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.

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.

Atopic dermatitis is the most common chronic condition in childhood and imposes a considerable burden on both children and their families. The German registry TREATgermany/kids systematically collects routine care data on children, adolescents, and adults with atopic dermatitis

Dupilumab is a first-in-class biologic for moderate-to-severe atopic dermatitis (AD). Whereas multiple real-world studies confirmed its robust effectiveness and favorable safety in adults,1 routine data on children and adolescents are still scarce. In an interim analysis on 61 pediatric patients of the Dutch BioDay registry dupilumab significantly improved disease severity, however, results were difficult to interprete, because a considerable proportion of patients were in the wash-out or concomitantly treated with immunosuppressants at baseline.2 TREATkids is a section of the TREATGermany registry and has been approved by the Medical Faculty of the Technical University of Dresden (No. EK 118032016) and by the respective ethics committees of the participating sites. It currently (data release May 2023) comprises 314 pediatric patients with moderate-to-severe AD (51.0% female, mean age 7.8). Their mean (±SD) baseline scores were Investigator Global Assessment [IGA, 3.2 (1.0)], Eczema Area and Severity Index [EASI, 13.4 (9.9)], peak pruritus numerical rating scale [PP-NRS, 5.5 (2.9)], and (Children's) Dermatology Life Quality Index [(c) DLQI, 9.5 (6.3)]. Systemic therapy was initiated in 99 of these 314 pediatric patients; most of them (n = 87) received dupilumab. Fifty nine of those had at least one documented follow-up visit after 3 (±14 days) or 6 months (±28 days). Baseline mean EASI, PP-NRS and (C)DLQI scores were 18.1 (±9.5), 7.1 (±2.5) and 13.0 (±5.7). Overall, dupilumab treatment led to significant reductions of all severity scores (Figure S1). The proportion of patients with an EASI50, 75 and 90 response were 92.2%, 58.8% and 25.5% at month 3, and 91.4%, 62.9%, and 48.6% at month 6, that is, slightly higher than observed in trials.3 An EASI ≤7 reflecting mild disease was achieved by 78.4% and 82.9% at month 3 and 6. PP-NRS was reduced by 55.3% and 57.6% until month 3 and 6 (p = 2.72e-06, p = 7.52e-05), and mean (C)DLQI improved by 59.7% and 62.3% (p = 7.41e-08). At month 3, 84.4% had experienced a 4-point reduction of the (C)DLQI (Table 1). Dupilumab was well tolerated with adverse events reported in only four patients. Three children experienced conjunctivitis and one child developed blepharitis, which led to discontinuation. Facial eczema was reported in one patient. A sensitivity analysis on patients with data on both month 3 and 6 indicated that while baseline characteristics did not differ significantly between children (n = 14) and adolescents (n = 14), the latter showed slightly more pronounced improvements with a median EASI reduction at month 3 of 88.2% versus 77.5%, and EASI75 response rates of 78.6% versus 57.1% (Table S1). We additionally analyzed 21 AD candidate biomarkers in tape strips from 14 patients using a Luminex assay (Bio-techne, Minneapolis, USA). Fifteen markers moderately correlated with disease severity measured by the EASI (Table S2). Eighteen proteins showed differential expression in lesional versus non-lesional skin at baseline. At month 3, 15 of these had decreased significantly (Table S3) and no longer showed significant differences to non-lesional skin. In the absence of data on healthy individuals, it is unclear whether they reached levels of non-AD skin. The most pronounced reductions were observed for fibronectin (log2FC-4.63), IL-8 (log2FC-3.52), and S100A9 (log2FC-2.13) (Figure 1). Fibronectin is central for adhesion and internalization of S. aureus.4 IL-8 has pleiotropic effects, including attraction and activation of neutrophils, which contribute to S. aureus colonization by release of neutrophil extracellular traps.5 S100A9 was reported to