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New Medications, Updated Guidelines, Promise Targeted Treatment for Eczema

November 3, 2017
Despite the pain and itching, most patients self-medicate for eczema. Two targeted therapies aim to reduce the inflammatory response of atopic dermatitis, promising improved symptom relief, but only for patients who seek care.

With Luz M. Fonacier, MD

Two new therapies offer promise of improved management for the pain and itching associated with eczema, an underdiagnosed, undertreated skin condition, moving clinical care toward the precision medicine model.1

“Sufferers of eczema may find relief with new, targeted therapies – one of the few advances coming out of eczema research,”1 said Luz M. Fonacier, MD, in a presentation at the 2017 American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Boston, Massachusetts. The topic of eczema in hospitalizations involving childhood asthma2 and the protective effect of a dog in the home.3

Eczema, also known as atopic dermatitis (AD), is a skin condition arising from an inflammatory response. Typical symptoms of AD include pain and itching, which is often marked by a scaly rash. For many individuals who develop this condition, it may begin in childhood, but there are many others for which it the onset occurs in adulthood,1 according to Dr. Fonacier, program director at New York University Winthrop Hospital and professor of Clinical Medicine, State University of New York at Stony Brook School of Medicine.

Emerging Medications Promise Targeted Treatment to Lessen Pain and itching associated with Eczema.

Symptoms of active eczema may become unrelenting and severe, and due to itching, may lead to infection, as well as disrupted sleep and increased stress from the untreated pain and other symptoms,1 according to Dr. Fonacier. Patients’ eczema often goes undiagnosed with many sufferers limiting their care to self-treatment, most often because they are unaware of effective treatment options and the benefits of proper management.1

Targeted Treatments to Lessen Pain of Eczema

“It has been 15 years since a new treatment to manage mild to moderate eczema has been developed, making the emergence of two topical medications well-received,”2,3  Dr. Fonacier said. Crisaborole is one of two recently approved targeted treatments for eczema, the other being dupilumab. Crisaborole, a PDE4 inhibitor, is a topical ointment developed to reduce inflammation in the skin4. This medication has been approved for patients two years of age and older.2

For more difficult cases of eczema, dupilumab a human monoclonal antibody, is recommended as it functions to inhibit signaling of two type 2 cytokines that are thought to enhance eczema and other inflammatory diseases.3 This biologic treatment is designed for patients whose eczema is moderate to severe and untreatable by topical ointments. Dupilumab is an injectable therapy that is approved for patients 18 years and older.3

“It is exciting to realize that only a year ago our options for the treatment of mild to moderate atopic dermatitis were limited to topical corticosteroids, topical calcineurin inhibitors, and emollient devices,”

”For patients with moderate to severe atopic dermatitis who do not respond to the standard topical medications, we were even more limited, relying on oral corticosteroids, ultraviolet light therapy, and non-FDA approved immunosuppressants,” Dr. Fonacier told Practical Pain Management.

“We are now empowered with safer small molecules and biologics that offer targeted treatment for the whole spectrum of inflammatory eczema. In the pipeline, there are over 20 chemicals targeting receptors with precision. We have the expertise to use these medications to improve our patients' quality of life,” said Dr. Fonacier.

In addition to these two treatments, Dr. Fonacier mentioned guidelines in development, which will be  known as the Atopic Dermatitis Yardstick; this guide will provide the latest recommendations for treatment of eczema.1

Severity of Hospitalization for Asthma with History of Eczema

Due to a high degree of comorbidity between asthma and allergies, researchers sought to determine whether the presence of allergies imposed an effect on severity of asthma attacks and response to treatment with regard to hospitalization.4

This study, presented at 2017 American College of Allergy, Asthma, and Immunology (ACAAI) Annual Scientific Meeting, followed hospitalization histories for children (N=39) who had undergone extensive testing for a wide array of common environmental allergens.

The researchers found that the number of allergies a child experienced did not predispose the patient to different levels of hospital treatment. However, a history of asthma did significantly correlate with more intense treatment needed upon hospitalization.Furthermore, children with eczema required a longer hospital treatment and greater use of albuterol.4

“There is a debate as to whether AD is an ‘inside out’ or an ‘outside in’ disease. This study supports that atopic dermatitis is a systemic disease and that inflammation is not limited to the skin but also involves other organ systems such as the lungs, nose, and the gastrointestinal tract. Furthermore, patients with systemic inflammation such as asthma and eczema seem to have more severe disease,” Dr. Fonacier said in commenting on his colleagues’ research.

These researchers hope to expand their work to gain a better understanding of the association between eczema and intensity of asthma treatment needed.4 The aim of future research will be to predict which children may be prone to a severe presentation of asthma.

Possible Protective Effect of a Dog

In another study presented at the ACAAI meeting suggested that having a dog may actually offer protection for children in a perhaps unexpected way.5

“Although eczema is commonly found in infants, many people don’t know there is a progression from eczema to food allergies to nasal allergies and asthma,” said Gagandeep Cheema, MD, a specialist in allergy & immunology in Detroit, Michigan, in an ACAAI press statement, “We wanted to know if there was a protective effect of having a dog that slowed down that progress.”

Based on findings from this study, the presence of a dog in the home during pregnancy may lead to children who are less likely to suffer from allergic eczema. Though the effect of this protection appears to weaken with a child’s age, diminishing by around age 10 years, this effect could be a factor in a young child’s inflammatory response and overall well-being.5

Takeaway Messages

Individuals who suffer from eczema now have available two new medications that have received approved for treatment of their inflammatory, atopic dermatitis, said Dr. Fonacier.

"Hopefully, these medications, along with recent research elucidating other associations between eczema and common factors in a patient’s life, will foster improved outcomes for those patients with eczema or at risk of developing eczema and its related conditions," he said. 

Last updated on: November 8, 2017
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