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Adult atopic dermatitis (AD) can seriously affect quality of life of patients and their families, and patients' disease is frequently not satisfactorily controlled with topical therapy. There is a need for alternatives to topical treatment in patients with moderate to severe AD.To investigate the efficacy and safety of oral pimecrolimus, and to determine the response to three different doses in the treatment of AD.In a double-blind, placebo-controlled, parallel-group, dose-finding study, patients with moderate to severe AD were randomized to receive either placebo, or oral pimecrolimus 10, 20 or 30 mg twice daily. The study consisted of a pretreatment phase, a 12-week double-blind treatment phase, and a 12-week post-treatment phase.In total, 103 patients were randomized. A clear, dose-dependent therapeutic effect of pimecrolimus treatment was observed, with a statistically significant onset of efficacy at week 2 and the greatest reduction from baseline of the Eczema Area and Severity Index of 66·6% at week 7 in the 30 mg twice daily dose group. Oral pimecrolimus was well tolerated and there were no signs of nephrotoxicity or the induction of hypertension.These data demonstrate the clinically relevant efficacy and short-term safety of oral pimecrolimus in adults with moderate to severe AD. Longer-term studies in larger cohorts are now required. [ABSTRACT FROM AUTHOR]

Summary: Background: Despite decades of use, the magnitude of efficacy of narrowband ultraviolet B (NB‐UVB) phototherapy for atopic dermatitis (AD) beyond industry‐sponsored trials remains unclear. Aim: To evaluate the clinical efficacy of NB‐UVB in AD under real‐world conditions. Methods: We conducted a historical inception cohort study using automated recording of dispensed drugs to provide an objective treatment outcome in a large population catchment of 420 000 people over 15 years. We analysed clinical treatment outcomes, recorded multicentre and prospectively over 15 years, of a large AD treatment cohort (n = 844), along with the drugs dispensed to this cohort. Results: The majority (70%) of patients with AD received significantly fewer topical corticosteroids (TCS) during the 12‐month window after finishing NB‐UVB compared with the 12‐month window before starting the treatment (median reduction from 37.5 to 19.7 g/month). The number of patients dispensed with oral corticosteroids and antihistamines also dropped significantly (from 20% to 10% and from 69% to 31%, respectively), while all AD‐unrelated drugs dispensed remained unchanged. Clinically, NB‐UVB treatment achieved a 'clear' or 'almost clear' status in 48.7% of patients, while 20.4% achieved 'moderate clearance'. Treatment outcomes scores were validated by a strong correlation with reduction in AD‐specific drug treatment. Conclusion: Our data confirm the significant efficacy of NB‐UVB for AD under conditions of routine care. [ABSTRACT FROM AUTHOR]

Summary: Background: Despite decades of use, the actual amounts of topical corticosteroids (TCS) and emollients used in moderate‐to‐severe atopic dermatitis (AD) under real‐world conditions are unknown. Thus, it remains unclear whether inadequate use is widespread. Objectives: To quantify the use of TCS and emollients in moderate‐to‐severe AD. Methods: Double‐blinded drug prescribing was recorded prospectively at the point of drug dispensing within a catchment area of approximately 450 000 people over a 31‐year period in a population‐based cohort marked by failure of disease control in primary care (n = 844). For each patient, prescribing was recorded over a 12‐month period in order to minimize fluctuations. Results: This approach resulted in a near‐complete dataset, which was essentially free of reporting bias and recording bias. Atopic comorbidities matched expected frequencies. Median use of TCS was statistically significantly higher in juvenile patients (age < 16 years) compared with adult patients (49·2 vs. 38·1 g per month), in male vs. female patients (46·8 vs. 29·7 g per month) and in patients receiving concurrent asthma treatment (40·4 vs. 26·7 g per month). TCS use was strongly associated with antidepressant treatment. Emollient use was unexpectedly low with a median of 9·6 g per day (range 1·4–30·1). Results were replicated in an independent validation cohort. Conclusions: Deficient use of emollients may be a factor contributing to AD severity. Our analysis showed that the use of TCS does not exceed current guidelines. Accurate quantification of topical treatments provides a widely accessible strategy to measure the real‐world impact of novel AD treatments. What's already known about this topic? Both emollient and topical corticosteroid (TCS) use have been a mainstay of atopic dermatitis (AD) treatment for over 60 years.The actual quantities used by patients under real‐world conditions are unknown. What does this study add? The real‐world use of emollients is fourfold lower than the amount recommended in current guidelines.Underuse of emollients may be a significant factor in disease exacerbation.The use of TCS is significantly higher in male patients and is higher in patients with AD who also have asthma.The use of TCS is strongly associated with concurrent antidepressant treatment. Linked Comment:Strowd and Feldman. Br J Dermatol 2020; 182:836–837. Plain language summary available online [ABSTRACT FROM AUTHOR]

Summary: Atopic dermatitis (AD), often known simply as eczema, is a widespread condition, affecting between 15‐25% of children and between 4‐7% of adults worldwide. AD causes dry and itchy skin, and for many is a life‐long affliction. AD varies enormously, fluctuating between mild and severe in many patients. Twice daily and generous application of moisturisers (called "emollients"), as well as steroid‐containing creams applied to inflamed skin areas, can help to treat AD. For this reason, guidelines recommend the use of a pint‐sized tub of emollients per week. However, it is unknown how much moisturiser and steroid creams patients actually use. In order to find this out, researchers from the U.K. analysed electronic pharmacy dispensing records, which show how much of a medication patients are using. The most important findings were as follows: First, most patients in fact only use tiny amounts of moisturisers ‐ less than a third of a standard toothpaste tube (17 gram), for what should cover their entire body twice daily. Second, the use of steroid creams does not, on the whole, exceed guideline recommendations, which is reassuring. Third, there is a strong association between the use of steroid creams and treatment for depression. Thus, the number of patients requiring regular antidepressant treatment is almost double among patients requiring high amounts of steroid creams (50 gram or more per month) compared to those using lower amounts. This finding confirms previous suggestions of a link between currently having depression and more severe AD. Importantly, the findings highlight an urgent need for increased use of moisturisers, and that mental health may impact more heavily than thought on AD severity. This is a summary of the study: Quantitative analysis of topical treatments in atopic dermatitis: unexpectedly low use of emollients and strong correlation of topical corticosteroid use both with depression and concurrent asthma [ABSTRACT FROM AUTHOR]