New agents and well-established therapies for treating AD

Dr. Maha Dutil discusses well-established Txs and new agents for AD, for all skin types (944 words, 3.3 min),

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Studies have shown that atopic dermatitis has differences among racial groups, and various treatment strategies may be necessary. Topical treatment of atopic dermatitis (AD) involves a multi-angle approach for managing flares and ongoing maintenance. Still, there are both well-established therapies and new agents for this condition that can produce improvement. That was one message Dr. Maha Dutil included in her presentation on AD at Skin Spectrum Summit in Toronto.

The basis of any care regimen is emollient use, Dr. Dutil said, noting that studies have shown that moisturizing alone can improve the eczema score. Bathing habits, too, are a non-medical factor that can impact AD symptoms, she said, recommending that patients with AD only bathe once every two to three days to reduce the drying effect. 

Topical treatments for AD include topical steroids, topical calcineurin inhibitors (CNIs) and PDE4 inhibitors. Steroid phobia is common even though when used properly, steroids are very valuable, she said. 

“If you counsel the patient and use low- to medium- potency steroids, you do not really have many side effects,” Dr. Dutil said. “There is a long history of safety when used correctly, and they are very effective at cooling inflammation down quickly. They relieve the itch, and they are inexpensive.” 

She recommends prescribing low-potency steroids for the face and folds and mid-potency steroids for the body, arms and legs. “I leave the high-potency [steroids] ... for the palms and soles.” 

For patients who do not respond to a topical steroid, have developed a side-effect or intolerance or have become dependent due to overuse, Dr. Dutil says switching to a topical CNI or a PDE inhibitor could be a good choice. 

Topical steroids should also be avoided in adolescents or preadolescents. “If you happen to hit them during their growth spurt with a topical steroid, you increase the risk of side- effects,” she said. 

CNIs “suppress inflammation by inhibiting calcineurin-dependent T-cell activation. They are anti-inflammatory without being anti-proliferative. They improve skin barrier function, and they reduce Staph. carriage.”

With these products, patients should be counselled that approximately 20% of patients experience a transient burning sensation on application, lasting roughly 10 minutes for the first few days of treatment. Although there is a safety warning in these products' monographs, Dr. Dutil noted that in 20 years of clinical experience with topical CNIs, no link had been found be- tween use of these products and skin cancers or lymphomas. 

A new option is PDE4 inhibitors, one of which, crisaborole, was approved in Canada in late 2018. “Phosphodiesterase degrades cyclic AMP and is overactive in patients with atopic dermatitis. So by decreasing phosphodiesterase, cyclic AMP goes up in the cell, and it re- duces inflammation,” said Dr. Dutil. 

She mentioned a four-week study of PDE4 inhibitor treatment in patients aged 2 and older with mild-to-moderate AD. By day 29, a third of patients were clear or almost clear in that study with a two-grade improvement.

“It helps the itch within a week. It is probably because cyclic AMP goes up in all the cells, not just the skin cells. It also goes up in nerve cells. That may be an effect.” 

The takeaway: The basis of any care regimen is emollient use. For patients that do not respond well to a topical steroid, switching to a topical CNI or a PDE inhibitor could be a good choice. 

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FROM THE LITERATURE ON ATOPIC DERMATITIS

Atopic dermatitis in the pediatric population: A cross-sectional, international, epidemiologic study

An international study of pediatric atopic dermatitis (AD) found that the skin condition is present in a substantial population percentage. The survey of 18 countries found that diagnosed AD ranged between 2.7% and 20.1% of the pediatric population. 

From “Ann. Allergy Asthma Immunol.”

A systematic review and meta-analysis of risk factors associated with atopic dermatitis in Asia

  • Gene-environment interaction is an important factor in identifying individuals at high risk of developing atopic dermatitis (AD), according to a recently published study conducted by researchers in Singapore. The researchers evaluated some modifiable factors that contribute to AD, including cultural lifestyle aspects specific to Asian families.

    From "World Allergy Organ J"

The ABC topical management of atopic dermatitis in Philippines: Expert recommendations

  • A panel of dermatologists in the Philippines came together to evaluate current atopic dermatitis treatment practices. They recommended the “ABC process” of AD management, including anti-inflammatory treatment, barrier repair, and skincare practices. 

    From “Journal of Drugs in Dermatology”

VIDEO: Hispanic and black children more likely to miss school due to atopic dermatitis

AT THE INTERSECTION OF SKIN AND SOCIETY

  • According to a recent article by the CBC, the province of Nova Scotia has repaid a fine imposed on Black civil rights pioneer Viola Desmond after a teenage student launched a campaign to have the fine symbolically repaid. In 1946, Desmond refused to leave the “whites only” section of a movie theatre, was forcefully removed from the premises and fined $26, which is the current equivalent of $368.29, according to the report. According to the article, the teenager behind the move to repay the fine is Varishini Deochand, who called on the Nova Scotia legislature to repay Desmond’s surviving sister, Wanda Robson, the money. Robson (pictured below holding a 10 dollar bill, which features her sister’s image) requested that the money be donated to charity. The province ultimately donated $1,000 to her alma mater, Cape Brenton University. Read the full article here.

This Week

Something to think about during the week ahead…

Next Week

A presentation by Dr. Renée Beach on traction alopecia in men wearing turbans.

Thank you to our panellists and delegates for making Skin Spectrum Summit 2020 a great success. Conference highlights will soon be posted to the Skin Spectrum website. As always, we welcome your questions and comments on topics in Ethnodermatology.

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