特应性皮炎（AD）前沿文献精读特辑（J Am Acad Dermatol / Contact Dermatitis / J Eur Acad Dermatol Venereol / Dermatol Ther (Heidelb)）

BACKGROUND: The long-term risk of allergic contact dermatitis (ACD) in children with atopic disease is a matter of debate. OBJECTIVES: The study aimed to assess the long-term risk of patients with childhood-onset atopic asthma and/or rhinitis (AtRD), with and without childhood-onset atopic dermatitis (CoAD), to develop ACD in adulthood. METHODS: A prospective cohort study with 15-year follow-up was conducted on 620 consecutive young adult patients (age 18-25 years) with childhood-onset AtRD (before the age of 16), and 173 healthy control subjects. All participants underwent skin prick tests for inhalant and food allergens. Patients were assigned to 2 cohorts. The NAD cohort included 483 patients with AtRD who had never had signs of atopic dermatitis. The AD cohort included 137 patients who, in addition to AtRD, had a presence or previous history of CoAD (onset within the first 5 years of life). Patients who showed clinical suspicion of contact dermatitis during follow up performed a patch test with a panel of 40 contact allergens. Those who tested positive for at least one contact allergen were considered to have contact allergy (CA). Patients with CA in whom the positive patch test had clinical relevance, assessed through detailed exposure analysis, were considered to be suffering from ACD. RESULTS: At the end of follow-up, the proportions of patients with CA (77.4% [106 of 137 patients] vs. 20.7% [100 of 483 patients]; p < 0.001) and patients suffering from ACD (52.6% [72 of 137 patients] vs. 14.7% [71 of 483 patients]; p < 0.001) were higher in the AD cohort than in the NAD cohort. In both cohorts, CA and ACD rates were higher than in control subjects (5.2% [9 of 173] controls; p < 0.001 and 1.7% [3 of 173 controls]; p < 0.001). In the overall group of participants, the multivariate Cox proportional hazards regression model showed that ACD was positively associated with AtRD (hazard ratio 1.67, 95% CI, 1.21-2.28, p = 0.001) and CoAD (hazard ratio 7.40, 95% CI, 5.74-9.52, p < 0.001) but not with IgE-mediated food allergy. In the AD cohort, the proportion of ACD did not differ between patients who had healed AD and those whose disease persisted into adulthood (49.2% [32 of 65 patients] vs. 55.5% [40 of 72 patients]), and the relative risk of ACD did not differ significantly between the two groups. CONCLUSIONS: Patients with childhood atopic asthma and/or rhinitis are exposed to an increased risk of ACD up to the fourth decade of life. The risk is independent of CoAD, even though the presence or past history of CoAD further increases the occurrence of ACD, regardless of whether patients have healed CoAD or not.

INTRODUCTION: Atopic dermatitis (AD) requires multidimensional assessment strategies that integrate clinician and patient perspectives. Minimal disease activity (MDA) has emerged as a treatment target, although its optimal definition and real-world determinants remain unclear. This study aimed to evaluate the proportion of patients achieving MDA under advanced therapies (ATs), identify associated factors, assess agreement between clinician-reported outcomes (CROs) and patient-reported outcomes (PROs), and propose a pragmatic operational definition of MDA. METHODS: Prospective observational study including patients ≥ 12 years with moderate-to-severe AD initiating AT (biologics or JAK inhibitors) in routine clinical practice. Assessments were performed at baseline and weeks 16, 24, and 48. MDA was defined as the simultaneous achievement of ≥ 1 CRO and ≥ 1 PRO using established cutoffs. Multivariable logistic regression was used to identify factors associated with MDA. Agreement analyses between outcomes were performed, and candidate MDA definitions were validated against external instruments. RESULTS: Ninety-six patients were included. MDA was achieved by 42.7%, 52.6%, and 46.0% of patients at weeks 16, 24, and 48, respectively. Lower baseline disease severity, fewer prior systemic treatments, and fewer AD-related comorbidities were associated with achieving MDA (p < 0.05). Agreement was high among CROs, more variable among PROs, and lower between CROs and PROs. The combination of Eczema Area and Severity Index (EASI) ≤ 3 and Dermatology Life Quality Index (DLQI) 0/1 showed the best performance across validation measures. CONCLUSIONS: ATs are effective in achieving MDA in AD. A composite definition integrating EASI ≤ 3 and DLQI 0/1 may represent a practical and clinically useful definition for routine clinical practice.

BACKGROUND: JAK inhibitors are increasingly used as systemic therapies for inflammatory dermatoses, but adults aged 65 and older are underrepresented in their clinical trials. OBJECTIVE: To synthesize the efficacy, safety, and regulatory evidence on JAK inhibitors in adults aged 65 and older with atopic dermatitis, alopecia areata, and psoriasis. METHODS: Clinical review synthesizing phase 3 trials, integrated safety analyses, real-world cohorts, and FDA/EMA labeling with age-stratified outcomes into practice recommendations (Supplementary Appendix 1B). RESULTS: In atopic dermatitis, upadacitinib 15 mg and abrocitinib 100 mg are effective in older adults, with higher doses generally avoided. In alopecia areata, baricitinib shows efficacy in small older-adult cohorts, while ritlecitinib data in this age group remain too limited for age-specific conclusions. In psoriasis, deucravacitinib provides durable responses and avoids boxed warnings for MACE or VTE, while catalytic JAK inhibitors for psoriatic arthritis need label-directed dosing and close monitoring. CONCLUSION: JAK inhibitors may be a reasonable option for carefully selected older adults, but the decision should be a deliberate one. It rests on disease-specific efficacy, baseline cardiovascular and oncologic risk, modifiable comorbidities, label-directed dosing, and close monitoring. Age-stratified data remain sparse, and each decision should be individualized.