<p>Welcome to&nbsp;<em>The Hematology Podcast</em>, your source for the latest insights into hematology and rare blood disorders. This podcast covers cutting-edge research, clinical advancements, and real-world cases tailored for healthcare professionals. Each episode offers expert perspectives on evolving therapies and best practices, helping you stay informed and improve patient outcomes. Whether you're focused on research or clinical practice, The Hematology Podcast is designed to keep you at the forefront of the field, transforming your approach to hematology.​</p>

<p><strong>Immune Thrombocytopenia (ITP) is an autoimmune disorder characterized by a low platelet count, which can lead to increased bleeding and bruising. In this episode, we will discuss the pathophysiology, clinical implications, and advancements in ITP.</strong></p>
<p>Our guest today, Professor Waleed Ghanima, is a renowned hematologist at Østfold Hospital and the University of Oslo in Norway. Prof. Ghanima has extensive experience in the field of hematology and has contributed significantly to research on ITP. Today, he will share his insights on ITP, its clinical management, and future directions in research and management.</p>
<h4 class="exptguest">Expert guest</h4>

ITP - Beyond platelet count - Episode 22

<p><strong>A new genomic definition of high-risk multiple myeloma (HR-MM) has been recently proposed by IMS/IMWG. The associated peer-reviewed publication is planned to be released in Spring 2025.</strong></p>
<p>Expert guest in this episode is Professor Monique Minnema, haematologist at the University Hospital in Utrecht in The Netherlands. She is an international expert with focus on diagnosis and treatment of malignant haematological diseases including Multiple Myeloma and Waldenström disease. She just recently accepted the vice-chair position of the HOVON Multiple Myeloma Working Group in the Netherlands.</p>
<h4 class="exptguest">Expert guest</h4>

High risk Multiple Myeloma - an update - Episode 21

MULTIPLE-MYELOMA

GAUCHER

RARE-DISEASE

ONCOLOGY

<h2>For additional insights and resources in hematology, refer to the following sites:​</h2>

<p>Educational programs for healthcare professionals</p>


<p>Heeft u vragen of wilt u meer weten? Wij zorgen dat u zo snel mogelijk geholpen wordt.</p>


Wij staan klaar

The Hematology Podcast - Season 5

<h2>Now Available: Rhino Rounds International 2025</h2>
<p>Rhino Rounds International 2025 brings together expert insights, clinical innovation, and international perspectives in one dynamic on-demand webinar.</p>
<p>Through the lens of leading experts <strong>Prof. Sietze Reitsma</strong> (Netherlands) and <strong>Prof. Martin Wagenmann</strong> (Germany), you'll gain a deeper understanding of how CRSwNP care is evolving — from redefining treatment goals like remission and cure, to interpreting real-world data that’s reshaping clinical decisions. The session concludes with a cross-border comparison of CRSwNP management in Germany and the Netherlands, offering valuable insights for improving outcomes in your own practice.</p>

CHRONIC-RHINOSINUSITIS-WITH-NASAL-POLYPS-CRSWNP

RESPIRATORY

Rhino Rounds International 2025

<h2>Split into three parts for convenient viewing</h2>

<h3>Part 1: New Definitions and Treatment Goals in CRSwNP – Control, Remission and Cure</h3>
<p data-font="small"><strong>Speaker:</strong> Prof. Sietze Reitsma</p>
<p>Prof. Reitsma discusses the transformation in nasal polyp treatment goals from symptom control to achieving remission with biologics. He presents Dutch PolyREG registry data as real-world evidence demonstrating improved patient outcomes.</p>

<h3>Part 2: Real-World Evidence in German Rhinology – Insights from the progNOSE Study</h3>
<p data-font="small"><strong>Speaker:</strong> Prof. Martin Wagenmann</p>
<p>Prof. Wagenmann presents a comprehensive analysis of real-world data on biologic treatments for CRSwNP. Gain valuable insights into the practical application of biologics, their potential to modify disease course, and the evolving treatment landscape. This presentation is essential for understanding the current state and future possibilities of CRSwNP management.</p>

