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Eczema (dermatitis)
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
This is an IL-4 alpha receptor inhibitor that blocks the function of IL-4 and IL-13. It is a targeted therapy approved by the FDA for the treatment of moderate-to-severe atopic dermatitis in patients aged 12 years and older whose disease is not adequately controlled with topical prescription treatments. It is injected every 2 weeks after a loading dose and decreases pruritus and Eczema Area and Severity Index (EASI) scores. The most common significant side-effects are injection site reactions, eye and eyelid inflammation, and cold sores.
Biologics in allergic disease
Published in Richard F. Lockey, Dennis K. Ledford, Allergens and Allergen Immunotherapy, 2020
Tara V. Saco, Farnaz Tabatabaian
Dupilumab is an anti-IL-4Rα humanized monoclonal antibody that blocks IL-4 and IL-13 signaling and is FDA approved for subjects 18 years and older with atopic dermatitis [29]. It also decreases IgE production by almost 40%. It is administered starting with a 600 mg sub-Q dose followed by 300 mg sub-Q every other week [31]. There is no validated biomarker to predict response to dupilumab for atopic dermatitis. Likewise, there are no black box warnings, but an important listed precaution is conjunctivitis. Dupilumab significantly decreases the Eczema Area and Severity Index, Investigator Global Assessment, and pruritus scores. The improvement in pruritus is clinically significant and translates to improvement in quality of life.
Clinical applications of magnesium in cutaneous medicine
Published in Kupetsky A. Erine, Magnesium, 2019
Laura Marie Jordan, Sunny K. Chun
The evidence supporting the magnesium treatment of atopic dermatitis is fluctuating. Proksch et al. reported the improvement of skin barrier function in atopic subjects after submerging their forearms for 15 minutes in Dead Sea salt solution compared with tap water as control.12 More recently, Heinlin et al. investigated the efficacy of synchronous balneophototherapy (narrow-band UVB treatment with synchronous bathing in Dead Sea salt solution) compared with that of narrow-band UVB therapy alone and found a statistically significant advantage in synchronous balneophototherapy after 6 months of treatment.43 However, Togawa et al. performed a randomized, double-blind pilot study that investigated the direct effects of ultra-pure soft water, in which Ca2+ and Mg2+ have been mostly removed, on skin barrier function in child AD patients. They found that mild AD patients experienced improvement in their eczema area and severity index.44 In a comparison study of 58 participants with hand eczema, it was found that 5% topical fumaric acid was less effective than 0.1% triamcinolone, reducing the erythema but not other eczema manifestations (excoriation, population, and lichenification).45
A 52-week multicenter retrospective real-world study on effectiveness and safety of dupilumab in children with atopic dermatitis aged from 6 to 11 years
Published in Journal of Dermatological Treatment, 2023
Cataldo Patruno, Gabriella Fabbrocini, Giuseppe Lauletta, Valeria Boccaletti, Cristiana Colonna, Riccardo Cavalli, Iria Neri, Michela Ortoncelli, Donatella Schena, Luca Stingeni, Katharina Hansel, Vincenzo Piccolo, Veronica Di Brizzi, Concetta Potenza, Ersilia Tolino, Luca Bianchi, Sara Manti, Rocco De Pasquale, Vito Di Lernia, Lucia Caminiti, Elena Galli, Paola Coppo, Andrea Chiricozzi, Clara De Simone, Cristina Guerriero, Fabrizio Giuseppe Amoruso, Eugenio Provenzano, Salvatore Leonardi, Amelia Licari, Gian Luigi Marseglia, Antonino Palermo, Sabrina Di Pillo, Daniele Russo, Viviana Moschese, Vincenzo Patella, Tiziana Peduto, Caterina Ferreli, Paola Zangari, Federica Veronese, Samantha Federica Berti, Michaela Gruber, Elena Pezzolo, Stefania Termine, Rosanna Satta, Federica Dragoni, Maria Esposito, Maria Concetta Fargnoli, Paolo Chiodini, Ylenia Vallone, Francesca di Vico, Vincenzo Picone, Maddalena Napolitano