correlate with AD severity.6 The results from our analysis demonstrate that dupilumab treatment is safe and leads to clinical and molecular improvements in the majority of pediatric AD patients. Larger-size and longer-term routine data along with analysis of extended biomarker panels will be key to more comprehensively evaluate effects of systemic therapies in pediatric AD. Dora Stölzl and Stephan Weidinger designed the study; Inken Harder and Melina Fonfara performed biomarker measurements; Dora Stölzl, Nicole Sander and Doreen Siegels contributed to methodology and analyzed and visualized the data; Jochen Schmitt, Thomas Werfel and Stephan Weidinger supervised the analysis; Dora Stölzl, Nicole Sanders and Stephan Weidinger wrote the manuscript draft; all authors reviewed and edited the manuscript. The authors thank the participating patients and caregivers, physcians and clinical staff, the TREATGermany and TREATkids study group, and the supporters of the registry. Open Access funding enabled and organized by Projekt DEAL. TREATkids is the children and adolesent section of TREATgermany, which is an academic, investigator-initiated clinical disease registry that is financially supported by AbbVie Deutschland GmbH & Co. KG, Almirall Hermal GmbH, Galderma S.A., LEO Pharma GmbH, Lilly Deutschland GmbH, Pfizer Inc. and Sanofi. Dora Stölzl has received lecture fees from Novartis and Sanofi. Susanne Abraham has received lecture and/or consultancy fees from Novartis, LEO Pharma, Amgen, Lilly, Sanofi, Beiersdorf, Janssen, UCB and AbbVie. Sascha Gerdes has been an advisor and/or received speakers' honoraria and/or received grants and/or participated in clinical trials of the following companies: AbbVie, Acelyrin, Affibody AB, Akari Therapeutics Plc, Almirall, Amgen, Anaptys Bio, Argenx BV, Biogen Idec, Bristol-Myers Squibb, Boehringer-Ingelheim, Celgene, Dermira, Eli Lilly, Galderma, Hexal AG, Incyte Inc., Janssen-Cilag, Johnson & Johnson, Klinge Pharma, Kymab, Leo Pharma, Medac, MSD, Neubourg Skin Care GmbH, Novartis, Pfizer, Principia Biopharma, Regeneron, Sandoz, Sanofi, UCB Pharma. Katja Nemat has received lecture and/or consultancy fees from Sanofi, Stallergenes, Berlin-Chemie and HAL. Susanne Lau has received grants from Novartis, DBV, Infectopharm and honoraria from ALK, Allergopharma, Boehringer, GSK, LEO Pharma, Nutricia, Lilly, Viatris, GSK, and Sanofi-Aventis. Annice Heratizadeh reports personal fees from AbbVie, Almirall, ALK, LEO Pharma, Novartis, Pierre Fabre, Klinge Pharma, Sanofi, Beiersdorf, Hans Karrer, Nutricia, Meda, and Lilly; and grants from Janssen and Pfizer. Andreas Wollenberg has received institutional research grants, consulting fees and/or study support from Abbvie, Aileens, Almirall, Beiersdorf, Galapagos, Galderma, Glenmark, GSK, Janssen, LEO Pharma, Eli Lilly, L'Oreal, MedImmune, MSD, Novartis, Pfizer, Pierre Fabre, Regeneron, Sanofi and UCB. Jochen Schmitt reports institutional grants for investigator-initiated research from the German Federal Joint Committee, German Ministry of Health, German Ministry of Research, European Union, German Federal State of Saxony, Novartis, Sanofi, ALK, and Pfizer. He participated in advisory board meetings as a paid consultant for Sanofi, Lilly, and ALK. Prof. Schmitt serves the German Ministry of Health as a member of the German National Council for Health and Care. Thomas Werfel has received institutional grants from LEO Pharma and Novartis, has performed consultancies for Abbvie, Almirall, Janssen, Galderma, LEO, Lilly, Novartis, Pfizer and Sanofi-Regeneron and has lectured at events sponsored by Abbvie, Janssen, Celgene, Galderma, LEO Pharma, Lilly, Sanofi and Novartis. Stephan Weidinger has received institutional research grants from LEO, Pfizer and Sanofi; has been an advisor and/or received speakers' honoraria from AbbVie, Almirall, Boehringer, Eli Lilly, Galderma, LEO Pharma, Pfizer, Sanofi, and Regeneron; has participated in clinical trials of AbbVie, Almirall, Anaptys Bio, Boehringer-Ingelheim, Eli Lilly, Galderma, GSK, Incyte Inc., Janssen-Cilag, Kymab, Leo Pharma, Pfizer, Regeneron, Sanofi, UCB. All of the other authors declare they have no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Data S1. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Journal of the European Academy of Dermatology and VenereologyEarly View LETTER TO THE EDITOR Treatment of moderate-to-severe atopic dermatitis with baricitinib: Results from an interim analysis of the TREATgermany registry Stephan Traidl, Corresponding Author Stephan Traidl [email protected] orcid.org/0000-0003-4806-599X Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany Correspondence Stephan Traidl, Department of Dermatology and Allergy, Hannover Medical School (MHH), Carl-Neuberg-Str.1, 30625 Hannover, Germany. Email: [email protected]Search for more papers by this authorLuise Heinrich, Luise Heinrich Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitaet Dresden, Dresden, GermanySearch for more papers by this authorDoreen Siegels, Doreen Siegels orcid.org/0000-0002-4049-9120 Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitaet Dresden, Dresden, GermanySearch for more papers by this authorAnnice Heratizadeh, Annice Heratizadeh orcid.org/0000-0002-9231-9865 Department of Dermatology and Allergy, Hannover Medical School, Hannover, GermanySearch for more papers by this authorBarbara Kind, Barbara Kind Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitaet Dresden, Dresden, GermanySearch for more papers by this authorEva Haufe, Eva Haufe Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitaet Dresden, Dresden, GermanySearch for more papers by this authorSusanne Abraham, Susanne Abraham orcid.org/0000-0001-7457-6481 Department of Dermatology, University Allergy Center, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, GermanySearch for more papers by this authorThomas Schäfer, Thomas Schäfer Practice Dr. Med. Thomas Schaefer/Dr. Med. Doreen Belz, Derma Koeln, Köln, GermanySearch for more papers by this authorMatthias Augustin, Matthias Augustin orcid.org/0000-0002-4026-8728 Institute for Health Services Research in Dermatology Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, GermanySearch for more papers by this authorInken Harder, Inken Harder Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, GermanySearch for more papers by this authorAndreas Pinter, Andreas Pinter orcid.org/0000-0002-1330-1502 Department of Dermatology, Venereology and Allergology, Clinical Research, University Hospital Frankfurt am Main, Frankfurt am Main, GermanySearch for more papers by this authorKnut Schäkel, Knut Schäkel orcid.org/0000-0001-6344-7799 Department of Dermatology, Ruprecht-Karls University Heidelberg, Heidelberg, GermanySearch for more papers by this authorAndreas Wollenberg, Andreas Wollenberg orcid.org/0000-0003-0177-8722 Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany Department of Dermatology and Allergy, University Hospital Augsburg, Augsburg, Germany Comprehensive Center for Inflammation Medicine, University of Luebeck, Luebeck, GermanySearch for more papers by this authorKonstantin Ertner, Konstantin Ertner Practice Dr. Med. Konstantin Ertner, Nuernberg, GermanySearch for more papers by this authorJutta Ramaker-Brunke, Jutta Ramaker-Brunke Practice 'Die Hautärzte' Braunschweig, Braunschweig, GermanySearch for more papers by this authorAnne Bong, Anne Bong Practice Dr. Med. Anne Bong, Emmerich, GermanySearch for more papers by this authorSven Quist, Sven Quist Dermatology Clinic, Helix Medical Excellence Center Mainz, Mainz, GermanySearch for more papers by this authorHannah Gorriahn-Maiterth, Hannah Gorriahn-Maiterth Practice Dermasana Karlsruhe, Karlsruhe, GermanySearch for more papers by this authorFlorian Schenck, Florian Schenck Dermatology Center Hannover, Hannover, GermanySearch for more papers by this authorMichael Sticherling, Michael Sticherling Department of Dermatology, University, German Center for Immunotherapy, Erlangen, GermanySearch for more papers by this authorIsaak Effendy, Isaak