Atopic dermatitis, also known as atopic eczema, is an inflammatory skin condition leading to itchy, red, swollen and cracked skin. It typically starts in childhood, but up to 40% of patients will continue to have eczema into adulthood. This skin condition can greatly affect patients with itchy skin interfering with sleep and focus on daily activities such as school, sports and work. Breakdown in the skin due to scratching can also lead to secondary skin infections. The reddened and thickened areas, known as lichenification, can also be embarrassing for patients in public.
Atopic dermatitis is a chronic condition that requires daily treatment. Typical treatments include daily hydration and multiple applications of lubrication, as much as 4-5 times a day. Topical steroids, beneficial to help control the inflammation, are also applied but can cause side effects such as thinning of the skin and decreased pigment leading to whitish areas where the steroids were applied. Oral antihistamines, like Benadryl or Claritin, can also be added to help with itching. Atopic dermatitis is a condition that is difficult for many patients to fully control.
Recently, two new treatments have been approved for atopic dermatitis and have shown significant improvement in control of this condition.
1. Eucrisa (crisaborole 2% ointment) has been approved for ages 2 and older for mild to moderate atopic dermatitis. It acts as a phosphodiesterase inhibitor that most likely affects cytokine signals in the inflammatory cascade, although exact mechanisms have not been clearly defined in atopic dermatitis. This medication is applied to involved areas of skin twice a day. Two studies have shown improvement in atopic dermatitis scoring, which resulted in clear to almost clear skin or improvement of 2 categories from baseline.
2. Dupixent (dupilmab) has been approved for patients 18 years and older with moderate to severe atopic dermatitis. This medicine is given as a subcutaneous injection and acts as an interleukin 4 receptor alpha antagonist that blocks the actions of interleukin 4 and 13 which are implicated in allergic diseases such as atopic dermatitis. Three studies showed improvement in atopic dermatitis symptoms ranging from 40 to 60% for patients who were already on typical medical treatment. Studies are currently being done in patients < 18 years old.
These are two new treatments for atopic dermatitis that address the underlying immune mechanisms and hold hope for better control of this disease for patients affected by them.
To learn more about eczema and how best to manage it, visit your trusted Allergy Partners physician.