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Marie Bosslett is the assistant editor of 

 and joined the MJH Life Sciences team in October 2024. She attended Loyola University Maryland in Baltimore and earned a Bachelor of Arts in Communication with minors in marketing and writing. When she’s not writing, Marie enjoys going to concerts, reading on the beach, and spending time with friends and family.

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The JAK inhibitor was significantly superior in all safety and efficacy endpoints, when compared to other AA treatment options.

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and joined the MJH Life Sciences team in February 2023. She attended Kent State University and earned a Bachelor of Science degree in journalism with minors in public relations and creative writing. She enjoys making and listening to music, reading, and spending time with her cats, Astrid and Marceline.

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Maddi Hebebrand is an associate editor of 

and joined the MJH Life Sciences team in May 2024. She attended Baldwin Wallace University, studying Media Production and Film, and is now finishing her Masters in Digital Media through Ohio University. When she's not writing, Maddi loves to read, attend concerts and spend time with her family.

According to the company, comparative tests revealed PN-881 surpasses or matches the efficacy of current injectable IL-17 therapies.

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Final Thoughts: The Importance of Comparative Studies in AD

Panelists offer concluding insights and emphasize the critical role of comparative studies in advancing atopic dermatitis treatment strategies.

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Dermatology Times Case-Based Peer Perspective

“Atopic Dermatitis in Practice: Case Studies From Diagnosis to Treatment,”

 Andrea Rosik, MS, PA-C, provided insights into managing atopic dermatitis (AD). Rosik, a dermatology physician assistant practicing at Hamzavi Dermatology in Shelby Township, Michigan, assessed 2 patient case studies to offer clinical advice for challenging AD cases.

Case 1: Psoriasis in a Woman With a Complex History

Rosik presented the case of a White woman aged 70 years with a history of hypertension, acid reflux, hypothyroidism, and psoriasis. The patient reported a diffuse rash following a COVID-19 infection, with symptoms affecting her scalp, face, extremities, and torso.

“She was complaining of some itching, flaking, scaling, and redness,” Rosik said. “She had a worsening of her skin condition, especially after an illness such as COVID-19.”

However, the roundtable attendees considered differential diagnoses, including an eczematous process, contact dermatitis, or a psoriasiform drug eruption. A biopsy was performed, revealing psoriasiform spongiotic dermatitis. This result prompted the group to discuss various interpretations of the biopsy findings, concluding that psoriasis, drug eruptions, or contact dermatitis could all be plausible.

The patient’s initial treatments included salicylic acid shampoo and topical steroids, which provided little relief. In frustration, she returned to the clinic, where Rosik and her team prescribed vitamin D analogues, topical calcineurin inhibitors, and topical steroids. Given her persistent symptoms, she was eventually started on an IL-23 inhibitor.

“Upon discussion with the group, the group had [concluded] that many of us providers would suggest alternativ treatment options for this patient. In-office samples were helpful, in this case, to start patients on medication after all the appropriate testing is performed and to get the patient on a drug while insurance approval is taking place,” Rosik said.

The patient saw some improvement but continued to experience a persistent rash. Rosik noted the patient’s frustration and ongoing symptoms, prompting further discussions about treatment approaches.

“When she was back in Michigan, she said her rash wasn’t completely resolved. She was still itching. She still had that scaling on her scalp, face, and extremities, and she was not completely clear,” Rosik said. “We had reviewed her biopsy results...and therefore, we had started her on dupilumab, which resulted in significant skin clearance.”

Despite the improvement, the patient returned with a small, itchy patch on her arm, and Rosik’s team provided samples of ruxolitinib cream, which helped address her flare-ups. The team also considered her complaint of joint pain and temporarily paused her dupilumab therapy to assess whether it was contributing to the symptoms.

Case 2: Chronic Atopic Dermatitis in a Man

The second case focused on a White man aged 37 years with a long history of asthma and AD. The patient reported a recurring rash that worsened over time. He had tried various treatments, including topical steroids, tacrolimus, and phototherapy, but struggled with managing his condition due to his work schedule.

The patient had been on dupilumab since 2018, which improved his quality of life, but he continued to experience flare-ups, particularly when sweating. At his follow-up visit, the patient expressed satisfaction with the improvement in his skin after using ruxolitinib cream. This outcome led to a broader group discussion about the benefits of nonsteroidal alternatives for patients who struggle with itching and topical steroid overuse.

“It was discussed that sweating also fits into atopic dermatitis,” Rosik noted. “At the patient’s follow-up visit, he was stating that his skin was much improved, and he really liked the ruxolitinib cream, and it significantly cleared up his skin and especially helped with any itching.”

