Atopic dermatitis is commonly associated with depressive symptoms and fatigue, which significantly impact quality of life. While clinical trials suggest beneficial effects of dupilumab on mental health, real-world evidence remains limited. This longitudinal cohort study analysed data from adult patients treated with dupilumab in the TREATgermany registry. Subgroups were defined by baseline Center for Epidemiologic Studies Depression Scale (CES D) scores ≥16 (clinically significant depressive symptoms) and Fatigue Severity Scale (FSS) scores >4 (significant fatigue). Clinical severity (Eczema Area and Severity Index [EASI], objective Scoring Atopic Dermatitis [oSCORAD]), quality of life (DLQI), psychological symptoms, treatment needs and benefits (PNQ, PBI) and drug survival were assessed over 12 months. Among 633 patients, those with elevated baseline CES-D (n=309) or FSS (n=281) scores reported greater disease burden measured by DLQI, while EASI and oSCORAD did not differ between subgroups. Both CES-D and FSS scores decreased markedly within the first 3 months. Sleep and social functioning needs were more frequently reported in high-burden subgroups and more often fulfilled after 12 months. Drug survival was comparable across subgroups. Dupilumab treatment was associated with significant improvements in depressive symptoms, fatigue and skin severity. Patients with higher baseline mental health burden showed comparable improvements in patient relevant domains, supporting the broad relevance of dupilumab in real-world atopic dermatitis care.

This guideline is a partial update of the S3 guideline on atopic dermatitis (AWMF register no. 013-027) published in 2023. The chapters on systemic therapy with biologics and Janus kinase inhibitors as well as the chapter on pregnancy, breastfeeding and family planning in the context of systemic therapies for atopic dermatitis have been updated. This was prompted by new approvals (lebrikizumab, nemolizumab), approval extensions (abrocitinib from 12 years of age, baricitinib from 2 years of age) and new evidence on the use of biologics before and during pregnancy. In addition, a new chapter on treatment goals, treatment expectations and criteria for treatment adjustment ("treat-to-target") in systemic therapies has been added to the guideline. This article only presents the updated and newly added chapters. The complete guideline is available on the AWMF website.

BACKGROUND:Atopic dermatitis (AD) substantially affects quality of life, yet standardized severity measures may not capture patient-centred priorities, making systematic needs assessment essential for personalized care. OBJECTIVES:This study aimed to systematically assess and rank treatment needs in adults with moderate to severe AD, identify patient subgroups with distinct need profiles and evaluate how well these needs were met after 2 years of specialized dermatological care. METHODS:In this prospective observational study from the TREATgermany registry, 697 adults with moderate to severe AD completed the validated Patient Benefit Index (PBI) at baseline (T1) and at 2-year follow-up (T2), capturing treatment goal importance and achievement. Subgroup analyses were performed based on age, sex, educational status and age at AD onset. Associations between clinical measures and perceived benefit were analysed. RESULTS:The most frequently prioritized treatment goals were being free of itching (97.8% high agreement), regaining control of the disease (95.3%) and relief from skin burning (92.0%). The importance of itch reduction was not correlated with baseline pruritus intensity, and perceived benefit was more closely linked to relative clinical improvement than to absolute disease severity. Beyond these shared priorities, treatment needs varied across subgroups: older patients valued treatment safety and reduced dependence on medical care, women emphasized psychosocial and appearance-related goals, individuals with lower educational status highlighted financial concerns and patients with adult-onset AD prioritized diagnostic certainty and disease control. After 2 years, 96.6% of patients reported meaningful treatment benefit. Patient-reported outcomes (POEM) were more strongly associated with perceived benefit than physician-assessed measures (oSCORAD, EASI). CONCLUSION:Patient treatment needs in AD vary by demographic and clinical factors, with pruritus consistently rated as the highest priority. Patient-reported outcomes align more closely with perceived benefit than physician assessments, underscoring the value of systematic needs assessments to guide individualized treatment decisions and shared decision-making.

Atopic dermatitis (AD) is driven by type 2 inflammation, with interleukin-13 (IL-13) as one of the central operators. Lebrikizumab is a monoclonal antibody that inhibits IL-13 signalling. Adult patients with moderate-to-severe AD who received lebrikizumab in the TREATgermany registry until 12/2024 were selected, and patient characteristics as well as effectiveness and safety outcomes after 1, 3 and 6 months were evaluated. A total of 108 patients were initiated on lebrikizumab, with 80 having follow-up data available for this analysis (“registry cohort”). Forty-one patients were switched to lebrikizumab without a “washout period” from another advanced systemic therapy (“switchers”). The mean Eczema Area and Severity Index (EASI) decreased from 14.8 at baseline to 5.6 and 3.0 at month 3 and month 6 and was comparable between switchers and nonswitchers. Clinically meaningful improvements were also seen across all patient reported outcomes (PROs) equally in both groups, e.g. a decrease of the mean peak pruritus numeric rating scale (PP-NRS) from 6.6 to 3.8 and 3.4 and the Dermatology Life Quality Index (DLQI) from 11.9 to 4.9 and 4.8. Overall, adverse events (AEs) were reported for 26.6% of patients within the first 3. The most frequently reported AE was conjunctivitis or other ocular complications, reported in 13 patients (20.3%). 32 patients (40%) had an initial EASI≥16 and were comparable to patients in lebrikizumab phase 3 studies. In this “trial-like” cohort, EASI-75 and EASI-90 response rates were 60% and 26.7% at month 3 and 70% and 50% at month 6. Lebrikizumab shows effectiveness in routine care well comparable to observations made in randomized controlled trials.

