Search Results (556)

Introduction: Atopic dermatitis (AD) is driven by complex pathways that mediate inflammation and pruritus. The pathophysiology of AD’s disease involves multiple pathways. Interleukin-13 (IL-13) is considered a major cytokine in Th2-type inflammation, responsible for changing the epidermal barrier and producing chronic inflammation, whereas interleukin-31 (IL-31) is considered a major inducer of pruritus. The exact correlation of each of these cytokines with disease severity in children with AD appears to vary across studies. This study was therefore designed to evaluate whether IL-13 and IL-31 levels contribute complementarily or independently to the overall clinical severity of AD in the Moroccan pediatric population and to analyze the correlation between serum IL-13 and IL-31 levels and investigate their correlation with disease severity in a pediatric cohort. Methods: A total of 52 children with moderate to severe AD were included. The severity of the disease was measured using the SCORing Atopic Dermatitis (SCORAD) index. Serum levels of IL-13 and IL-31 were measured by Enzyme-Linked Immunosorbent Assay (ELISA). Results: The IL-13 serum level showed a considerable positive correlation with the SCORAD score (r_s = 0.7, p < 0.0001). On the other hand, IL-31 levels revealed no correlation with SCORAD (r_s = 0.07, p = 0.62) but were positively correlated with pruritus intensity (r_s = 0.91, p < 0.001). Conclusion: Our results support the presence of different pathophysiological axes in pediatric AD, where IL-13 functions as a reliable biomarker of inflammatory severity. IL-31 acts as a systemic marker of the pruritic pathway. Full article

Background/Objectives: Microbial dysbiosis is implicated with a pathogenic role in both irritable bowel syndrome (IBS) and several dermatological conditions. Yet, few studies have assessed a potential overlapping epidemiologic association. We aimed to assess the 1-year prevalence of common dermatologic conditions following an initial IBS diagnosis and to evaluate the reverse association using reciprocal analyses. Methods: We conducted a retrospective study using TriNetX. Patients aged 18–50 with no history of inflammatory bowel disease, celiac disease, or infectious intestinal disease were matched 1:1 to healthy controls by demographics and comorbidities. The primary outcome was the prevalence of acne vulgaris, psoriasis, atopic dermatitis, hidradenitis suppurativa, rosacea, vitiligo, alopecia areata, and urticaria 1 year after IBS diagnosis, measured using Odds Ratios (ORs) and 95% confidence intervals. To confirm bidirectionality, reciprocal analyses were performed. Results: Over a 1-year period, IBS patients were less likely to have acne vulgaris (OR: 0.78, CIs: 0.75–0.80) and vitiligo (OR: 0.78, CIs: 0.64–0.95) compared to those without. IBS patients were more likely to have psoriasis (OR: 1.14, CIs: 1.08–1.21), hidradenitis suppurativa (OR: 1.11, CIs: 1.03–1.20), rosacea (OR: 1.10, CIs: 1.03–1.18), and urticaria (OR: 1.27, CIs: 1.21–1.34) compared to healthy controls. No association was found for atopic dermatitis or alopecia areata. In the reciprocal analysis, alopecia areata patients (OR: 0.76, CIs: 0.64–0.90) had a lower prevalence of IBS compared to healthy controls. IBS was shown to occur more frequently in patients with psoriasis (OR: 1.15, CIs: 1.07–1.23), rosacea (OR: 1.23, CIs: 1.15–1.31), and urticaria (OR: 1.06, CIs: 1.01–1.12) compared to healthy controls. No association was seen in patients with acne, atopic dermatitis, hidradenitis suppurativa, and vitiligo. Conclusions: IBS shows a bilateral positive overlapping association with psoriasis, rosacea, and urticaria. Hidradenitis suppurativa showed a positive association only among IBS patients, with no reciprocal relationship. Moreover, our findings suggest that acne and vitiligo were inversely associated with IBS; however, this was not supported in our reciprocal analysis. Although no association was initially found between IBS and alopecia areata, the reciprocal analysis suggests a potential inverse association. No association was seen with atopic dermatitis bilaterally. Clinicians who treat these disorders should be aware of the potential bidirectional association. Full article

