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Zoe Diana Draelos, MD, is a consulting professor of dermatology, Duke University School of Medicine, Durham, N.C. She is investigator, Dermatology Consulting Services, High Point, N.C., and a Dermatology Times Editorial Advisor and co-medical editor.

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 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 pivotal BE HEARD trials demonstrated bimekizumab’s efficacy, showing meaningful improvements over placebo in HS patients.

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Early initiation of treatment for atopic dermatitis (AD) offers the best possibility for altering the natural course of the disease, increasing the odds that children might outgrow the problem, according to Elaine Siegfried, M.D., professor of pediatrics in dermatology, Saint Louis University Health Sciences Center, St. Louis.

Early intervention curbs atopic dermatitis in children

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

“Cosmetologists and hairdressers are the people seeing our scalp, seeing within our hairline, that no one else is seeing, looking at our face every day. They get little to no training in skin cancer... so we created this program to help them recognize these issues early. The earlier we can intervene, the better,” said Bree Vanleeuwen, PA-C, in an interview with 

’ Editorial Advisory Board member, Renata Block, MMS, PA-C, fellow physician assistants Vanleeuwen and Jim Sutton, PA-C, of Utah Valley University discussed the 

—a unique initiative to train cosmetologists and hairdressers to recognize suspicious skin lesions and refer clients for dermatologic evaluation.

Funded by the SCAN Grant, SCAN has expanded from Utah to neighboring states, with the aim of launching chapters nationwide. As they prepare to present at the Society of Dermatology Physician Assistants (SDPA) conference in Las Vegas, Vanleeuwen and Sutton share how SCAN leverages community-based professionals for early detection, empowering these frontline observers to improve patient outcomes in skin cancer prevention and awareness.

Bree Vanleeuwen, PA-C, and Jim Sutton, PA-C, discussed the Skin Cancer Awareness project—a unique initiative to train cosmetologists and hairdressers to recognize suspicious skin lesions and refer clients for dermatologic evaluation. 

SCAN Project Empowers Cosmetologists in Early Skin Cancer Detection 

The goal of the SCAN program is dedicated to training cosmetologists, estheticians, and hairdressers to identify suspicious skin lesions on clients and refer them for further evaluation by dermatology professionals. Their goal is to educate these professionals who routinely observe skin up-close but often lack formal skin cancer awareness training. SCAN’s approach leverages the natural frequency of client visits, aiming to catch skin cancers early in populations that are less likely to see a dermatologist regularly.

Initially limited to hairdressers in Utah, SCAN has expanded to include cosmetologists across nearby states, with over 1200 professionals certified to date. Vanleeuwen and Sutton highlighted that, beyond Utah, their objective is to establish SCAN chapters across the United States, in collaboration with other universities. Their process now includes large-scale training sessions at cosmetology schools, ensuring new practitioners are equipped with foundational knowledge on skin cancer identification from the outset. They noted that by working with institutions rather than individuals, they can educate larger groups and build lasting partnerships, making it easier to return to teach new cohorts regularly.

During the conversation, Vanleeuwen and Sutton mentioned their upcoming presentation at the SDPA Fall conference in Las Vegas, Nevada, next week. At this meeting, they plan to discuss the SCAN project’s impact and explore the next steps, including potentially gathering more structured data on the outcomes of their training efforts. Vanleeuwen shared that while they have received anecdotal success stories—where trained professionals detected skin cancers and saved lives—they are keen to collect systematic follow-up data post-certification. This data could demonstrate SCAN’s long-term effectiveness and potentially justify further funding and expansion.

In discussing their motivations, Vanleeuwen emphasized a personal commitment to preventive care, which aligns with her background in dermatology and her work promoting sunscreen use through a personal venture. Sutton highlighted that Utah’s high melanoma incidence, likely influenced by high altitude and outdoor culture, further underscores the need for such proactive measures. Both expressed deep satisfaction in merging clinical and educational roles to contribute meaningfully to community health.

Vanleeuwen and Sutton acknowledged challenges, particularly in establishing community connections and engaging cosmetology schools. Initial “cold-calling” to set up partnerships proved daunting, but once they demonstrated SCAN’s benefits to both cosmetology students and schools, uptake became more consistent. They attribute their success to the academic resources at Utah Valley University, including student interns who assist with training and outreach. They encouraged other physician assistants to initiate similar projects, advising that a strong sense of mission and commitment to community needs is vital for long-term impact.

Through SCAN, Vanleeuwen and Sutton are fostering a new approach to community-based skin cancer detection, with the hope that their work will help reduce skin cancer rates nationally. Their efforts illustrate the powerful role non-dermatology professionals can play in early detection, ultimately improving patient outcomes.

The SCAN project, led by physician assistants Bree Vanleeuwen and Jim Sutton, aims to train cosmetologists and hairdressers to identify suspicious skin lesions and refer clients for dermatologic evaluation. Initially launched in Utah, the program has expanded to neighboring states, certifying over 1200 professionals. SCAN leverages frequent client visits to catch skin cancers early, especially in populations less likely to see dermatologists. The initiative plans to establish nationwide chapters and gather systematic data to demonstrate its effectiveness, with the ultimate goal of reducing skin cancer rates through community-based detection.

SCAN Project Empowers Cosmetologists in Early Skin Cancer Detection

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.

Polls 

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

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.

Marie Rosenthal

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