BACKGROUND AND OBJECTIVES:The relationship between atopic dermatitis (AD), weight, height, and body mass index (BMI) in children and adolescents and the impact of systemic treatments is controversial. We report the distribution of weight, height, and BMI in the German TREATkids cohort compared to a standardized German cohort (Kromeyer-Hauschild) and the impact of systemic glucocorticoids. PATIENTS AND METHODS:This multicenter, prospective study analyzed weight and height data from pediatric patients (2-17 years) with moderate-to-severe AD enrolled in TREATkids. RESULTS:According to Kromeyer-Hauschild metrics, the median height, weight, and BMI of the TREATkids cohort were 42nd, 52nd, and 59th percentiles, respectively. A height deficit was observed compared to the reference population. Despite shorter stature, the children exhibited weight percentiles comparable to the general population. This combination of reduced height and normal weight led to high BMI-for-age percentiles. A sensitivity analysis excluding patients who had received systemic corticosteroids showed similar results for height-for-age, weight-for-age, and BMI-for-age percentiles. CONCLUSIONS:Children and adolescents with moderate-to-severe AD in TREATkids exhibit distinct anthropometric patterns, characterized by height deficits but normal weight distribution, independent of systemic glucocorticoid treatment.

Real-world evidence on clinical and molecular outcomes of systemic therapy for pediatric atopic dermatitis remains limited. Within the prospective TREATkids registry, we conducted an observational analysis of children and adolescents treated with dupilumab in routine care. Baseline data from 200 and follow-up data from 124 patients were evaluated for clinician- and patient-/caregiver-reported outcomes, alongside epidermal proteomic profiling using tape strips and the Olink Explore Inflammation 384 (n = 20) panel and 16S ribosomal RNA gene sequencing for skin microbiome assessment in subsets (n = 48). At treatment initiation, disease burden was high (mean Eczema Area and Severity Index = 16.5, objective SCORing Atopic Dermatitis = 44.9, peak pruritus numerical rating scale = 6.6). By month 3, Eczema Area and Severity Index 50, 75, and 90 response rates were 87, 60, and 30%. Response rates at months 6 and 12 were generally consistent with those observed at month 3, with no discontinuations and conjunctivitis occurring in 4.0%. Proteomic analyses demonstrated marked baseline upregulation of alarmins, T helper 2 chemokines, and tissue-remodeling markers in lesional skin, followed by downregulation of 144/161 dysregulated proteins at month 3, including CCL17/TARC, CXCL8, IL-6, IL-18, and matrix metalloproteinases. Microbiome profiling showed baseline dysbiosis with Staphylococcus aureus overabundance and reduced α-diversity, normalizing toward a nonlesional-like state after therapy at month 3. Overall, dupilumab was associated with rapid, sustained clinical and molecular improvement.

Abstract BackgroundAtopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases, associated with itching, sleep disturbance, and impaired quality of life. Structured patient education can improve disease outcomes, but in-person programs are often unavailable in rural or underserved areas. Digital interventions may help overcome these barriers; however, their efficacy compared with routine care has not been evaluated. ObjectiveThis study aims to assess whether a digitally delivered, interdisciplinary care concept (ADCompanion) is noninferior to routine, real-world care, as available in well-served areas, in reducing disease severity among patients with AD. Secondary objectives include effects on quality of life, pruritus, psychosocial burden, family well-being, and health care costs. MethodsThis is a prospective, multicenter, 2-arm, 1:1 randomized noninferiority trial. Participants are stratified by age and disease severity. The intervention group receives standard therapy plus access to a digital platform with training modules and optional video consultations on skin care, nutrition, and psychosocial support. The control group receives routine care, optionally including face-to-face group training where available, and a basic app version for symptom tracking. The primary endpoint is physician-assessed disease severity (Scoring Atopic Dermatitis Index [SCORAD]) at 6 months; secondary endpoints include patient-reported outcomes, itch, quality of life, and disease-related costs. ResultsRecruitment of 603 participants across 7 centers in Germany was completed. Data collection was finalized in June 2025. At the time of protocol submission (February 2026), data cleaning had been completed, and the statistical analysis plan was finalized; final results are expected to be published in 2026. ConclusionsThis protocol describes a randomized trial designed to evaluate whether digitally delivered interdisciplinary care is noninferior to routine care for patients with AD. The findings of this study will inform the role of digital patient education as a complementary component within established care structures.

