Describe the diverse clinical presentation of chronic hand eczema 

Define the role of new and emerging topical therapies for the management of chronic hand eczema 

Identify treatment plans for patients who would benefit from new and emerging topical therapies based on patient characteristics, preferences, and treatment goals 

FC24: Chronic Hand Eczema: Hope on the Horizon: An Online Activity

Review the latest evidence on new and emerging therapies for chronic hand eczema (CHE) 

Select treatment plans informed by the latest clinical evidence for CHE management 

PosterToPractice: Updates in Chronic Hand Eczema: Getting Hands-On With Clinical Evidence

Describe the diverse clinical presentation of chronic hand eczema

Identify treatment plans for patients who would benefit from new and emerging topical therapies based on patient characteristics, preferences, and treatment goals

CMEswiper: Swiping Away Chronic Hand Eczema with Emerging Therapeutics: An Online Activity

Eczema

WEDNESDAY, March 19, 2025 -- Delgocitinib cream is well tolerated and efficacious for maintaining disease control up to 52 weeks in patients with chronic hand eczema (CHE), according to a study published online March 11 in the Journal of the American Academy of Dermatology.Melinda Gooderham, M.D., from Queens University in Kingston, Ontario, Canada, and colleagues examined the long-term safety and efficacy of delgocitinib cream as needed for 36 weeks in adults with CHE in a phase 3 open-label trial (DELTA-3). A total of 801 patients who completed the 16-week treatment period in DELTA 1 and 2 were treated on an as-needed basis with twice-daily delgocitinib. Patients with Investigator's Global Assessment for CHE (IGA-CHE) ≥2 were treated until achievement of IGA-CHE ≤1.The researchers found that delgocitinib was well tolerated, with COVID-19 and nasopharyngitis being the most frequent adverse events reported. Among delgocitinib-treated patients from the parent trials, DELTA-3 baseline IGA-CHE 0/1 (24.6 percent) and ≥75 percent/≥90 percent improvement in Hand Eczema Severity Index scores (51.8/31.8 percent) were maintained to week 36 (30.0 percent and 58.6/36.6 percent, respectively). Among those previously treated with cream vehicle, there was corresponding improvement from the DELTA 3 baseline of 9.1 percent and 23.7/12.0 percent to 29.5 percent and 51.5/35.7 percent, respectively, at week 36."Long-term delgocitinib treatment (up to 52 weeks for delgocitinib-treated patients in parent trials [DELTA 1 or DELTA 2]) with as-needed twice-daily delgocitinib cream for 36 weeks was well tolerated and no major safety concerns were identified in adult patients with CHE," the authors write.Several authors disclosed ties to biopharmaceutical companies, including LEO Pharma, which manufactures delgocitinib and funded DELTA-3.

Delgocitinib well tolerated and efficacious when used as needed in 36-week open-label trial&nbsp;

Delgocitinib Efficacious for Maintaining Chronic Hand Eczema Control

WEDESDAY, Feb. 5, 2025 -- For patients with mild atopic dermatitis, haptic feedback may be used as a nonpharmacological intervention to reduce nocturnal scratching, according to a study published online Feb. 5 in JAMA Dermatology.Albert F. Yang, M.D., from the University of Michigan in Ann Arbor, and colleagues conducted a single-arm, two-stage cohort study to examine the accuracy and efficacy of an artificial intelligence-enabled wearable sensor with closed-loop haptic feedback for reducing nocturnal scratch in patients with mild atopic dermatitis. Participants who self-reported moderate or severe scratching behaviors were enrolled. Haptic feedback, delivered by a wearable sensor mounted on the hand, was triggered on detection of nocturnal scratch by an artificial intelligence algorithm. Participants initially wore the sensor for sensing only for seven nights, followed by seven nights of wearing the sensor with haptic feedback activated.Ten patients were included and contributed 104 sleep nights and 831 monitoring hours. None of the patients were lost to follow-up. The researchers found that when haptic feedback was activated in the second week, there was a significant 28 percent decrease in mean scratch events nightly (45.6 versus 32.8) and a significant 50 percent difference (15.8 versus 7.9 seconds) in mean scratch duration per hour of sleep opportunity, with no decrease in total sleep opportunity."This technology may serve as a standalone or, more likely, a supportive therapeutic device for decreasing scratching behavior in patients with mild AD who may not meet the criteria for systemic therapy or prefer to not use topical corticosteroids yet still report a high degree of scratching," the authors write.Several authors disclosed ties to Maruho Co., which partially funded the study and has patents pending; one author disclosed ties to AbbVie.

Significant decrease seen in mean scratch events nightly and in mean scratch duration per hour of sleep opportunity

Haptic Feedback Can Reduce Nocturnal Scratching in Mild Eczema

WEDNESDAY, Nov. 13, 2024 (HealthDay News) -- The odds of eczema are increased with greater exposure to fine particulate matter of diameter ≤2.5 μm (PM2.5), according to a study published online Nov. 13 in PLOS ONE.Gloria F. Chen, from the Yale School of Medicine in New Haven, Connecticut, and colleagues examined the risk for eczema with PM2.5 exposure in a diverse national cohort of American adults in a cross-sectional study. Eczema cases in the All of Us Research Program were linked via three-digit zip code to average annual PM2.5 concentrations from the Center for Air, Climate, and Energy Solutions.The researchers found that the 12,695 individuals with eczema lived in areas with significantly higher PM2.5 concentrations than the 274,127 without eczema (0.83 versus 0.81 x 10 µg/m3). In a univariate analysis, PM2.5 concentration was significantly associated with eczema (odds ratio, 1.97); the findings persisted in multivariable analyses after controlling for demographics and smoking status (odds ratio, 2.21) and with the addition of atopic comorbidities (odds ratio, 2.38)."Our finding of an approximately twofold increased risk of eczema per 10 μg/m3 rise in PM<div class="raw-html-embed"></div>2.5 is clinically relevant as well as actionable, as the United States Environmental Protection Agency's Air Quality Index is based on differences in PM2.5 concentrations of comparable orders of magnitude," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0310498">Abstract/Full Text</a>

