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Improve the dupilumab therapy evaluation with dermoscopy and high‐frequency ultrasound in moderate‐to‐severe atopic dermatitis

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory disease. Monoclonal antibody dupilumab was approved to treat moderate‐to‐severe AD in recent years. An objective assessment of treatment response by skin imaging modality is adjuvant for clinical evaluations. This study aimed to explore th...

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Autores principales: Liu, Zhaorui, Niu, Zihan, Zhang, Dingding, Liu, Jie, Zhu, Qingli
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9838759/
https://www.ncbi.nlm.nih.gov/pubmed/36704877
http://dx.doi.org/10.1111/srt.13260
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author Liu, Zhaorui
Niu, Zihan
Zhang, Dingding
Liu, Jie
Zhu, Qingli
author_facet Liu, Zhaorui
Niu, Zihan
Zhang, Dingding
Liu, Jie
Zhu, Qingli
author_sort Liu, Zhaorui
collection PubMed
description BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory disease. Monoclonal antibody dupilumab was approved to treat moderate‐to‐severe AD in recent years. An objective assessment of treatment response by skin imaging modality is adjuvant for clinical evaluations. This study aimed to explore the value of dermoscopy and high‐frequency ultrasound (HFUS) imaging characteristics in treatment evaluation for moderate‐to‐severe AD patients treated with dupilumab. METHODS: Moderate‐to‐severe AD patients refractory to conventional therapy were enrolled in the study. All patients went through at least a 16‐week standardized treatment of dupilumab. Clinical scores (eczema area scoring index [EASI], SCOARD, numerical rating scale of pruritus, dermatology life quality index), dermoscopy, and HFUS examinations were conducted at 0, 2, 4, 8, 12, and 16 weeks of treatment. Erythema, scales, erosion, and pigmentation under dermoscopy were scored, and subepidermal low‐echogenic band (SLEB) thickness under HFUS was measured as quantitative indexes. Descriptive analysis and mixed effect linear regression models were used for statistical analysis. RESULTS: Sixteen patients were enrolled in the study and their average age was 45.63 ± 18.18 years. All clinical scores decreased with significant difference after 16‐week treatment compared with baseline. All patients achieved EASI 50 (EASI score decreased by 50% or more), and 9/16 patients reached EASI 75 after 16‐week treatment. Dermoscopy evaluation of erythema, scales and erosion scores were decreased, and the sign of pigmentation score was increased after treatment. For HFUS, the mean SLEB value was 0.51 ± 0.29 mm and decreased to 0.27 ± 0.15 mm after 16‐week treatment (p < 0.01). SLEB value decreased linearly with treatment time and correlated with clinical scores. However, SLEB values of two patients were 0.57 and 0.68 mm at week 16, respectively, which were higher than the average, and one of the patients showed EASI 75. CONCLUSION: Dermoscopy and HFUS were able to reveal deeper inflammation response than clinical scores in AD and can be an effective method to evaluate and monitor clinical improvement during dupilumab treatment for AD patients. The preliminary value of imaging methods for predicting the treatment endpoint of dupilumab remains to be verified.
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spelling pubmed-98387592023-04-13 Improve the dupilumab therapy evaluation with dermoscopy and high‐frequency ultrasound in moderate‐to‐severe atopic dermatitis Liu, Zhaorui Niu, Zihan Zhang, Dingding Liu, Jie Zhu, Qingli Skin Res Technol Original Articles BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory disease. Monoclonal antibody dupilumab was approved to treat moderate‐to‐severe AD in recent years. An objective assessment of treatment response by skin imaging modality is adjuvant for clinical evaluations. This study aimed to explore the value of dermoscopy and high‐frequency ultrasound (HFUS) imaging characteristics in treatment evaluation for moderate‐to‐severe AD patients treated with dupilumab. METHODS: Moderate‐to‐severe AD patients refractory to conventional therapy were enrolled in the study. All patients went through at least a 16‐week standardized treatment of dupilumab. Clinical scores (eczema area scoring index [EASI], SCOARD, numerical rating scale of pruritus, dermatology life quality index), dermoscopy, and HFUS examinations were conducted at 0, 2, 4, 8, 12, and 16 weeks of treatment. Erythema, scales, erosion, and pigmentation under dermoscopy were scored, and subepidermal low‐echogenic band (SLEB) thickness under HFUS was measured as quantitative indexes. Descriptive analysis and mixed effect linear regression models were used for statistical analysis. RESULTS: Sixteen patients were enrolled in the study and their average age was 45.63 ± 18.18 years. All clinical scores decreased with significant difference after 16‐week treatment compared with baseline. All patients achieved EASI 50 (EASI score decreased by 50% or more), and 9/16 patients reached EASI 75 after 16‐week treatment. Dermoscopy evaluation of erythema, scales and erosion scores were decreased, and the sign of pigmentation score was increased after treatment. For HFUS, the mean SLEB value was 0.51 ± 0.29 mm and decreased to 0.27 ± 0.15 mm after 16‐week treatment (p < 0.01). SLEB value decreased linearly with treatment time and correlated with clinical scores. However, SLEB values of two patients were 0.57 and 0.68 mm at week 16, respectively, which were higher than the average, and one of the patients showed EASI 75. CONCLUSION: Dermoscopy and HFUS were able to reveal deeper inflammation response than clinical scores in AD and can be an effective method to evaluate and monitor clinical improvement during dupilumab treatment for AD patients. The preliminary value of imaging methods for predicting the treatment endpoint of dupilumab remains to be verified. John Wiley and Sons Inc. 2022-12-23 /pmc/articles/PMC9838759/ /pubmed/36704877 http://dx.doi.org/10.1111/srt.13260 Text en © 2022 The Authors. Skin Research and Technology published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Liu, Zhaorui
Niu, Zihan
Zhang, Dingding
Liu, Jie
Zhu, Qingli
Improve the dupilumab therapy evaluation with dermoscopy and high‐frequency ultrasound in moderate‐to‐severe atopic dermatitis
title Improve the dupilumab therapy evaluation with dermoscopy and high‐frequency ultrasound in moderate‐to‐severe atopic dermatitis
title_full Improve the dupilumab therapy evaluation with dermoscopy and high‐frequency ultrasound in moderate‐to‐severe atopic dermatitis
title_fullStr Improve the dupilumab therapy evaluation with dermoscopy and high‐frequency ultrasound in moderate‐to‐severe atopic dermatitis
title_full_unstemmed Improve the dupilumab therapy evaluation with dermoscopy and high‐frequency ultrasound in moderate‐to‐severe atopic dermatitis
title_short Improve the dupilumab therapy evaluation with dermoscopy and high‐frequency ultrasound in moderate‐to‐severe atopic dermatitis
title_sort improve the dupilumab therapy evaluation with dermoscopy and high‐frequency ultrasound in moderate‐to‐severe atopic dermatitis
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9838759/
https://www.ncbi.nlm.nih.gov/pubmed/36704877
http://dx.doi.org/10.1111/srt.13260
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