Pruritus Visual Analog Scale Research Articles

Correlation between clinical efficacy on pruritus and serum interleukin-31 levels in dogs with atopic dermatitis treated with lokivetmab.

Studies on serum interleukin (IL)-31 levels in dogs with atopic dermatitis (AD) and their correlation with disease severity are limited. To the author's knowledge, there are no studies that measured serum IL-31 in dogs treated with lokivetmab injections, a selective inhibitor of this key cytokine in pruritus. The aim of the study was to evaluate serum IL-31 levels in dogs treated with lokivetmab and correlate it with the severity of canine atopic dermatitis using the pruritus visual analog scale (pVAS) and canine atopic dermatitis extent and severity index (CADESI-04). Ten client-owned dogs diagnosed with AD received two injections of lokivetmab four weeks apart. Disease severity was assessed using the pVAS and CADESI-04 scores before and after both injections. In addition, canine serum IL-31 levels were measured at the same moments. Serum IL-31 was detected in all dogs in the study. There was a significant reduction in pVAS scores and serum IL-31 after administrations. However, there was no difference in CADESI-04 scores, and there was no significant correlation between CADESI-04 scores and serum IL-31 in dogs diagnosed with AD. Nonetheless, a significant positive correlation was observed between the pVAS scores and serum IL-31 levels with lokivetmab therapy, which reinforces the role of IL-31 in the pathogenesis of pruritus in dogs with AD. The data presented here provide further evidence that IL-31 is directly involved in pruritus pathogenesis in dogs with AD. In addition, blocking IL-31 has a significant antipruritic effect, but has no influence on skin lesion severity and extension.

Effect of indoor house dust mite concentration on canine atopic dermatitis.

House dust mites (HDM) are regarded as essential environmental allergens not only in human, but also in canine atopic dermatitis (CAD), however, there are only a few studies on the influence of indoor HDM concentration on the disease. Our study analyzed the correlation between the indoor HDM concentration, the severity of CAD, and the residential environments in client-owned 35 AD and 13 healthy dogs. We measured the extent of CAD and severity index-04 (CADESI-04), pruritus visual analog scale (PVAS), and transepidermal water loss (TEWL), indoor relative humidity (RH) and analyzed the residential environment questionnaires to evaluate AD severity. The Der f 1 concentration had an inverse association with TEWL, and no association with CADESI-04 and PVAS. The Der f 1 concentration was significantly high in the group living near the green area and 40% or higher RH. Our results suggest two possibilities: (1) Living around green areas and maintaining an appropriate indoor climate may help to improve CAD clinical symptoms. (2) The HDM may contain endotoxin and when present in high concentrations in CAD, they play a preventive role by enhancing the skin barrier function. Further studies with a larger number of dogs may help further elucidate an association between CAD and Der f 1.

Induction of autophagy improves skin and hair conditions in dogs with underlying diseases.

Autophagy was reported to play a crucial role in maintaining general and skin health. The study used a synthesized autophagy inducer (AI) (Aquatide™ cospharm Inc.; Daejeon, Korea), for evaluating the effects of autophagy on skin and hair in dogs. Twenty-two dogs with poor skin and hair which were diagnosed with canine atopic dermatitis (CAD) or pituitary-dependent hyperadrenocorticism (PDH) were included. Clinical scores using Canine Atopic Dermatitis Extent and Severity Index-04 (CADESI-04), Pruritus Visual Analog Scale (PVAS) and skin barrier function using measurement of transepidermal water loss (TEWL) were evaluated and canine keratinocytes were also used in vitro investigation of pro-inflammatory cytokines after AI treatment. In the AI group, clinical scores and skin barrier function were improved at week 8 significantly compared to in the other groups. In particular, the AI significantly improved the hair surface damage at 8 weeks compared to the baseline. In vitro, the AI reduced pro-inflammatory cytokines by activating the 78-kDa glucose-regulated protein (GRP78). AI improve skin barrier function and hair damage and reduce pro-inflammatory cytokines by inhibiting reactive oxygen species (ROS) production in dogs.

