Journal of Drugs in Dermatology最新文献

Background and objective: Atopic dermatitis (AD) affects 15% to 20% of children. Evidence supporting the effectiveness of colloidal oatmeal-based moisturizers in improving mild-to-moderate AD is accumulating. Data on use with a bathing routine, where compromised skin could be affected, is lacking. This study evaluated the effectiveness and tolerability of 1% colloidal oatmeal-containing cream and gentle baby wash in children with AD.

Methods: In this open-label, single-arm study of children 3 to 72 months old with mild-to-moderate AD, 1% colloidal oatmeal-containing cream was applied twice daily, and a gentle baby wash was used ≥3 times/week for 4 weeks.

Primary endpoint: mean change from baseline at day 28 in the Eczema Area Severity Index (EASI) and Atopic Dermatitis Severity Index (ADSI) total scores. Adverse events (AEs), tolerability, skin barrier (SB), Infant Dermatitis Quality of Life (IDQoL), sleep (Brief Infant Sleep Questionnaire-Revised; BISQ-R), and pruritus were evaluated. Assessments were performed at baseline and on days 1, 3, 7, and 28.

Results: Twenty-nine of 31 enrollees completed the study. At all visits, improvements from baseline in EASI, ADSI, IDQoL, and pruritus were significant (P<0.05). SB significantly improved at most visits. Two AEs were reported and led to study discontinuation (papular rash; contact dermatitis).

Conclusions: The study regimen was effective and well-tolerated in this pediatric population with AD. Improvements occurred as early as day 1, with a rapid reduction in pruritus and increased well-being.

Management of CHE can be complicated by numerous factors, including the possibility that contact irritants or allergens–including occupational exposures–contribute to the condition. Additionally, there have been few effective directed treatment options available for the condition, and some of the most widely used treatments have potential limitations, including systemic exposure or tolerability concerns.

Background: Dupilumab has demonstrated benefits in patients with atopic dermatitis (AD), but there is limited information on real-world rates of dupilumab persistence and supplementation with topical and systemic treatments beyond adult populations.

Objective: This retrospective cohort study evaluated real-world dupilumab use among children (<13 years), adolescents (13–17 years), and adults (≥18 years) with moderate-to-severe AD, who initiated dupilumab (March 2017 to September 2021) in the United States.

Methods: The OM1 PremiOM™ AD dataset was used to assess dupilumab treatment persistence and treatment supplementation over a 24-month period.

Results: Of 5200 eligible patients who initiated dupilumab, 208 were children, 430 were adolescents, and 4562 were adults. Dupilumab persistence decreased consistently over 24 months of follow-up. The probability of dupilumab persistence at 12 and 24 months was 79.8% and 70.8% in children, 81.9% and 63.1% in adolescents, and 73.2% and 55.7% in adults, respectively. Across all patients, treatment supplementation increased over time; 31.5% received supplemental systemic therapy, and 62.1% received topical medications at 24 months.

Conclusions: Over a 2-year period, dupilumab persistence generally decreased while treatment supplementation increased for all patient groups, indicating a considerable proportion of patients with AD have unaddressed treatment needs.

Background: Our dermatology department consistently receives the largest proportion of internal on-call referrals from the Hematology-Oncology Department. Individuals with hematological malignancies are particularly susceptible to dermatologic conditions secondary to immunosuppression and multi-agent exposure, which can impact cancer therapy, leading to morbidity and mortality.

Methods: Our primary objective was to analyze the range of dermatologic conditions observed in patients with hematologic malignancies and to identify potential associations with anticancer therapies. We conducted a retrospective, single-center review of acute hematology-oncology referrals to our on-call service between August 2020 and November 2022. Consultations were identified retrospectively through the on-call referral log.

Results: One hundred and thirty-four (134) patients were included. The most common diagnoses were cutaneous adverse drug eruptions (22%), leukemia or lymphoma cutis (13%), infections (13%), and acneiform eruptions (10%). Notably, cutaneous drug reactions were more prevalent in patients with myeloid neoplasms (32%). Acneiform eruptions predominantly occurred in patients with myeloid lineage malignancies.

