Trending clinical topic: atopic dermatitis

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From new findings about diagnosis in patients with skin color to studies addressing associations with COVID-19 and other conditions, research presented at the 3rd Annual Breakthrough Atopic Dermatitis (RAD) Conference has led to the hottest clinical topic this week. At the conference, Andrew F. Alexis, MD, MPH, professor of clinical dermatology at Weill Cornell Medicine, New York, discussed differences in the clinical presentation of atopic dermatitis in people of color (see infographic).

Since pigmented skin can mask some redness and discoloration, Alexis stressed the need for clinicians to intervene. “It is important to recognize this clinical presentation and to carefully observe and assess the patient not only visually but with palpation, and to take into consideration the symptomatology, so as not to fall into the trap of calling post-hyperpigmentation inflammatory an atopic dermatitis lesion,” he said. . Treatment delays and undertreatment may contribute to a higher risk of pigmentation sequelae and other long-term sequelae in this patient population. Alexis emphasized being vigilant about both what to look for when presenting a patient and monitoring treatments specifically suited for skin of color.

In other research presented at RAD 2021, a reassuring study found that patients with atopic dermatitis do not appear to face an increased risk of contracting COVID-19 or being hospitalized due to the virus. The researchers carried out a cross-sectional study of 13,162 dermatology patients seen in the UK between June 2018 and February 2021. Of the 13,162 patients, 624 (4.7%) had atopic dermatitis. They found that 4.8% of patients without a history of COVID-19 infection had atopic dermatitis, compared to 3.4% with a history of COVID-19. The risk of COVID-19 in patients with atopic dermatitis was similar to that of controls (odds ratio adjusted [aOR], 0.67). The authors of a separate cross-sectional study published in May assessed the health insurance medical records of 269,299 patients who were tested for SARS-CoV-2 at University of California medical centers. Of these, 3.6% had tested positive for SARS-CoV-2. Among 5387 patients with atopic dermatitis, the infection rate was 2.9%, which was lower than that of patients without atopic dermatitis (3.7%; P = 0.0063). Hospitalization and mortality did not increase in patients with atopic dermatitis.

Less encouraging results have shown that atopic dermatitis particularly strikes older patients and may be associated with an increased risk of common comorbid conditions in later stages of life, including osteoporosis, dementia and cardiovascular disease. Patients aged 65 or older with this skin condition also have more profound sleep disturbances than younger adult patients. Using adjusted odds ratios, the researchers found that older adult age was associated with an increased number of sleep-disturbed nights due to atopic dermatitis in the previous week (aOR, 2.14; P = 0.0142), as well as increased fatigue over the last 7 days (aOR, 1.81; P = 0.0313), sleep disturbances in the last 7 days (aOR, 1.98; P = 0.0118), and difficulty staying asleep in the last 7 days (aOR, 2.26; P = .0030).

Atopic dermatitis that affects the head, neck, face and hands has a significantly higher impact on health-related quality of life in patients of different ages, and these patients appear to have more severe disease, according to a study. large cross-sectional study presented at RAD 2021. Of the 533 study participants, 453 (85%) had disease that affected the head, neck, face, hands and other areas, while 80 (15% ) only had other areas of the body affected. Patients with head, face, neck and hand involvement were more likely to have severe Validated Investigator’s Global Assessment for Atopic Dermatitis (vIGA-AD) scores (28.5% vs. 3%; P = 0.02) and higher median total body surface area affected (15% versus 10%; P ≤ .01). “These findings underscore the importance of detailed assessment of specific areas affected by AD to personalize treatment approaches based on patient needs,” said presentation author Lawrence F. Eichenfield, MD, during the presentation. a last-minute abstract session.

These and other presentations at RAD 2021 captured the attention of clinicians, resulting in this week’s hottest clinical topic.

Learn more about atopic dermatitis.

Jessica C. Bell