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Atopic Dermatitis Provider Toolkit

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Dermatology Hot Topics

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"Seemingly insignificant impacts on a patient can really change the trajectory of their life so it's very important to treat [atopic dermatitis] early."

Why is Early Treatment of Atopic Dermatitis So Important? Mona Shahriari, MD, Says it Could Change a Life

 Revolutionizing Atopic Dermatitis (RAD) 2025 

meeting in Nashville this month, Mona Shahriari, MD, assistant clinical professor of 

 at the Yale University School of Medicine, gave a presentation titled, "The Psychosocial Impact of Atopic Dermatitis" that focused on the cumulative life course impairment associated with the disease. During an interview at the meeting, 

 asked Shahriari what she hoped might be different in understanding of the emotional 

 if she made the same presentation at RAD 2026. 

"One moment during the session really struck me. I asked the audience how many were familiar with the term cumulative life course impairment. Only 3 or 4 hands went up. That was eye-opening," she said. Her hope for what might be different about this talk next year reflects what she hopes dermatologists at this year's meeting took home with them: 

When a patient with AD walks into your clinic, it might feel like just another rash on the schedule. But for them, it could be the reason they don’t leave the house. It could be the reason they don’t fall in love. It could be the reason they stop dreaming. Taking the time to ask the right questions, to understand the full burden of disease, and to start effective treatment—those things can genuinely transform lives.

Shahriari said she hopes that the research in the area of cumulative life course impairment in AD will have progressed and awareness increased so that when she asks the same question next year, there will be just 3 or 4 hands that do not go up. 

Mona Shahriari, MD is an assistant clinical professor of dermatology at Yale University School of Medicine in New Haven, CT and co-founder of Central Connecticut Dermatology in Cromwell, CT. 

For more RAD 2025 meeting coverage, please click here.

Atopic dermatitis is not just "another rash on the schedule. It could be the reason that patient doesn't leave the house," Shahriari says.

Clinical Topics

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Why Is Early Treatment of Atopic Dermatitis So Important? Mona Shahriari, MD, Says It Could Change a Life

Routine corticosteroid use after emergency department (ED) discharge for mild to moderate pediatric anaphylaxis offered no significant benefit in preventing return visits within 7 days, according to recent findings published in the journal  

The researchers found that 4.4% of children who received dexamethasone revisited a healthcare facility compared with 6.7% of those who received placebo, yielding an absolute risk reduction of just 2.3% (95% CI, –5.8 to 8.3%) and an estimated number needed to treat (NNT) of 44 (95% CI, 12 to ∞; 

Corticosteroids remain a common adjunct to epinephrine and antihistamines in the treatment of anaphylaxis, particularly in hospitalized patients, study authors wrote. Observational studies have suggested that steroids may shorten hospital stay for severe cases, but evidence for their role after ED discharge has been lacking. They pointed out that clinical practice guidelines from both US and European professional organizations recommend  corticosteroids as optional therapy for children following an ED stay for anaphylaxis. 

Do OCS Offer Meaningful Protection Against Recurrence? 

Previous research, specifically a large 2015 retrospective cohort study including 5052 children discharged from an ED following anaphylaxis, found that fully two-thirds (66%) received corticosteroids.

 Within 3 days, the study authors emphasized, 5% of both steroid-treated and untreated children returned to the ED, punctuating the question of whether or not steroids offer meaningful protection against post-discharge symptom recurrence.

“To our knowledge, this is the first randomized clinical trial to test the effect of steroids in decreasing anaphylactoid reaction in pediatric patients treated for mild-moderate anaphylaxis,” study investigators Rafah Al Sayyed, MD, from Hamad Medical Corporation, and Khalid Alansari, MD, FRCPC, FAAP, from Weill Cornell Medical College and Qatar University Medical College," wrote.

They conducted the randomized, blinded pilot trial at the Pediatric Emergency Center of Hamad General Hospital in Qatar between June 2018 and February 2024.  Eligible participants were aged 3 months to 14 years who presented with mild to moderate anaphylaxis, defined as acute allergic reactions involving at least 2 systems. Children with severe anaphylaxis, moderate to severe asthma, immunological disease, or current corticosteroid treatment were excluded.

Participants received standard acute therapy with epinephrine and H1-antihistamines. Before discharge, 152 of the original 352 children assessed were randomly assigned to receive either oral dexamethasone syrup (0.3 mg/kg, maximum 10 mg; n=68) or a matched placebo (n=75). All were prescribed a 5-day course of cetirizine and received daily follow-up calls for a week. The primary endpoint was revisit or readmission to any healthcare facility within 7 days.

Contrary to original projections, Alansari et al reported a far lower revisit rate among participants treated with placebo (6.7% vs the expected 35%). Just 3 of the 68 dexamethasone-treated children and 5 of 75 placebo-treated participants returned to the ED within 7 days. The calculated relative risk reduction of 33.8% did not meet statistical significance, according to the findings. 

