Atopic Dermatitis Management and Techniques: Beyond the Basics

Treatment

For decades, the mainstay of AD treatment has been topical corticosteroids.^{1, 2}
Crisaborole, a PDE-4 inhibitor, is approved for mild-to-moderate AD in patients aged 2 years and older.
For more severely affected patients, systemically administered broad immunosuppressant drugs are used, including cyclosporine, azathioprine, methotrexate, mycophenolate mofetil, and short courses of systemic corticosteroids.^3-5
Until recently, the only new class of medications for treating AD was topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, which have been commercially available since 2000 and 2001, respectively.
Dupilumab was the first biologic monoclonal antibody (IL-4/13) approved for AD, and is approved for patients aged 6 and older.^6,7
Other biologic agents in development for AD include lebrikizumab and tralokinumab, which target IL-13, and nemolizumab and BMS-981164, 2 agents that target IL-31.⁸
JAK inhibitors under investigation include oral agents (baricitinib, tofacitinib, and upadacitinib) and topical creams (delgocitinib and ruxolitinib).

Patient-Related Challenges

The propensity toward allergic disorders (ie, asthma, food allergy, allergic rhinoconjunctivitis, and eosinophilic esophagitis) and skin infections (especially S aureus and widespread herpes/eczema herpeticum) is clearly increased.^9–12
Neuropsychiatric issues (attention-deficit/hyperactivity disorder, depression, anxiety, conduct disorder, autism, and suicidal ideation) have been linked to AD more recently.^9–12
Assessment of disease severity is further complicated by a disconnect between physicians and their patients. The results of 1 study suggested that patients and physicians disagreed on the severity level of AD in approximately one-third of cases.¹³
Maintaining motivation and treatment adherence in patients with AD is an important, yet often difficult undertaking.

References

Darsow U, et al. ETFAD/EADV eczema task force 2009 position paper on diagnosis and treatment of atopic dermatitis. J Eur Acad Dermatol Venereol. 2010;24:317-328.
Paller AS, et al. Therapeutic pipeline for atopic dermatitis: end of the drought? J Allergy Clin Immunol. 2017;140:633-643.
Silvestre Salvador JF, et al. Atopic dermatitis in adults: a diagnostic challenge. J Investig Allergol Clin Immunol. 2017;27:78-88.
Eichenfield LF, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70:338-351.
Eichenfield LF, et al. Current guidelines for the evaluation and management of atopic dermatitis: a comparison of the Joint Task Force Practice Parameter and American Academy of Dermatology guidelines. J Allergy Clin Immunol. 2017;139(4S):S49-S57.
Dupilumab prescribing information. Available at: https://www.regeneron.com/sites/default/files/Dupixent_FPI.pdf.
House DW. Sanofi and Regeneron’s Dupixent successful in late-stage pediatric dermatitis study. August 6, 2019 (https://seekingalpha.com/news/3487406-sanofi-regenerons-dupixent-successful-late-stage-pediatric-dermatitis-study).
Boguniewicz M, et al. Expert perspectives on management of moderate-to-severe atopic dermatitis: a multidisciplinary consensus addressing current and emerging therapies. J Allergy Clin Immunol Pract. 2017;5:1519-1531.
Schmitt J, et al. Atopic eczema and attention-deficit/hyperactivity disorder in a population-based sample of children and adolescents. JAMA. 2009;301:724-726.
Miyazaki C, et al. Allergic diseases in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis. BMC Psychiatry. 2017;17:120.
Strom MA, et al. Association between atopic dermatitis and attention deficit hyperactivity disorder in U.S. children and adults. Br J Dermatol. 2016;175:920-929.
Thyssen JP, et al. Atopic dermatitis is associated with anxiety, depression, and suicidal ideation, but not with hospitalization or suicide. Allergy. 2018;73:214-220.
Wei W, et al. Discordance between physician- and patient-reported disease severity in adults with atopic dermatitis: a US cross-sectional survey. Am J Clin Dermatol. 2017;18:825-835.