Sixty-Ninth issue
September 18, 2024
Flare play: Standardizing atopic dermatitis terminology for patients and providers
Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by recurring flares. However, “flare” lacks a consistent definition in clinical and research settings. Understanding patient-reported attributes of AD flares can improve shared decision-making and help evaluate treatment effectiveness. This study utilized a consensus survey of 657 US adults with AD to develop a patient-centered, consensus-based working definition of an AD flare by identifying the attributes that patients associate with said flares.
What did they find?
Main Takeaway: While various definitions of an AD flare exist, none are standardized from the patient's perspective. Aligning with a patient-centered definition can enhance communication between patients and healthcare providers, improving AD management.
Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by recurring flares. However, “flare” lacks a consistent definition in clinical and research settings. Understanding patient-reported attributes of AD flares can improve shared decision-making and help evaluate treatment effectiveness. This study utilized a consensus survey of 657 US adults with AD to develop a patient-centered, consensus-based working definition of an AD flare by identifying the attributes that patients associate with said flares.
What did they find?
- 26 participants (92.3% aged 18-44 years, 69.2% women) participated in focus group activities.
- 631 participants (mean age 45.5 years, 84.5% women) completed an online survey.
- 12 statements reached consensus among participants regarding what should be included in a patient-centered definition of an AD flare.
- Over half (52.9%) of the survey participants reported alignment with their healthcare practitioner on the definition of a flare.
- The majority (77.6%) indicated that having a patient-centered definition of an AD flare would be helpful in communication with their healthcare provider.
- Only 4.9% felt that a patient-centered definition would not be helpful.
Main Takeaway: While various definitions of an AD flare exist, none are standardized from the patient's perspective. Aligning with a patient-centered definition can enhance communication between patients and healthcare providers, improving AD management.
Reduced atopic march risk in pediatric atopic dermatitis patients prescribed dupilumab: A population-based cohort study
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Thanks to dupilumab, kids with atopic dermatitis can say goodbye to wheezes and extra sneezes!
The atopic march describes the progression of atopic conditions like asthma and allergic rhinitis following atopic dermatitis (AD) onset, most often occurring during childhood. Dupilumab, a monoclonal antibody against IL-4Rɑ, is an AD treatment with the potential to modulate impaired skin barrier and allergic inflammation associated with atopic march progression. This retrospective cohort study investigated the impact of dupilumab on atopic march progression in pediatric patients with AD compared to those using conventional AD therapies.
What did they find?
Main Takeaway: The risk of atopic march progression toward asthma or allergic rhinitis was significantly reduced in pediatric AD patients, particularly younger ones, prescribed dupilumab compared to those on conventional systemic therapies.
The atopic march describes the progression of atopic conditions like asthma and allergic rhinitis following atopic dermatitis (AD) onset, most often occurring during childhood. Dupilumab, a monoclonal antibody against IL-4Rɑ, is an AD treatment with the potential to modulate impaired skin barrier and allergic inflammation associated with atopic march progression. This retrospective cohort study investigated the impact of dupilumab on atopic march progression in pediatric patients with AD compared to those using conventional AD therapies.
What did they find?
- Patient cohorts were matched with a U.S. healthcare database to include 2,192 pediatric patients with AD prescribed dupilumab and 2,192 prescribed conventional systemic therapies (systemic corticosteroids, methotrexate, azathioprine, or cyclosporine).
- Patients on dupilumab had a lower 3-year cumulative incidence of atopic march progression than those receiving conventional therapies (20.09% vs. 27.22%, respectively, P < 0.001).
- Dupilumab was associated with a significant risk reduction of atopic march progression (HR 0.68, 95% CI 0.55-0.83), asthma (HR 0.60, CI 0.45-0.81), and allergic rhinitis (HR 0.69, CI 0.54-0.88).
- The risk reduction for atopic march progression and asthma was greater in younger patients on dupilumab, with the strongest effect in preschoolers (HR 0.537, CI 0.381-0.756), followed by school-aged children (HR 0.635, 95% CI 0.466-865) and adolescents (HR 0.639, CI 0.440-0.927).
Main Takeaway: The risk of atopic march progression toward asthma or allergic rhinitis was significantly reduced in pediatric AD patients, particularly younger ones, prescribed dupilumab compared to those on conventional systemic therapies.
The relationship between childhood obesity and pediatric immune-mediated skin diseases
Journal of Investigative Dermatology
Journal of Investigative Dermatology
Higher weight, higher risks for pediatric skin diseases.
Immune-mediated skin diseases (IMSDs), including psoriasis, alopecia areata (AA), and atopic dermatitis (AD), significantly impact the pediatric population. With childhood obesity increasing globally, this population-based longitudinal study explored potential associations between body mass index (BMI) and IMSD development in children, using the nationwide database of infants and children from the Korean National Health Insurance Service.
What did they find?
Limitations: Obesity was only defined by BMI.
Main Takeaway: Children with higher BMI percentiles may have an increased risk of developing AA, AD, and psoriasis, highlighting the importance of implementing healthy interventions in the pediatric population to reduce this risk.