In multivariable analyses after adjustment for demographics and smoking status, odds ratio was 2.21 for eczema in areas with higher PM2.5

Greater Fine Particulate Matter Linked to Increased Odds of Eczema

FRIDAY, Oct. 4, 2024 (HealthDay News) -- For patients with moderate-to-severe atopic dermatitis (AD), lebrikizumab has long-term efficacy, according to a study presented at the annual meeting of the European Academy of Dermatology and Venereology, held from Sept. 25 to 28 in Amsterdam.Diamant Thaçi, Ph.D., from University Lübeck in Germany, and colleagues reported long-term efficacy and safety from the ADjoin long-term extension study. Adults aged 18 years and older and adolescents aged 12 to &lt;18 years were randomly assigned to receive lebrikizumab 250 mg every two weeks (LEBQ2W) or placebo in the ADvocate 1 &amp; 2 trials. Patients receiving lebrikizumab who met protocol-defined response criteria after 16 weeks were randomly assigned to receive LEBQ2W, lebrikizumab 250 mg every four weeks (LEBQ4W), or placebo. Participants who completed 52 weeks were eligible to enroll in ADjoin and received the same treatment regimen. Efficacy was assessed though week 100 of ADjoin.Overall, 82 patients receiving LEBQ2W and 99 receiving LEBQ4W entered ADjoin. The researchers found that of the patients with Investigator Global Assessment (IGA) scores of 0/1 at week 16 in the LEBQ2W and LEBQ4W groups, respectively, 81.5 and 83.3 percent maintained IGA 0/1 at week 52 (ADjoin week 0) and 82.9 and 84.0 percent maintained IGA 0/1 at week 152. Of the patients with Eczema Area and Severity Index 75 percent improvement (EASI 75) at week 16 in the LEBQ2W and LEBQ4W groups, 96.3 and 93.7 percent and 90.5 and 94.1 percent maintained EASI 75 at week 52 and week 152, respectively. Throughout ADjoin, 14.6 and 24.2 percent of those receiving LEBQ2W and LEBQ4W, respectively, used any rescue therapy."These three-year results provide compelling evidence of durable efficacy and a consistent safety profile," senior author Eric Simpson, M.D., from Oregon Health &amp; Science University in Portland, said in a statement.The study was funded by Eli Lilly, the manufacturer of lebrikizumab.<a target="_blank" rel="noopener noreferrer" href="https://investor.lilly.com/news-releases/news-release-details/new-data-show-lillys-ebglysstm-lebrikizumab-lbkz-provided">Press Release</a><a target="_blank" rel="noopener noreferrer" href="https://eadv.org/congress/">More Information</a>

Long-term efficacy seen for lebrikizumab every two weeks or every four weeks in moderate-to-severe atopic dermatitis

Long-Term Efficacy for Lebrikizumab Seen in Moderate, Severe Eczema

WEDNESDAY, Sept. 4, 2024 (HealthDay News) -- The association of prenatal ω-3 long-chain polyunsaturated fatty acid (n-3 LCPUFA) with the risk for childhood atopic dermatitis (AD) varies based on the maternal cyclooxygenase-1 (COX1) genotype, according to a study published online Aug. 28 in JAMA Dermatology.Liang Chen, from Herlev and Gentofte Hospital in Copenhagen, Denmark, and colleagues examined the association of n-3 LCPUFA supplementation during pregnancy with the risk for childhood AD overall and by maternal COX1 genotype. A total of 736 pregnant women at 24 weeks of gestation were randomly assigned to n-3 LCPUFA (fish oil) or placebo (olive oil) until one-week postpartum; 635 children completed clinical follow-up.The researchers observed an association between pregnancy n-3 LCPUFA supplementation and lower urinary thromboxane A2 metabolites at age 1 year (β = −0.46), which was also associated with the COX1 rs1330344 genotype (β per C allele, 0.47). There were no associations for n-3 LCPUFA supplementation or the maternal COX1 genotype with the risk for childhood AD until age 10 years; however, evidence of an interaction between these variables was seen. The risk for AD was lower in the n-3 LCPUFA group versus the placebo group among mothers with the TT genotype, while no association was seen for mothers with the CT genotype. An increased risk was seen for offspring of mothers with the CC genotype."These findings support use of a personalized prevention strategy for reducing the burden of AD in childhood by only providing n-3 LCPUFA supplementation to pregnant mothers carrying the COX1 rs1330344 TT genotype," the authors write.Several authors disclosed ties to the biopharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2823065">Abstract/Full Text (subscription or payment may be required)</a>

Risk for AD was lower in the n-3 LCPUFA versus placebo group among mothers with the TT genotype

Link Between n-3 LCPUFA, Eczema Varies by Maternal COX1 Genotype

WEDNESDAY, July 24, 2024 (HealthDay News) -- Use of oral corticosteroids for &gt;90 days during one year is associated with a slightly increased risk of adverse events (AEs), according to a study published online July 19 in JAMA Network Open.Yong Hyun Jang, M.D., Ph.D., from Kyungpook National University in Daegu, South Korea, and colleagues examined the association between long-term exposure to oral corticosteroids and occurrence of 11 AEs among adult patients with atopic dermatitis. Analysis included 164,809 cases and 328,303 controls.The researchers found that 3.4 percent of cases and 3.2 percent of controls were exposed to oral corticosteroids for &gt;30 days, while 0.4 percent in both groups were exposed to oral corticosteroids for &gt;90 days. There was no increased risk of AEs with use of oral corticosteroids for &gt;30 days (adjusted odds ratio, 1.00; 95 percent confidence interval, 0.97 to 1.04). However, the risk was higher with use of oral corticosteroids for &gt;90 days (adjusted odds ratio, 1.11; 95 percent confidence interval, 1.01 to 1.23). For each cumulative or consecutive year of ever long-term use, there was a small elevation of risk for experiencing an AE. "This study suggests that for patients with exacerbations of atopic dermatitis, limiting the duration of oral corticosteroid treatment to 90 days or less may limit adverse effects," the authors write.Several authors disclosed ties to the pharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821349">Abstract/Full Text</a>

