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Resume Cas clinique Nous rapportons l’observation d’une patiente ayant presente un angiœdeme du visage de facon concomitante a une injection intraveineuse d’alteplase, comme traitement thrombolytique d’un accident vasculaire cerebral (AVC) ischemique. Le bilan allergologique (prick-test et intradermoreaction) etait negatif, et la reintroduction d’alteplase bien toleree, eliminant une hypersensibilite allergique IgE (Immunoglobuline E) dependante. Discussion La survenue d’angiœdeme est un effet secondaire classique de l’alteplase. Il est souvent spontanement resolutif, mais peut entrainer un risque vital. Les facteurs de risque sont le sexe feminin, un AVC ischemique du cortex insulaire et un traitement par IEC (inhibiteur de l’enzyme de conversion). Sa physiopathologie est mal comprise, regroupant 3 principales hypotheses : une hypersensibilite dependant des IgE, une degranulation mastocytaire non specifique ou une activation bradykinique. Les tests cutanes, suivis d’une reintroduction d’alteplase en cas de negativite, sont donc interessants pour eliminer un mecanisme IgE. L’alteplase n’etant activee qu’en presence de fibrine, sa reintroduction n’entraine pas de risque hemorragique en l’absence de thrombose. Conclusion Une meilleure connaissance des angioedemes survenant sous alteplase pourrait permettre d’ameliorer leur gestion en urgence, mais aussi leur prise en charge allergologique.

An aqueous antiseptic containing "chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol" (CBB) is widely used in France. The only previous documented study dealing with allergic contact dermatitis (ACD) to this antiseptic is one small case series in children. The French Vigilance Network for Dermatology and Allergy (REVIDAL-GERDA) has collected many cases in the last few years.To evaluate the clinical and sensitization profiles of patients diagnosed with ACD to CBB.We performed a retrospective study of patients with contact dermatitis to CBB and positive tests to CBB and/or at least one of its components. All patients had to be tested with all components of CBB.A total of 102 patients (71 adults and 31 children) were included. The lesions were extensive in 63% of patients and 55% had delayed time to diagnosis. CBB patch tests were positive in 93.8% of cases. The allergen was identified in 97% of patients, mainly benzyl alcohol in adults (81.7%) and chlorhexidine digluconate in children (54.8%). About 32.4% of the patients were sensitized to several components.CBB is a cause of ACD at all ages. The components of the antiseptic should be tested. The sensitization profile seems to be different between adults and children.

Abrocitinib is an oral Janus kinase 1 inhibitor with demonstrated efficacy in moderate-to-severe atopic dermatitis (AD). To evaluate the long-term safety profile of abrocitinib and provide relevant information for practitioners. Data from patients who received ≥1 dose of abrocitinib 200 mg or 100 mg in the JADE clinical program were pooled in two cohorts. The consistent-dose (CD) cohort comprised patients who received the same abrocitinib dose during the entire exposure time in parent phase 3 studies and/or the long-term extension study JADE EXTEND (NCT03422822). Parent studies were: JADE MONO-1 (NCT03349060), JADE MONO-2 (NCT03575871), JADE TEEN (NCT03796676), JADE COMPARE (NCT03720470), JADE DARE (NCT04345367; 200 mg only) and JADE REGIMEN (NCT03627767); in JADE REGIMEN only patients from the open-label run-in phase (200 mg only) who did not subsequently enter the randomized phase were included. Patients from the phase 2b study (NCT02780167) were also included in the CD cohort. The variable-dose (VD) cohort comprised patients who received different doses of abrocitinib (200 and 100 mg) throughout exposure time in the parent study JADE REGIMEN and in JADE EXTEND, if enrolled. Patients included in the VD cohort completed the open-label period of JADE REGIMEN (abrocitinib 200 mg only) and entered the randomized phase (abrocitinib 200 mg, abrocitinib 100 mg or placebo); some patients subsequently entered the JADE REGIMEN rescue phase (abrocitinib 200 mg) and/or JADE EXTEND (abrocitinib 200 or 100 mg). The data cutoff was 16 April 2021. A Cox regression analysis evaluated risk factors for specific events of interest. Data from 3582 patients (4313.4 patient-years) were analysed: 2784 patients in the CD cohort (abrocitinib 200 mg, n = 1761, abrocitinib 100 mg, n = 1023) and 798 patients in the VD cohort. Duration of exposure was ≥48 weeks in 43.6%, 66.9% and 86.1% and ≥96 weeks in 18.0%, 23.2% and 45.4% of patients in the CD 200 mg, 100 mg and VD cohorts, respectively. In the CD and VD cohorts, the median age was 30.0 and 29.0 years; 490 (17.6%) and 145 patients (18.2%) were adolescents, and 143 (5.1%) and 30 patients (3.8%) were aged ≥65 years at screening, respectively. Incidence rates (IRs; unique patients with events per 100 patient-years) of serious adverse events (SAEs), deaths, and treatment-emergent adverse events of special interest are shown in Table 1. IRs for SAEs were consistent across abrocitinib doses but were higher in patients aged ≥65 years vs. younger patients. Serious infections were the most frequent SAEs; frequency was not dose related. Herpes zoster (HZ), herpes simplex and pneumonia were the most frequent serious infections. From a Cox regression analysis, potential risk factors for treatment-emergent HZ included abrocitinib dose, baseline age, medical history of HZ, absolute lymphocyte count

