Category Archives: Eczema

- Consistent evidence of symptomatic improvement across endpoints and favorable tolerability- Higher dose demonstrated trend towards significance on primary endpoint- Both doses statistically superior to vehicle on key secondary endpoints-Company plans to advance ARQ-151 development in atopic dermatitis, with Phase 2b initiation anticipated in 2H 2020

WESTLAKE VILLAGE, CA / ACCESSWIRE / December 16, 2019 / Arcutis Biotherapeutics, Inc., a privately held late-stage biopharmaceutical company focused on developing and commercializing treatments for unmet needs in immune-mediated dermatological diseases and conditions, or immuno-dermatology, today announced top line results for a Phase 2 proof-of-concept study evaluating ARQ-151 as a potential topical treatment for atopic dermatitis (AD). ARQ-151 is a once daily topical cream formulation of roflumilast, a highly potent and selective Phosphodiesterase type 4 inhibitor (PDE4), which the Company is developing for plaque psoriasis and AD.

The ARQ-151-212 study was a Phase 2 multi-center, double blind, vehicle-controlled proof-of-concept study, in which 136 adolescents (ages 12 years and above) and adults with mild to moderate AD involving between 1.5% and 35% body surface area (BSA) were randomized to receive once daily topical applications for 4 weeks of: (1) ARQ-151 0.15% cream, or (2) ARQ-151 0.05% cream, or (3) vehicle. The study assessed the safety, tolerability, pharmacokinetics (PK) and efficacy of the two dose levels of ARQ-151.

On the study's primary endpoint, the mean reduction in the Eczema Area and Severity Index (EASI) Total Score after 4 weeks of once-daily treatment, neither dose reached statistical significance versus vehicle, although ARQ-151 0.15% showed a trend towards significance, with a mean improvement of 6.4 in patients treated with ARQ-151 0.15% compared to 4.8 in patients treated with vehicle (p = 0.097). On the secondary endpoint of mean percent change from baseline on EASI, ARQ-151 0.15% demonstrated a statistically significant improvement versus vehicle (72.3% versus 55.8%, p = 0.049). Efficacy was also observed at both doses as measured by EASI-75 (ARQ-151 0.05%: 59.1% versus vehicle: 31.1%, p = 0.009 and ARQ-151 0.05%: 52.3% versus vehicle: 31.1%, p = 0.045). On the Validated Investigator Global Assessment - Atopic Dermatitis (vIGA-AD), ARQ-151 0.15% also demonstrated a statistically significant improvement versus vehicle in the percentage of patients achieving clear or almost clear (ARQ-151 0.15%: 52.3% versus vehicle: 31.1%, p = 0.040).

In this study, both doses of ARQ-151 were well-tolerated. 95% of subjects on active treatment completed the full study. The incidence of treatment-related Treatment Emergent Adverse Events (TEAEs) and application site reactions were low (< 5%) and similar between active treatment and vehicle. TEAEs were mild to moderate in severity. Among subjects receiving ARQ-151, there was only one Serious Adverse Event (SAE), which was unrelated to treatment, and only one discontinuation due to a TEAE.

Frank Watanabe, Arcutis' Chief Executive Officer, commented: "We are very encouraged by the results from this small, proof-of-concept study. The consistent separation from vehicle on multiple endpoints, and the magnitude of improvement in atopic dermatitis demonstrated in this study further reinforce our belief that ARQ-151 has the potential to be an effective atopic dermatitis therapy. As important, both doses evaluated showed a very favorable tolerability profile, which is particularly important given the majority of atopic dermatitis patients are children. Based on the strength of these results, we plan to pursue further development of ARQ-151 in atopic dermatitis, with a Phase 2b study planned for the second half of 2020."

Story continues

About ARQ-151

ARQ-151 is a topical cream formulation containing roflumilast, a PDE4 inhibitor, that the Company is developing to treat plaque psoriasis, including intertriginous psoriasis, and atopic dermatitis. PDE4 is an intracellular enzyme that regulates the production of pro-inflammatory and anti-inflammatory cytokines and cell proliferation. Roflumilast is a potent PDE4 inhibitor that was approved by the U.S. Food and Drug Administration (FDA) for systemic treatment to reduce risk of exacerbation of chronic obstructive pulmonary disease (COPD) in 2011, and has shown greater potency based on IC50 values (a non-clinical measure of a drug's potency) than other PDE4 inhibitors.

About Atopic Dermatitis

Atopic dermatitis (AD) is the most common type of eczema, occurring in approximately six percent of the U.S. population. AD is characterized by a defect in the skin barrier, which allows allergens and other irritants to enter the skin, leading to an immune reaction and inflammation. This reaction produces a red, itchy rash, most frequently occurring on the face, arms and legs, and the rash can cover significant areas of the body, in some cases half of the body or more. Disease onset is most common by 5 years of age, and the Company estimates that approximately 60% of patients suffering from AD are pediatric patients. The rash causes significant pruritus (itching), which can lead to skin damage caused by scratching or rubbing. Given that most of the patients are pediatric, the safety and tolerability of AD therapies is paramount.

