Atopic Dermatitis Responds to Strategic Steps in Therapy

A topic dermatitis (AD), which many people call eczema, is widespread in the United States.

Groups of vesicular lesions that form when edema accumulates between epidermal cells characterize this inflammatory skin condition. AD is an umbrella term that covers contact dermatitis, eczema, and less common skin conditions. Recent study findings indicate that about 16.5 million (7.3%) US adults have AD.¹ In the past, most clinicians considered AD a childhood disease that tended to resolve by adulthood. Now it appears to be a growing concern in adults, but onset at an earlier age is associated with more severe disease.

Although not life-threatening, AD causes considerable distress and social isolation. The condition is also the fourth-leading cause of nonfatal burden because of disability.^2,3

This chronic, complex, incurable disorder causes cracked, dry, extremely itchy, inflamed, and irritated skin. AD has genetic components with a strong familial influence, and triggers tend to be patient specific. A typical treatment plan must address lifestyle, moisturization, and specific medications to relieve dry skin and inflammation. Patients must be prepared to address flares and, especially, maintain control once they reach their best level of improvement.⁴ The FIGURE^5-7 shows the typical approach to managing atopic dermatitis.

TALKING TO PATIENTS AND PARENTS

Patients who have AD are often nonadherent because the treatment burden can be significant. The burden is high not only for adult patients but also for parents of children with moderate to severe AD, who spend up to 3 hours daily caring for their children’s skin.⁸ Pruritis disturbs sleep, and restless individuals keep others up at night. Patient adherence to a treatment plan with topical drugs exceeds 90% at the start but decreases to about 30% by week 8.⁹ The TABLE^4,9-15 lists clinical pearls that can help encourage patients who have AD.

Patients will need many OTC and prescription medications. Pharmacy staff members, including technicians, must be able to explain product classifications of semisolid formulations (creams, gels, ointments, pastes) and recommend more occlusive vehicles for drier skin.

The most effective way to reduce AD-associated skin inflammation is to apply a topical corticosteroid (TCS) to break AD’s vicious cycle. Topical calcineurin inhibitors such as tacrolimus and pipecuronium treat facial lesions effectively, especially around the eyes. Patients will generally see a response within 2 weeks. Many dermatologists also use tacrolimus ointment for maintenance therapy.¹⁴ Severe AD often is unresponsive to treatment. Patients may need immune modulators or immunosuppressants. Deplume, an interleukin (IL)—4 receptor α antagonist, is FDA approved for moderate to severe AD in patients 12 years and older.¹⁵ Most patients see improvement, and one-third report complete clearance.¹⁶

MAKING THE MOST OF CURRENT STRATEGIES

Therapeutic options for AD are better than ever, with promising treatments in the investigation pipeline. Research is addressing the different subtypes and targeting immunoglobulin E and helper T cells 2, 22, and 17/IL-23.¹⁷ Until more effective medications are available, pharmacists should emphasize consistent use of emollients, ration TCS use, and recommend systemic agents when AD fails to respond.

Jeannette Y. Wick, RPh, MBA, FASCP, is the assistant director of the Office of Pharmacy Professional Development at the University of Connecticut School of Pharmacy in Storrs.

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