Air Pollution and Its Implications for Atopic Dermatitis and Psoriasis: A Systematic Review

Presenter: Zahraa Zaini

Air pollution is increasingly being identified as an environmental factor contributing to inflammatory skin disorders. Exposure to pollutants, including particulate matter (PM), nitrogen dioxide (NO₂), and ozone (O₃), may induce oxidative stress, impair skin barrier function, and activate pro-inflammatory pathways. While atopic dermatitis (AD) and psoriasis have multifactorial aetiologies, environmental pollution may influence disease susceptibility and activity. This systematic review examines the available evidence on the association between air pollution exposure and outcomes in AD and psoriasis. A systematic search of PubMed, Embase and MEDLINE identified studies published between 2021 and 2026. Two reviewers independently screened records, with 1,128 records identified and 103 articles undergoing full-text screening: 77 on AD, 23 on psoriasis and 3 addressing both conditions. Higher exposure to PM2.5, NO₂ and O₃ was consistently associated with increased disease incidence and exacerbations. A 10 µg/m³ increase in PM2.5 correlated with a 7-14% rise in AD-related outpatient visits. In a cohort of 474,055 individuals, exposure to PM2.5, PM10 and NO₂ was associated with increased psoriasis risk (hazard ratios [HRs]: 1.41, 1.47 and 1.28, respectively); the highest exposure groups had nearly double the risk (HR 2.01). Air pollution represents an important environmental contributor to inflammatory skin disorders. Identifying these environmental triggers is crucial for effective patient education and the development of public health strategies. Further research is warranted to inform evidence-based clinical recommendations.

Comparative Efficacy of Upadacitinib and Nemolizumab with Background Topical Therapy in Adults and Adolescents with Moderate-to-Severe Atopic Dermatitis: A Placebo-Anchored Matching-Adjusted indirect Comparison

Presenter: Jonathan I. Silverberg

Atopic dermatitis (AD) is a chronic inflammatory skin condition characterised by eczematous lesions and pruritus. Upadacitinib (UPA), a Janus kinase 1 inhibitor, and nemolizumab (NEMO), an interleukin-31 receptor alpha antagonist, are both approved for the management of moderate-to-severe AD. This placebo-anchored matching-adjusted indirect comparison (MAIC) compared UPA, a Janus kinase 1 inhibitor, with NEMO, an interleukin-31 receptor alpha antagonist, using data from the phase 3 AD Up, ARCADIA 1 and ARCADIA 2 trials. Patients received UPA 15 mg (UPA15), UPA 30 mg (UPA30), or NEMO 30 mg alongside background topical therapy for 16 weeks. At Week 16, UPA demonstrated statistically significant superiority over NEMO across all assessed outcomes, with treatment benefits evident as early as Week 2. The matching-adjusted response rates were numerically higher with UPA15 and UPA30 than with NEMO for EASI 75 (42.9% vs 68.3% and 79.2%, respectively), EASI 90 (25.6% vs 48.4% and 67.6%), improvement in WP-NRS of ≥4 points (41.9% vs 54.2% and 62.4%), WP-NRS score of less than 2 (29.6% vs 40.1% and 50.8%), and achievement of both EASI 75 and WP-NRS improvement of ≥4 points (23.4% vs 45.5% and 57.8%). Placebo-adjusted response rates were also higher with UPA15 and UPA30 than with NEMO across all five outcomes: EASI 75 (+40.8% and +51.8% vs +13.4%), EASI 90 (+35.7% and +54.9% vs +8.0%), WP-NRS improvement of ≥4 points (+40.4% and +48.6% vs +24.0%), WP-NRS score of less than 2 (+31.4% and +42.2% vs +18.3%), and combined EASI 75 and WP-NRS improvement of ≥4 points (+36.2% and +48.5% vs +12.8%). The risk differences (RDs) for these comparisons were statistically significant (p < 0.001). 

The patients achieved higher rates of moderate and optimal treatment responses with UPA15 and UPA30 than with NEMO. These differences were evident as early as Week 2 and were maintained through Week 16.