<h3>Part 3: Differences and similarities between Germany and the Netherlands in the management of CRSwNP</h3>
<p data-font="small"><strong>Speaker:</strong> Prof. Sietze Reitsma<br><strong>Speaker:</strong> Prof. Martin Wagenmann<br><strong>Moderator:</strong> Dr. Digna Kamalski</p>
<p>Watch this interactive panel discussion with Prof. Reitsma and Prof. Wagenmann on patient cases presented by Dr. Kamalski, highlighting similarities and differences in the management of CRSwNP.</p>

<p>Prof. Reitsma is an ENT physician at the Amsterdam UMC and is a globally recognized leader in Chronic Rhinosinusitis with Nasal Polyposis and sinus and skull base surgery with more than 85 research publications. His expertise lies in understanding mucosal pathology in the upper and lower airways, with a particular focus on precision medicine. Prof. Reitsma's research encompasses diverse areas such as quality of life assessments, treatment outcomes, and economic considerations, aiming to improve patient care on individual and societal levels. A distinguishing aspect of Prof. Reitsma's work is his exploration of treatable traits and endotyping within CRSwNP. Through a combination of basic immunological research, epidemiological studies, and clinical trials, he seeks to uncover the underlying mechanisms of this condition and develop personalized treatment approaches.</p>

<p>Prof. Wagenmann, MD, PhD, is Head of Rhinology, Allergy, and Endoscopic Skull Base Surgery in the Department of Otorhinolaryngology at the University Hospital of Düsseldorf (UKD), Vice Chair of the UKD Interdisciplinary University Allergy Center, and Head of the UKD Research Laboratory of the ENT Department. Prof. Wagenmann’s main areas of expertise include clinical and immunological aspects of allergic rhinitis and chronic rhinosinusitis, specific immunotherapy with allergens, and mechanisms of head and neck cancer. Prof. Wagenmann is a member of various national and international scientific organizations, including the European Rhinologic Society and the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery, and has been involved in coordinating and coauthoring several national and international clinical guidelines, including the most recent version of the German guidelines on allergic rhinitis.</p>

<p>Dr. Digna Kamalski is a Dutch ENT specialist at the University Medical Center Utrecht, with expertise in rhinology, smell and taste disorders, and skull base surgery. She earned her PhD in 2014 on laser-assisted ear surgery. Dr. Kamalski led the COCOS study on smell loss after COVID-19 and was awarded the 2022 NuanceRing for her clear communication of medical research.</p>

<h2>Missed the live session? No worries!</h2>

<p>Join Professor Hans Aerts as he discusses biomarkers that can help diagnose and monitor Lysosomal Storage Diseases (LSDs), with particular focus on Gaucher disease (GD).</p>

<h3>This session covers:</h3>
<ul>
 <li><strong>Discovery and application</strong>&nbsp;of several plasma protein biomarkers selectively secreted by storage macrophages (Gaucher cells)</li>
 <li>Insights into&nbsp;<strong>sphingoid base lipids</strong>&nbsp;as novel biomarkers in GD and other sphingolipidoses like Fabry disease</li>
 <li>Understanding the&nbsp;<strong>value of biomarkers</strong>&nbsp;for diagnosis, monitoring disease manifestation and following response to therapeutic interventions</li>
</ul>

<p>Professor Hans Aerts chaired the department of Medical Biochemistry at Amsterdam UMC and later Leiden University. His research focuses on glycosphingolipids in health and disease with special attention for inherited lysosomal storage disorders like GD, as well as neurodegeneration and the Metabolic Syndrome.</p>
<p>He is co-founder and honorary president of the European Working Group on Gaucher Disease (IWGGD) and has contributed to the first applications of enzyme replacement therapy and substrate reduction therapy of GD1, as well as the discovery of widely used biomarkers.</p>

<h2>Who should watch?</h2>
<p>This webinar is ideal for:</p>
<ul>
 <li>Hematologists</li>
 <li>Metabolic Specialists</li>
 <li>Clinical Biochemists</li>
</ul>

