Jesper Elberling

Objectives:Atopic dermatitis (AD) requires lifelong self-management and patient-centred support. Agenda-setting with Conversation Cards (CCs), combined with continuity from familiar nurses, may strengthen consultations and improve well-being. This study evaluated whether consultations using CCs and designated contact nurses improve well-being (WHO-5), disease burden, shared decision-making, and self-management.Methods:In this prospective, non-randomised controlled study conducted in a dermatology outpatient clinic (2023–2025), patients received usual care or an intervention comprising: 1. systematic CC use; 2. continuity with two contact nurses; and 3. optional nurse contact between visits. Outcomes were assessed at baseline, six, and 12 months. Prespecified subgroups were >15 years and ≤15 years.Results:Two hundred patients were enrolled (100/group); 77 controls and 75 intervention participants completed 12 months. No significant between-group differences in WHO-5 were found in the full sample. Among patients >15 years, the intervention improved WHO-5 (+5.78; P=0.04), and more participants achieved a clinically meaningful increase (45.5% vs 21.8%; P=0.009). Shared decision-making (+3.67; P15 years and may strengthen routine self-management support in AD care as well as other chronic conditions.

Introduction: Pain and itch provoke different motor behaviors. Pain induces motor inhibition, whereas itch triggers an active scratching response. Acute pain is known to decrease corticospinal excitability, assessed by transcranial magnetic stimulation (TMS) through motor-evoked potentials (MEPs), but the effects of acute itch on bilateral corticospinal excitability are unknown. Objectives: We hypothesized that acute pain and itch differentially affect corticospinal excitability, decreasing and increasing MEPs, respectively. Methods: Nineteen healthy participants completed a 2-session, crossover study. Transcranial magnetic stimulation was applied targeting the right and left first dorsal interosseous (FDI) muscles. Motor-evoked potentials were recorded before, during experimentally induced pain (intramuscular hypertonic saline injection in the right FDI) or induced itch (cutaneous histamine application above the FDI), immediately after, and 30 minutes after provocation. Transcranial magnetic stimulation pulses were delivered every ∼7 seconds, and participants rated the pain and itch intensities using a numeric rating scale every ∼30 seconds. Results: Pain numeric rating scale scores were higher than itch scores from 0 to 120 seconds but lower at 390 seconds (all P < 0.05). Compared with baseline, both modalities reduced affected-hand MEPs (P = 0.003) with no changes in nonaffected-hand MEPs. Correlations between affected- and nonaffected-hand MEP reductions were found during pain (P = 0.009) and itch (P = 0.025). Conclusion: Opposite to the hypothesis, acute, experimental pain and itch induced similar corticospinal inhibition, suggesting a comparable effect on the motor output of the affected limb. This study found that the effects of acute pain and itch showed similar inhibition on bilateral corticospinal tract excitability.

Chronic pruritus (CP) is frequent in general medicine and the most common complaint in general dermatology. The prevalence of CP is expected to rise in the future due to the ageing population. The clinical presentation, underlying aetiology and treatment strategy of CP are heterogeneous. Also, individual treatment aims and physical, psychic and economic burdens of patients might vary. Chronic prurigo (CPG) is the most severe disease in the chronic pruritus spectrum, being associated with long‐standing scratch‐induced skin lesions and a therapy refractory itch‐scratch‐cycle. It is thus important to raise disease awareness for CP and CPG in the general public and among decision‐makers in the health system. Further, there is a need to support a rational clinical framework to optimize both diagnostics and therapeutics. Currently, there is still a shortcoming regarding approved therapies and understanding CP/CPG as severe medical conditions. Therefore, the EADV Task Force Pruritus decided to publish this white paper based on several consensus meetings. The group consented on the following goals: (a) ensure that CP is recognized as a serious condition, (b) increase public awareness and understanding of CP and CPG as chronic and burdensome diseases that can greatly affect a person's quality of life, (c) clarify that in most cases CP and CPG are non‐communicable and not caused by a psychiatric disease, (d) improve the support and treatment given to patients with CP to help them manage their disease and (e) publicize existing therapies including current guidelines. We aim to point to necessary improvements in access and quality of care directed to decision‐makers in health policy, among payers and administrations as well as in practical care.

Atopic dermatitis (AD) is a chronic, pruritic and inflammatory, dry skin condition with many known comorbidities. These include airway disease, food allergies, atopic eye disease and autoimmune conditions. Furthermore, there is often significant sleep disturbance as well as increased psychological distress and mental health problems. Severe AD therefore often has a significant impact on the quality of life of both patients and their families. In this review we discuss recent findings on the putative links between AD, its association with itch, sleep disturbance and neuropsychiatric morbidity, including the role of inflammation in these conditions. Itch was thought to predominantly drive sleep disruption in AD. We now understand changes in sleep influence immune cell distribution and the associated inflammatory cytokines, which suggests a bidirectional relationship between AD and sleep. We also increasingly recognize inflammation as a key driver in psychological symptoms and disorders. The link between cutaneous, systemic and possible brain inflammation could at least in part be driven by the sleep deprivation and itch‐driven neuronal proliferation seen in AD.