Clarifying sleep characteristics and analyzing risk factors of sleep disorders to promote a predictive, preventive, and personalized medicine in patients with burn scars

This study assessed sleep quality in patients with burn scars and investigated risk factors of sleep disorders to guide clinical therapy. From the strategy of predictive, preventive, and personalized medicine (PPPM/3PM), we proposed that risk assessment based on clinical indicators could prompt primary prediction, targeted prevention, and personalized interventions to improve the management of sleep disorders present in patients with burn scars. This retrospective study recruited patients with burn scars and healthy volunteers from the Shanghai Burn Treatment Center between 2017 and 2022. Relevant information and data, including demographic characteristics, scar evaluation, and sleep quality, were obtained through the hospital information system, classical scar scale, and self-report questionnaires. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and monitored using a cardiopulmonary-coupled electrocardiograph. Pain and pruritus were assessed using the visual analog scale (VAS). Scar appearance was assessed using the modified Vancouver scar scale (mVSS). The sample was comprised of 128 hypertrophic scar (HS) patients, with 61.7% males, a mean age of 41.1 ± 11.6years, and burn area of 46.2 ± 27.9% total body surface area (TBSA). Patients with PSQI ≥ 7 accounted for 76.6%, and the global PSQI score was 9.4 ± 4.1. Objective sleep data showed that initial enter deep sleep time, light sleep time, awakening time, light sleep efficiency, and sleep apnea index were higher but deep sleep time, sleep efficiency, and deep sleep efficiency were lower in HS patients than that in healthy controls. Preliminary univariate analysis showed that age, hyperplasia time of scar, narrow airway, microstomia, VAS for pain and pruritus, and mVSS total (comprised of pigmentation, vascularity, height and pliability) were associated with the PSQI score (p < 0.1). Multivariable linear regression showed narrow airway, VAS for pain and pruritus, and mVSS specifically height, were the risk factors for PSQI score (p < 0.1). This study model identified that narrow airway, pain, pruritus and scar appearance specifically height may provide excellent predictors for sleep disorders in HS patients. Our results provided a basis for the predictive diagnostics, targeted prevention, and individualized therapy of somnipathy predisposition and progression of HS patients in the setting of PPPM/3PM health care system, which contributed to a paradigm shift from reactive cure to advanced therapy.

Efficacy and Safety of Dimethyl Fumarate in Patients with Moderate-to-Severe Plaque Psoriasis: Results from a 52-Week Open-Label Phase IV Clinical Trial (DIMESKIN 1).

Although dimethyl fumarate (DMF) has been approved since 2017 for treatment of moderate-to-severe plaque psoriasis, limited data on its safety and efficacy are available in clinical practice. The objective was to assess the efficacy and safety of DMF in patients with moderate-to-severe plaque psoriasis through 52weeks in conditions close to real clinical practice. DIMESKIN 1 was a 52-week, open-label, phase IV clinical trial conducted at 36 Spanish sites. Adults with diagnosis of moderate-to-severe plaque psoriasis, treated with DMF as per its summary of product characteristics and with ≥ 1 post-baseline Psoriasis Area and Severity Index (PASI) value were included [intention-to-treat (ITT) population]. Efficacy analyses were performed for ITT population and are based on multiple imputation. Overall, 282 and 274 patients were included in the safety and ITT populations, respectively. At week24, 46.0%/24.8%/10.9% of patients achieved PASI 75/90/100 response, respectively. At week52, these percentages were 46.0%/21.9%/10.9%, respectively. Mean body surface area affected decreased from 17.4% to 6.9%/7.3% after 24/52weeks (p < 0.001, both). A total of 42.9%/49.4% of patients had a Physician's Global Assessment 0-1 at week24/52, respectively. Mean pruritus visual analogue scale (VAS) significantly decreased after 24 and 52weeks (p < 0.001, both), with 56.5% and 67.6% of patients, respectively, rating a pruritus VAS < 3. At week24/52, 61.3%/73.4% patients had a Dermatology Life Quality Index (DLQI) ≤ 5 and 34.7%/32.1% had a DLQI 0-1. The most frequent adverse events were gastrointestinal disorders (mainly diarrhea/abdominal pain in 50.0%/35.1% of patients, respectively), flushing (28.0%), and lymphopenia (31.2%), mostly mild/moderate. DMF significantly improves main severity and extension indexes and rates, as well as patient-reported outcomes such as pruritus and quality of life in patients with moderate-to-severe psoriasis after 24weeks of treatment. These improvements are sustained through 52weeks. The safety profile of DMF is similar to that previously described for fumarates. 2017-00136840.

