Tormenting itching, redness of the skin with swelling, blistering, scaling, and weeping of various skin areas, which can be affected to varying degrees, characterize atopic dermatitis. The disease usually begins between the 3rd and 6th month of life, but it is also possible to develop it as an adult. The Atopic dermatitis is usually a multifactorial disease; genetic predisposition, disturbances of the skin barrier and the immune system can be responsible, as well as provocation factors due to environmental influences. Every single aspect can cause atopic dermatitis, but it is usually a combination of these factors. Atopics very often also suffer from allergic asthma and food allergies, as well as hay fever.

Treatment options for atopic dermatitis

Treatment of atopic dermatitis currently does not target the cause, but is intended primarily to alleviate symptoms and prevent new flares. A stepwise therapy plan is used here to address different phases and individual disease courses. The cornerstone of the stepwise plan is basic therapy, in which the skin barrier disturbance should be favorably influenced by regular use of skincare products and dryness and itching should be reduced. In this stage possible triggering factors should also be identified and eliminated. In mild to moderate eczemas antiseptic and antipruritic products as well as phototherapy are additionally used. Anti-inflammatory creams or ointments should also be prescribed. After controlling the eczemas with the anti-inflammatory substances, a maintenance therapy is carried out for a further 3 months to prevent a rapid relapse. However, if the eczemas are very severe and respond inadequately to topical therapeutics, systemic immunosuppressants are required. Unfortunately, these drugs sometimes have pronounced side effects and can only be used for a limited time.

Allergen-specific immunotherapy

However, there are new therapeutic approaches for the treatment of atopic dermatitis. Small clinical studies have shown that immunotherapy, e.g. against house dust mites or birch pollen, especially at higher dosages, was able to produce a marked improvement in skin symptoms. It still needs to be clarified whether eczema patients with mild or severe disease can benefit from such immunotherapy and which dosage is most appropriate.

Targeted immunomodulation with biologics

Furthermore, there are increasing reports about the use of biologics in the treatment of atopic dermatitis that block a messenger substance relevant to disease development. These drugs have so far been used in the treatment of psoriasis. However, such drugs are also in development for the treatment of atopic dermatitis and are currently being tested in studies.

Products for combating itching

One strategy to relieve itching in atopic dermatitis is the blockade of interleukin-31. The tolerability of the antibody against interleukin-31 is currently being tested in a Phase 1 study in patients suffering from atopic dermatitis. Other products to combat itching are also currently being tested: for example neurokinin-1 receptor antagonists, which are already in Phase 2 trials. Dupilumab (anti-IL4R), which blocks a messenger important for disease development, is already in Phase 3. This drug showed very good success in previous studies and currently represents the most promising therapy for severe atopic dermatitis.

The complete article “New active substances in the pipeline for the treatment of atopic dermatitis” from springermedizin.de can be read here:

pdficon_largeNew active substances for the treatment of atopic dermatitis by Dr. Bangert from JUVENIS

 

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