Dupilumab but not cyclosporine treatment shifts the microbiome toward a healthy skin flora in patients with moderate‐to‐severe atopic dermatitis

Background: Atopic dermatitis (AD) patients display an altered skin microbiome which may not only be an indicator but also a driver of inflammation. We aimed to investigate associations among AD patients' skin microbiome, clinical data, and response to systemic therapy in patients of the TREATgermany registry. Methods: Skin swabs of 157 patients were profiled with 16S rRNA gene amplicon sequencing before and after 3 months of treatment with dupilumab or cyclosporine. For comparison, 16s microbiome data from 258 population-based healthy controls were used. Disease severity was assessed using established instruments such as the Eczema Area and Severity Index (EASI). Results: We confirmed the previously shown correlation of Staphylococcus aureus abundance and bacterial alpha diversity with AD severity as measured by EASI. Therapy with Dupilumab shifted the bacterial community toward the pattern seen in healthy controls. The relative abundance of Staphylococci and in particular S. aureus significantly decreased on both lesional and non-lesional skin, whereas the abundance of Staphylococcus hominis increased. These changes were largely independent from the degree of clinical improvement and were not observed for cyclosporine. Conclusions: Systemic treatment with dupilumab but not cyclosporine tends to restore a healthy skin microbiome largely independent of the clinical response indicating potential effects of IL-4RA blockade on the microbiome

Comprehensive Approach: Current Status on Patient Education in Atopic Dermatitis and Other Allergic Diseases

Allergic diseases are characterized by a complex complex chronic pathophysiology. Therapeutic patient education (TPE) programs are an important part of health care for allergic patients. These programs aim to increase the patient's adherence to evidence-based treatment and improve their ability to cope with the disease. TPE led by a multiprofessional team covers the complex pathogenesis of the disease, trigger factors, nursing and dietary issues, and the broad variety of treatment options available including psychological and behavioral aspects.Regarding atopic dermatitis (AD), randomized, controlled studies have demonstrated the beneficial effects of delivering structured group training to children, their caregivers, and adult patients with AD. Such intervention achieved substantial improvements in quality of life and objective clinical disease parameters. Besides AD, training programs have also been developed and evaluated for patients with anaphylaxis and asthma. This article provides an overview of the multitude of TPE concepts and their impact on subjective and objective outcomes. It focuses on AD but also sheds light on other allergic diseases such as anaphylaxis and asthma. Keywords: Anaphylaxis; Atopic dermatitis; Patient care; Therapeutic patient education programs

Non-Contact Dermatoscope with Ultra-Bright Light Source and Liquid Lens-Based Autofocus Function

Dermatoscopes are routinely used in skin cancer screening but are rarely employed for the diagnosis of other skin conditions. Broader application is promising from a diagnostic point of view as biopsies for differential diagnosis may be avoided but it requires non-contact devices allowing a comparably large field of view that are not commercially available today. Autofocus and color reproducibility are specific challenges for the development of dermatoscopy for application beyond cancer screening. We present a prototype for such a system including solutions for autofocus and color reproducibility independent of ambient lighting. System performance includes sufficiently high feature resolution of up to 30 µm and feature size scaling fulfilling the requirements to apply the device in regular skin cancer screening

Exacerbation of atopic dermatitis upon grass pollen exposure in an environmental challenge chamber

Background: It has frequently been speculated that pruritus and skin lesions develop after topical exposure to aeroallergens in sensitized patients with atopic dermatitis (AD). Objective: To study the cutaneous reactions to grass pollen in adult patients suffering from AD with accompanying clear IgE-sensitization to grass allergen in an environmental challenge chamber using a monocenter, double-blind, placebo-controlled study design. Methods: Subjects were challenged on two consecutive days with either 4000 pollen grains/m3 of Dactylis glomerata pollen or clean air. The severity of AD was assessed at each study visit up to five days post challenge by (objective) scoring atopic dermatitis (SCORAD) and Investigator Global Assessment (IGA). Additionally, air-exposed and non-air exposed skin areas were each scored by modified SCORAD and IGA assessments. Serum CCL17 (TARC) levels were determined by ELISA. The primary endpoint of the study was the change in objective SCORAD between pre-challenge and post-challenge. Results: Exposure to grass pollen induced a significant worsening of AD. A pronounced flare-up of air-exposed eczema rather than of covered skin areas occurred. With exposure to grass pollen a trend of increased CCL17 could be observed. Conclusions: This study demonstrates that controlled exposure to airborne allergens of patients with so-called “extrinsic” IgE-mediated form of AD induced a worsening of dermal symptoms. This trial was registered with ClinicalTrials.gov (NCT01475994)