American Academy of Dermatology Updates Guidelines for Eczema Management with Topical Skincare

To help ensure that adult patients with atopic dermatitis receive the best possible treatment, the American Academy of Dermatology (AAD) has published updated guidelines of care for the management of atopic dermatitis in adults with topical therapies in the Journal of the American Academy of Dermatology.

This is the second in a series of updated guidelines the AAD is producing on the condition. The updates, which outline best practices for topical treatment of the disease, were developed by an expert workgroup of 12 physicians, including 11 dermatologists, an allergist/pediatrician and one patient representative.

“Atopic dermatitis is the most common type of eczema, and it can interfere with a person's daily life without proper treatment,” said board-certified dermatologist Robert Sidbury, MD, MPH, FAAD, co-chair of the AAD's Atopic Dermatitis Guideline Workgroup. “The guidelines provide evidence-based recommendations for dermatologists to use in caring for their adult atopic dermatitis patients with topical treatments, which have come a long way since the guidelines were last revised in 2014. This update reflects the latest advances in topical medications that are now available to help adults with atopic dermatitis.”

Often called eczema or atopic eczema, atopic dermatitis affects 1 in 10 Americans. They often have red to dark patches and scaly skin and can also have extremely dry skin, hand eczema, eye problems, and skin that is easily irritated.

“While atopic dermatitis cannot be cured, it can be controlled with proper treatment,” said Dr. Sidbury. “A plan created by a board-certified dermatologist can help ease symptoms, reduce flare-ups, and prevent it from worsening. Topical treatments remain one of the most popular options due to their effective track record and overall safety.”

The Atopic Dermatitis Workgroup developed 12 recommendations on how to manage atopic dermatitis in adults with topical therapies. The workgroup provided new recommendations for non-prescription methods as well as prescription treatments.

Recommendations

Strong recommendations were made for topical treatments in which the benefits clearly outweigh the risks and burdens to the patient.  These recommendations apply to most patients in most circumstances.

According to AAD, strong recommendations were made for the use of the following:

• Moisturizers help to relieve patients' dry, cracked skin, decrease inflammation, and reduce the severity of and increase the time between flare-ups.
• Topical calcineurin inhibitors (pimecrolimus 1% cream and tacrolimus 0.03% or 0.1% ointment) reduce patients' inflammation and itching as well as decrease their flare-ups.
• Topical corticosteroids are commonly used as the first-line treatment for patients with atopic dermatitis in all skin regions. They help to relieve itching, decrease inflammation and can decrease infections.
• Phosphodiesterase-4 inhibitor (crisaborole ointment) can reduce patients' inflammation, help relieve itching, and decrease infections.
• Janus kinase inhibitor (ruxolitinib cream) can be used short term to ease the inflammation and itching of patients with mild to moderate atopic dermatitis. 

The guidelines provide conditional recommendations for the use of bathing and wet wrap therapy. Conditional recommendations apply to most patients, but the most appropriate action may differ depending on individual patient factors.

• Bathing, followed by moisturization, helps patients hydrate the skin. Bleach baths can help patients prevent infection and get rid of bacteria on their skin.
• Wet wrap therapy utilizes wet bandages to help hydrate and soothe patients' skin. This treatment provides a barrier against scratching, helps to decrease redness and inflammation, and can reduce the bacteria on patients' skin.

“These recommendations are based on the latest evidence-based research on the most effective topical treatments for our patients,” said Dawn Davis, MD, FAAD, co-chair of the AAD's Atopic Dermatitis Guideline Workgroup. “These recommended treatments can be used individually or in combination with other treatments.”

The guidelines made conditional recommendations against the use of topical antimicrobials, antiseptics, and antihistamines due to the low certainty of evidence, which means the true effect may be substantially different from the estimated effect. 

“These guidelines were updated to enable dermatologists to optimize topical treatments to provide adult atopic dermatitis patients with expert care,” said board-certified dermatologist Mark D. Kaufmann MD, FAAD, president of the AAD. “Since each patient's atopic dermatitis is unique, board-certified dermatologists can determine the treatments that will work best for them. I'm very grateful to our workgroup for providing these important updates to help patients worldwide.”

Vanderbilt's Eczema Investigational Drug

In other eczema treatment news, researchers at Vanderbilt University Medical Center (VUMC) have developed a new investigational drug that can block inflammatory signaling in a preclinical model of atopic dermatitis (eczema).

The peptide drug developed by the VUMC researchers silenced cytokine-expressing genes, suppressed skin infiltration by inflammatory cells, and healed skin lesions, all without apparent toxicity, at least in the animal model.

“We unraveled the mechanism of eczema by demonstrating that we can control at least 15 genes responsible for the production of the major mediators of skin inflammation,” said the lead investigator, Jacek Hawiger, MD, PhD, Distinguished Professor of Medicine and Louise B. McGavock Professor at VUMC.

Hawiger and his colleagues reported their findings Nov. 7 in the journal Scientific Reports. The topical drug, which is applied directly to inflamed skin, is now being tested in a multicenter clinical trial in patients with eczema.

Hawiger is also a professor of Molecular Physiology and Biophysics at Vanderbilt, and a Health Research Scientist at the Nashville Veterans Affairs Medical Center. Since the mid-1990s, he and his team have been investigating ways to interrupt inflammatory signaling.

The current study of eczema was supported by the Louise B. McGavock Chair, the Immunotherapy Program in the Department of Medicine, the U.S. Department of Veterans Affairs, the National Institutes of Health, and, initially, by Amytrx Therapeutics, a Nashville-based company Hawiger cofounded in 2014 to sponsor clinical trials of the drug.
In addition to Hawiger and his scientific partner, Jozef Zienkiewicz, PhD, Research Professor of Medicine, co-authors of the paper were Yan Liu, MD, Huan Qiao, MD, PhD, Katherine N. Gibson Corley DVM, PhD, Kelli L. Boyd DVM, PhD, and Ruth Ann Veach, BS.