Isosorbide fatty acid diesters constitute a novel class of bioactive compounds with emerging therapeutic applications in inflammatory and barrier-compromised disorders. Among them, isosorbide dicaprylate (IDC) and isosorbide di-linoleate/oleate (IDL) synergistically strengthen epidermal barrier integrity, enhance stratum corneum hydration, regulate keratinocyte differentiation, suppress proinflammatory signaling, and beneficially modulate the skin microbiome. Randomized, double-blind clinical trials in both pediatric and adult populations with atopic dermatitis (AD) demonstrate that topical IDC + IDL formulations significantly reduce pruritus, corticosteroid dependence, and Staphylococcus aureus colonization while improving sleep quality, disease severity scores, and overall quality of life. Extending applications within and even beyond dermatology, isosorbide dimethyl fumarate (IDMF)—a next-generation fumarate derivative designed to mitigate sensitization risk—exhibits potent anti-inflammatory and antioxidant activities through NRF2 activation and NF-κB/IRF1 suppression. Preclinical studies in psoriasis and neuroinflammatory models, including multiple sclerosis, reveal robust modulation of oxidative stress and immune pathways with improved safety and mechanistic precision compared to conventional fumarates, although its systemic use remains exploratory and requires clinical validation. Collectively, isosorbide diesters emerge as multifunctional therapeutic agents offering barrier repair, immune modulation, and inflammation control, representing promising alternatives to corticosteroids and systemic immunosuppressants across dermatologic and systemic inflammatory disorders. Full article

Background/Objectives: Nemolizumab provides rapid and effective relief from pruritus in patients with atopic dermatitis. However, it is frequently associated with cutaneous adverse events, and reliable predictors of their severity have not yet been clearly identified. This study aimed to investigate the relationship between the severity of nemolizumab-associated cutaneous adverse events and patients’ clinical background and to explore baseline factors that may be useful in predicting their severity. Methods: We retrospectively analyzed data from 40 patients with atopic dermatitis who received nemolizumab between May 2023 and March 2025. Clinical variables included demographics, prior therapies, phenotype, baseline Eczema Area and Severity Index subscores, serum biomarker levels, and treatment courses. The severity of cutaneous adverse events was classified as mild (<10% body surface area or limited to dryness/desquamation) or moderate-to-severe (≥10% body surface area). Results: Cutaneous adverse events occurred in 31 of 40 patients (78%); 13 were moderate-to-severe and 18 were mild. Most events appeared within 16 weeks of treatment initiation. Severity was associated with age, duration of disease, serum Thymus and Activation-Regulated Chemokine (TARC) level, and clinical phenotype. Patients with trunk-dominant phenotypes showed more severe cutaneous adverse events than patients with extremity-dominant or prurigo-type atopic dermatitis. Most cutaneous adverse events resolved within 12 weeks using topical therapy, without requiring treatment discontinuation. Conclusions: Baseline characteristics such as age, duration of disease, serum TARC levels, and severity of trunk lesions may be useful in predicting the risk of severe cutaneous adverse events, supporting their potential use in pre-treatment assessment and patient counseling. Full article

Background: Head and neck dermatitis (HND) represents a challenging phenotype of atopic dermatitis (AD), often showing suboptimal response or paradoxical worsening during biologic therapy. Objective: To review the efficacy and safety of current systemic treatments for HND, with a focus on dupilumab, tralokinumab, lebrikizumab, and janus kinase (JAK) inhibitors. Methods: We conducted a narrative review of randomized controlled trials, post hoc analyses, and real-world studies assessing clinical outcomes in patients with moderate-to-severe AD involving the head and neck. Outcomes included Eczema Area and Severity Index (EASI) H&N subscore, erythema grade, patient-reported measures, and adverse events. Results: Dupilumab shows substantial efficacy for HND in both clinical trials and real-life studies; however, responses are often less pronounced than in other anatomical regions, and facial redness (FR) has emerged as a notable adverse event in up to 9% of patients. Tralokinumab and lebrikizumab demonstrate significant improvements in HND involvement, with low incidence of paradoxical reactions. JAK inhibitors, particularly upadacitinib, provide rapid and marked improvement in refractory cases and in patients developing FR during biologic therapy. Conclusions: Systemic therapy for HND should be individualized, balancing efficacy and tolerability. JAK inhibitors represent a valuable alternative in biologic-refractory phenotypes or in patients experiencing dupilumab-associated FR. Full article

