AD is more common in children than in adults, with as many as 1 in 5 children globally affected by the condition compared with about 10% of adults. It can also affect infants, although systemic therapy is rarely utilized in such cases, the authors wrote.
The International Eczema Council recommends that physicians look at nontherapeutic solutions, such as avoiding triggers treating coexistent infections or educating parents and caregivers before considering systemic therapy. However, in cases when systemic therapy is warranted, the investigators said physicians and patients have several choices.
CsA, an immunosuppressive agent, has been shown to be effectivedespite symptoms often returning following cessation of the treatment. The investigators said a systematic review of 15 studies including 602 children and adults found a mean clinical improvement of 55% after 6 to 8 weeks of treatment. However, about half of those patients relapsed within 2 weeks of stopping CsA, and 80% had relapsed by 6 weeks.
It has a rapid onset of action and an acceptable short-term adverse effect profile, they wrote. However, relapse is common upon discontinuation of treatment, and potential long-term side effects are concerning.
The purine analog AZA has also been shown to be effective for both adults and children (who are typically prescribed a half-dose); however, the authors said one of the drugs 3 pathways is degrading to inactive metabolites by thiopurine methyltransferase (TPMT), which means it is not suitable for all patients.
TPMT activity is controlled by a genetic polymorphism, and patients can have high activity, intermediate activity, or low activity, the authors explained.
Patients with intermediate, low, or absent TPMT activity could be at an increased risk of myelotoxicity, the investigators said. In cases with low or absent TPMT activity, the risk could be life-threatening. Thus, the authors said TPMT genotyping or phenotyping is warranted to identify patients at risk of the complication.
MTX, a folic acid antagonist, has not been studied as extensively as the other therapies, but the authors said it has demonstrated similar efficacy to CsA and AZA. Compared with CsA, they said the improvement comes more slowly with MTX; however, MTX led to more durable responses, according to existing data.
Similarly, MMF has not been widely studied. Existing evidence suggests it can be effective in both children and adults with severe AD and may be better tolerated than AZA.
Lastly, the investigators turned to dupilumab, the only biologic approved by the FDA to treat childhood (ages 6 and above) and adult AD. The drug has performed well in clinical trials and has a favorable safety profile, aside from reports of injection-site reactions and conjunctivitis, the investigators said.
Dupilumab is considered the first-line systemic therapy of choice in the management of AD given its effectiveness upon clinical manifestations, excellent benefit/risk profile, and positive impact upon patients and families quality of life, they said.
The investigators said several other biologics and small-molecule drugs are currently being developed and investigated to treat AD, but that therapies appear to provide meaningful relief for many patients.
Ultimately, the choice of systemic therapy depends on each individual patients needs, and patient education is essential to improve treatment adherence, they concluded.
Reference
Davari DR, Nieman EL, McShane DB, Morrell DS. Current perspectives on the systemic management of atopic dermatitis. J Asthma Allergy. 2021;14:595-607. doi:10.2147/JAA.S287638
See the rest here:
Review Finds Several AD Treatment Options, More to Come - AJMC.com Managed Markets Network
- Retrospective analysis of 397 DABE | CCID - Dove Medical Press - December 3rd, 2023 [December 3rd, 2023]
- Derm In The News: November 26-December 2 - Dermatology Times - December 3rd, 2023 [December 3rd, 2023]
- When is the Best Time to Try Alternative Treatments for Eczema? - National Eczema Association - September 23rd, 2023 [September 23rd, 2023]
- How Eczema Negatively Impacted the Way She Talked to Herself - National Eczema Association - September 23rd, 2023 [September 23rd, 2023]
- Colloidal Oatmeal Effective in Improving Atopic Dermatitis in Black ... - Dermatology Times - September 23rd, 2023 [September 23rd, 2023]