Authors suggest limiting duration of oral corticosteroid treatment to 90 days or less to reduce risk of adverse effects

Adverse Event Risk Up for >90 Days Versus >30 Days of Corticosteroids for Eczema

FRIDAY, May 31, 2024 (HealthDay News) -- Long-term intermittent use of ruxolitinib cream is well tolerated and provides disease control in adolescent patients with atopic dermatitis (AD), according to a study published online May 2 in the American Journal of Clinical Dermatology.Lawrence F. Eichenfield, M.D., from the University of California San Diego, and colleagues assessed the safety and efficacy of 1.5 percent ruxolitinib cream versus vehicle and long-term disease control of ruxolitinib cream among adolescents using pooled data from phase 3 studies. The analysis included 245 adolescents (aged 12 to 17 years) with AD for at least two years.The researchers found that at week 8, substantially more patients who applied 1.5 percent ruxolitinib cream versus vehicle achieved Investigator's Global Assessment (IGA) treatment success (50.6 versus 14.0 percent), ≥75 percent improvement in the Eczema Area and Severity Index (60.9 versus 34.9 percent), and a 4-point improvement or greater in the itch numerical rating scale (52.1 versus 17.4 percent). During the long-term safety period, mean trough steady-state ruxolitinib plasma concentrations at weeks 12 and 52 were 27.2 and 15.5 nM, respectively. With ruxolitinib, the percentage of patients achieving an IGA score of 0 or 1 was sustained or further increased. Application site reactions through 52 weeks occurred in 1.8 percent of participants applying 1.5 percent ruxolitinib cream at any time. No patients reported serious adverse events."Treatment with 1.5 percent ruxolitinib cream in adolescent patients with mild-to-moderate atopic dermatitis had anti-inflammatory and antipruritic effects comparable with those observed in the overall study population," the authors write.The study was funded by Incyte, the manufacturer of ruxolitinib.<a target="_blank" rel="noopener noreferrer" href="https://link.springer.com/article/10.1007/s40257-024-00855-2">Abstract/Full Text</a>

Ruxolitinib cream well tolerated, and disease control maintained over a year with as-needed use

1.5 Percent Ruxolitinib Cream Safe, Effective for Teens With Eczema

FRIDAY, May 24, 2024 (HealthDay News) -- Antihypertensive drugs are associated with an increased risk for eczematous dermatitis in older adults, and the effect sizes are largest for diuretics and calcium channel blockers, according to a study published online May 22 in JAMA Dermatology.Morgan Ye, M.P.H., from the University of California in San Francisco, and colleagues examined whether antihypertensive drug use is associated with eczematous dermatitis in a longitudinal cohort study of individuals aged 60 years and older without eczematous dermatitis at baseline.The researchers found that the overall prevalence of eczematous dermatitis was 6.7 percent among 1,561,358 older adults during a median follow-up of six years. The incidence of eczematous dermatitis was higher among those receiving versus those not receiving antihypertensive drugs (12 versus 9 of 1,000 person-years of follow-up). Participants who received any antihypertensive drugs had a significantly increased risk for any eczematous dermatitis in adjusted analyses (hazard ratio, 1.29). When assessing each antihypertensive drug class individually, the largest effect sizes were seen for diuretics and calcium channel blockers, while the effect sizes were smallest for angiotensin-converting enzyme inhibitors and β-blockers (hazard ratios, 1.21, 1.16, 1.02, and 1.04, respectively)."Although additional research is needed to understand the mechanisms underlying the association of antihypertensive drug use and eczematous dermatitis, these data could be helpful to clinicians to guide clinical management when an older patient presents with eczematous dermatitis," the authors write.Two authors disclosed ties to the pharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2819258">Abstract/Full Text (subscription or payment may be required)</a>

Largest effect sizes seen for diuretics and calcium channel blockers, smallest for ACE inhibitors, β-blockers

Antihypertensives Linked to Eczematous Dermatitis in Seniors

TUESDAY, May 28, 2024 -- For pediatric and adult patients with atopic dermatitis (AD), tapinarof is efficacious and shows favorable safety and tolerability, according to a study published online May 20 in the Journal of the American Academy of Dermatology.Jonathan I. Silverberg, M.D., Ph.D., M.P.H., from the George Washington University School of Medicine and Health Sciences in Washington, D.C., and colleagues examined tapinarof efficacy and safety in adults and children aged as young as 2 years with AD. Two eight-week phase 3 trials were conducted involving 813 patients who were randomly assigned to tapinarof or vehicle.The researchers found that both trials met the primary efficacy end point of the Validated Investigator Global Assessment for Atopic Dermatitis score of 0 or 1 and ≥2-grade improvement from baseline at week 8: 45.4 versus 13.9 percent and 46.4 versus 18.0 percent for tapinarof versus placebo. At week 8, significantly superior ≥75 percent improvement in the Eczema Area and Severity Index score from baseline responses was seen with tapinarof versus vehicle: 55.8 versus 22.9 percent and 59.1 versus 21.2 percent. Tapinarof versus vehicle was associated with significant rapid improvements in patient-reported pruritus. Folliculitis, headache, and nasopharyngitis were common adverse events (≥5 percent) and were mostly mild or moderate; lower discontinuation due to adverse events was seen in the tapinarof versus vehicle groups."Tapinarof potentially fills a gap in the treatment armamentarium for a highly effective, nonsteroidal topical that can be used down to 2 years of age," the authors write.Several authors disclosed ties to biopharmaceutical companies, including Dermavant, which manufactures tapinarof and funded the study.