About Arcutis - Bioscience, applied to the skin.

Arcutis is a late-stage biopharmaceutical company focused on developing and commercializing treatments for unmet needs in immune-mediated dermatological diseases and conditions, or immuno-dermatology. Arcutis exploits recent innovations in inflammation and immunology to develop potential best-in-class therapies against validated biological targets, leveraging our deep development, formulation and commercialization expertise to bring to market novel dermatology treatments, while maximizing our probability of technical success and financial resources. Arcutis is currently developing three novel products (ARQ-151, ARQ-154 and ARQ-252) for multiple indications including psoriasis, atopic dermatitis, seborrheic dermatitis and eczema. For more information, please visit http://www.arcutis.com or follow Arcutis on LinkedIn.

Contact:

John W. SmitherChief Financial Officerjsmither@arcutis.com

Investors and Media:

Derek Cole720.785.4497derek.cole@IRadvisory.com

SOURCE: Arcutis Biotherapeutics, Inc.

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Arcutis Announces Top Line Results for Phase 2 Proof-of-Concept Clinical Trial Evaluating ARQ-151 as a Potential Topical Treatment for Atopic...

As the year comes to a close, Sanofi (NASDAQ:SNY) has a holiday gift for investors in the form of a new strategy. The French drugmaker announced a $2.5 billion biotech takeover in the growing immuno-oncology field earlier this week, then a day later said it is dropping research in the diabetes and cardiovascular fields. This is big news because Sanofi's top-selling drug is diabetes drug Lantus. The problem is that with pricing pressure from competitors, Lantus' sales have been sliding -- and fast.

IMAGE SOURCE: GETTY IMAGES.

Lantus brought in more than $1.2 billion in the third quarter of 2017, and by the same period last year, the figure dropped to less than $1 billion. Sanofi reported a 17.5% decline in Lantus sales to $837 million in the third quarter of this year. To make matters worse, the rest of the diabetes and cardiovascular business has followed, weighing down earnings, while areas including oncology and immunology grew.

That's why the stock market applauded new Chief Executive Officer Paul Hudson's plan to refocus the business. Sanofi shares gained 6.2% on Tuesday after Hudson's comments.

Hudson, in his quest to focus on products and areas that are growing, targets $11 billion in sales for eczema treatment Dupixent. Sales of the drug soared 142% in the third quarter to reach $635 million. The company also will prioritize the development of six innovative investigational products in the areas of hemophilia, lysosomal storage disorders, respiratory syncytial virus, breast cancer, and multiple sclerosis.

Halting research in diabetes and cardiovascular, along with other efforts, is meant to help Sanofi reach $2.2 billion in savings by 2022. In other financial news, the company plans on expanding its business operating income margin to 30% by that year and to 32% by 2025. Business operating income is a non-GAAP measure of financial performance in which Sanofi eliminates elements such as acquisition-related effects and adds items like share of profits or losses from certain investments. The company also aims to increase annual free cash flow 50% by 2022.

Sanofi is reorganizing its operations into three business units: specialty care, vaccines, and general medicine. Consumer healthcare, which includes products like over-the-counter painkillers, will be a stand-alone business with its own R&D and manufacturing processes. Reutersreported that Sanofi might sell the unit or look for a joint venture. Consumer healthcare generated $5.2 billion in sales for Sanofi in 2018, a 3% increase from the previous year. That was about half of the figure generated by the specialty care unit, which grew 29% year over year.

Sanofi said cash from its businesses will be spent on further investment internally, acquisitions, and -- good news here, investors -- increasing the annual dividend. The last payment, in May, was $3.42, increasing for the 25th straight year.

Considering all of the good news, Sanofi isn't looking expensive. According to Zacks research, it trades at 14.16 times earnings, slightly cheaper than the large-cap pharmaceutical industry average of 14.85. The stock has gained 17% so far this year to about $49, but Wall Street predicts at least a bit more upside, with the average analyst price target at $52. Investors should also bear in mind that analysts might adjust their estimates and outlooks in the wake of Hudson's presentation.

With total net sales down 1.1% in the third quarter and the former big businesses of diabetes and cardiovascular slowing, Sanofi didn't present the best investment case a few weeks ago. This week's news, however, changed the landscape. The company is acquiring immuno-oncology company Synthorx (NASDAQ:THOR) to boost a part of its own business that is growing. It is halting the spending on struggling units and reallocating resources to stronger ones. And it continues to think of investors with the goal of boosting dividends.

For those looking to add to pharmaceutical holdings, Sanofi looks like a promising candidate going into 2020 and beyond.

