Combination of glucosamine and low‐dose cyclosporine for atopic dermatitis treatment: A randomized,placebo‐controlled,double‐blind,parallel clinical trial

Our recent pilot study showed better outcomes using a combination of low‐dose cyclosporine and glucosamine than cyclosporine alone in the treatment of atopic dermatitis (AD). Here, a randomized, placebo‐controlled, double‐blind, parallel‐designed study was planned to compare the efficacy and safety of low‐dose cyclosporine and glucosamine combination to low‐dose cyclosporine alone for the treatment of patients with moderate to severe AD. AD patients with a Severity Scoring of Atopic Dermatitis (SCORAD) index ≥30 were randomly assigned in a 1:1 ratio to receive either cyclosporine 2 mg/kg and glucosamine 25 mg/kg (group A) or cyclosporine and placebo (group B) for 8 weeks. SCORAD indices, serum levels of chemokine ligand 17 and interleukin‐31, eosinophil counts, and blood cyclosporine levels were examined before and after treatment. The SCORAD indices for group A (n = 19) were significantly reduced after the treatment and a significant correlation between the changes in the SCORAD indices and changes in the serum levels of chemokine ligand 17, but not interleukin‐31, was detected. Glucosamine combined with cyclosporine did not increase adverse events and serum cyclosporine levels compared with cyclosporine alone. Therefore, combination of low‐dose cyclosporine and glucosamine may be useful to allow the long‐term use of cyclosporine in the treatment of patients with moderate to severe AD.     

Outpatient Home‐based Wet Wrap Dressings with Topical Steroids with Children with Severe Recalcitrant Atopic Dermatitis: A Feasibility Pilot Study

Wet wrapping (WW) appears to be effective in severe atopic dermatitis (AD) in children resistant to topical treatment. Seventeen children were included and were directed to use WW every night (≥6 hr) until lesions disappeared, followed by maintenance treatment of two to three treatments per week. The mean Scoring Atopic Dermatitis (SCORAD) score at baseline was 48.9. After 1 month of treatment the mean SCORAD score was 18.9, and efficacy was maintained after 3 months of treatment. The majority of patients were satisfied (91.7%) with the WW treatment; 92% considered it to be much more effective than the previous treatments received. WW was easy to perform for 75% of patients, 83% of patients stated that it was better tolerated, and 17% considered it to be tolerated equally to dermatologic corticosteroids without WW. The home WW program was continued on a maintenance basis for 75% of patients. This open‐label study showed that this program was a feasible and well‐tolerated alternative for the treatment of severe, refractory AD in children and adolescents.     

Moderate correlation between quality of life and disease activity in adult patients with atopic dermatitis

Background Studies assessing the relationship between disease activity and quality of life (QoL) in adults with atopic dermatitis (AD), before and after therapy are lacking. The relation between disease activity and QoL in AD patients was evaluated before (t = 0) and after 6 weeks (t = 6) of treatment with cyclosporin 5 mg/kg. Methods In 54 patients with severe AD, disease activity was assessed using objective Scoring Atopic Dermatitis index (SCORAD), Six Area Six Sign Atopic Dermatitis (SASSAD), ‘rule of nines’ extent score and serum levels of thymus and activation‐regulated chemokine (TARC). Patients filled out the Dermatology Life Quality Index (DLQI). To study the relation between disease activity and QoL, correlations were calculated and regression analysis was performed. Results At t = 0 there was a small, non‐significant correlation between the DLQI and the objective SCORAD, ‘rule of nines’ or serum TARC levels. At t = 6 the objective SCORAD, serum TARC and the ‘rule of nines’ score showed moderate and significant correlations with the DLQI (r = 0.34, P = 0.02; r = 0.31, P = 0.03; r = 0.49, P < 0.001). An individual’s improvement in disease activity (objective SCORAD, SASSAD and ‘rule of nines’) with 10 points was associated with an improvement of 1.3, 1.5 and 1.1 points respectively in DLQI. Conclusions Disease activity correlated better with QoL when disease activity was less severe and disease extent (‘rule of nines’) correlated better with QoL than disease severity. An individual’s improvement of 10 points in disease activity was accompanied by only a small improvement in QoL. Other factors than disease activity may influence QoL in patients with AD.     

