control symptoms, especially during acute flares.1Raju S. Hollis K. Neglen P. Use of compression stockings in chronic venous disease: patient compliance and efficacy.Ann Vasc Surg. 2007; 21: 790-795Abstract Full Text Full Text PDF PubMed Scopus (220) Google Scholar The annual health care cost of stasis dermatitis is $195 to $515 million, including unnecessary hospitalizations.2Weng Q.Y. Raff A.B. Cohen J.M. et al.Costs and consequences associated with misdiagnosed lower extremity cellulitis.JAMA Dermatol. 2017; 153: 141-146Crossref PubMed Scopus (98) Google Scholar High rates of noncompliance (60%-70%) with compression stocking use have been documented, but underlying factors are not well understood.1Raju S. Hollis K. Neglen P. Use of compression stockings in chronic venous disease: patient compliance and efficacy.Ann Vasc Surg. 2007; 21: 790-795Abstract Full Text Full Text PDF PubMed Scopus (220) Google Scholar We sought to characterize the patient-reported concerns that influence adherence to prescribed use of compression stockings. A cross-sectional survey was conducted at Saint Louis University with Institutional Review Board approval. An electronic medical record search identified patients who were seen in the outpatient dermatology clinic between February 1, 2017, and May 1, 2018, and were coded with International Classification of Diseases, 10th Revision I87.2 for stasis dermatitis. We reviewed patient records to confirm a board-certified dermatologist had diagnosed stasis dermatitis and recommended compression stocking use at the most recent office visit. We contacted 111 eligible patients, and 100 consented to participate. After obtaining verbal consent by phone, a physician administered an 11-item questionnaire (available online as Supplemental Material via Mendeley at https://doi.org/10.17632/gcfvmthr24.1). A flare was defined as an uncomfortable increase in symptoms, such as edema, erythema, pruritus, or weeping. Baseline characteristics of the sample (n = 100) and responses are described in Table I. Only 26% of patients reported wearing stockings daily as recommended (ie, ≥12 hours daily). A statistically significant association (P = .02) between flare frequency and compression stocking use was observed (Fig 1). Approximately 5% of patients with daily stocking use reported very frequent flares (≥3 times weekly), whereas 64% who reported no stocking use had very frequent flares. The most common reasons cited by patients for noncompliance with the physician recommendation, listed in order of frequency, were inability to put on the stockings, discomfort, unclear how the treatment will help, and cost.Table IPatient demographics and interview responsesVariableResult∗Data are presented as number (%), as mean ± SD, or as indicated. (N = 100)Demographics and medical history Female54 (54) Age, y68.8 ± 12.0 Use of topical steroids61 (61) History of hospitalization for cellulitis22 (22)Interview responses Knowledge of physician recommended stocking use91 (91) General understanding of how stockings work74 (74) Knowledge of hours recommended by the physician<8 h/d2 (2)8-12 h/d9 (10)12-16 h/d15 (16)>16 h/d7 (8)Unknown58 (64) Knowledge of compression strength36 (39) Patient use of compression stockingsAlmost daily26 (26)2-3 times/wk11 (11)3-5 times/wk21 (21)Not at all42 (42) Hours compression stockings worn when used(n = 58)<8 h/d11 (19)8-12 h/d22 (38)12-16 h/d17 (29)>16 h/d8 (14) Number of times reason cited for noncompliance with recommended treatmentInability to put on the compression stockings31Discomfort (too tight)25Unclear how the treatment will help13Cost12Other (too hot, appearance, other medical conditions, physician's lack of emphasis)11 Patient-reported interventions to increase complianceEducation regarding tips for putting on the stockings30Prescription for a slightly lower strength of compression26Financial assistance14Additional education from the physician regarding the utility of compression stockings12∗ Data are presented as number (%), as mean ± SD, or as indicated. Open table in a new tab The cross-sectional design does not permit drawing conclusions about the temporal relationship between compression stocking use and flare prevention. Sampling from a single, Midwestern academic institution limits the generalizability, and all telephone survey research is subject to recall bias. The sample size limited our ability to conduct stratified analysis. Patients expressed frustration with the inability to apply compression stockings because of tightness, poor fit, texture, or warmth. Although not as common, some patients reported out-of-pocket cost as a barrier. Furthermore, patients reported wanting physicians to provide more education about compression stocking application and ways of relieving discomfort. Physicians can provide such education during office visits. Early morning application, professionally fitted stockings, and donning-doffing devices can be promoted. If patients cite discomfort, physicians could prescribe a lower strength or recommend an alternate material. Local medical supply companies can help reduce out-of-pocket costs and offer patient assistance in selecting optimal fit, fabric, color, and length. At the initial encounter, we recommend referral to a local medical company that can assist in optimal stocking design and coordinate insurance benefits whenever possible. At subsequent visits, we recommend physicians regularly address barriers to compression stocking use. These simple interventions can contribute to improved patient compliance with compression stocking use and reduced flare frequency.

