Editor's Picks November 2024

Abstract

Although acute urticaria (AU) is highly prevalent (Figure 1), limited evidence and recommendations exist. According to a review by Badloe et al., corticosteroid addition to a second-generation oral H1-antihistamine did not improve acute urticaria symptoms in two out of three RCTs, and combination of a first-generation H1-antihistamine and H2-antihistamine (intravenously) was most effective for urticaria relief in two out of five studies.

Emek Kocatürk

Badloe FMS, Grosber M, Ring J, Kortekaas Krohn I, Gutermuth J. Treatment of acute urticaria: a systematic review. J Eur Acad Dermatol Venereol 2024;38:2082–2092. https://doi.org/10.1111/jdv.19904.

Chronic Nodular Prurigo (CNPG) is a pruritic skin condition with frequent comorbidities, characterized by the development of nodules due to scratching.

Pereira et al. evaluated the association between clinically relevant comorbidities (e.g. diabetes and hypertension), itch intensity, and quality of life (QoL) impairment in 513 adults with CNPG treated in 12 European countries (Figure 2). Conditions not typically involved in the pathophysiology of itch also appeared to be related to the perception of itch. Careful management of comorbidities in patients with CNPG is important to potentially alleviate itch intensity and improve QoL.

Pereira MP, Gutsche A, Weisshaar E, et al. Chronic nodular prurigo: association between comorbidities, itch and quality of life. J Eur Acad Dermatol Venereol 2024;38:e984–e988. https://doi.org/10.1111/jdv.20038.

International expert dermatologists drafted the Aiming High in Eczema/Atopic Dermatitis (AHEAD) recommendations, suggesting that disease severity should be assessed using both physician-reported and patient-reported outcomes. Physicians should discuss results with patients/caregivers, aiming for targets to optimize patient outcomes. The ultimate treatment goal is a satisfied patient with minimal impact on QoL, clear/almost-clear skin, and no/minimal itch.

They also established a novel, patient-centred, minimal disease activity (MDA) concept, where patients/caregivers choose one to three atopic dermatitis symptoms/features most important to them, physicians select corresponding patient-reported outcome measures, and both discuss optimal targets (Figure 3).

Silverberg JI, Gooderham M, Katoh N, et al. Combining treat-to-target principles and shared decision-making: international expert consensus-based recommendations with a novel concept for minimal disease activity criteria in atopic dermatitis. J Eur Acad Dermatol Venereol 2024;38:2139–2148. https://doi.org/10.1111/jdv.20229.

Vindenes et al. assessed the understudied relationship between the microbiome and self-reported hand eczema, hand hygiene practices, and moisturizer use. Individuals with hand eczema (HE) showed a more dysbiotic bacterial community over time, with an increase in Staphylococcus associated with active HE. Frequent hand washing as well as moisturizer use was linked to lower alpha diversity (i.e. decreased variety of bacterial species) (Figure 4).

In conclusion, while regular hand washing is essential, excessive washing may reduce bacterial diversity and increase susceptibility to certain skin conditions, and specific moisturizers that support skin barrier function should be recommended.

Vindenes HK, Drengenes C, Amin H, Irgens-Hansen K, Svanes C, Bertelsen RJ. Longitudinal analysis of the skin microbiome in association with hand eczema, hand hygiene practices and moisturizer use. J Eur Acad Dermatol Venereol 2024;38:2118–2129. https://doi.org/10.1111/jdv.19906.