<h2>Part I: Understanding Lysosomal Storage Diseases and Gaucher Disease</h2>
<p>Explore the historical background of LSDs with focus on Gaucher disease, including its discovery, genetic basis, and diverse clinical manifestations. Professor Aerts explains the pathophysiology of Gaucher disease as a macrophage disorder and discusses how GBA1 gene mutations affect enzyme function and disease progression.</p>

Lunch & Learn Webinar #2 - Biomarkers in Lysosomal Storage Diseases

<h2>Part II: Treatment Approaches for Lysosomal Storage Disorders</h2>
<p>Learn about established therapeutic strategies for Gaucher disease, focusing on enzyme replacement therapy (ERT) and substrate reduction therapy (SRT). This section details how these treatments target macrophages, reviews their historical development, and compares their efficacy in reducing organ volume and improving hematological parameters.</p>

<h2>Part III: Biomarkers in Diagnosis and Monitoring</h2>
<p>Discover key biomarkers used in LSDs, including chitotriosidase, CCL18, and glucosylsphingosine. This section explains their biological significance, laboratory measurement techniques, and clinical applications in diagnosis, disease monitoring, and treatment assessment, with special attention to their use in dried blood spots and emerging biomarker research.</p>

<h2>Beschikbare Curious Cases</h2>
<h3>Echte patiëntverhalen – uw keuzes maken het verschil</h3>

<p>Een pati&euml;nt met een voorgeschiedenis van psoriasis en myelodysplasie presenteert zich met aanhoudende anemie, leukopenie en nieuwe respiratoire klachten. Er zijn aanwijzingen voor een onderliggende systemische oorzaak, maar het plaatje blijft diffuus. U krijgt toegang tot labuitslagen, beeldvorming en aanvullende onderzoeken. Krijgt u de puzzel compleet en komt u tot de juiste diagnose?</p>


<p>Een verder gezonde man van 40 jaar komt met een vergrote milt zonder duidelijke verklaring. Bloedonderzoek laat milde trombocytopenie zien, maar levert geen sluitend antwoord op. Tijdens het diagnostisch traject ontdekt u afwijkingen die u in een andere richting sturen. Herkent u het patroon en vraagt u de juiste test aan?</p>


<p>Een jonge pati&euml;nt met langdurige vermoeidheid en gewrichtsklachten is gediagnosticeerd met seronegatieve reumato&iuml;de artritis. Ondanks behandeling blijven de klachten bestaan en komen er nieuwe symptomen bij. U onderzoekt stap voor stap waar het misgaat en welke hematologische afwijkingen over het hoofd zijn gezien. Weet u de juiste diagnose alsnog te stellen?</p>


<h2>Begin de diagnose</h2>
<h3>Aan u de beurt: wat zou ú doen?</h3>

<h2>Hematologen over Curious Cases</h2>
<h3>Ervaringen van uw collega's</h3>

<p>Curious Cases laat u meedenken met complexe patiëntverhalen gebaseerd op echte casussen uit de praktijk. U bepaalt zelf welke stappen u neemt in het diagnostisch proces en krijgt meteen feedback. Praktisch, to-the-point en ontworpen voor specialisten die hun klinisch inzicht willen aanscherpen.</p>

<p>De situaties zijn herkenbaar voor elke hematoloog en komen voort uit de dagelijkse praktijk.</p>


<p>Elke casus duurt ongeveer 10 tot 15 minuten &ndash; ideaal om even tussendoor te doen.</p>


<p>De focus ligt op praktische keuzes: wat doet u wel en wat niet &ndash; en waarom?</p>


Klinische patiëntcasussen die u aan het denken zetten – waar de diagnose niet voor zichzelf spreekt. Sommige klachten passen niet meteen in een standaardplaatje. Herkent u de signalen die wijzen op een minder voor de hand liggende oorzaak?