Background: Disturbed iron metabolism has been described in chronic diseases with pro-inflammatory/immune activation. This study aimed to characterize iron status in patients with atopic dermatitis (AD) and to examine its relationship with disease severity and quality of life. Methods: We prospectively enrolled 86 adult patients with moderate-to-severe AD. Clinical assessments included the Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (SCORAD), and the Dermatology Life Quality Index (DLQI). Blood samples were collected for hematologic parameters and iron-related biomarkers, including serum iron, ferritin, transferrin, transferrin saturation (Tsat), soluble transferrin receptor (sTfR), and hepcidin. Associations between iron markers and clinical outcomes were evaluated using beta regression models with variable selection and stability analyses. Results: Abnormalities in circulating iron biomarkers indicating iron deficiency were prevalent in patients with AD: 45% of patients had low Tsat (<20%), 37% low ferritin, and 26% reduced serum iron, despite largely normal hemoglobin. Patients with pro-inflammatory activation (as evidenced by elevated high-sensitivity C-reactive protein (hsCRP) above 5 mg/L) displayed a pattern characterized by lower iron, Tsat and higher sTfR levels. In multivariable analyses, lower serum iron remained associated with worse DLQI scores, while higher transferrin was associated with greater disease severity (EASI, SCORAD). Conclusions: Iron deficiency without anemia was a common feature of moderate-to-severe AD and was associated with higher clinical burden. Dysregulated systemic iron homeostasis was associated with impaired quality of life and increased disease severity. Full article

Background: Hypochlorous acid (HOCl) is an integral component of the human innate immune system. It possesses antimicrobial properties and is available in solution, dermal spray, and scar gel forms. Objectives/Methods: This review presents data from studies on the clinical use of HOCl in various specialties, including dermatology, surgery, dentistry, ophthalmology, and rhinology. Results: Due to its anti-inflammatory/antimicrobial/immunomodulatory and healing properties, HOCl is advantageous in treating various skin disorders: ulcus cruris (and wound care), diabetic ulcers, atopic dermatitis, seborrheic dermatitis, pruritus, acne vulgaris, etc. Also, the application of a HOCl spray/gel after surgical procedures may prevent infection, reduce inflammation, and accelerate healing. HOCl is also effective and safe for the prevention and treatment of hypertrophic and keloid scars. Growing evidence shows a broader role for HOCl in limiting cancer cell survival and slowing tumor growth. It is also important in treating various viral infections like SARS-CoV-2 (coronavirus), influenza, and herpes, thereby helping to prevent the spread of aerosols. In addition, since HOCl is an endogenous compound naturally present in mammals with a high safety profile, it may be an effective bacterial disinfectant in dental waterlines. In ophthalmology, adjuvant treatment with HOCl ophthalmic spray can reduce the duration of antibiotic/corticosteroid use, even in severe blepharitis. To fully harness the protective/therapeutic properties of HOCl, future advancements will rely on the development of new chemical compounds and sophisticated pharmaceutical formulations. Conclusions: The majority of clinical studies have confirmed that HOC1 is useful in therapy, although the results are not entirely consistent. Further research is essential to optimize HOCl dosing and to develop controlled-release systems aimed at maximizing its anti-inflammatory and photoprotective effects while minimizing tissue irritation and damage. Full article

