Acta dermato-venereologica最新文献

Tralokinumab is a monoclonal antibody selectively targeting IL-13, approved for moderate-to-severe atopic dermatitis (AD), for which real-world data are scarce. This prospective, observational, multicentric study aimed to assess the long-term effectiveness and safety of tralokinumab in patients with AD in a real-world setting. Primary outcomes included 50%, 75%, and 90% improvement in Eczema Area and Severity Index score (EASI50, EASI75, EASI90, respectively) and improvements in Dermatology Life Quality Index (DLQI) at 1 year. A total of 136 patients with AD were enrolled in the study; data at 1-year follow-up were available for 111 patients. After 1 year, 68.5% and 33.3% of patients achieved an EASI75 and EASI90, respectively. A significantly higher percentage of patients with than without foot involvement achieved EASI50 (p = 0.009) and EASI75 (p = 0.022). Similarly, hand involvement was significantly associated with higher EASI50 response (p = 0.005). Median DLQI score decreased from 9.00 (interquartile range (IQR): 6.00, 13.75) to 1.00 (IQR: 0.00, 4.00) after 1 year of treatment. Adverse events included blepharitis (n = 10), conjunctivitis (n = 6), and injection-site reactions (n = 2). Tralokinumab can be an effective and safe treatment for patients with moderate-to-severe AD. Involvement of certain body areas, such as hands and feet, might positively predict a clinical response to tralokinumab.

Pemphigus is a rare and life-threatening autoimmune disease that is easily ignored in children. This study aimed to attract attention to pemphigus in the paediatric population for better understanding and recognition of the clinical characteristics and management in children's different subtypes of pemphigus. The case series involved a retrospective record review of 3 patients who were referred to a department of dermatology from January 2022 to January 2024. All patients experienced a delayed diagnosis, but were eventually definitively diagnosed with pemphigus vulgaris, pemphigus foliaceus, and pemphigus erythematosus, because they all have intraepidermal blisters and elevated serum antibodies against Dsg1/Dsg3. In all 3 cases, systemic corticosteroids were used in combination with or without steroid-sparing adjuvants. The patient with pemphigus vulgaris experienced a recurrence due to discontinuous treatment; the other 2 patients achieved mostly remission after treatment, with the length of follow-up ranging from 5 to 12 months. Pemphigus in children has its own clinical characteristics and similar literature concerning improved strategies for clinical assessment and treatments are reviewed and discussed.

In recent years, several new systemic agents (biologics and Janus kinase inhibitors [JAKi]) have been registered for the treatment of moderate-to-severe atopic dermatitis (AD). However, comparisons of real-world drug survival data and insights into treatment patterns of these advanced systemics are limited. Data from a prospective observational single-centre registry were collected from 549 adult AD patients (759 treatment courses) receiving biologics (dupilumab, tralokinumab) or JAKi (abrocitinib, baricitinib, upadacitinib) and analysed using Kaplan-Meier survival curves. Cox regression analyses were used to evaluate predictors of survival. Frequencies and percentages summarized data on the initial and subsequent treatments received, with a Sankey diagram illustrating the switching patterns. The 18-month overall drug survival rates for dupilumab, abrocitinib, upadacitinib, tralokinumab, and baricitinib were 70.0%, 51.5%, 48.4%, 39.4%, and 20.4%, respectively. No significant predictors for drug survival were identified. Dupilumab was the predominant initial treatment (87.2%) and upadacitinib the most frequently used second and third treatment. In the total cohort, 57.9% of patients remained on their initial treatment and 26.8% switched to other treatments. In conclusion, dupilumab showed superior survival rates while baricitinib had the lowest survival rate. Frequent switching highlights the need for biomarkers that predict response to advanced systemic treatments to improve attrition rates.

Atopic dermatitis (AD) is a common inflammatory skin disease affecting 5-8% of adults, with many being of reproductive age and potentially experiencing AD- and treatment-related challenges during family planning and pregnancy (FPP). This study examined whether patients with AD receive FPP-related information from their dermatologist and their concerns about pregnancy and breastfeeding. A cross-sectional questionnaire study was conducted among 18-45-year-old patients with AD treated at dermatology departments in university hospitals or private dermatology clinics in Denmark, all undergoing either topical or systemic treatment. A total of 121 patients participated in the study. The most pronounced concern was the heritable nature of AD (88.4%), followed by concerns about the teratogenicity of their treatments (29.8%). Additionally, 37.1% of women expressed concern about their ability to breastfeed. One-third of patients with AD had discussed FPP with their dermatologists prior to pregnancy, and 15% reported having fewer biological children than they desired due to their disease. Adult patients with AD have significant unmet informational needs regarding FPP. Addressing these concerns at appropriate stages in their lives, potentially through structured communication, could provide patients with better opportunities to address their concerns and plan their family life based on comprehensive and accurate information.

Hidradenitis suppurativa is a chronic skin disease associated with significant disease burden. To assess patients' treatment benefits, disease-specific outcomes measurement is needed. This study aimed to develop a questionnaire called Patient Benefit Index for hidradenitis suppurativa (PBI-HS). After an open-item survey, the items were condensed into a 26-item questionnaire on patient needs and benefits, with a 5-point Likert scale. In the validation study, construct and content validity, responsiveness, and feasibility of the questionnaire were assessed at 2 time points. A 26-item questionnaire was created following open-item generation by n = 72 patients. In the validation study, 3 items perceived as most relevant by patients were: "to be free of pain" (mean: 3.6 on a scale of 0-4), "to be free of inflammation" (mean: 3.6), "to have no more scars" (mean: 3.1). Significant correlations of PBI-HS at follow-up visit were found with the physical global assessment for hidradenitis suppurativa (HS-PGA) (r = -0.471; p = 0.000), number of inflammatory lesions (r = -0.359; p = 0.005), and DLQI (r = -0.383; p = 0.003), indicating less disease burden in patients with higher treatment benefits. The PBI-HS is a feasible and valid instrument to assess patient-reported treatment benefits in hidradenitis suppurativa.

A consensus study of experts was conducted to establish a definition of the concept of super-responders (SR) in atopic dermatitis (AD). The study employed a Delphi methodology based on 2 rounds to define the concept of SR in AD, exploring the opinions of expert dermatologists in AD from across Spain regarding a series of statements developed after a systematic review. Consensus was predefined as an agreement of ≥ 80% among all respondents. In the first round, 4 statements reached consensus. In the second round, 2 additional statements reached consensus. To illustrate these definitions, a set of practical cases was provided, and the level of agreement among experts was evaluated. According to the agreed statements, time is important when defining the achievable response as SR. The concept of SR should associate a rapid response (before week 16), include both symptom variables, such as the Eczema Area and Severity Index and Investigators Global Assessment (IGA) and patient-reported outcomes, including pruritus or the Patient-Oriented Eczema Measure. This concept should be associated with complete or nearly complete clearance of lesions (IGA 0-1), and with sustained responses over time (at week 52). Mild flares (IGA ≤ 2) may occur without varying according to the patient's age.