Topical non-steroidal anti-inflammatory drugs (NSAIDs) can cause allergic contact dermatitis (ACD) and photocontact dermatitis. Although topical diclofenac is associated with fewer side effects than other topical NSAIDs, rare cases of contact dermatitis have been reported.

BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by unrelenting pruritus and recurrent eczematous lesions. It affects up to 15% of children and adolescents and up to 5% of adults, and confers a high and multifactorial burden to patients, families and society. With increasing awareness of this substantial burden, AD has become a priority for healthcare systems. AIM The Atopic Dermatitis Quality of Care (ADQoC) initiative set out to describe good practices for addressing the challenges that impede the management of AD. METHODS The initiative carried out a literature review and surveyed 32 expert care centres, catalogued findings, and analysed and elucidated global challenges to AD care along with good practice implementations that can address them. RESULTS The four challenges to quality care for AD are: (i) misconceptions about AD; (ii) delayed referral and access to AD specialists; (iii) poor patient access to AD treatments and poor adherence to medications; and (iv) managing the complexity of AD and its comorbidities. The initiative highlighted 5 of 10 good practice implementations as high priority for any AD care centre to focus on: (i) clinical assessment and diagnosis; (ii) a structured multidisciplinary care team; (iii) monitoring and evaluating care quality; (iv) patient education and communication; and (v) collaboration and exchange with patient groups. CONCLUSION These implementations can provide benefits for patients, healthcare providers and the healthcare system. They directly contribute to the efficacy of treatment, improved healthcare provider efficiency, improved education for patients and healthcare providers, and improved costs to healthcare systems. The initiative was launched on https://atopicdermatitiscare.kpmg.co.uk/ to provide an easy-to-use educational platform.

Background Cancer patients are being exposed to antineoplastic drugs more frequently and for longer periods, resulting in a higher risk of hypersensitivity reactions. The aim of this study was to assess the pharmaceutical time and direct cost of drug allergy explorations following immediate hypersensitivity reactions to antineoplastic agents. Methods A micro-costing method was used to collect data on consumption of human and material resources for allergy exploration preparations. The monetisation was carried out on the basis of prices and hourly wage costs applied in 2018. The number and type of allergy explorations prepared by the pharmacy as well as nature of antineoplastic drugs tested, and the number of culprit drugs reintroductions were collected. Results Almost 1.5 h is required to realise allergy tests for one patient including pharmacist time for prescription analysis and pharmacy technician's time for tests preparation. The mean manufacturing cost of these tests is estimated at €62.87 (€57.82–65.49) per culprit drug for one patient. Programming patients according to culprit drugs tested allows rationalising healthcare provider time and increasing efficiency. From January 2010 to December 2018, 277 patients were tested and 490 allergy explorations were performed, corresponding to more than 5000 preparations. Mostly, the culprit drug could be reintroduced ( n = 383, 78.2%) allowing patients to receive the best possible treatment. Conclusion Management of hypersensitivity reactions is constantly progressing, as it contributes to improving patient care in oncology. This activity is time-consuming for the pharmacy team but allows patients with previous hypersensitivity reaction to continue effective treatment.

