Factors Associated with Eczema Clinical Trial Awareness, Interest, and Participation in Adults.

Despite the need for improved eczema therapies and a rapid increase in available eczema clinical trials, participation remains low. The aim of this study was to identify factors associated with clinical trial awareness, interest, and barriers to enrolment and participation. An online survey, administered 1 May to 6 June 2020 to adults (≥ 18 years) with eczema in the USA, was analysed. Among 800 patients included, mean age was 49.4 years, most respondents were female (78.1%), White (75.4%), non-Hispanic (91.4%), and geographically living in an urban/suburban area (Rural-Urban Continuum Codes (RUCC) 1-3, 90.8%). Only 9.7% of respondents reported previous participation in clinical trials, while 57.1% had considered participation and 33.2% never considered participation. Higher satisfaction with current eczema therapy, clinical trial literacy, and confidence in finding eczema trial information were all associated with clinical trial awareness, interest, and successful participation. Younger age and having atopic dermatitis were associated with increased awareness, while female gender was a barrier to interest and successful participation.

The Frequency and Utility of Drug Cessation Trials in Older Adults With Chronic Eczematous Dermatitis of Unknown Etiology: A Retrospective Cohort Study.

Background: Eczematous dermatitis is a major cause of recalcitrant pruritic eruptions in older adults. Although some medications have been implicated, there are limited data demonstrating the utility of medication changes. Objective: To investigate the utility and possible harms of drug cessation trials (DCTs) in chronic eczematous eruptions in the aging (CEEA). Methods: This is a retrospective cohort study utilizing electronic health records of DCTs in adults older than 65 years with CEEA. Results: We identified 646 patients >65 years with new onset eczematous eruptions, 89 (14%) of whom had no identifiable etiology. In this cohort, 35 patients underwent a total of 40 DCTs. Although there was mention of improvement in 17.5% (7/40), all patients sought tertiary care for their persistent rash. Negative outcomes occurred in 45% (18/40), all of which were due to exacerbation of a comorbidity that the medication was prescribed to treat. Conclusion: Our experience suggests that patients with CEEA undergo DCTs that do not improve their dermatitis and can lead to dangerous worsening of underlying conditions. Further study of the etiology of CEEA is needed.

The Eczema Area and Severity Index-A Practical Guide.

ABSTRACT: Atopic dermatitis is a chronic inflammatory skin condition that affects approximately 18 million people in the United States. Assessing the extent and severity of atopic dermatitis is critical for determining baseline disease burden and treatment effectiveness for both investigators and clinicians. Considerable efforts over the past several decades have been made in developing a highly validated instrument called the Eczema Area and Severity Index (EASI). Although several guides exist for the EASI, questions continue to arise regarding its use and interpretation. This review was developed to serve as the definitive guide for the EASI and to address commonly asked questions.

Atopic dermatitis: Role of the skin barrier, environment, microbiome, and therapeutic agents.

Atopic dermatitis (AD) is a chronic, inflammatory skin disorder characterized by eczematous and pruritic skin lesions. In recent decades, the prevalence of AD has increased worldwide, most notably in developing countries. The enormous progress in our understanding of the complex composition and functions of the epidermal barrier allows for a deeper appreciation of the active role that the skin barrier plays in the initiation and maintenance of skin inflammation. The epidermis forms a physical, chemical, immunological, neuro-sensory, and microbial barrier between the internal and external environment. Not only lesional, but also non-lesional areas of AD skin display many morphological, biochemical and functional differences compared with healthy skin. Supporting this notion, genetic defects affecting structural proteins of the skin barrier, including filaggrin, contribute to an increased risk of AD. There is evidence to suggest that natural environmental allergens and man-made pollutants are associated with an increased likelihood of developing AD. A compromised epidermal barrier predisposes the skin to increased permeability of these compounds. Numerous topical and systemic therapies for AD are currently available or in development; while anti-inflammatory therapy is central to the treatment of AD, some existing and novel therapies also appear to exert beneficial effects on skin barrier function. Further research on the skin barrier, particularly addressing epidermal differentiation and inflammation, lipid metabolism, and the role of bacterial communities for skin barrier function, will likely expand our understanding of the complex etiology of AD and lead to identification of novel targets and the development of new therapies.

