Fragrance is widely used in consumer products and holds significant cultural and personal value, yet in dermatology it is most often approached as a risk factor due to its role as a leading cause of allergic contact dermatitis (ACD) and potential irritant or sensory trigger in susceptible individuals. As a result, avoidance or minimization of fragranced products is frequently recommended, particularly for patients with eczema, sensitive skin, xerosis, chronic pruritus, or suspected fragrance allergy. However, this paradigm may oversimplify sensitization risk and does not fully reflect advances in formulation science, evolving regulatory frameworks, or growing recognition of the role of scent in patient experience. This narrative perspective examines the historical basis for fragrance avoidance, including limitations in ingredient transparency, and addresses recent developments in exposure-based risk assessment and formulation. These include quantitative frameworks used to define concentration limits and their implementation through industry standards developed by the International Fragrance Association. Collectively, these developments reflect a more nuanced understanding of sensitization risk. In parallel, emerging interest in neurocosmetics highlights the interaction between olfactory signaling and the skin-brain axis, with potential implications for mood, stress, and treatment adherence. Taken together, these developments support a shift away from universal avoidance toward a careful, individualized approach to fragrance use in dermatologic care.

BACKGROUND:Dermatologic conditions are a significant reason for pediatric hospitalizations in the United States. A prior analysis of the 2012 Kids' Inpatient Database (KID) established a national benchmark for this burden, but changes in medical coding, healthcare delivery, and demographics necessitate an updated assessment. This study aimed to quantify the current inpatient burden of pediatric dermatology and to identify associated demographic risk factors, financial costs, and mortality using a recent, nationally representative database. METHODS:A cross-sectional study was conducted using the 2022 KID. Pediatric hospitalizations with a primary dermatology diagnosis (ICD-10-CM) were identified. Survey weights were used to generate national estimates of admission counts, costs, and mortality. Multivariable logistic regression was used to identify independent risk factors for a primary dermatology hospitalization. RESULTS:In 2022, there were an estimated 29,766 pediatric dermatology hospitalizations, representing 2.3% of all pediatric admissions and a decline from 4.2% in 2012. These admissions generated a total national cost of $449.3 million. After adjusting for covariates, factors associated with higher odds of a dermatology admission included age 2-5 years (OR: 1.35; 95% CI: 1.21-1.52), Asian/Pacific Islander race (OR: 1.49; 95% CI: 1.32-1.69), Native American race (OR: 1.17; 95% CI: 1.00-1.36), Hispanic ethnicity (OR: 1.07; 95% CI: 1.01-1.14), lowest income quartile (OR: 1.06; 95% CI: 1.01-1.12), and Medicaid coverage (OR: 1.09; 95% CI: 1.04-1.14). Female sex was associated with lower odds (OR: 0.95; 95% CI: 0.92-0.98). In-hospital mortality was 0.1%. CONCLUSION:The national burden of inpatient pediatric dermatology has decreased over the past decade. However, significant disparities related to socioeconomic status and race/ethnicity persist and have evolved. These findings underscore the continued need for interventions aimed at improving access to outpatient dermatologic care for underserved pediatric populations.

Atopic dermatitis (AD) is associated with an elevated risk of mood and anxiety disorders, attention-deficit/hyperactivity disorder, and suicidal ideation, though there remains a lack of data assessing the impact of atopic dermatitis on hospitalization for psychiatric illness among adolescents. We reviewed the 2022 Kids' Inpatient Database for adolescent patients with AD and sought to assess the primary outcome of whether their reason for hospital admission was psychiatric in nature, encompassing suicidal ideation, mood, psychotic, substance use, neurodevelopmental, trauma, personality, obsessive-compulsive, or eating disorders. A total of 1520 patients with AD were identified in this study, propensity-matched with 7634 controls, with psychiatric reasons accounting for 367 admissions (24.1%) in the AD cohort compared with 2034 (26.6%) in the control group (p = 0.2). On multivariate analysis, patients with atopic dermatitis did not have significantly different odds of experiencing hospital admission for psychiatric reasons relative to controls (aOR: 0.87; 95% CI: 0.72-1.05), suggesting that any added psychiatric burden from AD may not necessarily lead to severe disease progression requiring hospitalization.