- Combination Treatments in HS Require Further Review - Dermatology Times - September 23rd, 2023 [September 23rd, 2023]
- Addressing Misconceptions, Concerns Around Biosimilar Use - Dermatology Times - September 23rd, 2023 [September 23rd, 2023]
- Native American and Indigenous Communities Face Dermatologic ... - Dermatology Times - September 23rd, 2023 [September 23rd, 2023]
- Microwave Therapy Successful for Treating Warts in Children - Dermatology Times - September 23rd, 2023 [September 23rd, 2023]
- 9 Best Antifungal Body Washes Review - The Jerusalem Post - September 23rd, 2023 [September 23rd, 2023]
- Patients With Severe Psoriasis Have Higher Risk of Heart Disease ... - AJMC.com Managed Markets Network - September 23rd, 2023 [September 23rd, 2023]
- Swimming and skin: What to know if a child has eczema - Harvard Health - May 20th, 2023 [May 20th, 2023]
- Experts demand traffic-light labels to show strength of eczema cream - Daily Mail - May 20th, 2023 [May 20th, 2023]
- Its mosquito season. Here are tips for treating bites, preventing them in the first place - Yahoo News - May 20th, 2023 [May 20th, 2023]
- How new EU incentives will help all patients get the best treatments - Euronews - May 20th, 2023 [May 20th, 2023]
- Consistent Use of Ceramide-Containing Products Combined With ... - Dermatology Times - May 20th, 2023 [May 20th, 2023]
- The Best Swimming Skin and Hair Products | livestrong - Livestrong - May 20th, 2023 [May 20th, 2023]
- These 13 Household Items Contain Smells That Are Harmful To ... - Rock 92.9 - May 20th, 2023 [May 20th, 2023]
- FDA Approves First Pill to Treat Moderate-to-Severe Crohn Disease - HealthDay News - May 20th, 2023 [May 20th, 2023]
- Feds investigating eczema cream after two Oregon babies found with high levels of lead in blood - OregonLive - January 27th, 2023 [January 27th, 2023]
- Heres how to treat eczema and other skin conditions for cold weather - The Hindu - January 27th, 2023 [January 27th, 2023]
- Atopic eczema - NHS - November 23rd, 2022 [November 23rd, 2022]
- Seborrheic dermatitis - Symptoms and causes - Mayo Clinic - November 23rd, 2022 [November 23rd, 2022]
- Oatmeal skincare is the perfect solution for sensitive skin (+ best products to try) - Lifestyle Asia Singapore - November 23rd, 2022 [November 23rd, 2022]
- Eczema - StatPearls - NCBI Bookshelf - October 21st, 2022 [October 21st, 2022]
- Cold, dry weather can trigger eczema - how to reduce damage to the skin this winter - Express - October 21st, 2022 [October 21st, 2022]
- Eczema on lips nhs - kved.erxe.de - August 29th, 2022 [August 29th, 2022]
- xrfkc.vitalhaskap.pl - August 29th, 2022 [August 29th, 2022]
- Atopic eczema and alopecia areata - cyasn.kugel-lernfoerderung.de - August 29th, 2022 [August 29th, 2022]
- north shore zipline oahu - owk.tophouse.shop - August 29th, 2022 [August 29th, 2022]
- nak stock - vbi.maxense.shop - August 29th, 2022 [August 29th, 2022]
- Atopic eczema and alopecia areata - zayqif.hydra-market.shop - August 29th, 2022 [August 29th, 2022]
- fort worth map with zip codes - prxrzj.rids-gear.shop - August 29th, 2022 [August 29th, 2022]
- Ear Eczema: Symptoms, Causes, and Treatments - Healthgrades - August 29th, 2022 [August 29th, 2022]
- The Mutha Body Oil Is Worth the Splurge, Especially If You Have Sensitive Skin - POPSUGAR - August 29th, 2022 [August 29th, 2022]
- Are You Allergic to Your Beauty Products? A Patch Test Might Tell You - Allure - August 29th, 2022 [August 29th, 2022]
- Stinky sweat turns out to have a surprising health benefit : Goats and Soda - NPR - August 29th, 2022 [August 29th, 2022]
- Makeup for Eczema-Prone Skin: Considerations, Products, and Tips - Healthline - July 13th, 2022 [July 13th, 2022]
- Eczema Vaccinatum: Symptoms, Diagnosis, and Treatment - Healthline - July 13th, 2022 [July 13th, 2022]
- What Is Topical Steroid Withdrawal in Atopic Dermatitis Treatment? - Everyday Health - July 13th, 2022 [July 13th, 2022]
- A new 'cure for eczema' pill has been signed off but who is allowed to take it? - Cosmopolitan UK - July 13th, 2022 [July 13th, 2022]
- What Causes Dandruff And How To Get Rid Of It, According To A Dermatologist - Fatherly - July 13th, 2022 [July 13th, 2022]
- Allergies on the rise due to climate change - BusinessWorld Online - July 13th, 2022 [July 13th, 2022]
- Cryotherapy Treatment: Uses and Benefits - newschannelnebraska.com - July 13th, 2022 [July 13th, 2022]