A randomised, double-blinded comparison between subcutaneous rush and intralympathic allergen immunotherapy induction in atopic dogs.

Atopic dermatitis (AD) is one of the most common skin diseases in small animal practice. Allergen immunotherapy (AIT) is the only curative treatment for the disease, and oral, subcutaneous and intralymphatic administration of allergens are commonly employed. To compare the efficacy of AIT following an induction phase with intralymphatic injections (ILIT) or rush immunotherapy (RIT). Fifty privately owned dogs with AD. In a double-blinded study, dogs were randomly assigned to either four monthly ILIT of allergen extract or RIT with five injections administered subcutaneously at hourly intervals on the first day. They were assessed by validated scores; Canine Atopic Dermatitis Lesion Index (CADLI) and pruritus Visual Analog Scale (PVAS) at the beginning of the study and after 1, 3, 6 and 12 months. The latter were performed daily for 7 days before each revisit. Medication scores and a total clinical score were calculated and compared between each group and time point. There was no significant difference in CADLI and PVAS scores, or CADLI and medication scores between groups at any of the time points. A significant improvement with both ILIT and RIT was seen in total and pruritus scores, respectively. An owner global assessment of good-to-excellent treatment efficacy was seen in 40% of the dogs; total scores improved by 27% and 35% in the RIT and ILIT group, respectively. Adverse effects were not seen. Induction of AIT can be conducted either as RIT or ILIT with no loss in efficacy.

123 Anti-BP180, Pruritus, and Thymus and Activation-Regulated Chemokines as Surrogate Markers for Disease Activity in Bullous Pemphigoid

Bullous pemphigoid disease activity index (BPDAI) is the standard indicator of disease activity in bullous pemphigoid (BP). However, examining patients’ whole body is burdensome to both the patient and health care workers and is subjected to inter-examiner bias, hence the need to investigate other surrogate markers for BPDAI. The purpose of the study is to quantify and correlate candidate surrogate disease markers of BP namely visual analogue scale for pruritus (VAS-pruritus), thymus and activation-regulated chemokines (TARC), and anti-BP180 to bullous pemphigoid disease activity index (BPDAI).

A comparative study on a biodegradable hyaluronic acid microneedle patch with a needleless patch for dry skin in atopic dermatitis: a single-blinded, split-body, randomized controlled trial.

To overcome interruption of skin barrier in transdermal drug delivery, the microneedle (MN) patch penetrates the barrier by punching with its MNs. Setting a needleless patch (NL patch) as the control intervention, this study assessed the efficacy of a biodegradable hyaluronic acid MN patch (BHMN patch) for atopic dermatitis (AD) patients with dry skin. Similar two AD lesions were selected from the extremities of a participant. For one lesion, a BHMN patch was attached for 6-8h on where an aroma cream was applied (BHMN patch group). Simultaneously, an NL patch was attached on the other lesion as in the BHMN patch group (NL patch group). For 2weeks, the interventions were conducted 3 times a week. The local scoring AD (L-SCORAD) index, the visual analog scale for pruritus and skin dryness, skin hydration, the transepidermal water loss (TEWL), and safety were assessed. Fifteen participants finished this trial with no dropouts. Both groups improved the L-SCORAD index after 2weeks (p < 0.05), but the score of the BHMN patch group decreased more than that of the NL patch group (p < 0.05). The other outcomes, except for the TEWL, also showed statistical significance in intragroup comparisons. Nevertheless, none of the other outcomes showed statistical significance in intergroup comparisons. The TEWL showed no statistical significance even in intragroup comparison. Recoverable minor adverse events were reported in three cases. Considering the result of L-SCORAD index, the BHMN patch may be effective for ameliorating AD. However, a large-scale confirmatory trial is necessary to reassess other outcomes.Trial Registration: This study was registered with the Clinical Research Information Service, Republic of Korea (Submitted date: 04/01/2022, Registered date: 23/02/2022, The first participant enrollment: 01/12/2021, Registration No. KCT0007037).

The effect of uterine-derived mesenchymal stromal cells for the treatment of canine atopic dermatitis: A pilot study.

