Eczema and Clinical Trials
Atopic dermatitis, commonly known as eczema, is a skin condition that affects millions of people across the globe. The National Eczema Association, reports that 31 million Americans suffer from one form of eczema.1
The disease is characterized by the formation of itchy patches that become inflamed (dermatitis means inflammation of the skin) and may crack. The conversion of patches into blisters is also seen in some cases. These dry, crusted and scaly patches can occur on different parts of the body. The condition affects both children and adults.
Keeping in mind the high prevalence of the skin condition, atopic dermatitis needs to be treated effectively. However, there is no definitive cure for eczema, and doctors are left with symptom management only. The good news is that research is being conducted, and with every passing day, we are inching towards a permanent solution.
Let's have a look at the current treatment strategies.
Topical Steroids and Anti-Inflammatory Drugs
Topical steroids are the first line of treatment for eczema, and they have shown promising results. It is recommended to use topical steroids for not more than 6 weeks and to use under medical supervision.2
Calcineurin inhibitors are specialized drugs that suppress the immune system, thereby preventing flares. Based on the latest analyses, researchers advocate the use of topical steroids along with calcineurin inhibitors for hand eczema. 3
Vitamin Supplements
Alitretinoin is a compound similar to vitamin A that is sufficient in treating severe and refractory forms of chronic hand eczema in most individuals. 4 The vitamin-like drug can be applied topically. It is considered to be highly effective and safe in use for pediatric chronic hand eczema patients. 5 Alitretinoin needs to be given for longer durations and in higher doses to be most effective. 6
Antibody Treatment
The use of antibodies (Ig) therapy is gaining popularity rapidly. Dupilumab is a monoclonal antibody that inhibits the activity of interleukins (chemicals involved in the progression of disease). Dupilumab therapy is well-tolerated by most patients as a long term treatment option for atopic dermatitis patients. 7
Systemic Corticosteroids
The use of systemic corticosteroids is reserved for cases that are non-responsive to topical therapy. The International Eczema Council has a consensus on abstaining from routine usage of systemic corticosteroids; stating they should be reserved for special circumstances. 8
Phototherapy
Dermatologists in Europe prefer prescribing phototherapy for the management of chronic eczema in infants and adults. Eczema phototherapies are typically used for whole-body cases and involve using a narrow band of UV light to treat the affected areas. Topical antibiotics and phototherapies are considered the first line of treatment for moderate to severe eczema. 9
References
- https://nationaleczema.org/research/eczema-facts/
- Diepgen, Thomas L., et al. "Guidelines for diagnosis, prevention and treatment of hand eczema." JDDG: Journal der Deutschen Dermatologischen Gesellschaft 13.1 (2015): e1-e22.
- Solman, L., et al. "What's new in atopic eczema? An analysis of systematic reviews published in 2016. Part 1: treatment and prevention." Clinical and Experimental Dermatology 44.4 (2019): 363-369.
- Napolitano, Maddalena, et al. "Alitretinoin for the treatment of severe chronic eczema of the hands." Expert Opinion on Pharmacotherapy (2021): 1-9.
- Luchsinger, I., et al. "Safe and effective use of alitretinoin in children with recalcitrant hand eczema and other dermatoses–a retrospective analysis." Journal of the European Academy of Dermatology and Venereology 34.5 (2020): 1037-1042.
- Al-Dhubaibi, Mohammed Saleh, and Ahmad Abdulsalam Setting. "The effectiveness of alitretinoin for the treatment of chronic hand eczema: a meta-analysis." International Journal of Health Sciences 12.2 (2018): 70.
- Bosma, Angela L., et al. "Long-term effectiveness and safety of treatment with dupilumab in patients with atopic dermatitis: Results of the TREAT NL (TREatment of ATopic eczema, the Netherlands) registry." Journal of the American Academy of Dermatology 83.5 (2020): 1375-1384.
- Drucker, A. M., et al. "Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement." British Journal of Dermatology 178.3 (2018): 768-775.
- Vermeulen, F. M., et al. "The European TREatment of ATopic eczema (TREAT) Registry Taskforce survey: prescribing practices in Europe for phototherapy and systemic therapy in adult patients with moderate-to-severe atopic eczema." British Journal of Dermatology 183.6 (2020): 1073-1082.