An Innovative Oat‐Based Sterile Emollient Cream in the Maintenance Therapy of Childhood Atopic Dermatitis

Although emollients are recommended in the management of atopic dermatitis (AD), regimens for emollient maintenance therapy are awaiting validation. We conducted an international, multicenter, open‐label trial to assess the effects of a 3‐month maintenance treatment regimen with a sterile, preservative‐free emollient cream containing oat plantlets in children (ages 6 mos–6 yrs) with moderate AD. After a 14‐day run‐in stabilization phase using a topical corticosteroid (TCS) treatment of medium potency, 108 children with a SCORing Atopic Dermatitis (SCORAD) index of 20 or less were included in the study. Emollient was applied twice daily for 3 months. Rescue TCS treatment was used only in cases of flare‐ups. The SCORAD index, Patient‐Oriented SCORAD (PO‐SCORAD) index, number of flares, TCS use, and tolerance were assessed at months 1, 2, and 3 (M1, M2, M3). AD severity improved, with a highly significant decrease in the SCORAD and PO‐SCORAD indexes at M2 and M3 (p < 0.001). Changes from baseline to M3 were 48.6 ± 73.6% for SCORAD and 29.6 ± 125.3% for PO‐SCORAD. The number of flares and TCS use significantly decreased by M3 (both p < 0.001). Very good tolerance was recorded in 100% of children at M2 and M3. Notwithstanding the limitations inherent in open‐label trials, twice daily application of the oat‐based sterile emollient cream led to a significant improvement of clinical symptoms, evidenced by parallel changes in the SCORAD and PO‐SCORAD indexes and fewer flare‐ups. Clinical benefit and less TCS use were maintained at M3. Tolerance was very good.     

Methotrexate and azathioprine for severe atopic dermatitis: a 5‐year follow‐up study of a randomized controlled trial

Atopic dermatitis (AD), commonly known as eczema, is a chronic inflammatory skin disease causing intense itching and/or pain, which can affect the sleep and health‐related quality of life of both the patient and their family. It affects around 10–20% of people in developed countries. Worldwide AD is in the top 50 of most common diseases. Systemic treatment, meaning a medicine that works within the body rather than just being applied to the skin, is used for patients suffering from moderate‐to‐severe AD, and for whom topical (applied to the skin) treatment is insufficient. Long‐term evidence of most systemic treatments is lacking, especially of off‐label (that is not registered for AD) prescribed methotrexate (MTX) and azathioprine (AZA). This study, from the Netherlands, aimed to find out if MTX and AZA are effective and safe treatments in the long‐term. Patients participated in a follow‐up study of a randomized controlled trial (a study which compares different treatments in actual patients) in which they were seen every 3 months for 5 years. MTX and AZA doses could be in‐ or decreased if the patients’ doctors felt it necessary. The measure how effective the treatments were, the researchers used scoring systems that allowed them to compare symptoms after 5 years compared with when the patients started treatment – in this case, the SCORing Atopic Dermatitis (SCORAD) index in which a reduction in the score shows an improvement in symptoms, and Investigator Global Assessment (IGA). Adverse events (unwanted side effects) were also investigated. Drug survival (that is how long a patient is on treatment) was also analysed. Thirty‐five of 43 originally included patients participated in this follow up study, of which 27 completed the whole 5 years follow up. At year 5, mean relative reduction in SCORAD index was similar in MTX and AZA group: 52.8% and 53.8%. Twelve serious adverse events occurred in 5 years; for three the treatment was the possible cause. Drug survival was longer for MTX, but low in both groups after 5 years (MTX n = 5, AZA n = 1). Based on this relatively small study, MTX and AZA seem to be effective and safe as maintenance treatments in moderate‐to‐severe AD up to 5 years. Few patients in both groups stayed on their originally allocated drug, although some stopped taking the treatment because their symptoms had cleared. This low drug survival underlines the need for effective treatments for AD patients. Further, more long‐term and good sampled studies are needed.     