The cutaneous microbiota contributes to skin barrier function, ensuring effective protection against pathogens and contributing to the maintenance of epidermal integrity. Dysbiosis is frequently present in atopic dermatitis (AD), a chronic inflammatory disease associated with skin barrier defects. Dysbiosis is associated with reduced bacterial diversity and marked Staphylococcus aureus colonization, which is favoured in the case of certain local AD-specific properties such as reduced skin acidity, eased bacterial adhesion and decreased antimicrobial peptide production. Furthermore, S. aureus-associated skin dysbiosis, via the production of staphylococcal virulence factors, may also participate in the immunopathology of AD by altering the epidermal barrier and inducing an inflammatory response. However, there are currently no arguments for recommending screening for, and treatment of S. aureus-associated dysbiosis outside the setting of cutaneous superinfection. Nonetheless, modulation of the skin microbiota may hold promise for AD management. Here, we describe the relationships that exist between the skin microbiota and AD.

Human immunoglobulins are used for treating diverse inflammatory and autoimmune disorders. Eczema is an adverse event reported but poorly described.To describe the clinical presentation, severity, outcome, and therapeutic management of immunoglobulin-associated eczema.This retrospective and descriptive study included a query of the French national pharmacovigilance database, together with a national call for cases among dermatologists.We included 322 patients. Eczema occurred preferentially in men (78.9%) and in patients treated for neurological pathologies (76%). The clinical presentation consisted mainly of dyshidrosis (32.7%) and dry palmoplantar eczema (32.6%); 5% of cases exhibited erythroderma. Sixty-two percent of the eczema flares occurred after the first immunoglobulin course. Eczema was observed with 13 intravenous or subcutaneous immunoglobulin types and recurred in 84% of patients who maintained the same treatment and in 68% who switched the immunoglobulin type. After immunoglobulin discontinuation, 30% of patients still had persistent eczema.Retrospective study, with possible missing data or memory bias.Immunoglobulin-associated eczema occurred with all immunoglobulin types, preferentially in patients with neurologic diseases who required prolonged immunoglobulin treatment. Recurrence was frequent, even after switching the immunoglobulin type, which can lead to a challenging therapeutic situation when immunoglobulin maintenance is required.

Alcoholic chlorhexidine 2 % is recommended for the prevention of catheter infections. A retrospective study was conducted in a nutritional assistance unit in a cohort of patients with a long-term central venous route. The tolerance (number of skin reactions) and efficacy (number of infections/days of catheters) of this antiseptic used in repeated care in these patients were described.

Resume L’eczema de contact allergique (ECA) est une dermatose inflammatoire frequente. Il se definit comme une reaction d’hypersensibilite retardee induite suite au recrutement dans la peau de lymphocytes T (LT) specifiques d’antigenes chez des individus prealablement sensibilises. Les lesions d’eczema ont tendance se developper sur des zones prealablement atteintes et a s’aggraver au fil du temps. Cette observation clinique a conduit a s’interroger sur la contribution des lymphocytes T residents memoires (TRM) aux recidives et a la severite de l’ECA. Les TRM sont des LT memoires qui persistent a long terme dans les tissus peripheriques tels que la peau sans recirculer dans l’organisme. Bien que ces cellules assurent une surveillance immunitaire efficace contre les pathogenes, elles peuvent egalement participer au developpement et a l’aggravation de nombreuses maladies inflammatoires comme les allergies cutanees. Des travaux recents ont ainsi mis en evidence le role majeur des TRM dans la physiopathologie de l’ECA, en faisant une cible therapeutique potentielle. Cette revue se propose donc de decrire les caracteristiques generales des TRM et leur contribution dans l’ECA.

