Eric W. Baum, M.D., M.Sc. Clinical Professor, Department of Dermatology UAB Medical Center<\/p>\n
Atopic dermatitis is a chronic inflammatory skin disease with a
\nmulti-varied etiology. It is characterized by pruritus, which can be
\nquite severe and unrelenting. The skin lesions are polymorphic in
\nnature and may present as erythema, excoriation, papules, papulovesicles,
\nlichenified and have a serous exudate.
\nIt is a high prevalence disease that can affect 18 million children
\nand adults. Psoriasis, another chronic inflammatory disease only
\naffects 7.5 million people in the United States. Atopic dermatitis
\n(AD) has a tremendous economic impact on our society. It is
\nestimated to cost $3.8 billion each year. Co-morbidities include,
\nsocial, psychological and quality of life issues. The greatest risk
\nfactor is a family history of atopy.
\nThe diagnosis is usually fairly simple, with rashes on the antecubital fossa and popliteal
\nareas behind the knees. Minor criteria such as an infraorbital pleat (Dennie Morgan Line)
\nand discoloration under the eyes (atopic shiners) as well as \u201cchicken skin\u201d on arms, thighs
\nand cheeks (keratosis pilaris) make this a fairly simple clinical diagnosis. More
\nsophisticated criteria such as Hanifin-Rajka, The American Academy of Dermatology and
\nthe United Kingdom working party exist for study participants.
\nTreatment of the disease offers many choices based on symptoms and severity. Various
\ntrigger factors have been elucidated, but even if recognized do not guarantee successful
\nresults. Trigger factors can be classified by 3 general categories.<\/p>\n
Topical treatments have been the mainstay of treatment for mild to moderate AD. This
\ncan reduce inflammation, pruritus and infection, but often times, are not able
\nto adequately control disease symptoms. These include, various potencies of topical
\ncorticosteroids (TCS) based on patients age, body mass and location. Moisturizers are a
\nmainstay of therapy whether they are humectants, emollients or occlusive with various
\nexcipients to help restore impaired epidermal barrier function.
\nOral antibiotics have been replaced by bleach baths, except when skin infection is severe.
\nAntihistamines only offer sedation to alleviate pruritus to some extent, but do not offer
\nany help in improving the skin disease. Topical calcineurin inhibitors were approved 15
\nyears ago and do offer improvement in selective patients and for chronic management
\ndue to being non-steroids. They are generally expensive and come with a black box
\nwarning.
\nA new understanding of molecular level disease mechanisms has begun to offer new
\ntreatments, both topically and systemically. This is beginning to meet the current unmet
\nneed of safe and effective choices for this chronic skin disease.
\nThe first is Eucrisa, a PDE4 blocker approved for topical therapy in mild to moderate
\natopic dermatitis. This works by regulating the degradation of cyclic amp which decreases
\nthe production of inflammatory cytokines. Other than itching, it is a well-tolerated topical
\nalternative and can be used in conjunction with (TCS) to limit their use.
\nThe use of immunosuppressants such as cyclosporine, imuran and methotrexate is
\nbeyond the scope of this article. Systemic side effects limit their use to experienced
\nclinicians.
\nThe really impactful news was the approval of the first biologic for moderate to severe
\nAD for patients (adult) 18 years or older. It is an immunomodulator and unlike the
\nbiologics, approved for psoriasis, is not an immunosuppressant. No blood work or TB
\ntesting is required. It blocks (2) of the proven cytokines implicated in the disease of AD,
\nIL 4 and IL 13. It is called Dupixent (dupilumab). Currently, studies are almost complete
\nfor the indication in adolescents. Phase III studies demonstrated excellent results in
\ndecreasing and clearing the skin signs of this chronic inflammatory disease.
\nAfter not having new treatment choices for AD for many years, there are new exciting
\ntreatments now available. The future is even brighter, since many other companies are
\nnow investigating other new products in phase II and III studies.
\n1. Fonacier Luz MD Peer CME, email. (peercme.com)<\/p>\n","protected":false},"excerpt":{"rendered":"
Eric W. Baum, M.D., M.Sc. Clinical Professor, Department of Dermatology UAB Medical Center Atopic dermatitis is a chronic inflammatory skin disease with a multi-varied etiology. It is characterized by pruritus, which can be quite severe and unrelenting. The skin lesions are polymorphic in nature and may present as erythema, excoriation, papules, papulovesicles, lichenified and have […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[],"class_list":["post-588","post","type-post","status-publish","format-standard","hentry","category-articles-from-our-physicians"],"yoast_head":"\n