In a recent issue of the New England Journal of Medicine, Ruzicka and colleagues1 reported the results of a phase 2 trial of subcutaneous nemolizumab, a humanized antibody against IL-31 receptor A, in adults with atopic dermatitis (AD). Its accompanying editorial2 referenced the character in HBO’s The Night Of played by John Turturro, who displayed symptoms of AD and used a chopstick to scratch his dermatitis. As dermatologists, we were disappointed but not surprised at the representation of our specialty, albeit fictiously, of the multiple doctors’ failed treatments. We thought that he was likely suffering from allergic contact dermatitis (ACD) with the prominent dorsal foot involvement completely unresponsive to all standard therapies.
Given that the recent American Academy of Dermatology-commissioned Burden of Skin Disease reported more than 13 million Americans sought care for contact dermatitis resulting in more than $1.5 billion in medical treatment3, it is no surprise that fictional lead characters are presenting in popular television segments with the condition. In another HBO series, The Sopranos, Tony Soprano, played by the late James Gandolfini, presented to his doctor in the “House Arrest” episode with a highly pruritic dermatitis on his arm and is quickly prescribed a cortisone cream:
Physician: “Are you under any undue stress lately?”
Tony: “Is that the only word you people know?”
Physician: “Sometimes pressure can result in contact dermatitis.”
Tony: “Oh, is that what that is? See now I knew that was bad.”
Physician: “It means rash. … “I’ll write you a script for cortisone cream.”
Most dermatologists are well aware of the associated insurmountable suffering and significant societal costs associated with the failure to administer a diagnostic patch test that can often identify the cause of dermatitis and provide an opportunity for permanent remission.
Perhaps in the Turturro character’s case, the bacitracin ointment he was applying was a culprit allergen. These HBO shows point out (through their characters’ afflictions) both the association of stress with dermatitis and the need to consider ACD in patients with “AD.” Because it is known that polysensitization occurs when topical treatments containing potential allergens are applied to chronic presensitized primary dermatitis sites4 and that “AD” suffers have increased risk for sensitization to allergens in their topical therapy and hygiene product5, dermatologists should administer early patch test intervention in patients with chronic dermatitis.
Dr Machler is a clinical professor of dermatology in the department of dermatology at NYU Ronald O. Perelman School of Medicine in New York, NY.
Dr Jacob, Section Editor of Allergen Focus, is a board-certified dermatologist and professor at Loma Linda University in Loma Linda, CA. She is founder and chief executive officer of the Dermatitis Academy public outreach education campaign.
Disclosure: The authors report no relevant financial relationships.
References
1. Ruzicka T, Hanifin JM, Furue M, et al; XCIMA Study Group. Anti-interleukin-31 receptor A antibody for atopic dermatitis. N Engl J Med. 2017;376(9):826-835.
2. Schneider LC. Ditching the itch with anti-type 2 cytokine therapies for atopic dermatitis. N Engl J Med. 2017;376(9):878-879.
3. Lim HW, Collins SAB, Resneck JS Jr, et al. The burden of skin disease in the United States. J Am Acad Dermatol. 2017;76(5):958-972.e2.
4. Gaul LE. Development of multiple sensitivities from primary sensitivity to nickel. Ann of Allergy. 1959;17(2):209-214.
5. Zug KA, McGinley-Smith D, Warshaw EM, et al. Contact allergy in children referred for patch testing: North American Contact Dermatitis Group data, 2001-2004. Arch Dermatol. 2008;144(10):1329-1336.
In a recent issue of the New England Journal of Medicine, Ruzicka and colleagues1 reported the results of a phase 2 trial of subcutaneous nemolizumab, a humanized antibody against IL-31 receptor A, in adults with atopic dermatitis (AD). Its accompanying editorial2 referenced the character in HBO’s The Night Of played by John Turturro, who displayed symptoms of AD and used a chopstick to scratch his dermatitis. As dermatologists, we were disappointed but not surprised at the representation of our specialty, albeit fictiously, of the multiple doctors’ failed treatments. We thought that he was likely suffering from allergic contact dermatitis (ACD) with the prominent dorsal foot involvement completely unresponsive to all standard therapies.
Given that the recent American Academy of Dermatology-commissioned Burden of Skin Disease reported more than 13 million Americans sought care for contact dermatitis resulting in more than $1.5 billion in medical treatment3, it is no surprise that fictional lead characters are presenting in popular television segments with the condition. In another HBO series, The Sopranos, Tony Soprano, played by the late James Gandolfini, presented to his doctor in the “House Arrest” episode with a highly pruritic dermatitis on his arm and is quickly prescribed a cortisone cream:
Physician: “Are you under any undue stress lately?”
Tony: “Is that the only word you people know?”
Physician: “Sometimes pressure can result in contact dermatitis.”
Tony: “Oh, is that what that is? See now I knew that was bad.”
Physician: “It means rash. … “I’ll write you a script for cortisone cream.”
Most dermatologists are well aware of the associated insurmountable suffering and significant societal costs associated with the failure to administer a diagnostic patch test that can often identify the cause of dermatitis and provide an opportunity for permanent remission.