Dupilumab is a therapeutic antibody targeting IL-4 and IL-13 receptor subunit alpha used for the treatment of atopic dermatitis (AD) patients. Cases of psoriasis-like reactions induced under dupilumab treatment (DI-Pso) for AD were recently reported. To understand the pathogenesis of DI-Pso, we performed gene expression profiling studies on skin biopsies of DI-Pso (n=7) compared with plaque psoriasis (PSO), AD and healthy controls (HC) (n=4 each). Differential gene expression was performed using enrichment and gene ontology analysis. Gene expression was validated by qPCR and protein levels assessed by immunohistochemistry. Transcriptomic and protein analysis of DI-Pso compared with HC, PSO and AD skins revealed an activation of Th17/IL-23 pathways associated with a significant expression of IL-36, surrogate marker of pustular psoriasis (PP). By contrast, Th2 representative genes' expression were strongly decreased in DI-Pso across comparison. Matching analysis with public data of PP skin corroborated that DI-Pso and PP upstream regulators overlap, greater than with PSO. Furthermore, DI-Pso showed strongly decreased expression of many barrier skin genes compared with HC, PSO and AD. Our data indicate that pathogenesis of DI-Pso relied on a shift of skin immune responses from a Th2 to an IL-36 and Th17 polarization and on intensified skin barrier alterations.

Background: Insights into the real-world treatment paradigm and long-term burden of atopic dermatitis (AD) are needed to inform clinical and health policy decisions.Methods: The prospective, observational EUROSTAD study enrolled adults with moderate-to-severe AD starting or switching systemic therapy (51 sites in 10 European countries). We report the baseline characteristics, treatment patterns, and outcomes of these patients using descriptive statistics.Results: A 12-month enrollment period of EUROSTAD was completed and 308 patients were enrolled: average age 37 years, AD duration 25 years, 43% were female. Most patients reported use of systemic therapy (93%) and >= 1 atopic comorbidity (82%). Mean [standard deviation] disease severity/burden measures were high: Investigator's Global Assessment (3.1 [0.8]), Eczema Area and Severity Index (16.2 [10.9]), Peak Pruritus Numerical Rating Scale (5.5 [2.5]), sleep impairment Visual Analog Scale (49.8 [31.6]) scores, and time lost from work (4.1 [13.7] days/year) or usual activities (16.8 [38.7] days/year). Most patients showed borderline or clinical levels of anxiety (59%) and/or depression (63%) using the Hospital Anxiety and Depression Scale.Conclusions: Adults with moderate-to-severe AD starting/switching systemic treatment enrolled in EUROSTAD have a high burden of longstanding disease despite continuous use of topical drugs, emollients, and systemic therapies.

Resume Introduction Une majorite des adultes consultant pour une dermatite atopique (DA) presente une forme moderee a severe, alors qu’existent des consensus d’experts et de traitements efficaces. L’objectif de cette enquete etait d’evaluer les pratiques en soins primaires pour la prise en charge diagnostique et therapeutique de la DA de l’adulte. Methodes Une enquete de pratique a ete realisee a l’aide d’un questionnaire en ligne aupres de 2307 medecins generalistes (MG) francais de janvier a mars 2019. Resultats Les reponses de 200 MG ont ete analysees. Parmi eux, 63 % (n = 126) exprimaient des difficultes dans la prise en charge de la DA. Le diagnostic de DA etait facile pour 50 % (n = 101) des MG, avec une excellente connaissance des criteres diagnostiques de la DA. La prise en charge therapeutique comprenait les emollients en traitement de fond et les dermocorticoides (DC) pour les poussees pour 99 % (n = 198) des MG. Cependant, la prescription de DC etait : (i) reservee aux lesions severes dans 50 % des cas, (ii) de duree variable entre les MG, (iii) mal quantifiee, avec une meconnaissance de l’unite phalangette par 78 % des MG. L’inobservance aux DC etait rapportee comme etant la principale cause d’echec therapeutique dans 79 % des cas, alors meme que les conseils d’utilisation des DC semblaient discordants ou insuffisants. Conclusions Malgre une bonne connaissance theorique, des ameliorations sont necessaires dans la prise en charge pratique de la DA en soins primaires. Le developpement de fiches d’information pourrait ameliorer cette prise en charge.