Effendy Department of Dermatology Venereology and Allergology, University Hospital – Medical School OWL – University of Bielefeld, Bielefeld, GermanySearch for more papers by this authorBeate Schwarz, Beate Schwarz Practice Dr. Med. Beate Schwarz, Langenau, GermanySearch for more papers by this authorChristiane Handrick, Christiane Handrick Practice Dr. Med. Christiane Handrick, Berlin, GermanySearch for more papers by this authorAndrea Asmussen, Andrea Asmussen Practice Dr. Med. Andrea Asmussen, Dermatology at Lesum, Bremen, GermanySearch for more papers by this authorStephan Weidinger, Stephan Weidinger Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, GermanySearch for more papers by this authorJochen Schmitt, Jochen Schmitt Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitaet Dresden, Dresden, GermanySearch for more papers by this authorThomas Werfel, Thomas Werfel Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, GermanySearch for more papers by this authorthe TREATgermany study group, the TREATgermany study groupSearch for more papers by this author Stephan Traidl, Corresponding Author Stephan Traidl [email protected] orcid.org/0000-0003-4806-599X Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany Correspondence Stephan Traidl, Department of Dermatology and Allergy, Hannover Medical School (MHH), Carl-Neuberg-Str.1, 30625 Hannover, Germany. Email: [email protected]Search for more papers by this authorLuise Heinrich, Luise Heinrich Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitaet Dresden, Dresden, GermanySearch for more papers by this authorDoreen Siegels, Doreen Siegels orcid.org/0000-0002-4049-9120 Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitaet Dresden, Dresden, GermanySearch for more papers by this authorAnnice Heratizadeh, Annice Heratizadeh orcid.org/0000-0002-9231-9865 Department of Dermatology and Allergy, Hannover Medical School, Hannover, GermanySearch for more papers by this authorBarbara Kind, Barbara Kind Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitaet Dresden, Dresden, GermanySearch for more papers by this authorEva Haufe, Eva Haufe Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitaet Dresden, Dresden, GermanySearch for more papers by this authorSusanne Abraham, Susanne Abraham orcid.org/0000-0001-7457-6481 Department of Dermatology, University Allergy Center, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, GermanySearch for more papers by this authorThomas Schäfer, Thomas Schäfer Practice Dr. Med. Thomas Schaefer/Dr. Med. Doreen Belz, Derma Koeln, Köln, GermanySearch for more papers by this authorMatthias Augustin, Matthias Augustin orcid.org/0000-0002-4026-8728 Institute for Health Services Research in Dermatology Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, GermanySearch for more papers by this authorInken Harder, Inken Harder Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, GermanySearch for more papers by this authorAndreas Pinter, Andreas Pinter orcid.org/0000-0002-1330-1502 Department of Dermatology, Venereology and Allergology, Clinical Research, University Hospital Frankfurt am Main, Frankfurt am Main, GermanySearch for more papers by this authorKnut Schäkel, Knut Schäkel orcid.org/0000-0001-6344-7799 Department of Dermatology, Ruprecht-Karls University Heidelberg, Heidelberg, GermanySearch for more papers by this authorAndreas Wollenberg, Andreas Wollenberg orcid.org/0000-0003-0177-8722 Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany Department of Dermatology and Allergy, University Hospital Augsburg, Augsburg, Germany Comprehensive Center for Inflammation Medicine, University of Luebeck, Luebeck, GermanySearch for more papers by this authorKonstantin Ertner, Konstantin Ertner Practice Dr. Med. Konstantin Ertner, Nuernberg, GermanySearch for more papers by this authorJutta Ramaker-Brunke, Jutta Ramaker-Brunke Practice 'Die Hautärzte' Braunschweig, Braunschweig, GermanySearch for more papers by this authorAnne Bong, Anne Bong Practice Dr. Med. Anne