Conclusion: Dermatology plays a vital role in providing consultative services to patients with hematology-oncology conditions. With the emergence of novel therapies, the landscape of dermatologic complications in this population is evolving. Consequently, the demand for dermatology expertise is expected to increase to facilitate prompt diagnosis and management and to ensure optimal patient outcomes.

Chronic hand eczema (CHE) affects up to 10% of the general population and is associated with significant physical discomfort, impaired hand function, and reduced quality of life, yet effective long-term treatment options remain limited. Delgocitinib cream, a nonsteroidal topical pan-JAK inhibitor, has demonstrated high efficacy and safety in adult Phase 3 pivotal trials, significantly improving clinical signs, symptoms, and quality of life for patients across diverse CHE subtypes. Comparative studies suggest delgocitinib offers superior or similar benefits to systemic therapies like the oral retinoid alitretinoin and the biologic dupilumab, with negligible systemic exposure. These findings support delgocitinib cream as an innovative and promising topical therapy addressing a critical unmet need in CHE patient management.

Atopic dermatitis (AD), a chronic inflammatory skin disease, is typically treated with topical corticosteroids in patients with mild to moderate disease, creating an ongoing need for nonsteroidal therapies. As part of a phase 2, randomized, dose-ranging study of ruxolitinib (Janus kinase [JAK]1/JAK2 inhibitor) cream, twice-daily 1.5% ruxolitinib cream was compared with twice-daily 0.1% triamcinolone cream (midpotency topical corticosteroid) in adults with mild to moderate AD for ≥2 years. Triamcinolone cream was only used for 4 continuous weeks of the 8-week vehicle-controlled period for safety considerations; thus, data here are reported up to week 4 in the study. At week 4, substantially more patients who applied 1.5% ruxolitinib cream vs 0.1% triamcinolone cream achieved ≥75% or ≥90% improvement from baseline in the Eczema Area and Severity Index (56.0% vs 47.1% and 26.0% vs 13.7%, respectively) and Investigator’s Global Assessment Score of 0/1 with ≥2-grade improvement from baseline (38.0% vs 25.5%). Significantly more patients achieved ≥2-point improvement in itch numerical rating scale (NRS) on day 2 with 1.5% ruxolitinib cream vs 0.1% triamcinolone cream (42.5% vs 20.5% [P=0.0412]), and significantly more patients achieved ≥4-point improvement in itch NRS at week 4 (62.5% vs 32.3% [P=0.0128]). Ruxolitinib cream was well tolerated, with no clinically significant application site reactions. Treatment-emergent adverse events were mild/moderate in severity; nasopharyngitis and headache were most common (n=2 [4.0%] each). In summary, ruxolitinib cream is a well-tolerated nonsteroidal therapy with efficacy at least as good as a midpotency topical corticosteroid while avoiding the potential concerns of long-term corticosteroid use.

Background: Atopic dermatitis (AD) is a common heterogeneous disorder that typically starts in infancy and early childhood, is associated with the development of comorbidities, and may persist into adulthood. Skin barrier dysfunction is a pivotal contributor to AD and is impacted by S. aureus colonization and immunological, genetic, and environmental (SAIGE) factors. Managing AD in clinical practice remains challenging due to multiple contributing SAIGE factors.

Methods: A global expert panel of 7 pediatric dermatologists and dermatologists used a modified Delphi process comprising face-to-face discussions and an online follow-up to define five consensus statements providing recommendations based on the literature, clinical experience, and the panel’s opinion for healthcare providers treating pediatric patients with AD.

Results: The panel defined SAIGE factors that compromise skin barrier function and contribute to AD development. The recommendations focus on the impact of SAIGE factors in pediatric AD development, reducing exposure to modifiable risk factors to mitigate skin barrier dysfunction. Continuous skincare that is initiated from birth may delay and mitigate AD, specifically in high-risk populations.

Conclusions: According to panel consensus, recognizing and mitigating SAIGE factors and initiating ceramide-containing skincare from birth are important. The panel recommendations underscore the need for clinician education to improve knowledge of the impact of SAIGE factors and therapeutic mitigation strategies to delay flare development and reduce AD severity.