Original post:
Sanofi Says Its $2.5 Billion Biotech Takeover Is Just the Beginning - The Motley Fool

Eczema facts

What is eczema?

Rather than a specific health condition, eczema is a reaction pattern that the skin produces in a number of diseases. It begins as red, raised tiny blisters containing a clear fluid atop red, elevated plaques. When the blisters break, the affected skin will weep and ooze. In older eczema, chronic eczema, the blisters are less prominent and the skin is thickened, elevated, and scaling. Eczema almost always is very itchy.

Are there different types of eczema? What causes and risk factors of eczema?

There are at least 11 distinct types of skin conditions that produce eczema. In order to develop a rational treatment plan, it is important to distinguish them. This is often not easy.

Eczema is a nonspecific term for many types of skin inflammation (dermatitis). There are different categories of eczema, which include allergic, contact, irritant, and nummular eczema, which can be difficult to distinguish from atopic dermatitis. These types of eczema are listed and briefly described below. Atopy is a medical syndrome that includes three associated conditions that tend to occur in the same individual: atopic dermatitis, inhalant allergies, and asthma. All three components need not be present in the same individual simultaneously.

What are eczema symptoms and signs?

Almost all patients with eczema complain of itching. Since the appearance of most types of eczema is similar, elevated plaques of red, bumpy skin, the distribution of the eruption can be of great help in distinguishing one type from another. For example, stasis dermatitis occurs most often on the lower leg while atopic dermatitis occurs in the front of the elbow and behind the knee.

What specialists treat eczema?

Eczema often is treated by family physicians, but since there are many causes of eczema, it may be necessary to seek help from a health specialist if things are not improving. Most dermatologists specialize in the diagnosis and treatment of all forms of eczema.

How do health care professionals diagnose eczema?

An accurate diagnosis requires an examination of the entire skin surface and a careful health history. It is important for a doctor to rule out curable conditions caused by infectious organisms. Occasionally, a sample of skin (biopsy) may be sent for examination in a laboratory.

What is the treatment for eczema?

The treatment of acute eczema where there is significant weeping and oozing requires repeated cycles of application of dilute solutions of vinegar or tap water often in the form of a compress followed by evaporation. This is most often conveniently performed by placing the affected body part in front of a fan after the compress. Once the acute weeping has diminished, then topical steroid (such as triamcinolone cream) applications can be an effective treatment. In extensive disease, systemic steroids may need to be utilized either orally or by an injection (shot).

What are home remedies for eczema?

Mild eczema may respond to compresses composed of tepid water followed by room air evaporation. Chronic eczema can be improved by applying water followed by an emollient (moisturizing cream or lotion). Mild eczema can be effectively treated with nonprescription 1% hydrocortisone cream.

Does diet affect eczema?

The role of diet in atopic dermatitis is controversial. There is little compelling evidence that diet plays a significant role for majority of people who have eczema, no matter which type they have.

Is there a cure for eczema?

Each type of eczema requires a specific sort of therapy. The easiest eczemas to cure permanently are those caused by fungi and scabies. Allergic contact eczema can be cured if a specific allergenic substance can be identified and avoided.

Is eczema contagious?

Eczema caused by fungi and scabies is transmissible to others. None of the other types of eczema are contagious.

What is the prognosis of eczema?

Most of the patients with eczema do quite well under the care of a dermatologist who has made an accurate diagnosis. Occasionally, eczema can become infected by microorganisms, such a staphylococci or herpes simplex virus. This is because the normal barrier function of the skin has been damaged by the inflammatory condition. In this situation, the infection could be contagious and require antibiotics treatment. An important signal would be the development of fever and pustules, plus pain at the site of the rash.

Is it possible to prevent eczema?

The judicious use of moisturizing creams or ointments can be an effective treatment for many people in preventing certain types of eczema.

Medically Reviewed on 3/15/2018

References

Wold, Lindsey, Jennifer K. Chen, and Heather P. Lampel. "Hand Dermatitis: An Allergist's Nightmare." Curr Allergy Asthma Rep 14.474 (2014): 1-9.

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Eczema Types, Treatment, Home Remedies & Symptoms

MIAMI (CBSMiami) Its not often television news anchors become the story, but after developing a skin condition called perioral dermatitis earlier this year and hiding it for months, CBS4s Frances Wang decided to share what was happening on social media hoping to spread awareness.

She also wanted to share it because she knew many people deal with the physical and emotional pain of skin conditions, and wanted people to know theyre not alone.

The response she received was overwhelming in the best way, she said. The more national outlets picked up her story, the more people from all over the world reached out to connect, vent, or just talk.

(Courtesy: Frances Wang)

She says sharing her story was freeing and instrumental in her healing both physically and emotionally.

Frances took some time off in October and is now happy to be back at CBS Miami.

Thanks to a support group on Facebook, she was able to connect in-person with three incredible women right here in South Florida who are undergoing similar situations.