Immune-mediated skin diseases (IMSDs), including psoriasis, alopecia areata (AA), and atopic dermatitis (AD), significantly impact the pediatric population. With childhood obesity increasing globally, this population-based longitudinal study explored potential associations between body mass index (BMI) and IMSD development in children, using the nationwide database of infants and children from the Korean National Health Insurance Service.
What did they find?
- Children with obesity had a higher risk of developing pediatric IMSDs compared to those with a normal BMI (P < 0.01).
- Children who went from a normal to an overweight BMI had a higher risk of AD compared to those who maintained a normal BMI (AHR: 1.15, 95% CI: 1.11-1.20; P < 0.001).
- Children who reduced their BMI to normal had a lower AD risk than those who maintained an overweight BMI (AHR: 0.87, 95% CI: 0.81-0.94; P < 0.001).
Limitations: Obesity was only defined by BMI.
Main Takeaway: Children with higher BMI percentiles may have an increased risk of developing AA, AD, and psoriasis, highlighting the importance of implementing healthy interventions in the pediatric population to reduce this risk.
In situ protein expression analysis of melanocyte differentiation antigen TRP1 (tyrosinase-related protein-1)
The American Journal of Dermatopathology
The American Journal of Dermatopathology
Don’t trip about TRP
Tyrosinase-related protein 1 (TRP1) is a melanocyte differentiation antigen involved in melanogenesis. Monoclonal antibodies (mAbs) can be used to detect these antigens in pigmented lesions, with mAbs capable of detecting TRP1 having recently become available. Researchers compared the specificity of six mAbs to detect TRP1. TRP1 expression was analyzed in compound nevi (n=10), primary melanoma (n=15), metastatic melanoma (n=40), and nonmelanocytic neoplasms (n=35).
What did they find?
Main Takeaway: The monoclonal antibody EPR13063 may be a useful diagnostic tool for primary melanoma and a specific marker for detecting TRP1 expression.
Tyrosinase-related protein 1 (TRP1) is a melanocyte differentiation antigen involved in melanogenesis. Monoclonal antibodies (mAbs) can be used to detect these antigens in pigmented lesions, with mAbs capable of detecting TRP1 having recently become available. Researchers compared the specificity of six mAbs to detect TRP1. TRP1 expression was analyzed in compound nevi (n=10), primary melanoma (n=15), metastatic melanoma (n=40), and nonmelanocytic neoplasms (n=35).
What did they find?
- mAB EPR13063 showed strong staining of melanocytes in normal skin, with no staining in other normal tissues.
- TRP1 expression was positive in 100% of compound nevi, with the strongest staining in junctional melanocytes.
- 100% (15/15) of primary melanoma samples were immunopositive for TRP1, compared to 44% (17/40) of metastatic melanoma samples.
- TRP1 expression was negative in 100% of nonmelanocytic neoplasms.
Main Takeaway: The monoclonal antibody EPR13063 may be a useful diagnostic tool for primary melanoma and a specific marker for detecting TRP1 expression.
Is that mole something to worry about, or just a harmless spot?
Journal of Dermatologic Surgery
Journal of Dermatologic Surgery
Do I whack it or let it chill?
Physicians and parents often express concern about scalp nevi in children, leading to unnecessary biopsies or surgeries. This retrospective cohort study analyzed 72 nevi in 56 Chinese children, examining clinical and dermoscopic features to assess potential risks. Dermoscopy with photographic documentation was performed, and data on lesion size, shape, location, and histopathologic findings were collected.
What did they find?
Main Takeaway: Scalp nevi in Chinese children are generally benign, suggesting that invasive procedures can often be avoided.
Physicians and parents often express concern about scalp nevi in children, leading to unnecessary biopsies or surgeries. This retrospective cohort study analyzed 72 nevi in 56 Chinese children, examining clinical and dermoscopic features to assess potential risks. Dermoscopy with photographic documentation was performed, and data on lesion size, shape, location, and histopathologic findings were collected.
What did they find?
- The parietal region was the most common location for scalp nevi, found in 48.6% of cases.
- Histopathology showed 76.4% of nevi were compound nevi, while 13.9% were intradermal nevi. No cases of melanoma were detected.
- Dermoscopy showed a globular pattern in 69.4% of the nevi, with only 1.4% showing the rare reverse-eclipse pattern.
- 33.3% of nevi were larger than 6 mm, and clinical asymmetry was more common in lesions exceeding 6 mm (P < 0.05).
Main Takeaway: Scalp nevi in Chinese children are generally benign, suggesting that invasive procedures can often be avoided.
Botulinum toxin: A solution compared to powder for the treatment of glabellar lines
Journal of Cosmetic Dermatology
Journal of Cosmetic Dermatology
There’s another [botox A] solution to wrinkles!