Curious Cases - Daag uzelf uit met complexe hematologische casussen

<p><strong>PREVIOUS EPISODE</strong></p>
<h2><strong>Polyp Gossip Episode 3: Living with CRSwNP: Daily Challenges and Solutions</strong></h2>

<p>In this episode of Polyp Gossip, we dive into the real-life experiences of patients living with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), exploring how the condition impacts their daily routines, relationships, and overall well-being. Our guests share their journeys, shedding light on the emotional and physical toll of the condition.</p>

<p>Surgical Whispers: is One Surgery Enough Before Biologics?</p>


<p>Scent-sational Secrets: The Smell Loss Truth</p>


<h2>Biography</h2>
<h3>Wytske Fokkens</h3>
<p>Wytske J. Fokkens, MD, PhD, is a Professor at the Department of Otorhinolaryngology at the Academic Medical Center in Amsterdam. She is the Director of the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) Innovation Forum, Chairperson of the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS), and a member of the European Rhinologic Society Foundation Committee.&nbsp;</p>
<p>Prof. Fokkens is a founding member of EUFOREA, member of the Allergic Rhinitis and its Impact on Asthma Initiative, which develops guidelines for the management of concurrent allergic rhinitis and asthma, and center leader for the Global Allergy and Asthma European Network, a consortium of leading European research centers specializing in allergic diseases. She received the 2015 Paul Ehrlich Award for Experimental Research from the European Academy of Allergy and Clinical Immunology (EAACI) in 2015 and is an honorary member of EAACI, the Spanish and Greek Societies of Otorhinolaryngology, and the Romanian Rhinologic Society.&nbsp;</p>
<p>Prof. Fokkens is the author of more than 500 peer-reviewed papers on allergy and rhinology. Her main field of interest is sinus surgery and mucosal pathology of the upper and lower airways. She has written a textbook on rhinology and skull base surgery and has led an advanced sinus surgery course for more than 15 years. She serves as Editor-in-Chief of&nbsp;<em>Rhinology</em>&nbsp;and Associate Editor of&nbsp;<em>Allergy</em>.</p>
<h3>Peter Hellings</h3>
<p>Peter W. Hellings, MD, PhD, is a Professor and Clinic Head at the Department of Otorhinolaryngology at the University Hospitals of Leuven, and a Guest Professor at Ghent University, Belgium.</p>
<p>Prof. Hellings' research has led to novel insights into the pathophysiology of allergy and chronic airway inflammation, with over 350 scientific publications in top journals in the field of allergology, rhinology, and respiratory care. He is the founder of the European Forum for Research and Education in Allergy and Airway Diseases, an international nonprofit involving a consortium of European key opinion leaders aiming at the implementation of optimal care for chronic respiratory diseases. He is also the founder and director of the European Rhinoplasty Course and a member of European and American guideline committees.</p>

In this episode of Polyp Gossip, we dive into the real-life experiences of patients living with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), exploring how the condition impacts their daily routines, relationships, and overall well-being. Our guests share their journeys, shedding light on the emotional and physical toll of the condition.

Polyp Gossip – Episode 3

<p>Join Dr. Andreas Kindmark as he discusses the assessment of bone health and the management of bone disease in patients with Lysosomal Storage Diseases (LSDs).</p>

<h3>This session covers:</h3>
<ul>
 <li>The critical role of <strong>early identification</strong> and <strong>accurate measurement</strong> of bone disease</li>
 <li>Techniques and methodologies for <strong>assessing bone health</strong></li>
 <li>Insights into how <strong>bone involvement manifests</strong> in various lysosomal storage disorders</li>
</ul>

<p>Dr. Andreas Kindmark is an MD, Associate Professor, and Senior Consultant at <strong>Uppsala University Hospital, Sweden</strong>. He is a Certified Clinical Densitometrist, and coordinating Process Leader for the Uppsala University Hospital national highly specialized care (NHV) units for skeletal dysplasias and osteogenesis imperfecta. He is also a member of the Management and Monitoring working group for the International Working Group for Gaucher disease. Specialized in metabolic diseases, bone, and mineral metabolism, he brings invaluable expertise to this discussion.</p>

<h2>Who should watch?</h2>
<p>This webinar is interesting for:</p>
<ul>
 <li>Endocrinologists</li>
 <li>Hematologists</li>
 <li>Radiologists</li>
</ul>

