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Atopic Dermatitis in the Era of Precision Medicine

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dermatology".

Deadline for manuscript submissions: closed (25 September 2024) | Viewed by 16046

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Special Issue Editors

Dr. Elena Pezzolo

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Guest Editor

1. Department of Dermatology, San Bortolo Hospital, Vicenza, Italy
2. Study Center of the Italian Group for Epidemiologic Research in Dermatology (GISED), Bergamo, Italy
Interests: dermatology; psoriasis; atopic dermatitis; skin; keratinocytes; clinical dermatology; skin cancer; epidemiology
Special Issues, Collections and Topics in MDPI journals

Dr. Paolo Gisondi

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Guest Editor

Associate Professor, Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
Interests: psoriasis; psoriatic arthritis; atopic dermatitis; metabolic syndrome; vitamin D; alopecia areata; autoimmune bullous diseases; hidradenitis suppurativa; biologic therapy; urticaria
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Atopic dermatitis (AD) is a complex and highly heterogeneous inflammatory skin disease. The complexity of the underlying pathogenetic mechanisms explains the wide spectrum of clinical manifestations, as regards the age of onset, natural history, ethnicity, severity, comorbidities, and therapeutic response. Advances in recent years have also highlighted the role of the skin microbiome, neuro-immunological signals, and epigenetic regulation in the modulation of AD. Hence, there is a need for a comprehensive picture of AD with all its multiple facets as the background for precision medicine. Moreover, the recent introduction of novel targeted therapies for AD has driven the need for patient stratification, based on immunologic biomarkers as potential tools in the movement toward a personalized medicine.

This Special Issue is open for submissions of papers that aim to bring together the most relevant scientific research on AD, focusing on new validated biomarkers with the aim of stratifying AD into more homogeneous subgroups and on the responding AD populations in the development of present and forthcoming biologicals, small molecules, and specific immunotherapy regimens. Precision medicine will help select treatment responders, risk prediction, and the best disease-modifying strategies for each patient.

Dr. Elena Pezzolo
Dr. Paolo Gisondi
Guest Editors

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Keywords

atopic dermatitis
biologics
biomarkers
pathogenesis
precision medicine
target therapies
treatment
small molecules

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Published Papers (6 papers)

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Research

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13 pages, 9610 KiB

Open AccessArticle

Efficacy and Safety of Dupilumab in the Treatment of Hand Eczema: A Retrospective Study

by Claudia Paganini, Virginia Maffei, Laura Vellucci, Marina Talamonti, Alessandra Petruzzellis, Lorenzo Le Pera, Cosimo Di Raimondo, Luca Bianchi and Marco Galluzzo

J. Clin. Med. 2024, 13(7), 1876; https://doi.org/10.3390/jcm13071876 - 24 Mar 2024

Viewed by 1683

Abstract

Background: Hand eczema (HE) is a prevalent chronic condition that exerts a substantial and enduring adverse effect on quality of life (QoL) and imposes an economic burden on society. Managing HE poses challenges due to the limited effectiveness and potential adverse effects associated with many currently available topical and systemic treatments. Methods: This article examines twenty-one patients affected by HE treated with dupilumab, a fully human monoclonal antibody targeting interleukin IL-4 and IL-13 signaling. This involves a retrospective descriptive statistical analysis. Results: At week 6, HECSI-75 was achieved by 12 patients (57.9%). The proportion of patients meeting the HECSI-75 criteria steadily increased over the observation weeks, reaching 90% at week 16 and 100% at week 104. Furthermore, HECSI-90 and HECSI-100 were achieved by 75% and 60% of patients at week 16 and by 100% and 85% of patients at week 68, respectively. All patients who reached week 104 maintained complete disease remission according to HECSI 100. Conclusions: In all patients, dupilumab was shown to be an effective drug in achieving disease clearance, as indicated by all the parameters considered at each evaluation point (Week 6, Week 16, Week 32, Week 52, Week 68, Week 84, and Week 104), in comparison to the initial baseline. Full article

(This article belongs to the Special Issue Atopic Dermatitis in the Era of Precision Medicine)

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11 pages, 243 KiB

Open AccessArticle

The Burden of Pediatric Atopic Dermatitis: Quality of Life of Patients and Their Families

by Inga Kisieliene, Antanas Mainelis, Odilija Rudzeviciene, Matilda Bylaite-Bucinskiene and Andreas Wollenberg