Significantly more eczema patients who received tapinarof met primary efficacy end point at week 8

Tapinarof Efficacious, Safe for Pediatric, Adult Patients With Eczema

WEDNESDAY, March 20, 2024 -- For adults with moderate-to-severe chronic hand eczema (CHE), treatment with delgocitinib cream 20 mg/g for 36 weeks yields ongoing improvements, according to a study presented at the annual meeting of the American Academy of Dermatology, held from March 8 to 12 in San Diego.Melinda Gooderham, M.D., from the SKiN Centre for Dermatology in Peterborough, Ontario, Canada, and colleagues examined the long-term safety and efficacy of delgocitinib cream for up to 36 weeks in adults with moderate-to-severe CHE who completed the 16-week treatment period in the DELTA-1 and DELTA-2 trials. A total of 801 participants were treated on an as-needed basis with twice-daily delgocitinib cream in DELTA-3.The researchers observed no safety concerns during delgocitinib cream treatment in DELTA-1, DELTA-2, or DELTA-3. The most frequent treatment-emergent adverse events were COVID-19 and nasopharyngitis in DELTA-3. In DELTA-3, improvement from baseline to week 36 continued in Investigator's Global Assessment for CHE clear/almost clear, ≥75 percent/≥90 percent improvement in the Hand Eczema Severity Index, and ≥4-point itch/pain reduction among delgocitinib-treated patients."Overall, with delgocitinib cream 20 mg/g treatment, no safety concerns were identified and efficacy further improved, supporting the benefit of long-term as-needed use of delgocitinib cream in patients with CHE," the authors write.The DELTA trials were sponsored by LEO Pharma, the manufacturer of delgocitinib.

No safety concerns observed during 36 weeks of treatment with delgocitinib cream 20 mg/g

AAD: Long-Term Safety, Efficacy Seen for Delgocitinib Cream in Hand Eczema

WEDNESDAY, Jan. 3, 2024 (HealthDay News) -- An increase in carbon monoxide (CO) levels associated with the Canadian wildfires of 2023 correlated with increased atopic dermatitis (AD), dermatitis, and eczema-related clinic visits in a Boston hospital system, according to a study published online Dec. 16 in Dermatology and Therapy.Kathyana P. Santiago Mangual, from Massachusetts General Hospital in Boston, and colleagues examined the impact of air pollution on AD and skin health and assessed how wildfires exacerbate the disease burden. CO levels were obtained for the Boston region during the months following the Canadian wildfires of 2023; patient records on dermatology clinic visits for dermatitis and eczema were examined at the Mass General Brigham hospital system, 300 miles from the wildfires.The researchers found that compared with the previous four years, there was a correlation for the notable rise and atypical summer peak in CO levels in the Boston region during 2023 with a spike in AD, dermatitis, and eczema-related clinic visits."According to the United Nation's Environment Programme of 2022, we must learn to live with fires," the authors write. "Amidst the escalating frequency of wildfires and other contributors to pollution, physicians and government agencies must work together to improve air quality conditions and safeguard the well-being of patients, especially those who are most vulnerable."<a target="_blank" rel="noopener noreferrer" href="https://link.springer.com/article/10.1007/s13555-023-01080-1">Abstract/Full Text</a>

Atypical summer peak CO levels in Boston region in 2023 linked to spike in AD, dermatitis, eczema-related clinic visits

Skin Clinic Visits Increased With High Carbon Monoxide Levels Due to Wildfires

MONDAY, Oct. 30, 2023 (HealthDay News) -- For adults with atopic dermatitis (AD) receiving dupilumab treatment, a reversible lymphoid reaction (LR) has been observed, which mimics cutaneous T-cell lymphoma (CTCL), according to a study published online Oct. 18 in JAMA Dermatology.Celeste M. Boesjes, M.D., from the University Medical Center Utrecht in the Netherlands, and colleagues conducted a retrospective observational case series involving adult patients with AD treated with dupilumab to examine the clinical and histopathological features of patients clinically suspected for CTCL.The study included 14 patients suspected for CTCL with deterioration of symptoms during dupilumab treatment. The researchers found that three of these were retrospectively diagnosed with preexistent mycosis fungoides (MF) and 11 were diagnosed with an LR. The patients diagnosed with an LR showed MF-like symptoms, but had different histopathologic findings, including sprinkled distribution of small hyperchromatic lymphocytes in the upper epidermal section, a dysregulated CD4:CD8 ratio, and overexpression of CD30, without CD2/CD3/CD5 loss. There was a median of four months to clinical worsening. In all patients, posttreatment biopsies showed complete clearance of the LR."Clinical and histopathologic recognition of an LR is important, and treatment discontinuation is recommended in these patients," the authors write.Several authors disclosed ties to the biopharmaceutical industry.