<h2>Part I: Bone Health Fundamentals &amp; Diagnostic technologies</h2>
<p>Gain a deeper understanding of how&nbsp;<strong>bone mass changes throughout life</strong>&nbsp;and why it matters to patients with LSDs. In this video, explore&nbsp;<strong>advanced techniques</strong>&nbsp;for assessing bone health, and learn the critical roles of different bone cells in maintaining skeletal integrity.</p>

Addressing Bone Disease in Lysosomal storage diseases

<h2>Part II: The impact of LSDs on Bone Health</h2>
<p>How can&nbsp;<strong>early intervention</strong>&nbsp;prevent irreversible bone damage in patients with&nbsp;<strong>LSDs</strong>? Explore how&nbsp;<strong>LSDs</strong>, especially&nbsp;<strong>Gaucher disease</strong>, impact skeletal health. Learn how&nbsp;<strong>advanced imaging</strong>&nbsp;techniques can enhance diagnosis and guide better treatment strategies, ultimately improving the quality of life for patients.</p>

<p>Mucus plugs are a critical yet often overlooked aspect of asthma that significantly contribute to airway obstruction and disease progression.<sup>1</sup></p>
<p>Understanding the mechanisms behind their formation, particularly the role of type 2 inflammation and the cytokine IL-13, is essential for improving asthma management.<sup>1</sup></p>

In healthy lungs, mucus is vital<sup>1</sup>

<h2>Type 2 inflammation and IL-13</h2>
<p>Type 2 inflammation is characterized by the activation of T-helper 2 (Th2) cells and innate lymphoid cells (ILC2s), leading to the production of cytokines, particularly IL-4, IL-5, and IL-13.<sup>1</sup></p>
<p>IL-13 is a key driver of mucus hypersecretion in asthma, significantly increasing the expression of MUC5AC, a mucin that contributes to mucus plug formation.<sup>1</sup></p>

<h2>IL-13 is mainly responsible for mucus overproduction and decreased mucociliary clearance<sup>1,2</sup></h2>

<p><strong>Increased levels of MUC5AC lead to mucus plugs that are resistant to clearance, contributing to airway obstruction and exacerbations.<sup>1</sup></strong></p>

<p>In asthma, the ratio of MUC5AC to MUC5B is dysregulated, with MUC5AC being dramatically upregulated, particularly in eosinophilic asthma. This change results in mucus that is stickier and more tenacious.<sup>1</sup></p>

<h4>MUCUS PLUGGING IS A KEY COMPONENT OF REMODELING IN ASTHMA, LEADING TO FIXED OBSTRUCTION AND LUNG FUNCTION DECLINE<sup>3-5</sup></h4>

<h2>Presence of mucus plugs is associated with worsening clinical asthma outcomes<sup>6</sup></h2>

<p data-font="small">Plugs contribute to ongoing inflammation, creating a cycle that exacerbates symptoms and leads to airway remodeling.</p>

<p>Patients with high mucus scores have substantially<sup>2,6</sup>:</p>
<ul>
 <li><strong>increased IL-13 levels and eosinophil counts</strong> in sputum</li>
 <li><strong>increased level of FeNO</strong>, another biomarker of type 2 inflammation</li>
</ul>

Mucus plugs can be identified and quantified using HRCT imaging of the lungs<sup>4</sup>

The burden of mucus plugs persists in severe asthma patients and impacts OoL<sup>5</sup>

ASTHMA

<h2>To know more about mucus plugging</h2>

<p>In deze webinar bespreekt professor Bart Lambrecht mucusplugs en hun cruciale rol bij longaandoeningen.</p>