The roundtable discussion concluded that ruxolitinib cream would be a beneficial alternative for this patient, particularly in addressing flare-ups. Rosik emphasized that nonsteroidal treatments like ruxolitinib are effective, well tolerated, and valuable for patients with sensitive skin.

Andrea Rosik, MS, PA-C, shared insights on managing atopic dermatitis (AD) through two patient case studies. The first case involved a 70-year-old woman with psoriasis exacerbated by COVID-19, initially treated with topical therapies and later with dupilumab and ruxolitinib cream. The second case featured a 37-year-old man with chronic AD and asthma, who found relief with dupilumab and ruxolitinib cream, especially for flare-ups related to sweating. The discussions highlighted the effectiveness of nonsteroidal treatments like ruxolitinib for patients with sensitive skin.

Andrea Rosik, MS, PA-C, provides insights into managing challenging cases of atopic dermatitis. 

Exploring the Atopic Dermatitis Treatment Paradigm and Challenging Cases: Part 2

Alitretinoin Versus Phototherapy as the First-Line Treatment in Adults with Severe Chronic Hand Eczema: the ALPHA RCT

 compared the speed and efficacy of oral alitretinoin versus ultraviolet light therapy when treating adults with chronic hand eczema. Wittmann et alfound that alitretinoin was convenient, cost-effective, and led to more rapid improvement after 23 weeks. The study included 441 participants who had severe unresponsive CHE even after topical corticosteroid treatment. After 12 weeks, hand eczema symptoms improved for both groups of patients but improved most for those who took alitretinoin, with an estimated fold change of 0.66 (0.52, 0.82), p = 0.0003. With alitretinoin, 27.6% of patients were clear or almost clear while 23.6% of patients using UV therapy had the same results. Additionally, both groups had a lower median HECSI score. The investigators noted that more research is needed to address the long-term benefits of both treatments.

Development and Validation of a Patient-Reported Outcome Measure of the Impact of Chronic Hand Eczema on Health-Related Quality of Life: the Hand Eczema Impact Scale (HEIS)

Weisshaar et al developed a new, 9-item, patient-reported outcome measure that is specific to patients with CHE. The Hand Eczema Impact Scale (HEIS) aims to accurately capture the impact of CHE on individuals’ daily lives and track aspects such as physical function and emotional well-being. The development consisted of qualitative interviews with 20 participants combined with the results from a phase 2b trial of 258 patients (

). Inter-item correlations (all > 0.50) and confirmatory factor analysis (factor loadings ≥ 0.80) supported unidimensionality of the HEIS score, and mostly provided support for the HEIS Proximal Daily Activity Limitations (PDAL) score. Other psychometric testing such as internal consistency (Cronbach's alpha ≥ 0.89) and test-retest reliability showed strong results (intra-class correlation coefficient ≥ 0.79). These findings show correlations with other quality-of-life measures, validating the performance and reliability of HEIS. The study authors confirm that HEIS can be used in clinical trials and further research to assess the effectiveness of CHE treatments.

Risk Factors that Limit Use of Oral JAK Inhibitors in Chronic Hand Eczema: Findings from the Danish Skin Cohort

The Danish Skin Cohort‘s recent study analyzed which black-box warnings can apply to patients of CHE using off-label JAK inhibitors. The investigators found that most patients have risk factors that can impact the safety of JAKi use for CHE treatment. 941 adults with CHE were examined for 12 months. Data was collected through register linkage and patient interviews. Of these participants, 81.6% had at least 1risk factor that could potentially impact the use of oral JAKi. The most common risk factors were heavy smoking (current or former), obesity, hypercholesterolemia, and hypertension. Among patients who did not have any risk factors at baseline, 20.2% developed 1 or more risk factors during the study. Andersen et al addressed the limitation that certain risk factors may be unreported. Nonetheless, clinicians should properly assess these risk factors when selecting CHE treatment options.

Th1 and Th2 Cytokine Expression in Hyperkeratotic Chronic Hand Eczema and the Role of Tofacitinib a Oral JAK Inhibitor

Sardana et al assessed the efficacy of oral tofacitinib while analyzing the tissue cytokines of Th1 and Th2 in patients with CHE. Tofacitinib targets both Th1 and Th2 cell lines and was found to be effective in reducing symptoms of CHE. A total of 21 patients were involved in the trial. All had used one or more other treatment options including topical corticosteroids, methotrexate, and acitretin. Lesional and non-lesional tissue samples were assessed before tofacitinib (5 mg) was prescribed twice daily. Both cytokines were much more elevated in the affected skin, showing that these immune responses are involved in disease progression. More specifically, there was an upregulation of IL-4 [n = 5/11, 1.87-fold increase], TNF-α (n = 5/11, 5.13-fold) and IFN-γ (n = 6/11, 1.98-fold) as compared to uninvolved skin. The average Hand Eczema Severity Index score was 90 at 4 weeks. Adverse effects were observed in 4 patients while 3 patients experienced a relapse in CHE symptoms 7 months after discontinuing tofacitinib. Overall, the study authors verified that tofacitinib was very effective in patients with predominant tissue Th1/Th2 cells related cytokine expression.

