Trending Clinical Topic: Atopic Dermatitis

Ryan Syrek


January 14, 2022

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From new findings about diagnosis in patients with skin of color to studies tackling associations with COVID-19 and other conditions, research presented at the 3rd Annual Revolutionizing Atopic Dermatitis (RAD) Conference resulted in this week's top trending clinical topic. At the conference, Andrew F. Alexis, MD, MPH, professor of clinical dermatology at Weill Cornell Medicine, New York City, discussed differences in the clinical presentation of atopic dermatitis in skin of color (see Infographic).

Because pigmented skin may mask some redness and alteration of color, Alexis stressed the need for clinicians to get hands-on. "It's important to recognize this clinical presentation and look carefully and assess the patient not just visually but with palpation, and take into consideration symptomatology, so that you don't fall into the trap of calling an atopic dermatitis lesion postinflammatory hyperpigmentation," he said. Delays in treatment and undertreatment can contribute to a higher risk for pigmentary and other long-term sequelae in this patient population. Alexis emphasized vigilance in both what to investigate during a patient's presentation as well as keeping an eye toward treatments specifically suited to skin of color.

In other research presented at RAD 2021, a reassuring study found that patients with atopic dermatitis do not appear to face an increased risk of acquiring COVID-19 or becoming hospitalized owing to the virus. Researchers performed a cross-sectional study of 13,162 dermatology patients seen in the UK between June 2018 and February 2021. Of the 13,162 patients, 624 (4.7%) had atopic dermatitis. They found that 4.8% of patients without a history of COVID-19 infection had atopic dermatitis, compared with 3.4% with a history of COVID-19. The risk for COVID-19 in patients with atopic dermatitis was similar to that of controls (adjusted odds ratio [aOR], 0.67). Authors of a separate cross-sectional study published in May evaluated the health insurance medical records of 269,299 patients who were tested for SARS-CoV-2 across University of California medical centers. Of these, 3.6% had a positive test for SARS-CoV-2. Of 5387 patients with atopic dermatitis, the infection rate was 2.9%, which was lower than in those without atopic dermatitis (3.7%; = .0063). Hospitalization and mortality were not increased in patients with atopic dermatitis.

Less encouraging findings showed that atopic dermatitis hits elderly patients particularly hard and may be associated with increased risk for comorbid conditions common in later stages of life, including osteoporosis, dementia, and cardiovascular disease. Patients aged 65 years or older with the skin condition also have more profound sleep disturbances than younger adult patients. Using adjusted odds ratios, researchers found that older adult age was associated with an increased number of nights of sleep disturbance due to atopic dermatitis in the past week (aOR, 2.14; P = .0142), as well as increased fatigue in the past 7 days (aOR, 1.81; P = .0313), trouble sleeping in the past 7 days (aOR, 1.98; P = .0118), and trouble staying asleep in the past 7 days (aOR, 2.26; P = .0030).

Atopic dermatitis that involves the head, neck, face, and hands has a significantly higher impact on health-related quality of life in patients of various ages, and these patients appear to have more severe disease, according to a large, cross-sectional study presented at RAD 2021. Of the 533 study participants, 453 (85%) had disease that affected the head, neck, face, hands, and other areas, whereas 80 (15%) had only other body regions affected. Patients with head, face, neck, and hand involvement were more likely to have severe Validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD) scores (28.5% vs 16.3%; P = .02) and a higher median total body surface area affected (15% vs 10%; P ≤ .01). "These findings highlight the importance of detailed assessment of specific areas affected by AD to personalize treatment approaches to the needs of patients," presenting author Lawrence F. Eichenfield, MD, said during a late-breaking abstract session.

These and other presentations at RAD 2021 captured widespread attention from clinicians, resulting in this week's top trending clinical topic.

Learn more about atopic dermatitis.


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