Histopathologic findings included sprinkled distribution of small hyperchromatic lymphocytes in the upper epidermal section

Lymphoid Reaction Observed in Eczema Patients Receiving Dupilumab

TUESDAY, Sept. 26, 2023 (HealthDay News) -- For children and young people with severe atopic dermatitis (AD), ciclosporin (CyA) and methotrexate (MTX) are both effective over 36 weeks, according to a study published online Sept. 19 in the British Journal of Dermatology.Carsten Flohr, Ph.D., from Guy's and St. Thomas' NHS Foundation Trust and King's College London, and colleagues compared the safety and efficacy of CyA versus MTX in children and young people with severe AD. Eligible participants were aged 2 to 16 years and were unresponsive to potent topical treatment. One hundred three participants were randomly assigned to oral CyA (4 mg/kg/day) or MTX (0.4 mg/kg/week) for 36 weeks (52 and 51 patients, respectively).The researchers observed greater improvement in disease severity by 12 weeks with CyA (mean difference Objective Severity Scoring of Atopic Dermatitis [o-SCORAD], −5.69). A 50 percent decrease in o-SCORAD (o-SCORAD-50) was reached by more participants in the CyA than MTX arm at 12 weeks (odds ratio, 2.60). MTX was superior by 60 weeks (odds ratio, 0.33); a trend was also seen for o-SCORAD-75, 50 percent reduction from baseline in the Eczema Area and Severity Index (EASI-50), and EASI-75. The CyA arm had higher participant-reported flares posttreatment (odds ratio, 3.22). Improvement in quality of life was seen with both treatments and was sustained after cessation of treatment. Both treatments had comparable frequency of adverse events."The TREAT trial demonstrated that both CyA and MTX are effective well-tolerated treatments for children and young people with severe AD," the authors write. "CyA acts more quickly, while MTX induces better disease control after treatment discontinuation."Several authors disclosed ties to the pharmaceutical industry.

Greater improvement seen in disease severity by 12 weeks with ciclosporin, but MTX was superior by 60 weeks

Both Ciclosporin, Methotrexate Effective for Severe Eczema in Children

TUESDAY, Sept. 5, 2023 (HealthDay News) -- The gut microbiome may play a role in development of eczema in infancy, according to a study published online Aug. 30 in mSystems.Man Kit Cheung, Ph.D., from the Chinese University of Hong Kong, and colleagues characterized the development and determinants of the gut microbiome in a prospective cohort of 112 term Chinese children. The analysis included results from sequencing 713 stool samples collected at nine time points from birth to 3 years using 16S rRNA gene sequencing.The researchers identified mode of delivery, feeding mode, and intrapartum antibiotics as the major determinants of the early-life gut microbiome, the effects of which persisted up to 12 months. Alterations in the infant gut microbiota preceded the development of eczema, including a depletion of Bacteroides and an enrichment of Clostridium sensu stricto 1 in the gut microbiome of infants with eczema at 1 year old. Similar patterns were seen in Cesarean section-born infants within the same time frames, suggesting a role of the gut microbiota in previously reported associations between Cesarean section and an increased risk for eczema."The first year of life could be a critical period to restore the gut bacteria to a more desirable composition," the study's principal investigator, Paul Chan, M.D., also from the Chinese University of Hong Kong, said in a statement.

Similar patterns also observed in C-section-born infants

Alterations in Infant Gut Microbiota Precede Development of Eczema

<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">WEDNESDAY, July 12, 2023 -- Various factors have been identified that contribute to discordant severity grading (DSG) for eczema and psoriasis, according to a study published online July 12 in JAMA Dermatology.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">Valencia Long, M.B.B.S., from the National University Healthcare System in Singapore, and colleagues tested and validated a model explaining the cognitive, behavioral, and disease factors associated with DSG. A theoretical model was derived in a qualitative study and was validated using structural equation modeling in this subsequent cross-sectional quantitative study. A total of 1,053 patients (76.2 percent with eczema and 23.8 percent with psoriasis) and their 44 attending physicians were recruited. The outcome was the difference between global disease severity as scored independently by the patient and dermatologist.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">The researchers found that 46.3 percent of the 1,053 patient-physician pairs demonstrated discordance (42.4 percent positive [higher patient-graded severity] and 3.8 percent negative [lower patient-graded severity]). There was poor agreement observed between patient and physician rating (intraclass correlation, 0.27). Positive discordance was associated with higher symptom expression and greater quality-of-life impairment, but was not associated with patient or physician demographics. Higher quality-of-life impairment was associated with lower resilience and stability, increased negative social comparisons, lower self-efficacy, increased disease cyclicity, and greater expectation of chronicity.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">"This study brings to the surface key lessons for dermatologists -- that many reasons for discordance are, in fact, modifiable," the authors write.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">One author disclosed ties to the pharmaceutical industry.

Higher patient-graded severity for eczema, psoriasis linked to higher symptom expression, greater quality-of-life impairment

Contributory Factors Identified for Discordant Severity Grading for Eczema, Psoriasis

WEDNESDAY, June 28, 2023 (HealthDay News) -- Crisaborole is effective as a long-term maintenance therapy for pediatric and adult patients with mild-to-moderate atopic dermatitis (AD), according to a study published online May 15 in the American Journal of Clinical Dermatology.Lawrence F. Eichenfield, M.D., from the University of California San Diego and Rady Children's Hospital-San Diego, and colleagues examined long-term efficacy and safety of crisaborole once daily (QD) versus vehicle QD as maintenance therapy for patients (aged ≥3 months) with mild-to-moderate AD. Eligible patients received crisaborole twice daily during an open-label run-in period of up to eight weeks and were then randomly assigned to receive crisaborole or vehicle QD (135 patients in each group).The researchers found that patients who received crisaborole versus vehicle had longer median time of flare-free maintenance (111 versus 30 days). For patients who received crisaborole versus vehicle, the mean number of flare-free days was higher (234.0 versus 199.4 days). In addition, patients receiving crisaborole had a lower mean number of flares (0.95 versus 1.36). No clear trend was observed between the groups in maintenance of pruritus response. Crisaborole was well tolerated, with no new safety findings for use as maintenance treatment."Crisaborole QD is effective as a long-term maintenance therapy, demonstrating a significant reduction in the incidence of AD-related flares compared to vehicle in pediatric (aged ≥3 months) and adult patients with mild-to-moderate AD," the authors write.Several authors disclosed ties to biopharmaceutical companies, including Pfizer, which manufactures crisaborole and funded the study.

