ECZEMA - Latest updates

/

The term eczema and dermatitis are used interchangeably, denoting an inflammatory reaction pattern involving several layers of the skin. Acute eczema/dermatitis is characterized by pruritus (itchiness), erythema and vesiculations (blisters). Chronic eczema is characterized by pruritus, over infections and fissures. 

There are many causes and different types of dermatitis:

  • Contact dermatitis

  • Irritant dermatitis

  • Chronic dermatitis/eczema

  • Atopic dermtatitis

  • Lichen simple

  • Dyshidrotic eczmea

  • Seborrheic dermatitis

Many of the conditions have predisposing factors, such as atopy (allergies), autoimmune baselines, fair skin, low termperature, climate, mechanical irritation, occupational exposure,  plant/alllergen exposure, etc. 

Clinically, they can vary and have different manifestations:

  • Dry patches, rash, blisters

  • Itchy or painful or burning

  • Scabs or scales

Treatment will depend on diagnosis but with a careful clinical history taking and visual examination/assessment, we can safely and efficiently treat all conditions. Recent advancements in eczema treatment include the FDA approval of two new medications: a biologic (Nemolizumab) and a topical cream (Vtama). Additionally, research continues to explore novel approaches like topical probiotics and targeted therapies based on immune system understanding. 

New Treatments:

  • Nemolizumab:

    A biologic medication (IL-31 inhibitor) for moderate to severe atopic dermatitis, used with topical corticosteroids or calcineurin inhibitors when other topical treatments are insufficient.

  • Vtama:

    A topical nonsteroidal cream (aryl hydrocarbon receptor agonist) for adults and children 2 years and older with atopic dermatitis. 

Other Notable Developments:

  • Topical Steroid Withdrawal (TSW):

    Research is defining diagnostic criteria for TSW, a condition distinct from eczema, potentially linked to excess NAD+. 

  • Topical Probiotics:

    NIAID research has led to the availability of a topical probiotic containing Roseomonas mucosa, which can relieve eczema symptoms. 

  • Long-term Treatment Benefits:

    A study published in the Journal of the American Academy of Dermatology (JAAD) found that some patients with delayed responses to eczema treatment may still see significant improvements with continued treatment over a longer period (52 weeks). 

  • Personalized Care:

    Emerging research supports a more personalized approach to eczema treatment, acknowledging individual responses and tailoring treatment accordingly. 

  • Understanding the Immune System:

    Research continues to focus on the Th2 immune response and its role in eczema, particularly the cytokines IL-4 and IL-13. 

  • Targeted Therapies:

    Ongoing research explores therapies that target specific pathways in the immune system, such as JAK inhibitors and PDE4 inhibitors, offering potential for better management of eczema symptoms.