Concomitant Atopic Dermatitis and Psoriasis: From Clinicopathological Profiling to Target Treatment Observation Based on a Prospective Cohort

Presenter: Mengmeng Li

Atopic dermatitis (AD) and psoriasis (PsO) are traditionally considered distinct inflammatory skin diseases, but their coexistence can complicate diagnosis and treatment selection. This prospective, single-centre observational cohort study examined the clinicopathological features and treatment responses of patients meeting the Hanifin & Rajka criteria for AD and the clinicopathological criteria for PsO were enrolled in China between August 2022 and August 2024, with an additional one-year follow-up. The cohort included 44 patients, of whom 40/44 (90.9%) were diagnosed with both diseases concurrently and 34/44 (77.3%) developed symptoms in adulthood. Facial involvement occurred in 16/44 (36%), alongside predominant lesions on the trunk and extensor limb surfaces. Clinical and histopathological assessments identified three phenotypes: coexistent, eczematized and indeterminate overlap. Among patients receiving upadacitinib, a selective Janus kinase 1 (JAK1) inhibitor, 5/7 achieved high-level responses in both the Psoriasis Area and Severity Index (PASI) and Eczema Area and Severity Index (EASI). Dupilumab was ineffective in all treated patients, while biologics targeting interleukin (IL)-17, IL-12/23 and IL-23 showed variable outcomes. These findings propose a clinicopathological framework for concurrent AD and PsO and suggest potential therapeutic value for JAK1 inhibition, warranting validation in larger multicentre studies.

Efficacy of Upadacitinib in Patients with Itch-Dominant Atopic Dermatitis: A Post-Hoc Analysis from The Phase 3 Measure Up 1 and Measure Up 2 Trials

Presenter: Nina Magnolo

Atopic dermatitis (AD) is a chronic systemic inflammatory condition characterised by eczematous skin lesions and intense pruritus. Pruritus is considered the most burdensome symptom, often accompanied by sleep disturbances, pain, and impaired quality of life. Clinical presentations vary in terms of itch intensity and extent of skin involvement, resulting in distinct phenotypes. The itch-dominant phenotype, observed in approximately one-quarter of patients with AD, is characterised by severe pruritus despite mild-to-moderate skin lesions. Upadacitinib (UPA), an oral selective Janus kinase inhibitor, is approved for the treatment of moderate-to-severe AD in patients aged 12 years and older.This post-hoc analysis of the phase 3 Measure Up 1 and Measure Up 2 trials assessed UPA in patients aged 12–75 years with moderate-to-severe AD, defined by body surface area (BSA) involvement ≤40% and Worst Pruritus Numerical Rating Scale (WP-NRS) score ≥7. A total of 435 patients (PBO, n = 156; UPA15, n = 140; UPA30, n = 139), representing 26% of the overall population across both trials, presented with an itch-dominant phenotype at baseline. The baseline mean (SD) scores for EASI, body surface area (BSA), WP-NRS, and Dermatology Life Quality Index (DLQI) were 21.9 (5.5), 28.1 (8.1), 8.2 (0.9), and 17.3 (6.9), respectively, with the DLQI score indicating a very large effect on patients’ lives. At Week 16, higher proportions of patients receiving UPA15 or UPA30 achieved skin clearance and itch relief compared with placebo (PBO), with many simultaneously attaining no or minimal itch and clear or almost clear skin (multiple domain assessment, MDA). No or minimal itch (WP-NRS 0/1) was achieved by 30.0% of patients receiving UPA15 and 54.0% receiving UPA30, compared with 4.5% receiving PBO. Optimal skin clearance was achieved by 59.3% and 52.1% of patients receiving UPA15, respectively, and 76.3% and 72.7% receiving UPA30, compared with 12.8% and 9.6% receiving PBO. MDA outcomes were also higher with UPA15 and UPA30, with simultaneous achievement of EASI ≤3 and WP-NRS 0/1 reported in 24.3% and 50.4% of patients, respectively, and EASI 90 and WP-NRS 0/1 in 22.9% and 48.9%, respectively, compared with 3.2% and 2.6% with PBO.