- Mutations of Filaggrin Leading to Eggs & Milk Allergies - Physician's Weekly - June 18th, 2022 [June 18th, 2022]
- How AI & the Pandemic Are Changing the Skin & Hair Clinic Experience - The Quint FIT - June 18th, 2022 [June 18th, 2022]
- How to treat your childs dry skin in winter - Lowvelder - June 15th, 2022 [June 15th, 2022]
- Topical steroid: Types, uses, side effects and treatment as revealed by doctors - Hindustan Times - June 15th, 2022 [June 15th, 2022]
- Psoriasis in the Belly Button: Symptoms, Causes, and Treatment - Healthline - June 15th, 2022 [June 15th, 2022]
- In his last days, my father asked for Yiddish music - Forward - June 15th, 2022 [June 15th, 2022]
- Throwing away the water after cooking rice? Know how it could benefit your skin and hair - Times Now - June 15th, 2022 [June 15th, 2022]
- Family 'devastated and numb' as boy, 9, dies a day after breaking his arm - Coventry Live - June 15th, 2022 [June 15th, 2022]
- Happy Cappy Not Just For Babies; Everyone With Sensitive Skin Can Benefit - Pediatric Shampoo Granted Trademark in New Campaign: 'No Scalp Left... - June 15th, 2022 [June 15th, 2022]
- Eczema on black skin: Pictures, symptoms, and treatment - June 11th, 2022 [June 11th, 2022]
- Eczema on the Ears or Eyebrows: How to Cope - Everyday Health - June 11th, 2022 [June 11th, 2022]
- What People With Eczema Need to Know About Self-Screening for Skin Cancer - National Eczema Association - June 11th, 2022 [June 11th, 2022]
- How to protect children with eczema from scratching until they bleed - Channel NewsAsia - June 11th, 2022 [June 11th, 2022]
- Autism, allergies and other diseases and disorders afflicted baby boomers, too - PolitiFact - June 11th, 2022 [June 11th, 2022]
- Is saltwater good for the skin? What to know Beaufort South Carolina The Island News - The Island News - June 11th, 2022 [June 11th, 2022]
- What's trending? The most-read stories on APAC beauty market and consumer insights - CosmeticsDesign-Asia.com - June 11th, 2022 [June 11th, 2022]
- Canada to require a warning be printed on every cigarette - Coventry Live - June 11th, 2022 [June 11th, 2022]
- Holistic Acne Treatments That Are Better Than What You've Been Doing - The List - June 11th, 2022 [June 11th, 2022]
- Almirall: Eight out of Ten Patients Maintained Skin Clearance at One Year in Lebrikizumab Atopic Dermatitis Monotherapy Trials - PR Newswire UK - June 7th, 2022 [June 7th, 2022]
- Woman left balding and bedbound by chronic eczema clears the condition with a 9 face cream - The Independent - June 7th, 2022 [June 7th, 2022]
- Poll: Six in 10 people would eat food that has fallen on the floor - Coventry Live - June 7th, 2022 [June 7th, 2022]
- The itch that rashes: Treating and understanding eczema - El Paso Inc. - June 5th, 2022 [June 5th, 2022]
- Celebrities With Eczema Speak Out - Everyday Health - June 5th, 2022 [June 5th, 2022]
- Lotion, Cream, Gel, and Ointment Similarly Effective for Childhood Eczema - HealthDay News - June 5th, 2022 [June 5th, 2022]
- Antibiotics Given Before C-sections Are Not Linked to Asthma, Eczema in Young Children - Pharmacy Times - June 5th, 2022 [June 5th, 2022]
- Eczema Skin-Care Products Market Size, Scope and Forecast | Alliance Pharma Plc., Bausch Health Companies Inc., Bayer AG., AbbVie Inc., Eli Lilly and... - June 5th, 2022 [June 5th, 2022]
- What are the benefits of ceramides for the skin? - Medical News Today - June 5th, 2022 [June 5th, 2022]
- Some Allergies Associated With Lower Risk of SARS-CoV-2 Infection - Smithsonian Magazine - June 5th, 2022 [June 5th, 2022]
- The CDC is sending monkeypox vaccines to people at high risk in a race to prevent the spread - CNBC - June 5th, 2022 [June 5th, 2022]
- Missing Sikeston teen may be heading to Kansas City area - KMBC Kansas City - June 5th, 2022 [June 5th, 2022]
- Should you cleanse or exfoliate first? What to know - Medical News Today - June 5th, 2022 [June 5th, 2022]
- Dry Skin: Eczema, Itchy Skin, Causes, Treatments, Relief, Types - May 17th, 2022 [May 17th, 2022]
- Foods to Eat and Foods to Avoid If You Have Eczema - The Beet - May 17th, 2022 [May 17th, 2022]
- 3 Women With Eczema Describe the Ways They Combat Nighttime Flare-Ups - Verve Times - May 17th, 2022 [May 17th, 2022]
- The Challenges of Parenting a Child With Eczema - Verve Times - May 17th, 2022 [May 17th, 2022]
- Manuka Honey Benefits for Skin: Benefits, Masks, and More - Greatist - May 17th, 2022 [May 17th, 2022]