Introduction Atopic dermatitis (AD) is a common inflammatory disease of the skin, which may have a substantial impact on patients' health-related quality of life (HRQoL). The aim of this study was to quantify the economic burden (direct and indirect costs) of moderate-to-severe AD and evaluate the prevalence and impact of psychosocial comorbidities among patients in the European Union-5 (France, Germany, Italy, Spain, and the UK). Methods Data were analyzed from the 2017 EU5 National Health and Wellness Survey. Respondents with a physician diagnosis of AD/eczema who were considered to have moderate-to-severe AD based on a Dermatology Life Quality Index (DLQI) score ≥ 6 were included. Direct costs, indirect costs, and psychosocial comorbidities (sleep difficulties and anxiety based on self-report, depression based on the Patient Health Questionnaire-9) were reported descriptively. Generalized linear models were used to examine the relationship between psychosocial comorbidities and health outcomes (the Short Form-36 version 2 [SF-36v2], EuroQoL 5-dimension 5-level, Work Productivity and Activity Impairment questionnaire, and healthcare resource utilization). Results Overall, 1014 patients were included in the analysis. Total annual direct costs ranged from €2242 to €6924 and total annual indirect costs ranged from €7277 to €14,236, depending on the level of disease severity. Sleep difficulties, anxiety, and depression were reported by 61.6%, 52.7%, and 75.8% of patients, respectively. These comorbidities were significantly associated with reduced physical and mental component summary scores from SF-36v2 and increased overall work impairment (p

Background Chronic venous disease (CVD) is secondary to venous hypertension, leading to vascular inflammation and tissue changes. The impact of CVD on skin structure and barrier function is not well characterized. Objective We aimed to assess the characteristics of skin alterations in mild-to-moderate CVD by non-invasive techniques based on a prospective exploratory study. Material & methods Female subjects (30-75 years) with CVD (Stage C2 to C4, CEAP classification) were eligible. Stage C0-C1 CVD subjects were used as controls. Women with leg surgery or a medical history that could impact the results were excluded. The skin changes on lesional (LS) and non-lesional (NLS) areas were assessed by biometric analysis including skin echography, viscoelasticity evaluation, confocal microscopy and trans epidermal water loss (TEWL) measurements. Results Thirty-four subjects were enrolled. Based on computation of 26 biometric parameters using Principal Component Analysis, a significant difference between LS and NLS zones, regardless of the CEAP class, was evidenced. C2-C4 subjects presented with dermal thickening suggesting oedema associated with decreased cell density, while no difference in skin viscoelasticity was observed compared to the C0-C1 control group. Epidermal structural modifications were associated with increased TEWL correlating with CVD severity. Conclusion Skin alterations in CVD patients are detectable by non-invasive methods. These findings may help to better assess new therapeutic strategies.

Background The therapeutic options in atopic dermatitis rely on consensus-based guidelines, also established for psoriasis and chronic urticaria. However, the therapeutic approach in atopic dermatitis, especially in the moderate-to-severe forms of the disease, seems less aggressive than in psoriasis and in chronic urticaria with a less frequent use of systemic agents. Objectives To compare in real-life conditions the therapeutic management of adults with atopic dermatitis with those with psoriasis and chronic urticaria. Methods A transversal analysis was performed in May 2017, using retrospective data from a monocentric database. Data on epidemiology, severity, therapeutic educational intervention and systemic treatments were analysed from 401 patients with atopic dermatitis, compared with data from 230 patients with chronic urticaria and 535 patients with psoriasis. Results A high proportion (73%) of atopic dermatitis patients presented with a moderate-to-severe form of the disease compared to only 39% of chronic urticaria and 17% of psoriasis patients. Most of atopic dermatitis patients (78%) had completed a therapeutic educational programme, while the adherence was lower in chronic urticaria (35%) and in psoriasis (3%) patients. A systemic treatment, including biologicals, was recorded in 8% of atopic dermatitis patients, while it concerned 26% and 47% of chronic urticaria and psoriasis patients, respectively. Conclusions We confirmed that atopic dermatitis treatment mostly relies on topical treatments. Only a minority of moderate-to-severe atopic dermatitis patients who are eligible for a systemic treatment receive such therapy. This may suggest promoting a more frequent use of systemic agents in moderate-to-severe atopic dermatitis.

