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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.

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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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Daily Derm Times: March 3, 2025

Single-use packaging and excess sample distribution contribute to environmental harm, necessitating a shift in industry practices.

The Environmental Cost of Conferences

Phase 3 trial results presented at AAAAI/WAO 2025 highlight dupilumab's efficacy in reducing itch severity and urticaria activity in CSU patients.

Q&A: Thomas Casale, MD, Discusses Abstract on Dupilumab and Significant Itch, Hive Reduction in Chronic Spontaneous Urticaria

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Edgar Charles, MD, is vice president and senior global program lead of Early/Late Development Immunology at Bristol Myers Squibb.

Edgar Charles, MD, on Long-term Deucravacitinib Psoriasis Data

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.

clinical

Video Series

Professor Diamant Thaçi, MD, PhD, discusses findings from the ARCADIA and OLYMPIA clinical trial programs, highlighting nemolizumab’s rapid efficacy in treating atopic dermatitis and prurigo nodularis.

Diamant Thaçi, MD, PhD: Understanding the Impact of Nemolizumab Efficacy Post Approvals in EU, UK, and Switzerland

The European Commission recently approved Galderma’s nemolizumab

 (Nemluvio) for the treatment of moderate to severe atopic dermatitis (AD) in patients aged 12 and older and moderate to severe prurigo nodularis (PN) in adults.

Additionally, nemolizumab was also approved for the same indications 

Approval was based on strong phase 3 ARCADIA and OLYMPIA trial results, demonstrating rapid and sustained efficacy. With its first-in-class mechanism and 4-week dosing interval, nemolizumab offers a promising new option for dermatologists and patients in these regions.

 spoke with one of the researchers involved in the studies, Diamant Thaçi, MD, PhD, a university professor at University of Lübeck in Germany, to discuss the data supporting the approval and what the action means for patients with AD and PN.

These conditions, often characterized by severe and persistent itch, pose significant treatment challenges, making the results of these trials particularly relevant to clinical practice.

"In both clinical trials, in the ARCADIA and OLYMPIA programs, this has been a very comprehensive program investigating efficacy and safety of nemolizumab in 2 very important indications," Thaçi said.

Clinical Outcomes: Rapid and Significant Itch Relief

A key takeaway from the trials was the rapidity of symptom relief observed with nemolizumab. Thaçi emphasized the importance of treatments that deliver fast results, particularly for patients suffering from severe itching.

"It is very important that the treatment options that we have nowadays, that they are not only effective, let's say after 2 or 3 months, but that they have a rapid response," he noted. "This is especially [true for] diseases which are compared with itch, and we are talking about a bothering itch, a very severe itch... improvement of the itch within hours and days."

This rapid onset of action differentiates nemolizumab from other available treatments and provides a critical benefit for patients whose quality of life is significantly impacted by persistent pruritus, he added.

Efficacy Across Different Patient Profiles

Thaçi also highlighted the drug’s effectiveness across various patient populations. While it was initially believed that patients with more severe itch might respond better, the trials demonstrated efficacy across the spectrum.

"We do see that patients who are prone to be more itchy, who have a more severe itch, that [their] perception [is that] they do respond better. However, in the clinical trials, it has been shown that in the vast majority of the patients, there was no big difference between the patient who has a severe or less severe itch," he said.

This finding suggests that nemolizumab can be a viable option for a broad range of patients, not just those experiencing extreme symptoms.

Unlike existing therapies, nemolizumab targets interleukin-31 (IL-31), a cytokine known to play a central role in itch signaling.

"Also in this population, we had a very nice response showing that nemolizumab, with the inhibition of IL-31, offers a little bit more from the treatment options which are already on the market," Thaçi said.

By blocking IL-31, nemolizumab effectively disrupts the itch-scratch cycle, providing relief and potentially improving skin healing over time.

Safety Considerations and Clinical Implications

While efficacy remains paramount, Thaçi underscored the significance of safety in managing chronic dermatological conditions.

"In my personal opinion, efficacy is very important, but in diseases like atopic dermatitis and prurigo nodularis, safety plays a very important role," he said.