J. Clin. Med. 2024, 13(6), 1700; https://doi.org/10.3390/jcm13061700 - 15 Mar 2024

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Abstract

(1) Background: Atopic dermatitis (AD) is one of the most common inflammatory skin conditions, thus having a significant impact on the quality of life (QoL) of patients and their families. We performed a survey to gather more data to help describe the burden of AD in Lithuania and to help expand the treatment plan to this important aspect of the disease. (2) Methods: A cross-sectional study was conducted involving healthy and AD pediatric patients. The assessment instruments used were the Patient-Oriented Eczema Measure (POEM), QoL, and original questionnaires (the original questionnaire was designed by the authors to determine the demographics, medical history, and treatment methods of the respondents). (3) Results: This study included 302 participants in total: 247 AD patients (51% boys) and 55 non-AD patients (51% boys). The mean age for AD patients was 6.8 ± 4.4. years, and this was 10.5 ± 3.1 years for the control patients. A significant difference was found between the QoL questionnaire scores and the Family Dermatology Life Quality Index (FDLQI) score for the atopic dermatitis group (QoL: 6.3 ± 5.6; FDLQI: 7.1 ± 6.9) and controls (QoL 0.5 ± 1.1; FDLQI 2.1 ± 5.9) (p = 0.000). The mean QoL questionnaire score for severe AD was 14.3 ± 6.2 (very large effect), that for moderate AD was 6.9 ± 4.4 (moderate effect), and that for mild AD was 4.4 ± 4.2 (small effect) (p = 0.000). (4) Conclusions: Our study revealed a moderate effect of AD on dermatology-related QoL in patients and their families. It has been shown that increased disease severity was associated with a greater impairment of QoL in both patients and patient’s parents. The burden of AD in children and their parents is considerable and should be taken into account in the management of atopic dermatitis. Full article

(This article belongs to the Special Issue Atopic Dermatitis in the Era of Precision Medicine)

12 pages, 3694 KiB

Open AccessArticle

Dupilumab for Treatment of Prurigo Nodularis: Real-Life Effectiveness for up to 84 Weeks

by Claudia Paganini, Marina Talamonti, Virginia Maffei, Cosimo Di Raimondo, Luca Bianchi and Marco Galluzzo

J. Clin. Med. 2024, 13(3), 878; https://doi.org/10.3390/jcm13030878 - 2 Feb 2024

Viewed by 4256

Abstract

(1) Background: Prurigo nodularis (PN) is a persistent and inflammatory dermatological condition characterized by chronic itching and the formation of hardened nodules, significantly impacting the affected individuals’ quality of life and psychological well-being. The management of PN poses challenges due to the limited efficacy and undesirable side effects associated with current interventions. (2) Methods: This article examines sixteen patients affected by PN treated with dupilumab, a fully human monoclonal antibody targeting interleukin IL-4 and IL-13 signaling. This involves a retrospective descriptive statistical analysis. (3) Results and (4) Conclusions: In all patients, dupilumab proves to be an effective drug in achieving disease clearance, as indicated by all the parameters considered as assessed by both physicians and patients at each evaluation point (Week 6, Week 16, Week 32, Week 52, Week 68, and Week 84), in comparison to the initial baseline. Full article

(This article belongs to the Special Issue Atopic Dermatitis in the Era of Precision Medicine)

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11 pages, 706 KiB

Open AccessArticle

Predictive Factors of Early Response to Dupilumab in Patients with Moderate-to-Severe Atopic Dermatitis

by Silvia Ferrucci, Giovanni Casazza, Martina Zussino, Simona Tavecchio, Angelo V. Marzano and Micol Tedeschi

J. Clin. Med. 2023, 12(20), 6575; https://doi.org/10.3390/jcm12206575 - 17 Oct 2023

Cited by 2 | Viewed by 3069

Abstract

Efforts have been made to identify factors influencing clinical response in patients with atopic dermatitis (AD) treated with dupilumab. A retrospective single-center observational study was carried out by analyzing data from 492 patients aged 12 years and older with moderate-to-severe AD. The study aimed to identify baseline demographic and clinical factors that could predict the achievement of a mild level of disease, i.e., an Eczema Area and Severity Index (EASI) ≤ 7, within 4 weeks from dupilumab initiation. Classic, generalized lichenoid and inflammatory phenotypes compared with a nummular eczema phenotype (OR = 6.9, 95% CI 2.04–23.48 and OR = 4.22, 95% CI 1.22–14.66, respectively) and a baseline EASI ≤ 24 and between 24–29, compared with a baseline EASI ≥ 29 (OR = 3.1, 95% CI 1.81–5.41 and OR = 1.8, 95% CI 1.05–3.07, respectively), were found to be predictive factors of early response to dupilumab, highlighting the importance of early biological treatment of AD. Full article

