News - November/December 2021

Survey Identifies Patient-Reported AD Symptom Burden
Patients with atopic dermatitis (AD) reported itch and redness were the most common symptoms to worsen during a disease flare, according to a study by Bacci et al in Journal of Drugs in Dermatology.

Adults with AD were recruited through the National Eczema Association as well as clinical sites to complete a web-based survey. The survey incorporated clinical tools (Patient-Oriented SCORing Atopic Dermatitis, Recap of Atopic Eczema, and skin pain numeric rating scale) and questions on current and historical clinical presentation, flare characteristics (ie, frequency, severity), AD treatments used, and patient demographics.

In total, 186 adults completed the survey. They most frequently reported dryness, itch, redness, roughness, and flaking as current disease signs. Itch, dryness, and redness were the most bothersome AD symptoms. A majority of patients reported having a disease flare within the past month, and during the flare, itch and redness worsened. Uncontrolled and severe disease were most associated with flare frequency, duration, and average severity.

“The results of this study demonstrate the diverse and considerable symptomatic burden experienced by people with AD, even while being treated for AD,” wrote the study authors.

Reference
Bacci E, Rentz A, Correll J, et al. Patient-reported disease burden and unmet therapeutic needs in atopic dermatitis. J Drugs Dermatol. 2021;20(11):1222-1230. doi:10.36849/jdd.6329

TNF Inhibition Associated With Lower Risk of Adverse COVID-19 Outcomes
An international research group has found that patients with immune-mediated inflammatory diseases (IMIDs) who were treated with tumor necrosis factor (TNF) inhibitor monotherapy during the pandemic had lower risk of adverse COVID-19 outcomes than other therapies. The results of their study were published in JAMA Network Open.

To examine the association between COVID-19 hospitalization and commonly prescribed immunomodulatory therapies, the researchers performed a pooled analysis of three international COVID-19 registries for IMIDs. Included in the analysis were adults with psoriasis, inflammatory arthritis, or inflammatory bowel disease from March 12, 2020, to February 1, 2021. Within each digital registry, clinicians reported patient outcomes and characteristics. Treatments included were:

• TNF inhibitor monotherapy
• TNF inhibitors in combination with methotrexate (TNF-M)
• TNF inhibitors in combination with azathioprine/6-mercaptopurine therapy (TNF-AM)
• Methotrexate monotherapy (MM)
• Azathioprine/6-mercaptopurine monotherapy (AM)
• Janus kinase inhibitor monotherapy (JAK)

In total, 6077 patients were included, with 3563 (58.6%) women and a mean age (SD) of 48.8 (16.5) years. Of the total number of patients, 1297 (21.3%) were hospitalized and 189 (3.1%) died. Pooled analysis revealed that patients receiving TNF inhibitor monotherapy had the lowest odds of hospitalization or death compared with patients receiving any other therapy (TNF-AM, P=.006; AM, P=.001; MM, P<.001; JAK, P=.004), except patients who received TNF-M (P=.33).

The authors concluded that TNF inhibitor monotherapy was associated with a lower risk of adverse COVID-19 outcomes vs commonly prescribed immunomodulatory therapies for IMIDs. 

Reference
Izadi Z, Brenner EJ, Mahil SK, et al. Association between tumor necrosis factor inhibitors and the risk of hospitalization or death among patients with immune-mediated inflammatory disease and COVID-19. JAMA Netw Open. 2021;4(10):e2129639. doi:10.1001/jamanetworkopen.2021.29639

Laser-Retinoid Combination Therapy Improves Photodamage, Facial Dyspigmentation
A single-center study showed that nonablative fractionated laser plus topical retinoid is well-tolerated and efficacious for treating hyperpigmentation and photodamage of the face.

To evaluate treatment outcomes and patient satisfaction, the investigators treated patients with facial dyspigmentation and photodamage with 1927-nm thulium fiber laser alone or laser in combination with 0.05% tretinoin lotion.

After treatment patients in both study arms (laser alone vs combination therapy) demonstrated a significant change in Investigator Assessed Overall Hyperpigmentation and Investigator Assessed Overall Photodamage. Overall, both combination therapy and laser alone were well tolerated.

The only statistically significant difference between the groups was Subject Global Aesthetic Improvement Scale and Subject Satisfaction at 30 days posttreatment. In this evaluation, patients who received combination therapy reported lower levels of perceived improvement and satisfaction.

The authors concluded that combination therapy with 1927-nm thulium fiber laser and 0.05% tretinoin lotion was well-tolerated with successful outcomes. They noted future studies should investigate variations in this combination therapy, including duration of use or retinoid concentration.

Reference
Almukhtar R, Carr E, Angra K, Lipp M, Boesn M, Goldman M. Single-center, prospective, double-blind, evaluator-blind, non-randomized, vehicle-controlled trial with a 1927 nm non-ablative fractionated laser and topical 0.05% tretinoin lotion for facial dyspigmentation and photodamage. J Drugs Dermatol. 2021;20(11):1174-1179. doi:10.36849/jdd.6182

Bone Density Not Affected by Sun-Protective Measures
In a cross-sectional study, sun-protective behaviors were not associated with decreased bone mineral density (BMD) or increased risk of osteoporotic fracture. The results were published in JAMA Dermatology.

Data of adults who participated in the National Health and Nutrition Examination Survey (dermatology, 2017-2018) were analyzed for sun-protective behaviors, site-specific and total BMD, and osteoporotic fractures. Sun-protective behaviors included staying in the shade, wearing long sleeves, and sunscreen use, and fracture sites were the hip, wrist, and spine.

In total, the data from 3418 adults (average age, 39.5 years) were included. Of these patients, 31.6% reported staying in the shade, 11.8% reported wearing long sleeves, and 26.1%  reported sunscreen use. These individual photoprotective behaviors were not associated with diminished site-specific and total BMD z scores. Further, moderate to frequent shade was associated with reduced prevalence of spine fractures, “possibly owing to risk-averse behaviors,” added the authors.

“These reassuring findings add to the growing body of evidence on the safety of sun protection, with no considerable negative association with bone health,” they concluded. 

Reference
Afarideh M, Sartori-Valinotti JC, Tollefson MM. Association of sun-protective behaviors with bone mieral density and osteoporotic bone fractures in US adults. JAMA Dermatol. Published online October 27, 2021. doi:10.1001/jamadermatol.2021.4143