What’s new in Atopic Dermatitis

Gabriela Cobos, MD, reviewed the AAD guidelines for managing atopic dermatitis (AD) in her lecture at the SDPA Annual Summer Dermatology Conference in Boston. Taking a thorough history and evaluating what treatments patients have tried in the past is essential for determining the best course of treatment for these patients.  An important question to ask patients is how much their eczema is affecting their everyday life. Of note, adult onset of AD is increasing with 1:4 patients with AD reporting onset in adulthood. Presentation of AD in the adult patient may not affect classic sites, for example, lateral eyebrow thinning may be a sign of AD in the adult patient.  Dr. Cobos reminded us to “always think about multiple diagnoses and not anchoring on one” when approaching our patients with eczematous presentations.  Included among the differential diagnosis is scabies, drug reactions, allergic contact dermatitis, psoriasis, pre-bullous bullous pemphigoid and connective tissue disease.

Coverage: SDPA Annual Summer Dermatology Conference, June 22-25, 2023 – BOSTON

As AD is a condition of epidermal barrier dysfunction, it is key to work with patients on limiting trauma, use of emollients, minimizing allergens and instruction of proper bathing routines. An enlightening figure Dr. Cobos revealed is up to 1/3 of patients with AD do not pick up their topical prescriptions, therefore, we need to focus on meeting treatment preferences for these patients.   Additional treatment options include traditional immunosuppressants, narrow band UVB, biologics and JAK inhibitors. Unfortunately, insurance often dictates the access of all treatment options for our patients. Dr. Cobos emphasizes personalized medicine as our goal in the approach to patients with the new era of therapeutics and focus on biomarkers helping us accomplish this goal.

Biologic medications target the inflammatory cytokines of AD. In her experience, patients on dupilumab continue to have improvement after 16 weeks with increased clearance at 6 months of treatment.   When Dr. Cobos sees the side effect of red facial dermatitis in patients who are using dupilumab, she will switch these patients to talokinumab and in her experience, these patients will not have the same side effect. JAK inhibitors have broader immunosuppression than biologic medications with increased side effects of acne and nausea.  One of the benefits of JAK inhibitors for patients is the rapid onset of action with patients improving as early as 2 weeks. Approved therapies include abrocitinib and upadacitinib.  Dr. Cobos reports that she believes JAK inhibitors to be extremely effective in the right patient. Lastly, Dr. Cobos highlighted unique case presentations of AD in her practice.