(This article belongs to the Special Issue Atopic Dermatitis in the Era of Precision Medicine)

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9 pages, 540 KiB

Open AccessArticle

Prevalence of Non-Alcoholic Fatty Liver Disease in Adult Individuals with Moderate-to-Severe Atopic Dermatitis

by Martina Maurelli, Paolo Gisondi, Francesco Bellinato, Alessandro Mantovani, Giovanni Targher and Giampiero Girolomoni

J. Clin. Med. 2023, 12(18), 6057; https://doi.org/10.3390/jcm12186057 - 19 Sep 2023

Viewed by 1456

Abstract

Background: There are no published studies on the prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with atopic dermatitis (AD). Objectives: To estimate the prevalence of NAFLD (assessed via liver ultrasonography) in adults with moderate-to-severe AD. Methods: We performed a retrospective, cross-sectional, observational study including adult patients affected by moderate-to-severe AD, moderate-to-severe chronic plaque psoriasis, or a previous diagnosis of thin melanoma in situ (considered as the control group) who attended the Verona University Hospital between January 2022 and April 2023. Fatty liver was assessed via liver ultrasonography. Results: A total of 144 adults with AD, 466 with chronic plaque psoriasis, and 99 with thin melanoma were included. The prevalence rates of ultrasound-detected NAFLD among patients with in situ melanoma, those with moderate-to-severe AD, and those with moderate-to-severe chronic plaque psoriasis were 23.2% (23 out of 99), 24.1% (36 out of 144), and 49.8% (228 out of 466), respectively (p < 0.01). Logistic regression analysis revealed that being of male sex, a higher age, a higher body mass index, and psoriasis were independently associated with NAFLD, whereas AD was not. Conclusions: Our findings show that the prevalence of ultrasound-detected NAFLD in patients with moderate-to-severe AD was comparable to that of patients with a previous diagnosis of in situ melanoma. It is plausible to hypothesize that the Th2-type inflammation typically characterizing AD is not a risk factor for NAFLD. Patients with moderate-to-severe psoriasis, but not those with AD, should be screened for NAFLD and other metabolic comorbidities. Full article

(This article belongs to the Special Issue Atopic Dermatitis in the Era of Precision Medicine)

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Review

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14 pages, 838 KiB

Open AccessReview

“De Novo” Psoriasis and Relapse of Psoriasis Induced by Dupilumab: Three New Cases and Review of the Literature

by Ilaria Trave, Ilaria Salvi, Martina Burlando, Emanuele Cozzani and Aurora Parodi

J. Clin. Med. 2023, 12(19), 6291; https://doi.org/10.3390/jcm12196291 - 29 Sep 2023

Cited by 6 | Viewed by 3458

Abstract

Atopic dermatitis and psoriasis are traditionally considered diseases that cannot coexist, since they are described as the result of the activation of opposing inflammatory pathways. However, this belief has been debunked, and numerous cases of psoriasis induced by dupilumab, a biologic treatment for atopic dermatitis, have been reported. We report three cases of dupilumab-induced psoriasis and we present a literature review including cases of “de novo” psoriasis and of the relapse of psoriasis that occurred during treatment with dupilumab. In total, 39 publications met the inclusion criteria, including 112 AD patients, 101 of whom developed “de novo” psoriasis, and 11 with a flare of pre-existent psoriasis. In the first group, patients more frequently developed plaque psoriasis on the scalp and extremities, after an average latency period from the initiation of dupilumab of 5 months. In the second group, the incidence of dupilumab-induced relapses of psoriasis was 43%, after an average of 4 months since the first administration. The most common psoriasis type was plaque psoriasis, with the involvement of the scalp and upper extremities. Dupilumab was interrupted in 38% of patients with “de novo” psoriasis and in 50% of relapsed patients, leading, in most cases, to an improvement of psoriasis. In conclusion, atopic dermatitis and psoriasis can definitely co-exist, and biologic drugs used to treat the former can promote the latter. It is thus crucial to perform a careful personal and familiar anamnesis before prescribing any biologic treatment. Moreover, a study of cytokine expression and blood proteomic markers could be considered in these patients. Full article

(This article belongs to the Special Issue Atopic Dermatitis in the Era of Precision Medicine)

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