POSTER PRESENTATIONS

2021 Pediatric dermatology  
Objectives: As new and expensive treatment options will become available for pediatric patients with atopic dermatitis (AD) in the near future, more insight in the current economic and humanistic burden of this population is needed. The present study investigates the economic and humanistic burden in pediatric AD patients. Method: This cohort study includes mild to severe AD patients aged 4 to 17 years, treated in the Wilhelmina Children's Hospital, University Medical Center Utrecht, located in
more » ... the Netherlands between December 2018 and May 2020. Data related to the economic and humanistic burden are collected from both baseline questionnaires and retrospectively from electronic medical records from different medical institutions and pharmacies. Patients are categorized into mild, moderate or severe AD based on their Eczema Area and Severity Index (EASI) score. Associations between costs and severity will be investigated. Direct and indirect costs are calculated as annual costs per patient. Results: The results of approximately 75 pediatric AD patients will be presented. The primary outcome includes the economic burden of Dutch pediatric AD patients, stratified into direct and indirect costs. Secondary outcomes relate to the humanistic burden of Dutch pediatric AD patients, such as Patient-Oriented Eczema Measure and (Children's) Dermatology Life Quality Index. Dicussion: The results of this study will provide more insight in the economic and humanistic burden in pediatric AD patients. In future studies our results can be used as reference prices per AD severity category, making it possible to compare the current economic and humanistic burden to those after treatment with new therapies. P003 | Efficacy and safety of abrocitinib in adolescents with moderate-to-severe atopic dermatitis (AD) from the JADE clinical trial program Objectives: To investigate efficacy and safety of abrocitinib, a oncedaily oral Janus kinase 1 inhibitor, as monotherapy or combination therapy in adolescents with moderate-to-severe AD Method: Patients aged 12-17 years with moderate-to-severe AD and an inadequate response to ≥4 consecutive weeks of topical medication or treatment with systemic therapy for AD, both within the past 6 months, were randomly assigned (2:2:1 JADE MONO-1/ MONO-2 [NCT03349060/NCT03575871]; 1:1:1 JADE TEEN [NCT03796676]) to receive once-daily oral abrocitinib (200 mg or 100 mg) or placebo as monotherapy (JADE MONO-1, JADE MONO-2) or in combination with medicated topical therapy (JADE TEEN) for 12 weeks. Coprimary endpoints were proportion of patients achieving Investigator's Global Assessment (IGA) response (clear [0] or almost clear [1] with ≥2-grade improvement from baseline) and proportion of patients who achieved ≥75% improvement in Eczema Area and Severity Index score (EASI-75) at week 12. A key secondary endpoint was the proportion of patients achieving ≥4-point improvement in Peak Pruritus Numerical Rating Scale (PP-NRS4 response) at week 12. Drug safety was also assessed. ABSTRACTS Results: Overall, 285 and 124 adolescents in JADE TEEN and JADE MONO-1/MONO-2, respectively, were treated. In JADE TEEN, more abrocitinib-treated (200 mg, 100 mg) than placebo-treated patients achieved IGA (46.2%, 41.6% vs 24.5%; P < 0.05 for both doses), EASI-75 (72.0%, 68.5% vs 41.5%; P < 0.05 for both doses), and PP-NRS4 (55.4%, 52.6% vs 29.8%; P < 0.01 for 200 mg vs placebo) responses at week 12. Adverse events (AEs) were reported for 62.8%, 56.8%, and 52.1% of patients in 200-mg, 100-mg, and placebo groups, respectively; 1 (1.1%), 0, and 2 participants (2.1%) had serious AEs. JADE MONO-1/MONO-2 safety results were similar, but efficacy results were lower, as expected for monotherapies. Dicussion: Results from JADE clinical trials suggest that abrocitinib was effective in adolescents with moderate-to-severe AD, with an acceptable safety profile. P004 | Increased incidence of conjunctivitis with dupilumab treatment in adolescents appears to be specific to atopic dermatitis Marjolein de Bruin-Weller 1 ; Objectives: To report the incidence of conjunctivitis in adolescents treated with dupilumab or placebo in clinical trials for atopic dermatitis (AD) or asthma. Method: Patients aged ≥12 to <18 years received subcutaneous (SC) dupilumab 300 mg every 4 weeks (q4w; n = 83), 200/300 mg every 2 weeks (q2w; n = 82), or placebo (n = 85) for 16 weeks for moderateto-severe AD in the randomized, placebo-controlled LIBERTY AD ADOL