Andi Cisneros, 28, of Kendall works in insurance. Jenny Santiago, 36, of Pembroke Pines works in the cruise line industry and has 3 children. Alona DiPaolo works for the Broward County government and has a 10-year-old son.

These three South Florida women dont know each other, but theyre all connected through the skin condition called perioral dermatitis.

In Alonas case, its her son who is suffering.

Dr. Robert Kirsner, chair of the University of Miamis Phillip Frost Department of Dermatology, calls perioral dermatitis a cousin of rosacea. The condition presents itself differently, depending on the person, but board-certified dermatologists should be able to recognize it right away.

Examples of perioral dermatitis (CBS4)

You usually get a rash. Sometimes its red bumps, sometimes its a scaly rash around the openings of the face, explained Dr. Kirsner. Its called perioral because its usually around the mouth. It can also be around the nose or the eyes and it can go on other parts of the face as well, but it usually starts [around the mouth.]

Perioral dermatitis can be caused by anything from allergies to hormones. Even household items like fluoride toothpaste have been blamed as the culprit.

The most common cause of perioral dermatitis is steroids.

Most people would link [perioral dermatitis] to steroid usage of some sort, often topical, said Dr. Kirsner. Youre giving topical steroids, which initially help, but then perpetuates the condition and makes it worse.

WATCH THE ENTIRE UNEDITED INTERVIEW WITH DR. KIRSNER

Thats exactly what happened with Alonas 10-year-old-son. Topical steroids prescribed for his eczema triggered perioral dermatitis.

In Andis case, she believes her condition was stress-induced, but does worry that Flonase, a steroid nasal spray, contributed to the problem.

I never had skin problems [growing up], but then it was rosacea, adult acne, and now this thing that wouldnt go away. I was extremely self-conscious. It just sucked, said Andi. I had a couple of weddings. Id look at myself in the mirror [and] seeing everything was really hard. I think when your face is clear, you feel prettier, you feel more productive in all aspects of your life.

Dermatologists will typically prescribe an antibiotic and some sort of topical for perioral dermatitis. For Andi, that solution worked in about 3 weeks.

I am paranoid. I dont want it to come back and if it does, I feel itll come back ten times worse, said Andi. Id rather have rosacea and acne, theyll go away [but] I feel this just wouldnt leave.

For Jenny, treatment wasnt as easy. It took a lot of trial and error, and the condition came during her pregnancy.

Anything I thought I could fix or cover it with because I was so self-conscious, thinking everyones looking at me, said Jenny. Here I was in a very healthy pregnancy with [my 3rd baby] that we wanted, and I was crying because I had spots all over my face.

Many people who suffer from perioral dermatitis estimate they spend thousands on tests and treatments, a lot of which may not be covered by insurance.

Examples of perioral dermatitis (CBS4)

Everyones I guess treatment looks different because I tried I feel like everything. I was ordering things online that [people] were recommending that they didnt sell in the states, said Jenny. I spent my maternity leave trying to get samples of what would fix it.

After Jenny had her baby, the condition went away. However, her baby boy is now suffering from eczema, and she worries she passed that along to him.

For Alona, even finding a dermatologist for her son is hard. She is about to see her sixth.

I still havent found [a dermatologist] I can trust. Im at the point where I understand why people are skeptical about the medical industry and dermatologists in South Florida, said Alona. As a parent, you want to make sure people are seeing your child for who they are and not whats wrong with his face. Its frustrating, but at the same time I know it can be something [more] terrible.

Dr. Loretta Ciraldo, a board-certified dermatologist in Aventura with more than 40 years of experience, is empathetic to Alonas frustrations.

Frankly, there are many physicians where theres more of a priority on putting in [Botox], fillers, lasering people and the medical aspect of dermatology is sometimes a little more difficult to have addressed by your doctor, said Dr. Ciraldo.

Dr. Ciraldo adds that especially with social media and the high standard of beauty in South Florida, skin disease can have a great emotional impact on people.

We can really be traumatized by it, said Dr. Ciraldo. Stress is a very big factor. The more stressed out we are by our appearance, the more delayed our clearing.

WATCH THE UNEDITED INTERVIEW WITH DR. CIRALDO

Dr. Kirsner believes the reason many people arent aware of perioral dermatitis is because its not as talked about or easily recognized as acne.

Its not as common as acne, but dermatologists see it routinely, said Dr. Kirsner. It affects peoples appearance, and they dont want to talk about it, they hide it, put makeup on, try to do a thousand different treatments.

Dr. Kirsner adds that there is still a lot more that needs to be learned about this condition.

We dont know what always causes it, said Dr. Kirsner.