Bong, Emmerich, GermanySearch for more papers by this authorSven Quist, Sven Quist Dermatology Clinic, Helix Medical Excellence Center Mainz, Mainz, GermanySearch for more papers by this authorHannah Gorriahn-Maiterth, Hannah Gorriahn-Maiterth Practice Dermasana Karlsruhe, Karlsruhe, GermanySearch for more papers by this authorFlorian Schenck, Florian Schenck Dermatology Center Hannover, Hannover, GermanySearch for more papers by this authorMichael Sticherling, Michael Sticherling Department of Dermatology, University, German Center for Immunotherapy, Erlangen, GermanySearch for more papers by this authorIsaak Effendy, Isaak Effendy Department of Dermatology Venereology and Allergology, University Hospital – Medical School OWL – University of Bielefeld, Bielefeld, GermanySearch for more papers by this authorBeate Schwarz, Beate Schwarz Practice Dr. Med. Beate Schwarz, Langenau, GermanySearch for more papers by this authorChristiane Handrick, Christiane Handrick Practice Dr. Med. Christiane Handrick, Berlin, GermanySearch for more papers by this authorAndrea Asmussen, Andrea Asmussen Practice Dr. Med. Andrea Asmussen, Dermatology at Lesum, Bremen, GermanySearch for more papers by this authorStephan Weidinger, Stephan Weidinger Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, GermanySearch for more papers by this authorJochen Schmitt, Jochen Schmitt Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitaet Dresden, Dresden, GermanySearch for more papers by this authorThomas Werfel, Thomas Werfel Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, GermanySearch for more papers by this authorthe TREATgermany study group, the TREATgermany study groupSearch for more papers by this author First published: 28 March 2024 https://doi.org/10.1111/jdv.19979 Stephan Weidinger, Jochen Schmitt and Thomas Werfel are considered as equally contributing senior authors Read 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. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Open Research DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request. REFERENCES 1Wollenberg A, Christen-Zäch S, Taieb A, Paul C, Thyssen JP, de Bruin-Weller M, et al. ETFAD/EADV eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. J Eur Acad Dermatol Venereol. 2020; 34(12): 2717–2744. 10.1111/jdv.16892 CASPubMedWeb of Science®Google Scholar 2Traidl S, Heratizadeh A. Modern systemic therapies for atopic dermatitis: which factors determine the choice of therapy? Dermatologie (Heidelb). 2022; 73(7): 529–537. 10.1007/s00105-022-05003-7 PubMedGoogle Scholar 3Bieber T. Atopic dermatitis: an expanding therapeutic pipeline for a complex disease. Nat Rev Drug Discov. 2022; 21(1): 21–40. 10.1038/s41573-021-00266-6 CASPubMedWeb of Science®Google Scholar 4Traidl S, Freimooser S, Werfel T. Janus kinase inhibitors for the therapy of atopic dermatitis. Allergologie. 2021; 44(9): 710–723. 10.5414/ALX02272 Google Scholar 5Reich K, Kabashima K, Peris K, Silverberg JI, Eichenfield LF, Bieber T, et al. Efficacy and safety of Baricitinib combined with topical corticosteroids for treatment of moderate to severe atopic dermatitis: a randomized clinical trial. JAMA Dermatol. 2020; 156(12): 1333–1343. 10.1001/jamadermatol.2020.3260 PubMedWeb of Science®Google Scholar 6Heratizadeh A, Haufe E, Stölzl D, Abraham S, Heinrich L, Kleinheinz A, et al. Baseline characteristics, disease severity and treatment history of patients with atopic dermatitis included in the German AD registry TREATgermany. J Eur Acad Dermatol Venereol. 2020; 34(6): 1263–1272. 10.1111/jdv.16078 CASPubMedWeb of Science®Google Scholar 7Traidl S, Heinrich L, Siegels D, Rösner L, Haufe E, Harder I, et al. High recurrence rate of eczema herpeticum in moderate/severe atopic dermatitis-TREATgermany registry analysis. J Dtsch Dermatol Ges. 2023; 21(12): 1490–1498. 10.1111/ddg.15205_g Google Scholar 8Williams HC, Burney PG, Hay RJ, Archer CB, Shipley MJ, Hunter JJ, et al. The U.K. working Party's diagnostic criteria for atopic dermatitis. I. Derivation of a minimum set of discriminators for atopic dermatitis. Br J Dermatol. 