{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:04:56Z","timestamp":1790168696356,"version":"4.1.0"},"reference-count":15,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acad Dermatol Venereol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dupilumab provides substantial clinical benefit in moderate\u2010to\u2010severe atopic dermatitis, but whether clinical improvement is accompanied by microstructural resolution on reflectance confocal microscopy (RCM) remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe baseline clinical and RCM findings, evaluate longitudinal clinical and microstructural changes and explore associations between baseline RCM features and week 24 outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective real\u2010world cohort study at a tertiary academic hospital in Buenos Aires, Argentina. Consecutive paediatric and adult patients aged \u22656\u2009months with moderate\u2010to\u2010severe atopic dermatitis initiating dupilumab were assessed at baseline, week 12 and week 24. Clinician\u2010reported outcomes, patient\u2010reported outcomes and prespecified binary RCM features were summarized at each visit. Paired baseline\u2010to\u2010week 24 analyses assessed within\u2010patient clinical changes and RCM feature transitions. Associations between baseline RCM findings and week 24 outcomes were explored using Fisher's exact tests and linear regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty\u2010seven patients were included; 19 (51.4%) were paediatric and 25 (67.6%) were male. Baseline disease burden was high, with median EASI 28.0 (IQR 19.0\u201333.0). Baseline RCM showed epidermal disorganization, spongiosis and dilated vessels in all patients, with dermo\u2010epidermal junction inflammation in 34\/37 (91.9%). In paired baseline\u2010to\u2010week 24 analyses, median EASI decreased from 28 (IQR 18\u201332) to 2 (IQR 1\u20136), with a median individual improvement of 22 points; EASI\u201075 was achieved by 76.2%. Several baseline\u2010positive confocal features resolved by week 24, including acanthosis (81.8%), hyperkeratosis (72.7%), parakeratosis (66.7%) and epidermal inflammation\/exocytosis (64.7%). However, epidermal disorganization, spongiosis and dilated vessels remained frequent, including among EASI\u201075 responders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Persistent RCM abnormalities, particularly epidermal disorganization, spongiosis and dilated vessels, were observed at week 24, even among EASI\u201075 responders. These findings suggest that clinical response to dupilumab may not always coincide with complete microstructural normalization and that RCM may provide complementary information beyond clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jdv.70725","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:20:21Z","timestamp":1790166021000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prospective reflectance confocal microscopy monitoring in dupilumab\u2010treated atopic dermatitis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2026-9301","authenticated-orcid":false,"given":"Luc\u00eda","family":"Mac Donald","sequence":"first","affiliation":[{"name":"Department of Dermatology Hospital Italiano de Buenos Aires  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2149-4308","authenticated-orcid":false,"given":"Mar\u00eda Valeria","family":"Angles","sequence":"additional","affiliation":[{"name":"Department of Dermatology Hospital Italiano de Buenos Aires  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8002-4234","authenticated-orcid":false,"given":"Paula Carolina","family":"Luna","sequence":"additional","affiliation":[{"name":"Department of Dermatology Hospital Alem\u00e1n  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7983-1450","authenticated-orcid":false,"given":"Sebasti\u00e1n","family":"Marciano","sequence":"additional","affiliation":[{"name":"Research Department Hospital Italiano de Buenos Aires  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8427-6033","authenticated-orcid":false,"given":"Diego Hern\u00e1n","family":"Giunta","sequence":"additional","affiliation":[{"name":"Research Department Hospital Italiano de Buenos Aires  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8917-3615","authenticated-orcid":false,"given":"Margarita","family":"Larralde","sequence":"additional","affiliation":[{"name":"Department of Dermatology Hospital Alem\u00e1n  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6315-7916","authenticated-orcid":false,"given":"Luis Daniel","family":"Mazzuoccolo","sequence":"additional","affiliation":[{"name":"Department of Dermatology Hospital Italiano de Buenos