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CBS4s Frances Wang Brings Awareness To Skin Condition In Order To Help Others - CBS Miami

If you walk through the aisles of any beauty retailer, like Sephora or Ulta, youll see hundreds of different products highlighting different skin care ingredients that promise to give you the smooth complexion of a baby and the radiance of a mythical goddess. There is vitamin C for brightening, CBD for calming, retinol for anti-aging, and now, theres cica for, well, almost everything.

For over 3,000 years cica has been used by herbalists and tigers to treat wounds, and in more recent years its been studied as an effective skin care ingredient to treat an array of skin conditions, such as acne and eczema, which is why its been popping up in so many skin care products. If youre still hung up on the tigers bit we just mentioned, listen up. Its been reported that tigers roll around in the natural ingredient to help treat their wounds after a fight, hence its modern nametiger grass.

To further understand what cica is and what it should be used for, we consulted a board-certified dermatologist to break it down for us.

Cica, short for Centenella asiatica, is a green plant thats been used as a medicinal herb for thousands of years, explains Dendy Engelman, M.D., a celebrity dermatologist based in New York City. Its now used as an active ingredient in cosmetic products to help target an array of skin concerns, and its suitable for even the most sensitive skin.

Studies show that with continued use, cica helps with soothing psoriasis, eczema, acne, and the effects of aging, as well as the treatment of wounds, including infections, burns, and scars. Its most well-known for its healing and antibacterial properties, making it great for skin thats more sensitive or prone to dryness, adds Dr. Engelman.

Because cica is anti-inflammatory and anti-microbial, its a great option for acne-prone skin types to keep blemishes at bay, explains Dr. Engelman. Its also a powerful ingredient for those who are recovering from acne scarring or usage of harsh acne-targeting skin products.In fact, studies show that after six months of continued use, cica helped to reduce the thickness of scars, so not only does it help to prevent acne, but it can help to heal skin thats already been affected by it.But thats not allDr. Engelman adds that because of cicas powerful properties, it also serves as a shield for the skin to help keep it moisturized and prevent aging.

We all know that certain ingredients work best on certain types of skinfor example, people with very sensitive skin dont typically react well to retinol, so they use bakuchiol insteadbut other products, like hyaluronic acid and cica, are suited for all skin types. Cica is safe for all skin types, and everyone can benefit from using it. In many ways its a universal ingredient to make the skin look more supple, glowing and moisturized, slowing the skins aging process by keeping moisture levels within the skin regulated, explains Dr. Engelman.

Below, some of our favorite skin care products with cica:

Courtesy of L'Oral Paris

If youre looking for quick results, this is the cica product for you. It takes only two weeks to see the appearance of fine lines and wrinkles improve with everyday use, and will also make skin feel plump and soft, raves Dr. Engelman. It strengthens the skin barrier by regulating moisture levels and defending skin against free radicals and other environmental agents.

Courtesy of Dr. Dennis Gross

This is a daily peel that gently exfoliates skin without stripping it of its natural oils, since as we know, stripping the skin with over-drying ingredients can make breakouts worse, says Dr. Engelman. All acne starts with a clogged pore, and this peel usesAHAswhich remove debris and dead skin that can lead to clogged poresand cica to soothe and repair irritated skin.

If youre looking for an overnight treatment that will work to calm sensitive skin, this could be the product for you. For best results, use at night two-to-three times per week, and at least five minutes after applying your favorite serums (you want to let them absorb into the skin).

Courtesy of Dr. Jart+

One of the many perks of cica is that it helps combat skin redness, and thats what this tinted treatment is formulated to do. Apply a thin layer of this green-to-beige formula to counteract redness caused by inflammation and sensitivity, but do take into account that its not a color-corrector. For a more intense result youll need to use a color-correcting concealer and/or foundation. What we love about this product is that it works as a first layer to help mask redness while treating the skin, and it has the added benefit of having an SPF 30.

Using a booster is an easy way to incorporate a new ingredient to your skincare routine without having to swap out all your products. To use, simply add a few drops into your favorite facial cream or mask, or mix it with your daily serum for extra benefits.

Formulated with vitamin B3 (known for helping skin retain moisture), madecassoside (a compound extracted from Centella asiatica), and glycerin (an effective moisturizer), this is the perfect heavy-duty facial cream for when your skin needs a little extra TLC, like during the winter when skin gets drier. Apply as needed to dry, clean skin.

Dont forget that your body needs skincare too! This cream is especially good for those with psoriasis and eczema looking for a body product. Slather it on day and night for best results.