What new studies have you published? Share with us by emailing 

1. Wittmann M, Smith IL, Brown ST, et al. Alitretinoin versus phototherapy as the first-line treatment in adults with severe chronic hand eczema: the ALPHA RCT. 

 2024;28(59):1-123. doi:10.3310/TWQC0141

2. Weisshaar E, Yüksel YT, Agner T, et al. Development and Validation of a Patient-Reported Outcome Measure of the Impact of Chronic Hand Eczema on Health-Related Quality of Life: the Hand Eczema Impact Scale (HEIS). 

. Published online October 21, 2024. doi:10.1007/s13555-024-01267-0

3. Andersen YMF, Sieborg J, Nymand L, et al. Risk factors that limit use of oral JAK inhibitors in chronic hand eczema: Findings from the Danish Skin Cohort. 

 2024;17:61-66. Published 2024 Sep 2. doi:10.1016/j.jdin.2024.08.006

4. Sardana K, Sharath S, Khurana A, et al. Th1 and Th2 cytokine expression in hyperkeratotic chronic hand eczema and the role of Tofacitinib a oral JAK inhibitor.

 2024;316(10):682. Published 2024 Oct 14. doi:10.1007/s00403-024-03438-7

The ALPHA study demonstrated that oral alitretinoin is more effective and faster than phototherapy for treating severe chronic hand eczema (CHE). The Hand Eczema Impact Scale (HEIS) was developed to assess CHE's impact on quality of life. The Danish Skin Cohort identified risk factors limiting the use of JAK inhibitors in CHE treatment. Tofacitinib, a JAK inhibitor, was effective in reducing CHE symptoms by targeting Th1 and Th2 cytokines. These studies highlight advancements in understanding and treating CHE, emphasizing the need for personalized treatment approaches.

This review of the latest dermatologic studies includes discussions on the development of the Hand Eczema Impact Scale, the role of tofacitinib on Th1 and Th2 cytokines, and more.

Journal Digest: October 25

 that it has presented new data on the prevalence, severity, and treatment of chronic hand eczema at the European Society of Contact Dermatitis Congress in Dresden, Germany, this week.

In total, 4 posters were presented related to the multinational Chronic Hand Eczema epidemiology, Care, and Knowledge of real-life burden, or CHECK, study. Additionally, 1 poster and 3 encore posters were presented related to the Real-World trEatment & mAnagement of chronic hand eczema in cLinical practice, or RWEAL, study involving physician-reported outcomes.

The CHECK study involved more than 60,000 adult participants from Canada and several European nations, including France, Germany, Italy, Spain, and the UK. The subsequent RWEAL study validated the findings of the CHECK study, with nearly 300 physicians (n=292) and a medical chart review of almost 2,000 (n=1,939) patients, all of whom were from the same nations as described in the CHECK study.

Among the posters related to the CHECK study, researchers reported a total of 5.6% of study participants self-reporting chronic hand eczema within the past year, and a total of 4.7% of participants reporting a physician diagnosis within the same time frame.

Furthermore, an estimated 1 in 5 patients reported an attribution of their condition to their occupation, with 1 in 3 individuals attributing their chronic hand eczema to household or leisure activities.

 Among patients whose chronic hand eczema had been diagnosed with a physician, researchers noted persistent symptoms regardless of ongoing treatment or therapy.

RWEAL data further supported these findings, with 1 in 4 patients with moderate to severe chronic hand eczema reporting progression from topical corticosteroid use to phototherapy or systemic modalities.

Recent research into perceptions of topical corticosteroids has pointed toward an underlying fear or phobia of corticosteroid use among patients with chronic hand eczema. The research, published in the 

Journal of the American Academy of Dermatology

, reported a notable percentage of patients believing these medications enter the bloodstream and damage the skin. Concerns about long-term health effects were common, particularly among those with severe conditions.

"It is a privilege to present the results from the largest real-world studies LEO Pharma has ever completed," said Kreesten Meldgaard Madsen, chief development officer of LEO Pharma, in a news release.

"Our findings from the CHECK study are supported by the physician-reported outcomes of the RWEAL study and for the first time at this scale, the data from both studies can show the needs among people living with this debilitating disease, and the immense impact it can have on quality of life."

The CHECK and RWEAL study findings add to the body of research describing unmet needs in chronic hand eczema treatment, with researchers describing their influence.

