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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.

Articles

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Kaitlyn Bader is the assistant managing editor of 

 and joined the MJH Life Sciences team in June 2022. She attended Otterbein University in Westerville, Ohio, and earned a Bachelor of Arts degree in literary studies with minors in creative writing and film studies. Prior to health care news, Kaitlyn worked in industrial marketing. She enjoys cooking, reading, and tending to her house plants.

Jason Hawkes, MD, MS, emphasized the importance of biologic treatments transforming the management of both prurigo nodularis and atopic dermatitis. 

Clinical Features and Cytokine Pathways in Prurigo Nodularis vs Atopic Dermatitis

A recent study indicated that 43.3% of lesions achieved a high efficacy score following Alexandrite laser therapy.

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Maggi Ahmed, MD, PhD, demonstrated superior pigmentation outcomes and reduced CD8+ T cell numbers in her recent research results.

Combining Surgical Precision With Immunological Innovation in Vitiligo Treatment

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

Alexandra Golant, MD, shares how sleep improvement is measured and the difference an effective treatment makes for the patient’s entire family.

Measuring Sleep Impact

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 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, Alexandra Golant, MD, assistant professor and residency program director at the Icahn School of Medicine at Mount Sinai in New York, New York, shares how sleep improvement is measured and the difference an effective treatment makes for the patient’s entire family.

One concern often voiced by parents is the impactof atopic dermatitis on a child's sleep. In the studies involving ruxolitinib, how does the treatment influence sleep patterns in pediatric patients, and what implications does this have for their overall well-being?

 Given what we know about the rapid onset of itch reduction for the use of topical ruxolitinib for our pediatric AD populations in these trials, it's really unsurprising that we see significant improvements in quality of life outcome measures when you look at Patient Oriented Eczema Measure (POEM) [and] when you look at Dermatology Life Quality Index (DLQI) scores in these patients. I think a large part of that is the itch reduction, allowing patients to sleep more comfortably.

I often say that AD, particularly when a child has AD, it becomes really a family disease. It becomes a family experience if you have or if you know a young child when a child is not sleeping. It's not just the child that's up at night. It's sometimes 1 or both parents, sometimes siblings. So, improving itch and really been able to improve that quality of life for these young patients is an incredible outcome of any therapy, including what we see here with with ruxolitinib.

Brian Kim, MD, underscores the importance of the manifestations in patients not visible on the skin's surface.

Rethinking Itch Severity in Atopic Dermatitis

Brian Kim, MD, professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York, New York, delves into the complexities of AD, highlighting the evolving landscape of diagnostics and treatment. While advancements abound, he underscores the critical gap in addressing severe itch, often overshadowed by the visible manifestations of skin rash. Kim advocates for a paradigm shift, urging the medical community to prioritize itch assessment alongside traditional markers of disease severity, thus paving the way for enhanced patient care and management strategies in AD.

What is upcoming in the atopic dermatitis landscape?

 There's a lot coming in AD, it's hard for me to even go over the whole list of things to look out for you know, I mentioned a number of different pathways that people are looking at. At but also I think the thing to think about AD also is: Where are the gaps?

So I think actually the population is growing and a big population that's overlooked is patients with severe itch and more moderate or even mild disease, and I think a paradox right now in the field of AD is that you could actually have based on your skin, a rash that looks moderate or even mild to moderate. But if you have 10 out of 10, severe itch, you're still considered to have mild to moderate disease. And I think we need to get beyond that. And this is something that is a bit of a problem to me. I think that itch in atopic dermatitis needs to be still looked at much more closely and much more seriously by everyone in the field. We see patients even who go on biologics that have residual itch, but because their rash is better, we think that they're better and there's not much more we need to know but I think we can really improve that. And so there's a lot more growth to be had in AD diagnosis, management, and treatment.

Brian Kim, MD, underscores the critical gap in addressing severe itch in atopic dermatitis, often overshadowed by the visible manifestations of skin rash.

Alexandra Golant, MD, explains why she is confident in the latest safety and efficacy data from ruxolitinib trials to treat pediatric patients with AD.

Understanding Long-Term Safety, Efficacy, and Demographic Variances in Ruxolitinib Trials

In this episode, Alexandra Golant, MD, assistant professor and residency program director at the Icahn School of Medicine at Mount Sinai in New York, New York, explains why she is confident in the latest safety and efficacy data from ruxolitinib trials to treat pediatric patients with atopic dermatitis.

Can you elaborate on how the safety and efficacy of ruxolitinib compare to the vehicle in pediatric patients? Are there differences for younger pediatric versus older pediatric patients? Are there notable differences in outcomes across various demographic factors, such as ethnicities?

The clinical trial programs for topical ruxolitinib (Opzelura), even in the pediatric population, included a diverse range of ethnicities. The data that I've seen hasn't shown data stratified by ethnicity, but the inclusion of these populations would suggest that the efficacy outcomes are applicable to a wide range of patient populations consistent with the diversity of patients that we see in our offices.

Looking at the trials of topical ruxolitinib in our pediatric patients, we see efficacy and safety data that is fortunately quite consistent with what we saw in the trials for our adult patients using this therapy for AD. We see high rates of skin clearance, looking at IGA success, EASI 75, patients that experienced very rapid itch reduction. We know that topical ruxolitinib is a topical JAK inhibitor, and the hallmark of our JAK inhibitors is speed, [and] its efficacy of onset, particularly for itch. What I love about using these agents is that translates into very rapid itch reduction in days, sometimes even shorter than days. Hours after using it, patients will report significant itch reduction. And that fortunately translated beautifully into our younger patient population as well. On the flip side of efficacy is always safety and we saw a very consistent safety profile for use of topical rucks in our pediatric patients.

