Conjunctivitis in atopic dermatitis patients with and without dupilumab therapy - international eczema council survey and opinion

Background

Conjunctivitis is common in patients with atopic dermatitis (AD) in general and a commonly reported adverse event in AD clinical trials with dupilumab.

Objective

To survey opinions and experience about conjunctivitis occurring in AD, including those during dupilumab treatment in a group of AD experts from the International Eczema Council (IEC).

Methods

Electronic survey and in‐person discussion of management strategies.

Results

Forty‐six (53.5%) IEC members from 19 countries responded to the survey. Consensus was reached for several statements regarding diagnostic workup, referral and treatment. IEC members suggest that patients with AD should (i) routinely be asked about ocular complaints or symptoms, (ii) obtain information about the potential for conjunctivitis before starting dupilumab therapy and (iii) if indicated, be treated with dupilumab despite previous or current conjunctivitis. In cases of new‐onset conjunctivitis, there was consensus that dupilumab treatment should be continued when possible, with appropriate referral to an ophthalmologist.

Limitations

The study relies on expert opinion from dermatologists. Responses from few dermatologists without dupilumab access were not excluded from the survey.

Conclusion

The IEC recommends that dermatologists address conjunctivitis in patients with AD, especially during treatment with dupilumab.

Quality of health care of atopic eczema in Germany: results of the national health care study AtopicHealth

BACKGROUND

The successful treatment of atopic eczema (AE) should result in the improvement of both physical symptoms and patient's quality of life (QoL). This study was conducted using a sample of dermatologists throughout Germany. This is due to dermatologists being the main health care providers of AE.

OBJECTIVES

Obtaining reliable data on quality of care of AE from both the patient's and the physician's perspective.

METHODS

This cross-sectional study assessed: the individual clinical history; dermatology-specific QoL (DLQI); state of health (EQ-5d-VAS); treatments; burden caused by disease and treatment; patient-defined treatment benefit (PBI).

RESULTS

Data from 1678 adult patients (60.5% female, mean age: 38.4 ± 15.9) were analysed. The most frequently used treatments during the last five years were emollients (90.4%) and topical corticosteroids (85.5%). In this study, 75.8% of the patients felt only moderately or not at all impaired by their treatment. The mean DLQI (0 = minimum-30 = maximum QoL impairment) was 8.5 ± 6.5. The EQ-5d-VAS (100 = best possible) was 63.6 ± 22.0 on average. 26.6% reported suffering 'often' or 'every night' from sleeplessness due to severe itching. Mean PBI was 2.4 ± 1.1 (4 = maximum benefit).

CONCLUSIONS

This study provides first data on the health care of adults with AE in Germany at a national level and reveals the need for a more effective care. Whereas most patients consider their treatment-related burden as low, the daily burden of the disease seems to be high: one third reports sleeplessness due to itching which indicates insufficient therapeutic regimes in these cases. A better implementation of the German national guideline for AE and a systematic analysis of the difficulties causing its limited effects is needed.

Noninvasive stratum corneum sampling and electron microscopical examination of skin barrier integrity: pilot study with a topical glycerin formulation for atopic dermatitis

INTRODUCTION

Therapy of atopic dermatitis encloses use of medicated and nonmedicated preparations. Results of clinical and biophysical procedures indirectly describe the condition of the impaired skin barrier (SB). Direct evaluation of SB integrity is only possible by electron microscopical visualization, e.g. intercellular lipid lamellae (ICLL) organization of the stratum corneum.

METHOD

SB integrity was measured by morphometric analysis of ICLL in healthy and atopic skin and after a 15-day treatment (plus 7-day follow-up) of atopic skin with a glycerin preparation.

RESULTS

Significant treatment effect was shown by the restoration of the ICLL.

CONCLUSIONS

The study reveals that morphometric analysis of ICLL organization is suitable to differentiate between healthy and diseased skin and to semiquantitatively determine the effect of a nonmedicated glycerin formulation.

LIMITATION

Small treatment cohort.

