Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by intense itch and eczematous lesions. Nemolizumab, an interleukin-31 receptor alpha antagonist, has shown efficacy and safety with background topical corticosteroids and/or topical calcineurin inhibitors in the ARCADIA 1&2 phase 3 trials, and is approved for the treatment of moderate-to-severe AD in individuals aged ≥12 years in several countries including, the US and Europe. However, there is a need for a study that better reflects real-world settings and routine clinical practice beyond the limitations of controlled trials. Objective: To report key design features of RE-UNITE-AD study. Methods: RE-UNITE-AD (NCT06988605) is a prospective, multicenter, non-interventional study (NIS) in adults and adolescents with moderate-to-severe AD who are newly initiated on nemolizumab per physician’s discretion in accordance with the local label. This AD study aims to enroll 1000 participants across 200 sites in Europe and North America. AD patients with peak pruritus numerical rating scale (PP-NRS) score ≥7 without prior biologic/Janus kinase inhibitors (JAKi) (or use more than 3 months before baseline) or PP-NRS ≥4 for those with recent discontinuation of biologic/JAK inhibitors (less than 3 months before baseline) are eligible for this study. Patients with any PP-NRS score may be enrolled if the reason for discontinuation of prior biologic/JAKi is safety-related. Patients who have contraindication(s) for the use of nemolizumab per the local label and/or treatment with a drug under clinical development/investigation within 3 months prior to baseline are excluded. Primary endpoints evaluated Investigator’s Global Assessment (IGA) and PP-NRS scores in clinical practice at month 6. Secondary endpoints evaluated Eczema Area and Severity Index, Scoring Atopic Dermatitis, IGA, PP-NRS, Average Pruritus-NRS, Sleep Disturbance-NRS, and Pain-NRS scores through month 12. Additional assessments include itch-scratch behaviour, quality of life, and patient-perceived benefit. Safety endpoints include serious adverse events regardless of causality and non-serious adverse drug reactions. Conclusion: This NIS reflects real-world clinical practice and is expected to complement the existing evidence from pivotal trials on the clinical effectiveness and safety of nemolizumab in patients with moderate-to-severe AD.

Prurigo nodularis (PN) is a chronic neuroimmune‐mediated skin disease that requires comprehensive assessment and targeted management to optimize patient care. The objective of this consensus exercise was to generate an evidence‐based overview of the diagnosis and management of patients with PN for Canadian dermatologists and other healthcare professionals. Based on a review of the current literature and guided by a steering committee of 4 Canadian experts in the management of PN, statements were developed on the topics of disease definition, pathophysiology, assessment, and treatment. A panel of 14 dermatologists and 1 allergist used an 11‐point Likert scale to vote on their belief of agreement with statements generated using a modified Delphi process. Six statements reached consensus. Reflecting the consolidated clinical opinions and experience of the expert panel, these recommendations aim to guide Canadian physicians on the diagnosis and treatment of PN.

Background Topical corticosteroids (TCS) remain the first-line treatment for atopic dermatitis (AD) and related inflammatory skin diseases, yet no standardized definition of response exists. This gap contributes to heterogeneity in clinical practice and complicates trial design. We therefore aimed to develop consensus-based definitions of response and inadequate response to TCS therapy through a structured international eDelphi process. Methods A PubMed search (1974–July 2025) identified 403 relevant publications. Candidate statements were drafted from the evidence and refined by the ADCARE Steering Committee, categorized into 3 domains (status quo, unmet need, proposals), and evaluated in a three-round eDelphi survey among certified ADCARE members. Eighty-four dermatologists and allergists from 32 countries participated (Round 1 response rate 98%; Round 2, 80%; Round 3, 76%). Statements were rated on a 5-point Likert scale; consensus was defined as ≥75% agreement (scores 4 or 5). Results In total, 66 of 83 statements reached consensus. In the status quo domain, agreement centred on baseline severity, body surface area, and anatomical site as guiding factors for TCS choice, with potency and licensed duration considered central to safe prescribing. In the unmet-need domain, experts highlighted the absence of standardized definitions, variability in monitoring and escalation strategies, and gaps in long-term evidence and integration of patient-reported outcomes. In the proposal domain, consensus supported relative improvement thresholds (≥50% in EASI, SCORAD, itch NRS, IGA, PGA, POEM) and 14 days as a meaningful evaluation point. Absolute cut-offs, very short (7 days) or long (3 months) timeframes, and rigid escalation rules did not achieve consensus. These parameters were synthesized into concise and extended definitions of TCS response and inadequate response. Conclusions This GA2LEN ADCARE initiative represents the first international consensus on defining TCS response and inadequate response, offering a framework to harmonize clinical practice, enhance trial comparability, and support guideline development.