Aires  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"issue":"5","key":"e_1_2_13_2_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.xjidi.2022.100131","article-title":"Type 2 inflammation contributes to skin barrier dysfunction in atopic dermatitis","volume":"2","author":"Beck LA","year":"2022","journal-title":"JID Innov"},{"issue":"3","key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.jid.2015.11.007","article-title":"Influence of Th2 cytokines on the cornified envelope, tight junction proteins, and \u03b2\u2010defensins in filaggrin\u2010deficient skin equivalents","volume":"136","author":"H\u00f6nzke S","year":"2016","journal-title":"J Invest Dermatol"},{"issue":"24","key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"2335","DOI":"10.1056\/NEJMoa1610020","article-title":"Two phase 3 trials of dupilumab versus placebo in atopic dermatitis","volume":"375","author":"Simpson EL","year":"2016","journal-title":"N Engl J Med"},{"issue":"5","key":"e_1_2_13_5_1","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1111\/bjd.16156","article-title":"Dupilumab with concomitant topical corticosteroid treatment in adults with atopic dermatitis with an inadequate response or intolerance to ciclosporin a or when this treatment is medically inadvisable: a placebo\u2010controlled, randomized phase III clinical trial (LIBERTY AD CAF\u00c9)","volume":"178","author":"Bruin\u2010Weller M","year":"2018","journal-title":"Br J Dermatol"},{"issue":"4","key":"e_1_2_13_6_1","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1007\/s40257-020-00527-x","article-title":"Dupilumab provides favorable safety and sustained efficacy for up to 3\u2009years in an open\u2010label study of adults with moderate\u2010to\u2010severe atopic dermatitis","volume":"21","author":"Beck LA","year":"2020","journal-title":"Am J Clin Dermatol"},{"issue":"3","key":"e_1_2_13_7_1","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s40257-022-00683-2","article-title":"Long\u2010term efficacy and safety of dupilumab in adolescents with moderate\u2010to\u2010severe atopic dermatitis: results through week 52 from a phase III open\u2010label extension trial (LIBERTY AD PED\u2010OLE)","volume":"23","author":"Blauvelt A","year":"2022","journal-title":"Am J Clin Dermatol"},{"issue":"10356","key":"e_1_2_13_8_1","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1016\/S0140-6736(22)01539-2","article-title":"Dupilumab in children aged 6\u2009months to younger than 6\u2009years with uncontrolled atopic dermatitis: a randomised, double\u2010blind, placebo\u2010controlled, phase 3 trial","volume":"400","author":"Paller AS","year":"2022","journal-title":"Lancet"},{"issue":"11","key":"e_1_2_13_9_1","doi-asserted-by":"crossref","first-page":"3388","DOI":"10.1111\/all.15432","article-title":"Dupilumab significantly improves skin barrier function in patients with moderate\u2010to\u2010severe atopic dermatitis","volume":"77","author":"Berdyshev E","year":"2022","journal-title":"Allergy"},{"issue":"1","key":"e_1_2_13_10_1","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.jid.2019.05.024","article-title":"IL\u20104R\u03b1 blockade by dupilumab decreases Staphylococcus aureus colonization and increases microbial diversity in atopic dermatitis","volume":"140","author":"Callewaert C","year":"2020","journal-title":"J Invest Dermatol"},{"issue":"5","key":"e_1_2_13_11_1","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1111\/all.14151","article-title":"Dual blockade of IL\u20104 and IL\u201013 with dupilumab, an IL\u20104R\u03b1 antibody, is required to broadly inhibit type 2 inflammation","volume":"75","author":"Le Floc'h A","year":"2020","journal-title":"Allergy"},{"issue":"1","key":"e_1_2_13_12_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jaad.2020.05.153","article-title":"Reflectance confocal microscopy: principles, basic terminology, clinical indications, limitations, and practical considerations","volume":"84","author":"Shahriari N","year":"2021","journal-title":"J Am Acad Dermatol"},{"issue":"6","key":"e_1_2_13_13_1","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1002\/lsm.23386","article-title":"Reflectance confocal microscopy, optical coherence tomography, and multiphoton microscopy in inflammatory skin disease diagnosis","volume":"53","author":"Csuka EA","year":"2021","journal-title":"Lasers Surg Med"},{"issue":"2","key":"e_1_2_13_14_1","doi-asserted-by":"crossref","DOI":"10.3390\/healthcare11020152","article-title":"Reflectance confocal microscopy in monitoring atopic dermatitis treated with topical calcineurin inhibitors","volume":"11","author":"Bratu 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