Diagnosis of contact allergy (CA) to Amerchol L-101 (AL-101), a marker for lanolin allergy, is problematic. Positive patch test reactions are frequently doubtful or weakly positive and difficult to associate with clinical relevance.To gain further insight on the allergic or irritant nature of skin reactions induced by AL-101 patch test.We re-tested in a dose-response fashion, 10 subjects with AL-101 CA and performed comprehensive transcriptomic analysis (gene arrays, quantitative real-time polymerase chain reaction [qRT-PCR]) of samples of their skin reactions.Eight of the 10 CA subjects reacted positively upon re-test, whereas two did not react. Most of AL-101 positive patch tests expressed an allergy signature with strong activation of gene modules associated with adaptive immunity and downregulation of cornification pathway genes. In addition, the breadth of gene modulation correlated with the magnitude of patch test reactions and the concentration of AL-101 applied. However, we observed that some of the positive patch test reactions to AL-101 expressed no/few allergy biomarkers, suggesting the induction of an irritant skin inflammation in these samples.This study confirms that AL-101 is an allergen that can cause both contact allergy and contact irritation. Our results also highlight that molecular profiling might help to strengthen clinical diagnosis.

International audience

Epicutaneous immunotherapy (EPIT) protocols have recently been developed to restore tolerance in patients with food allergy. The mechanisms by which EPIT protocols promote desensitization rely on a profound immune deviation of pathogenic T- and B-cell responses.To date, little is known about the contribution of skin dendritic cells (skDCs) to T-cell remodeling and EPIT efficacy.We capitalized on a preclinical model of food allergy to ovalbumin (OVA) to characterize the phenotype and functions of OVAsup+/supskDCs throughout the course of EPIT.Our results showed that both Langerhans cells and dermal conventional cDC1 and cDC2 subsets retained their ability to capture OVA in the skin and to migrate toward the skin-draining lymph nodes during EPIT. However, their activation/maturation status was significantly impaired, as evidenced by the gradual and selective reduction of CD86, CD40, and OVA protein expression in respective subsets. Phenotypic changes during EPIT were also characterized by a progressive diversification of single-cell gene signatures within each DC subset. Interestingly, we observed that OVAsup+/supLangerhans cells progressively lost their capacity to prime CD4sup+/supTsubEFF/subcells, but gained regulatory T-cell stimulatory properties. In contrast, cDC1 were inefficient in priming CD4sup+/supTsubEFF/subcells or in reactivating TsubMEM/subcells in vitro, whereas cDC2 retained moderate stimulatory properties, and progressively biased type 2 immunity toward type 1 and type 17 responses.Our results therefore emphasize that the acquisition of distinct phenotypic and functional specializations by skDCs during EPIT is at the cornerstone of the desensitization process.

