Dermatitis®

Abstract: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease that significantly impairs quality of life. In recent years, treatment has advanced from broad immunosuppressants to targeted biologics and small-molecule therapies that modulate type 2 inflammation and itch signaling. Dupilumab, tralokinumab, lebrikizumab, and nemolizumab are now FDA-approved biologics with demonstrated efficacy and favorable long-term safety, while oral Janus kinase inhibitors (JAKis) such as abrocitinib, upadacitinib, and baricitinib often provide rapid disease control but carry black-box warnings. Comparative trials highlight faster itch relief with JAKis but durable disease control and safety advantages with biologics. The expanding treatment landscape necessitates individualized therapy selection. Key clinical considerations include patient age, pregnancy status, infection, malignancy, or thromboembolic risk, comorbid conditions, and history of adverse effects. Equally important are patient-centered preferences such as dosing frequency, route of administration, storage logistics, and willingness to self-inject. Access and affordability also influence care, with many manufacturers offering copay support and patient assistance programs. Future directions emphasize head-to-head comparative studies, biomarker development for precision treatment, and equitable access to advanced therapies. This narrative review synthesizes current evidence on biologics and JAKis in AD, outlining efficacy, safety, and practical decision-making factors to guide dermatologists in aligning therapies with both clinical context and patient priorities.

Background: Some patients with atopic dermatitis (AD) have an inadequate response or intolerance to dupilumab. Stapokibart, a novel anti-IL-4Rα antibody, is a potential alternative.

Objective: To assess the real-world effectiveness and safety of switching from dupilumab to stapokibart in moderate-to-severe AD.

Methods: This retrospective study included 85 patients (67 mild and 18 moderate-to-severe after dupilumab) who switched to stapokibart for ≥16 weeks. Efficacy and safety were evaluated over 16 weeks.

Results: Stapokibart led to rapid and significant improvements in all patients. By week 16, the Eczema Area and Severity Index (EASI) scores dramatically decreased, and high rates of EASI-90 (89.6% mild and 88.9% moderate-to-severe) were achieved. The mild group showed faster and deeper remission (e.g., EASI-100: 71.6% vs 50.0%). Disease control and quality of life improved significantly. The most common adverse event (AE) was injection site reaction (2.4%); no serious AEs or discontinuations occurred.

Conclusion: Switching to stapokibart is an effective and safe strategy for patients with an inadequate response to dupilumab, inducing rapid and profound clinical improvement. It is a valuable sequential treatment for AD.

There is no consensus on the impact of meteorological factors and air pollutants on childhood atopic dermatitis (AD). Literature was searched in 3 databases (PubMed, Web of Science, and Embase) up to May 1, 2025, and evaluated by 2 independent reviewers. Cross-sectional studies, cohort studies, or time-series analyses were included, reporting outcomes of meteorological factors, air pollutants, and childhood AD. The Newcastle–Ottawa Scale and Agency for Healthcare Research and Quality scale were used to assess study quality. A random-effects model was applied to estimate pooled risk ratios. From 132 identified literature, 49 studies involving nearly 7,091,746 participants were included. Air pollutants were positively correlated with the risk of childhood AD (odds ratio [OR] [95% confidence interval or CI] = 1.030 [1.005, 1.056] for carbon monoxide [CO]; 1.116 [1.075, 1.264] for nitrogen dioxide [NO₂]; 1.059 [1.013, 1.108] for ozone; 1.114 [1.039, 1.260] for particulate matter [PM] with diameter of 10 µm [PM₁₀]; 1.041 [1.009, 1.074] for PM with diameter of 2.5 µm [PM_2.5]). No clear associations were observed between sulfur dioxide, temperature, humidity, and ultraviolet radiation (UVR) and the risk of childhood AD. Subgroup analysis showed that higher temperature and UVR might reduce the risk of AD, increased concentrations of CO, NO₂ in developed countries, and PM₁₀, PM_2.5, and NO₂ might increase the incidence risk in developing countries. Air pollutants represented significant risk factors for childhood AD, underscoring the imperative to prioritize environmental quality improvement for AD prevention.