"The heavy burden of chronic hand eczema is well understood but prevalence has been historically understudied in the general population," said Sonja Molin, MD, chair of the Division of Dermatology at Queen’s University and lead study author.

"Large-scale, multinational studies like CHECK provide powerful insights to help us better understand this debilitating disease."

LEO Pharma presents data from the largest-ever multinational real-world studies of chronic hand eczema (CHE) in adults at the ESCD 2024 Congress. News release. LEO Pharma. September 5, 2024. Accessed September 5, 2024. 

https://www.leo-pharma.com/media-center/news/2024-leo-pharma-presents-data-from-the-largest-ever-multinational-real-world-studies

Apfelbacher C, Bewley A, Molin S, et al. Prevalence of Chronic Hand Eczema in adults: A cross-sectional multi-national study of 60,000 respondents in the general population. Presented at the 2024 European Society of Contact Dermatitis (ESCD) congress; September 04-07 2024; Dresden, Germany. Poster presentation #3

Crepy MN, Molin S, Gimenez-Arnau AM, et al. Exploring the relationship between Chronic Hand Eczema occupation, and household/leisure activities. Presented at the 2024 European Society of Contact Dermatitis (ESCD) congress; September 04-07 2024; Dresden, Germany. Poster presentation #19

Gimenez-Arnau AM, Bewley A, Apfelbacher C, et al. Physician-reported treatment patterns in Chronic Hand Eczema – results from the multinational RWEAL medical chart review. Presented at the 2024 European Society of Contact Dermatitis (ESCD) congress; September 04-07 2024; Dresden, Germany. Poster presentation #27

Christensen MO, Sieborg J, Nymand LK, et al. Prevalence and clinical impact of topical corticosteroid phobia among patients with chronic hand eczema – findings from the Danish skin cohort. 

 August 2024. doi:10.1016/j.jaad.2024.07.1503

LEO Pharma presented significant data on chronic hand eczema at the European Society of Contact Dermatitis Congress. The CHECK study, involving over 60,000 participants, revealed a 5.6% self-reported prevalence and 4.7% physician-diagnosed cases. The RWEAL study, with nearly 300 physicians and 2,000 patients, confirmed these findings, highlighting persistent symptoms despite treatment. Occupational and leisure activities were major contributors. Concerns about corticosteroid use were prevalent. These studies underscore the unmet needs and quality of life impact in chronic hand eczema management.

The data was presented at the European Society of Contact Dermatitis in Dresden, Germany, this week.

LEO Pharma Presents Prevalence, Severity, and Treatment CHECK Data for Chronic Hand Eczema

Telehealth and Research Strides for Young Patients

Video content above is prompted by the following:

How do you see advancements in telemedicine or digital health tools aiding in the management and follow-up care of pediatric vitiligo patients?

In terms of future treatments, what emerging research might focus on halting or slowing the progression of the disease?

Advancements in telemedicine and digital health tools are significantly enhancing the management and follow-up care of pediatric vitiligo patients. These technologies facilitate remote consultations, enabling continuous monitoring and timely interventions without the need for frequent in-person visits. Emerging research in vitiligo treatment is focusing on understanding the disease's pathogenesis to develop therapies that can halt or slow its progression. This includes exploring the role of immune modulation, genetic factors, and novel drug targets. Such innovations promise to improve patient outcomes and quality of life for those affected by vitiligo.

Lisa Swanson, MD, discusses how telemedicine and digital health tools can aid in the management and follow-up care of pediatric patients with vitiligo by enabling remote monitoring, improving access to specialists, and facilitating patient engagement, while emerging research into vitiligo treatments may focus on developing therapies to halt or slow the progression of this autoimmune skin condition.

Anticipating Advances for Pediatric Vitiligo

What advances in research or new therapies do you believe hold the most promise for improving outcomes in pediatric vitiligo treatment?

How do you envision the future of vitiligo management for children, particularly in the context of personalized medicine and innovative treatment strategies?

Recent advancements in pediatric vitiligo treatment focus on personalized medicine and innovative therapies. Promising research includes the development of targeted biologics and JAK inhibitors, which aim to modulate immune responses and promote repigmentation. Additionally, advancements in phototherapy and laser treatments offer improved efficacy and safety profiles for children. The future of vitiligo management is likely to emphasize individualized treatment plans, integrating genetic and molecular insights to tailor therapies. This approach aims to enhance treatment outcomes, minimize side effects, and improve the quality of life for pediatric patients.

The panelist discusses advances in targeted therapies, including novel biologics and small molecules, as well as the development of personalized treatment approaches tailored to individual patient characteristics, which hold great promise for improving outcomes and enhancing the quality of life for children living with vitiligo in the future.

Darin Painter

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