Nationally recognized dermatitis specialist Dr. Matthew Zirwas reviewed atopic dermatitis (AD), highlighting new and emergent treatments for attendees at the SDPA 20th Annual Fall Dermatology Conference in Miami. He summarized the evolution of AD treatment noting “how well we can treat AD now and how bad we were at it until five years ago” due to availability of the newer effective treatments dupulimab, tralokinumab and systemic JAK inhibitors. Zirwas calls himself a “matchmaker” in outlining his approach to the treatment for the AD patient where he matches the “right patient with the right drug.” He emphasized the importance of shared decision-making with patients and shared his thought process on selecting the most effective treatment regimen. Furthermore, Dr. Zirwas worked through his typical script on how he approaches this conversation with patients.
Coverage: SDPA 20th Annual Fall Dermatology Conference Nov. 17-20, 2022, in Miami
Dr. Zirwas encouraged attendees to rethink the approach to the treatment of AD. With 7.2% of adults in the US suffering from AD vs 3% with psoriasis, there is a mismatch in the prescribing of biologics for AD compared to psoriasis. While improving the quality of life for patients is clearly an important goal for these AD patients, prevention of infection should also be a target. The risk of serious infections in patients with moderate to severe AD is “shockingly high.” Effective therapy is not immunosuppressive but reduces risk of infection dramatically.
JAK inhibitors work rapidly in the reduction of itching and improvement of AD severity. The efficacy of JAK inhibitors is directly dose related as is its immunosuppression. Limitations of JAK inhibitors include age, dependence on current FDA approval, and avoidance in pregnancy and the lactating patient. Dr. Zirwas outlined his baseline laboratories for these patients and monitoring throughout treatment. He highlighted a recent meta-analysis that revealed JAK inhibitors and dupulimab does not increase the risk of venous thromboembolism (VTE) or deep vein thrombosis (DVT). Dupulimab is an excellent treatment option for AD patients with no documented serious side effects. The use of dupulimab may make molluscum contagiosum worse initially but it will also make it go away, and Dr. Zirwas encouraged providers to “treat through it.” Tralokinumab is an option for patients who want less frequent injections or an alternative option for patients who had an inadequate response to dupulimab.
Byline: Sarah B.W. Patton, PA-C
Pictured: Matthew Zirwas, MD, FAAD, Dermatologists of the Central States