Longer median time of flare-free maintenance, greater number of flare-free days, and lower mean number of flares

Crisaborole Effective for Long-Term Maintenance in Mild-to-Moderate Eczema

WEDNESDAY, May 10, 2023 (HealthDay News) -- A mindfulness and self-compassion training intervention is effective for improving quality of life (QOL) among adults with atopic dermatitis, according to a study published online May 10 in JAMA Dermatology.Sanae Kishimoto, M.P.H., from Kyoto University in Japan, and colleagues examined the efficacy of mindfulness and self-compassion training in improving QOL for adults with atopic dermatitis in a randomized clinical trial. A total of 107 adults were randomly assigned to receive eight 90-minute weekly group sessions of online mindfulness and self-compassion training or to a waiting list (56 and 51 patients, respectively).The researchers observed a greater improvement in the Dermatology Life Quality Index score at 13 weeks in the intervention group (between-group difference estimate, −6.34). At 13 weeks, the standardized effect size (Cohen d) was −1.06. Greater improvements were seen in the intervention versus the waiting-list group for all secondary outcomes, including eczema severity, itch- and scratching-related visual analog scales, self-compassion and all of its subscales, mindfulness, psychological symptoms, and participants' adherence to dermatologist-advised treatments."The present study is the first, to our knowledge, to show that group-format mindfulness and self-compassion enhances the QOL for adults with atopic dermatitis," the authors write.Several authors disclosed financial ties to the biopharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2804875">Abstract/Full Text (subscription or payment may be required)</a>

Intervention group showed greater improvement in Dermatology Life Quality Index score at 13 weeks and in secondary end points

Mindfulness, Self-Compassion Training Improves QOL in Eczema

WEDNESDAY, May 3, 2023 (HealthDay News) -- Greenness around the home during early childhood does not seem to protect against eczema, according to a study published online April 7 in Pediatric Allergy and Immunology.Minna Lukkarinen, from University of Turku in Finland, and colleagues evaluated the impact of 12 land cover classes and two greenness indices around homes at birth on the development of doctor-diagnosed eczema by the age of 2 years among 5,085 children.The researchers found that neither greenness indices nor residential or industrial/commercial areas were associated with eczema by age 2 years. There was an association observed for coniferous forests (adjusted odds ratios [aORs], 1.19 [95 percent confidence interval (CI), 1.01 to 1.39] for the middle and 1.16 [95 percent CI, 0.98 to 1.28] for the highest versus lowest tertile) and mixed forests (aOR, 1.21 [95 percent CI, 1.02 to 1.42] for the middle versus lowest tertile) with elevated eczema risk. There was also a trend seen toward higher coverage with agricultural areas and elevated eczema risk (aOR, 1.20 [95 percent CI, 0.98 to 1.48] versus none). Transport infrastructure was inversely associated with eczema (aOR, 0.77 [95 percent CI, 0.65 to 0.91] for the highest versus lowest tertile)."Our results do not support the hypothesis that greenness and nature-related exposures around home would prevent [eczema] and the urban-related exposures increase the risk of allergic diseases in small children," the authors write.

Exposure to coniferous, mixed forests and agriculture areas associated with elevated eczema risk

Nearby Nature Does Not Protect Against Early Childhood Eczema

WEDNESDAY, April 26, 2023 &nbsp;-- For patients with chronic hand eczema (CHE), rapid improvement is seen with gusacitinib 80 mg treatment, according to a study published online April 22 in the Journal of the American Academy of Dermatology.Pablo A. Jimenez, M.D., from Asana BioSciences in Lawrenceville, New Jersey, and colleagues examined the efficacy and safety of gusacitinib in a double-blind phase 2 study in 97 patients with CHE. Participants were randomly assigned to placebo or gusacitinib (40 or 80 mg) for 12 weeks (part A) and then received gusacitinib through week 32 in part B.The researchers found a 69.5, 49.0, and 33.5 percent decrease in the modified Total Lesion Symptom Score (mTLSS) for patients receiving 80 mg gusacitinib, 40 mg gusacitinib, and placebo, respectively. Significant improvement in the Physician's Global Assessment (PGA) was seen in 31.3 and 6.3 percent of patients receiving 80 mg gusacitinib and placebo, respectively. A 73.3 versus 21.7 percent decrease in the hand eczema severity index (HECSI) was observed for patients receiving 80 mg gusacitinib versus placebo. A significant decrease in hand pain was noted for patients receiving 80 mg gusacitinib. Significant reductions over placebo were seen for 80 mg gusacitinib in mTLSS, PGA, and HECSI as early as week 2. Upper respiratory infection, headache, nausea, and nasopharyngitis were reported as adverse events."In this double-blind, placebo-controlled study in 97 moderate-to-severe steroid refractive CHE patients, gusacitinib was well tolerated and showed significant efficacy with a fast onset of action," the authors write.The study was funded by Asana BioSciences, the manufacturer of gusacitinib.Abstract/Full Text (subscription or payment may be required)

Significant reductions seen over placebo for 80 mg gusacitinib in mTLSS, PGA, HECSI as early as week 2

Chronic Hand Eczema Rapidly Improves With Gusacitinib

In two January data briefs published by the U.S. Centers for Disease Control and Prevention National Center for Health Statistics, data are presented regarding the prevalence of seasonal allergy, eczema, and food allergy among children and adults in 2021.