Interventions to reduce Staphylococcus aureus in the management of eczema.

Interventions to reduce Staphylococcus aureus in the management of eczema.

Phase 2 trial of a neurokinin-1 receptor antagonist for the treatment of chronic itch in patients with epidermolysis bullosa: A randomized clinical trial

Chronic pruritus causes major morbidity in epidermolysis bullosa (EB). The substance P-neurokinin 1 receptor (SP-NK1) pathway is a promising target for treating EB-related pruritus. To evaluate the safety and efficacy of the oral NK1 receptor antagonist serlopitant in treating moderate-severe pruritus in EB. The study randomized 14 patients to serlopitant or placebo for 8weeks, followed by a 4-week washout and optional open-label extension. The primary end point was change in itch as measured by the Numeric Rating Scale. Secondary end points were change in itch during dressing changes and wound size. We observed greater itch reduction with serlopitant, equivalent to a 0.64-point comparative reduction on the 11-point Numeric Rating Scale by week 8, although this failed to meet statistical significance (P=.11). More serlopitant patients achieved ≥3-point reduction compared with placebo (43% vs 14%, P=.35). In post hoc analysis excluding 1 patient with a concurrent seborrheic dermatitis flare, serlopitant achieved significantly greater median itch reduction from baseline by week 4 (-2 points vs 0, P=.01). We observed no statistically significant differences in secondary end points. Serlopitant was well-tolerated. Small sample size due to disease rarity. The potential itch reduction with serlopitant observed in this trial will be pursued by a larger powered trial (NCT03836001).

The infantile cutaneous microbiome: A review.

Recent focus on the neonatal intestinal microbiome has advanced our knowledge of the complex interplay between the intestinal barrier, the developing immune system, and commensal and pathogenic organisms. Despite the parallel role of the infant skin in serving as both a barrier and an interface for priming the immune system, large gaps exist in our understanding of the infantile cutaneous microbiome. The skin microbiome changes and matures throughout infancy, becoming more diverse and developing the site specificity known to exist in adults. Delivery method initially determines the composition of the cutaneous microbiome, though this impact appears transient. Cutaneous microbes play a critical role in immune system development, particularly during the neonatal period, and microbes and immune cells have closely intertwined, reciprocal effects. The unique structure of newborn skin influences cutaneous microbial colonization and the development of dermatologic pathology. The development of the infantile skin barrier and cutaneous microbiome contributes to future skin pathology. Atopic dermatitis flares and seborrheic dermatitis have been linked to dysbiosis, while erythema toxicum neonatorum is an immune response to the establishment of normal bacterial skin flora. Physicians who care for infants should be aware of the impact of the infantile skin microbiome and its role in the development of pathology. A better understanding of the origin and evolution of the skin microbiome will lead to more effective prevention and treatment of pediatric skin disease.