BackgroundAtopic dermatitis (AD) is a chronic inflammatory disease significantly impacting patients' quality of life (QoL). While multiple outcome measures exist, a critical gap remains in establishing treatment goals that meaningfully connect improvements in clinician-reported outcome measures (ClinROMs) with patient-reported outcome measures (PROMs).ObjectiveTo determine the Eczema Area and Severity Index (EASI) threshold that best corresponds with clinically meaningful and optimal treatment responses in PROMs, linking ClinROMs and PROMs.MethodsLIBERTY AD CHRONOS, a randomized controlled trial, included adult patients treated with dupilumab 300 mg every 2 weeks plus topical corticosteroids. In this post-hoc analysis of the trial, repeated-measures regression analysis was used to quantify the relationship between EASI and improvements in PROMs.ResultsMost clinically meaningful responses in PROMs were associated with 50-75% EASI improvement from baseline with the greatest impact on achieving clinically meaningful and optimal PROM responses when transitioning from EASI-50 to EASI-75 and minimal additional benefit when transitioning from EASI-75 to EASI-90 and EASI-90 to EASI-100. Two PROM composite end points, encompassing treatment responses in symptoms and QoL, confirmed these findings.ConclusionsThis analysis bridges clinician-reported EASI with PROMs, demonstrating that EASI-75 aligns closely with clinically meaningful and optimal treatment responses from the patient perspective, providing a treatment goal that is both meaningful to patients and visually quantifiable for physicians in moderate-to-severe AD [Graphical abstract available online].Clinicaltrials.gov IdentifierNCT02260986 (registered October 06, 2014).

The pathogenesis of atopic dermatitis (AD) points to skin barrier dysfunction as a critical piece of the puzzle. Deficiencies in fatty acids and ceramides-key elements of the skin barrier-have been linked to AD. Fatty acids can be separated into omega-3 and omega-6, which can be found in a variety of foods such as fish, nuts, seeds, and even plants. In dogs, supplementation with oral fatty acids has shown promising benefits. This review aims to explore whether humans can similarly benefit from these supplements based on current literature. The results of our search varied by compound type. For borage oil and evening primrose oil, evidence of their effectiveness is mixed, though they may offer some preventative benefits. Fish oil supplements appear to be effective in treating AD, as they reduce clinical scores and symptom severity. Oral ceramides, blackcurrant seed oil, and hempseed oil have yet to be thoroughly studied, but preliminary results are promising. Among the studies, the supplementation doses and duration of treatment varied extensively. The literature did not provide comparative analysis between the supplements, and data on the overall safety and tolerability of these supplements are limited. While some evidence is promising, the reliability of these products, as well as their optimal dosage and frequency, remains uncertain.

Atopic dermatitis, the most common inflammatory skin disease of childhood, affects up to 20% of US children and frequently prompts emergency department (ED) visits. Clinicians must distinguish uncomplicated flares from secondary infections or treatment complications and initiate appropriate acute interventions. Evidence supports the judicious use of topical corticosteroids, with systemic therapy reserved for severe or refractory cases. The therapeutic landscape has expanded to include biological and targeted agents, which, while generally initiated in specialty settings, influence long-term care and require awareness in the ED. Families benefit from structured, actionable discharge planning, including provision of an "Eczema Action Plan," clear instructions on topical regimens, moisturizer use, and guidance on follow-up with primary care and dermatology. Emphasis on communication and education helps prevent recurrence, reduces unscheduled visits, and fosters adherence to outpatient management.