Background and Objectives: Atopic dermatitis (AD) is a chronic inflammatory skin disorder primarily affecting children, driven by genetic, immunologic, and environmental factors. Emerging evidence links gut microbiota alterations to immune modulation and AD severity. Probiotics, live microorganisms providing health benefits when consumed in adequate amounts, have been proposed as a potential adjunctive therapy. This review evaluates the efficacy of various probiotic treatments in reducing SCORAD indices and symptoms in children with AD, and its effects on immunologic markers such as IgE. Materials and Methods: Through a systematic literature review of multiple electronic databases through 9 October 2024, we identified randomized controlled trials (RCTs) in pediatric patients with an established diagnosis of atopic dermatitis. Our search strategy was as follows: “((atopy) OR (dermatitis) OR (hypersensitivity)) AND pediatric AND probiotic” yielding 25 total studies. Patients were treated with either a probiotic regimen or placebo and assessed for levels of IgE and SCORAD indices. Results: Of 25 studies extracted, 14 RCTs evaluated the effects of probiotics on atopic dermatitis using SCORAD scores. Eleven showed significant reductions in SCORAD indices. Pooled analysis using a random-effects model (Hedges’ g ≈ 0.65, p < 0.05) indicated a moderate to large improvement in AD severity with probiotic therapy. However, heterogeneity in probiotic strains, intervention duration, and limited sample sizes are limitations that warrant further investigation. Secondary analysis of IgE changes showed a non-significant effect (g ≈ 0.15, p = 0.13), possibly due to short study durations (mean 12 weeks). Conclusions: Probiotics demonstrate a moderate to large clinical impact in reducing SCORAD indices among children with atopic dermatitis. These findings highlight their potential as a future adjunctive, non-pharmaceutical therapy for the roughly 9.6 million pediatric patients affected in the United States. Further studies are needed to clarify strain-specific effects and patient factors influencing response. Full article

Background/Objectives: Next-generation drugs, such as JAK inhibitors and biologics, have proved to be very effective treatment choices in several autoimmune and autoinflammatory skin disorders. However, these drugs are not without risk. Due to their immune-modulating properties, these drugs may pose a risk of infection, which could vary between drug target, disorder type and pathogen. Our goal was to determine infection risk and how it may vary by drug target, pathogen and skin disorder, namely psoriasis, atopic dermatitis, alopecia areata, vitiligo and hidradenitis suppurativa. Methods: We performed a systematic search and meta-analysis where we extracted the rates of different infections from the adverse events of each trial that were found and met our inclusion criteria. Results: We found significant associations in psoriasis and atopic dermatitis where infection risk varied by drug, skin condition and pathogen type. We specifically found that there was an increased risk of viral infection for patients with atopic dermatitis with both JAK inhibitors and biologics. We also found an increased risk of fungal infections in psoriasis patients receiving targeted therapies. Lastly, we observed a decreased risk of bacterial infections in atopic dermatitis with dupilumab specifically. Additionally, there was a significantly higher incidence of herpes simplex infections in atopic dermatitis patients with target-selective JAK inhibitors, while no increased risk was observed with herpes zoster. Conclusions: There is a varied risk with these next-generation medications that needs to be considered when determining treatment regime. Full article

Background/Objectives: Mechanical alloknesis (m-alloknesis), the sensation of itch evoked by normally non-pruritic mechanical stimuli, is commonly observed in dry skin-associated conditions, such as xerosis, atopic dermatitis (AD), and psoriasis. Janus kinase (JAK) inhibitors are currently used to treat AD and suppress inflammation and itch. However, their specific roles in the modulation of m-alloknesis remain unclear. Therefore, in this study, we investigated the effects of various oral JAK inhibitors on m-alloknesis using a murine model of AD. Methods: An AD-like phenotype was induced in mice through the repeated topical application of an ointment containing Dermatophagoides farinae (house dust mite) extract. The mice were then orally treated with one of three JAK inhibitors: the JAK1/2 inhibitor baricitinib, the JAK1-selective inhibitor abrocitinib, or the JAK2-selective inhibitor AZ960. M-alloknesis was evaluated by quantifying scratching behavior in response to 30 controlled mechanical stimuli applied to lesional skin. Results: The JAK inhibitor treatments did not affect skin barrier integrity, dermatitis severity, or spontaneous scratching behavior. However, baricitinib and abrocitinib significantly reduced m-alloknesis scores, whereas AZ960 had no effect. Conclusions: These results suggest that JAK1 signaling plays a critical role in the induction of m-alloknesis in AD. Selective JAK1 inhibition is a promising therapeutic strategy for attenuating m-alloknesis and improving quality of life for patients with AD, independent of general skin inflammation and barrier function. Full article