Abstract: Background: Allergic contact dermatitis (ACD) is a chronic inflammatory skin condition with a substantial impact on daily functioning. Although psychosocial factors such as stress, resilience, and social support influence disease burden in other inflammatory dermatoses, their role in ACD remains poorly defined.

Objective: To compare perceived stress, resilience, and perceived social support between patients with clinically confirmed ACD and matched healthy controls and to examine their associations with key clinical variables.

Methods: We conducted a cross-sectional case–control study involving 225 adults with exclusive ACD, diagnosed through clinically relevant patch testing, and 225 matched controls without dermatologic disease. Participants completed the Perceived Stress Scale, the Connor–Davidson Resilience Scale, and the Multidimensional Scale of Perceived Social Support. Clinical severity, chronicity, and occupational exposure were also recorded. Group comparisons and multivariable linear regressions were performed.

Results: Patients with ACD reported significantly higher perceived stress (41.0 ± 7.1 vs 36.0 ± 6.7; P < 0.001) and markedly lower resilience (61.8 ± 17.3 vs 79.0 ± 3.1; P < 0.001) compared to the control group. In contrast, no significant differences were observed in perceived social support between groups (P = 0.11).

Conclusion: ACD is associated with substantial psychological vulnerability characterized by elevated stress and reduced resilience. Integrating psychosocial screening into routine management may improve clinical outcomes and patient care.

Abstract: Background: Patch testing is the gold standard for diagnosing contact allergies, but its diagnostic accuracy can be influenced by subjective visual assessment and variability in measurement using 2D imaging systems.

Objective: This study evaluated the accuracy of the Iko Derma Monitor 3D imaging system in comparison to a standard clinic iPad for patch test reaction evaluation.

Methods: Forty-two patients undergoing patch testing were included, yielding 293 evaluated reactions. Reactions were imaged on day 2 and day 4 using the Iko Derma Monitor, an iPad, and a handheld dermatoscope. Measurements of lesion area were compared across imaging modalities, and statistical tests were conducted to assess changes over time and accuracy differences between the Iko Derma Monitor and iPad.

Results: The 3D imaging device demonstrated significantly higher accuracy than the iPad when compared to the dermatoscope as the reference standard (P < 0.001). Both devices detected significant changes in lesion area over time, but the 3D device provided more consistent and sensitive measurements.

Conclusion: The Iko Derma Monitor 3D camera offers superior accuracy and sensitivity compared to iPad-based imaging for patch test reactions. Its ability to standardize documentation may improve diagnostic precision and expand access to remote or underserved populations.

Abstract: Background: Atopic dermatitis (AD) is linked to increased cardiovascular risk. While GLP-1 receptor agonists (GLP-1RAs) show cardiometabolic benefits in the general population, their impact in patients with AD remains unclear.

Objective: To evaluate whether GLP-1RA use is associated with a reduced risk of major adverse cardiovascular events (MACE) in patients with AD.

Methods: This retrospective cohort study used TriNetX Research Network. Patients with AD ≥12 years old who used GLP-1RAs between April 2005 and December 2020 were 1:1 propensity-score matched to patients with AD not on GLP-1RA by demographic and cardiovascular risk factors. The primary outcome was incidence of MACE (cerebrovascular disease [CVD], heart failure [HF], atherosclerosis, ischemic heart disease [IHD], and percutaneous coronary intervention [PCI]) at 5, 10, and 20 years post-index date.

Results: Of the 547,246 patients with AD, 24,936 (4.6%) used GLP-1RAs. After propensity-matching, at 20 years, patients with AD on GLP-1RA had lower odds of CVD (adjusted odds ratio [aOR] 0.718 [0.643–0.800]), HF (aOR 0.791 [0.732–0.854]), atherosclerosis (aOR 0.768 [0.715–0.826]), and IHD (aOR 0.900 [0.841, 0.963]), compared with patients with AD not using GLP-1RAs.

Conclusions: In patients with AD, GLP-1RA use was associated with a reduced long-term risk of CVD, HF, IHD, and atherosclerosis, highlighting their potential cardiometabolic benefit in this population.

