Easing the Burden of Moderate-to-Severe Eczema: Understanding the Treatment Ladder

I was compensated by Med-IQ through an educational grant from Sanofi Genzyme and Regeneron Pharmaceuticals to write about the signs, symptoms, and treatments available for atopic dermatitis or eczema. All opinions are my own. 

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A few months ago, I shared that I was partnering with Med-IQ to talk about Atopic Dermatitis, more broadly known as Eczema. When I shared my first blog post, we were getting ready to head into winter, which is when the girls Eczema starts to get a bit worse. With this blog post, I want to chat more about the treatment ladder and how to deal with your (or your loved ones’) Eczema. Before I do that, I want to re-cap a few of the things I talked about in my last post, which you can find here. You can also watch this Facebook Live Session with Christine Burke with Dr. Peter Lio.

For Reference, Peter A. Lio, MD  is a Clinical Assistant Professor of Dermatology and Pediatrics and the Founding Director, Chicago Integrative Eczema Center in Chicago, IL.

The word “eczema” has two meanings. It can mean either of the following:
– A group of conditions that cause inflamed, irritated, and often itchy skin
– Any one of the conditions within this group, such as atopic dermatitis, contact dermatitis, or stasis dermatitis.American Academy of Dermatology – Eczema Resource Center

• More than 31 million Americans have some form of eczema.
  • Around 16.5 million adults in the US have atopic dermatitis, with 6.6 million reporting moderate-to-severe symptoms
• Although atopic dermatitis most commonly develops early in life, it can persist into adulthood for many patients.
  • 10% to 25% of children have atopic dermatitis; of which, approximately 1/3 have moderate-to-severe disease
  • 5% to 10% of adults have atopic dermatitis (3% of elderly); of which, approximately 1/2 have moderate-to-severe disease
• 80% of individuals affected with AD experience disease onset prior to 6 years of age, and current data suggest at least 80% will “outgrow” their AD by adolescence or adulthood. 
• Atopic dermatitis affects all races; however, African-American/black and Hispanic children tend to have more severe AD.
• Atopic dermatitis is commonly associated with other allergic/atopic conditions such as allergy, asthma, hay fever, and food allergies.

You can read more about causes and symptoms of Eczema here.

Knowing what we know about Eczema, What can we do?

We are fortunate that, so far, the girl’s eczema clears up with gentle skincare treatments like topical ointments. We use soaps and cleansers that are oil-based, do not contain preservatives, and moisturize their skin. It seems to be the perfect trifecta and is a significant first step when figuring out your eczema. With that being said, if that didn’t work, we were ready to start identifying and picking out any specific irritants or allergens that were causing the flare-ups. Examples of triggers: a reaction to food or something you touch, such as wool or animals, pollen, certain soaps, fabrics, and lotions.

Now, if the case is a moderate-to-severe atopic dermatitis patient and topical ointments aren’t working – it is time to move up the ladder to systemic therapies. 

While your doctor can help you identify what might work for you, here are a few examples of systemic therapies.

• Nonspecific immunosuppressants systemic corticosteroids. However, these can cause rebound flares and multiple adverse effects with long-term use.
  • Just like anything – it is important to find out what works best for you and to monitor to see they are working.
• There are systemic agents, approved by the FDA, that are now available that work to target the underlying causes of atopic dermatitis, including the factors that cause itch and inflammation.
  • An example is dupilumab, which is approved for use in patients age 6 years and older with moderate-to-severe atopic dermatitis that is not controlled by topical therapies.

Most Important

You are not alone! There is a wealth of knowledge out there and doctors who want to help. It’s important to seek out a healthcare provider who ask for your preferences, discuss your prior experiences, and partner with you to develop an eczema action plan. If treatment isn’t successful or if your doctor isn’t comfortable with systemic treatments, you may need to consider a treatment change or switch to a dermatologist or pediatric dermatologist with expertise in treating eczema.

Keep in mind, atopic dermatitis is a chronic condition. A formal, written plan or “Eczema Action Plan” can help you follow your recommended management plan. It is important to follow the treatment instructions carefully. If your symptoms do not improve or have any side effects, you and your doctor can determine whether another treatment is right for you.

Don’t give up!

Med-IQ is conducting an anonymous survey and would appreciate your input. The survey will take less than 10 minutes to complete. Survey responses are shared only in aggregate. Your responses to these survey questions will provide Med-IQ with important information about your experiences with atopic dermatitis, which will help us develop future educational initiatives. Once you’ve completed the survey, you will have the option of providing your email address to be entered into a drawing administered by SOMA Strategies to win 1 of 10 $100 VISA gift cards. If you choose to enter, your email address will be used only to randomly draw the winners and notify them of their prize.

You can find the link here.