Atopic dermatitis (AD) is a chronic inflammatory skin disease marked by pruritus and eczematous lesions that significantly impacts patient quality of life. This review covers the intricate interplay of barrier dysfunction, immune dysregulation, and microbial dysbiosis in the complex pathophysiology of AD. The roles of epigenetic factors and environmental exposures are also examined. The evolving understanding of these factors has revolutionized AD treatment. Beyond foundational topical agents, the landscape for moderate-to-severe AD treatment is now dominated by highly targeted immunotherapies, such as biologics and Janus Kinase (JAK) inhibitors, that precisely block specific inflammatory pathways. Emerging strategies explore microbiome modulation and vitamin D supplementation. This paradigm shift from broad immunosuppression to precision medicine offers improved disease control and reduced systemic toxicities and enables more personalized AD management, significantly benefiting patients. Full article

Canine atopic dermatitis (AD) is a chronic allergic skin disease in which various immunological markers have been investigated. While peripheral eosinophil counts, serum allergen-specific immunoglobulin E (IgE), and cytokines have each been evaluated in allergic disorders, their simultaneous assessment in dogs with AD has rarely been reported in Korea. This study aimed to evaluate the diagnostic and clinical utility of these parameters in affected dogs. A total of 93 dogs were included between August 2019 and February 2020, comprising 65 dogs diagnosed with AD and 28 healthy controls. Clinical information, peripheral blood eosinophil counts and ratios, serum allergen-specific IgE using a multiple allergen panel (60 allergens), and cytokines related to T helper 2 (Th2) and T regulatory (Treg) cells (IL-4, IL-13, IL-31, TGF-β1) were analyzed. The mean age of AD dogs was 6.34 ± 3.99 years, with a predominance of small breeds and males. Eosinophil counts and ratios showed no significant difference between groups. In contrast, allergen-specific IgE levels were significantly elevated for several allergens, including Dermatophagoides pteronyssinus, Acarus siro, Tyrophagus putrescentiae, alder/birch, hazel, oak, cladosporium, and selected dietary antigens (pea, soybean, pumpkin, apple) (p < 0.05). Sensitization rates were also higher for Acarus siro, Tyrophagus putrescentiae, oak, and sheep sorrel (p < 0.05). Th2-related cytokines tended to increase and TGF-β1 tended to decrease in AD dogs, though without statistical significance. These findings indicate that peripheral eosinophil counts have limited diagnostic value, whereas allergen-specific IgE testing provides clinically useful information for the diagnosis and management of canine AD. Further research stratifying disease stages and assessing local tissue cytokine expression is warranted. Full article

T helper 2 (Th2)-mediated dermatoses are inflammatory skin diseases driven by CD4⁺ Th2 cells that produce interleukin (IL)-4, IL-5, IL-13, and IL-31, promoting immunoglobulin E (IgE) class switching, eosinophil recruitment, mast cell degranulation, and pruritus. We aimed to place these conditions in context and clarify how Th2 biology informs diagnosis and therapy. We conducted a narrative synthesis of mechanistic, translational, and clinical evidence on Th2 pathways in atopic dermatitis (AD), prurigo nodularis, bullous pemphigoid, chronic spontaneous urticaria, and selected type I/IVb hypersensitivity reactions, with focused appraisal of trials targeting IL-4Rα, IL-13, and IL-31R. Persistent Th2 activation is associated with epidermal barrier dysfunction, immune dysregulation, and pruritogenic neural signaling; AD is the archetype, showing prominent lesional IL-4/IL-13 activity correlated with severity and itch. Across disorders, pathway-directed biologics against IL-4Rα, IL-13, and IL-31R consistently reduce disease activity and pruritus in AD and prurigo nodularis, with emerging signals of benefit in bullous pemphigoid and chronic spontaneous urticaria. The Th2 axis provides a unifying pathogenic framework and actionable therapeutic target across multiple dermatoses. Integrating cytokine profiling with clinical phenotypes may refine patient stratification and optimize the deployment of existing and next-generation Th2-targeting therapies. Full article