Canine atopic dermatitis (cAD) is a common allergic skin condition among dogs that may respond to treatment with mesenchymal stromal cells (MSCs). The aim of this pilot study was to evaluate the safety and efficacy of allogeneic uterine tissue-derived MSCs (UMSCs) for the reduction and control of clinical signs associated with cAD. At two sites, seven client-owned dogs with cAD received two doses of approximately 3.6 x 107 UMSCs given intravenously over 30 min, on Day 0 and Day 14, with monthly clinical follow-up until Day 90 and optional owner phone interview on Day 180. Primary outcomes were pruritus and skin lesions. Pruritus was measured by the owner-assessed Pruritus Visual Analog Scale (PVAS), with treatment success defined as a 2-point reduction in PVAS score at any timepoint after treatment. Skin lesions were evaluated by two veterinarians according to the Canine Atopic Dermatitis Extent and Severity Index (CADESI-4). The secondary outcome was safety, which was evaluated via physical exam and hematology, including complete blood count (CBC), serum chemistry, and urinalysis (UA). Treatment was generally well tolerated and associated with a significant reduction in PVAS on Day 30 that was maintained through Day 180. On Day 60, five dogs (71%) achieved treatment success (at least 2-point reduction in PVAS), and three dogs (43%) had a PVAS improvement of 4-5 points. Mean CADESI-4 score was significantly improved on Day 14, Day 30, Day 60, and Day 90, with the lowest mean score observed on Day 60. Three dogs exhibited mild and transient adverse events. These findings suggest that IV-administered allogeneic UMSCs reduce and control clinical signs of cAD, with a durable benefit lasting 3–6 months.

Evaluation of the efficacy and safety of artemether emulsion on localized senile pruritus: A randomized pilot study.

Background:Localized senile pruritus is a continued health problem for the elderly. This study aimed to evaluate the efficacy and safety of artemether emulsion on localized senile pruritus.Methods:Sixty patients diagnosed with senile pruritus were randomized into the artemether emulsion (1%) group or emulsion base group in a 1:1 ratio (the artemether group vs the control group). The patients used artemether emulsion or emulsion base for pruritus twice daily for 2 weeks. The pruritus visual analog scale (VAS) and the rate of adverse events were evaluated in week 0 and week 2.Results:The VAS scores in week 2 after treatment decreased significantly compared with those before treatment in both groups (P < .05). After treatment, patients receiving the artemether emulsion had significantly lower mean VAS scores compared to those who received the emulsion base (1.21 ± 1.64 vs 3.67 ± 2.97, P < .05). When the VAS scores were compared between the 2 groups before treatment, the effective rate of the artemether group was significantly higher than that of the control group (χ2 = 55, P < .05) in week 2 after treatment. Besides, no adverse events occurred in both groups.Conclusions:Both artemether emulsion and emulsion base were effective in treating localized senile pruritus, and artemether emulsion was superior to emulsion base.

Efficacy of Antimicrobial Treatment in Dogs with Atopic Dermatitis: An Observational Study.

Simple SummaryAtopic dermatitis (AD) is a very common allergic skin disease of dogs that is usually accompanied by skin infections, bacterial, fungal, or both. Although treatment of bacterial and fungal infections in dogs with AD has been recommended and is widely practiced, there are only a few studies evaluating its efficacy. The aim of this study was to evaluate the change in the severity of skin lesions and pruritus after the administration of systemic antimicrobials that resulted in the resolution of the infections. In total, 39 dogs were used, and treatment was prescribed according to the laboratory findings. For the evaluation of the skin lesions and pruritus, validated scales were used, and the scores before and after the treatment were compared. The severity of skin lesions and pruritus decreased significantly, by 30% and 35%, respectively. The efficacy of antimicrobial treatment was assessed as good to excellent by the clinician and the owner in 55% and 60% of the dogs, respectively. There was high variability in the response to treatment among dogs and further studies are needed to find factors that can predict the response to antimicrobial treatment in dogs with AD and skin infections.There is a shortage of studies reporting the efficacy of antimicrobial treatment of dogs with atopic dermatitis (AD) and skin infections (SIs). The aim of this study was to evaluate the change in the severity of skin lesions and pruritus, and the overall efficacy of antimicrobial treatment, in dogs with AD and bacterial overgrowth/infection and/or Malassezia dermatitis. A total of 20 dogs with AD and SIs were prospectively enrolled (group A) and they were examined before and after the administration of systemic antimicrobials that resulted in the resolution of SIs. In addition, 19 dogs fulfilling the same inclusion criteria and treated with systemic, with or without topical antimicrobials, were included retrospectively (group B). Since there were no major differences between the groups, their results were combined. The severity of skin lesions decreased significantly, by 30% based on Canine Atopic Dermatitis Extent and Severity Index-4 (CADESI-4), by 28.1% based on the erythema domain of CADESI-4 and based on owner’s global assessment of the severity of skin lesions. Pruritus decreased significantly, by 34.7% based on the Pruritus Visual Analogue Scale (PVAS). The efficacy of antimicrobial treatment was assessed as good to excellent by the investigator and the owner in 55% and 60% of the dogs, respectively. Despite the significant improvement, there was high variability in the response to treatment among dogs. Further studies are needed to find factors that determine the response to antimicrobial treatment in dogs with AD and SIs.

