Looking at atopic dermatitis treatment options

On July 23, 2020, our sister publication HCPLive presented a webinar panel discussion focused on current treatments for atopic dermatitis (AD) as well as what the future may hold for treatments. The panel was led by Lawrence Eichenfield, MD, professor of dermatology and pediatrics at Rady Children’s Hospital in San Diego, California.

For children who may have mild-to-moderate AD, a nonpharmacologic approach may be what’s needed to manage symptoms, notedPeter Lio, MD, clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine in Chicago, Illinois. One of the simplest approaches is to ensure the child isn’t exposed to a trigger, such as a type of fabric. The next is to set up a regimen of bathing and moisturizing. Lio said that many families make dietary changes to try and combat AD, but he has found that although many children with AD do have food allergies, the allergen is frequently not the trigger for AD. Lio also spoke about the fact that studies have shown that over 50% of parents have tried complementary and alternative medicines, ranging from probiotics to Reiki to treat AD, but many studies on these therapies indicate that they don’t work.

The panel discussed the safety outcomes for systemic therapies. Lio likes to use phototherapy with younger patients, but noted that it can be difficult as it requires patients to come into the office and potentially expensive because some patients are paying a $50 copay, 3 times a week to get it. For patients who can’t undergo phototherapy, all of the immunosuppresants available have potential adverse outcomes including blood pressure spikes for prednisone and cyclosporine, kidney damage with prednisone, and potential liver issues with methotrexate.

The discussion next turned to Dupixent (dupilumab), which was recently approved for use in children aged 6 to 11 years. Elaine Siegfried, MD, professor of pediatrics and dermatology at SLUCare physician group in St. Louis, Missouri, spoke to how difficult it was to use the drug in younger children before the approval and stated that even after the approval it can still take time to get it. She said that she will often start patients on methotrexate. She also said that although there is strong level one evidence for dupilumab dosing that gaps in knowledge still remain.

The webinar ended with a look to what the future could hold for AD treatments. Siegfried spoke on the current robust nature of the pipeline, which prompted Eichenfeld to compare it to the state of the psoriasis pipeline in the past few years. Lio said that he felt like they were getting close to precision medicine for treatment options and also reflected on how active moisturizers and breakthroughs in barrier repair could potentially reduce the need to prescribe drugs that work with the immune system. Fred Ghali, MD, pediatric dermatologist at Pediatric Dermatology of North Texas in Grapevine, said that the treatments were moving from broader suppression to targeted approaches.