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Eric Simpson, MD, MCR, FAAD, lead author of a recently-published article highlighting roflumilast cream 0.15%, joined us for a Q+A interview.

 Q+A: Roflumilast cream 0.15% for AD with Eric Simpson, MD, MCR, FAAD

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.

More than half of treatment responders maintained stable EASI ≤ 7, according to a poster from EADV.

Significant Proportion of Patients With AD Maintain Stable EASI With Tralokinumab Treatment

A poster presented at EADV 2024 explored patient-reported outcomes from. the TRACE study for AD.

9 Months of Treatment With Tralokinumab Results in Improved QoL, Itch, and Sleep

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.

Hypothyroidism and Hashimoto's thyroiditis were found to significantly increase the risk of developing AA, unlike hyperthyroidism.

Thyroid Disorders and Their Link to Alopecia Areata

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Advancements in assistance from artificial intelligence include ambient listening to take notes during physician and patient conversations.  

Jordan Miller, MD: 2024 Dermatology Predictions  

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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Video Series

Mona Shahriari, MD, explores potential areas of research that can contribute to continuous improvement in pediatric atopic dermatitis management.

Remaining Research Gaps and Bright Future in AD

This news content has been independently developed and is not endorsed by the American Academy of Dermatology.

 Expert Perspectives series, 5 experts delve into the multifaceted aspects of pediatric atopic dermatitis (AD) care including demographic variances to long-term safety and efficacy, comparative analyses, key takeaways from recent research, personalized approaches, and future research directions. Discover clinical insights into the role of ruxolitinib (Opzelura) in addressing critical challenges and enhancing patient outcomes.

In this episode, Mona Shahriari, MD, assistant clinical professor of dermatology at Yale University in New Haven, Connecticut, explores potential areas of research that can contribute to continuous improvement in pediatric atopic dermatitis management.

Dermatology Times Interview With Mona Shahriari, MD

: In the context of pediatric care, what patient-centric outcomes does ruxolitinib offer that are particularly valuable in enhancing the overall experience and well-being of young patients? How does it address aspects beyond clinical endpoints that matter to both patients and their families?

 I would say any of my patients with mild, moderate, or severe AD would be an excellent candidate in which the itch improvement, as well as the lesion improvement, would be paramount. I think that the one place that this does make it much easier for patients is when I have a patient, oftentimes, I'm giving them 1 topical for the face, 1 topical for the body, 1 topical maybe for the hands, and then you're using this topical twice a day for the next 2 weeks. And after 2 weeks, I'm transitioning you to this nonsteroidal medication, but if your eczema flares, you're going to go back to the original regimen. If you're dealing with adolescents and adults, maybe they can handle that complex regimen, but in the pediatric patient, mom and dad and the family are really involved in this and it can be very complex depending on what else they have going on. So oftentimes, we send them home with these complex regimens, and we're setting them up for failure because they come back and without a doubt, they put that high potency steroid on their face. And guess what it worked great, but now they have some adverse events because of what they did. So I think the place where ruxolitinib really does shine for patients is in simplifying that treatment regimen for patients who have multiple areas of involvement, who want that quick improvement in the itch, but also that substantial improvement in terms of lesions of their AD.
When you look at patient reported outcomes, itch is by far the most significant issue that AD patients struggle with. And that translates to whether you're a pediatric patient, an adolescent, or an adult...everybody. Itch is by far a significant issue. And there are a lot of studies that show whether you have mild, moderate or severe disease, your itch is actually your number one issue that you want to have treated with the lesional improvement being a close second. And when we look at some of the data in terms of our patient reported outcomes, it is the most common one that we see potentially translates to other patient reported outcomes and other signs of the patient experience with a disease. Itch can impact sleep. If you're not sleeping well, you're not productive at work. If you're not sleeping well, you may not be as able to function. You may not be as able to function effectively in a school environment as well. So all these factors kind of play into the overall patient experience with the disease, and I think that's where ruxolitinib shines.
It can really help reduce the itch and improve the sleep and a lot of our patients. There's also data that shows, with respect to skin and pain, that can help. The quality of life of these patients are also improved whether you're looking at pediatric patients, or you're looking at adults, as well as the adolescent patients. And I think one piece that we don't want to forget about is the family impact, because when a child has AD, the whole family has AD. Any regimen that can really help reduce the burden on the child actually reduces the burden on the family as well. So this is another great place this drug comes into play.