1994; 131(3): 383–396. 10.1111/j.1365-2133.1994.tb08530.x CASPubMedWeb of Science®Google Scholar 9Williams HC, Jburney PG, Strachan D, Hay RJ. The U.K. Working Party's diagnostic criteria for atopic dermatitis. II. Observer variation of clinical diagnosis and signs of atopic dermatitis. Br J Dermatol. 1994; 131(3): 397–405. 10.1111/j.1365-2133.1994.tb08531.x CASPubMedWeb of Science®Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Background: There are conflicting data on a potential association between obesity and atopic dermatitis (AD). The purpose of this study was to investigate the relationship between obesity and AD disease severity. Methods: Patients from the TREATgermany registry cohort were divided into three groups according to their body mass index (BMI). Due to low numbers, underweight patients (BMI <18.5 kg/m(2)) were excluded from the analysis. Physician- and patient-reported disease severity scores as well as additional phenotypic characteristics were evaluated for association with BMI. Generalized linear mixed models and multinomial logit models, respectively, were applied to investigate the association of BMI, age, sex and current systemic AD treatment with disease severity. Results: This study encompassed 1416 patients, of which 234 (16.5%) were obese (BMI >= 30 kg/m(2)). Obesity was associated with lower educational background and smoking. Otherwise, obese and non-obese AD patients had similar baseline characteristics. Increased BMI was associated with higher oSCORAD (adjusted beta: 1.24, 95% CI: 1.05-1.46, p = 0.013) and Patient-oriented eczema measure (POEM) (adjusted beta: 1.09, 95% CI: 1.01-1.17, p = 0.038). However, the absolute difference in the overall oSCORAD was small between obese and non-obese AD patients (Delta oSCORAD = 2.5). Allergic comorbidity was comparable between all three groups, with the exception of asthma which was more pronounced in obese patients (p < 0.001). Discussion: In this large and well-characterized AD patient cohort, obesity is significantly associated with physician- and patient-assessed measures of AD disease severity. However, the corresponding effect sizes were low and of questionable clinical relevance. The overall prevalence of obesity among the German AD patients was lower than in studies on other AD cohorts from different countries, which confirms previous research on the German population and suggests regional differences in the interdependence of AD and obesity prevalence.

ZusammenfassungHintergrundTREATgermany ist ein multizentrisches Register, das Patienten mit moderater bis schwerer atopischer Dermatitis (AD) aus derzeit 74 Studienzentren (Universitätskliniken, Krankenhäuser und Praxen) in Deutschland umfasst. Bis zum 31. August 2021 wurden 1.230 erwachsene Patienten eingeschlossen.MethodenIn TREATgermany füllen Patienten und Ärzte Fragebögen zu Symptomen, Krankheitsschwere, Lebensqualität, Depressivität und Fatigue aus. Die Einschränkungen der Arbeitsleistung werden insbesondere mit dem Work Limitations Questionnaire (WLQ) erfasst. Um Assoziationen zwischen beruflicher Leistung/Arbeitseinschränkungen und Symptomen zu bestimmen, wurden Korrelationen und Regressionsmodelle berechnet.ErgebnisseDie untersuchte Stichprobe von 228 berufstätigen Patienten beschrieb einen durchschnittlichen Produktivitätsverlust von 6% bei der Arbeit innerhalb der letzten zwei Wochen vor der Aufnahme in das Register. Der WLQ‐Wert für den Produktivitätsverlust war moderat mit Juckreiz (r = 0,32) und Schlafstörungen (r = 0,39) und stark mit depressiven Symptomen (r = 0,68) und Fatigue (r = 0,60) korreliert.SchlussfolgerungenDie Analysen der Registerdaten zeigen, dass eine moderate bis schwere AD einen negativen Einfluss auf die Arbeitsproduktivität der Patienten hat. Die Analysen weisen außerdem auf die relevanten Zusammenhänge zwischen Arbeitsproduktivität, depressiven Symptomen und Fatigue hin, was die durch die psychologischen Komponenten der AD verursachte Krankheitslast verdeutlicht.