trial (NCT03054428); or add-on SC dupilumab 200 mg q2w (n = 34), 300 mg q2w (n = 34), or placebo (n = 39) for 52 weeks for uncontrolled moderate-to-severe asthma in the randomized, placebo-controlled LIBERTY ASTHMA QUEST trial (NCT02414854). Conjunctivitis events (MedDRA Preferred Terms: conjunctivitis, allergic conjunctivitis, bacterial conjunctivitis, viral conjunctivitis, adenoviral conjunctivitis, atopic keratoconjunctivitis) during the treatment period were summarized. Results: The proportion of patients with ≥1 conjunctivitis event was 4.7%/10.3% in the placebo/combined dupilumab (300 mg q4w or 200/300 mg q2w) groups in the AD ADOL trial, and 2.6%/2.9% in the placebo/combined dupilumab (200 mg or 300 mg q2w) groups in the ASTHMA QUEST trial. 2.4%/7.9% of patients (placebo/combined dupilumab) in the AD ADOL trial had ≥1 conjunctivitis event considered related to study drug; no events were considered related to study drug in the ASTHMA QUEST trial. Conjunctivitis cases in both trials were mostly mild or moderate in severity, most resolved during the treatment period, and none resulted in permanent discontinuation of study treatment. Dupilumab demonstrated significant efficacy and acceptable safety vs placebo in the AD ADOL and ASTHMA QUEST trials. Dicussion: A higher incidence of conjunctivitis was observed in adolescents treated with dupilumab than with placebo only in the AD clinical trial, whereas the incidence of conjunctivitis in adolescents in the asthma clinical trial was low and similar between dupilumab and placebo. Similar results were reported in adults. Objectives: No clinically important changes in hematology, serum chemistry, and urinalysis parameters have been reported for adults and adolescents with moderate-to-severe atopic dermatitis (AD) treated with dupilumab. We assess the impact of dupilumab treatment on laboratory values in children aged ≥6-<12 years with severe AD. Method: In LIBERTY AD PEDS (NCT03345914), a multicenter, phase 3 trial, patients aged ≥6-<12 years with severe AD were randomized 1:1:1 to subcutaneous dupilumab every 2 weeks (q2w; 100 mg if baseline weight <30 kg, 200 mg if ≥30 kg); 300 mg q4w; or placebo; for 16 weeks, all with concomitant medium-potency topical corticosteroids. Results: Safety was assessed in 362 patients (q2w/q4w/placebo: n = 122/n = 120/n = 120). Baseline mean eosinophil counts were 0.82/0.83/0.85 × 10 9 /L for q2w/q4w/placebo. Increases from baseline in mean eosinophil counts were observed in all groups, with the highest mean increase at Week (Wk) 8 for placebo (+0.10 × 10 9 /L) and dupilumab q4w (+0.17 × 10 9 /L), and at Wk16 for dupilumab q2w (+0.25 × 10 9 /L). No treatment-related, clinically relevant, events were associated with eosinophilia. There were no meaningful trends 14 | Pediatric Dermatology ABSTRACTS in mean changes from baseline in leukocyte counts or hemoglobin levels at Wk16. At Wks4/8/16, mean platelet values were lower in both dupilumab groups compared with baseline, but remained within normal range (q2w/q4w/placebo: −19.3/−18.8/+5.0 at Wk16). There were no clinically meaningful trends in mean changes from baseline in chemistry parameters in any group. Mean decreases from baseline in lactate dehydrogenase (LDH) were observed in both dupilumab groups up to Wk16 (q2w/q4w/placebo: −42.2/−39.4/−0.4 U/L at Wk16). The dupilumab safety profile was consistent with the known dupilumab safety profile. Dicussion: There were no clinically important changes in laboratory parameters attributable to dupilumab treatment in children aged ≥6-<12 years with severe AD in LIBERTY AD PEDS. Consistent with a reduction in systemic inflammation and tissue damage, decreases in platelet counts and LDH levels were observed in both dupilumab groups. P006 | Long-Term Efficacy and Safety of Dupilumab in a Phase 3, Open-Label Extension Trial in Children With Uncontrolled, Moderate-to-Severe Atopic Dermatitis Objectives: Long-term treatment options of AD in children are limited. We report efficacy and safety data from the ongoing, long-term LIBERTY AD PED-OLE trial of dupilumab (NCT02612454). Method : Patients aged ≥6 months to <18 years with moderate-tosevere AD who had participated in a previous dupilumab study were enrolled in this OLE study. Patients aged ≥6 years to <18 years received 300 mg every 4 weeks (q4w), which could be up-titrated in case of inadequate clinical response at Week (Wk) 16 as: patients <60 kg-200 mg q2w; patients ≥60 kg-300 mg q2w. Data are reported here for patients aged ≥6 years to <12 years (n = 362 at OLE baseline, n = 309 at Wk4, n = 34 at Wk52; data cutoff: July 22, 2019). Results: 18% of patients had an Investigator's Global Assessment score of 0/1 at OLE baseline, 24.6% at Wk4, and 44.1% at Wk52. Mean percent change (standard deviation) from parent study baseline (PSBL) to OLE baseline in Eczema Area and Severity Index (EASI) was −59.4(36.4), with incremental improvement at Wk4 (−71.1[26.2]) and Wk52 (−85.7[17.5]). At OLE baseline, 41.2% of patients achieved ≥75% reduction in EASI relative to PSBL, increasing to 54.4% at Wk4, and 79.4% at Wk52. Treatment-emergent adverse events (TEAEs) were reported in 58.8% of patients; 2.5% of patients had a serious TEAE. Most common TEAEs were AD exacerbation (15.5%), and nasopharyngitis (13.0%). Dicussion: Long-term treatment with dupilumab showed sustained improvement in signs of AD in the cohort of patients who completed up to 52 weeks. Data were consistent with the known dupilumab safety profile. P007 | Childhood psoriasis in 10 hospitals. Study of clinical characteristics and comorbidities with special reference to the psoriasis/overlap subtype Objectives: Pediatric psoriasis (PP) is probably more frequent than previously considered and also different from that of adults, including the presentation called psoriasis-dermatitis overlap (PDO), with features of psoriasis and atopic dermatitis (AD). Comorbidities in children may be underestimated. The objective of this study is to determine the prevalence of PP in 10 hospitals in Spain and to describe the clinical presentations, associated comorbidities and the evolution of the PDO patients. Method: 1st phase: Cross-sectional, multicenter observational study of PP prevalence in 10 hospitals in Spain during one year. 2nd Phase: Study of the cohort of patients diagnosed with PDO. Results: We collected 97 patients (39 boys) aged between 2 months and 16 years. The clinical forms were plaque psoriasis (58), guttate psoriasis (22), palmoplantar (3) psoriasis (3), inverse (12) and 19 cases of PDO. The majority were moderate or mild. The most frequent treatment was topical. Five cases received narrowband UVB, 5 methotrexate, 4 ciclosporin, 1 etanercept, 1 ustekinumab and 9 adalimumab. Some isolated comorbidities were detected, highlighting the presence of overweight or obesity in 21 children. POD was presented by 19 children. They were younger, with less scalp involvement and more family history of AD. We have the evolution of 12 patients with PDO. Two of them evolved to AD, one towards psoriasis and 10 remained as PDO Dicussion: We stand out the existence of a significant number of PP, with different clinical forms, and associated comorbidities, which leads us to consider that this pathology may be underdiagnosed in | 15 Pediatric Dermatology ABSTRACTS childhood. The clinical profile of patients with POD highlights how difficult it can be diagnose psoriasis in children. A greater monitoring of them can help to establish what clinical characteristics allow to know what their evolution will be P009 | Paediatric atopic dermatitis incidence and treatment patterns in the UK: Results from a large population-based primary care cohort study (Objectives: To examine trends in the incidence of paediatric atopic dermatitis (AD) and associated treatment patterns in a large contemporary primary care population over a 10-year period (2009-2018). Method: The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) database encompasses 2.7 million people currently registered with 293 general practitioner practices in England. Incident AD cases were identified using a validated algorithm based on the presence of 1 diagnostic code with ≥2 ADrelated treatment codes on separate days. Active AD was defined as ≥2 AD-related diagnosis or treatment codes within a 1-year period, and was assumed to last for 1 year. Prescription records (emollients/ soap substitutes, topical corticosteroids [TCS], topical calcineurin inhibitors, topical antimicrobial agents, systemic immunomodulators, and oral antihistamines) were examined for paediatric patients with active AD. Analyses were stratified by age group (infants, <2 years; children, 2-11 years; and adolescents, 12-17 years), sex, ethnicity, and socioeconomic status. Results: Approximately 90 000 paediatric patients with incident AD were included in the analysis, of whom >50% had active AD. AD incidence was markedly higher in infants (11.9 per 100 personyears) than in children (1.8 per 100 person-years) or adolescents (0.5 per 100 person-years). Asian