Emerging Systemic Therapeutic Biologics and Small Molecules for Atopic Dermatitis: How to Decide Which Treatment Is Right for Your Patients.

The evolving discoveries in atopic dermatitis (AD) broaden our understanding of the pathogenesis of the disease and, above all, enable better management for patients. Dupilumab was the first biologic for AD, and since its approval, many new treatments have emerged in both late- and early-stage clinical trials. These trials have led to a further understanding of the pathogenesis of AD and to the identification of additional potential therapeutic targets. This review will highlight the emerging therapies and provide approaches on how to choose the right treatment for your patients.

Validation of a novel patient-operated device for measuring skin barrier function in atopic dermatitis.

BACKGROUND: Transepidermal water loss (TEWL) and capacitance are used in atopic dermatitis (AD) trials to provide objective data on clinical change and response to therapy. Many barrier devices are costly, limiting their utility. GPSkin is a novel low-cost, patient-operable device that measures both TEWL and capacitance via smartphone application. OBJECTIVE: This validation study investigated the correlation of GPSkin with the AquaFlux and Corneometer, and the reliability of these devices, in patients with AD. METHODS: Fifty AD patients with varying disease severity performed self-measurements with GPSkin, while investigators collected data with all 3 devices, on both nonlesional and lesional skin. CONCLUSION: GPSkin and AquaFlux demonstrated strong correlation for TEWL on nonlesional and lesional skin by Spearman's correlation (rs ), independent of device user. For capacitance, GPSkin and the Corneometer showed moderate correlation when obtained by patients, yet a strong correlation when obtained by a clinician. Despite good correlation, GPSkin showed poor agreement with both the AquaFlux and Corneometer in Bland-Altman plots. GPSkin underestimated both TEWL and capacitance. Overall, the devices had good test-retest reliability. None of the devices could discriminate between AD severity states. While GPSkin marks an exciting advancement in barrier technology, further study is needed for validation on AD skin.

Validation of a novel smartphone application-enabled, patient-operated skin barrier device.

BACKGROUND: Transepidermal water loss (TEWL) and surface capacitance measure skin barrier permeability and stratum corneum (SC) hydration, respectively, and are frequently utilized in atopic dermatitis clinical trials. Many barrier devices are costly and often used only in the academic setting. GPSkin is a low-cost, patient-operated device that measures both TEWL and SC hydration. This study aimed to test the reliability of GPSkin and assess its correlation with current industry standards. MATERIALS AND METHODS: GPSkin was compared to the Biox AquaFlux (TEWL) and Courage-Khazaka Corneometer (SC hydration). Participants with healthy skin (n = 50) collected measurements with GPSkin in Trial 1 without any device education and in Trial 2 with additional instruction. In Trial 2, the investigator also performed measurements with GPSkin. Spearman's coefficients (rs ) were performed to assess device correlation. Intraclass correlation coefficients (ICC) were calculated to determine reliability. RESULTS: Overall, GPSkin was moderately correlated with current industry device measurements for TEWL (Trial 1 rs :0.48; Trial 2 rs :0.40 participant, 0.34 investigator) and SC hydration (Trial 1 rs :0.63; Trial 2 rs :0.45). GPSkin demonstrated "good" test-retest reliability for both TEWL (ICC: 0.89) and SC hydration (ICC: 0.85) measurements when participants were provided with some device education. There was no difference in reliability between participants provided with device education and investigators. CONCLUSION: Based on these findings, we concluded that GPSkin provides reasonably precise and reliable measurements of SC hydration and TEWL as compared to current devices.

Subcutaneous panniculitis-like T-cell lymphoma responsive to combination therapy with methotrexate and corticosteroids.

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare condition that falls underneath the umbrella of primary cutaneous T-cell lymphomas (CTCLs). SPTCL can be very difficult to diagnose as it may mimic other subtypes of CTCL, such as γ/δ T-cell lymphoma (TCL), or other forms of panniculitis. Confirmation of diagnosis often requires immunohistochemical analysis and is essential for proper prognosis and therapeutic management. Herein, we present a case of SPTCL that mimicked lupus panniculitis and was successfully treated with prednisone taper and methotrexate.