OBJECTIVE:To systematically synthesise the benefits and harms of add-on oral antihistamines for managing atopic dermatitis (eczema). DESIGN:Systematic review and network meta-analysis of randomised trials. DATA SOURCES:Medline, Embase, CENTRAL, the United States Food and Drug Administration, and the European Medicines Agency databases from database inception to 5 May 2025. STUDY SELECTION:Randomised trials assessing add-on oral H1 antihistamines, H2 blockers, mast cell stabilisers (nedocromil sodium and sodium cromoglycate), or their combinations. Paired reviewers independently screened records, extracted data, and assessed risk of bias using a modified Cochrane Risk of Bias tool version 2. METHODS:Random effects bayesian meta-analyses synthesised atopic dermatitis severity (oSCORAD-objective scoring atopic dermatitis, 0-83; minimal important difference 8.2; lower better), itch severity (numerical rating scale, 0-10; minimal important difference 3; lower better), sleep disturbance, atopic dermatitis related quality of life, and harms. The network meta-analysis GRADE (Grading of Recommendations Assessment, Development and Evaluation) and Core GRADE approaches informed certainty of evidence ratings. RESULTS:47 trials enrolled 6230 children and adults with primarily moderate to severe atopic dermatitis. With moderate certainty, compared with placebo, adding a first generation or second generation H1 antihistamine likely resulted in a small reduction in atopic dermatitis severity (mean difference -1.87, 95% credible interval -3.47 to -0.27) and itch severity (-0.89, -1.41 to -0.37). Although statistically detectable, these effects are well below established minimal important differences (smallest change in an outcome that a patient would identify as important). With low certainty, all studied interventions may not improve sleep disturbance or reduce atopic dermatitis exacerbations. First generation agents probably increase cognitive impairment and may increase treatment discontinuation because of adverse events (risk difference 66 more per 1000, 95% credible interval 0 to 231 more; moderate certainty). Second generation agents differ in their risk of cognitive impairment (range of mean effects 0 more per 1000 for loratadine, 16 more per 1000 for levocetirizine, and 17 more per 1000 for cetirizine). CONCLUSIONS:Among patients with atopic dermatitis, adding H1 antihistamines probably results in a clinically unimportant reduction in atopic dermatitis severity and itch severity, and may not reduce sleep disturbance or atopic dermatitis exacerbations. First generation agents increase cognitive impairment and may increase treatment discontinuation because of adverse events. Cognitive impairment risk differs among second generation agents. These findings provide evidence against routine antihistamine use in atopic dermatitis management and will inform updated clinical guidelines. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42022345643.

Although type 2 inflammatory pathway dysfunction is a hallmark of atopic dermatitis (AD), disease symptoms in many patients are also driven by other immune/inflammatory pathway dysfunctions, all of which lead to varied treatment response profiles of targeted systemic therapies for individual patients. Adding complexity to the process of identifying which systemic therapy to prescribe for an individual patient is that these treatments have varied safety profiles, routes of administration, monitoring requirements, and costs—all of which are reviewed during today’s shared decision-making discussions. This patient assessment study aimed to better understand patients' attitudes toward contemporary AD treatments, their experiences, and their perceptions of a molecular test to predict treatment response. A 32-question assessment tool, deemed eligible for IRB exemption, was made available to any attendees with AD at the 2024 Eczema Expo who wished to complete it. Regarding treatment objectives, results indicated the top three factors most important to respondents (n = 40) were itch control (70

BACKGROUND:Individuals with atopic dermatitis (AD) may be referred for patch testing to rule out allergic contact dermatitis (ACD). While past expert consensus outlines when and how to patch test these patients, clinical management and measurement of meaningful clinical improvement is particularly challenging in this population. OBJECTIVE:To develop practical clinical recommendations in the assessment and management of patients with AD undergoing patch testing. METHODS:An international modified electronic (e)Delphi consensus exercise was conducted among 18 AD and ACD experts. RESULTS:Following 4 rounds, a total of 21/24 (87.5%) clinical management statements and 15/18 (83.3%) clinical assessment statements reached consensus. Avoidance of cutaneous sources of allergens with positive (+, ++, and +++) and doubtful (+/-) reactions, use of hyporeactive products, and strict adherence to a "safe products list" of allergen-free products were recommended. Follow-up at approximately 3 months with assessment via both (1) patient-reported outcomes (PRO) and (2) clinician-reported outcomes (ClinRO) validated measurement tools were recommended to guide therapeutic decision-making. CONCLUSION:This eDelphi exercise establishes clear recommendations to manage, evaluate, and further treat patients with AD following patch testing.