Use of Cytopoint in the Allergic Dog

Allergic dermatitis is the most common type of skin disease in dogs. Of all dogs, 20 to 30% present with some type of allergic dermatitis. Pruritus is one of the most important signs of allergic dermatitis and is often the most challenging to control. Interleukin-31 (IL-31) has been found to be one of the main initiators of pruritus in dogs with allergic dermatitis. Cytopoint®, a caninized monoclonal anti-IL-31 antibody, has been shown to be effective for the treatment of dogs against allergic dermatitis and atopic dermatitis. US label indication. A recent retrospective study reported that Cytopoint achieved treatment success in 87.8% of the cases with allergic dermatitis. No prospective cohort studies have been performed investigating the effects of Cytopoint in dogs with allergic dermatitis using the dosing protocol prescribed on the product label in the United States. In this study, our objectives were to assess the efficacy of Cytopoint for treatment of canine allergic dermatitis of variable etiologies and management of the associated pruritus, and add to the body of evidence available to the veterinarian as they make treatment recommendations. Dogs included in this study had moderate to severe pruritus according to the Pruritus Visual Analog Scale (PVAS; ≥ 50 mm) and a history of likely continuation of pruritus at the time of presentation. On day 0, investigators recorded the initial body weight and every patient received one dose of Cytopoint (minimum 2 mg/kg SQ) and an isoxazoline product for parasite control. Treatment success for this study was defined as a ≥20 mm reduction in PVAS from Day 0. On Day 7, 94% of the dogs had achieved treatment success. On Day 28, 98% had achieved treatment success and cumulatively by day 56, 100% of the dogs achieved treatment success. This prospective study provides evidence that Cytopoint effectively treats dogs with allergic dermatitis of different types and the associated pruritus.

IL-31 levels correlate with pruritus in patients with cholestatic and metabolic liver diseases and is farnesoid X receptor responsive in NASH.

Pruritus is associated with multiple liver diseases, particularly those with cholestasis, but the mechanism remains incompletely understood. Our aim was to evaluate serum IL-31 as a putative biomarker of pruritus in clinical trials of an farnesoid X receptor (FXR) agonist, cilofexor, in patients with NASH, primary sclerosing cholangitis (PSC), and primary biliary cholangitis (PBC). Serum IL-31 was measured in clinical studies of cilofexor in NASH, PSC, and PBC. In patients with PSC or PBC, baseline IL-31 was elevated compared to patients with NASH and healthy volunteers (HVs). IL-31 correlated with serum bile acids among patients with NASH, PBC, and PSC. Baseline IL-31 levels in PSC and PBC were positively correlated with Visual Analog Scale for pruritus and 5-D itch scores. In patients with NASH, cilofexor dose-dependently increased IL-31 from Week (W)1 to W24. In patients with NASH receiving cilofexor 100 mg, IL-31 was higher in those with Grade 2-3 pruritus adverse events (AEs) than those with Grade 0-1 pruritus AEs. IL-31 weakly correlated with C4 at baseline in patients with NASH, and among those receiving cilofexor 100 mg, changes in IL-31 and C4 from baseline to W24 were negatively correlated. IL-31 messenger RNA (mRNA) was elevated in hepatocytes from patients with PSC and NASH compared to HVs. In a humanized liver murine model, obeticholic acid increased IL-31 mRNA expression in human hepatocytes and serum levels of human IL-31. IL-31 levels correlate with pruritus in patients with cholestatic disease and NASH, with FXR agonist therapy resulting in higher serum levels in the latter group. IL-31 appears to derive in part from increased hepatocyte expression. These findings have therapeutic implications for patients with liver disease and pruritus.