Phase 3 trial results indicated a favorable safety profile, further supporting nemolizumab's potential as a long-term treatment option.

Galderma’s Nemluvio (nemolizumab) approved in the European Union for moderate-to-severe atopic dermatitis and prurigo nodularis. News release. February 14, 2025. Accessed February 25, 2025. 

https://www.galderma.com/news/galdermas-nemluvior-nemolizumab-approved-european-union-moderate-severe-atopic-dermatitis-and

Galderma’s Nemluvio (nemolizumab) granted marketing authorization in the United Kingdom and Switzerland for moderate-to-severe atopic dermatitis and prurigo nodularis. News release. February 18, 2025. Accessed February 25, 2025. 

https://www.galderma.com/news/galdermas-nemluvior-nemolizumab-granted-marketing-authorization-united-kingdom-and-0

Christophe Piketty, MD, PHD, discusses the promising efficacy, novel mechanisms, and patient benefits of nemolizumab in targeting IL-31 for atopic dermatitis and psoriasis.

Christophe Piketty, MD, PhD: Nemolizumab's Unique Mechanism of Action and Next Steps Globally

Galderma’s nemolizumab (Nemluvio) recently received approval

 from the European Commission for the treatment of moderate to severe atopic dermatitis (AD) in patients 12 years and older, as well as moderate to severe prurigo nodularis (PN) in adults.

 The therapy has also been authorized for the same indications 

 spoke with Christophe Piketty, MD, PhD, a dermatologist and the global program head at Galderma R&D, to discuss the unique mechanism of action of nemolizumab and the next steps for global approval.

Nemluvio and IL-31: A Novel Mechanism of Action

Piketty began by highlighting the significance of Nemluvio's unique mechanism of action. While other biologics typically target IL-13 or IL-4 for conditions like AD, nemolizumab targets the IL-31 pathway, a cytokine pathway that plays a central role in these diseases.

The importance of this distinction lies in the significant therapeutic potential that targeting IL-31 offers, as it directly affects skin inflammation, bio disruption, and even fibrosis.

"We know that IL-31, of course, is the main driver for itch,” Piketty remarked, underscoring how this cytokine influences the pathological processes that lead to itching in AD and PN. "Nemluvio is markedly improving itch."

Addressing Skin Inflammation and Fibrosis

Piketty continued by elaborating on how nemolizumab's impact extends beyond just alleviating itch. He highlighted recent data demonstrating how IL-31 targeting also addresses skin inflammation in both AD and PN. For instance, in AD, the biologic helps to improve biodisruption, a key feature of the disease's pathophysiology.

"Targeting IL-31 could improve the biodisruption, which is a key feature of the pathophysiology of atopic dermatitis," Piketty explained.

Additionally, PN, which is associated with significant tissue remodeling and fibrosis, has shown significant improvements with nemolizumab treatment. 

"We know that there is a lot of data now demonstrating that targeting IL-31 could improve also fibrosis," Piketty said. This antifibrotic effect explains the quick improvement of thick lesions observed in patients treated with nemolizumab 

The approvals in the European Union, UK, and Switzerland follow nemolizumab's approval in the US last year.

"The submission process is ongoing at the moment. We have received the approval in the US last year for both AD and PN," Piketty said. "We have received a formal approval in Europe for both indications."

The drug is awaiting approval in Australia, Singapore, and several other countries. Additionally, ongoing submissions are happening in South Korea and Brazil, with more submissions planned for the coming months.

"It’s moving fast, I think, and soon we will have a lot of countries where the review will be approved," Piketty said. He expressed confidence that this rapid expansion will make a significant difference for patients suffering from AD and PN globally.

Treatment Regimen: Convenience for Patients

One of the standout features of nemolizumab is its convenient treatment regimen. According to Piketty, the biologic allows for injections every 4 weeks, which is notably less frequent than other biologics on the market.

For patients who respond well to treatment, the regimen becomes even more convenient. After reaching specific response markers such as EASI75 or IGA response at week 16, patients can switch to an even less frequent injection schedule. 

"When using Nemluvio in combination with topical corticosteroids or topical calcineurin inhibitors, we have demonstrated that for patients responding, those patients could move to an even more convenient regimen," he explained.