<p>Republished with permission of American Society for Clinical Investigation, from Journal of Clinical Investigation, Dunican EM, Mucus plugs in patients with asthma linked to eosinophilia and airflow obstruction, Vol 128/No. 3, Copyright 2018; permission conveyed through Copyright Clearance Center, Inc. Reprinted from the American Journal of Respiratory and Critical Care Medicine, Tang M, et al, Mucus Plugs Persist in Asthma, and Changes in Mucus Plugs Associate with Changes in Airflow over Time, Vol 205/Issue 9,Copyright 2022, with permission from the American Thoracic Society.</p>
<p>*Data from 146 of the 658 adult patients with asthma enrolled in SARP. Of those included in SARP (n=658), 66% of patients met American Thoracic Society/European Respiratory Society criteria for severe asthma. Patients were non-smokers and were required to have evidence of bronchial hyperresponsiveness or reversible airflow obstruction.</p>
<p><strong>ACT</strong>, Asthma Control Test; <strong>FeNO</strong>, fractional exhaled nitric oxide; <strong>FEV1</strong>, forced expiratory volume in 1 second; <strong>OCS</strong>, oral corticosteroid; <strong>SARP</strong>, Severe Asthma Research Program</p>

Mucus plugs in Asthma, and the influence of Type 2 inflammation

<p>EASD and ADA recommend the addition of basal insulin for people with T2DM who do not achieve glycemic goals on a GLP-1 RA-based regimen.<sup>*2,3</sup><br>
  The management of type 2 diabetes (T2D) often requires treatment intensification to achieve optimal glycemic control. The DELIVER-G study explores the real-world outcomes of adding Insulin Glargine 300 U/mL (Gla-300) to GLP-1 receptor agonist (GLP-1RA) therapy in people with type 2 diabetes (PWD2). This study builds on findings from the RESTORE-G real-world study, which examined treatment intensification following GLP-1RA therapy.</p>

Adding Toujeo<sup>®</sup> to GLP-1 RA significantly improved glycemic control<sup>1</sup>

Adding Toujeo<sup>®</sup> to GLP-1 RA did not significantly increase hypoglycemia<sup>1</sup>

Adding Toujeo<sup>®</sup> to GLP-1 RA did not increase weight and body mass index (BMI)<sup>1</sup>

<h2>Study design</h2>
<p>DELIVER-G was a retrospective analysis of 271 patients with type 2 diabetes receiving GLP-1 RA therapy who were insulin-naïve prior to subsequent treatment intensification with Toujeo<sup>®</sup>. DELIVER-G analysed data from a large US electronic medical record data source (IBM<sup>®</sup> Explorys).</p>

<h2>Study population</h2>
<p>Insulin-naïve adult patients (N=271) with T2DM receiving GLP-1 RA therapy ± OAD(s) that was subsequently intensified by adding Toujeo<sup>®</sup>. A total of 156 (57,6%) patients received daily GLP-1 RA and 115 (42,2%) received weekly GLP-1 RA before treatment intensification; 250 (92,3%) patients were receiving at least one OAD prior to intensification with Toujeo<sup>®</sup> (the mean number of OADs was two).</p>
<p><sup>*</sup>Data were extracted from a US electronic medical record data source (IBM<sup>®</sup> Explorys). Patients selected for inclusion had ≥12 months’ pre-Toujeo<sup>®</sup> data and ≥6 months of follow-up data.</p>
<p><sup>**</sup>Paired Student’s t-test. Change in HbA1c between baseline and follow-up was assessed using the last value recorded within the 3- to 9-month period following intensification with Toujeo<sup>®</sup>.</p>
<p><sup>†</sup>Identified by ICD-9 or ICD-10 codes, or a blood glucose recording ≤70 mmol/L, or the number of hypoglycaemic events in the 6-month baseline period vs the 6-month follow-up period. Incidence of any hypoglycaemia pre- and post-intensification with Toujeo<sup>®</sup> was 8,49% and 9,59%, respectively (p=0,513). Paired Student’s t-test.</p>
<p><sup>‡</sup>One hypoglycaemia-associated inpatient visit was recorded during the baseline period and none during the follow-up period after intensification with Toujeo<sup>®</sup>; no hypoglycaemia-associated ED visits were recorded during the baseline period and one during the follow-up period. Incidence of any (8,49% vs 9,59%, p=0,513), and inpatient/ED-associated hypoglycaemia (0,37% vs 0,74%, p=1,000), as well as event rates of any (0,33 vs 0,46 PPPY, p=0,170) and inpatient/ED-associated hypoglycaemia (0,01 vs 0,04 PPPY, p=0,466) were similar before and after addition of Toujeo<sup>®</sup>. When analysed by baseline GLP-1 RA regimen, incidence of hypoglycaemia increased from baseline to follow-up (3,9% to 8,3%, p=0,02; event rate 0,21 to 0,44 PPPY, p=0,017) for those on daily GLP-1RAs. No significant change was observed for those on weekly GLP-1 RAs.</p>

