Atopic Dermatitis Treatment Considerations
Atopic dermatitis (AD), more popularly known as eczema, is a chronic relapsing inflammatory skin condition. It is characterized by rash/lesions, itching, and inflammation that ranges in severity. It affects about 15 percent of all children and 7 percent of all adults in the U.S.
Genetic predisposition, epidermal dysfunction, skin abnormalities, immune dysregulation, and neuroimmune system disorders all contribute to the onset and persistence of AD.
Atopic Dermatitis: Impact on Quality of Life
AD can affect mental health in addition to physical health. Studies have shown that chronic physical symptoms can lead to lack of confidence, anxiety, depression, and suicidal thoughts.
Studies have also shown that patients who suffer from AD can be less productive at school/work. They may have more frequent visits to the hospital for comorbidities commonly associated with AD such as cardiovascular disease and allergies.
Atopic Dermatitis: Treatment Options
Standard treatments, like topical corticosteroids and immunosuppressants, are considered first-line treatment options. However, as with all medications, side effects can occur when used over a long period of time. These may include thinning of the skin, increased risk of infection, skin sensitivity, dryness, redness, swelling, and excessive hair growth on the treated areas. It is important that AD, like all other conditions, be carefully monitored by and consulted with an appropriate provider.
Recent advances in the understanding of immune-related diseases like AD have led to the development of newer treatment options such as targeted therapies. These work by blocking proinflammatory mediators such as cytokines and Janus kinase proteins, leading to a significant decrease in the physical presentation and overall progression of AD.
Targeted AD therapies recently approved by the FDA include:
Atopic Dermatitis: The Treatment Option Triage
The new AD therapies can be more effective, but also are much more expensive, than standard treatments.
Topical corticosteroids and calcineurin inhibitors are currently considered first-line therapies for AD.
Biologic treatments, such as Dupixent and Adbry, are currently considered second-line therapies for patients with worsening AD symptoms who have already tried the first-line therapies. Side effects can include, but are not limited to, upper respiratory tract infections, conjunctivitis, blepharitis, injection site reactions, and eosinophilia.
Janus kinase (JAK) inhibitors, such as Cibinqo and Rinvoq, are currently considered last-line therapies for patients who are refractory to, or unable to take, the other treatments. Side effects can include, but are not limited to, acne, impetigo, hypertension, upper respiratory tract infections, contact dermatitis, abdominal discomfort, herpes zoster, thrombocytopenia, neutropenia and fatigue.
Targeted drug therapies will continue to advance the treatment of severe diseases. As with any condition, working with your health care provider will help you compare the risks versus benefits.
References
Agboola F, Atlas SJ, Brouwer E, et al. JAK inhibitors and monoclonal antibodies for the treatment of atopic dermatitis: effectiveness and value. J Manag Care Spec Pharm. 2022;28(1):108-114. doi:10.18553/jmcp.2022.28.1.108
Li H, Zhang Z, Zhang H, Guo Y, Yao Z. Update on the Pathogenesis and Therapy of Atopic Dermatitis. Clin Rev Allergy Immunol. 2021;61(3):324-338. doi:10.1007/s12016-021-08880-3
Puar N, Chovatiya R, Paller AS. New treatments in atopic dermatitis. Ann Allergy Asthma Immunol. 2021;126(1):21-31. doi:10.1016/j.anai.2020.08.016
Silverberg JI, Thyssen JP, Fahrbach K, et al. Comparative efficacy and safety of systemic therapies used in moderate-to-severe atopic dermatitis: a systematic literature review and network meta-analysis. J Eur Acad Dermatol Venereol. 2021;35(9):1797-1810. doi:10.1111/jdv.17351
Newsom M, Bashyam AM, Balogh EA, Feldman SR, Strowd LC. New and Emerging Systemic Treatments for Atopic Dermatitis. Drugs. 2020;80(11):1041-1052. doi:10.1007/s40265-020-01335-7