Atopic dermatitis (AD) is a chronic inflammatory skin condition that affects up to 25% of children and impairs both skin barrier function and quality of life. This study examined the effectiveness of an emulgel containing hyaluronic acid, glycerol, grape seed oil, Calendula officinalis, aloe vera and sh-oligopeptide-1 (a synthetic Epidermal Growth Factor) for treating paediatric AD. In a randomised, self-controlled trial, 57 children (aged 2–14) applied the emulgel twice daily for 10 days to one forearm and left the other forearm as a control. Skin barrier parameters such as transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema and pH were measured. After applying the emulgel, lesional skin showed reduced erythema (p = 0.007), lower TEWL (p = 0.002) and higher SCH (p < 0.001). Non-lesional skin showed improved SCH (p < 0.001). SCORing Atopic Dermatitis (SCORAD) and Eczema Area and Severity Index (EASI) scores indicated milder disease post-treatment (mild cases: 64.9% to 80.7% SCORAD; 82.5% to 93.0%EASI). The Dermatology Life Quality Index improved by ~3.5 points, and patients reported high satisfaction with no adverse effects. This emulgel is an effective and well-tolerated adjunctive therapy for paediatric AD, enhancing barrier function and clinical outcomes. Full article

Background: Cyclosporine (CSA) is a fast-acting systemic immunosuppressant frequently used in moderate-to-severe atopic dermatitis (AD), but its long-term use is limited by toxicity. AD affects as many as 20% of children and nearly 10% of adults worldwide and its chronic, recurrent course often requires several systemic treatment lines, making optimization of sequential therapy a high clinical priority. Tralokinumab, an IL-13–targeting monoclonal antibody, represents a safer alternative with a slower onset of action. This study aimed to compare the effectiveness and safety of tralokinumab initiated as monotherapy versus in overlap with CSA during the transition from conventional to biologic therapy. Methods: We conducted a prospective observational study involving 27 adults with moderate-to-severe AD treated with tralokinumab for at least 16 weeks. Patients were categorized into two groups: tralokinumab monotherapy plus topical agents (TM; n = 23) and tralokinumab initiated with a cyclosporine overlap for up to 12 weeks (TO; n = 4). Disease severity was evaluated using the Eczema Area and Severity Index (EASI), Investigator Global Assessment (IGA), and numerical rating scale (NRS) for pruritus at baseline and weeks 16, 24, and 52. Results: Both TM and TO groups demonstrated significant clinical improvement across all outcomes, with no statistically significant differences between groups (p > 0.05 for EASI, IGA, and NRS). At week 52, TM patients showed mean reductions of 18.66 (EASI), 2.21 (IGA), and 4.49 (NRS), while TO patients showed reductions of 15, 2, and 3.50, respectively. Tralokinumab was discontinued in eight patients (29.6%), most commonly due to lack of efficacy. Discontinuation rates did not differ significantly between groups. However, the very small size of the TO group (n = 4) substantially limits statistical power and any contrasts should be interpreted as exploratory. Conclusions: In this prospective real-world cohort, we observed improvement after initiating tralokinumab, with and without a short cyclosporine bridge. In light of CSA’s risks, TM may be considered a reasonable first-line systemic option. Prospective randomized studies are needed to determine whether overlap confers additional benefit. Full article