Excerpt from:
What is cica? Everything a dermatologist wants you to know about this buzzy ingredient - Yahoo Lifestyle

Patients with moderate-to-severe atopic dermatitis may have a 20% increased risk of atrial fibrillation, suggests a study published in the Journal of the American Academy of Dermatology.1

Atrial fibrillation is common affecting 4% of individuals 60 years or older and carries with it an increased risk of stroke.2 Research has shown that inflammation is significant risk factor for developing atrial fibrillation, as patients with inflammatory disease such as rheumatoid arthritis, psoriasis or individuals with inflammatory biomarkers have been shown to be have an increased risk of atrial fibrillation.3,4

RELATED:More evidence of cardiovascular disease in atopic eczema

The authors of the study speculated that patients with atopic dermatitis might also have an increased risk for atrial fibrillation because of the presence of low-grade inflammation due to the disease and the increased prevalence of cardiovascular risk factors, such as obesity, hypertension and diabetes, among this group.5,6

To test their hypothesis, they conducted a nationwide population-based 35-year cohort study to examine whether patients in Denmark with hospital-diagnosed moderate-to-severe atopic dermatitis were at long-term increased risk of atrial fibrillation.

Using the Danish National Patient Registry (DNPR) they identified patients born in Denmark between January 1, 1947 and January 1, 1983 who had received a hospital diagnosis of atopic dermatitis from January 1, 1977 until January 1 2013 and matched each with ten individuals of the same sex and birth year. Patients were followed up until death, emigration, atrial fibrillation diagnosis or until 2013.

References:

1. Schmidt SAJ, Olsen M, Schmidt M, et al. Atopic dermatitis and risk of atrial fibrillation or flutter: a 35-year follow-up study.Journal of the American Academy of Dermatology (2019);

2. Page RL. Clinical practice. Newly diagnosed atrial fibrillation. N Engl J Med. 2004;351(23):24082416.

3. Lazzerini PE, Capecchi PL, Laghi-Pasini F. Systemic inflammation and arrhythmic risk: lessons from rheumatoid arthritis. Eur Heart J. 2017;38(22):17171727.

4. Upala S, Shahnawaz A, Sanguankeo A. Psoriasis increases risk of new-onset atrial fibrillation: a systematic review and meta-analysis of prospective observational studies. J Dermatolog Treat. 2017;28(5):406410.

5. Silverberg JI, Becker L, Kwasny M et al. Central obesity and high blood pressure in pediatric patients with atopic dermatitis. JAMA Dermatol. 2015;151(2):144152.

6. Silverberg JI, Greenland P. Eczema and cardiovascular risk factors in 2 US adult population studies. J Allergy Clin Immunol. 2015;135(3):7218.e726.

Excerpt from:
Atopic dermatitis linked to increased risk of atrial fibrillation - Dermatology Times

A new study in the headlines this week has renewed claims that fish oil pills might be helpful for Attention Deficit Hyperactivity Disorder (ADHD) in children, but a deeper look at the research says it's too early to say anything for sure.

The double-blind, randomised trial found thata high dose of omega-3 fatty acid EPA (or eicosapentaenoic acid) might work better than a placebo, but only for kids who have ADHD andan omega-3 deficiency.

"The omega-3 supplements only worked in children that had lower levels of EPA in their blood, as if the intervention was replenishing a lack of this important nutrient," explains biological psychiatrist Carmine Pariante from King's College, London.

Fish oil supplements have been explored as a treatment for ADHD in the past - with mixed results. So much so, that they are not currently approved by the US Food and Drug Administration (FDA) as a way to manage ADHD.

ADHD is a disorder marked by ongoing inattention, hyperactivity or impulsivity.Such behaviour is thought to reflect differences in brain development and activity, and fish oil has often been linked to improved cognitive function.

Furthermore, children with ADHD are sometimesknown to haveinsufficient fatty acid levels, presenting with dry skin, eczema and dry eyes. Recentstudies on animals have also connected omega-3 fatty acids in the brain's frontal cortex with hyperactivity.

Fish oil is one of themost popular sources of polyunsaturated fatty acids, and both EPA and docosahexaenoic acid (DHA) appear to be lower than normal in children with ADHD.

But while some studies have noted improvements in ADHD symptoms when this supplement was taken, others have not. In fact, some researcherssuspect it might even make things worse.Differences in dosages and the ratio of fatty acids only makes comparing these results all the more difficult.

In a 2013 systematic review of 10 randomised, placebo-controlled trials, only two showed a statistically significant benefit; while 6 showed no benefit at all, and 2 more showed benefits on only some ADHD rating scales.

A laterreviewon fish oil pills in 2017 showed greater promise. Of the 16 studies examined, 13 showed modest benefits in ADHD symptoms, including hyperactivity, impulsivity, attention, visual learning, word reading, and memory.

Yet even in cases where results appear positive, the effects are often modest and can sometimes take high dosages for months on end to kick in.

The latest research took place over a mere 12 weeks, and involved 92 children with ADHD aged 6 to 18. After being given a small daily dose of EPA, the participants with omega-3 deficiencies were found to have a few mild cognitive benefits, while those who already had normal levels of the fatty acid showed no benefits whatsoever.