Efficacy and side effects of Blacksoap® as adjuvant therapy of scabies: a randomized control trial

BACKGROUND Blacksoap® is recognized as adjuvant therapy for scabies, but there has been no significant study on its effectiveness. This study aimed to compare the efficacy and safety between Blacksoap® and placebo on standard treatment for pruritus visual analog scale (VAS) and transepidermal water loss (TEWL) scores before and after receiving therapy.&#x0D; METHODS This single-blind randomized controlled trial was held in a boarding school in West Java in 2018. Subjects were recruited consecutively by random cluster sampling. Both groups received standard permethrin 5% cream therapy. The intervention group (n = 37) obtained Blacksoap®, while the control (n = 41) received baby soap. During the initial assessment, pruritus VAS and TEWL scores were taken. The cure rate, scores of pruritus VAS and TEWL, as well as side effects were assessed and compared during the first and fourth weeks. Data were analyzed using SPSS software version 20 (IBM Corp., USA) by a third party, mostly using non-parametric tests.&#x0D; RESULTS The cure rate of the intervention group was lower than the control in the first week with 75% versus 81% but higher in the fourth week with 97% versus 92%. There was no significant difference in the scores of pruritus VAS and TEWL, as well as side effects between the two groups.&#x0D; CONCLUSIONS The efficacy and safety of scabies treatment were similar between Blacksoap® and placebo adjunctive to standard treatment. Blacksoap®, on top of standard scabies treatment, might benefit patients by providing a higher cure rate in 4 weeks without any considerable adverse effects.

Associations Between Atopic Dermatitis and Anxiety, Aggression, and Fear-Based Behaviors in Dogs.

The goal of this study was to determine if anxiety, aggression, and fear-related behaviors are more common in pruritic dogs with atopic dermatitis than nonpruritic, healthy dogs. One hundred forty-one pruritic dogs >1 yr of age with a clinical diagnosis of atopic dermatitis and a >3 mo history of pruritus were recruited. Dog owners completed a behavioral survey (canine behavioral assessment and research questionnaire) and a pruritus scale (pruritus visual analog scale). Pruritic, atopic dogs showed significant increases in fear- and anxiety-related behaviors as well as aggression compared with a large control group of healthy dogs. Stranger-directed aggression, owner-directed aggression, familiar-dog aggression, dog-directed fear, nonsocial fear, touch sensitivity, excitability, and attention-seeking behaviors were all increased in the study group. Trainability was decreased in the study group. Chronically pruritic dogs experience fear and anxiety and are more likely to display aggression. This is an important welfare issue for these animals. Early recognition of the behavioral derangements that can be associated with chronic pruritic skin disease could allow early intervention with a multidisciplinary approach for these patients, thus improving patient and owner quality of life and long-term treatment outcomes.

Efficacy of 5% permethrin-2% fusidic acid cream compared to 5% permethrin-placebo in the treatment of impetiginized scabies.

Scabies is caused by Sarcoptes scabiei var hominis, often causing secondary bacterial infections, especially by Streptococcus pyogenes and Staphylococcus aureus. Permethrin 5% cream is the first-line of treatment that is recommended, combined with Fusidic acid 2% cream as the first-line topical antibiotic. We investigated the efficacy of a combination of permethrin 5% cream and fusidic acid 2% cream for the treatment of impetiginized scabies. A double-blind, randomized clinical trial was organized at two Islamic boarding schools in Bogor, West Java, Indonesia. Forty subjects were randomly allocated into the intervention group (permethrin 5% and fusidic acid 2%; n = 20), and the control group (permethrin 5% and placebo; n = 20). Treatment efficacy was determined through the visual analogue scale (VAS) for pruritus and pain, and by examining bacterial cultures. Treatment efficacy in the intervention group was higher than in the control group on day 7 (80% vs. 35%) and day 14 (95% vs 35%, p ≤ 0.001, RR 2.714) with decreasing VAS for pruritus (p = 0.04) and pain (p = 0.035). The most common bacterium was Staphylococcus aureus. Some minor adverse effects such as itch and heat occurred temporarily. Treating impetiginized scabies with permethrin 5% and fusidic acid 2% cream is more effective than treating with only 5% premethrin. The most common bacterium causing secondary infection in impetiginized scabies is Staphylococcus aureus.

