Currents: Atopic Dermatitis

AD Takes Big Toll on QOL

Itch, skin dryness, and other eczema symptoms negatively affect quality of life, according to a new study published in the Annals of Allergy, Asthma and Immunology.

Of 602 adults with eczema, symptoms that were the biggest burden were itch (54 percent) followed by excessive dryness or scaling (19 percent), and red or inflamed skin (seven percent). Skin pain and sleep disturbance were the next most burdensome symptoms, the study showed.

“Those with moderate or severe eczema were less likely to report itch or excessive dryness or scaling as their most burdensome symptoms,” says Jonathan I. Silverberg, MD, PhD, MPH, lead author of the study. “A higher proportion of that group reported blisters or bumps, sleep disturbance, pain and open sores or oozing as their most burdensome symptoms. In addition, a high percentage of all those surveyed considered themselves to only have fair (25 percent) or poor (15 percent) overall health and reported being somewhat (16 percent) or very (11 percent) dissatisfied with life compared to those who do not have eczema.” Dr. Silverberg is an Assistant Professor of Dermatology, Medical Social Sciences and Preventive Medicine at Northwestern University Feinberg School of Medicine in Chicago.

Eczema was associated with worse quality of life than several other common chronic illnesses, including heart disease, diabetes, and high blood pressure. Moreover, moderate and severe eczema were associated with dramatically lower quality of life than all other chronic disorders examined.

“We were not surprised to discover that symptoms of eczema can lead to mental health disturbance and impaired quality of life,” says allergist Luz Fonacier, MD, ACAAI Fellow and co-author of the study. “Even those with mild eczema reported it limited their lifestyle, impacted activities or led to avoidance of social interactions. The harmful effects were even worse for those with moderate and severe eczema. Almost half of adults with severe eczema reported quite a bit or a great deal of a burden in their lives.”

Novartis Enters Licensing Deal for IL-17C Compound for Atopic Dermatitis

Novartis has entered into an exclusive license agreement with biotech companies Galapagos NV (Mechelen, Belgium) and MorphoSys AG (Planegg/Munich, Germany) to acquire the exclusive global development and marketing rights to MOR106 for atopic dermatitis and all other potential indications. Novartis will make an upfront payment of EUR 95 million to Galapagos and MorphoSys, and additional payments, royalties and fees pending achievement of agreed milestones. The closing of the license agreement is subject to the expiration or termination of the waiting period under the Hart-Scott-Rodino Antitrust Improvements Act.

“We are a leader in immuno-dermatology and committed to reimagining the care of patients with severe diseases such as psoriasis, chronic spontaneous urticaria, and atopic dermatitis. There is a key role for biologics to treat these severe diseases, which are more than just skin conditions, as they have complex underlying root causes,” says Eric Hughes, Global Development Unit Head, Immunology, Hepatology and Dermatology. “We are pleased to work with Galapagos and MorphoSys who have a proven track record of developing drug candidates for severe inflammatory diseases.”

MOR106 is a monoclonal antibody directed against IL-17C. MOR106 is an extension of the Novartis AD portfolio, which includes oral ZPL389 in phase II. MOR106 has demonstrated first signs of efficacy and was generally safe and well tolerated in a double blind placebo-controlled Phase Ib study. MOR106 is a potentially first in class anti-IL-17C monoclonal antibody for AD and possibly other diseases. The in-licensing of MOR106 underlines Novartis commitment to lead immuno-dermatology, adding to Novartis marketed product portfolio Cosentyx and Xolair.

Topical Fundamentals
“Topical therapy is so important for atopic dermatitis and, of course, as dermatologists we really carry the mail on this point. And, especially when I talk to non-dermatologists who sometimes get a little bit caught up perhaps in the immunology—of which there are some really exciting developments happening right now...I still think it’s so important to remember the topical fundamentals. So the most important thing, I think, is moisturization. That skin barrier is critical…,” says Peter A. Lio, MD. Watch his full interview with DermTube Journal Club host Joshua Zeichner, MD for more on his approach to helping his patients control eczema.

Link Between Diet and Skin Disease Took Center Stage at Summer AAD

Dermatologists must help patients determine if any foods may cause skin conditions—including eczema—to flare and provide evidence-based recommendations about next steps.

“People looking to improve their skin health may think that changing their diet is the answer, but a dermatologist will tell you that’s not necessarily the case,” says board-certified dermatologist Rajani Katta, MD, FAAD, a clinical professor of dermatology at McGovern Medical School at the University of Texas Health Science Center at Houston. “While diet can impact your skin in certain conditions, a lot of the information that’s out there on the web is not based on sound scientific research.” Dr. Katta discussed diet and skin disease at the American Academy of Dermatology’s annual summer meeting in Chicago.

Since anyone can post anything they want on the Internet, patients should be told to be wary of the information they find there, Dr. Katta says. Many websites are sponsored by companies trying to sell products, she says, so any recommendations they make should be taken with a grain of salt.

Among the biggest misconceptions patients have related to diet and dermatology is an overemphasis on the role of food allergies in skin conditions, Dr. Katta says. While some food allergies can affect the skin, they play a limited role in skin disease overall, she says. “Food allergies are not the cause of every skin condition,” she notes. “People tend to blame them a lot more than they should.”

Gluten, in particular, may be mistakenly identified as a source of skin inflammation, Dr. Katta says. Those with inflammatory skin disease like psoriasis and eczema may cut gluten from their diet in an attempt to improve their condition, she says, but such a change would only make a real difference for those with a diagnosed gluten allergy or hypersensitivity. “Gluten is not inherently inflammatory,” she says. “The vast majority of people can eat gluten without any problems.”

Dermatologists can help patients with skin diseases like acne, rosacea, and atopic dermatitis determine if there are any foods that may cause their condition to flare, Dr. Katta says, and if that’s the case recommend dietary changes that might be helpful.