 Among patients with itch-dominant moderate-to-severe AD, a higher proportion of those treated with UPA achieved optimal treatment targets for itch relief, and skin clearance compared with placebo. 

Exposure to Sugar Rationing in The First 1000 Days of Life and Risk of Atopic Dermatitis

Presenter: John Tetteh

Early-life dietary exposures may influence the long-term risk of atopic dermatitis (AD),  the United Kingdom’s sugar rationing during World War II provides a natural experiment to investigate this association. This population-based, quasi-experimental regression discontinuity study used UK Biobank data linked to primary care records from 29,075 participants born between October 1951 and March 1956. Individuals exposed to rationing during pregnancy and early childhood were compared with those never exposed, with follow-up for AD diagnosis until age 66 years. The incidence of AD was 12.48 per 10,000 person-years. Exposure extending from in utero through 24 months postnatally was associated with a lower risk of AD (adjusted hazard ratio [aHR], 0.82; 95% confidence interval [CI], 0.73–0.92). Consistent associations were observed using Cox and flexible parametric models (aHR, 0.81; 95% CI, 0.72–0.91 for both). This exposure was associated with 24 fewer AD cases per 1,000 individuals and a delay in disease presentation of up to 9 years (7.14–11.07). No associations were observed for negative control outcomes. These findings suggest an association between early-life sugar rationing and reduced long-term AD risk, although the observational design does not establish that reducing sugar intake directly prevents the disease.

Extent of Cutaneous involvement as a Marker of Systemic inflammation and Metabolic Dysregulation in Seborrheic Dermatitis

Presenter: Fatih Boynueğrioğlu

Seborrheic dermatitis (SD) is a chronic inflammatory skin disorder traditionally associated with Malassezia colonisation and sebaceous gland activity, with emerging evidence suggesting links to systemic inflammation and metabolic dysregulation. This cross-sectional observational study involving 118 patients investigated the association between the extent of cutaneous involvement, disease severity, and metabolic and inflammatory parameters. Disease severity was assessed using the modified Seborrheic Dermatitis Area and Severity Index (SEDASI). Cutaneous involvement was evaluated across four anatomical sites: scalp, face, ears, and trunk. Simultaneous scalp and facial involvement was the most common presentation (36.4%). Patients were classified as having mild (n = 38), moderate (n = 41), advanced (n = 27), or severe (n = 12) disease. Significant differences in fasting glucose and C-reactive protein (CRP) levels were observed across severity groups, with higher values in advanced and severe disease. The number of affected anatomical sites showed significant positive correlations with HbA1c, CRP, total cholesterol, HOMA-IR, LDL cholesterol, and fasting glucose. Additionally, a family history of diabetes mellitus was significantly associated with greater disease severity, with its prevalence increasing in the advanced and severe groups (p = 0.043). Overall, extensive cutaneous involvement and greater disease severity were associated with systemic inflammation and metabolic dysregulation, particularly elevated HbA1c, HOMA-IR, CRP, and LDL levels. The strongest association was observed with HbA1c, highlighting the potential importance of metabolic screening in patients with widespread or severe SD. These findings should be interpreted in the context of the study's cross-sectional, single-centre design.