Salivary chromogranin A levels correlate with disease severity but do not reflect anxiety or personality of adult patients with atopic dermatitis

Stress‐induced scratching is an issue in patients with adult atopic dermatitis (AD). Although itching and stress are believed to be intimately related, no objective index is available; therefore, most evaluations are subjective. Using saliva, which is easily collected, we investigated the degree to which AD severity and patient stress levels are reflected in stress proteins in the saliva. Here, we evaluated the severity (Scoring Atopic Dermatitis [SCORAD] score), stress (State–Trait Anxiety Index [STAI] score), personality (Tokyo University Egogram [TEG] II score) and quality of life (Dermatology Life Quality Index [DLQI] score) of 51 patients with AD who were examined in the Department of Dermatology of Shimane University between April and December 2015. We collected saliva and measured salivary chromogranin A (CgA), amylase and cortisol. The amount of salivary CgA per protein in patients with AD was correlated with their SCORAD score (r = 0.458, P < 0.001). There was no correlation between cortisol or amylase levels and SCORAD score. SCORAD score was correlated with DLQI (r = 0.390, P = 0.006). CgA per protein was correlated with DLQI (r = 0.393, P = 0.004). There was no correlation between scores for the anxiety component of the STAI, TEG II or DLQI. Our results suggested that patients with more severe AD may have high stress levels. The personalities of these patients with AD tended to involve elevated anxiety levels.     

The effect of topical virgin coconut oil on SCORAD index,transepidermal water loss,and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized,double‐blind,clinical trial

Atopic dermatitis (AD) is a chronic skin disease characterized by defects in the epidermal barrier function and cutaneous inflammation, in which transepidermal water loss (TEWL) is increased and the ability of the stratum corneum to hold water is impaired, causing decreased skin capacitance and hydration. This study investigated the effects of topical virgin coconut oil (VCO) and mineral oil, respectively, on SCORAD (SCORing of Atopic Dermatitis) index values, TEWL, and skin capacitance in pediatric patients with mild to moderate AD, using a randomized controlled trial design in which participants and investigators were blinded to the treatments allocated. Patients were evaluated at baseline, and at 2, 4, and 8 weeks. A total of 117 patients were included in the analysis. Mean SCORAD indices decreased from baseline by 68.23% in the VCO group and by 38.13% in the mineral oil group (P < 0.001). In the VCO group, 47% (28/59) of patients achieved moderate improvement and 46% (27/59) showed an excellent response. In the mineral oil group, 34% (20/58) of patients showed moderate improvement and 19% (11/58) achieved excellent improvement. The VCO group achieved a post‐treatment mean TEWL of 7.09 from a baseline mean of 26.68, whereas the mineral oil group demonstrated baseline and post‐treatment TEWL values of 24.12 and 13.55, respectively. In the VCO group, post‐treatment skin capacitance rose to 42.3 from a baseline mean of 32.0, whereas that in the mineral oil group increased to 37.49 from a baseline mean of 31.31. Thus, among pediatric patients with mild to moderate AD, topical application of VCO for eight weeks was superior to that of mineral oil based on clinical (SCORAD) and instrumental (TEWL, skin capacitance) assessments.     

Dupilumab treatment improves quality of life in adult patients with moderate‐to‐severe atopic dermatitis: results from a randomized,placebo‐controlled clinical trial

