Doctors from across the world meet in Beijing to discuss skin disease

The 16th Georg Rajka International Symposium on Atopic Dermatitis, or ISAD, was held in Beijing for the first time from Oct 17 to 19. The meeting brought together specialists to discuss the latest advancements in the chronic skin condition.

The experiences of patients should help shape goals for atopic dermatitis, two dermatologists in Beijing said, highlighting the need to assess itching and quality of life effects alongside its visible appearance.

Atopic dermatitis, or AD, is a chronic immune-mediated inflammatory disease of the skin that often begins in childhood and can persist into adulthood.

Vimal Prajapati, a clinical associate professor at the University of Calgary, said: "Atopic dermatitis can affect all aspects of an individual's life, from relationships to school, work, and even confidence."

One focus of the discussion was minimal disease activity, or MDA. The concept combines doctors' assessments with patients' reports of symptoms, with goals such as clear or almost clear skin and no or almost no itching.

Zhang Jianzhong, a chief physician in the department of dermatology at Peking University People's Hospital, said doctors can observe visible skin disease, measure the affected area, and see scratch marks. Itching, however, is something patients experience themselves.

"We cannot see the itch," he said.

For example, a patient's skin may look better while itching still interrupts sleep. Asking about that lived experience gives doctors information that a visual examination alone cannot provide. Both perspectives matter when doctors and patients review whether their management plan is addressing the disease's effects.

That makes listening to patients essential when assessing disease control, Zhang said. Medical scores may be useful in research, but patients can find them difficult to understand. Explaining the goals in everyday language can give both sides a clearer basis for discussion.

International recommendations known as Aiming High in Eczema/Atopic Dermatitis link treatment targets with shared decision-making. Patients identify the symptoms that trouble them the most, while doctors help select ways to assess those concerns alongside the visible signs of disease.

The process gives patients a role in deciding what successful management should mean for them. A discussion may begin with itching or poor sleep, and then move to agreed goals and a plan to review progress. Treatment choices need to take individual circumstances into account.

Chinese research is also contributing evidence from everyday medical practice. At the ISAD, AbbVie released the 12-month interim results of REACH-AD, an ongoing observational study of a JAK inhibitor in adolescents and adults with moderate to severe AD across 40 centers in China.

"This is a wonderful study," Prajapati said, noting that REACH-AD examines not only treatment patterns but also MDA attainment in routine care.

The study plans to enroll 1,000 adolescents and adults with moderate to severe AD and follow each patient for a year. The interim analysis covered 500 patients, including 74 adolescents.

Zhang said the interim results showed 48.8 percent of patients achieved MDA at 12 months, and he hoped to see more patients achieve MDA by the end of the study.

For Prajapati, research from China has relevance beyond the country. He said Canadian doctors treat people from diverse backgrounds, including patients originally from China, making evidence from different populations valuable to their work.

"Clinical trial populations are not necessarily representative of real-world populations," he said.

Collecting data across countries and regions can help doctors understand differences in the patients they see and the settings in which care is delivered, he added.

Zhang described Chinese dermatology's development as a progression from learning from overseas colleagues to participating in research and working together. He said that closer international collaboration should serve a shared goal: better disease control and a better quality of life for patients with AD and other immune-mediated skin diseases.

Both Prajapati and Zhang said that given all of the recent advances in atopic dermatitis management, this is the best time to be a doctor who treats AD and the best time to be a patient.