: Based on the current state of research, what gaps or uncertainties still exist in our understanding of ruxolitinib's effectiveness and safety in pediatric atopic dermatitis? What areas of research would you recommend for future investigations to further enhance our knowledge and optimize treatment strategies?

: I think the most important gap that we currently have is long-term safety studies because our pediatric data is still pretty new. When we look at the safety data actually, it looks comparable to our adults and we have maximal use studies with patients who have up to 35% of their body surface area involved. They use topical ruxolitinib and we didn't see any impacts from a systemic JAK inhibition standpoint, on their hematologic numbers, so I feel pretty confident in the safety data. We have the short-term safety data and kids are not just small adults. So we want to keep in mind that longer term safety data is something we want to obtain. But the other piece is that AD is one of those conditions where maybe topicals alone aren't going to do it for every one of our patients. And for those people who have moderate to severe disease, you may want to add a systemic. What is the safety of combining topical ruxolitinib with a systemic agent, potentially a JAK inhibitor or a targeted biologic? The label states that we should not be combining it. There are some case studies out there saying that the safety is not a concern. I would love to see larger scale prospective studies that really look at that in more detail, so when we're making decisions in the trenches, we can be assured that there's evidence to back up what we're doing.

I think the biggest takeaway is now is a good time to have AD because there's so much innovation happening in the field. We have many medications that are still coming down the pipeline. They're going to be approved over the next 1 to 2 years. But we're also looking at more unique mechanisms. In the past, our goal was to just kind of quiet down the disease. There is potential for disease modification. If we're treating our patients earlier when they're babies, is there a chance we can prevent the progression to moderate to severe disease? Can we prevent the development of certain comorbidities, potentially the atopic march? If we treat earlier, there's a lot of things pushing us toward maybe a cure for AD. We're not ready for primetime yet, but I think the future is bright in this disease state.

Mona Shahriari, MD, expands on benefits of ruxolitinib in managing itch and inflammation in pediatric atopic dermatitis.

Pediatric Potency: Ruxolitinib vs Triamcinolone

 Expert Perspectives series, 5 experts delve into the multifaceted aspects of pediatric atopic dermatitis care including demographic variances to long-term safety and efficacy, comparative analyses, key takeaways from recent research, personalized approaches, and future research directions. Discover clinical insights into the role of ruxolitinib (Opzelura) in addressing critical challenges and enhancing patient outcomes.

In this episode, Mona Shahriari, MD, assistant clinical professor of dermatology at Yale University in New Haven, Connecticut, expands on benefits of ruxolitinib in managing itch and inflammation in pediatric atopic dermatitis.

: In comparing ruxolitinib to other treatments, especially in terms of itch relief and inflammation reduction, what distinguishes its performance in pediatric patients? Are there specific scenarios or patient profiles where ruxolitinib demonstrates superior efficacy in addressing both itch and inflammation simultaneously?

 As someone who sees a lot of pediatric patients, I think one of the issues we currently have in the topical treatment landscape is that we've had a lot of topical corticosteroids. Those have been our mainstay and our go-to agents, but they come with limitations. For starters, they are broadly immune suppressive and not targeted. There's limitations on the duration of use. Oftentimes, you can use it for 2 to 4 weeks. And then after that, you're worried about local and systemic adverse events, as well as tachyphylaxis. You do need to take a break from the medication.
Also, the same agent can't be used on different body areas. You might need something a little weaker on the face in the groin, and a something a little bit stronger on the trunk and the arms. In that pediatric population, especially in dealing with the infants who have a high BSA to volume ratio. So you have to be cautious with overusing topical corticosteroids because there's a higher chance of systemic absorption and potentially impacts on the HPA axis in terms of suppression and finally, I see a lot of patients with skin color, and I don't love the topical corticosteroids in those individuals, because you have that tendency to get postinflammatory pigmentary changes as a result of overuse of TCS.
I think what we really need in the space currently is a treatment that can simplify the regimen and also allow for us to deliver better patient care, because when we have a topical corticosteroids, we know we had those limitations. So we had the next generation of our non steroids that hit the space and we thought this was going to be the best thing ever. And from a safety standpoint, it definitely helped address some of the unmet needs that we had in the topical corticosteroid landscapes. However, their efficacy left something to be desired. So what we really need nowadays is an agent that one, simplifies the regimen for our patients, one topical that you could use on any effective area head-to-toe for as long as you need to to effectively treat the disease. But also, we don't want to compromise efficacy when we're giving that agent to our patients. And that's really I think, where topical ruxolitinib helps meet these gaps.