BackgroundTREATgermany is a multicenter registry including patients with moderate-to-severe atopic dermatitis (AD) from currently 74 study centers (university clinics, hospitals and practices) in Germany. As of August 31, 2021, 1,230 adult patients were enrolled. MethodsIn TREATgermany, patients and physicians fill in questionnaires pertaining to symptoms, disease severity, quality of life, depressiveness, and fatigue. In particular, limitations in work performance are assessed using the Work Limitations Questionnaire (WLQ). To assess associations between occupational performance/work limitations and symptoms, correlations and regression models were calculated. ResultsThe examined sample of 228 employed patients reported an average of 6% at-work productivity loss within the past two weeks prior to enrolment in the registry. The WLQ productivity loss score was moderately associated with itch (r = 0.32) and sleep loss (r = 0.39) and strongly associated with depressive symptoms (r = 0.68) and fatigue (r = 0.60). ConclusionsThe analyses of the registry data show that moderate-to-severe atopic dermatitis has a negative impact on the work productivity of the patients. The analyses further point out the relevant associations between work productivity, depressive symptoms, and fatigue highlighting the disease burden caused by the psychological components of AD.

Background: The role of allergy as risk factor for Long-COVID (LC) is unclear. We aimed to systematically review and appraise the epidemiological evidence on allergic diseases as risk factors for LC (PROSPERO: CRD42023391245). Methods: We examined literature for prospective cohort studies with a follow-up duration of 12 months for LC symptoms, published within the timeframe from January 2020 and January 2023 that recruited individuals with confirmed SARS-CoV-2 infection and information on pre-existing allergic diseases. Risk of bias and certainty of evidence were assessed (GRADE). Random effects meta-analyses were used to pool unadjusted ORs within homogeneous data subsets. Results: We identified 13 studies (participants range = 39 - 1,950), all of which were associated with high risk of bias. Four of these studies did not provide data to calculate ORs. Significant associations were observed between increased LC incidences and pre-existing asthma measured in hospital-based populations ( n = 6) and pre-existing rhinitis ( n = 3) ( OR = 1.94; 95% CI [1.08, 3.50]; OR = 1.96; 95% CI [1.61, 2.39]), respectively. However, the level of certainty regarding these exposure outcome associations was very low. Conclusion: Findings show that allergies may increase the risk of LC, although the reliability of this evidence is tenuous.

BackgroundEczema herpeticum (EH) is a disseminated skin infection caused by herpes simplex virus in atopic dermatitis (AD) patients. The frequency of EH and the clinical features of EH patients have not yet been investigated in a larger cohort.MethodsWe sought to investigate the TREATgermany cohort, a multicenter, non-interventional clinical registry of moderately to severely affected AD patients in Germany. Baseline characteristics of patients included between December 2017 and April 2021 were compared between patients without, single, and multiple EH.ResultsOf the 893 patients, 195 (21.8%) had at least one EH. Of the 195 patients with EH, 107 had multiple EH (54.9%), representing 12.0% of the total study population. While there were no differences in demographic characteristics, previous treatment, and disease scores at enrollment (itch, IGA, oSCORAD, EASI), patients with EH had more frequent atopic comorbidities and sensitizations to house dust mite, food, and mold.DiscussionTREATgermany registry data suggest a high prevalence and recurrence rate of EH, while there appears to be no specific clinical phenotype, besides an increase in allergies, to identify EH patients in the daily routine.