The TREATgermany registry was set up in 2016. We provide results on long-term dupilumab therapy in adults with moderate and severe atopic dermatitis (AD) in a routine care setting. The analysis cohort of 294 patients is one of the largest cohorts with 2-year follow-up data on treatment effects of dupilumab obtained from an AD registry to date. We report the Harmonising Outcome Measures for Eczema (HOME) core outcome set. The Eczema Area Severity Index (EASI) 75 and EASI 90 response rates for patients on treatment at month 24 were 78.8% and 51.2%, respectively.

BACKGROUND:Sodium lauryl sulfate (SLS) has been included as an irritant control in the baseline patch test series of the German Contact Dermatitis Research Group (DKG) for two decades, although its diagnostic value remains controversial. OBJECTIVE:To evaluate the strengths and limitations of SLS as an irritant control in patch testing. METHODS:We retrospectively analysed data from 43 478 consecutive patients patch tested with 0.25% SLS aq. and 189 allergens within the IVDK network. SLS reactions were graded from 1 (weak) to 5 (strong). Associations between SLS reactivity and allergen-specific responses were examined. RESULTS:Overall, 22.4% of all patients reacted positively to SLS, most with weak erythema (SLS 1). Stronger SLS reactions (SLS 2-5) were associated with male sex, age ≥ 40 years, occupational dermatitis and hand dermatitis. Positive SLS reactions correlated with several allergens of high irritative potential, notably cocamidopropyl betaine, formaldehyde, sorbic acid and diphenylguanidine. In contrast, plant-derived allergens showed weak or inconsistent associations. Importantly, grading SLS reactions (1-5) did not improve diagnostic discrimination compared to a simple positive/negative classification. CONCLUSION:While SLS can indicate skin irritability for certain allergens, it is not a universal marker. Our large-scale analysis supports binary SLS classification and provides a robust evidence base for the ongoing debate on whether and how irritant controls should be used in patch testing.

Atopic dermatitis (AD) is an inflammatory, multifactorial skin disease characterized by eczematous skin lesions, severe itching, and serious limitations in quality of life. Since 2016, TREATgermany has been a national clinical registry for patients with moderate to severe AD with around 2,550 participating patients, enabling the collection of physical, patient-reported social and psychological data as well as the collection of biosamples in routine care. TREATgermany is one of the largest academically managed AD registries in the world. This current review summarizes a selection of published analyses from registry data from TREATgermany, which retrospectively identified important correlations with regard to treatment response and safety, and investigated quality of life, performance, and mental health under everyday conditions. In addition, initial molecular signatures were identified from the blood and skin samples obtained from the patients included in the registry, which may be useful as prognostic markers.

Unter dem Präventionsbegriff versammeln sich Maßnahmen, die eingesetzt werden, um Krankheiten oder gesundheitliche Schädigungen zu vermeiden sowie das Risiko der Erkrankung verringern oder ihr Auftreten zu verzögern. Einteilen lassen sich Präventionsmaßnahmen anhand verschiedener Kriterien: zeitliche Differenzierung (Primär‑, Sekundär- und Tertiärprävention), Kontext (Verhaltens- und Verhältnisprävention) und Empfänger (General- und Individualprävention). Von Gesundheitsförderung („health promotion“) wird gesprochen, wenn durch entsprechende Maßnahmen menschliche Gesundheitspotenziale und -ressourcen gestärkt und gesteigert werden sollen. Dies umfasst unter anderem Maßnahmen zur Entwicklung eines gesundheitsförderlichen Verhaltens (Empowerment) und Maßnahmen hinsichtlich der Einbindung und Beteiligung, z. B. hinsichtlich der Planung und Umsetzung eines gesundheitsförderlichen Verhaltens (Participation). Ein Ziel dieser Maßnahmen ist generell die Steigerung der Gesundheitskompetenz („health literacy“). Im vorliegenden Beitrag werden Beispiele für Maßnahmen der Prävention und Gesundheitsförderung für beruflich bedingten Hautkrebs (individuelle Lichtschutzberatung [ILB] für Außenbeschäftigte) sowie beruflich bedingte Handekzeme im Sinne der Berufskrankheit Nummer 5101 (ambulante und stationäre Individualpräventionsmaßnahmen) beschrieben, die durch das Beispiel der ambulanten altersadaptierten Kleingruppenschulungen für Patienten mit Neurodermitis nach dem jeweils multizentrisch evaluierten Konzept der Arbeitsgemeinschaft Neurodermitisschulung (AGNES e. V.) bzw. der Arbeitsgemeinschaft Neurodermitisschulung im Erwachsenenalter (ARNE) ergänzt werden. Thematisiert werden anhand dieser Beispiele auch Aspekte der Nachhaltigkeit sowie der Digitalisierung (eHealth, eLearning) im Bereich Prävention und Gesundheitsförderung.