Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, National Clinical Research Center for Dermatologic and Immunologic Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Skin Res Technol. 2023 Jan;29(1):e13260. doi: 10.1111/srt.13260.
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.
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.
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.
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.
特应性皮炎（AD）是一种慢性炎症性疾病。近年来，单克隆抗体度普利尤单抗已被批准用于治疗中重度 AD。皮肤成像方式的客观治疗反应评估可辅助临床评估。本研究旨在探讨在接受度普利尤单抗治疗的中重度 AD 患者中，皮肤镜和高频超声（HFUS）成像特征在治疗评估中的价值。
纳入对常规治疗反应不佳的中重度 AD 患者。所有患者均接受至少 16 周的度普利尤单抗标准化治疗。在治疗 0、2、4、8、12 和 16 周时进行临床评分（湿疹面积评分指数[EASI]、SCOARD、瘙痒数字评分量表、皮肤病生活质量指数）、皮肤镜和 HFUS 检查。在皮肤镜下对红斑、鳞屑、糜烂和色素沉着进行评分，并测量 HFUS 下的表皮下低回声带（SLEB）厚度作为定量指标。采用描述性分析和混合效应线性回归模型进行统计学分析。
本研究纳入 16 例患者，平均年龄为 45.63±18.18 岁。与基线相比，所有临床评分在 16 周治疗后均有显著下降。所有患者均达到 EASI 50（EASI 评分下降 50%或更多），16 周治疗后 9/16 例患者达到 EASI 75。皮肤镜下红斑、鳞屑和糜烂评分降低，色素沉着评分增加。HFUS 方面，平均 SLEB 值为 0.51±0.29mm，治疗 16 周后降至 0.27±0.15mm（p<0.01）。SLEB 值随治疗时间呈线性下降，与临床评分相关。然而，两名患者在第 16 周时的 SLEB 值分别为 0.57 和 0.68mm，高于平均值，其中一名患者达到 EASI 75。
皮肤镜和 HFUS 能够揭示 AD 比临床评分更深层次的炎症反应，可作为评估 AD 患者接受度普利尤单抗治疗临床改善的有效方法。成像方法预测度普利尤单抗治疗终点的初步价值仍有待验证。