INTRODUCTION:Lebrikizumab significantly reduced itch and itch interference on sleep in patients with moderate-to-severe atopic dermatitis (AD) at week 16 in two phase 3 trials. We investigated itch reduction and the efficacy of improving itch interference on sleep in lebrikizumab-treated patients over 52 weeks. METHODS:At week 16 in ADvocate1 and ADvocate2, patients who met protocol-defined response criteria to lebrikizumab 250 mg every 2 weeks (Q2W) were re-randomized 2:2:1 to lebrikizumab Q2W, lebrikizumab 250 mg every 4 weeks (Q4W), or placebo Q2W to week 52; patients who did not achieve protocol-defined response continued open-label lebrikizumab Q2W. The Pruritus Numeric Rating Scale (NRS) evaluated the worst itch intensity over the previous 24 h in daily electronic diaries; the Sleep-Loss Scale measured the interference of itch on sleep over the last night. For week 16 responders, data after systemic rescue medication or discontinuation due to lack of efficacy were imputed with non-responder imputation; data after topical corticosteroid usage and discontinuation due to other reasons were set as missing; all missing data were imputed with multiple imputation. Descriptive statistics using observed data are reported for week 16 by non-responders. RESULTS:At week 52 among patients who met week-16 protocol-defined response criteria, 73.4% and 71.8% receiving lebrikizumab Q4W and Q2W, respectively, reported ≥3-point improvement in the Pruritus NRS. Mean percent improvement from baseline to week 52 in the Pruritus NRS was 59.9% and 59.6% with lebrikizumab Q4W and Q2W, respectively. For patients who did not achieve a week-16 protocol-defined response, 73.3% achieved ≥3-point improvement on the Pruritus NRS at week 52, with mean percent improvement from baseline to week 52 of 59.2%. At week 52 in responders, ≥1-point improvement in the Sleep-Loss Scale was achieved by 77.9% and 78.9% of patients receiving lebrikizumab Q4W and Q2W, respectively, with a mean percent improvement from baseline to week 52 of 64.4% and 65.9%. For week-16 non-responders, 86.1% of patients achieved ≥1-point improvement in the Sleep-Loss Scale at week 52, with a mean percent improvement of 74.9%. CONCLUSION:These findings indicate that lebrikizumab is an effective AD treatment to reduce itch and improve sleep loss due to itch over the long term for both patients who did and did not meet protocol-defined response criteria at week 16.

Dupilumab, an IL-4 and IL-13 antagonist, is a biological medication approved for treating moderate-to-severe atopic dermatitis (AD) and other inflammatory conditions. While dupilumab has been effective in managing AD, recent reports suggest a possible link between dupilumab and the unmasking or progression of cutaneous T-cell lymphomas (CTCL), including mycosis fungoides and Sézary syndrome. This systematic review examines 35 studies, including case reports, case series, and retrospective studies, to investigate the association between dupilumab and CTCL development or exacerbation. Findings reveal both cases of symptom relief and worsening pruritus or disease progression in patients treated with dupilumab. Mechanisms proposed include misdiagnosis of early-stage CTCL as AD and potential dupilumab-induced changes in immune signaling pathways that may promote malignant transformation. Key limitations of existing studies include small sample sizes, lack of standardized treatment duration, and limited long-term follow-up, making it challenging to establish causation. While dupilumab remains an important therapy for AD, these findings underscore the need for careful patient evaluation, particularly in those with persistent or atypical presentations. Further large-scale, longitudinal studies are essential to clarify the role of dupilumab in CTCL development and progression and to optimize patient safety in clinical practice.