Perhaps in the Turturro character’s case, the bacitracin ointment he was applying was a culprit allergen. These HBO shows point out (through their characters’ afflictions) both the association of stress with dermatitis and the need to consider ACD in patients with “AD.” Because it is known that polysensitization occurs when topical treatments containing potential allergens are applied to chronic presensitized primary dermatitis sites4 and that “AD” suffers have increased risk for sensitization to allergens in their topical therapy and hygiene product5, dermatologists should administer early patch test intervention in patients with chronic dermatitis.
Dr Machler is a clinical professor of dermatology in the department of dermatology at NYU Ronald O. Perelman School of Medicine in New York, NY.
Dr Jacob, Section Editor of Allergen Focus, is a board-certified dermatologist and professor at Loma Linda University in Loma Linda, CA. She is founder and chief executive officer of the Dermatitis Academy public outreach education campaign.
Disclosure: The authors report no relevant financial relationships.
References
1. Ruzicka T, Hanifin JM, Furue M, et al; XCIMA Study Group. Anti-interleukin-31 receptor A antibody for atopic dermatitis. N Engl J Med. 2017;376(9):826-835.
2. Schneider LC. Ditching the itch with anti-type 2 cytokine therapies for atopic dermatitis. N Engl J Med. 2017;376(9):878-879.
3. Lim HW, Collins SAB, Resneck JS Jr, et al. The burden of skin disease in the United States. J Am Acad Dermatol. 2017;76(5):958-972.e2.
4. Gaul LE. Development of multiple sensitivities from primary sensitivity to nickel. Ann of Allergy. 1959;17(2):209-214.
5. Zug KA, McGinley-Smith D, Warshaw EM, et al. Contact allergy in children referred for patch testing: North American Contact Dermatitis Group data, 2001-2004. Arch Dermatol. 2008;144(10):1329-1336.
In a recent issue of the New England Journal of Medicine, Ruzicka and colleagues1 reported the results of a phase 2 trial of subcutaneous nemolizumab, a humanized antibody against IL-31 receptor A, in adults with atopic dermatitis (AD). Its accompanying editorial2 referenced the character in HBO’s The Night Of played by John Turturro, who displayed symptoms of AD and used a chopstick to scratch his dermatitis. As dermatologists, we were disappointed but not surprised at the representation of our specialty, albeit fictiously, of the multiple doctors’ failed treatments. We thought that he was likely suffering from allergic contact dermatitis (ACD) with the prominent dorsal foot involvement completely unresponsive to all standard therapies.
Given that the recent American Academy of Dermatology-commissioned Burden of Skin Disease reported more than 13 million Americans sought care for contact dermatitis resulting in more than $1.5 billion in medical treatment3, it is no surprise that fictional lead characters are presenting in popular television segments with the condition. In another HBO series, The Sopranos, Tony Soprano, played by the late James Gandolfini, presented to his doctor in the “House Arrest” episode with a highly pruritic dermatitis on his arm and is quickly prescribed a cortisone cream:
Physician: “Are you under any undue stress lately?”
Tony: “Is that the only word you people know?”
Physician: “Sometimes pressure can result in contact dermatitis.”
Tony: “Oh, is that what that is? See now I knew that was bad.”
Physician: “It means rash. … “I’ll write you a script for cortisone cream.”
Most dermatologists are well aware of the associated insurmountable suffering and significant societal costs associated with the failure to administer a diagnostic patch test that can often identify the cause of dermatitis and provide an opportunity for permanent remission.
Perhaps in the Turturro character’s case, the bacitracin ointment he was applying was a culprit allergen. These HBO shows point out (through their characters’ afflictions) both the association of stress with dermatitis and the need to consider ACD in patients with “AD.” Because it is known that polysensitization occurs when topical treatments containing potential allergens are applied to chronic presensitized primary dermatitis sites4 and that “AD” suffers have increased risk for sensitization to allergens in their topical therapy and hygiene product5, dermatologists should administer early patch test intervention in patients with chronic dermatitis.
Dr Machler is a clinical professor of dermatology in the department of dermatology at NYU Ronald O. Perelman School of Medicine in New York, NY.
Dr Jacob, Section Editor of Allergen Focus, is a board-certified dermatologist and professor at Loma Linda University in Loma Linda, CA. She is founder and chief executive officer of the Dermatitis Academy public outreach education campaign.
Disclosure: The authors report no relevant financial relationships.
References
1. Ruzicka T, Hanifin JM, Furue M, et al; XCIMA Study Group. Anti-interleukin-31 receptor A antibody for atopic dermatitis. N Engl J Med. 2017;376(9):826-835.
2. Schneider LC. Ditching the itch with anti-type 2 cytokine therapies for atopic dermatitis. N Engl J Med. 2017;376(9):878-879.
3. Lim HW, Collins SAB, Resneck JS Jr, et al. The burden of skin disease in the United States. J Am Acad Dermatol. 2017;76(5):958-972.e2.
4. Gaul LE. Development of multiple sensitivities from primary sensitivity to nickel. Ann of Allergy. 1959;17(2):209-214.
5. Zug KA, McGinley-Smith D, Warshaw EM, et al. Contact allergy in children referred for patch testing: North American Contact Dermatitis Group data, 2001-2004. Arch Dermatol. 2008;144(10):1329-1336.