Atopic dermatitis is a skin disease, commonly known as eczema. It affects up to 1 in 10 adults. Atopic dermatitis is usually very itchy, causing people to wake up at night, and feel “low”. This state of general discomfort is known as reduced quality of life. Dupilumab is a new treatment approved in the U.S.A. for adults with moderate‐to‐severe atopic dermatitis. The treatment blocks some of the mechanisms involved in the disease. In a clinical trial conducted in Europe, researchers observed 109 patients with moderate‐to‐severe atopic dermatitis. The patients received dupilumab over 12 weeks. They found that the treatment improved the eczema and its symptoms, such as itch. The researchers also studied how the treatment affected quality of life in 64 out of 109 patients in the study. These patients had answered a set of questions that measures how atopic dermatitis affects their quality of life (Quality of Life Index for atopic dermatitis [QoLIAD]). Thirty‐two patients received dupilumab 300 mg weekly, by injection under the skin, and 32 received placebo. About 6 out of 10 patients treated with dupilumab had better quality of life over the 12 weeks, whereas only about 1 in 10 placebo‐treated patients improved. The researchers also found a relatively strong link between improvements with dupilumab in QoLIAD score and improvements in the eczema and symptoms. Dupilumab was well‐tolerated by the patients. The authors conclude that dupilumab, a new breakthrough treatment for atopic dermatitis, improves eczema and its symptoms, and in turn, the patients’ quality of life.     

Oral Cyclosporine Weekend Therapy: A New Maintenance Therapeutic Option in Patients with Severe Atopic Dermatitis

Cyclosporine A (CyA) is a systemic therapy used to control severe atopic dermatitis (AD) in children, but its use may be associated with serious side effects. Intermittent short‐course therapy has been used to minimize these risks without the loss of clinical benefits. We conducted a 20‐week study using intermittent short‐course CyA therapy in five patients with severe AD and a Scoring Atopic Dermatitis (SCORAD) score >40. The result was a reduction in the cumulative dose of CyA and serum CyA level, which allows for a longer duration of CyA treatment and decreases the risk of relapse in patients with severe AD.     

Impact of disease severity on work productivity and activity impairment in Japanese patients with atopic dermatitis

Atopic dermatitis (AD) is a common inflammatory skin disease that is characterized by chronic and persisting pruritic and eczematous lesions. There has been no study of work productivity and activity in AD patients in relation to disease severity. The purpose of this study was to examine the impact of disease severity on work productivity and activity impairment (WPAI) in adult AD patients using the Japanese version of the questionnaire. Data were collected from 112 AD patients who visited the Jikei University Hospital. Outcomes as measured by the questionnaire included employment status, total work productivity impairment (TWPI) and total activity impairment (TAI). We investigated the correlation between TWPI or TAI scores and severity scoring of AD (SCORAD) for disease severity and dermatology life quality index (DLQI) for quality of life impairment. Both TWPI and TAI scores were significantly correlated with the SCORAD and DLQI scores (P < 0.001), indicating disease severity is significantly associated with WPAI in Japanese adult AD patients. Further studies are necessary to evaluate the effects of treatments on WPAI for severe AD patients.     

Effects of a Short‐Term Parental Education Program on Childhood Atopic Dermatitis: A Randomized Controlled Trial

Parental education is important in managing childhood atopic dermatitis (AD). We evaluated the long‐term effects of a 2‐day parental education program (PEP) on childhood AD. In an investigator‐blinded, randomized controlled trial, 59 children age 6 months to 6 years with moderate to severe AD and their mothers were recruited in Japan. Participants were given a booklet about AD and received conventional treatment alone or in combination with a 2‐day PEP comprising three lectures, three practical sessions, and a group discussion. The primary outcome was evaluation of eczema severity using SCORing Atopic Dermatitis (SCORAD) at 6 months. Secondary outcomes included changes in symptom scores, amount of corticosteroid used, parental quality of life as determined according to the Dermatitis Family Impact questionnaire, and change in parental anxiety regarding the use of corticosteroids in their children. Participants in the PEP group had a significantly lower SCORAD score than those in the control group at 6 months (mean difference 10.0, 95% confidence interval [CI] = 2.3–17.7, p = 0.01) and objective SCORAD score (mean difference 7.1, 95% CI = 0.8–13.5, p = 0.03). The sleeplessness symptom score (mean difference 1.6, 95% CI = 0.0–3.1, p = 0.048) and corticosteroid anxiety score (p = 0.02) in the PEP group were significantly better than in the control group at 6 months. There was no significant difference between groups in the amount of corticosteroid used or quality of life. The PEP had positive long‐term effects on eczema severity and parental anxiety about corticosteroid usage.     