BACKGROUND:Ultraviolet B (UVB) phototherapy is recommended in clinical guidelines for atopic dermatitis, but it is uncertain whether narrowband or broadband UVB is more effective and better tolerated. OBJECTIVES:To compare, in a parallel-group randomized clinical trial, the efficacy and safety of broadband with narrowband UVB for the treatment of moderate-to-severe atopic dermatitis. METHODS:Participants were aged ≥ 18 years and had moderate-to-severe atopic dermatitis that was refractory to topical corticosteroid treatment. Participants were randomized 1 : 1 via a centralized computer randomization scheme to full-body broadband or narrowband UVB phototherapy, with ongoing concomitant topical therapy. Participants were blinded to the treatment, but the treating and assessing clinicians were not. The primary outcome was change in Eczema Area and Severity Index (EASI) at 12 weeks. Secondary outcomes included achieving 0 or 1 and an improvement of ≥ 2 on the validated Investigator Global Assessment for Atopic Dermatitis scale (vIGA-ADTM) and change in Patient-Oriented Eczema Measure (POEM), Peak Pruritus Numeric Rating Scale (PP-NRS), Dermatology Life Quality Index (DLQI) and Recap of atopic eczema (RECAP). Efficacy analyses were conducted on a modified intention-to-treat (ITT) population, including all randomized participants who received at least one dose of phototherapy. The trial was registered with ClinicalTrials.gov (NCT04818138). RESULTS:Thirty-four participants were randomized to broadband UVB and 35 to narrowband UVB. Thirty-two participants received at least one dose of broadband UVB and 34 received at least one dose of narrowband UVB and were included in the modified ITT analysis. The mean (SD) patient age was 37.1 (15.9) years in the broadband UVB arm and 33.2 (12.1) in the narrowband UVB arm. The mean change in EASI score in the broadband UVB arm was -8.1 [95% credible interval (CrI) -12.1 to -4.1] and in the narrowband UVB arm it was -8.9 (95% CrI -13.0 to -4.9). In the adjusted analysis, the difference between arms in change in EASI was -0.7 (95% CrI -5.6 to 4.1). There were no significant differences between arms for vIGA, POEM, PP-NRS, DLQI or RECAP. Four patients withdrew from phototherapy due to adverse events in the broadband arm; none withdrew from the narrowband arm. CONCLUSIONS:In this study, broadband and narrowband UVB were similarly effective for the treatment of moderate-to-severe atopic dermatitis. Narrowband UVB was better tolerated.