Patients who achieve these milestones could reduce their injection frequency to once every 2 months, offering a substantial improvement in treatment convenience. 

"I spent a lot of time on the development of this drug, from the beginning actually, in 2016," Piketty shared. "It’s quite a long journey, but now I’m pretty happy to see that the product is available for patients."

Christophe Piketty, MD, PHD, discusses the promising efficacy, novel mechanisms, and patient benefits of nemolizumab in targeting IL-31 for atopic dermatitis and prurigo nodularis.

Hyperhidrosis is not rare. According to the 

, approximately 385 million people worldwide live with hyperhidrosis.

In fact, they note that the amount of people living with chronic, excessive sweating is even higher than the amount of people living with other dermatologic conditions like psoriasis.

Just how common is hyperhidrosis in real-world comparisons?

The prevalence of hyperhidrosis is much higher in younger populations than in the general population, with 8.8% of individuals between the ages of 18 to 39 years old living with the condition. 

When comparing these statistics to everyday, common occurrences like hair color, the number of people with hyperhidrosis is greater than the 1% of individuals with natural red hair and 2% of individuals with natural blond hair. 

Despite how common hyperhidrosis is, it is estimated that 27% of those with the condition never receive a diagnosis.

 wants to hear from you. What percentage of the global population is estimated to have hyperhidrosis?

 to share your hyperhidrosis insights or research.

Albert. Fact check: Hyperhidrosis - International Hyperhidrosis Society: Official site. Home - International Hyperhidrosis Society. October 24, 1970. Accessed November 16, 2023. 

https://www.sweathelp.org/home/news-blog/542-fact-check-hyperhidrosis.html

Hyperhidrosis affects approximately 385 million people globally, surpassing the prevalence of other dermatologic conditions like psoriasis. It is notably more common in younger populations, with 8.8% of individuals aged 18 to 39 experiencing the condition. Comparatively, hyperhidrosis is more prevalent than natural red or blond hair, which affects 1% and 2% of the population, respectively. Despite its prevalence, 27% of those with hyperhidrosis remain undiagnosed. The article encourages engagement during Hyperhidrosis Awareness Month to share insights and research on the condition.

Click here to answer this week's poll for Hyperhidrosis Awareness Month.

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POLL: What Percent of the Global Population is Estimated to Have Hyperhidrosis?

A bidirectional genetic analysis revealed a possible correlation between androgenetic alopecia and depression.

 It was found that patients with depression do not have a higher risk of developing androgenetic alopecia. Conversely, patients with androgenetic alopecia are more likely to be clinically depressed.

Mendelian randomization with genome-wide association studies (GWAS) datasets occurred. The two-sample analysis used data from the Neale Lab Consortium. The alopecia dataset included 154,988 European male and female patients with 35,563 cases and 119,435 controls. The depression dataset of 484,598 was split into 27,568 cases and 457,030 controls.

To assess genetic correlation, investigators utilized the inverse variance weighted, MR-Egger regression, weighted median, and simple and weighted mode methods. Eligible single nucleotide polymorphisms associated with androgenetic alopecia were selected as instrumental variables. Thus, the significance threshold was 

 < 1.0 × 10–5. Instrumental variables were assumed to be independent of confounding factors and were "hypothesized to influence the outcome solely through exposure risk factors," according to the authors.

It was found that patients with depression do not have a higher risk of developing androgenetic alopecia (odds ratio = 1.101, 95% confidence interval =0.890–1.362, 

 = 0.374). The Cochrane’s Q test showed that there was no significant heterogeneity in the data (

= 0.420) and the MR-Egger intercept showed no evidence of directional pleiotropy (

“We hypothesize that this may be partly due to depression potentially increasing the risk of other types of hair loss, such as telogen effluvium, or due to patients’ heightened concern about pre-existing hair loss and the influence of antidepressants,” the researchers concluded.