Quality of Life of Parents Living with a Child Suffering from Atopic Dermatitis Before and After a 3‐Month Treatment with an Emollient

Abstract: Atopic dermatitis (AD) can be extremely disabling and may cause psychological problems for affected children and their families. Moisturizers and emollients are important in the baseline daily skin care of patients with AD. To assess the effect of a 3‐month, twice‐daily treatment with an emollient on the quality of life (QoL) of parents with a child with mild to moderate AD (SCORing Atopic Dermatitis [SCORAD] ≤30, a multicenter open trial was performed by eight dermatologists on 191 volunteers. Evaluation by the dermatologist of the child’s clinical condition (SCORAD) and of the efficacy and overall safety of the treatment was associated with a QoL questionnaire completed by one parent of the atopic child. A self‐assessment of the global QoL and of the efficacy and overall safety was also performed. During the study, mean SCORAD dropped from 28 to 12 (p < 0.001), with good improvement in skin dryness and pruritus criteria. At the same time, the self‐assessment of the global parent QoL scores dropped from 4.4 to 2.1 (p < 0.001) with 60%, 48% and 79% favorable parent opinions regarding wellbeing or improvement of the health condition, quality of sleep, and efficacy of the emollient, respectively. This trial revealed the efficacy of the product in improving parent QoL (85% of parents noted improvement in QoL), and its global safety was considered to be very good or good, with 80% favorable opinions in parents’ declarative judgements and dermatologists’ assessments. The emollient evaluated improves the course of AD and can improve the QoL of patients and their families.     

Safety and efficacy of topical E6005, a phosphodiesterase 4 inhibitor,in Japanese adult patients with atopic dermatitis: Results of a randomized,vehicle‐controlled,multicenter clinical trial

The safety and efficacy of topical E6005, a novel phosphodiesterase 4 inhibitor, in Japanese adults with atopic dermatitis were evaluated. A total of 78 patients were randomized to receive either the 0.2% E6005 ointment or vehicle control (without E6005) at an allocation ratio of 2:1. The randomization phase of 4 weeks was followed by an extension phase of 8 weeks. In the extension phase, all 67 subjects who completed the randomization phase were treated with 0.2% E6005 ointment. The 4‐week application of topical E6005 twice daily was safe and well tolerated. The safety profile for up to 12 weeks was similar to that for the first 4 weeks. No deaths or other serious adverse effects were observed during the entire study period of 12 weeks. Plasma E6005 was undetectable in all subjects at all sampling points while very low plasma concentrations of an E6005 metabolite were detected in 47% of subjects receiving E6005 treatment. At the end of week 4, Eczema Area and Severity Index (EASI), Severity Scoring Atopic Dermatitis (SCORAD)‐objective, SCORAD‐C (visual analog scales for pruritus and sleep loss), itch Behavioral Rating Scale, and the severity of the targeted eczematous lesions in the topical E6005 group showed trends toward improvement compared with those in the vehicle group (not statistically significant). However, the group receiving topical E6005 for 12 weeks showed significant score reductions from baselines for EASI (P = 0.030), SCORAD‐objective (P < 0.001) and SCORAD‐C (P = 0.038). These results further support the development of topical E6005 for the treatment of atopic dermatitis.     

5‐Methoxypsoralen plus ultraviolet (UV) A is superior to medium‐dose UVA1 in the treatment of severe atopic dermatitis: a randomized crossover trial

Background Ultraviolet (UV) A1 and psoralen plus UVA (PUVA) are effective treatment options for severe atopic dermatitis (AD); however, their relative efficacy has not yet been determined in a head‐to‐head study. Objectives To compare UVA1 and oral 5‐methoxypsoralen (5‐MOP) plus UVA with respect to efficacy, tolerability and duration of response in patients with severe generalized AD. Methods Forty patients were included in this randomized observer‐blinded crossover trial. The patients received either 15 exposures to medium‐dose UVA1 as the first treatment and, in cases of relapse, another 15 exposures to 5‐MOP plus UVA as the second treatment, or vice versa. All patients were followed until 12 months after discontinuation of the last treatment. The SCORAD score was determined by a blinded investigator at baseline, after 10 and 15 treatments each and during the follow‐up period. In addition, all adverse events were recorded during the whole study period. Results Twenty‐three patients completed the crossover treatment. Both phototherapies resulted in clinical improvement; however, PUVA reduced the baseline SCORAD score to a significantly greater extent than UVA1 (mean ± SD 54·3 ± 25·7% vs. 37·7 ± 22·8%; P = 0·041). The median length of remission was 4 weeks (interquartile range 4–12) after UVA1 and 12 weeks (interquartile range 4–26) after PUVA therapy (P = 0·012). Conclusions PUVA provides a better short‐ and long‐term response than medium‐dose UVA1 in patients with severe AD.     

