Dupilumab, Growth, and the Under-Treated Pediatric Patient
Broadcasting from RAPIDS 2026 in Fort Lauderdale, the SkinSync team sat down with nurse practitioner Stephanie Simmerman to walk through the abstracts she presented from the podium. First up was a poster examining dupilumab in children ages two to five and its relationship to growth and bone concerns. Simmerman framed the clinical stakes plainly: there are real dangers to under-treating kids with moderate to severe atopic dermatitis, including a kind of 'failure to thrive' where growth is limited.
The abstract looked at serum biomarkers, specifically total ALP. Simmerman reported that at the 16-week mark, patients treated with dupilumab showed an increase in total ALP, and when correlated with growth charts, there was significant improvement in growth and development over that 16-week window. She noted the authors flagged that boys increased in growth more than girls, but that this particular poster didn't fully address the difference, positioning it as a next knowledge gap to explore.
For Simmerman, the practical value is in the conversation clinicians can have with worried families. Simmerman acknowledged that starting an injection in a young child is frightening for parents, more than for the child, and that the injection can sting. But seeing improvement in symptoms and growth, with a medication she described as non-immunosuppressive, makes the decision feel worthwhile.
Spacing the Dose: Maintaining Control in Adults
The discussion then shifted to adults with moderate to severe disease and the question every improving patient asks: when can I stop? Simmerman presented an abstract on a lebrikizumab that she praised as genuinely real-world. Patients were treated up front, then randomized to continue at the standard every-two-week dosing, spaced to every four weeks, every eight weeks, or placebo.
The takeaway, per Simmerman, was that patients on the typical two-to-four-week dosing still achieved a high level of disease control, with meaningful preservation of quality of life. She connected this directly to her own practice, noting that once patients are stable, clinicians have different comfort windows before 'tinkering' with the regimen, anywhere from six to twelve months to two years. The data supports the idea that spacing out dosing can be reasonable, which aligns with what patients want: the least amount of medicine needed to still feel good and not itch.
The Weight of Chronic Itch
A poster from UT Health San Antonio examined chronic itch in adults, stratifying patients by duration: less than 12 weeks, 13 to 54 weeks, and greater than 54 weeks. Simmerman highlighted that pain severity was similar regardless of how long the itch had been present, which she found interesting. But when researchers examined interference with enjoyment of activity, the longer someone had the itch, the more it interfered.
Simmerman, who lives with eczema herself, said that tracks intuitively: early on, a patient is still optimistic and the burden feels manageable, but chronic, unrelenting itch gradually removes people from the activities that matter to them. She reminded listeners that many patients arriving for systemics have been itchy for a long time and under-treated, and that the reward of getting them onto effective therapy quickly can be dramatic and immediate.
Community Outreach and the Author in the Audience
One of the most memorable moments Simmerman recounted was presenting a 'hair care and healthcare' poster whose author, Miriam, turned out to be sitting in the audience. Miriam had independently designed a community intervention training barbers and cosmetology students to recognize scarring alopecia conditions, using a pre-survey, a PowerPoint training, and a post-test, plus a QR code to track referrals and follow-up.
The point, Simmerman stressed, is that scarring alopecias are diagnosed late, and by then there is little that can be done, so early recognition is key. She noted the study was not industry-sponsored and that the room began riffing on how the model could extend to other conditions like HS. Simmerman found it inspiring that Miriam, not yet a practicing nurse practitioner, was already driven to close gaps in care.
Getting Patients from Decision to Systemic Therapy
In her operational efficiency lecture, Simmerman tackled the bottlenecks that slow patients from decision to starting systemic therapy. She acknowledged that operational efficiency isn't taught in school and that new grads face an overwhelming array of drugs all at once. Her answer is to share knowledge in a digestible way, be honest about your own pinch points, and stay connected with colleagues at conferences.
She structures the patient conversation in 'chapters,' resisting the urge to cover disease state, medication access, and everything else in a single visit. For new grads without a supportive, collaborative physician, she encouraged leaning on medical science liaisons and the phone-a-friend model: referring a patient for a second opinion and getting them back, rather than 'dumping' on a colleague. Simmerman, who joked she's been called the 'rash queen' and doesn't want the crown, credited her consultant and mentor, Dr. Camisa, while acknowledging not everyone has that resource.
Her goal for a first visit is for the patient to walk away empowered, with expectations set for what comes next even if the exact drug hasn't been chosen. She argued that this front-loaded, empathetic visit actually improves efficiency down the line by reducing callbacks and inbox questions. These visits are a labor of love and time-intensive, especially when frustrated, hope-depleted patients finally land in what she calls the inflammatory clinic, but she noted a well-trained team is essential so clinicians can spend their time where it matters most.