and black ethnic groups had the highest AD incidence. Higher socioeconomic status was associated with higher incidence of AD in infants, but the reverse association was seen in children and adolescents. Emollients/soap alternatives were the most frequently prescribed treatment in all paediatric age groups (range, 54.3%-74.2%), followed by mild TCS (27.5%-60.6%), topical antimicrobial agents (10.5%-22.3%), and oral antihistamines (18.2%-24.2%). Escalation of medication potency was more common with increasing age and more common in paediatric patients of non-white ethnicity. Higher socioeconomic status and non-white ethnicity were associated with higher rates of systemic immuno-modulatory therapy and specialist dermatology referrals. Background: Atopic Dermatitis (AD) is the most prevalent chronic skin disease affecting up to 20% of children in developed countries, and frequently leading to an impaired quality of life of affected children and their families. Education is one of the most important aspects of managing AD. Storytelling is a powerful method of patient education. Aim: Production and evaluation of educational videos with the method of storytelling for parents of children, aged 0 to 5 years, with AD. Method: A team consisting of Advanced Practice Nurses (APN's), pediatric dermatologists, a video producer and a communication specialist produced the videos. The video production process consisted of several steps. After the production, a multi professional team and parents of affected children tested the videos to ensure the understandability, the helpfulness and importance of the educational videos. Results: We created 6 different videos in all. The content of the educational videos includes information on the causes of AD, symptoms, skin care, treatment instruction and living with AD. The videos have a real storyline; two families with affected children share their experience with the disease and how they deal with problems. An APN, a pediatric dermatologist and psychologist provide evidence-based information about AD. The evaluation of the videos showed that the information in the videos are simple, understandable and relevant. Dicussion: Evidence-based videos with the method of storytelling are an innovative, creative and modern method to support mediabased education. Patient stories are an effective means of educating patients because they increase personal relevance and may reduce counter-arguing. Storytelling is an excellent method to provide complex information in a simple and understandable information to patients and families. A study investigating the effects of these videos on quality of life, eczema severity and steroid-phobia compared to classic patient education is ongoing. 16 | Objectives: To examine the influence of maternal cholecalciferol supplementation during pregnancy on risk of atopic eczema in the offspring at ages 12, 24 and 48 months. Method: The Maternal Vitamin D Osteoporosis Study (MAVIDOS) study; a multicentre, double-blind, randomised, placebo-controlled trial that recruited pregnant women from three study sites in the UK (Southampton, Oxford, and Sheffield). Participants were allocated to either cholecalciferol 1000 IU/day or matched placebo, taken from around 14 weeks' gestation until delivery. The primary outcome was neonatal whole-body bone mineral content. Offspring were assessed for atopic eczema at ages 12 (n = 636), 24 (n = 611) and 48 (n = 450) months, ascertained based on the UK Working Party Criteria for the Definition of Atopic Dermatitis. Results: Mothers and offspring characteristics did not differ significantly between the intervention and placebo groups with the exception of longer breast feeding duration in the intervention group. After adjusting for breastfeeding duration, offspring of mothers who received 1000 IU cholecalciferol had lower odds ratios (OR) of atopic eczema at ages 12 months: OR (95%CI) 0.55 (0.32-0.97), P = 0.04. The OR of atopic eczema in the intervention group at ages 24 and 48 months were 0.77 (0.47-1.24), P = 0.28 and 0.71 (0.35-1.43), P = 0.34, respectively. Discussion: Our data provide evidence of a clinically important impact of antenatal cholecalciferol supplementation on the offspring's risk of atopic eczema and support existing evidence for immunomodulatory functions of cholecalciferol and its involvement in skin barrier formation. We found an effect of antenatal cholecalciferol supplementation on offspring risk of atopic eczema in infancy, which weakened as the children grew older. The