: Considering the challenges in managing pediatric patients with atopic dermatitis, can you discuss how ruxolitinib specifically addresses unmet needs in the current care landscape? Are there particular aspects of the treatment that fill gaps or provide solutions to challenges faced by dermatologists in pediatric atopic dermatitis management?

: Topical ruxolitinib has many clinical trials currently in the space. We've looked at both adolescent and adult patients with respect to their itch improvement, as well as respect to their to the lesion reduction that they've been having. And one unique thing about this drug is the speed at which it works. We have improvement of the skin lesions within 2 weeks depending on which study that you look at and each improvement in as little as 12 hours or 15 minutes, depending on which study we're looking at. In those same results that we saw in our adolescents and our adults, we were able to see within our pediatric population as well, our age 2 to 11 year olds. But I really think what's different about this medication is we do have an analysis where ruxolitinib goes head-to-head against the mid potency topical corticosteroid triamcinolone. Oftentimes, when we have these non steroidal medications, as we talked about earlier, the efficacy piece is what's missing. The safety piece is definitely there. And when we looked at this head-to-head, it was actually pretty impressive. When it came to the lesional improvement, ruxolitinib rival triumphs alone, and when it came to the itch improvement, actually the patients did a little bit better in terms of how quickly their itch improved and though that was not necessarily the pediatric population we're looking at, a lot of the data does translate over to that younger population. So for me, I'm very excited to be able to pack the punch of a topical corticosteroid with all the safety of a nonsteroidal with ruxolitinib.

Sonya Kenkare, MD, explains her approach to itch and the support system of multiple specialties to help a pediatric patient with atopic dermatitis.

Utilizing Multidisciplinary Solutions for Itch 

 Expert Perspectives series, 5 experts delve into the multifaceted aspects of pediatric atopic dermatitis care (AD) including demographic variances to long-term safety and efficacy, comparative analyses, key takeaways from recent research, personalized approaches, and future research directions. Discover clinical insights into the role of ruxolitinib (Opzelura) in addressing critical challenges and enhancing patient outcomes.

In this episode, Sonya Kenkare, MD, dermatologist at Illinois Dermatology Institute in Hinsdale, Illinois, explains her approach to itch and the support system of multiple specialties to help a pediatric patient with AD.

Dermatology Times Interview With Sonya Kenkare, MD

: Itch is a significant concern for both pediatric patients and their caregivers. Can you delve into how ruxolitinib addresses itch in comparison to the vehicle, and are there specific mechanisms or pathways targeted that contribute to improved itch relief in pediatric atopic dermatitis?

 Topical ruxolitinib is a topical JAK1/JAK2 inhibitor, and it is able to reduce edge through that pathway. And it was shown in studies compared to the vehicle to have a statistically significant higher reduction of pruritis within 12 hours. After 2 days, it was able to reduce the itch score by 4 points, which was the endpoint that the investigators were looking for. And the vehicle was never able to achieve that level of improvement.

I think that one of the most difficult parts of managing AD in the kiddos isn't even the application of the moisturizers which the parents are so diligent about. It's how to get that itch under control because when they keep scratching, that inflammation does not go away. And that's the beauty of topical ruxolitinib. By helping to get that itch under control without sedating a child with an oral antihistamine, we're able to see progress occur more quickly. I really try to address the entire impact of this disease on the quality of life to help a patient get even more keyed in to a treatment regimen because it helps improve compliance and it helps improve motivation. When someone realizes that all of these things that may be impacting their life, their quality of sleep, their ability to focus, their self consciousness about their appearance and behaviors, when they realize that all of those things can improve by being compliant with a treatment regimen, their motivation goes through the roof, and medications like topical steroids, topical non-steroidal anti-inflammatories, topical ruxolitinib; those help a lot.

For my patients, with pediatric AD especially, I do see a high rate of asthma and allergies come along with that. So I do often co-manage with pediatric pulmonologist or pediatric allergist to try to make sure that my patient's overall health is being addressed from all of the different angles. Occasionally, behavioral health therapists can be helpful because the itch can be so pervasive. It's truly beyond frustrating for a child and having that emotional support can be extremely helpful.

Utilizing Multidisciplinary Solutions for Itch

Sonya Kenkare, MD, details where ruxolitinib fits within the current landscape of pediatric atopic dermatitis treatments.

Comparing the Landscape of Topicals

In this episode, Sonya Kenkare, MD, dermatologist at Illinois Dermatology Institute in Hinsdale, Illinois, details where ruxolitinib fits within the current landscape of pediatric AD treatments.

