Editor's Picks January 2023

The itchscratch cycle impacts the quality of life of patients suffering from atopic dermatitis (AD). Rapid and sustained reduction of itch, often the most burdensome symptom of this condition, is an important treatment goal for clinicians, patients, and caregivers. Blauvelt et al. describe results from 2 pivotal trials investigating a topical nonsteroidal Janus kinase (JAK) inhibitor, ruxolitinib cream. The studies included 1200 adolescents and adults with an Investigator's Global Assessment (IGA) score of 2 or 3 (i.e. mild or moderate AD), randomized in a 2:2:1 ratio to 0.75% ruxolitinib cream, 1.5% ruxolitinib cream or vehicle cream (all BID) for 8 weeks of doubleblinded treatments. The investigators found that twice daily applications as monotherapy led to rapid and sustained itch reduction. Either strength of the cream achieved a clinically important ≥2point itch reduction using a numerical rating scale (i.e. NRS2) within approximately 12 h (with Ruxolitinib cream 1.5% reaching 13.1% vs. 6.9% for vehicle, p < 0.05), along with further improvements through 8 weeks (Figure 1). There was also a 36h clinically meaningful reduction in itch as a ≥4point itch reduction was statistically significant, with further improvements through 8 weeks. Itch reduction was observed regardless of subgroup, while a greater proportion of patients who applied ruxolitinib cream achieved ≥4point improvement (i.e. NRS4) at week 8 versus vehicle regardless of demographics (e.g. age, race) or baseline clinical characteristics (e.g. body surface area [BSA], IGA, itch NRS). The authors conclude with a discussion of the role of JAK inhibition in the mediation of itch, and the benefits of reducing itch quickly in terms of adherence. Blauvelt A, Kircik L, Papp KA, et al. Rapid pruritus reduction with ruxolitinib cream treatment in patients with atopic dermatitis. J Eur Acad Dermatol Venereol 2023; 37:137-46. doi:10.1111/jdv.18571