 Benjamin Zablotsky, Ph.D., from the National Center for Health Statistics in Hyattsville, Maryland, and colleagues used data from the 2021 National Health Interview Survey (NHIS) to describe the percentage of children who had diagnosed seasonal allergy, eczema, or food allergy. The researchers found that 18.9, 10.8 and 5.8 percent had a seasonal allergy, eczema, and a food allergy, respectively, in 2021. The likelihood of having a seasonal allergy was higher for boys than girls (20.0 versus 17.7 percent). There was variation observed by age in the percentage of children with eczema (10.4, 12.1, and 9.8 percent in children aged 0 to 5, 6 to 11, and 12 to 17 years, respectively). The likelihood of having a food allergy was increased for non-Hispanic Black versus non-Hispanic White and Hispanic children.

 Amanda E. Ng, M.P.H., and Peter Boersma, M.P.H., both from the National Center for Health Statistics, used 2021 NHIS data to describe the prevalence of seasonal allergy, eczema, or food allergy among adults. The researchers found that 25.7, 7.3, and 6.2 percent of adults had a seasonal allergy, eczema, and a food allergy, respectively, in 2021. Compared with Hispanic, non-Hispanic Black, and non-Hispanic Asian adults, the percentage of adults with a seasonal allergy was higher in non-Hispanic White adults. Women were more likely than men to have eczema (8.9 versus 5.7 percent). With increasing age, the prevalence of food allergy decreased. 

 "For all three allergies, women were more likely than men to have a diagnosed allergy," Ng and Boersma write.
<a href="https://www.cdc.gov/nchs/products/databriefs.htm" class="rm-stats-tracked" target="_blank">Data Brief - Children</a><a href="https://www.cdc.gov/nchs/products/databriefs.htm" class="rm-stats-tracked" target="_blank">Data Brief - Adults</a>

18.9 percent of children and 25.7 percent of adults had seasonal allergy; 10.8 and 7.3 percent had eczema in 2021

CDC Reports on Prevalence of Seasonal and Food Allergies, Eczema

Immediate and delayed patch test reactions to individual fragrances have been identified in the Thai population, according to a study published online June 8 in the
 
 Journal of the American Academy of Dermatology.
 




 Nutchaya Amornruk, M.D., from Chulalongkorn University in Bangkok, and colleagues examined the prevalence of an immediate patch test reaction to fragrance in patients with fragrance allergic contact dermatitis in a prospective study. A total of 291 patients were given standard patch tests for allergic contact dermatitis, and those with positive reactions were asked to undergo additional patch tests to 28 different fragrance substances for immediate and delayed reactions.




 The researchers found that the most frequently encountered substances in positive immediate reactions and standard (delayed) patched tests were cinnamic aldehyde and cinnamic alcohol. Reactions to benzyl alcohol, sorbic acid, and coumarin were observed more frequently in immediate patch tests than standard patch tests.




 "Cinnamic aldehyde and cinnamic alcohol were found to be the most common fragrance allergens eliciting immediate reactions in the Thai population in our current study," the authors write. "Given that both fragrance substances were major components of spices and essential oils that were frequently used in a variety of Asian foods, beverages, and personal care products such as mouthwash, it was expected that a high prevalence of immediate allergic reaction to these substances would exist in the Thai population."




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Cinnamic aldehyde and cinnamic alcohol were most frequently encountered substances in immediate, delayed reactions

Immediate, Delayed Reactions to Fragrances ID'd in Thai Population

There are no differences in effectiveness between the four main types of moisturizers for childhood eczema, according to a study published online May 23 in
 
 The Lancet Child &amp; Adolescent Health
 
 .




 Matthew J. Ridd, Ph.D., from the University of Bristol in the United Kingdom, and colleagues compared the clinical effectiveness and safety of the four main emollient types. Children (aged 6 months to 12 years) with eczema were randomly assigned to lotions (137 children), creams (140 children), gels (135 children), and ointments (138 children).




 The researchers observed no difference in eczema severity between emollient types over 16 weeks. Results remained unchanged even with multiple imputation, sensitivity, and subgroup analyses. There were also no differences seen in total number of adverse events between the treatment groups (36, 39, 40, and 35 percent for lotions, creams, gels, and ointments, respectively). However, stinging was less common with ointments (9 percent) compared with lotions (20 percent), creams (17 percent), and gels (19 percent).




 "A study of this type has been long overdue. It has not been in the interest of the manufacturers to directly compare types of moisturizer in the way we have done in this trial," Ridd said in a statement. "Our findings challenge conventions about how often moisturizers need to be applied, which types are less likely to cause problems and which patients should be recommended certain types."




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Patient choice and personal preferences should guide selection decisions

Lotion, Cream, Gel, and Ointment Similarly Effective for Childhood Eczema

Wildfire air pollution in San Francisco was associated with increased public interest in specific skin symptoms and diseases, according to a study presented at the annual meeting of the Society for Investigative Dermatology, held from May 18 to 21 in Portland, Oregon.




 Noting that wildfire smoke has been shown to exacerbate atopic dermatitis and itch for patients at one tertiary care medical center, Raj Fadadu, a medical student at the University of California in San Francisco, and colleagues examined the effects of wildfire air pollution on the skin based on trends in online searches. Daily environmental data, including fine particulate matter (PM
 
 2.5
 
 ) concentration and smoke plume density score, were obtained for San Francisco during the wildfire season from June through November 2020 and were compared to the same months in 2016. Search data for common skin symptoms and conditions were collected from Google Trends, which provides a daily Search Volume Index (SVI) ranging from 0 to 100 for each term.




 The researchers found that a 10-µg/m
 
 3
 
 increase in mean weekly PM
 
 2.5
 
 was associated with an increased mean weekly SVI for eczema, acne, itchy, itchy skin, and red skin. In models for psoriasis, there were no statistically significant results observed.




 "These results can inform skin health counseling and education that clinicians and public health practitioners provide during wildfires as well as suggest avenues for further study," the authors write.




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Searches for eczema, acne, itchy, itchy skin, red skin increased with a 10 µg/m

Google Searches for Skin Conditions Increase During Wildfires

Elimination diets may be associated with modest improvement in eczema severity but with some potential risks, according to a review published online July 18 in the
 
 Journal of Allergy and Clinical Immunology: In Practice
 
 .