A randomized double‐blind controlled trial to compare a triclosan‐containing emollient with vehicle for the treatment of atopic dermatitis

The use of topical antiseptics in the treatment of atopic dermatitis (AD) has previously been explored. However, no triclosan‐containing leave‐on emollient has been evaluated previously, to our knowledge. The aims of this study were to assess the safety and efficacy of an emollient containing triclosan compared with the emollient alone (vehicle) for the treatment of AD. Eligible patients with mild to moderate AD were randomized to receive either the study cream or vehicle. All patients also received a low‐potency corticosteroid cream to use during the treatment phase of the study if necessary. Patients were assessed for severity according to the SCORing Atopic Dermatitis (SCORAD) Index, amount of corticosteroid used, patient assessment of cream, and adverse events (AEs). In total, 60 patients received either the study cream or vehicle, and an intention‐to‐treat analysis was performed. At day 14, there was a significant decrease in SCORAD from baseline for the study cream compared with vehicle (P < 0.05). At day 27, although there was an improved mean reduction from baseline, this was no longer significant (P > 0.05). Only four patients had mild treatment‐related AEs. The mean total amount of topical steroid applied by the patients using the study was significantly lower than that used by controls (P = 0.40). Triclosan‐containing leave‐on emollient was safe and highly acceptable to patients. However, the overall benefit on day 27 was not significant. Nevertheless, the amount of topical steroid used by patients was significantly less with the study cream than with the vehicle, thus further studies are needed to confirm its steroid‐sparing effect.     

Anti‐immunoglobulin E in the treatment of refractory atopic dermatitis

Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease affecting > 10% of children and 1–3% of adults, and can cause significant morbidity. The incidence of AD seems to be increasing. Omalizumab, a monoclonal antibody, has recently been suggested as a potential new systemic treatment for patients with recalcitrant AD with elevated IgE levels, based on its efficacy in treating asthma and allergic rhinitis. We report a study of 10 patients with AD (aged 19–35 years) who received anti‐IgE treatment for persistent asthma. All patients, regardless of IgE value, were treated with a fixed schedule of eight cycles of omalizumab 300 mg administered subcutaneously at intervals of 2 weeks. Eczema symptoms were scored at baseline and after 2, 4 and 6 months of treatment. There was a steady improvement in the objective SCORAD (SCORing Atopic Dermatitis), with significantly lower scores observed at the 6‐month evaluation. At 2 months after the end of treatment, two patients had a very good result (SCORAD reduction of > 50%), five patients had a satisfactory result (reduction of 25–50%), and three patients had no clinically relevant result (reduction of 25–50%). No patient had worsening of the AD (increase of > 25% in SCORAD), and once a clinical improvement occurred, none of the patients experienced worsening of their eczema symptoms while on omalizumab. With the caveats of the financial expense and unknown long‐term risks of malignancy associated with omalizumab, this drug should be considered for treatment‐resistant patients with AD, particularly patients with high IgE level whose symptoms are not controlled by routine therapies. Omalizumab has proven useful in treating asthma, but it may also prove valuable for other conditions, such as allergic rhinitis, food allergies, chronic urticaria, and AD, as shown by the present study.     