Recruitment to the local tissue and alerted phenotype are the hallmarks of basophils in chronic urticaria (CU). Chemokine receptors such as chemokine (C-C motif) receptor 4 (CCR4) or CCR8 have been studied in skin diseases, e.g., atopic dermatitis, but not in CU. In this study, we aimed to define CU’s basophil homing potential and receptor profile and the effect of Omalizumab treatment on these. Unstimulated and activated (anti-IgE, fMLP, C5a, and Substance P) whole blood basophils from 11 Omalizumab-treated CU patients and 10 healthy subjects were investigated with flow cytometry. Unstimulated basophils in CU showed higher expression of the skin-associated (CCR8) and scavenger (CCX-CKR) receptors and lower expression of the lung-associated (CCR3) receptor in contrast to healthy ones. IgE-mediated activation increased the percentage of CCR8 and CCX-CKR in CU compared to healthy group and elevated the expression of the lung-associated chemokine receptor, XCR1, in all groups. A trend of augmented expression of the coagulation cascade (CD87) and fMLP (FPR1) receptors was seen on basophils in CU, while a tendency of reduced expression was seen for itch (IL-31RA) and immunotolerance (CD109) receptors. fMLP and C5a increased the expression of CCR4, CCR8, CCX-CKR, and CD87 and decreased CCR2 and CCR3, though no changes between the groups were found. In conclusion, CU basophils exhibit skin-homing potential amplified by IgE-mediated stimulation.

Background: Evaluation of effectiveness and safety of new systemic treatments for atopic dermatitis (AD) after approval is important. There are few published data exceeding 52‐week therapy with dupilumab.Objectives: To examine the safety, effectiveness and drug survival of dupilumab in a Danish nationwide cohort with moderate‐to‐severe AD up to 104 weeks exposure.Methods: We included 347 adult patients with AD who were treated with dupilumab and registered in the SCRATCH registry during 2017–2022.Results: At all visits, we observed improvement in AD severity measured by Eczema Area and Severity Index (EASI) [median (IQR)]. EASI score at baseline was 18.0 (10.6–25.2), at week 4: 6.5 (3.5–11.6), at week 16: 3.7 (1.2–6.2), at week 52: 2.0 (0.8–3.6), at week 104: 1.7 (0.8–3.8). While drug survival was high (week 52: 90%; week 104: 86%), AD in the head‐and‐neck area remained present in most patients at high levels; proportion with head‐and‐neck AD at baseline was 76% and 68% at week 104. 35% of patients reported any AE. Conjunctivitis was the most frequent (25% of all patients) and median time to first registration of conjunctivitis was 201 days.Conclusions: While 2‐year drug survival was 86%, dupilumab was unable to effectively treat AD in the head‐and‐neck area, and conjunctivitis was found in 25% of patients.

BackgroundAccording to their parents, some children with aluminium contact allergy and vaccination granulomas may react to aluminium-containing foods by developing dermatitis, granuloma itch and subjective symptoms. ObjectivesThe objective of this study is to determine whether oral intake of aluminium-containing pancakes can cause adverse events and/or systemic contact dermatitis (SCD) in children with vaccination granulomas and aluminium contact allergy. Patients/MethodsA total of 15 children aged 3-9 years (mean age, 5 years) with vaccination granulomas and positive patch-test results to aluminium chloride hexahydrate 2%/10% pet. completed a 3-week blinded randomized controlled crossover oral aluminium/placebo provocation study with pancakes. Granuloma itch and other subjective symptoms were evaluated daily on a visual analogue scale (VAS). Dermatitis was evaluated by the primary investigator, and sleep patterns were tracked with an electronic device. Aluminium bioavailability was assessed by measuring aluminium excretion in the urine. The children served as their own controls with the placebo provocations. ResultsAll 15 children completed the study. The mean VAS scores were slightly higher during aluminium provocations compared with placebo for granuloma itch (mean VAS, 1.5 vs. 1.4, p = 0.6) but identical for other subjective symptoms (0.6 vs. 0.6, p = 1). There were no differences in sleep patterns and no significant correlation between urinary aluminium excretion and symptom severity. Three children developed a symmetrical rash on the face or buttocks on day 4 of the aluminium provocations, but not during placebo provocations. ConclusionsNo difference was found between oral aluminium intake and the occurrence of subjective symptoms and granuloma itch, but on a case-basis oral aluminium may be associated with the development of systemic contact dermatitis.