Introduction Le role des medicaments dans la survenue d’eruptions eczematiformes du sujet âge (EESA) a ete suggere dans une etude cas-temoin francaise montrant une frequence de prise des inhibiteurs calciques de 26 % chez les patients ayant une EESA (OR de 2,5 par rapport aux temoins sans eczema). Ces resultats ont ensuite ete confirmes par une etude retrospective americaine. Des cas isoles d’EESA ont depuis ete rapportes avec le clopidogrel, les IEC, les ARAII et les diuretiques. Notre etude initiale ayant ete realisee il y a 15 ans, nous en avons realise une nouvelle pour reevaluer l’association entre les prises medicamenteuses et les EESA. Materiel et methodes Cette etude retrospective a ete conduite dans 16 centres du GREAT, FISARD ou DAG de 2018 a 2020. Nous avons compare la frequence des 10 classes medicamenteuses les plus prescrites entre la population etudiee (patients de plus de 65 ans developpant un eczema chronique sans cause identifiee) et la population generale de reference du meme âge dont les donnees ont ete obtenues grâce a l’Echantillon Generaliste des Beneficiaires (EGB) issu de la base informatique de la Securite Sociale, apres standardisation indirecte sur le sexe et l’âge. Tous les patients inclus avaient des lesions eczematiformes etendues (plus de 20 % de la surface corporelle), depuis plus de 3 mois. Une biopsie cutanee evocatrice d’eczema devait avoir ete realisee ainsi qu’une immunofluorescence directe negative ou des anticorps BPAG 1 et 2 negatifs afin d’eliminer une pemphigoide au stade pre-bulleux. Les patients n’avaient pas d’antecedent de dermatite atopique dans l’enfance. Resultats Cent quatre vingt cinq patients (120 H et 65 F) d’âge moyen 79,5 ± 7,5 ans ont ete inclus. L’hypertension arterielle representait la comorbidite la plus frequente (69,7 % des patients). Les patients prenaient en moyenne 5,0 ± 3,2 medicaments. Les medicaments les plus frequemment prescrits etaient les inhibiteurs calciques (39,5 %), les statines (36,8 %), les antiagregants plaquettaires (31,9 %), les betabloquants (30,8 %), les ARA2 (29,2 %), les diuretiques thiazidiques (23,8 %), les IEC (22,7 %), les IPP (21,6 %), les diuretiques de l’anse (17,8 %) et les benzodiazepines (15,1 %). Un ou plusieurs medicaments etaient arretes chez 60 (32,4 %) patients. Parmi eux, 31 (51,7 %) ne presentaient plus de lesion a 6 mois. L’analyse comparative par rapport a l’EGB est en cours. Discussion Les caracteristiques des patients concordent avec celles observees dans notre etude precedente, en particulier la predominance masculine et la polymedication. La frequence de prise des inhibiteurs calciques (39,5 %) est encore plus elevee (× 1,5) que dans notre etude initiale confirmant le tres fort risque lie a cette classe medicamenteuse. La comparaison avec les donnees de l’EGB (analyse en cours avec resultats prevus prochainement) permettra peut-etre de mettre en evidence une association avec d’autres classes medicamenteuses.

International audience

Atopic dermatitis (AD) is frequently misdiagnosed and undertreated, resulting in increased morbidity. In 2019, the Atopic Dermatitis Quality of Care Initiative was launched globally to investigate barriers to AD care and note good practice interventions to improve care. The initiative included a literature review to define the challenges in AD and a survey of 32 AD centers to define good practice interventions. One topic studied was best practices for clinical assessment and diagnosis. The literature review revealed the primary gaps included difficulty differentiating AD from other skin disorders, diagnosing atypical AD, staging AD severity in individual patients, and delays in assessment and treatment due to referral time lag. The best clinical practices used by leading AD centers included the use of validated diagnostic criteria, established AD scoring tools including patient-reported outcome measures and electronic health records (EHR), the formation of multidisciplinary teams (MDTs), and improved communication between health care providers (HCPs) and patients. Most centers worked with patient advocacy groups and implemented educational programs for HCPs. AD centers are overcoming issues in AD care. Educating health care providers and the public, using screening surveys, using established guidelines, and communicating with MCTs and patients through EHRs are the most frequently used strategies.

Dupilumab, an anti-IL-4ɑ monoclonal antibody, has shown a positive benefit-risk ratio when treating moderate to severe atopic dermatitis (AD) in clinical studies (1). High persistence on dupilumab has recently been reported in clinical-practice setting with 77% of patients remaining in treatment for 12 months in a retrospective study including 1,963 patients with AD but reasons for discontinuation were not investigated (2).