TYPE-2-DIABETES

DIABETES

<p data-font="small">CLICK HERE TO READ THE FULL PUBLICATION</p>

DELIVER-G: Real-world analysis in insulin-naïve adults with T2DM on GLP-1 RA ± OAD(s), intensifying their therapy by starting basal insulin and discontinuing GLP-1 RA, or adding basal insulin to ongoing GLP-1 RA, or initiating a FRC product and discontinuing current GLP-1 RA†<sup>1</sup>

The Deliver-G study

<p>Atopic dermatitis (AD) is a prevalent condition in the elderly, presenting unique challenges in diagnosis and treatment due to its varied presentation and the overall medical condition of the patients.</p>
<p>In this DermTalks podcast episode, Dr. Stine Simonsen, clinical associate professor at the university of Copenhagen and dermatologist at the Copenhagen University Hospitals in Denmark, shares her insights on managing atopic dermatitis in the elderly population.</p>

<p><em>"Atopic dermatitis is prevalent in the elderly and may present in this age group. Special considerations are necessary when treating elderly patients such as considering the patient's overall health, current medications and comorbidities are essential for effective management."</em></p>
<p><strong>Dr. Stine Simonsen<br>
   Dermatologist, Copenhagen University Hospitals, Denmark</strong></p>

<h2>Key highlights</h2>
<p>The elderly population is defined by the OECD as individuals aged 65 years and over, while the United Nations defines an older person as someone over 60 years of age. Atopic dermatitis in the elderly presents unique challenges in diagnosis due to its varied presentation. Also, when considering treatment in this population, it’s essential to account for the patient’s overall medical condition, current medications, and their general physical and mental health status.</p>
<h4>Article of interest:</h4>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/32086792/" target="_blank"><em>Tanei R. Atopic Dermatitis in Older Adults: A Review of Treatment Options. Drugs Aging. 2020 Mar;37(3):149-160</em></a></p>