In dogs with atopic skin disease, is lokivetmab more effective than oclacitinib in reducing the score of a recognised scoring system?

PICO question&#x0D; In dogs with atopic skin disease, is lokivetmab more effective than oclacitinib in reducing the Canine Atopic Dermatitis Lesion Index score (or some other recognised scoring system)?&#x0D; &#x0D; Clinical bottom line&#x0D; Category of research question&#x0D; Treatment&#x0D; The number and type of study designs reviewed&#x0D; One randomised controlled trial and one before and after study were critically appraised&#x0D; Strength of evidence&#x0D; Weak&#x0D; Outcomes reported&#x0D; One randomised controlled trial studied the effects of lokivetmab and oclacitinib and found that both drugs were similar in reducing the Canine Atopic Dermatitis Lesion Index (CADESI-03) score.&#x0D; An additional study was evaluated but had non-standardised data as it was a before-and-after study on use of lokivetmab. The paper noted that dogs’ response to oclacitinib can be used to predict how well these dogs respond to lokivetmab. This study also reported a reduction in Pruritus Visual Analog Scale (PVAS) score between before and after lokivetmab administration&#x0D; Conclusion&#x0D; In view of the strength of evidence and outcomes from the studies, there is insufficient quality of evidence to answer the PICO question and so further comparative study is required&#x0D; &#x0D; How to apply this evidence in practice&#x0D; The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.&#x0D; Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.&#x0D; &#x0D;

Real-world outcomes in patients with moderate-to-severe plaque psoriasis treated with guselkumab for up to 1 year

ABSTRACT Background Real-world data on guselkumab, especially at times >6 months, are limited. Research design and methods We performed a longitudinal, retrospective analysis on 307 patients with moderate–severe chronic plaque psoriasis (Psoriasis Area Severity Index [PASI] >10) treated with guselkumab for up to 12 months. Main outcome measures PASI 75, PASI 90, and PASI 100 were assessed at baseline and at 4, 12, 20, 28, 36, 44, and 52 weeks. Results At 12 weeks, PASI 75, PASI 90, and PASI 100 were achieved in 56.4%, 33.6%, and 24.1% of patients, respectively. At 52 weeks, PASI 75, PASI 90, and PASI 100 were achieved in 82.7%, 68.7%, and 51.1% of patients, respectively. Patients without comorbidities and those naïve to previous biological therapy had better responses. The mean Dermatology Life Quality Index score decreased from 14.0 at baseline to 3.1 at 12 weeks and 1.6 at 6 months, which was maintained at later times. Similar improvements were seen in pruritus visual analog scale. Conclusions Guselkumab maintains its efficacy for up to 12 months among responders in a real-world cohort of patients with moderate–severe plaque psoriasis, confirming data from prior real-world studies with smaller cohorts and shorter duration of follow-up.

Medihoney Derma Cream Treatment for Mild to Moderate Atopic Dermatitis in Children: An Open-Label Randomized Pilot Study.