A retrospective chart review was conducted through electronic medical records of each patient from 36 Italian dermatological or pediatric referral centers. Inclusion criteria were: AD patients aged from 6 to 11 years; disease inadequately controlled with topical conventional approved therapies and defined according to the following scores: (i) Eczema Area and Severity Index (EASI, a tool combining the assessment of the severity of lesions and the area affected into a single total score in the range 0 (no disease) to 72 (maximal disease) ≥24 or <24 with at least one of the following clinical characteristics: (i) involvement of sensitive areas (face, neck, hands, genitals); (ii) Pruritus Numerical Rating Scale (P-NRS, an 11-point scale used by subjects to rate their worst itch severity over the past 7 days with 0 indicating ‘no itch’ and 10 indicating ‘worst itch imaginable’.) ≥7; (iii) Children’s Dermatology Life Quality Index (c-DLQI, a 10-item validated questionnaire used to assess the impact of AD disease symptoms and treatment on quality of life) score ≥10. The outcomes of the study were the evaluation of efficacy and safety profile of dupilumab in a 52-week real-life experience in children aged 6–11 years.
An evaluation of abrocitinib for moderate-to-severe atopic dermatitis
Published in Expert Review of Clinical Immunology, 2022
Angelina Labib, Gil Yosipovitch
Gooderham et al. conducted a randomized, double-blind, placebo-controlled phase II clinical trial that evaluated the efficacy of PF-04965842 in 267 patients with moderate-to-severe AD [52]. Patients received either 10 mg, 30 mg, 100 mg, 200 mg, or placebo once daily for a total of 12 weeks. Following 12 weeks of oral abrocitinib treatment, Investigator’s Global Assessment (IGA) scores was clear or almost clear in 43.8% of patients receiving 200 mg (p < 0.001), 29.6% of patients receiving 100 mg (p < 0.001), and 5.8% of patients receiving placebo [52]. Similarly, Eczema Area and Severity Index (EASI) was reduced in 59.0% in the 100 mg treatment group (p < 0.001), 82.6% in the 200 mg treatment group (p < 0.001), and 35.2% in the control group [52]. Pruritus numerical rating scores (NRS) were reduced by 4 points or greater in 22.7% (OR 0.86 (0.39 to 1.90)), 33.3% (OR 1.44 (0.68 to 3.03)), 50.0% (OR 2.84 (1.40 to 5.76)), and 63.6% (OR 5.11 (2.43 to 10.77)) of respective treatment groups, compared to 25.5% of the control group. One hundred and eighty-four patients (68.9%) reported adverse effects, the most common being AD, upper respiratory infections, headache, nausea, and diarrhea [52]. The adverse effect of AD refers to the exacerbation of AD symptoms. These results demonstrated that abrocitinib has a mild side effect profile and rapidly improved symptoms of AD, particularly itch.
Topical treatment utilization for patients with atopic dermatitis in the United States, and budget impact analysis of crisaborole ointment, 2%
Published in Journal of Medical Economics, 2018
Ryan Clark, Duygu Bozkaya, Mark Levenberg, Steven Faulkner, Timothy W. Smith, Robert A. Gerber
Atopic dermatitis (AD) is a chronic, inflammatory skin disease characterized by pruritus and eczematous lesions1. Diagnosis of AD is based on clinical presentation and patient family history, instead of diagnostic testing2. Disease severity helps guide clinical decision-making, and is evaluated in clinical trials by use of a wide variety of assessment tools, including the Investigator’s Static Global Assessment/Investigator’s Global Assessment and Eczema Area and Severity Index (EASI)3. In the US, AD is estimated to affect ∼10% of children4 and 10% of adults5. The prevalence of AD in adults is higher in females (11.1%) than in males (9.1%)5, and prevalence is higher in non-Hispanic black children4,6.