BACKGROUND:About 2% of the German population are affected by psoriasis. A growing number of cost-intensive systemic treatments are available. Surveys have shown high proportions of patients with moderate to severe psoriasis are not adequately treated despite a high disease burden. Digital therapy recommendation systems (TRS) may help implement guideline-based treatment. However, little is known about the acceptance of such clinical decision support systems (CDSSs). Therefore, the aim of the study was to access the acceptance of a prototypical TRS demonstrator.METHODS:Three scenarios (potential test patients with psoriasis but different sociodemographic and clinical characteristics, previous treatments, desire to have children, and multiple comorbidities) were designed in the demonstrator. The TRS demonstrator and test patients were presented to a random sample of 76 dermatologists attending a national dermatology conference in a cross-sectional face-to-face survey with case vignettes. The dermatologist were asked to rate the demonstrator by system usability scale (SUS), whether they would use it for certain patients populations and barriers of usage. Reasons for potential usage of the TRS demonstrator were tested via a Poisson regression with robust standard errors.RESULTS:Acceptance of the TRS was highest for patients eligible for systemic therapy (82%). 50% of participants accepted the system for patients with additional comorbidities and 43% for patients with special subtypes of psoriasis. Dermatologists in the outpatient sector or with many patients per week were less willing to use the TRS for patients with special psoriasis-subtypes. Dermatologists rated the demonstrator as acceptable with an mean SUS of 76.8. Participants whose SUS was 10 points above average were 27% more likely to use TRS for special psoriasis-subtypes. The main barrier in using the TRS was time demand (47.4%). Participants who perceived time as an obstacle were 22.3% less willing to use TRS with systemic therapy patients. 27.6% of physicians stated that they did not understand exactly how the recommendation was generated by the TRS, with no effect on the preparedness to use the system.CONCLUSION:The considerably high acceptance and the preparedness to use the psoriasis CDSS suggests that a TRS appears to be implementable in routine healthcare and may improve clinical care. Main barrier is the additional time demand posed on dermatologists in a busy clinical setting. Therefore, it will be a major challenge to identify a limited set of variables that still allows a valid recommendation with precise prediction of the patient-individual benefits and harms.

ZusammenfassungHintergrundDas Eczema herpeticatum (EH) ist eine disseminierte Hautinfektion, die durch Herpes‐simplex‐Viren bei Patienten mit atopischer Dermatitis (AD) verursacht wird. Die Häufigkeit des EH und die klinischen Charakteristika von EH Patienten wurden bisher noch nicht in einer größeren Kohorte untersucht.Methodik87 Patienten des TREATgermany Registers, einem multizentrischen, nichtinterventionellen klinischen Register mit moderat bis schwer betroffenen AD‐Patienten in Deutschland, wurden in dieser Analyse betrachtet. Patienten, die zwischen Dezember 2017 und April 2021 in das Register eingeschlossen wurden, wurden unterteilt in die Gruppen ohne, mit einem und mit mehreren EH und basierend auf den klinischen Charakteristika verglichen.ErgebnisseVon 893 Patienten berichteten 195 (21,8%) über mindestens eine EH. 107 der 195 Patienten mit EH hatten sogar mehrere EH in der Anamnese (54,9%), was 12,0% der gesamten Studienpopulation entspricht. Während hinsichtlich demographischer Merkmale, Vorbehandlungen und Krankheitsscores (Juckreiz, IGA, oSCORAD, EASI) keine Unterschiede festgestellt wurden, litten Patienten mit EH häufiger an atopischen Begleiterkrankungen und Sensibilisierungen gegen Hausstaubmilben, Nahrungsmittel und Schimmelpilze.SchlussfolgerungenDie Daten des TREATgermany‐Registers deuten auf eine hohe Prävalenz und Rezidivrate des EH hin, während es neben einer Häufung von Allergien keinen spezifischen klinischen Phänotyp zu geben scheint, um EH‐Patienten in der täglichen Routine zu identifizieren.

Background: TREATgermany, a registry for patients with moderate to severe atopic dermatitis (AD), established an additional questionnaire in spring 2020 to investigate the effects of the coronavirus pandemic on the daily life of patients with AD. Material and Methods: A questionnaire was used to analyze general information regarding a patient's experience of the coronavirus pandemic and, using the Inventory of Life- Changing Events, the resulting personal burden. To analyze possible associations between disease severity (EASI score, oSCORAD, IGA, PGA, POEM), quality of life (DLQI) and personal burden, t-tests, analyses of variance and correlations were evaluated, controlled for sex and age. Results: 58 % (n = 233) of the included 400 registry patients reported high burden scores caused by the coronavirus pandemic, regardless of an actual infection. Men showed significantly higher burden scores than women, and younger than older respondents (both P = 0.03). There were no differences in burden scores related to the physician's assessment of disease severity. However, patients with higher quality of life impairments and higher disease severity perceived the burden of the coronavirus pandemic as less severe (DLQI P = 0.019, PGA P = 0.044). Conclusions: Our data show that registry patients considered the coronavirus pandemic as a life-changing event and perceived the burden differently. This should be taken into account in the treatment of patients with moderate to severe AD as well as in further studies.