Itch-Dominant Phenotype in Atopic Dermatitis: Prevalence, Biomarker Dissociation, and Therapeutic Implications

Presenter: Do Young Park

Severe pruritus in atopic dermatitis (AD) may occur despite limited skin involvement, potentially leaving symptom burden inadequately represented by lesion-based assessments alone. This retrospective study characterized clinical features, inflammatory biomarkers and treatment responses in 289 patients classified by baseline Eczema Area and Severity Index (EASI; cutoff 16) and Itch Numeric Rating Scale (NRS; cutoff 7). The itch-dominant group, defined by moderate lesions and severe itch (ML-SI), comprised 103 patients (35.6%), making it the largest subgroup. Despite severe pruritus, these patients showed no significant differences from the moderate-lesion, moderate-itch group in total immunoglobulin E (IgE; p=0.33) or peripheral eosinophil counts (p=0.80). Higher erythema and trunk EASI subscores independently predicted the itch-dominant phenotype (odds ratios [ORs] 1.57 and 1.28, respectively). At follow-up, ML-SI patients had the greatest median itch reduction (3.0 points; p<0.001), while EASI improvement did not differ significantly between groups (p=0.251). These findings suggest that itch severity may not parallel conventional inflammatory biomarkers or overall lesion severity, supporting assessment of pruritus alongside skin-based measures in AD.

Long-Term Upadacitinib Safety in Moderate-to-Severe Atopic Dermatitis Up to 7 Years: An integrated Analysis with Over 9600 Patient-Years of Exposure

Presenter: Emma Guttman-Yassky

Long-term treatment of atopic dermatitis (AD) requires sustained disease control alongside ongoing safety monitoring. This integrated analysis pooled three phase 3 trials—Measure Up 1, Measure Up 2 and AD Up—to assess the long-term safety of upadacitinib (UPA) in adults and adolescents aged 12–75 years with moderate-to-severe AD. Overall, 2,683 patients received UPA 15 mg (n=1,337) or 30 mg (n=1,346), contributing 9,623.7 patient-years of exposure over up to 524 weeks. The incidence rates of adverse events of special interest (AESIs) were as follows: serious infections (UPA 15 mg: 2.2 events/100 patient-years [E/100 PY]; UPA 30 mg: 2.7 E/100 PY), herpes zoster (3.2 and 5.1 E/100 PY, respectively), nonmelanoma skin cancer (NMSC; 0.4 and 0.5 patients/100 PY, respectively), malignancies excluding NMSC (0.3 and 0.4 patients/100 PY, respectively), adjudicated major adverse cardiovascular events (0.2 and less than 0.1 patients/100 PY, respectively), and adjudicated venous thromboembolic events (0.1 and 0.2 patients/100 PY, respectively). These findings demonstrate consistently low rates of adverse events of special interest over up to seven years of upadacitinib treatment. Rates were generally similar between doses and major cardiovascular, thromboembolic, and malignancy rates remained comparable to or below background rates reported in real-world AD populations, supporting the established benefit-risk profile of upadacitinib in moderate-to-severe AD.

Patient‑Reported Outcomes in Paediatric Atopic Dermatitis Treated with Mometasone Furoate 0.1% Cream

Presenter: Dhiraj Dhoot

Rapid relief of itching, rash and skin dryness is an important treatment goal in children with atopic dermatitis (AD). This multicentre, retrospective, cross-sectional observational study assessed the effectiveness, onset of symptom relief and tolerability of mometasone furoate 0.1% cream in children aged 2–12 years with mild-to-moderate AD across 408 centres in India. Among 1,084 children, 61.1% had mild and 38.9% had moderate disease. After 7 days of treatment, mean patient-reported scores on a 10-point scale were 7.7 for itch reduction, rash reduction and dryness improvement, and 7.8 for overall symptom improvement. Clear or almost clear responses (scores 8–10) were reported for itching in 66%, rash in 68%, dryness in 65% and overall symptoms in 70%. Symptom improvement was typically observed within 3–5 days, with mean times ranging from 4.5 to 4.7 days. Reported adverse events included irritation or burning (3.6%), itching (3.3%) and skin redness (3.0%). These real-world findings suggest rapid and clinically meaningful improvement in itching, rash, skin dryness, and overall symptoms within the first week of treatment, with generally good tolerability. Although the observational design and lack of a comparator limit causal inference, the results support the short-term use of mometasone furoate 0.1% cream in the routine management of paediatric atopic dermatitis.

EADV Congress 2026, 30 Sep - 03 Oct 26, Vienna