: Considering the latest research findings, how would you differentiate the safety and efficacy profile of ruxolitinib from currently available treatments for pediatric atopic dermatitis? Are there specific patient populations or scenarios where ruxolitinib might offer distinct advantages?

 In our pediatric patients, safety is essential and fitting into their lifestyle is also essential because if a kid, and depending on how young the kid may be, the parents are given really complex instructions. They can be difficult to follow. One of the examples of something being easy is ruxolitinib because it only needs to be used once a day to achieve excellent reduction in pruritis and inflammation without giving us the side effects of topical steroids. Ruxolitinib has shown an excellent safety profile in ages all the way down to 2 through adulthood. It has given an excellent return on investment in terms of use of time for reducing pruritis and helping reduce inflammation. Ruxolitinib is excellent, particularly in the little ones with safety data down to the age of 2. We really try to be judicious in our youngest patients with the use of topical steroids. Topical steroids can cause skin thinning and discoloration with long-term use. So while they can be really useful to help in an acute flare, we don't want to continue them long-term, but we do want to sustain continued relief of pruritus and ruxolitinib is excellent for this.

: Given the most recent research on ruxolitinib, what are the key takeaways that you believe every practicing dermatologist should be aware of? How might this information impact the way dermatologists approach the management of atopic dermatitis in pediatric patients?

I think it's essential that dermatologists are aware that ruxolitinib was shown to reduce pruritus better than the vehicle as soon as 12 hours after the first application. Within 2 days, it reduced the itch score by 4 points, and the vehicle never achieved that level of success. I think having another wonderful non-steroidal anti-inflammatory medication in our toolbox is so helpful, especially one that is so well targeted towards the most problematic symptom of AD, which is which reducing edge helps the body heal reduces inflammation and allows our patients to feel more comfortable, get better sleep, have a higher quality of life and that's what we want for all of our patients.

Alan Irvine, MD, DSc, shares insights on the impact of ruxolitinib on quality of life in pediatric patients.

Assessing Quality of Life and AAD Research Considerations 

In this episode, Alan Irvine, MD, DSc, dermatologist at Trinity College Dublin in Dublin, Ireland, shares insights on the impact of ruxolitinib on quality of life in pediatric patients and 2024 AAD research presentations to take into consideration.

: Beyond clinical measures, how does ruxolitinib influence the quality of life for pediatric patients with atopic dermatitis? Are there improvements in daily activities, social interactions, or psychological well-being that can be attributed to the treatment?

 So we did see a poster at AAD 2024 here in San Diego looking at quality of life in the pediatric ruxolitinib trial. It covered a wide range of patient-related outcome measures, everything from sleep to comfort to skin pain, quality of sleep, patient-reported outcomes information system (PROMIS) measures, lots of validated tools. Across the board, within 2 weeks and within 4 weeks of treatment there was a very significant shift in improvement, pretty much universally across all the quality of life measures that are recognized as being relevant for AD. So it's very positive in that way in younger kids reported by the parents, and the older kids reported by themselves are trending very well in the right direction with significant differences between the active drug and the vehicle arm in new studies.

In today's session, we looked at a broad range of different aspects of AD, you know, what we're learning about the epidemiology and with the microbiome role. We are in-depth looking at the barrier, including prevention and correction with treatments. We looked at the pipeline for systemic therapies and where things are positioning with novel topical therapies. So it was a comprehensive afternoon chaired by Amy Paller, MD. One of the standouts was the 52-week amlitelimab data for the first time because the OX40s have been developed with the hope that they may allow dose spacing lot longer than what currently available, injectable biologic therapies, which is 4 weeks and that might bring patients to a point where they can enjoy long-term control or an element of remission or disease modification over over a period of months after their initial induction treatment. The treatment is required to maintain them, and that step would be less frequent and that's a kind of a major step change in the management of AD.

There's a huge amount of innovation and activity around in topical therapies. Systemic therapies, like amlitelimab, is probably going to be the most interesting novel one that we that we will see, the first long-term data not including the withdrawal arm. There continues to be more evidence around long-term safety and JAK inhibitors. There's plenty of follow-up data on the monoclonals, including not yet licensed nemolizumab. There's some more data on that as well. So it's been a very rich conference in terms of new data, some really completely new classes of drugs. Very exciting time for for patients and their physicians.

Alan Irvine, MD, DSc, shares insights on the impact of ruxolitinib on quality of life in pediatric patients and 2024 AAD research presentations to take into consideration.

Jordan Miller, MD

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