Chronic inflammatory skin diseases (CISD) including atopic dermatitis (AD), psoriasis, and hidradenitis suppurativa (HS) are chronic conditions contributing to health inequities. Their burden among North American Indigenous peoples remains poorly characterized. This scoping review assessed Indigenous representation in clinical research, Phase III/IV trials, and practice guidelines on CISD in Canada and the United States, identifying evidence gaps and proposing strategies to enhance inclusion. Following PRISMA-ScR methodology, MEDLINE, Embase, CINAHL, Cochrane Library, Indigenous-focused databases, and gray literature were searched from inception to May 2022. Phase III/IV therapeutic trials for AD and psoriasis (2011-2021) were reviewed separately to evaluate reporting of Indigenous participants and North American guidelines were screened for Indigenous considerations. Of 49 studies included, 39% specifically focused on Indigenous populations of primarily pediatric, rural, and remote Canadian cohorts. Prevalence estimates for AD among Indigenous children ranged from 10% to 25%, with frequent comorbid asthma. Data on psoriasis suggested potentially higher morbidity among First Nations populations, while HS evidence was extremely limited. Indigenous representation was minimal in clinical trials (1.3% of total participants reported under Indigenous categories across included Phase III/IV therapeutic trial reports for AD and psoriasis), and only one recent guideline explicitly incorporated Indigenous perspectives. Overall certainty in burden estimates was low, especially for psoriasis and HS. To address these gaps, key recommendations include consistent reporting of Indigenous identity, setting recruitment targets in trials, supporting Indigenous-led cohorts and registries, and integrating Indigenous and remote care expertise into guidelines. Advancing CISD research and clinical equity requires alignment with Indigenous data sovereignty and governance principles.

Background:Atopic dermatitis is a chronic, relapsing, and remitting inflammatory skin disease. Multiple systemic therapeutic options are available to treat atopic dermatitis. Objective:To provide evidence-based recommendations on the use of systemic therapies for atopic dermatitis in Canada that consider the nuances of the Canadian healthcare system and provide guidance for populations of clinical interest. Methods:A panel of 14 experts, including 11 dermatologists from Canada and 3 from the United States, reviewed available literature on systemic therapies for atopic dermatitis. The published evidence, along with clinical expertise and opinion, was used to draft a concise set of statements to guide healthcare providers in Canada on systemic treatment of atopic dermatitis. Results:During 3 rounds of virtual meetings with all 14 experts voting in all meetings, a total of 29 statements reached the 75% agreement required for consensus. Limitations:The consensus statements are based on expert opinions and consensus in the absence of evidence-based clinical research for patient outcomes. The statements represent considerations for patient management and not specific guidelines for patient treatment. Conclusion:The recommendations and statements provided serve to guide Canadian healthcare providers on the practical aspects of managing systemic-eligible patients with atopic dermatitis.

Northern and rural Canadian Indigenous communities (NRCIC) are well known to face health disparities, yet many remain formally not documented, including dermatologic challenges. We performed a mixed methods cross-sectional national survey of healthcare practitioners (HCPs) (n=50; mostly dermatologists, general practitioners, nurses, and pediatricians) to better understand the current NRCIC dermatology status and care needs, barriers to accessing dermatology and impacts of the COVID-19 pandemic, facilitators and barriers to virtual care, and practitioner recommendations. Most HCP participants identified NRCIC as underserviced in dermatologic care. HCPs reported atopic dermatitis and bacterial skin infections among the most common conditions, and consistently raised concerns for disproportionately severe and inadequately managed disease compared to urban populations. Barriers to accessing dermatology care in NRCIC broadly encompassed proximity to care, long wait times, inadequate supply and access to therapies, impractical and burdensome skin care regimens, socioeconomic and implementation barriers, transportation challenges, and cultural barriers. Although the COVID-19 pandemic helped establish virtual care for NRCIC to mitigate access-to-care issues, participants identified travel and cost-effectiveness barriers, concerns for poor infrastructure to sustain virtual care, inadequate photo quality, and lack of in-person care as persistent and growing problems. As future solutions, HCPs recommended increasing in-person dermatologist visits to remote communities, increasing educational dermatology care programs for rural HCPs, increasing use of virtual care to these communities, stimulating assistance (eg. coordinators) to facilitate care, and further cultural safety training. Future research addressing NRCIC, including direct input from community members, may help bridge dermatologic care gaps and improve health equity.