[Associated diseases and differential diagnostic considerations in childhood atopic eczema]

Atopic eczema (AE) is a chronic inflammatory skin disease which affects 10 to 20% of children and 1 to 3% of adults. AE is usually diagnosed based on standard criteria such as those of Hanifin and Rajka, whereby the age-related variation must be considered. There are numerous other diseases which go along with AE or show a very similar clinical picture and represent important differential diagnostic considerations including parasitic diseases, immunodeficiency, nutritional diseases, certain neoplastic disorders and various corneal abnormalities. Additionally, it is important to consider diseases which can occur in association with AE, such as keratosis pilaris, alopecia areata or sweat disturbances.

[Cheilitis granulomatosa Melkersson-Rosenthal syndrome]

Melkersson-Rosenthal syndrome is a rare disorder characterized by a triad of recurrent orofacial swelling, recurrent paralysis of the facial nerve and lingua plicata. The complete triad only occurs in 25% of MRS cases. Monosymptomatic or oligosymptomatic variants are more frequent; other findings include granulomas in other facial sites, regional lymphadenopathy, fever, psychotic disorders and hyperplastic gingivitis are associated with MRS. This can be a diagnostic challenge. The etiology and pathogenesis of MRS are unknown. Corticosteroids or clofazimine appear the best therapeutic options.

Efficacy and functionality of silver-coated textiles in patients with atopic eczema

BACKGROUND

Microbial skin colonization with Staphylococcus aureus is known to play an important role in atopic eczema (AE). Recently, an antibacterial effect of silver-coated textiles on S. aureus colonization has been demonstrated.

OBJECTIVES

To investigate clinical efficacy and functionality of silver-coated textiles in AE, a multicentre, double-blind, placebo-controlled trial was conducted.

PATIENTS/METHODS

From November 2001 to August 2002, 68 consecutive outpatients clinically diagnosed with generalized AE were included in the study. Inclusion criteria were the clinical diagnosis of AE with a moderate severity as measured by the scoring of atopic dermatitis (SCORAD) index with at least 20. Patients were instructed to wear either silver-coated (verum, 35 patients + 2 dropouts) or cotton garments (placebo, 22 patients + 9 dropouts) directly on the skin for 2 weeks. Only basic skin care and ongoing therapy with topical steroids or oral antihistamines was permitted. Clinical severity was assessed using the 'SCORAD' before, during and at the end of study. Quality of life (QOL), wearing comfort (WC) and functionality (FU) of study clothes were measured in parallel. Patients documented their subjective and objective symptoms daily.

RESULTS

In the verum group, eczema improved significantly after 1 week with further enhancement until the end of study (P = 0.03 and P < 0.001). Silver-coated textiles were comparable to cotton in WC and FU. Pruritus and self-assigned skin condition improved significantly more than with placebo (P < 0.001 and P = 0.003).

CONCLUSIONS

In conclusion, silver-coated textiles are able to improve objective and subjective symptoms of AE significantly within 2 weeks, showing a good wearing comfort and functionality comparable to cotton.

Efficacy of Crisis Intervention Treatment with Topical Corticosteroid Prednicarbat with and without Partial Wet-Wrap Dressing in Atopic Dermatitis

BACKGROUND

The wet-wrap treatment has been reported to be beneficial in acute episodes of atopic dermatitis (AD) skin lesions.

OBJECTIVE

The efficacy of topical corticosteroid prednicarbat with and without additional wet-wrap dressing was investigated in a prospective, randomized and controlled study.

METHODS

In the left-right comparison study, 24 adults and children with an acute episode of AD were included. One arm or leg was randomly treated with the topical corticosteroid prednicarbat plus wet-wrap dressing; only prednicarbat was applied on the leg or arm of the other side.

RESULTS

After 48-72 h of treatment, in both groups an improvement of the local SCORAD was observed. In comparison to the side of the body treated with corticosteroid alone, the decrease of the local SCORAD in the corticosteroid plus wet-wrap dressing group was significantly better. The severity of AD improved in the wet-wrap group at an average of 4.4 points, in the corticosteroid group 3.0 (p<0.011).

CONCLUSIONS

Wet-wrap therapy with a topical corticosteroid is an effective treatment option in patients with exacerbated AD. The treatment is helpful in improving skin conditions, shortening the time of corticosteroid application.