Purpose of review We bring updated knowledge on tissue-resident memory T cells (TRM), underlining their major role in the recurrence and the severity of allergic contact dermatitis (ACD). Recent findings ACD is a frequently encountered skin disease. It is defined as a delayed-type hypersensitivity reaction initiated by the recruitment of antigen-specific T cells into the skin of sensitized patients. ACD lesions tend to develop on already-exposed areas and worsen over time. That clinical observation has raised questions on the contribution of TRM to ACD recurrence and severity. TRM are memory T cells that persist in peripheral tissues, such as the skin, without recirculating through the blood. These cells provide effective immune memory against pathogens, but they may also participate in the development or exacerbation of numerous inflammatory diseases, including skin allergies. Recent works have demonstrated a major role for TRM in ACD pathophysiology. Summary In ACD, TRM accumulate preferentially at the allergen contact site during the sensitization phase. Thereafter, these cells cause a rapid and intense response to any new allergen exposure. They also play a key role in flare-ups of ACD and the chronicity and severity of the disease. These aspects suggest that TRM may have an interest as therapeutic targets.

Background Pivotal phase III studies demonstrated that abrocitinib, an oral, once-daily, JAK1-selective inhibitor, is effective treatment for moderate-to-severe atopic dermatitis (AD) as monotherapy and in combination with topical therapy. Objective The aim of this study was to evaluate the long-term safety of abrocitinib 200 mg and 100 mg in an integrated analysis of a phase IIb study, four phase III studies, and one long-term extension study. Methods Two cohorts were analyzed: a placebo-controlled cohort from 12- to 16-week studies and an all-abrocitinib cohort including patients who received one or more abrocitinib doses. Adverse events (AEs) of interest and laboratory data are reported. Results Total exposure in the all-abrocitinib cohort (n = 2856) was 1614 patient-years (PY); exposure was ≥ 24 weeks in 1248 patients and ≥ 48 weeks in 606 (maximum 108 weeks). In the placebo-controlled cohort (n = 1540), dose-related AEs (200 mg, 100 mg, placebo) were nausea (14.6%, 6.1%, 2.0%), headache (7.8%, 5.9%, 3.5%), and acne (4.7%, 1.6%, 0%). Platelet count was reduced transiently in a dose-dependent manner; 2/2718 patients (200-mg group) had confirmed platelet counts of < 50 × 103/mm3 at week 4. Incidence rates (IRs) were 2.33/100PY and 2.65/100 PY for serious infection, 4.34/100PY and 2.04/100PY for herpes zoster, and 11.83/100PY and 8.73/100PY for herpes simplex in the 200-mg and 100-mg groups, respectively. IRs for nonmelanoma skin cancer, other malignancies, and major adverse cardiovascular events were < 0.5/100PY for both doses. Five venous thromboembolism events occurred (IR 0.30/100PY), all in the 200-mg group. There were three deaths due to gastric carcinoma (diagnosed at day 43), sudden death, and COVID-19. Conclusion Abrocitinib, with proper patient and dose selection, has a manageable tolerability and longer-term safety profile appropriate for long-term use in patients with moderate-to-severe AD. Trial Registries ClinicalTrials.gov: NCT02780167, NCT03349060, NCT03575871, NCT03720470, NCT03627767, NCT03422822. Supplementary Information The online version contains supplementary material available at 10.1007/s40257-021-00618-3.

Background Atopic dermatitis (AD) is a chronic, inflammatory skin disease that affects as many as 12.5% of children aged 0-17 years and 3% of the adult population. In the United States, 31.6 million children and adults are estimated to be living with AD. Objective Therapeutic patient education (TPE) has proven its value in the management of chronic diseases for which adherence to therapy is suboptimal. This article explores experts' opinions and treatment practices to determine if TPE is a recommended and effective method for treating AD. Methods Forty-two (51%) of 82 Councilors and Associates of the International Eczema Council (IEC), an international group with expertise in AD, responded to an electronic survey on TPE and AD. Results Most respondents (97.5%) agreed that TPE should play an important role in the management of AD. Many respondents (82.9%) believed that all patients with AD, regardless of disease severity, could benefit from TPE. Limitations The International Eczema Council survey lacks specific information on AD severity. Conclusions Publications have shown the positive effect of TPE on the course of the disease, the prevention of complications, and the autonomy and quality of patient life. Survey respondents agreed that TPE can improve the quality of patient care and patient satisfaction with care.