findings are supportive of developmental influences on atopic eczema acting in utero and point to a potentially modifiable prenatal influence on atopic eczema and may help direct preventive strategies for this prevalent, chronic condition. P013 | No increased risk of cancer in children using topical tacrolimus for atopic dermatitis: A 10-year prospective cohort study Objectives: Approval of topical tacrolimus ointment 0.03% in atopic dermatitis (AD) patients 2-15 years old was granted pending long-term pediatric safety data. APPLES™ (A Prospective Pediatric Longitudinal Evaluation to Assess the Long-Term Safety of Tacrolimus Ointment for the Treatment of Atopic Dermatitis) was an observational study designed to address the possibility of increased cancer risk in this population. Method: Children with AD were eligible if they had exposure to topical tacrolimus for ≥6 weeks before age 16. There were no treatment restrictions during the study. Patients were observed over 10 years under actual-use conditions, with regular clinic visits and completion of questionnaires. The primary outcome was occurrence of any malignancy. Standardized Incidence Ratios (SIRs) for cancer events were analysed with respect to sex-, age-, and race-matched background population data from national cancer registries. A sensitivity analysis examined SIR assuming a hypothetical increase in cancer incidence after loss to follow-up. Results : Between May 2005 and August 2012, APPLES enrolled 7954 patients at 314 sites in 9 North American or European countries and closed on 31 January 2019. Median study persistence was 6.4 years, with 14.7% of patients (1171/7954) remaining on-study for ≥10.0 years. Patients accrued 44629 patient-years (PYRS) of follow-up. No lymphomas occurred, and 6 incident cancers were observed: 1 chronic myeloid leukemia, 1 alveolar rhabdomyosarcoma, 1 carcinoid tumor of the appendix, 1 spinal cord neoplasm, 1 malignant paraganglioma, and 1 spitzoid melanoma. The calculated SIR was 1.01 (95% CI 0.37 to 2.20). Dicussion: Cancer incidence observed in the APPLES cohort closely matched incidence rates in sex-, age-, race-and nationality-matched background populations. Sensitivity analysis confirms the robustness of this finding, despite the loss of follow up for some patients. The APPLES study suggests no increase in long-term cancer risk due to exposure of children with AD to topical tacrolimus ointment. | 17 Pediatric Dermatology ABSTRACTS P014 | Cosmetic emollient for subjects with sensitive, reactive and dry skin, with atopic dermatitis tendency: Clinical evaluation Objectives: Aim of the study is to evaluate the moisturizing, softening and soothing efficacy of a cosmetic emollient containing Rice Bran Oil, Butyrospermum parkii Butter, Glycosphingolipids, Phospholipids and Cholesterol. Method: 20 male and female subjects with previous history of atopic dermatitis and showing cutaneous manifestations of dry/desquamate/sensitive skin are enrolled. Product effects are evaluated after 24 hours, 48 hours, 14 days and 28 days of use. Measured parameters were skin moisturizing, trans epidermal water loss (TEWL) and skin desquamation. The study is completed with clinical analysis and self-assessment. Tested formula was an oil-in-water emulsion. Results: The product determines a statistically significant increase of skin moisturizing index vs. T0 at each monitored check. The product shows a statistically significant decrease of TEWL vs. T0 at each monitored check. The product determines a statistically significant improvement of skin micro-relief, skin hydration and skin desquamation. Already after 24 hours after products application, skin erythema statistically significant reduce on the treated areas. The product application shows, starting from T24h, a statistically important reduction of skin tightness and skin pinching sensation. Dicussion: The product determines an improvement of the considered parameters at all study times. A significant increase of the moisturizing index, a statistically important reduction of the TEWL and a significant improvement of the skin micro-relief are reported. The itching and skin tightness sensations significantly decrease soon after 24 hours since the single product application. The clinical analysis shows an improvement of skin hydration, of skin desquamation and of skin redness. Almost all subjects positively judge the product both in terms of cosmetic acceptability and efficacy. No Adverse Event was found and the products tolerability was good. P015 | Skin microbiome changes after treatment with a topical emollient plus in subjects predisposed to atopic dermatitis Objectives: Atopic dermatitis (AD) is a common, chronic inflammatory skin disease, characterized by disturbances in epidermal barrier function and hyperactive immune response. Evidence suggests that epidermal barrier impairment and disturbances in the skin microbiome are linked in AD. AD flares are associated with a substantial loss of biodiversity in the skin microbiome. This study evaluated changes in the skin microbiome, after treatment with an emollient plus (EP/Dermoflan), containing liquorice extract, xylitol and galactooligosaccharide in subjects predisposed to AD. Method: In this monocentric, open study, subjects were considered predisposed to AD if they met the following criteria: hyperreactive/very dry skin; ≥1 episode of dermatitis during life; skin prone to irritation/erythema; and frequent itching. EP was applied twice daily between the neck and shoulders. To assess alpha and beta microbiome diversity, bacterial DNA was extracted from treated areas at baseline (T0) and after 28 days of treatment (T28). Changes in the skin microbiome at T28 versus T0 in EP-treated areas were evaluated. Results : Eleven subjects aged 18-65 years predisposed to AD were included. Alpha diversity, an index of the biodiversity of the microbial population in terms of number of species and their distribution, significantly increased in EP-treated areas at T28 versus T0 (P = 0.037). Beta diversity, indicating the degree of variability of a group in terms of comparison against other observed groups, significantly increased in EP-treated areas at T28 versus T0 (P = 0.033). Dicussion: EP significantly increased diversity of the bacterial population in the skin after 28 days of treatment. Improvement in skin dysbiosis may be associated with positive results from previous studies, in which clinical improvement in AD was seen after EP treatment. Further analyses are needed to confirm these findings in larger populations, and to identify a direct correlation between changes in the microbiome and clinical improvement of AD. P016 | Prevalence and comorbidity of atopic dermatitis during childhood: A cross-sectional, population-based study in Spain Background: Atopic dermatitis (AD) is very common, especially during childhood, and is usually accompanied by chronic comorbidities. Objectives: To explore AD prevalence in children based on their socio-demographic characteristics, and to exhaustively analyse their multimorbidity profile through the description of the most frequent comorbidities and the identification of those statistically associated with AD. 18 | Pediatric Dermatology ABSTRACTS Method: Cross-sectional, population-based study conducted in the EpiChron Cohort (Aragón, Spain) on the prevalence of AD in children under 18 years of age. We carried out a descriptive analysis of their socio-demographic characteristics and comorbidities (i.e., chronic diagnoses/conditions registered in their electronic health records from 1 January 2011 to 31 December 2015). Sex-and age-adjusted odds ratios (OR) were calculated for each comorbidity using logistic regression models. Results: 33 591 children had a diagnosis of AD, resulting in an overall prevalence of 15.5%. AD prevalence was higher in girls compared to boys, in 3-to 9-year-olds compared to children of other ages, and in Spanish children compared to those of other nationalities. Multimorbidity (i.e., presence of at least one other chronic condition besides AD) was present in 43% of children with AD, with the most frequent chronic comorbidities being asthma (13.1%), psychosocial disorders (7.9%), and visual impairment (7.8%). A large number of diseases were, regardless of their prevalence, statistically associated with AD. The most strongly associated ones were (OR) chronic cystic breast disease (2.49), asthma (2.10), allergic rhinitis (1.99), and irritable bowel syndrome (1.90). Dicussion: AD during childhood is frequently associated with other chronic diseases of a diverse nature, such as neuropsychiatric, visual, cardio-metabolic, and autoimmune. A better knowledge of the constellation of comorbidities associated with AD disease in children might help prevent or delay their appearance. Future longitudinal studies are encouraged to shed light on the potential common underlying pathophysiological mechanisms involved in the identified associations. P017 | Atopic dermatitis with severe verrucous hyperkeratotic plaques Amélie Gorris; Doris Weiss; Dagmar Födinger; Objectives: A 9-year-old girl with atopic dermatitis (AD) suffering from MRSA associated recurrent pruritic pyoderma was intensely treated with Methylprednisolonaceponat 0.1% dressing, Octenisept ® antiseptic solution and Mupirocin ointment on the nostrils and was cured of pyoderma and MRSA superinfection. 