Epigenetic age acceleration has previously been observed in inflammatory skin disease; however, less is known regarding recently described age-related gene expression patterns ("transcriptional clocks"). We investigated the role of transcriptional clocks in patients with hidradenitis suppurativa (n = 37), those with atopic dermatitis (n = 27), those with plaque psoriasis (n = 28), and healthy subjects (n = 38) using 7 clock algorithms, to improve the understanding of underlying pathophysiology and disease trajectory. Five of 7 transcriptional clocks demonstrated moderate-to-strong accuracy in predicting age across groups (patients with atopic dermatitis: ρ = 0.40-0.86, those with hidradenitis suppurativa: ρ = 0.46-0.74, those with plaque psoriasis: ρ = 0.50-0.80, healthy subjects: ρ = 0.32-0.60; P < .05). Age acceleration was observed in lesional versus healthy (patients with atopic dermatitis: +3.9∼9.8y, t = 2.8∼5.9; those with hidradenitis suppurativa: +5.0∼6.1y, t = 2.5∼4.1; those with plaque psoriasis: +6.5∼12.5y, t = 5.1∼8.0; P < .05) and in lesional versus nonlesional skin in all diseases and less frequently observed in nonlesional versus healthy skin. In atopic dermatitis, loss-of-function sequence variants in the FLG gene were associated with transcriptional age acceleration, including FLGR244X/2282del4 dual carrier status (t = 2.3, P < .05) and FLGR501X carrier status (t = 2.6, P < .05). Pathway enrichment analyses revealed that clock genes are enriched in signatures related to aging, inflammation, and metabolism. Our study provides evidence for transcriptional age acceleration in inflammatory skin disease and sets a foundation for further investigation into the role of age-related transcriptional changes in the pathophysiology of these diseases.

Introduction: Atopic dermatitis (AD) patients have a high burden of mental health comorbidities, and approaches to management with adults have not been systematically studied. We aimed to review guideline-based mental health recommendations for adult AD patients and to compare with empiric evidence for suggested interventions with a group of diverse AD stakeholders.

Disparities in environmental and social determinants of health (DOH) are associated with morbidity in atopic dermatitis (AD). The socioecological model (SEM) is a framework that can be applied to better understand how such DOH impacts patients with AD. We include a case scenario of a remote Indigenous patient reflective of real-world situations of living with AD and examine relevant impact, gaps in knowledge, and further research needs. This review highlights a variety of social and environmental exposures as important DOH which must be addressed to achieve optimal management in AD. The "rainbow model" is a modified framework to help illustrate how complex environmental and social forces impact both AD presentation and therapeutic success. However, practical applications and outcome metrics for health promotion are limited. An inter- and transdisciplinary approach is paramount to address the complex challenges associated with AD care, as well as multistakeholder approach integrating culturally-competent equitable health frameworks. This review underscores the importance of expanding the focus of AD management beyond basic science and clinical trials to recognize and address health disparities and to promote optimal health and well-being in patients with AD, and contributes a working approach to mapping the complex interventions and patient-oriented research needed using a focus on remote North American Indigenous patients affected by AD.

