Prescription therapies for treating atopic dermatitis

An article recently published in Dermatol Ther (Heidelb) discussed therapies available for treating pediatric atopic dermatitis (AD), both now and in the future.

Up to 20% of children worldwide experience AD, causing pinky, scaly patches and plagues to appear on the skin. Comorbidities often present with AD include allergic rhinitis, food allergies, and asthma. Patients with AD also often present with cutaneous bacterial or viral infections, sleep disturbances, and mental health disorders.

As AD involves complex genetic predisposition, alongside other factors, there are multiple methods of treating the condition. Prescription therapies are one method of combating AD. These include topical corticosteroids (TCS), a common treatment for AD. 

TCS are available through creams, ointments, foams, lotions, and gels depending on the location and severity of AD. They have been proven safe and well tolerated when used properly, with no evidence of skin thinning when using TCS intermittently. Adverse events include rosacea, perioral dermatitis, striae, acne, and rarely systemic absorption.

Other prescription therapies include pimecrolimus cream and tacrolimus ointment, both of which are topical calcineurin inhibitors (TCIs). TCIs are often used as adjuncts to TCS for treating mild to moderate AD in children aged 2 years and older. Like TCS, these TCIs have an anti-inflammatory effect. 

TCIs can be used more frequently in thinner areas of the skin. A burning sensation is the most common adverse event, but can be mitigated by refrigeration of the product before use.

Phosphodiesterase 4 (PDE-4) inhibitors are also used for treating AD. One PDE-4 inhibitor is crisaborole, which is approved for use in children aged 3 months and older with mild to moderate AD. Adverse events include stinging and burning, with no serious adverse events recorded.

Phototherapy can be used to treat severe refractory pediatric AD as an adjunct to topical therapies. Phototherapy is often given 2 to 3 times per week and has shown complete clearance or little AD activity in up to 40% of children. 

Adverse events of phototherapy include pruritus, herpes simplex virus reactivation, skin burning, transient erythema, and potential increased risk of skin cancer. As pediatric patients have a potential increased risk of skin cancer, attention to adverse events should be given, and many research authors recommended avoiding the use of phototherapy in this group.

Systemic therapies may also be used for treating pediatric AD. However, adverse events limit long-term use of these therapies, and the emergence of new therapies in the future may cause systemic therapies to be used less.

Multiple biologics are being developed for treating AD, but Dupilumab is the only biologic currently approved by the US Food and Drug Administration (FDA) for use in pediatric patients aged 6 months and older with AD. Biologics in development include lebrikizumab, tralokinumab, and nemolizumab.

Janus kinase (JAK) inhibitors are a newer treatment for AD. They are oral and topical medications mainly used in children aged 12 years and older. JAK inhibitors have seen significant success in reducing AD symptoms, with ruxolitinib and upadacitinib currently approved, while abrocitinib is an oral inhibitor still undergoing testing.

There is no known cure for AD, but the list of available treatments continues to grow. Investigators suspect that even more therapies will be available in the future.

Reference

Johnson H, Yu J. Current and emerging therapies in pediatric atopic dermatitis. Dermatol Ther (Heidelb). 2022;12:2691–2703. doi:10.1007/s13555-022-00829-4