INTRODUCTION Atopic dermatitis (AD) is an increasingly prevalent chronic heterogeneous inflammatory skin disorder characterised by pruritus and eczematous lesions. Recent guidelines recommend using topical therapies for AD management. We describe the treatment satisfaction and disease activity in adolescent and adult patients with moderate-to-severe AD using topical therapies in the US. Methods Data were drawn from the 2025 Adelphi Real World Topical Experience AD Disease Specific Programme, a cross-sectional survey with elements of retrospective data collection in the US. Health care practitioners (HCPs, dermatologists/allergists/immunologists/nurse practitioners/physician assistants) provided information on clinical characteristics, including physician-determined current disease severity (moderate/severe AD), treatment satisfaction, disease control, and reasons for dissatisfaction with current treatment. Patients (≥13 years) were required to be currently on topical therapy (corticosteroids/calcineurin inhibitors) for their AD, either as monotherapy or in combination with another treatment. Patients were stratified by type of treatment: topical monotherapy (no concomitant systemic treatment, TM) vs topical + advanced systemic (oral JAK-i or biologic, TAS). All analyses were descriptive. Results Sample (mean age=32.2 years, 55% female) included TM: n=115 (84% moderate, 16% severe) and TAS: n=46 (87% moderate, 13% severe) patients with AD. Current head and neck involvement was reported in 61% TM and 67% TAS; current upper limb involvement in 77% TM and 83% TAS; current trunk involvement in 52% TM and 52% TAS; and current lower limb involvement in 69% TM and 65% TAS. Current mean (SD) BSA was reported as 17.2% (16.5) TM and 18.6% (18.7) TAS. Physician-determined success of treatment was reported in 58% TM and 61% TAS. HCPs reported they were “satisfied, and I believe this is the best control that can be realistically achieved for this patient” in 31% TM and 46% TAS; “satisfied, but I believe better control can be achieved for this patient” in 51% TM and 33% TAS; “not satisfied, and I believe this is the best control that can be realistically achieved for this patient” in 1% TM and 7% TAS; and “not satisfied, but I believe better control can be achieved for this patient” in 17% TM and 15% TAS. The main reason for dissatisfaction was “AD is still impacting the patient's quality of life” among TM and TAS, followed by “Lack of skin clearance” in TM and “Patient not satisfied” and “Persistent skin changes” in TAS. At data collection, flaring was observed in 33% TM (flare severity: 61% moderate, 34% severe) and 30% TAS (flare severity: 64% moderate, 36% severe). Mean (SD) number of patient-reported flares in the past 12 months was 3.2 (2.2) TM and 4.1 (3.9) TAS; however, only 25% TM and 27% TAS patients indicated reporting every flare to their HCP. Conclusions While most HCPs were satisfied with the current treatment, over one-third still believed that better control can be achieved. Additionally, patients on topicals with or without systemic medication were actively flaring, and most patients did not report every flare to their HCP. Results indicate unmet treatment needs and a need for better awareness in patients with AD.
Introduction Topical therapies remain a cornerstone in the management of atopic dermatitis (AD). However, there is limited understanding of real-world usage patterns and patient experiences. This study aims to describe the burden of topical therapy in the US. Methods The study utilized data from the Adelphi Real World 2025 Topical Experience AD Disease Specific Programme, a cross-sectional survey with elements of retrospective data collection in the United States. This analysis included patients (≥13 years) with current moderate-to-severe AD and receiving topical therapy (topical corticosteroid or topical calcineurin inhibitor). Results were stratified by type of treatment: topical only monotherapy (TM, no concomitant systemic treatment) and topical + advanced systemic (TAS, oral JAK-i or biologic). Data collected (patient and physician completed forms) were analyzed descriptively; sample size varied for each response. Results Mean age of the 161 patients included in this analysis was 32.2 years; 55% were females. Seventy-one percentage of patients were prescribed TM and 29% TAS. Current flaring was observed in 33% TM and 30% TAS. Application frequency varied, with 15% TM, 15% TAS applying the treatment once daily; 59% TM, 38% TAS applying twice daily, and 4% TM, 5% TAS applying more than twice daily. Average time spent per application was <2 minutes for 38% TM, 41% TAS; 2–5 minutes for 45% TM, 32% TAS, and >5 minutes for 14% TM and 24% TAS. About 67% patients agreed/strongly agreed to “I don't like the way my skin feels”; 70% TM and 55% TAS found their topical medication convenient to use. Participants reported that their topical medication impacted daily activities (37% TM and 43% TAS), clothing choices (36% TM, 40% TAS) and disrupted bedtime routine or sleep (35% TM, 36% TAS). When asked about how well the topical medication helps their eczema, 39% TM and 31% TAS were satisfied and felt it offered the best control that can be realistically achieved; 40% TM and 29% TAS were satisfied but believed better control was possible. Around 3% TM and 17% TAS were not satisfied but considered it the best achievable control, while 18% TM and 24% TAS were not satisfied and believed better control could have been achieved. Conclusion Patients reported frequent application, disruption to daily routine, interference with clothing choices, and variable satisfaction with treatment effectiveness. Some patients experienced flares while using topical treatments, regardless of the use of systemics. Physicians should consider the patient experience of using topical medications in shared decision conversations for the treatment and management of AD.