To the Editor: Topical corticosteroids are considered the main treatment for atopic dermatitis (AD), especially during a flare.1 Although topical corticosteroids have enormous benefits in reducing inflammation, they may be accompanied by significant adverse effects. In addition, the worldwide prevalence of topical corticosteroids phobia is extremely high, ranging from 31% to 95.7%,2 and may lead to poor adherence, resulting in persistent disease and rapid escalation to systemic agents.2 To avoid these adverse effects and the excess use of topical corticosteroids, other topical treatment modalities for AD are needed.3 Medihoney Derma Cream (Med-D-Cream) is a topical emollient cream containing 30% Medihoney antibacterial honey, coconut oil, German chamomile flower extract, evening primrose oil, aloe vera, vitamin E, glucose oxidase, and Leptospermum compounds. It has broad antibacterial and antipruritic activity,4 and by preserving skin barrier integrity and moisture, it aids in maintaining skin pH. Med-D-Cream is licensed for skin and wound care in Australia, Europe, and the United States. To offer an alternative corticosteroid-sparing option for treating mild to moderate AD in children, we conducted a trial comparing the safety and efficacy of Med-D-Cream to a common mild potency corticosteroid cream used worldwide for the treatment of AD (hydrocortisone 1% cream). The trial comprised children aged 2 to 18 years diagnosed with mild to moderate AD, with an Investigator Global Assessment (IGA) score of 2 to 3 and body surface area (BSA) of 1% to 10%, including 30 patients, 20 using Med-D-Cream, and 10 as controls using hydrocortisone 1% cream. Patients applied creams for 2 weeks and were then followed up for 2 more weeks to measure responses using IGA, BSA, Eczema Area and Severity Index score, SCORing Atopic Dermatitis, and Visual Analogue Scale pruritus (Fig. 1). The duration of treatment was limited to 2 weeks to avoid prolonged use of a topical steroid. The response rate (IGA score of 0 or 1 with at least 1-grade reduction after 2 weeks of treatment) was 47.4% (9/19) in the intervention group (Med-D-Cream) and 60% (6/10) in the control group (hydrocortisone 1% cream). There was no statistically significant difference between the 2 arms in response rates. No significant changes were found between the 2 groups regarding the secondary outcomes (BSA, Eczema Area and Severity Index score, SCORing Atopic Dermatitis, and Visual Analogue Scale pruritus). In the Med-D-Cream group, 2 of the 20 patients (10%) had adverse events, which resulted in 1 patient's withdrawal. No adverse events were seen in the hydrocortisone group. Our study had some limitations. First, we had a small sample size because it was a pilot study; however, the cohort size did allow us to draw statistical conclusions. Second, the study had relatively short treatment and follow-up periods (4 weeks overall), limiting the ability to observe potential allergic contact dermatitis and properly assess Med-D-Cream's effect on barrier function. Despite these limitations, this is the first randomized study designed to explore Med-D-Cream clinical activity and compare it with a topical corticosteroid in the pediatric population.Figure 1: Flowchart of the study design and population.In conclusion, the study demonstrated that Med-D-Cream, an emollient, is safe and effective in treating pediatric mild to moderate AD. Although it failed to show that Med-D-Cream had superiority over hydrocortisone 1% cream, it showed comparable clinical efficacy. Amir Horev Pediatric Dermatology Service Soroka University Medical Center Beer Sheva, Israel Faculty of Health Sciences Ben-Gurion University of the Negev Beer Sheva, Israel [email protected]Maayan SherSarah Weissmann Faculty of Health Sciences Ben-Gurion University of the Negev Beer Sheva, IsraelLior Golan Faculty of Health Sciences Ben-Gurion University of the Negev Beer Sheva, Israel Clinical Research Unit Soroka University Medical Center Beer Sheva, IsraelAnat Horev Neurology Department Soroka University Medical Center Beer Sheva, Israel

The effect of a mixed cannabidiol and cannabidiolic acid based oil on client-owned dogs with atopic dermatitis.

BackgroundCannabidiol (CBD) and cannabidiolic acid (CBDA) are reported to have antinociceptive, immunomodulatory and anti‐inflammatory actions.ObjectivesTo determine if CBD/CBDA is an effective therapy for canine atopic dermatitis (cAD).AnimalsThirty‐two privately owned dogs with cAD.Materials and methodsProspective, randomised, double‐blinded, placebo‐controlled study. Concurrent therapies were allowed if remained unchanged. Dogs were randomly assigned to receive either 2 mg/kg of an equal mix of CBD/CBDA (n = 17) or placebo for 4 weeks. On Day (D)0, D14 and D28, Canine Atopic Dermatitis Extent and Severity Index, 4th iteration (CADESI‐04) and pruritus Visual Analog Scale (pVAS) scores were determined by investigators and owners, respectively. Complete blood count, serum biochemistry profiles and cytokine bioassays were performed on serum collected on D0 and D28.ResultsThere was no significant difference in CADESI‐04 from D0 to D14 (p = 0.42) or D28 (p = 0.51) in either group. pVAS scores were significantly lower for the treatment group at D14 (p = 0.04) and D28 (p = 0.01) and a significant change in pVAS from baseline was seen at D14 (p = 0.04) and not D28 (p = 0.054) between groups. There was no significant difference in serum levels of interleukin (IL)‐6, IL‐8, monocyte chemoattractant protein ‐ 1, IL‐31 or IL‐34 between groups at D0 or D28. Elevated alkaline phosphatase was observed in four of 17 treatment group dogs.Conclusions and clinical relevanceCBD/CBDA as an adjunct therapy decreased pruritus, and not skin lesions associated with cAD in dogs.