Abstract: Background: Contact urticaria (CU) is an underdiagnosed condition representing a significant proportion of allergic skin diseases. Standard patch testing typically cannot detect immediate hypersensitivity reactions characteristic of CU. Despite the need for accurate diagnosis to guide management decisions, specialized immediate-testing protocols required for CU identification lack standardization and are not readily available at most dermatology/allergy centers.

Objective: To present a practical CU testing protocol that addresses current diagnostic gaps for immediate-type reactions and can be implemented in dermatology/allergy practices.

Methods: We describe our institutional protocol combining short-term occlusive testing with selective skin prick testing for CU diagnosis. The protocol includes patient selection criteria, allergen series and testing materials, step-by-step procedure, safety measures, clinic workflow optimization, and billing considerations.

Conclusions: Our CU testing protocol is a method useful for diagnosing immediate hypersensitivity reactions missed by patch testing alone. Incorporating this technique may result in identification of culprit allergens and optimize management through targeted avoidance strategies.

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) and morbilliform drug eruption (MDE) are 2 distinct drug eruptions that can appear clinically similar at presentation. Given the significant morbidity of DRESS, there is a need for objective markers that can aid in early recognition.

Objective: The purpose of this study is to explore the diagnostic potential of routine hematological data on or near the date of rash onset.

Methods: We use machine learning as an exploratory method to identify any early hematological patterns capable of differentiating DRESS from MDE.

Results: We found that lymphocyte count, pan-immune inflammation value, neutrophil-to-lymphocyte ratio, and platelet levels were strong discriminators of DRESS from MDE at initial presentation.

Conclusions: These findings highlight the potential of hematologic profiles to enhance early diagnostic accuracy.

Background: Little is known about the patient burden of hand eczema (HE) in atopic dermatitis (AD).

Objective: To assess the patient burden of HE and explore how HE severity influences quality of life (QoL).

Methods: A prospective, dermatology practice-based study was performed in adult and pediatric patients with AD. HE severity was assessed by Physician’s Global Assessment (none, mild, moderate, severe). QoL was assessed using the Dermatology Life Quality Index (DLQI), Patient Health Questionnaire-9 (PHQ-9), PROMIS Itch Questionnaire (PIQ), and Sleep Disturbance.

Results: Overall, 542 patients were studied, including 362 (66.8%) of White race and 320 (59.9%) of female sex (mean ± SD age: 46.2 ± 17.1 years). In multivariable ordinal logistic regression models adjusting for demographics and total Eczema Area and Severity Index scores, mild HE compared to no HE was associated with more severe numeric rating scale (NRS) average itch (adjusted odds ratio [95% confidence interval]: 2.58 [1.26–5.31], P = 0.0101), interference of itch on QoL (PROMIS PIQ-Interference; 2.92 [1.15–7.39], P = 0.0242), impact of itch on mood and sleep (PROMIS PIQ-Mood; 2.56 [1.12–5.88], P = 0.0266). However, mild HE was not associated with significantly worse DLQI total scores overall (1.59 [0.84–3.00], P = 0.1559) or individual items from DLQI. Moreover, moderate-severe HE compared to no HE was associated with significantly worse NRS average itch (3.84 [1.54–9.59], P = 0.0042), interference of itch on QoL (PROMIS PIQ-Interference; 4.19 [1.44–12.22], P = 0.0091), and impact of itch on physical activities (PROMIS PIQ-Physical; 2.85 [1.04–7.76], P = 0.0410). In addition, moderate-severe HE was associated with significantly worse QoL (DLQI; 2.82 [1.25–6.35], P = 0.0129), particularly itch/soreness (4.99 [2.24–11.10], P = 0.0001), embarrassment/self-consciousness (2.42 [1.13–5.21], P = 0.0239), impact on social and leisure activities (2.88 [1.34–6.16], P = 0.0068), and problems with partner/family relationships (2.75 [1.27–5.97], P = 0.0109).

Conclusions: Even mild HE was associated with substantial impacts on patient QoL in patients with AD, even after controlling for overall AD severity. However, moderate-severe HE had even worse disease impacts across all domains.