We know that the medication even hopefully when approved for our younger patients will still have the same warning language, will still have that same boxed warning. It's the same drug, but the safety data would support very confident use in this patient population. The available data from the clinical trials looking at topical ruxolitinib in that pediatric under 12, that 2 to 12 population, shows really consistent safety profiles. The safety profile we see with topical ruxolitinib in that 2 to 12 age range pediatric patient population really was consistent with what we saw from the large phase 3 clinical trial programs from our patients 12 and up.
This included the primary study period as well as that long term safety follow up. So, no new signals, no new amplification of adverse events, really consistent with what we know true from its label today.

The available data gives me a lot of confidence for the use of this topical the way we traditionally use topicals, which is allowing patients to maintain,
to use this as needed over long periods of time. I have really no concerns from this data set, no new alarm bells relative to what we know about data from our adolescent or our adult population with AD.

Alexandra Golant, MD, explains why she is confident in the latest safety and efficacy data from ruxolitinib trials to treat pediatric patients with atopic dermatitis. 

Understanding Long-Term Safety, Efficacy, and Demographic Variances in Ruxolitinib Trials 

Brian Kim, MD, explores long-term ruxolitinib data and combination therapies in the treatment of pediatric atopic dermatitis.

Exploring Long-Term Data and Combination Therapies

Brian Kim, MD, professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York, New York, explores long-term ruxolitinib data and combination therapies in the treatment of pediatric AD.

 I'm a physician scientist. So I spend 90% of my time doing science, running a laboratory to make basic discoveries. Ten percent of my time is in the clinic, and we also design clinical trials to bring new treatments to patients as well based on our science.

 In the pursuit of understanding the long-term effects of ruxolitinib in pediatric patients, what types of long-term follow-up studies are needed to ensure a comprehensive assessment of safety, efficacy, and sustained benefits? How might these studies inform evolving treatment guidelines?

I think for any drug, for long-term observation, you want to look at, not just efficacy, but also safety. Is there anything weird that's showing up that you didn't expect? Or any kind of even small effect, [such as] irritation or something like that? And I think that's true at topical ruxolitinib. It's a great drug. We have a lot of experience with it in adults now. So we know it has a very good profile, and I don't anticipate anything in postmarket long-term in children or anything like that, but you do need to make sure there isn't any kind of excessive absorption or infection or something that maybe you didn't anticipate.

We do see a lot of potential for topical ruxolitinib to be combined with other treatments. In fact, that is something that I already do in the clinic. So one thing I think we often don't appreciate is that with the advent of many systemic therapies, biologic therapies, that are highly effective for AD, we're actually increasing the population of patients who have more localized rashes or itch in particular. And that's where actually topical ruxolitinib can come in and really be effective and mop up residual disease and that population is actually growing. So I think we're going to see a lot more combination of topical ruxolitinib, especially since it is topical. It allows you to kind of mop up hot spots and such. I think you'll see it also expand into other conditions in the future.

 What is new or exciting in the atopic dermatitis space?

There are a number of things that are exciting in the AD space. There's a lot at this meeting [AAD]. There's new mechanisms of action. There are new targets. A number of them, people are hearing about literally as I speak, such as nemolizumab, which targets IL-31 receptor. There's also OX40 as a target. There's a number of agents that are coming for AD, but even earlier, there are new agents that are trying to target multiple pathways at once, barrier pathways that actually come with a very different kind of mechanism of action.
And I think what we'll see a lot more in the coming years is what we call bispecific antibodies that target 2 pathways to treat AD, not an additive fashion, but actually synergistically. So the the 2 pathways by knocking them out, you'll see actually much, much more amplified effects in terms of efficacy. Unfortunately, a lot of these pathways are already proven to be quite safe in terms of blocking. So what I predict is a lot more efficacy with even improved safety, something that a lot of people ask me is, "You know, what do you think about topical JAK inhibitors?"

I actually have a very strong opinion on this. I think topical JAK inhibitors are gonna put topical steroids out of business. And what I've realized, actually from my experience with topical JAK inhibitors like ruxolitinib, which I'm very biased about because I did design the pivotal phase 2 clinical trial, so I'm very academically biased for its success in many ways. But also it is a very effective treatment. One of the things that I've learned from using topical ruxolitinib is that actually topical steroids have a lot of drawbacks that I either didn't see or didn't perhaps want to see because it was the only thing I had topically to use for eczema and other dermatosis. It does damage the barrier. It thins the skin. It makes the blood vessels pop out, and these are things that actually long-term are not good for inflammation, but topical steroids work. So what we were doing is we were actually using topical steroids to treat say eczema for 2 weeks short-term game, but then after that we weren't really sure what to do with the steroids. Are we risking overusing them and long-term actually paying because we're actually damaged in a barrier and causing all these effects on the skin that actually make the eczema long-term actually much worse? We're completely avoiding that now, with topical JAK inhibitors is what I found.

It's much easier if you just say, "Just use it twice a day. Don't worry about it. Just use it. And we'll see you in a month." Topical steroids...we've been playing this game of how much is underuse, how much is overuse? I don't think anyone could really answer that question. And that is something that's always plagued dermatology. How do we actually really use topical steroids? Long-term, not short-term. Short-term gain, but there's a bit of long-term pain associated with them.

Improved Quality of Life: Upadacitinib's Role in Managing AD

Key opinion leaders examine upadacitinib's role in managing atopic dermatitis and its impact on improving patients' quality of life.

Maggi Ahmed, MD, PhD

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