Sunscreens play an essential role in preventing skin cancer and photoaging. Nevertheless, concerns about their systemic absorption and environmental impacts persist. In this extensive literature review, we discuss the mechanisms of action, efficacy, and safety concerns related to sunscreen use, aiming to clarify current understandings and dispel prevalent myths. Despite ongoing debates regarding certain ingredients, the scientific consensus supports the use of sunscreens as a critical defense against ultraviolet (UV) radiation. Continued research is necessary to address safety concerns and to refine sunscreen formulations for optimal protection and minimal adverse effects. J Drugs Dermatol. 2025;24(2):142-146. doi:10.36849/JDD.8102.

Purpose Lebrikizumab is a novel, high-affinity immunoglobulin G4 monoclonal antibody that targets interleukin-13, a central mediator in atopic dermatitis (AD). In previous studies in patients with moderate-to-severe AD, lebrikizumab, administered subcutaneously via a prefilled syringe with a needle safety device (PFS-NSD), demonstrated rapid and durable dose-dependent efficacy. We assessed the pharmacokinetics and safety of lebrikizumab using either a PFS-NSD or an investigational autoinjector. Such devices have been developed to make self-injection easier for patients, thus increasing adherence over long treatment durations. Methods The current study compared the pharmacokinetics and safety of 250 mg lebrikizumab (2 mL of a 125-mg/mL solution) administered subcutaneously at 1 of 3 different injection sites (abdomen, arm, or thigh) in 241 healthy participants using either a PFS-NSD (N = 122) or an investigational autoinjector (N = 119). Findings Statistical analysis demonstrated 2-mL (125 mg/mL) lebrikizumab autoinjector was bioequivalent to 2-mL (125 mg/mL) lebrikizumab PFS-NSD as 90% CIs of the geometric least squares means ratios for lebrikizumab AUC(0-tlast), AUC(0-∞), and Cmax were all completely contained within the prespecified confidence limits of 0.80 and 1.25. Injection-site location did not appear to impact lebrikizumab systemic exposure for either device. Lebrikizumab was well tolerated with no SAEs reported after PFS-NSD or autoinjector administration. Implications Bioequivalence was demonstrated between 250 mg lebrikizumab 2-mL autoinjector and prefilled syringe devices, showing both devices to be suitable options for administering lebrikizumab.

Introduction Parkinson disease (PD) is a multifaceted neurodegenerative disorder known for its hallmark motor symptoms. However, nonmotor manifestations, specifically dermatological changes, precede motor symptoms and may thus serve as vital early indicators of PD. Objectives This article explores the skin-related changes associated with PD, focusing on alterations in sebum composition, microbial dysbiosis, and the potential for leveraging dermatological assessments as early, noninvasive diagnostic markers for PD. Methods A comprehensive literature review was conducted to investigate dermatological manifestations of PD, focusing on sebum changes in affected individuals. Research explored the clinical relevance of altered lipid profiles, volatile organic compound (VOC) contributions, and microbiome dysbiosis in those with PD. Results Individuals with PD exhibit excess sebum production characterized by altered lipid profiles, including elevated short-chain fatty acids (SCFAs) and disruptions in sphingolipid metabolism. The lipid-rich environment also promotes overgrowth of Malessezia yeast, contributing to varied dermatological symptoms in those with PD. VOCs identified in sebum have been linked to unique odors and serve as biomarkers for diagnostic potential. These findings support the potential for early PD diagnosis through dermatologic assessment and sebum analysis. Conclusion Dermatological manifestations in PD offer promising noninvasive biomarkers for early diagnosis. Future research should aim to further elucidate the mechanisms underlying sebum dysregulation in PD and validate the clinical relevance of these biomarkers in larger populations.

Patient education initiatives for atopic dermatitis (AD) improve medication adherence, treatment satisfaction, severity of disease, and quality of life. An international survey was conducted to better understand the journey of diagnosis and treatment, unmet needs, and educational preferences of patients and caregivers for children diagnosed with AD residing in the US, Europe, Japan, and the Gulf region. A cross-sectional, anonymous, multilingual online survey was conducted from December 2024–January 2025. Eligible individuals were aged ≥ 18 years and either a patient diagnosed with AD by a medical professional or a caregiver for a child ages 6–12 years with AD. Of the 1103 survey participants (68