By Peter Galvin, MD
Eczema is a skin condition that can cause redness, swelling, scaling, oozing/weeping, and dryness. By far the most common form of eczema is atopic dermatitis, sometimes called atopic eczema. It is what most doctors and patients are referring to when using the term eczema. It is a chronic inflammatory skin condition that affects more than 200 million people worldwide, including about 20% of children and 10% of adults. Although atopic dermatitis is more common in children (and often continues into adulthood), about one in four adults with it have adult-onset disease. Factors involved in the development of atopic dermatitis include a weakened skin barrier, increased activity of immune cells in the skin, and an altered microbiome (microorganisms living on the skin). It may affect certain areas of the body including skin folds, the head, face, and neck, hands and wrists, and feet and ankles. The most common symptom is itching, but it can cause skin pain and may affect sleep.
Atopic dermatitis can decrease quality of life, reduce productivity at school and work, and increase healthcare costs. There are known triggers for flare-ups that vary among individuals and may include emotional stress, rapid changes in temperature or humidity, sweating, allergens, and irritants. Although patients may receive education about how to identify and avoid triggers, many patients have already discovered this information on their own. Advice to those with atopic dermatitis include to bathe daily, use soap-free cleansers, and apply fragrance-free and irritant-free skin moisturizers directly after bathing. Although there is no cure for atopic dermatitis, medications that regulate inflammation and immune system activity can help improve or resolve symptoms. For mild to moderate atopic dermatitis, first-line treatment is topical anti-inflammatory creams and ointments including topical steroids. These treatments and others like them rely on steps to interrupt the inflammatory pathway. Inflammation results from a series of steps involving various proteins and enzymes, similar to how blood clots. The steps necessary to form a blood clot involve enzymes and proteins and is called the clotting cascade. The inflammation pathway involves enzymes known as Janus kinases. When first discovered, these enzymes were called “Just another kinase” (JAK). Those familiar with Roman mythology will recognize the name Janus, who was the two-faced Roman god of beginnings, endings, and duality. When it was found that these kinases had two nearly identical domains, one with kinase activity and the other with anti-kinase activity, the name was changed to Janus kinases. Janus kinase (JAK) inhibitors interrupt the inflammatory pathway. If you watch TV ads, the names of several of these topical inhibitors might be familiar, including tofacitinib (Xeljanz) and upadacitinib (Rinvoq).
For more severe atopic dermatitis, various treatments include injectable biologics, oral JAK inhibitors, phototherapy (narrow-band UVB light), and oral immunomodulators like methotrexate, mycophenolate, and azathioprine. The treatments for severe inflammation and various forms of cancers overlap, as both JAK inhibitors and immunomodulators are used as chemotherapy for a number of forms of cancer and require close laboratory monitoring.
For more information go to the American Academy of Dermatology at:
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