<h3>Prevalence of AD in the Elderly</h3>
<p>AD is prevalent in the elderly, with onset and clinical course varying<sup>1</sup>. It may present as a new disease in older adults (senile onset), as a recurrence of childhood AD (outgrowth-recurrence form), or as a continuation and/or recurrence of adolescent/adult AD<sup>2</sup>. The prevalence in the elderly varies from 1.2% to 17.1% in studies, with a recent UK study showing a prevalence of 8.2% in adults aged 75-99 years<sup>1</sup>.</p>
<h3>Incidence and Ethnic Differences</h3>
<p>The incidence of AD in the elderly is 8 in 1000 person-years for individuals over 80 years, compared to 174 in 1000 person-years in children under 1 year in the UK. Senile onset AD is higher in males and in Black and Asian populations compared to White ethnic groups and is associated with lower socioeconomic status<sup>1</sup>.</p>
<h3>Clinical Presentation in the Elderly</h3>
<p>AD in the elderly does not have a single presentation<sup>1</sup>. It often manifests as chronic lichenified eczema on the upper body, similar to that seen in adolescents and young adults<sup>2</sup>. The "reverse sign," where the typical distribution of eczema is reversed, is more common in the elderly. AD in the elderly is less likely to affect the face and scalp and more likely to affect the buttocks or genitals. Refractory facial erythema, loss of the lateral eyebrows (Hertoghe sign), Dennie–Morgan infraorbital folds, and neck dermatitis are also observed<sup>2</sup>.</p>
<h3>Diagnostic Challenges</h3>
<p>Diagnosing AD in the elderly can be challenging due to the lack of clear diagnostic criteria. Traditional criteria, such as the UK Working Party or Hanifin and Raika, should be used<sup>2</sup>. When diagnosing AD in the elderly, it is essential to exclude other pruritic skin disorders, such as cutaneous T-cell lymphoma, asteatotic dermatitis, nummular eczema, contact dermatitis, chronic prurigo, adverse drug reactions, scabies, Ofuji disease (in Japanese), chronic eczematous eruption of aging, and eczematous variants of bullous pemphigoid<sup>2</sup>. Extra attention to treatment of refractory disease is needed, and cutaneous T cell lymphoma must be ruled out by histopathology, since this diagnosis should be excluded before initiating any systemic therapy<sup>2,4</sup>.</p>
<h3>Immune Mechanisms</h3>
<p>Adult-onset AD patients may be less likely to have IgE-specific allergies and filaggrin mutations compared to childhood-onset AD<sup>1</sup>. In elderly patients with high serum total IgE, Th2 cytokines (IL-4, IL-5, and IL-13) dominate in peripheral blood, while Th1 cytokines (IFN-γ) dominate in those with low serum total IgE. In the skin, elderly patients with AD show decreased Th2 and Th22 cytokines and increased Th1 cytokines in lesional skin compared to adult AD patients<sup>2</sup>.</p>
<h3>Considerations for Treatment</h3>
<p>When choosing therapies for elderly patients, considerations include cognitive ability, functional independence, ability to self-administer medication, renal function, comorbidities, polypharmacy, and drug interactions<sup>2-4</sup>. Data supporting treatment choices for elderly patients with AD are limited due to their exclusion from trials (upper age limit or comorbidities). A systematic review of randomized controlled trials (RCTs) from 2020 of systemic immunomodulatory treatments for AD, found that in the trials reporting proportion of participants aged 65 or older, 4% were 65 or older<sup>5</sup>.</p>
<p>Comorbidities such as heart disease, cerebrovascular disease, diabetes mellitus, chronic renal disease, and osteoporosis and pharmacological interactions must be considered when starting systemic treatment<sup>3</sup>.</p>
<h4>1. Topical therapies</h4>
<p>Basic treatment is similar to other age groups, however, applying sufficient topical medication may be difficult or even become a burden. Therefore, solutions to this challenge should be considered, including help from relatives or community-based caregivers<sup>2</sup>.</p>
<h4>2. Phototherapy</h4>
<p>Phototherapy may be burdensome or even impossible for some elderly patients due to the number of visits needed per week<sup>2,3</sup>.</p>
<h4>3. Systemic Therapies</h4>
<p>Traditional systemic therapies are effective in the elderly, but due to comorbidities, the risk of skin cancer, and the risk of infection, cyclosporine, azathioprine, and mycophenolate mofetil are not the best choices. Methotrexate may be considered, but it is advised to use a lower starting dose<sup>2-4,14-17</sup>.</p>
<h4>4. Biologics</h4>
<p>Biologics such as dupilumab and tralokinumab are reasonable treatment options, with data showing similar efficacy in the elderly as in other age groups<sup>6,8</sup>. These treatments are well tolerated, no routine screening and monitoring are required, and no interactions are known<sup>9,10</sup>.</p>
<h4>5. Janus Kinase Inhibitors</h4>
<p>JAK inhibitors are indicated for elderly patients with AD, but caution is needed in patients over 65 years of age due to the higher risk of serious infections, cardiovascular disease, malignancies, thromboembolic events, and mortality. For those patients, a lower starting dose is indicated, and careful monitoring is recommended, alongside with screening for risk factors such as increased cardiovascular events, increased risk of cancer, and smoking<sup>11-13</sup>.</p>
<h3>Conclusion</h3>

<p>Atopic dermatitis is prevalent in the elderly and may present in this age group. Like pediatric AD or adult AD, it is driven by a Th2 pathway. Special considerations are necessary when treating elderly patients such as considering the patient's overall health and comorbidities are essential for effective management.</p>

ATOPIC-DERMATITIS

DERMATOLOGY

<p>CLICK HERE TO READ DUPIXENT COMPULSORY INFORMATION</p>

Speaker : Dr. Stine Simonsen, Copenhagen University Hospitals, Denmark

Managing Atopic Dermatitis in the Elderly

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