Table of Content

Current Issue

Spring/Summer 2025, Vol. 32 No. 1

Hong Kong J. Dermatol. Venereol. (2025) 32, 76-77


Reports on Scientific Meetings

EADV Congress 2023

Reported by AKC Cheng 鄭嘉俊

Date:   11-15 October 2023
Venue:   Berlin, Germany
Organiser:   European Academy of Dermatology and Venereology

Topical Coacillium 22.25% solution in children moderate to severe alopecia areata (AA)

Speaker: Ulrike Blume-Peytavi
Charité – Universitätsmedizin Berlin, Germany

Two-third of people with alopecia areata are diagnosed before the age of 30. Hair loss is not just a cosmetic problem, but also affects emotions, quality of life and personality development in children. Some might have other associated comorbidities. Forty percent of patients have spontaneous regrowth but one-third of patients have progressive disease. First-line therapy include topical corticosteroids. Second-line treatment include topical irritation therapy such as anthralin or DCP-sensitisation. Ritlecitinib, the first JAK3/TEC family kinase inhibitor was approved by the European Medicines Agency (EMA) in September 2023 for adolescent over the age of 12 with severe alopecia areata. However, limited effective and safe options are available for younger children with alopecia areata.

A novel topical agent for AA was presented in the EADV 2023: Coacillium 22.25%, a pleiotropic botanical cutaneous solution was being studied in children and adolescents with moderate to severe alopecia areata in a randomised, double-blind, placebo-controlled phase 2/3 study (RAAINBOW trial). Sixty-two children with moderate to severe AA were randomly assigned to apply coacillium solution 22.25% or placebo twice daily for 24 weeks, followed by a treatment-free period for another 24 weeks. After 24 weeks, patients treated with coacillium saw a mean SALT score improvement of 23%, whereas placebo-treated patients regressed by 8%. After 24 weeks of treatment, 26% of patients treated with coacillium achieved 40% reduction in SALT, compared to 5% in placebo-treated patients. Improvement in quality-of-life endpoints in terms of CDLQI and EQ-5D Y were consistent with treatment effect. Patients expressed improvement in quality of life was early as after 12 weeks of treatment. After coacillium discontinuation at 24 weeks, mean SALT score continued to improve from 44 to 29 at week 48. Eighty-two percent in the coacillium group experienced hair growth during the treatment-free period versus 37% in placebo group. By week 48, 47% of coacillium-treated patients had reached a SALT score of <=20 compared with only 9% of placebo-treated patients. The topical solution was reported to have excellent safety profile with no drug-related serious adverse events. Most adverse events were local, mild to moderate and transient.

Topical coacillium solution is the first drug to show sustained remission after treatment discontinuation in AA. Coacillium cutaneous solution is a potential safe and effective treatment option for children and adolescents with moderate to severe AA. Larger trials are needed to better understand the treatment response.

Learning points:
Topical coacillium solution may be an potential treatment option for young children with moderate to severe AA with favourable safely profile.

Topical Tapinarof cream for pruritis relief in adults and children down to two years of age with moderate to severe atopic dermatitis

Speaker: Jonathan Silverberg
George Washington University, Washington DC, USA

Tapinarof is a topical medication that binds to topical aryl hydrocarbon receptor (AhR) that works by supressing inflammatory cytokines, modulating skin barrier protein expression and reducing oxidative stress. Tapinarof was FDA-approved for the treatment of plaque psoriasis in adults in 2022. New pruritis data in adults and children down to two years of age with atopic dermatitis were announced in EADV 2023.

ADORING 1 (n=407) and ADORING 2 (n=406), were two identical, double-blind, vehicle-controlled trials. Patients were randomised 2:1 to receive tapinarof cream 1% or vehicle once daily for 8 weeks. Patients with a Validated Investigator Global Assessment for Atopic Dermatitis score (vIGA-AD) of ≥3, an Eczema Area and Severity Index (EASI) score of ≥6, and body surface area involvement of 5% to 35% were included in the trials. The Peak Pruritis-Numerical Rating Scale (PP-NRS) considers a patient's worst itch over the past 24 hours and was assessed on an 11-point scale, in which 0 represents "no itch" and 10 represents their "worst imaginable itch."

407 and 406 patients aged 2-81 years were randomised in ADORING 1 and 2, respectively. Patients treated with tapinarof cream had a reduction in mean weekly PP-NRS scores as early as week one compared with vehicle (-2.0 vs -1.2 [P<0.0001]) and (-2.0 vs -1.3 [P=0.0010]), in ADORING 1 and ADORING 2, respectively. Patients treated with tapinarof cream had a greater reductions in mean PP-NRS scores versus vehicle for all visits through week 8 (-4.1 vs -2.6 and -4.1 vs -2.4 [both P<0.0001]), in both ADORING 1 and ADORING 2.

Common side effects of tapinarof from studies for plaque psoriasis include folliculitis, headache, nasopharyngitis and contact dermatitis.

Tapinarof cream once daily demonstrated rapid onset of pruritis relief. Further improvement in itch was observed through week 8. Tapinarof cream may be a potential non-steroidal topical treatment option for pruritis relief in in adults and children down to two years of age with moderate to severe atopic dermatitis. Further studies focused on the paediatric population alone would be needed to assess the efficacy and safety in this population. Ongoing phase 3 studies are also evaluating the efficacy of tapinarof cream for atopic dermatitis.

Learning points:
Tapinarof is a novel non-steroidal topical medication that has the potential to be used for the treatment of atopic dermatitis in patients down to 2 years without restrictions on duration, extent, or sites of application.