Neuromodulator botulinum toxin A is commonly used to reduce wrinkles in the glabellar and forehead areas temporarily. A newer, ready-to-use (RTU) liquid formulation of botulinum toxin A reduces the risk of dosing errors. In this open-label randomized phase IV study, 150 participants were treated with either 50 units of RTU aboBoNT-A solution (n=99) or 20 units of the classic powder-form onaBoNT-A (n=51). Each participant received two injections into each corrugator supercilii muscle and one into the procerus muscle. Usability and aesthetic improvement were evaluated at 1, 3, 5, and 6 months in the RTU group and at 1 month in the powder group.
What did they find?
Main Takeaway: Botulinum toxin A solution can be effective for treating glabellar lines, with investigators favoring it over powder formula due to its time-saving, user-friendly, and easy-to-learn application.
Neuromodulator botulinum toxin A is commonly used to reduce wrinkles in the glabellar and forehead areas temporarily. A newer, ready-to-use (RTU) liquid formulation of botulinum toxin A reduces the risk of dosing errors. In this open-label randomized phase IV study, 150 participants were treated with either 50 units of RTU aboBoNT-A solution (n=99) or 20 units of the classic powder-form onaBoNT-A (n=51). Each participant received two injections into each corrugator supercilii muscle and one into the procerus muscle. Usability and aesthetic improvement were evaluated at 1, 3, 5, and 6 months in the RTU group and at 1 month in the powder group.
What did they find?
- The mean preparation time was significantly shorter for the RTU aboBoNT-A solution compared to the powder formulation (0:33 vs 1:34 minutes, respectively; P < 0.0001), with 100% of investigators agreeing that the solution saves time.
- After one month of RTU aboBoNT-A solution injection, 94% of participants were very satisfied or satisfied with their appearance, up from 64% at baseline.
- At one month, 99% of participants who received the RTU aboBoNT-A solution showed improved aesthetic appearance of the glabella compared to baseline, with 76% maintaining this improvement at month 6.
Main Takeaway: Botulinum toxin A solution can be effective for treating glabellar lines, with investigators favoring it over powder formula due to its time-saving, user-friendly, and easy-to-learn application.
Disparities in diagnosis and access to care for infantile atopic dermatitis
British Journal of Dermatology
British Journal of Dermatology
Is your baby's dermatology appointment on hold?
Atopic dermatitis (AD) is a common inflammatory skin condition that can lead to medical and psychosocial challenges. This study sought to identify variations in diagnosis and access to dermatologic care among infants with AD based on race and ethnicity.
What did they find?
Main Takeaway: Non-Hispanic Black and Hispanic infants with AD face longer wait times and more emergency department visits, emphasizing the need for more equitable healthcare access for these populations.
Atopic dermatitis (AD) is a common inflammatory skin condition that can lead to medical and psychosocial challenges. This study sought to identify variations in diagnosis and access to dermatologic care among infants with AD based on race and ethnicity.
What did they find?
- Non-Hispanic white infants (84%) were more likely to receive a prescription for AD from their pediatrician compared to Hispanic infants (54.1%).
- Non-Hispanic Black and Asian infants experienced longer wait times to see a dermatologist after receiving an AD prescription from their PCP (P < 0.001, P = 0.007).
- Non-Hispanic Black infants (26.5%) and Hispanic infants (18.3%) were more likely to visit the emergency department for AD in their first year of life compared to non-Hispanic white infants (5.6%).
Main Takeaway: Non-Hispanic Black and Hispanic infants with AD face longer wait times and more emergency department visits, emphasizing the need for more equitable healthcare access for these populations.
DERMLITE QUESTION OF THE WEEK
Gamma-delta T lymphocytes are a minor subset of circulating T cells in peripheral blood. Gamma-delta T-cell lymphomas are rare and aggressive, with hepatosplenic and primary cutaneous subtypes. These lymphomas often present with a double CD4 and CD8 negative or CD8 positive phenotype.
Report of case:
Main Takeaway: Non-healing wounds with an aggressive clinical course should raise suspicion for primary cutaneous gamma-delta lymphoma. This case revealed an exceedingly rare presentation of a CD4 positive, CD8 negative phenotype, with few similar cases reported in the literature.
Report of case:
- An 85-year-old male with a past medical history of psoriasis presented with a large, non-healing ulcer on the left lateral thigh that slowly expanded over 9 months.
- Physical examination revealed a 15-cm gangrenous ulcer, which was debrided and sent for pathology examination.
- Histopathology showed skin ulceration with necrosis and a nodular lymphoid infiltrate composed of large cells with irregular nuclei, open chromatin, prominent nucleoli, and scant cytoplasm.
- Immunohistochemistry of the neoplastic infiltrate was positive for CD3, CD4, and TCR delta, and negative for CD8.
- These findings rendered a diagnosis of gamma-delta T cell lymphoma, primary cutaneous subtype.
Main Takeaway: Non-healing wounds with an aggressive clinical course should raise suspicion for primary cutaneous gamma-delta lymphoma. This case revealed an exceedingly rare presentation of a CD4 positive, CD8 negative phenotype, with few similar cases reported in the literature.
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Copyright © 2023 - All Rights Reserved.