 Paul Oykhman, M.D., from McMaster University in Hamilton, Ontario, Canada, and colleagues conducted a systematic literature review to identify the benefits and harms of dietary elimination for the treatment of atopic dermatitis.




 Based on 10 randomized controlled trials (599 participants), the researchers found that dietary elimination may slightly improve eczema severity (50 percent with versus 41 percent without dietary elimination improved SCORAD [SCOring Atopic Dermatitis] by a minimally important difference of 8.7 points), pruritus (daytime itch score mean difference [MD]: −0.21), and sleeplessness (sleeplessness score MD, −0.47) with low certainty evidence. Elimination strategy (empiric versus guided by testing) and food-specific sensitization were not associated with subgroup differences. There were insufficient data examining harms of elimination diets, but there was indirect evidence suggesting elimination diets may increase the risk for developing immunoglobulin E-mediated food allergy.




 "My advice to anyone with atopic dermatitis-type eczema is that if you're going to pursue this dietary option, make sure you keep using your usual medicated creams, moisturizers, and talk to your doctor first," a coauthor said in a statement.




 Several authors disclosed financial ties to the pharmaceutical industry.




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Authors warn of some potential downsides to inform decision-making

Elimination Diets Aid Eczema Severity Only Modestly

In Episode 53 of Derms and Conditions, our host James Q. Del Rosso, DO, continues his conversation with Matt Zirwas, MD, a dermatologist in Columbus, Ohio, and founder of the Bexley Dermatology Research Clinic. After reviewing localized eczematous dermatitis in part 1, they switch gears to discuss adults with scattered eczematous dermatitis in part 2. &nbsp;

In episode 53 of Derms and Conditions, our host James Q. Del Rosso, DO, continues his conversation with Matt Zirwas, MD, a dermatologist in Columbus, Ohio, and founder of the Bexley Dermatology Research Clinic. After reviewing localized eczematous dermatitis in part 1, they switch gears to discuss adults with scattered eczematous dermatitis in part 2. Dr. Zirwas shares several pearls for differentiating among atopic dermatitis, psoriasis, photosensitive dermatitis, CTCL, and contact dermatitis, and describes a new method for diagnosing scabies. &nbsp;He also discusses when to perform a biopsy and management approaches when the biopsy does not provide a clear answer. Dr. Zirwas then names several topical products with low allergenicity, including everything from cleansers and moisturizers to detergents and fabric softeners, that are beneficial to patients with sensitive skin. Dr. Del Rosso asks about disease-directed therapy and systemic treatment options, prompting Dr. Zirwas to dive into his medications of choice for each phenotype and patient population.This episode is full of pearls for a variety of eczematous and inflammatory dermatoses, so tune in to learn more!

Matt Zirwas, MD

Derms and Conditions Podcast

Thinking Through Diagnostic Challenges in Patients with Eczema: Considerations and Pitfalls Part 2

Seminar-in-Depth: Chronic Hand Eczema: In Plain Sight

Chronic hand eczema (CHE) can be extremely debilitating for patients and lead to disturbances of life, work, and sleep. In this seminar-in-depth, April Armstrong, MD, MPH, and Christopher Bunick, MD, PhD, take a deep dive into the epidemiology and pathogenesis of chronic hand eczema and review some of the latest treatments pending approval for CHE treatment. Chronic hand eczema is defined as eczema that persists for more than 3 months or recurs more than 2 times within a 12-month period. Symptoms fluctuate in severity over time and include pruritus, burning, and stinging. Drs Armstrong and Bunick reviewed the 8 different etiologic subtypes of CHE, including irritant contact, allergic contact, atopic hand eczema, protein contact dermatitis, hyperkeratotic hand eczema, acute recurrent vesicular hand eczema, nummular eczema, and pulpitis. Of these, irritant contact dermatitis is the most common form of CHE, but in a large registry study of patients with CHE, 50% were classified as having more than one predominant subtype. Moving on to pathogenesis, Drs Armstrong and Bunick discussed that the JAK-STAT pathway is a driver for many of the CHE subtypes, including irritant contact dermatitis, atopic hand eczema, and allergic contact dermatitis. Historically, treatment of CHE has been limited to moderate and potent topical corticosteroids, despite surveys indicating that most patients would prefer a steroid-free topical therapy. Pivoting to new treatments on the horizon, Drs Armstrong and Bunick introduced delgocitinib cream, a topical pan-JAK inhibitor. In pivotal Phase 3 trials of delgocitinib cream for CHE, 24.3% of delgocitinib-treated patients achieved IGA treatment success at Week 16 compared to just 8.4% of vehicle-treated patients. Long-term efficacy trials demonstrated maintenance of response out to 36 weeks. Delgocitinib led to rapid and sustained improvement in itch scores, with 47.2% of patients having a 4-point reduction in itch score at Week 16, compared to 21.6% of patients on vehicle. Improvement in itch compared to vehicle was seen as early as Week 2. Delgocitinib was well-tolerated in long-term efficacy and safety studies with no systemic pharmacologic effects expected with twice-daily use. In a match-adjusted indirect comparison, delgocitinib cream outperformed dupilumab over 16 weeks of CHE treatment in some measures. To conclude, Drs Armstrong and Bunick discussed efficacy and safety data of ruxolitinib 1.5% cream, a topical JAK1/JAK2 inhibitor, for CHE. In a Phase 2 study, ruxolitinib 1.5% cream led to 53.2% of patients achieving IGA treatment success at Week 16, compared to just 10.9% of vehicle-treated patients. Improvement in itch was seen as early as Week 2. Ruxolitinib cream was well tolerated with no new safety signals observed. &nbsp;

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