The review emphasized that itch remains one of the most burdensome symptoms for patients. “Pruritus is a central driver of disease burden and quality-of-life impairment,” the authors wrote, noting its impact on sleep and daily functioning. Chronic itching—especially at night—can interfere with sleep, leading to fatigue, irritability and reduced quality of life. By more effectively targeting inflammation and itch, newer therapies may help reduce these disruptions and support more consistent disease control. Systemic therapies are recommended only when the topic agents don’t adequately control symptoms, according to the article. It that case, they said, among the most promising are JAK)inhibitors. “Targeted systemic therapies offer an additional option for patients with moderate to severe disease who have not achieved adequate control,” the authors wrote. While earlier safety concerns emerged in other patient populations, more recent real-world data has provided important context. In a large multinational study of more than 17,000 patients with immune-mediated inflammatory diseases, JAK inhibitors were not associated with increased risks of mor- tality, major adverse car- diovascular events, blood clots, or malignancy com- pared with conventional systemic therapies over a 2-year period.3 These findings are particularly relevant for veterans, many of whom may already have elevated cardiovascular risk due to age or service-related exposures. The authors emphasized that improved recogni- tion of eczema as a chronic condition is essential to optimizing care. “Early and accurate diagnosis is critical to appropriate management and improv- ing patient outcomes,” they wrote. Looking Ahead The guideline authors emphasized that treatment advances are shifting expectations for long-term disease control. “Emerging therapies offer the potential for more sustained management of atopic dermatitis,” they wrote, underscoring the importance of aligning treatment strate- gies with evolving evidence. For Gulf War veterans living with chronic skin condi- tions, these changes may offer new opportunities for more effective, individualized care. 1Steele L, Quaden R, Ahmed ST, Harrington KM, Duong LM, Ko J, Gifford EJ, Polimanti R, Gaziano JM, Aslan M, Helmer DA, Hauser ER; Department of Veterans Affairs Cooperative Studies Program #2006 and the VA Million Veteran Program. Association of deployment character- istics and exposures with persistent ill health among 1990-1991 Gulf War veterans in the VA Million Veteran Program. Environ Health. 2024 Oct 25;23(1):92. doi: 10.1186/s12940-024-01118-7. PMID: 39456027; PMCID: PMC11520114. 2Armstrong AW, Nong Y, Bunick CG, Chovatiya R, et al.. Advanced Topi- cal Nonsteroidal Therapies for Atopic Dermatitis: Consensus Statements from an Expert Panel. J Drugs Dermatol. 2026 Mar 1;25(3):221-227. doi: 10.36849/JDD.9806. PMID: 41811426. 3Lin TL, Fan YH, Fan KS, Juan CK, Chen YJ, Wu CY. Real-World Safety of JAK Inhibitors in Skin Immune-Mediated Inflammatory Diseases: Boxed Warning Outcomes from a Multinational Cohort Study. Clin Pharmacol Ther. 2026 Mar 14. doi: 10.1002/cpt.70258. Epub ahead of print. PMID: 41830903. Conduct of the Persian Gulf War Source: 1. U.S. Department of Defense. Conduct of the Persian Gulf War: Final Report to Congress Washington, DC; April 1,1992 https://apps.dtic.mil/sti/citations/ADA249270C 2 0 2 6 C O M P E N D I U M O F F E D E R A L M E D I C I N E 8 1
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