Gene expression has been shown to be associated with dysregulated aging and age-related diseases(1). To this end, we investigated the role of transcriptional age, referring to chronological age that has been predicted using algorithmic genome-wide RNA transcription signatures, in the pathobiology of atopic dermatitis and psoriasis, by leveraging a public transcriptional dataset generated using the Illumina HiSeq 2500 platform (GSE121212). The cohort includes lesional and non-lesional skin from adults with atopic dermatitis (n=28, mean age 34.1 ± 11.0, 10F/17M) and plaque psoriasis (n=27, mean age 41.9 ± 15.7, 14F/14M), and healthy subjects (n=38, mean age 32.6 ± 11.6, 22F/16M). Transcriptional age was calculated for five validated algorithms using the RNAAgeCalc package(2). Transcriptional age dysregulation (discrepancy between predicted and true age) was calculated as the mean groupwise difference in residuals generated from the linear regression of calculated on chronological age. Compared to healthy subjects, transcriptional age was accelerated in both atopic dermatitis (+2.6∼8.0 [95%-CI 0.3∼10.8] years, p=9.1x10-7∼4.1x10-2) and psoriasis (+5.2∼7.2 [95%-CI 2.2∼9.9] years, p=6.8x10-6∼1.0x10-3). Moreover, both keratosis pilaris (+5.1∼5.4 [95%-CI 0.7∼9.3] years, p=1.6x10-2∼2.1x10-2) and palmar hyperlinearity (+5.3∼21.1 [95%-CI 0.1∼32.6] years, p=1.2x10-5∼4.3x10-2) were associated with accelerated transcriptional age, the latter trend being more pronounced proportional to the strength of hyperlinearity in both lesional and non-lesional skin. In keeping with prior pathway enrichment analyses of transcriptional age genes(3), these findings suggest that accelerated transcriptional age is associated with a proinflammatory state and skin barrier loss, and highlight transcriptional aging algorithms as potential biomarkers in elucidating the complex mechanisms underlying inflammatory skin diseases.

Lebrikizumab treatment in moderate-to-severe atopic dermatitis (AD) improved patient-reported outcomes in the phase-3 trials ADvocate1&2 (monotherapy) through 52 weeks and ADhere (combination topical corticosteroids) through 16 weeks. We report the impact of lebrikizumab on AD signs/symptoms as reported by the Patient-Oriented Eczema Measure (POEM) at week 104 of continuous treatment in ADjoin, a long-term extension.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease resulting from the complex interplay of genetic and environmental factors, meriting exploration using temporally dynamic biomarkers. DNA methylation-based algorithms have been trained to accurately estimate biological age, and deviation of predicted age from true age (epigenetic age acceleration) has been implicated in several inflammatory diseases, including asthma. Objective: We sought to determine the role of epigenetic and biological aging, telomere length, and epigenetically inferred abundance of 7 inflammatory biomarkers in AD. Methods: We performed DNA methylation-based analyses in a pediatric AD cohort (n = 24, mean +/- standard deviation [SD] age 2.56 +/- 0.28 years) and age-matched healthy subjects (n = 24, age 2.09 [0.15] years) derived from blood using 5 validated algorithms that assess epigenetic age (Horvath, Skin&Blood) and biological age (PhenoAge, GrimAge), telomere length (TelomereLength), and inflammatory biomarker levels. Results: Epigenetic and biological age, but not telomere length, were accelerated in AD patients for 4 algorithms: Horvath (+0.88 years; 95% confidence interval [CI], 0.33 to 1.4; P = 2.3 x 10-3), Skin&Blood (+0.95 years; 95% CI, 0.67 to 1.2; P = 1.8 x 10-8), PhenoAge (+8.2 years; 95% CI, 3.4 to 13.0; P = 1.3 x 10-3), and GrimAge (+1.8 years 95% CI, 0.22 to 3.3; P = .026). Moreover, patients had increased levels of (32 microglobulin (+47,584.4 ng/mL; P = .029), plasminogen activation inhibitor 1 (+3,432.9 ng/mL; P = 1.1 x 10-5), and cystatin C (+31,691 ng/mL; P = 4.0 x 10-5), while levels of tissue inhibitor metalloproteinase 1 (-370.7 ng/mL; P = 7.5 x 10-4) were decreased compared to healthy subjects. Conclusion: DNA methylation changes associated with epigenetic and biological aging, and inflammatory proteins appear early in life in pediatric AD and may be relevant clinical biomarkers of pathophysiology. (J Allergy Clin Immunol Global 2024;3:100275.)