The absolute risk reduction of 2.3% corresponded to an NNT of 44. Subgroup analyses by severity, cause, or systems involved showed no significant differences. Secondary outcomes—including readmission and need for hospital admission—were also not statistically significant. No serious drug-related adverse events were reported. 

“Uncommon recurrence and a high number needed to treat after ED anaphylaxis treatment suggests against routine ED predischarge corticosteroid without a clinical rationale,” the team wrote

Among the study's limitations the authors acknowledged that the trial was underpowered as a result of CVOID-19-related recruitment suspension and an overestimation of the revisit rates. They did note that the actual 6.7% rate is consistent with other study results. 

Unnecessary use of corticosteroids should be avoided, Alansari and colleagues wrote. Repeated exposure without express clinical need carries potential risks, particularly for youth. Even short courses have been associated with vomiting, behavioral changes, and sleep disturbances.

Longer-term or repeated use carries more serious risks, including growth suppression, reduced bone mineral density, increased susceptibility to infection, and Cushingoid features.

"We conclude that dexamethasone treatment of ED-discharged anaphylaxis children aged 3 months to 14 years should not be routine, but rather restricted to those patients for whom there is a sound clinical rationale, because the proportion of patients likely to be spared return within 7 days if all are treated is quite small," they concluded. 

Al Aayyed R, Alansari K. Randomized blinded pilot trial of corticosteroid after mild-moderate anaphylaxis to prevent recurrence. Medicine. 2025;104(31):p e43600. doi: 10.1097/MD.0000000000043600 

Michelson KA, Monuteaux MC, Neuman MI. Glucocorticoids and hospital length of stay for children with anaphylaxis. a  restrospective study. 

. 2015;167(3):719-24.e243. doi:10.1016/j.jpeds.2015.05.033 

Aljebab F, Choonara I, Conroy S. Systematic review of the toxicity of short-course oral corticosteroids in children. 

. 2016 Apr;101(4):365-70. doi: 10.1136/archdischild-2015-309522

Aljebab F, Choonara I, Conroy S. Systematic review of the toxicity of long-course oral corticosteroids in children. 

 2017;26;12(1):e0170259. doi:10.1371/journal.pone.0170259

Corticosteroids following resolution of anaphylaxis should be chosen with clear, clinical rationale and reserved for select children, study authors concluded.

Pilot Trial Challenges Routine Steroid Use After Pediatric Anaphylaxis ED Discharge

When We Say "OX40 Inhibition," What Do We Mean? Emma Guttman-Yassky Explains

When We Say "OX40 Inhibition," What Do We Mean? Emma Guttman-Yassky, MD, PhD, Explains

"What does it mean to target OX40 and the OX40 ligand pathway?" Emma Guttman-Yassky, MD, PhD, phrased the question like the veteran dermatology professor and researcher that she is, during a recent interview with 

Guttman-Yassky was in Paris for the 2025 European Academy of Dermatology and Venerology Annual Meeting, held September 17-20. She and colleagues were presenting recent data on the OX40 inhibitor rocatinlimab for the treatment of atopic dermatitis from the phase 3 ROCKET clinical trial program, under the auspices of rocatinlimab codevelopers, Amgen and Kyowa Kirin.

The therapeutic landscape for moderate-to-severe AD has evolved rapidly and significantly in the last decade as targeted therapies have been successively approved and marketed. They include dupilumab (IL-4 receptor antagonist), IL-13 inhibitors (tralokinumab, lebrikizumab), and JAK inhibitors (upadacitinib, abrocitinib, baricitinib).

 These agents have become guideline-recommended first-line systemic treatments, providing superior efficacy and safety compared to conventional immunosuppressants.

There is still a significant unmet need, however, for treatments that can deliver sustained remission and potentially modify the atopic dermatitis disease course. The majority of treatments typically reach maximum efficacy by 12-16 weeks with disease returning quickly when they are stopped. This fact has helped illuminate research into the persistence of underlying immunological memory that drives AD pathogenesis.

This has led to investigation of the OX40-OX40L costimulatory pathway as a novel therapeutic target. As Guttman-Yassky explains in the short video above, OX40 (CD134) is a member of the tumor necrosis factor receptor superfamily expressed on activated T cells, particularly memory T cells, while OX40L (CD252) is expressed on antigen-presenting cells and other immune cells.

The OX40-OX40L interaction provides critical costimulatory signals that promote T-cell activation, proliferation, and survival, with particular importance in maintaining memory T-cell responses.

 In people with atopic dermatitis, this pathway is dysregulated, and elevated expression has been observed in skin lesions and in peripheral blood.

EADV 2025: Guttman-Yassky has great confidence in the future of agents that block the OX40 pathway, suggesting that they have the potential for disease modification. 

Grace Halsey

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