guidance reflecting the benefits and limitations of topical ad treatments in conjunction with patient understanding of treatment goals supports robust shared decision-making in the management of ad.
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many people with eczema (also called atopic dermatitis) know that genetics, allergens, and stress can play a role in this condition. those with eczema hav
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introduction hand dermatitis is an umbrella term that encompasses several similarly appearing conditions including endogenous eczema in atopic patients, allergic contact dermatitis, and irritant contact dermatitis. in some cases, they...
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atopic dermatitis (ad) is a common, chronic skin disorder that can significantly impact the quality of life of affected individuals as well as their families. although the pathogenesis of the disorder is not completely understood, it appears to result from the complex interplay between defects in skin barrier function, environmental and infectious agents, and immune abnormalities. there are no specific diagnostic tests for ad; therefore, the diagnosis is based on specific clinical criteria that take into account the patient’s history and clinical manifestations. successful management of the disorder requires a multifaceted approach that involves education, optimal skin care practices, anti-inflammatory treatment with topical corticosteroids and/or topical calcineurin inhibitors (tcis), the use of first-generation antihistamines to help manage sleep disturbances, and the treatment of skin infections. systemic corticosteroids may also be used, but are generally reserved for the acute treatment of severe flare-ups. topical corticosteroids are the first-line pharmacologic treatments for ad, and evidence suggests that these agents may also be beneficial for the prophylaxis of disease flare-ups. although the prognosis for patients with ad is generally favourable, those patients with severe, widespread disease and concomitant atopic conditions, such as asthma and allergic rhinitis, are likely to experience poorer outcomes.
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atopic dermatitis (ad) is a skin condition that may cause a rash and itching due to inflammation of the skin. topical therapies applied over the skin may not be enough to control the ad in trial participants who require systemic anti-inflammatory treatment. this study compares upadacitinib to dupilumab in pediatric participants with moderate to severe ad who are candidates for systemic therapy. adverse events and change in the disease activity will be assessed. upadacitinib is an approved drug for treating ad patients aged 12 or older. participants will receive upadacitinib (given as daily dose) or dupilumab (given at label indicated dose every 2 or 4 weeks). participants will be stratified depending on disease severity, age and response to previous treatment. there is 1 in 5 chance for participants to receive dupilumab during the randomized cohort. approximately 675 participants aged 2 to less than 12 years of age will be enrolled in this study at approximately 150 sites worldwide. the study population (as defined by participants age or prior treatment) to be enrolled in the study is dependent on local regulatory requirement and/or agreement. participants will receive upadacitinib oral tablets once daily (or oral solution twice a day) for 160 weeks, or dupilumab as per its label for 52 weeks, and followed for 30 days after the last dose of upadacitinib and at least 12 weeks after the last dose of dupilumab. there may be higher treatment burden for participants in this trial compared to their standard of care . participants will attend regular visits during the study at a hospital or clinic. the effect of the treatment will be checked by clinical assessments, blood tests, checking for side effects and completing questionnaires.
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introduction atopic dermatitis (ad) is a highly prevalent disease in canada with significant patient burden. treatment guidance for topical therapy (the mainstay of ad management), with particular consideration of emerging treatments, may further improve patient care. here, we aim to provide healthcare professionals with ad treatment recommendations from the perspective of 10 canadian dermatologists with expertise in managing ad. methods the panel of dermatologists conducted a systematic literature review and leveraged their clinical experience to develop generally accepted principles, consensus statements, and a treatment algorithm using an iterative consensus process. results the panel collectively developed six generally accepted principles, 10 consensus statements, and a treatment algorithm. the guidance notes that assessment of disease severity should encompass both physician-rated measures and patient-reported outcomes. disease education, lifestyle-based strategies (e.g., trigger avoidance), and supportive measures (e.g., moisturizers) can help reduce signs and symptoms of ad. choice of therapy should consider disease-, patient-, and treatment-related factors. although topical corticosteroids (tcs) are often used as first-line treatment in ad, they should be limited to intermittent short-term use. noncorticosteroid topical therapies (e.g., topical calcineurin inhibitors; topical phosphodiesterase-4 inhibitors; and topical janus kinase inhibitors) can be used for widespread involvement of ad according to approved use. once treatment goals are achieved, noncorticosteroid topical maintenance therapy should continue to prevent flares and reduce the need for tcs. conclusion guidance reflecting the benefits and limitations of topical ad treatments in conjunction with patient understanding of treatment goals supports robust shared decision-making in the management of ad. graphical abstract
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