Fifty‐two week follow‐up safety and effectiveness results of dupilumab treatment of moderate‐to‐severe atopic dermatitis from a retrospective,multicentric series

Atopic dermatitis (AD) is a chronic, systemic disease that has a multifactorial etiology, where immune system disorders and epidermal barrier dysfunction are added to the influence of genetic and environmental factors. Dupilumab has been approved by United States and the European Union regulatory agencies in 2017 for the treatment of moderate‐to‐severe AD in adult patients who are candidates for systemic treatment. In this short report, we present a retrospective, multicentric study, in which five hospitals in Andalusia, Spain, have taken part. Our objective is to evaluate the safety and effectiveness of dupilumab in patients with moderate‐to‐severe AD treated with dupilumab with at least 52 weeks of follow‐up.     

SCORAD 75: a new metric for assessing treatment outcomes in atopic dermatitis

Objective The scoring atopic dermatitis (SCORAD) is a well‐established severity‐scoring tool for atopic dermatitis (AD). Dead Sea climatotherapy (DSC) is a natural selective balneo‐phototherapy utilized for many years to treat severe AD. The study’s goal was to evaluate the impact of DSC on AD patients through assessment of SCORAD scores and to identify parameters associated with greater improvement. Methods The files of 78 European patients (37 male patients and 41 female patients, mean age 37.8 years) with AD undergoing DSC were included in this retrospective study. Three sub‐groups were delineated based on disease severity (as determined using the SCORAD). Demographic and clinical parameters as well as treatment characteristics – maximal and cumulative sun exposure doses – were recorded. SCORAD values were again recorded for assessment of treatment response. SCORAD 75 was defined as ≥75% decrease in SCORAD values following therapy. Statistical analysis including logistic regression models was used in multivariable analysis. Results After an average of 30 days of treatment, mean SCORAD values dropped from 50.5 to 11 (76.7%, P < 0.001). 64.1% of all patients, regardless of sub‐group, reached SCORAD 75, whereas 78.9% of patients with severe disease achieved this result. In a multivariate logistic regression, factors associated with achieving SCORAD 75 were maximal sun exposure, family history of AD and age at disease onset (P = 0.002, P = 0.009 and P = 0.040 respectively). Conclusion Dead Sea climatotherapy is a particularly effective treatment method for the sub‐population of adults with severe AD. The SCORAD 75 can be useful for defining sub‐populations in which treatment is more likely to be successful.     

Nemolizumab in moderate to severe atopic dermatitis: An exploratory analysis of work productivity and activity impairment in a randomized phase II study

Atopic dermatitis negatively impacts work productivity. This study investigated the impact of nemolizumab on work productivity and activity impairment in adults with moderate to severe atopic dermatitis inadequately controlled by topical treatments in a two‐part, phase II, randomized control trial. The Work Productivity and Activity Impairment – Atopic Dermatitis questionnaire was an exploratory end‐point. Part A was a 12‐week, placebo‐controlled study in which patients received s.c. nemolizumab 0.1, 0.5 or 2.0 mg/kg every 4 weeks or 2.0 mg/kg every 8 weeks. Part B was a 52‐week extension in which all patients received active treatment. A total of 138 patients had Work Productivity and Activity Impairment – Atopic Dermatitis data; 104 were employed at baseline. At week 12, patients receiving nemolizumab every 4 weeks showed greater mean (standard error) Work Productivity and Activity Impairment – Atopic Dermatitis improvement (score reduction) from baseline versus placebo: Percent Work Time Missed (0.1, 0.5 or 2.0 mg/kg vs placebo): –4.0% (3.9%), –1.7% (4.2%) and –1.6% (4.2%) versus 4.9% (4.5%); Percent Impairment While Working, –15.8% (6.0%), –24.1% (6.5%) and –34.3% (6.4%) versus –16.5% (7.1%); Percent Overall Work Impairment, –16.3% (6.0%), –23.1% (6.5%) and –34.5% (6.3%) versus –16.6% (7.1%); and Percent Activity Impairment, –13.4% (5.3%), –23.5% (5.3%) and –41.9% (5.5%) versus –10.9% (5.7%). Improvements were sustained through week 64. Nemolizumab‐treated patients with moderate to severe atopic dermatitis reported improvements in Work Productivity and Activity Impairment through week 64.