4-Years later, she presented to our Pediatric Dermatology Outpatient Clinic with severe atopic dermatitis and verrucous hyperkeratotic plaques on the wrists and ankles. Method: Blood tests, bacterial skin-smears and HPV typing of the verrucous hyperkeratotic lesions were performed. Results: Eosinophilia of 14%, elevated ECP (198 ug/L) and total IgE levels (>5000 kIU/L) associated with polyvalent inhalant and food sensitization were found. Skin-smear confirmed Staphylococcus aureus superinfection. The hyperkeratotic lesions were HPV negative. After ruling out HPV infection, a systemic therapy with oral cyclosporine A (CsA) 3 mg/kg was started, a combination preparation of | 19 Pediatric Dermatology ABSTRACTS Oral antihistamines were prescribed for 16 patients, however only 1 received a 1-month trial prescription, as recommended. Skin infection was diagnosed in 5 patients. Antibiotics were prescribed in 4: topical (n = 1); oral (n = 1); intravenous (n = 2). 1 patient received acyclovir for eczema herpeticum. Dicussion: These results highlight opportunities to improve the management of childhood atopic eczema in secondary care. Disease severity should be assessed routinely, and potential triggers including diet should be explored more often. Greater attention to discussion of steroid side-effects is needed. Antihistamines should be reviewed after a 1-month trial before continuing. P019 | Clinical efficacy of fecal microbial transplantation treatment in adults with moderate-to-severe atopic dermatitis Objectives: Patients with atopic dermatitis (AD) suffer from a multidimensional disease burden. We report clinically meaningful improvements in AD signs, symptoms, and quality of life in children treated with FDA-approved doses of dupilumab. Method: In LIBERTY AD PEDS phase 3 trial (NCT03345914), children aged 6-11 years were randomized to dupilumab 300 mg every 4 weeks (300 mg-q4w, loading dose 600 mg), 100 mg/200 mg-q2w (loading dose 200 mg/400 mg), or placebo; with concomitant medium-potency topical corticosteroids (TCS). We evaluated the proportion of patients reaching a composite endpoint at Week (Wk) 16 of achieving: ≥50% improvement in Eczema Area and Severity Index (EASI-50); and ≥3-point improvement in Peak Pruritus Numerical Rating Scale (PP-NRS) score; and ≥6-point improvement in Children's Dermatology Life Quality Index (CDLQI) from baseline. Results: This analysis included 243 patients (<30 kg: 300 mg-q4w + TCS/placebo + TCS; ≥30 kg: 200 mg-q2w + TCS/placebo + TCS, n = 61/61/59/62). In both the 300 mg-q4w and 200 mg-q2w dupilumab dosing regimens, almost half of the children treated with dupilumab achieved all 3 clinically meaningful endpoints (objective and patient-reported) at Wk16 (49.2%/9.8%, 300 mg-q4w/placebo <30 kg and 47.5%/8.1% 200 mg-q2w/placebo ≥30 kg; P < 0.0001 for both). A significantly higher proportion of patients achieved EASI-50 or ≥3-point improvement in PP-NRS or ≥6-point improvement in CDLQI at Wk16 vs placebo (95.1%/62.3%, 300 mg-q4w/placebo <30 kg and 94.9%/59.7% 200 mg-q2w/placebo ≥30 kg; P < 0.0001 for both). Safety profile was consistent with the known dupilumab safety profile in adult and adolescents. Dicussion: Dupilumab + TCS provides clinically meaningful and statistically significant improvements in AD signs (EASI-50), symptoms (PP-NRS), and quality of life (CDLQI) in children aged 6-11 years with severe AD. Objectives: In LIBERTY AD PEDS (NCT03345914), a 16-week double-blind, placebo-controlled, phase 3 trial, dupilumab significantly improved atopic dermatitis (AD) signs and symptoms in children with severe AD. Here, we assess time to onset of pruritus improvement in children with severe AD treated with dupilumab FDA-approved doses. Method: Children aged ≥6-<12 years were randomized to dupilumab 300 mg every 4 weeks (300q4w, baseline weight <30 kg; 600 mg loading dose), 200 mg every 2 weeks (200q2w, baseline weight ≥30 kg; 400 mg loading dose), or placebo. All patients received concomitant medium-potency topical corticosteroids (TCS). We report change from baseline in daily Peak Pruritus Numerical Rating Scale (NRS) scores and proportion of patients who achieved ≥4-point improvement from