However, having androgenetic alopecia may exacerbate the risk of developing depression (odds ratio = 1.015, 95% confidence interval = 1.002–1.029, 

 = 0.020). Conversely, non-significant results in data heterogeneity and horizontal pleiotropy were found via Cochrane’s Q test (

The research does have some limitations such as the selection bias of a European population and no specific sub-analysis based on gender, age, or disease duration. Future literature should explore the underlying biological mechanisms that can further define the relationship between these two conditions.

Both depression and androgenetic alopecia have similar pathogenesis factors including genetics, hormones, stress, and immune dysregulation.

 Alopecia can affect a person’s self-esteem and self-consciousness, thus reducing their mental health and quality of life. 

About 65% of men with androgenetic alopecia experience mild to moderate emotional distress.

 Other questionnaire-based studies have confirmed these findings, with female patients demonstrating more pronounced effects.

Clinical interventions, such as hair transplantation, have been proven to have positive psychological benefits on patients. Even minor improvements experienced with topical minoxidil treatment can enhance quality of life. But even with these dermatological therapies, the investigators recommend evaluating patient perceptions of their hair loss via psychological questionnaires and follow-up assessments to provide psychosocial support and intervention when needed.

“This will help patients to establish effective psychological coping mechanisms,” the authors wrote. “Furthermore, early intervention can also lead to the optimized allocation of medical resources, thereby elevating the overall standard of healthcare.”

1. Li, H., Cai, H., Li, P., Zeng, Y., & Zhang, Y. (2025). Assessing Causality Between Androgenetic Alopecia with Depression: A Bidirectional Mendelian Randomization Study. 

, 18, 445–451. https://doi.org/10.2147/CCID.S501182

2. Sadick NS, Callender VD, Kircik LH, Kogan S. New Insight Into the Pathophysiology of Hair Loss Trigger a Paradigm Shift in the Treatment Approach. 

3. Cash TF. The psychological effects of androgenetic alopecia in men.

. 1992;26(6):926-931. doi:10.1016/0190-9622(92)70134-2

A bidirectional genetic analysis suggests a correlation between androgenetic alopecia and depression, indicating that while depression does not increase the risk of alopecia, those with alopecia are more prone to depression. The study utilized Mendelian randomization with GWAS datasets, focusing on European populations. Despite limitations like selection bias and lack of sub-analysis, the research highlights shared pathogenesis factors such as genetics and stress. Clinical interventions, including hair transplantation and minoxidil, can improve psychological well-being, emphasizing the need for psychosocial support and early intervention to enhance healthcare standards.

A two-set Mendelian randomization analysis revealed a genetic correlation between depression and androgenetic alopecia.

Patients with Androgenetic Alopecia Have a Higher Risk of Depression

A recent study study aimed to assess the efficacy and safety of Botulinum toxin type A (BTX-A; Botox) in treating this condition. The research, following PRISMA guidelines, reviewed 6 studies encompassing open-label, controlled trial, double-blind placebo-controlled, and observational designs. The results consistently indicated that BTX-A effectively reduced symptoms of hyperhidrosis with no significant side effects. The treatment significantly improved QoL, decreased sweat rate and production, and did not adversely affect grip strength. Additionally, the prolonged antisudorific effect suggested the potential for long-term management of palmar hyperhidrosis with BTX-A.

However, this treatment may not be effective in many cases.

Other treatment options, including topical agents, medical devices, systemic therapies, and surgical interventions, are available for palmar hyperhidrosis, given its significant impact on quality of life. Nonsurgical approaches, such as topical antiperspirants, iontophoresis, and systemic agents, are supported by current literature, with topical therapies often beneficial for mild to moderate cases. 

As the disease severity increases, systemic oral medication, like anticholinergic drugs, may become necessary, and surgical approaches are considered last-line for severe refractory cases. Recent therapeutic advancements are emerging as promising alternatives in clinical trials. However, the selection of treatment modalities should consider disease severity, benefit-to-risk profile, cost, patient preference, and clinician expertise, with the review providing insights to help clinicians optimize decision-making in managing excessive hand sweating.

Do you use all or any of these in combination? We want to know. Email us at 

Botox? Iontophoresis? Let us know what you most often recommend to your patients with severe palmar hyperhidrosis.

Edgar Charles, MD

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