Journal of the European Academy of Dermatology and VenereologyEarly View LETTER TO THE EDITOR Dysregulation of epigenetic, biological and mitotic age in the context of biologic drug treatment and phototherapy in plaque psoriasis patients Richie Jeremian, Corresponding Author Richie Jeremian [email protected] orcid.org/0000-0001-9258-6296 Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada McGill University Health Centre (MUHC) Center of Excellence for Atopic Dermatitis, Montréal, Quebec, Canada Correspondence Richie Jeremian, Faculty of Medicine and Health Sciences, McGill University, Research Institute of the McGill University Health Centre (RI-MUHC), 1001 Decarie Boulevard, Montréal, QC H4A 3J1, Canada. Email: [email protected]Search for more papers by this authorYuliya Lytvyn, Yuliya Lytvyn orcid.org/0000-0003-1805-9994 Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaSearch for more papers by this authorRayyan Fotovati, Rayyan Fotovati Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, CanadaSearch for more papers by this authorKaiyang Li, Kaiyang Li orcid.org/0000-0001-8557-166X Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada McGill University Health Centre (MUHC) Center of Excellence for Atopic Dermatitis, Montréal, Quebec, CanadaSearch for more papers by this authorAlexandra Malinowski, Alexandra Malinowski Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, CanadaSearch for more papers by this authorMuskaan Sachdeva, Muskaan Sachdeva orcid.org/0000-0002-2252-5663 Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaSearch for more papers by this authorCarolyn Jack, Carolyn Jack Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada McGill University Health Centre (MUHC) Center of Excellence for Atopic Dermatitis, Montréal, Quebec, CanadaSearch for more papers by this authorMelinda Gooderham, Melinda Gooderham orcid.org/0000-0001-8926-0113 SKiN Centre for Dermatology, Peterborough, Ontario, CanadaSearch for more papers by this authorDavid O. Croitoru, David O. Croitoru Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaSearch for more papers by this authorJensen Yeung, Jensen Yeung Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaSearch for more papers by this authorVincent Piguet, Vincent Piguet Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Ontario, CanadaSearch for more papers by this author Richie Jeremian, Corresponding Author Richie Jeremian [email protected] orcid.org/0000-0001-9258-6296 Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada McGill University Health Centre (MUHC) Center of Excellence for Atopic Dermatitis, Montréal, Quebec, Canada Correspondence Richie Jeremian, Faculty of Medicine and Health Sciences, McGill University, Research Institute of the McGill University Health Centre (RI-MUHC), 1001 Decarie Boulevard, Montréal, QC H4A 3J1, Canada. Email: [email protected]Search for more papers by this authorYuliya Lytvyn, Yuliya Lytvyn orcid.org/0000-0003-1805-9994 Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaSearch for more papers by this authorRayyan Fotovati, Rayyan Fotovati Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, CanadaSearch for more papers by this authorKaiyang Li, Kaiyang Li orcid.org/0000-0001-8557-166X Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada McGill University Health Centre (MUHC) Center of Excellence for Atopic Dermatitis, Montréal, Quebec, CanadaSearch for more papers by this authorAlexandra Malinowski, Alexandra Malinowski Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, CanadaSearch for more papers by this authorMuskaan Sachdeva, Muskaan Sachdeva orcid.org/0000-0002-2252-5663 Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaSearch for more papers by this authorCarolyn Jack, Carolyn Jack Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada McGill University Health Centre (MUHC) Center of Excellence for Atopic Dermatitis, Montréal, Quebec, CanadaSearch for more papers by this authorMelinda Gooderham, Melinda Gooderham orcid.org/0000-0001-8926-0113 SKiN Centre for Dermatology, Peterborough, Ontario, CanadaSearch for more papers by this authorDavid O. Croitoru, David O. Croitoru Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaSearch for more papers by this authorJensen Yeung, Jensen Yeung Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaSearch for more papers by this authorVincent Piguet, Vincent Piguet Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Ontario, CanadaSearch for more papers by this author First published: 15 April 2024 https://doi.org/10.1111/jdv.19978Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. 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Background: Atopic dermatitis (AD) is a common, chronic skin disease normally managed in outpatient settings, with emergency department (ED) and inpatient care often representing a failure of standard care with consequent added costs for healthcare systems.