Introduction: Many patients recovered from Covid-19 without requiring any critical treatment, vulnerable populations such as older people, especially those with comorbidities, are more likely to develop a severe infection and face higher mortality rates. Background: Why are older Adults are Higher Risk? The majority of older adults have comorbid conditions, which are associated with a higher risk for COVID-19. Many live in residential care homes, which have seen the highest number of COVID-19 cases due to tightly shared living spaces. With weakened immune systems, older adults living in poverty face additional challenges in protecting themselves from the virus, as it is difficult for them to comply with public health measures such as social distancing. 32.5% of individuals in the lowest income quartile were hospitalized due to COVID19, compared to only 11.4% of individuals from the highest income quartile. Methods: The data was retrieved from the Canadian MIS Database (CMDB) and the discharge abstract database (DAD). The CMDB contains financial and statistical operations information on public hospitals and regional health authorities across Canada. Case selection is based on COVID-19 diagnosis codes available in the International Statistical Classification of Diseases and Related Health Problems. Results: Elderly faced higher rates of hospitalization during the pandemic. The average length of hospital stay was also higher for older adults—hospitalizations of individuals under age 65 without comorbidity 41,707 with comorbidity 12,372. Hospitalizations of individuals 65 and older without comorbidity were 22,221 with comorbidity 24,731. Higher Hospitalization rates and issues of inequality in the healthcare system globally. As the pandemic progressed, hospitalization increased in number significantly. The average length of stay for individuals younger than age 65 without comorbidity is 7.7 days compared to 17.0 days in patients with comorbidity. The average full length of stay for individuals 65 and older without comorbidity was 13.2 days, While in patients with comorbidity 19.2 days. Older adults had higher in-facility death rates due to COVID-19 hospitalization. The in-facility death rate of individuals younger than 65 without comorbidity is 2.5%, With comorbidity at 12.9%. In-facility death rate of individuals 65 and older without comorbidity is 14.4%, with comorbidity at 23.2%. Conclusion: By analyzing and comparing various hospitalization rates for Canada, the precise data indicate that older adults have been disproportionately impacted by COVID-19. It is now important to determine the underlying structural issues that have caused this inequality to prioritize healthy aging.
Positive Patients After Extremity Amputation for Acute Thrombotic Events"We are thankful for the opportunity to address the comments by Dr. Bozzani et al. regarding our case series of histology findings of 4 COVID-positive patients with Rutherford III acute limb ischemia.Bozzani et al. describe the numerous factors that are associated with coagulopathy including "high-grade inflammation, hypoxia, immobilization, and diffuse intravascular coagulation," and state that "direct damage to the endothelium by the virus is not yet demonstrated." 1 They surmise that thrombosis may not be secondary to direct endothelial damage by virus particle but rather that it may be a result of an immune response to viral infection of the endothelial cells which persists long beyond the acute phase of infection. 2hile hypoxia and immobilization can certainly enhance thrombosis in patients with COVID-19, we have seen arterial thrombosis in patients with COVID-19 who present without history of respiratory symptoms, without hypoxia, and who were completely ambulatory.In fact, the patient's first presentation to the hospital was a thrombotic event. 3Furthermore, the case series published by Bozzani et al. included 2 patients with early rethrombosis of the lower extremities within 24 hr of thrombectomy suggesting lower extremity tissue-specific preponderance in the acute phase rather than just the pleiotropic response of COVID-19 infection with global, unregulated inflammatory cascade. 2 In conclusion, we agree with Bozzani et al. that the mechanism of acute arterial thrombosis in COVID-19 patients is unclear and likely multifactorial.We wish to encourage more tissue studies to clarify the question of an infectious angiitis as a component of this pathology.There have been reports of viral invasion in
This paper aims to determine an effective method, if any, if it is possible to enhance fingerprints on rusted metals such as tin and steel. This will be accomplished using common enhancements techniques such as Redwop, cyanoacrylate glue fuming, Dragon’s Blood, and black magnetic powder. Redwop proved to be an effective method on both the tin and steel samples tested. The other methods were also successful to a degree on the remaining tin samples except for cyanoacrylate glue fuming. The results show that to a degree, it is possible to visualize fingerprint ridge detail over varying heavily rusted portions of metal with multiple techniques. The study does not attempt any extraction methods, but it does effectively show that fingerprints may be enhanced on varying degrees of rusted metals.
