The dermatology drug approval and enforcement feeds both returned nothing today, which is the usual pattern — drug regulators publish little that dermatologists act on directly, and AAD, EADV and IADVL documents issued as web pages do not reach this sweep.
Two consensus documents landed instead. The first is an American Academy of Dermatology Good Practice Statement, developed by a multidisciplinary workgroup using GRADE, on the diagnostic workup of adults with presumed atopic dermatitis that has not responded to optimised treatment. Its central message is the one dermatologists know and general clinicians often do not: when eczema does not respond, the first question is whether it is eczema. Misdiagnosis and concomitant conditions are common in this group, and the statement supports diagnostic reassessment rather than further therapeutic escalation. The workgroup is explicit that this rests on indirect evidence and expert consensus, because direct data on workup strategies do not exist.
The second is a US Delphi consensus on severe alopecia areata, from 31 experts across three survey rounds with a 70% agreement threshold. Oral Janus kinase inhibitors were agreed as primary long-term therapy for all patients, with dupilumab as an alternative where there is comorbid atopy. Supplemental options include oral and topical minoxidil, intralesional, oral and high-potency topical corticosteroids, and topical JAK inhibitors and prostaglandins by body site. Patient support resources should be offered alongside drug treatment.
The explicit exclusions matter: these recommendations do not cover children, pregnancy, mild-to-moderate disease, or patients with significant comorbidity.
- When adult atopic dermatitis fails optimised treatment, reconsider the diagnosis before escalating therapy
- Consider cutaneous T-cell lymphoma, allergic contact dermatitis, scabies and drug eruption among the mimics worth excluding
- In severe alopecia areata, oral JAK inhibitors are the consensus primary long-term therapy, with dupilumab where there is comorbid atopy
- The alopecia consensus explicitly excludes children, pregnancy, mild-to-moderate disease and significant comorbidity
- Note the coverage gap: AAD, EADV, IADVL and CDSCO documents do not reach this feed
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