Clinical and histopathological characterization of paradoxical head and neck erythema in atopic dermatitis patients treated with dupilumab: a case series.

We report on 7 AD patients presenting with a paradoxical head-neck erythema which appeared 10 to 39 weeks after start of dupilumab treatment. Patients presented with a relatively sharp demarcated, patchy erythema in the head and neck area that showed no or less scaling compared to their usual eczema. Only 1 patient experienced symptoms of itch and burning, although this was notably different from his pre-existent facial AD. Except for a notable "red face", eczema on other body parts had greatly improved in 6 out of 7 patients with a mean NRS treatment satisfaction of 9/10 at time of biopsy. Treatment of the erythema with topical and systemic drugs was unsuccessful. Despite the presence of this erythema, none of our patients discontinued dupilumab treatment. Lesional skin biopsies showed an increased number of ectatic capillaries, and a perivascular lymphohistiocytic infiltration in all patients. In addition, epidermal hyperplasia with elongation of the rete ridges was observed in 4 patients, resembling a psoriasiform dermatitis. Additional immunohistochemical stainings revealed increased numbers of plasma cells, histiocytes and T-lymphocytes. Interestingly, spongiosis was largely absent in all biopsies. We report on AD patients treated with dupilumab developing a paradoxical erythema in a head-neck distribution. Both clinically and histopathologically we found a heterogeneous response, which was most suggestive of a drug-induced skin reaction. PMID: 31749159 [P...
Source: The British Journal of Dermatology - Category: Dermatology Authors: Tags: Br J Dermatol Source Type: research

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Authors: Patruno C, Amerio P, Chiricozzi A, Costanzo A, Cristuado A, Cusano F, Foti C, Girolomoni G, Guarneri F, Naldi L, Offidani A, Pigatto P, Prignano F, Stingeni L, Calzavara Pinton P Abstract Atopic dermatitis (AD) places significant burden not only on quality of life, but is also associated with considerable costs to healthcare systems. Diagnosis of AD may be challenging when it starts in adolescence or adulthood, and is further complicated as its manifestations are different from those generally seen in children. Accordingly, better definition of diagnostic criteria for adult onset AD is needed to avoid misd...
Source: Giornale Italiano di Dermatologia e Venereologia - Category: Dermatology Tags: G Ital Dermatol Venereol Source Type: research
Abstract BACKGROUND: The optimal approaches for monitoring sleep disturbances in adults with atopic dermatitis (AD) is not established. Multiple patient-reported outcome measures for AD and itch have sleep-related items. These items have not been validated previously. OBJECTIVE: Assess the measurement properties of sleep-related items from the Patient- Oriented Eczema Measure (POEM), SCORing AD (SCORAD), 5-dimensions of itch (5D) and ItchyQOL in adults with AD. METHODS: We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n=115). RESULTS...
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: Ann Allergy Asthma Immunol Source Type: research
New research implicates the nervous system, which was already known to be responsible for the inflammation of atopic dermatitis, but is now being blamed for the itchiness as well.Medscape Medical News
Source: Medscape Allergy Headlines - Category: Allergy & Immunology Tags: Dermatology News Source Type: news
Conclusions: Dupilumab significantly improved disease severity, pruritus, sleep loss and quality of life with an acceptable safety profile. PMID: 31647347 [PubMed - as supplied by publisher]
Source: Journal of Dermatological Treatment - Category: Dermatology Tags: J Dermatolog Treat Source Type: research
Authors: Cork MJ, Danby SG, Ogg GS Abstract Atopic dermatitis (AD), also known as atopic eczema, is a chronic inflammatory skin condition associated with a significant health-related and socioeconomic burden, and is characterized by intense itch, disruption of the skin barrier, and upregulation of type 2-mediated immune responses. The United Kingdom (UK) has a high prevalence of AD, affecting 11-20% of children and 5-10% of adults. Approximately 2% of all cases of childhood AD in the UK are severe. Despite this, most AD treatments are performed at home, with little contact with healthcare providers or services. Her...
Source: Journal of Dermatological Treatment - Category: Dermatology Tags: J Dermatolog Treat Source Type: research
Capsule Summary: Ruxolitinib cream improved Eczema Area Severity Index and Investigator ’s Global Assessment responses in patients with atopic dermatitis (AD), with rapid, sustained improvement in itch. Ruxolitinib cream may offer a novel and effective treatment for AD.
Source: Journal of Allergy and Clinical Immunology - Category: Allergy & Immunology Authors: Source Type: research
CONCLUSIONS: Methyl paraben exposure may increase the risk of itchy rash in African Americans, whereas triclosan may decrease the risk of itchy rash and eczema. The potential effect of triclosan and methyl paraben in pruritus and eczema warrants further study. PMID: 31433379 [PubMed - as supplied by publisher]
Source: Dermatitis - Category: Dermatology Authors: Tags: Dermatitis Source Type: research
The objective of this study was to identify and evaluate PROMs used in studies of AD and CHE. The aim was to explore the assessment of key symptoms and im pacts, and identify any gaps in the measures in use. A structured review of the PubMed database was conducted to identify PROMs used or developed for use in AD or CHE. The Dermatology Life Quality Index (DLQI), the Pruritus/Itch Numeric Rating Scale (NRS), the Patient-Oriented Eczema Measure (POEM), and the Quality of Life in Hand Eczema Questionnaire (QOLHEQ) were identified and reviewed in detail. With these measures, the AD and CHE symptoms and impacts most commonly e...
Source: The Patient - Patient-Centered Outcomes Research - Category: International Medicine & Public Health Source Type: research
Discussion Atopic dermatitis (AD) has a prevalence of 3-5% in the overall U.S. population but is increasing with an estimated 10-15% lifetime risk in childhood. It is even more common in children of color with a prevalence in African-American/black children of 17% and Hispanic children of 14%. Health care utilization data also appears to support more severe disease in children of color also. Atopic dermatitis or eczema is a common dermatological skin problem which characteristically is a pruritic, papular eruption with erythema. Like most papulosquamous eruptions it often occurs in intertrigenous areas in people with alle...
Source: - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
Authors: Cork MJ, Eckert L, Simpson EL, Armstrong A, Barbarot S, Puig L, Girolomoni G, de Bruin-Weller M, Wollenberg A, Kataoka Y, Remitz A, Beissert S, Mastey V, Ardeleanu M, Chen Z, Gadkari A, Chao J Abstract Background: Atopic dermatitis (AD) profoundly affects quality of life (QoL). Dupilumab significantly improves clinical outcomes, is well tolerated, and approved to treat inadequately controlled moderate-to-severe AD in adults; however, its effect on patient-reported outcomes (PROs) is not fully characterized. Objective: To evaluate the impact of dupilumab on patient-reported AD symptoms and QoL. Methods: Poo...
Source: Journal of Dermatological Treatment - Category: Dermatology Tags: J Dermatolog Treat Source Type: research
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