Despite its ubiquitous nature, atopic dermatitis (AD) has proven a difficult disease to treat. One likely reason is that understanding of AD is still evolving. However, encouraging developments on the research and clinical front may provide greater insight into the disorder. With National Atopic Dermatitis Awareness Month approaching in October, experts discuss clinical and advocacy efforts that may influence therapy and boost awareness.
Therapy and Advocacy
Although treatments for atopic dermatitis have not seen tremendous growth recently, a number of developments point to new directions in understanding and treating AD. One area of particular interest in the research spectrum concerns the filaggrin gene and its role in atopic dermatitis, according to Amy Paller, MD, Walter J. Hamlin Professor and Chair of Dermatology and Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “The filaggrin gene has been the focus of a heavy amount of recent research into barrier function and the link between atopic dermatitis and other inflammatory disorders,” says Dr. Paller. With increased emphasis on barrier function, Dr. Paller predicts that future therapies will continue the focus on improving the barrier.
Vitamin D represents another recent area of interest that has been the focus of some inquiry research, according to Dr. Paller. “There is some interesting evidence regarding the effect of vitamin D on inflammation and the role of antimicrobial peptides, as well as some elegant work on whether inflammation can be reversed with increased vitamin D,” says Dr. Paller. The evidence at this point may not be extensive enough to warrant the inclusion of vitamin D therapy in treatment regimens, but as the picture on vitamin D becomes clearer, Dr. Paller suspects that for the select number of patients who are vitamin D deficient that supplementation may be helpful.
In general, Dr. Paller notes the need for more effective agents to combat atopic dermatitis. A number of research strands are exploring possibilities ranging from biologics to barrier repair that may prove to be vital developments. In the meantime, Dr. Paller notes that current therapies —including calcineuron inhibitors— can be very effective when used appropriately. However, continued issues with adherence pose a roadblock to efficacy. Ideally, spending more time with patients to discuss the importance of treatment and the nature of the disease would help to increase compliance. Treatment models in Europe have indicated a significant increase in quality of life and reduced severity when coupled with education. Given how strapped for time most physicians already are, it may be difficult for many to add any more education time. “Although it may not be practical to simply spend more time with each patient to foster greater awareness and education, we must explore ways to increase compliance,” says Dr. Paller. She observes that several “eczema centers” have been started in the US, including Rady Children's Center in San Diego and Northwestern University Eczema Care Center, both of which can be very beneficial for patients. Another resource that Dr. Paller finds indispensable in efforts to increase awareness and education is the National Eczema Association (NEA). “The NEA is not only a great vehicle for patient education and advocacy but is also a wonderful resource for doctors who refer and provide information to patients,” Dr. Paller says.
In addition to Eczema Awareness Month, current initiatives of the NEA include the Research Grants program, a new brochure “Topical Corticosteroids Myths & Facts,” and various other educational resources, such as a bathing and moisturizing DVD, and “Tools for School” packet. The NEA also holds a Patient Conference with Kids Camp (in Atlanta, GA in 2012) and support groups for patients, and is involved in social media through Eczema Expert. For physicians, the NEA offers a Physician Referral Directory to assist in referring patients to providers.
The NEA boasts extensive advocacy campaigns, such as lobbying for NIH/NIAMS funding and holding membership with the NIAMS Coalition and the Coalition of Skin Diseases. According to Julie Block, CEO of the NEA, “A major challenge in the upcoming years will be the changes in health care policy, which may make it harder to get all but generic medications, may restrict access, and risk decreasing research in developing new treatment strategies.” It is incumbent upon physicians to become more involved not just in spreading awareness, but also in trying to increase the quality of life of their patients with atopic dermatitis, she suggests. “By supporting eczema patients and caregivers, NEA improves quality of life and health,” says Ms. Block. “Education and support empowers patients to battle the eczema beast, adhere to good bathing and moisturizing regimens, and increases treatment compliance.”
Ms. Block notes several ways doctors can become more involved. This includes referring all eczema patients to the NEA or hosting a support group meeting. Smaller ways to get involved include distributing patient brochures, signing up for the NEA Physicians Referral Director, or by advocating for more Federal research for eczema, notes Ms. Block.
The Right Direction
Despite the amount of movement on advocacy and research fronts, the state of care in terms of new innovations in management of AD is disappointingly stable, notes Dr. Paller. “Progress in atopic dermatitis research has been slower than other areas— such as psoriasis—perhaps due to the nature of dealing primarily with a pediatric population,” she says. She predicts that the next five years may bring significant changes to the treatment paradigm of atopic dermatitis, with clinicians perhaps having an alternative to steroids to combat the disorder. According to Dr. Paller, acquiring improved understanding of the disease will be key toward realizing the potential of various developments in research. “Atopic dermatitis is one of several skin conditions in which having good understanding of what is happening can be a great motivator for compliance and adherence to effective therapies,” notes Dr. Paller. “It may also help to identify and eliminate potential triggers,” she continues. Additionally, future research may also importantly clarify the strong immune-psyche link in atopic dermatitis. “There is no question that stress and psychological stressors can worsen atopic dermatitis,” she explains. Understanding atopic dermatitis in these various respects will hopefully contribute to broader improvements in patient quality of life in addition to more efficacious treatments. Says Dr. Paller, “Being able to understand atopic dermatitis, to have a better sense of how to control it, and having tools to combat it, goes a very long way toward improving the quality of life of our patients.”
For additional resources on eczema management and awareness, visit www.practicaldermatology.com on September 21 or after. Click “Skin Disease Awareness.”