Contemporary treatments for atopic dermatitis and the dawn of targeted biological therapiesContemporary treatments for atopic dermatitis and the dawn of targeted biological therapies
Atopic dermatitis (AD) is a very common, clinical heterogenous, chronic systemic disease driven by skin barrier disruption and in large part by immune dysregulation in the form of type 2 inflammation. Typically, the disease will manifest as recurrent flares in childhood with a characteristic distribution pattern, although onset at any age is possible. AD is often associated with other atopic conditions including asthma, allergic rhinitis, allergic conjunctivitis and food allergies. Owing to pruritus (and associated sleep loss) as well as secondary skin infections and the psychosocial burden of visible skin lesions, AD has a major impact on a patient’s (and caregiver’s) quality of life. The diagnosis of AD is clinical and does not require any routine allergy testing or blood work. Management follows a stepwise approach that builds upon therapeutic patient education of the “general measures” that includes frequent and liberal use of emollients, occlusive dressings, gentle skin cleansing regimens (bath practices) and trigger avoidance inter alia. As a basis, pharmacological therapy includes various topical therapies. In individuals where control is not attained (and suitably maintained), stepping-up to broadly acting systemic immunosuppressive therapies or targeted immunomodulating biological therapies should follow without undue delay. Phototherapy (where available) may similarly be trialed. The aim of therapy is to establish long-term disease control; restore the skin barrier function (thereby reducing transepidermal water loss and curtailing antigen entry); achieve relief from symptoms (skin inflammation, visible lesions and pruritus); avoid exacerbations (flares); address comorbidities and improve patient quality of life.