Atopic dermatitis, there is also a 'treatment like this'Professor Lee Dong-hoon, Department of Dermatology, Seoul National University Hospital

 

 

What is atopic dermatitis?

 

'Atopy' means 'strange, inappropriate'. Constitutionally, allergic reactions to food or inhaled substances are easily manifested, which is called atopy. Atopic diseases include atopic dermatitis, asthma, and allergic rhinitis. Atopic dermatitis is a chronic allergic inflammatory disease with very severe itching, and is very common, accounting for 10% of all pediatric populations and 3% of adults. Recently, there has been an increasing trend of patients in Korea due to Western-style living environment and pollution.

 

According to global statistics, 15~20% of children and 1~3% of adults suffer from atopic dermatitis, and 17% of European adults and 23% of Asian children are diagnosed every year. This steady incidence has been maintained consistently since the 90s.

 

Why should atopic dermatitis be treated?

 

There are a variety of reasons why there is a need for treatment for atopic dermatitis. First of all, for functional reasons, patients with atopic dermatitis may penetrate the skin with foreign substances such as bacteria due to the weakening of the skin barrier, and if they do not receive proper treatment, they will suffer from sequelae and complications. These sequelae and complications include lichenification*, skin infections, and allergic streaks. However, if atopic dermatitis is treated in a timely and appropriate manner, it can protect the skin barrier and prevent other diseases.

*Lichenification: Thickening of the skin caused by scratching the skin for too long

 

According to one survey, about 80% of patients with moderate to severe atopic dermatitis reported that their quality of life was significantly affected, and 15% said they were being treated for eye problems related to atopic dermatitis. Other symptoms include itching, sleep disturbances, and mental health issues.

 

From an aesthetic point of view, the need for atopic dermatitis can be very stressful because it causes symptoms such as dryness, white nasal rash*, eczema around the eyes and ears, cheilitis, dandruff on the scalp, and prominent pores.

*White rhinosis: A skin disease in which the dead skin cells on the surface of the skin peel off thinly like rice bran.

 

As mentioned above, it affects all aspects physically, mentally, and socially, so treatment for atopic dermatitis is essential.

 

Are there any management principles for the treatment of atopic dermatitis?

 

Treatment for atopic dermatitis is a long-term battle. Therefore, it is important to have a positive attitude and to continue to receive treatment so that it does not recur or worsen. You should also pursue treatments that have fewer side effects than quick treatments. As a personalized treatment, it is recommended that you choose one family doctor and receive treatment consistently.

 

First of all, topical treatments include topical steroids, topical immunomodulators, antihistamines, and skin infection controls.

 

First, topical steroids are good treatments that are well known for both their effectiveness and side effects. Possible side effects include sagging capillaries, skin barrier damage, acne, and stretch marks, but it is safe when used correctly. Do not avoid atopic dermatitis treatment because of side effects, but use it exactly as prescribed by your specialist.

 

Second, ointments or creams can be used without the risk of side effects of steroids, but there may be irritation symptoms such as burning or redness after application. In this case, applying the ointment cold can help. Ointment-type topical immunomodulators can prevent recurrence when applied 2~3 times a week for maintenance treatment.

 

Third, antihistamines and skin infection control drugs are mostly safe treatments to take for a long time. Side effects that may occur include drowsiness, dry mouth, and constipation.

 

Systemic treatments include antibiotics and antivirals. Antibiotics are used when atopic dermatitis worsens and impetigo* occurs, and antiviral drugs are used in cases of herpes eczema caused by herpes simplex virus.

*Impetigo: A bacterial infection that causes blisters, pus, and scabs.

 

Selective treatment for atopic dermatitis is performed in patients with severe symptoms or intractable diseases. There are oral immunomodulatory treatments, ultraviolet light therapy, and immunotherapy, as well as biologics and JAK inhibitors. These elective therapies are used in combination with managerial or topical treatments.

 

There is a biologic, a drug called Dupigent, which was approved by the US FDA in 2017. It is an injection that focuses on atopy. Dupigent selectively completely inhibits IL-4 and IL-13, cytokines that cause atopy. It is used for the treatment of severe atopic dermatitis that is not adequately controlled with topical treatments or where topical treatments are not recommended.

 

The 'JAK' in JAK inhibitors refers to enzymes in cells in the body that give orders to proteins that are responsible for regulating immunity and inflammation. It is a drug that partially and reversibly modulates various signaling pathways, rather than selectively, like Dupigent. Currently used drugs include baricitinib, upadacitinib, and abrocitinib.

 

How does clinical research on atopic dermatitis work?

 

All of the drugs introduced above have been developed through clinical trials. If you have a severe case of atopic dermatitis, but other drugs you have tried have not worked, you can participate in clinical studies to see if you have a therapeutic effect.

The phases of clinical research are as follows:

Phase 1 Recruiting health volunteers and sick patients to confirm the safety of the drug

See what the actual effects of phase 2 are, and set the appropriate dose

Phase 3 Efficacy and safety confirmed in many patients

Phase 4 Acts on a different mechanism to see if it is effective in other diseases

There may be vague worries because it is a clinical study, but patients who have not been able to treat atopic dermatitis with other drugs may have a good way to overcome atopic dermatitis by participating in clinical studies.