Chatterjee, Manas

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by pruritus and eczematous lesions. Abrocitinib, a selective Janus kinase 1 (JAK1) inhibitor, has recently been approved in India for moderate-to-severe AD in adults. This prospective real-world case series evaluated the effectiveness and safety of abrocitinib in patients with moderate-to-severe AD who showed an inadequate response to cyclosporine. Nine patients (five females, four males; mean age 19.44 ± 7.68 years, range 10–34 years) were included. Three were adolescents or children in whom abrocitinib was used off-label. The mean disease duration was 13.33 ± 8.06 years, and eight patients had a positive family history of AD. Prior treatments included cyclosporine, methotrexate, and systemic corticosteroids. Abrocitinib was prescribed at a mean dose of 177.77 ± 44.09 mg daily (seven patients received 200 mg, two received 100 mg). Effectiveness was assessed at baseline and weeks 2, 4, 8, and 12 using the Eczema Area and Severity Index (EASI), Investigator’s Global Assessment (IGA), and Peak Pruritus Numerical Rating Scale (PP-NRS). Significant and progressive reductions were observed in all scores. Mean EASI decreased from 48.22 ± 7.88 at baseline to 6.33 ± 3.35 at week 12 ( P < 0.0001). IGA scores improved from 4 to 1.22 ± 0.44, while PP-NRS declined from 8.44 ± 0.52 to 2 ± 0.86 by week 12, with significance evident early in treatment. Most patients demonstrated good adherence, and dose adjustments were required in some cases. One patient developed mild thrombocytopenia. Abrocitinib demonstrated rapid, significant clinical improvement and was generally well-tolerated, supporting its role as an effective option for moderate-to-severe AD, particularly in patients with inadequate response to cyclosporine.

AbstractBackgroundThe International Dermoscopy Society (IDS) recently released a set of five basic dermoscopic parameters (vessels, scales, follicular findings, “other structures,” and specific clues) encompassing a total of 31 subitems to standardize the use of dermoscopy in non‐neoplastic dermatoses, yet they have been developed taking into account Caucasian/Asian skin, with consequent possible limitations if used in dark skin.ObjectivesTo validate the abovementioned criteria for the use in dark‐skinned patients (phototypes IV–VI) through an expert consensus.MethodsThe two‐round Delphi method was adopted, with an iterative process consisting of two rounds of email questionnaires. Potential panelists were recruited via e‐mail from all over the world based on their expertise on dermoscopy of non‐neoplastic dermatoses in skin of color.ResultsTwenty‐two panelists took part in the validation process. All of the five originally proposed parameters and subitems reached agreement during the first round, aside from “follicular red dots.” Additionally, during round 1, five new subitems were proposed (perifollicular scales distribution, follicular openings obliteration, broken hairs, eccrine pigmentation, and eccrine ostia obliteration), along with the possibility to change the denomination of parameter 3 (from “follicular findings” to “follicular/eccrine findings”) and split it into two subparameters (“follicular findings” and “eccrine findings”). All such proposals reached agreement during the second round and therefore were included in the final list, for a total of 37 items.ConclusionsAlthough nearly all the dermoscopic criteria originally proposed by the IDS are applicable even to darker phototypes, several additional variables need to be assessed.