"On the other hand, it is possible to have too much of a good thing," sayschild psychiatrist Jane Chang from China Medical University. For those kids with high levels of omega-3 already, any additional dosage may actually have detrimental effects, and Chang urges parents to consult with their child's physician before they try anything new - even a supplement.

Meanwhile, areviewin 2018 warned that health care providers should notreinforce the idea that fatty acids can replace treatments that have far more robust evidence.

The authors argue that while fish oil supplements may have small beneficial effects on children with ADHD, further high-quality research is needed before we can suggest them as an additional treatment - let alone a substitute for more serious approaches.

The study was published in Translational Psychiatry.

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Here's The Real Truth About Treating ADHD With Omega-3 Fish Oil Pills - ScienceAlert

"My patients understand itch is transferred like nerve pain," said Gil Yosipovitch, MD, director of the Miami Itch Center and chair of the National Eczema Association scientific advisory committee.

But clinicians have argued whether atopic dermatitis is a "rash that itches" or an "itch that rashes," he acknowledged.

New evidence supports the patient-reported sensation that "eczema is the itch that rashes," Yosipovitch told Medscape Medical News.

The research, published in Nature and presented during the President's Symposium at the 28th European Academy of Dermatology and Venereology Congress in Madrid, shows that neurons serving the skin directly interact with mast cells to trigger the massive histamine release associated with atopic dermatitis inflammation.

These new findings confirm a direct role for the nervous system, which is responsible for the itchiness and was already implicated in the inflammation.

"We, as a profession, have this thinking that eczema is an immune condition, and we forget that the immune system works with nerves," Yosipovitch explained. "Ten years ago, you wouldn't accept it because there weren't any data."

Atopic dermatitis, a form of eczema, is far more than just itching skin. The condition cycles through flares and remissions and can take over the entire body, leading to discomfort and inflammation. In fact, the root of "eczema" is a Greek word for boiling, which is an apt description of the burning inflammation and itching people experience.

Eczema affects about one in five children, some of whom show signs of it shortly after birth. Genetic variants can increase susceptibility.

For newborns at high risk for eczema, the pre-emptive application of petroleum jelly might delay onset or limit escalation, one study suggests. However, studies on the use of cream emollients and oil baths have yielded disappointing results, as reported by Medscape Medical News.

The investigators used dust mite antigens from the skin of reactive patients to induce a reaction in mice.

The condition is so similar in mice and humans that it is difficult to distinguish samples from one another at the microscopic level, presenter Nicolas Gaudenzio, PhD, an immunologist at INSERM in Toulouse, France, told Medscape Medical News.

For their study, Gaudenzio and his colleagues used several mouse models to show that sensory neurons and immune cells work together to detect allergens related to the common dust mite.

The team pursued this research question because levels of neuropeptides signaling molecules produced by sensory neurons called nociceptors are elevated in people with atopic dermatitis, as are markers for mast cells.

To examine the association between neurons and mast cells, the researchers exposed mice to dust mite allergens and monitored their skin. They found that nociceptors, which transmit pain and itch messages, and mast cells do not chat with each other from a distance. Instead, they cluster together and make physical contact, with the mast cells gathering around the nociceptors like bees around a hive.

We don't really know why some people are reacting and others are not.

We don't really know why some people are reacting and others are not.

Although these neuronmast cell units seem to be part of normal immune defense, not everyone reacts to ubiquitous dust mite allergens. In some people, "they can literally fire up the nerve fibers," he pointed out, "but we don't really know why some people are reacting and others are not. That's a black box."

Nociceptors and mast cells occur in other tissues that show an allergic response, the researchers explain, including the lungs, upper airways, and gut.

After his presentation, audience questions to Gaudenzio homed in on the same subject: Does this discovery mean new therapeutic possibilities for this sometimes-intractable condition?

That is not clear, Gaudenzio said, but the next steps will be to block the interaction between the sensory neuron and the mast cells to see if doing so forestalls the cascade of events that leads to the inflammation.

28th European Academy of Dermatology and Venereology (EADV) Congress. Presented October12, 2019.

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Evidence Growing That Eczema Itch More Than Skin Deep - Medscape

Why do we itch? The reasons are many and varied. But what's becoming ever clearer is many who experience chronic itching due to skin conditions also shoulder a profound psychological burden no scratching can relieve.

While the nature of this link around conditions like eczema and psoriasis has been investigated before, scientists say we're still only beginning to understand how skin disorders, mental health problems, and quality of life all intersect.

"There are already studies showing evidence of a correlation between itch and mental health problems in general, and in specific skin disorders, but there is a lack of a cross-sectional study across chronic skin diseases," says dermatologist Florence J. Dalgard from Lund University in Sweden.

To help fill that gap, Dalgard and her team analysed data collected from thousands of dermatology patients with skin issues in 13 European countries, including the UK, France, Germany, Russia, and elsewhere.

