⚡Eczema trial tests bathing frequency

Good morning — it’s Saturday, November 22, and we’re covering a landmark trial examining bathing frequency in eczema, new data on topical ruxolitinib in mild hidradenitis suppurativa, and more.

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The first large trial to explore the effect of bathing frequency on eczema symptoms, published in BJD, found that weekly bathing was non-inferior to daily bathing for short-term symptom control.

The study enrolled 438 UK participants aged 1 year and older with self-reported eczema, excluding those with very mild disease. The trial was conducted entirely online. Participants were randomized to weekly bathing (1–2 times per week) or daily bathing (≥6 times per week) for four weeks, while continuing their usual treatments.

The primary endpoint was weekly patient-reported symptoms using the Patient-Oriented Eczema Measure (POEM; range 0–28, with higher scores indicating more severe symptoms). Mean baseline POEM score was 14.7.

At Week 4, POEM scores were similar in both groups (mean 11.6 vs 10.6; P = 0.30), with no evidence of a significant difference.

Secondary outcomes for itch, eczema control, and quality of life were consistent with the primary result. Participants in the weekly bathing group used flare-control creams on slightly fewer days each week, by about half a day.

Adherence to the assigned bathing frequency was high at around 80–90% each week in both groups. No serious unintended effects or harms were reported.

Limitations included the unblinded design, short study duration, and reliance on self-reported eczema status and symptoms.

This trial marks the start of the Rapid Eczema Trials research programme. The project is a five-year citizen science initiative where people with eczema help co-design multiple online trials that address practical questions about self-management of eczema. Next up is a study on the optimal duration of steroid cream use during flares.

> Topical ruxolitinib shows early efficacy in mild hidradenitis suppurativa: A Phase 2 study published in JAAD showed that ruxolitinib 1.5% cream (Opzelura) achieved greater reductions in abscess and inflammatory nodule (AN) counts than vehicle in milder hidradenitis suppurativa. The findings seek to address a major evidence gap for the roughly 66% of patients with mild disease, a group for whom no therapies are currently approved. Investigators randomized 69 adults with Hurley stage I–II disease and an AN count of 3–10 to ruxolitinib 1.5% cream or vehicle twice daily for 16 weeks. All patients then applied as-needed ruxolitinib through Week 32. Mean baseline AN count was 5.4. At Week 16, ruxolitinib produced a larger change from baseline in AN count than vehicle (least squares mean –3.6 vs –2.4; P = 0.02), with benefit sustained through Week 32. Flares were also less frequent during the blinded period (3% vs 26% of participants). Two patients experienced flares in the open-label phase and two more during the safety follow-up (about one month after discontinuation). The cream was well tolerated. Limitations included the small sample size and a higher discontinuation rate with ruxolitinib during the blinded period (10 vs 3 patients), mainly due to loss to follow-up. The topical JAK inhibitor could reduce reliance on antibiotics and enable earlier intervention before progression to tunneling disease. Larger Phase 3 trials are underway.

> First trial comparing baricitinib to azathioprine in moderate-to-severe atopic dermatitis: A randomized single-center trial published in the BJD found that baricitinib, a JAK1/2 inhibitor, was superior to azathioprine for moderate-to-severe atopic dermatitis. Investigators randomized 40 adults to baricitinib 4 mg once daily or weight-based azathioprine 1.5–2.5 mg/kg daily for 12 weeks. All patients received topical corticosteroids once daily and 10% urea cream twice daily. At Week 12, 65% of baricitinib-treated patients achieved EASI 75 (≥75% improvement in eczema severity) compared with 15% on azathioprine (P = 0.002). Secondary endpoints generally favored baricitinib, though not all differences were statistically significant. Both regimens were well tolerated. There were no serious adverse events and no discontinuations. Limitations included the small sample size, open-label design, single-center setting, and short duration.

> Unorthodox JAK dosing tested in pediatric alopecia areata: A randomized trial published in JAAD explored unorthodox weight-based, twice-daily dosing of tofacitinib and baricitinib in 100 children (ages 2–17) with moderate-to-severe pediatric alopecia areata. Average baseline scalp coverage was 30–32% (mean SALT score 68–70; range 0–100). In moderate alopecia areata (SALT 25–49), 33% on tofacitinib and 41% on baricitinib achieved ≥90% scalp coverage (SALT ≤10) at Week 24 (P = 0.87). In severe (SALT 50–94) and very severe disease (SALT ≥95), 45% vs 31% and 47% vs 32% achieved ≥80% scalp coverage (SALT ≤20) (P = 0.75 and P = 0.51). Overall, SALT90 responses (≥90% improvement in coverage) were numerically higher with baricitinib (37% vs 22%; P = 0.16). Both drugs were well tolerated, with no serious adverse events. Only one discontinuation occurred in each arm. Acne was more frequent with tofacitinib (12% vs 6%). Key limitations were the short duration, open-label design, and modest sample size. The authors noted that baricitinib appeared less effective in severe alopecia areata here compared with outcomes reported for the standard 4-mg once-daily dose in the BRAVE-AA-PEDS trial at Week 36. They attributed this difference to dose fractionation in the current study.

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