Comparison of real-world treatment outcomes of systemic immunomodulating therapy in atopic dermatitis patients with dark and light skin types

Indigenous underrepresentation in American and Canadian atopic dermatitis clinical trials: a 10-year cross-sectional analysis

This article highlights the underrepresentation of Indigenous participants in American and Canadian atopic dermatitis clinical trials and explores some contributing factors and potential solutions.

Dupilumab impact on psychiatric and sleep disorder risk reduction in atopic dermatitis: A population-based cohort study

BACKGROUND

Patients with atopic dermatitis (AD) have a higher risk of developing psychiatric and sleep disorders.

OBJECTIVE

To compare the risk of psychiatric and sleep disorders in patients with AD treated with dupilumab vs those on conventional drugs (systemic corticosteroids, methotrexate, cyclosporin, and azathioprine).

METHODS

This retrospective cohort study used the TriNetX Global Collaborative Network (LLC, Cambridge, MA) and included adult patients with AD newly prescribed dupilumab (DUPI-cohort) or conventional drugs without previous dupilumab exposure (CONV-cohort). Propensity score matching was performed for age, sex, race, comorbidities, and laboratory measures. Risks of various psychiatric disorders, such as anxiety, depressive disorders, adjustment disorders, and attention deficit hyperactivity disorder, including sleep disorders, were compared between cohorts, with hazard ratios determined using Cox regression.

RESULTS

After matching, both the DUPI- and CONV-cohorts included 6114 patients each, with an average age of 44 years and 53% female. The racial distribution in both cohorts was approximately 49% White, 15% Black or African American, and 12% Asian. During the 3-year follow-up, the DUPI-cohort had reduced risks of anxiety (hazard ratio 0.76, 95% CI 0.64-0.89), depressive disorders (0.70, 0.58-0.86), adjustment disorders (0.535, 0.37-0.78), and sleep disorders (0.78, 0.65-0.94), whereas the risk of attention deficit hyperactivity disorder was not significantly affected (0.92, 0.61-1.38). These findings were consistent across age groups, sexes, races, and atopic comorbidities, with a more pronounced effect in Black or African American patients.

CONCLUSION

Patients with AD prescribed dupilumab exhibited a lower risk of psychiatric and sleep disorders, with the effect being more evident within the Black or African American subgroup.

Integrating skin color assessments into clinical practice and research: A review of current approaches

Skin color classification can have importance in skin health, pigmentary disorders, and oncologic condition assessments. It is also critical for evaluating disease course and response to a variety of therapeutic interventions and aids in accurate classification of participants in clinical research studies. A panel of dermatologists conducted a literature review to assess the strengths and limitations of existing classification scales, as well as to compare their preferences and utilities. We identified 17 skin classification systems utilized in dermatologic settings. These systems include a range of parameters such as UV light reactivity, race, ethnicity, and degree of pigmentation. The Fitzpatrick skin type classification is most widely used and validated. However it has numerous limitations including its conflation with race, ethnicity, and skin color. There is a lack of validation data available for the remaining scales. There are significant deficiencies in current skin classification instruments. Consensus-based initiatives to drive the development of validated and reliable tools are critically needed.

Understanding Atopic Dermatitis in Asian and European Population Cohorts Using Complementary Omics Techniques

Atopic dermatitis is highly heterogeneous with respect to pathogenesis, clinical manifestations, and treatment response. There is evidence that ancestry and skin type each contribute to this heterogeneity, indicating the need to improve understanding of disease mechanisms in diverse populations. Methods to integrate multiomics studies have been well-described, but this review focuses on the importance and the strategies needed to integrate data across different ancestral groups, focusing, because of data availability, on Asian and European populations. Skin scientists and clinicians will each benefit from an understanding of how the multiple complimentary layers of omics data may inform future clinical management, from insight into disease pathogenesis and treatment targets.

An updated reappraisal of dupilumab in children and adolescents with moderate-severe atopic dermatitis

Atopic dermatitis (AD) is still a demanding challenge in clinical practice. Type 2 inflammation is the most common inflammatory pathway in children and adolescents with AD. Anti-inflammatory drugs, mainly corticosteroids (CS) and immunomodulant agents are the primary therapeutic approach to dampening type 2 inflammation. However, AD patients may require long-term high CS doses or drug combinations with possibly significant adverse effects to achieve and maintain disease control. In this regard, the advent of biologics constituted a breakthrough in managing this condition. Dupilumab is a monoclonal antibody directed against the IL-4 receptor α-subunit (IL-4Rα), antagonizing both IL-4 and IL-13 and is approved for pediatric severe AD. This review presents and discusses the most recent published studies on dupilumab in children and adolescents with AD. There is convincing evidence that dupilumab is safe and effective in managing AD. It can reduce skin lesions and associated itching, reduce the need for additional medications, and improve disease control and quality of life. However, a thorough diagnostic pathway is mandatory, especially considering the different AD phenotypes. The ideal eligible candidate is a child or adolescent with AD requiring systemic treatment because of severe clinical manifestations and impaired quality of life.

Immunopathogenesis of Atopic Dermatitis: Focus on Interleukins as Disease Drivers and Therapeutic Targets for Novel Treatments

Atopic dermatitis is a chronic, recurrent inflammatory skin disorder manifesting by eczematous lesions and intense pruritus. Atopic dermatitis develops primarily as a result of an epidermal barrier defect and immunological imbalance. Advances in understanding these pathogenetic hallmarks, and particularly the complex role of interleukins as atopic dermatitis drivers, resulted in achieving significant therapeutic breakthroughs. Novel medications involve monoclonal antibodies specifically blocking the function of selected interleukins and small molecules such as Janus kinase inhibitors limiting downstream signaling to reduce the expression of a wider array of proinflammatory factors. Nevertheless, a subset of patients remains refractory to those treatments, highlighting the complexity of atopic dermatitis immunopathogenesis in different populations. In this review, we address the immunological heterogeneity of atopic dermatitis endotypes and phenotypes and present novel interleukin-oriented therapies for this disease.