In total, over 3,500 patients with varying skin diseases took part in the study, undergoing physical examinations and filling out a questionnaire which asked questions about their socio-economic background and experiences with itching, while also measuring symptoms of depression, anxiety, and suicidal ideation.

More than 1,300 people without skin conditions acted as a control group, self-reporting the same information.

When the research team analysed the responses, they found a number of associations between skin conditions, itching, mood disorders, and quality of life impairments.

In patients with skin conditions who reported itching, the prevalence of depression was 14.1 percent. This lowered to 5.7 percent in patients who didn't itch.

Controls without skin disorders who reported itching also had around a 6 percent prevalent of depression - while only 3.2 percent in the control group members who didn't have itching reported depression.

Anxiety bore a similar pattern, showing up in 21.4 percent of the patients with skin conditions and itching, and dropping to 12.3 percent in patients without itching, while approximately 8 percent of the controls reported anxiety.

The prevalence of suicidal ideation was higher in patients with itch (15.7 percent) than in patients without itch (9.1 percent); similarly, it was higher in controls with itch (18.6 percent) than controls without (8.6 percent).

Patients with itch further reported experiencing more negative life events than the patients without itch did (38.2 percent compared to 32.4 percent respectively), and the patients who experienced itching were also likely to experience more economic problems.

While the team acknowledge their data can prove nothing about causation one way or the other (and submit that mental health suffering could potentially induce itch to some degree), they suggest it is much more likely that skin diseases are the cause of itching, which then leads to mental health effects.

"Speculative reasons for this correlation is that itch correlates with skin inflammation and skin inflammation induces serotonin network in the brain leading to depression and anxiety," the authors write in their paper.

While more research is needed to explore the hypothesis, for now at least, the link between itching and depression looks more firmly established than ever.

And that, the researchers say, should be reflected in how we treat patients with skin conditions with a multidisciplinary team of physicians to help support these people, and everything they may be dealing with.

At the same time, preventative programs might be able to play a role in helping to ease itching and maybe reducing the development of the serious psychological symptoms that appear to stem from it.

"Our findings demonstrate that the presence of itch in dermatological patients is significantly associated with clinical depression, suicidal ideation and stress," the researchers conclude.

"The study reveals that itch contributes substantially to the psychological burden of dermatological patients and confirms the multi-dimensional suffering of dermatological patients with itch."

The findings are reported in Journal of Investigative Dermatology.

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Itchy Skin Conditions And Mental Health Are Linked, And We Need to Talk About It - ScienceAlert

NewsScienceTests found it significantly reduced the severity of the disease in a matter of weeks

Wednesday, 23rd October 2019, 7:00 pm

Scientists have raised hopes of an effective new treatment for the most common form of eczema after tests found it significantly reduced the severity of the disease in a matter of weeks.

All 12 of the atopic dermatitis patients injected with the new drug saw a reduction in symptoms of 50 per cent of more - and in 83 per cent of cases the improvement took just 29 days.

But while the results show promise, the researchers cautioned that a much bigger study was needed to confirm the findings - and they are now working on a clinical trial involving 300 patients to do this.

"Patients with atopic dermatitis experienced significant improvement in their symptoms after a single dose," said Professor Graham Ogg, of the University of Oxford, who led the research.

About 1.5 million people in the UK are thought to have atopic dermatitis - a long-term condition where skin inflammation results in dry, cracked, red, itchy and painful skin.

More effective, less frequent

A range of treatments for atopic dermatitis are already available which can be of help to many patients. However, the researchers are hopeful that their new treatment will be more effective and longer-lasting, so it won't need to be administered as often.

Damaged skin cells release a substance called IL-33 which activates the body's immune cells to come and fight a possible infection. But sometimes the immune cells are over-activated - for example in people with atopic dermatatis - causing inflammation.

The new drug is based on an artificially created antibody called etokimab and is classed as a targeted therapy because it targets and effectively smothers the IL-33 molecules behind the condition.

This calms down the body's immune response and curbs the eczema.

Healthcare industry reaction

Emma Wedgeworth, consultant dermatologist at the British Skin Foundation, said: "There is no doubt in my mind that targeted therapies like this are the future of treatment for severe eczema.

For so long, we have relied on strong general immunosuppressants to treat severe cases.....The emergence of new therapies is hugely exciting for patients and clinicians alike."

Professor Patrick Chinnery, clinical director at the Medical Research Council, which part funded the trial, said the results were "exciting".

He hopes the new drug may potentially be adapted to treat other diseases relating to the immune system such as the skin diseases psoriasis and hidradenitis suppurativa - and maybe some immune diseases affecting other organs as well.

"The trial suggests that [the same mechanism] may have an important role in a number of immune-related disorders which will also lead to new avenues of research for other conditions," he said.

The study is published in the journal Science Translational Medicine.

The trial was funded by the antibody development company AnaptysBio.

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Eczema drug raises hopes of effective and long-lasting treatment - inews