baseline in Peak Pruritus NRS. Results: 243 patients were included in this post hoc analysis (300q4w + TCS/placebo + TCS<30 kg/200q2w + TCS/placebo + TCS ≥ 30 kg, n = 61/61/59/62). Mean percent change from baseline (standard error) in daily Peak Pruritus NRS decreased after a single dose of dupilumab, as early as Day 8 in the dupilumab 300q4w group vs control (-13.8% [2.9] vs -5.1% [2.9]; P < 0.05) and Day 16 for children treated with dupilumab 200q2w vs control (−22.1% [3.4] vs −12.6% [3.3]; P < 0.05). A higher proportion of dupilumab-treated patients showed clinically meaningful response (≥4-point improvement) in Peak Pruritus NRS vs control, as early as Week 3 in the dupilumab 300q4w group (14.8% vs 3.3%; P < 0.05) and Week 5 in the dupilumab 200q2w group (28.1% vs 12.9%; P < 0.05). Dicussion: Dupilumab + TCS treatment provided rapid and clinically meaningful improvement in intensity and frequency of itch in children with severe AD. 22 | Objectives: Atopic dermatitis (AD), a chronic inflammatory skin disease, can affect different parts of the body. Dupilumab inhibits interleukin-4 and interleukin-13 signaling and is approved for treating multiple type 2 inflammatory diseases, including AD. We evaluated improvement in AD signs across anatomical regions in children with severe AD treated with FDA-approved doses of dupilumab, using Eczema Area and Severity Index (EASI) regional scores. Method: In the double-blind, 16-week, phase 3 LIBERTY AD PEDS trial (NCT03345914), children aged ≥6-<12 years with severe AD were randomized 1:1:1 to dupilumab 300 mg every 4 weeks (300 mg-q4w, loading dose 600 mg); 100 mg/200 mg-q2w (loading dose 200 mg/400 mg); or placebo; with concomitant mediumpotency topical corticosteroids (TCS). Improvement in AD signs across anatomical regions was assessed using EASI regional scores. Results : This analysis included 243 patients treated with FDAapproved doses of dupilumab, or placebo (<30 kg: 300 mg-q4w + TCS/placebo + TCS; ≥30 kg: 200 mg-q2w + TCS/placebo + TCS, n = 61/61/59/62). Mean (SD) baseline EASI regional scores in the 300 mg-q4w/placebo < 30 kg/200 mg-q2w/placebo ≥ 30 kg groups | 23 Pediatric Dermatology ABSTRACTS Objectives: Juvenile dermatomyositis (JDM) is the most common pediatric inflammatory myopathy. Myositis-specific antibodies (MSA) are associated with characterized clinical features in adults, less described in children. The aim of the study was to identify a clinico-immunological correlation in JDM, particularly upon dermatological signs. Method: An observational, retrospective, multicenter cohort study was performed including children (age <18 years) with pure DMJ (according to the 119th ENMC criteria) and overlapping DMJ (according to Troyanov criteria) with a follow-up >6 months and a search for ASM by immunodot. We performed a descriptive, univariate but also clustering statistical analysis of patient subgroups. | 29 Pediatric Dermatology ABSTRACTS P042 | Isolated linear scaly lesions must evoke the Conradi-7 markers, blood cultures remained negative; Amphotericin-B dosage was escalated (5 mg/kg). Results: Skin biopsy performed a week after onset of lesions revealed septate hyphae. Skin culture revealed heavy growth of fusarium. Fusarium keratoplasticum, a part of Fusarium solani complex P068 | Omenn syndrome with striking skin peeling mimicking epidermolytic ichthyosis Objectives: Extensive skin peeling at birth is suggestive of epidermolytic ichthyosis due to KRT1 or KRT10 mutations. However, the P073 | A case of oculocerebrocutaneous syndrome Objectives: To present a case of Oculocerebrocutaneous syndrome (OCCS), a rare neurocutaneous disorder, in a female infant necessitating neurosurgical and ophthalmological surgery. Method: Case report and review of the medical literature. Results: We present the case of a female born with clinical and imaging features consistent with OCCS in the form of aplasia cutis, periorbital skin appendages, an eyelid coloboma, a lipodermoid cyst, an epidermoid cyst and mild hypoplasia of the inferior cerebellar vermis and hemispheres, in keeping with a Dandy-Walker variant. She developed hydrocephalus and required a ventriculoperitoneal shunt as well as ophthalmic surgery. She is awaiting surgical repair of her cleft palate and aplasia cutis. | 43 Pediatric Dermatology ABSTRACTS P080 | Secukinumab improves quality of life of paediatric patients with moderate-to-severe plaque psoriasis: 52-week results from a Phase III, randomised study
doi:10.1111/pde.14594 fatcat:6fro2ruz2bavva6kjgxpq2ailu