Eczema (Atopic Dermatitis) Updates from a Memphis Dermatologist
George Woodbury Jr. M.D. (06/06/2022)
Atopic dermatitis or Eczema is a common and aggravating itchy rash more common with the change of seasons. Let’s take a look at new management strategies, from my perspective as a Memphis Board-certified Dermatologist, practicing in Cordova TN at Rheumatology and Dermatology (www.Rheumderm.com: 1-901-753-0168) since 1993.
Eczema often develops on the arms and legs, but also the face, neck, or body, affecting 3% of the population. It runs in families along with asthma, hay fever, and food allergies, and seems to be more common among Asian-Americans and African-Americans, though it affects all racial groups.
Years ago, we used to think that food allergies were the trigger. But Dermatologic research points to a combination of genetic factors – and low skin oil level.
Sometimes allergies to certain fragrances, dyes, preservatives, or components within latex or certain metals can cause attacks of itching in patients with Eczema. As a member of the American Contact Dermatitis Society, at Rheumatology and Dermatology I offer extended Allergy Patch Testing to help search for trigger chemicals. This type of testing can lead to a “cure” from the itching of Eczema, by identifying the trigger factor, which could be a metal like nickel, or a preservative, fragrance, dye, or component of latex.
In 2021, the good news is that Dermatologists have a growing arsenal of medications to put the itching of Eczema to rest. We have the topical steroids, of which there are over 30 available, most of which are by prescription only. Topical steroids must be used carefully, to minimize thinning of the skin, and stretch marks. Dermatologists also sometimes use oral agents like prednisone or injectable steroids like methylprednisolone to help with an “Eczema crisis.”
We now also have five promising steroid-free prescription medications:
· Tacrolimus ointment;
· Pimecrolimus ointment; and
· Atopiclair®, and
· Crisaborole Ointment (Eucrisa®), a new steroid-free medication based upon boron research.
· Opzelura® Cream (Ruxolitinib), a new topical Janus kinase inhibitor that works on the Interleukin system involved in itching,
· and three new systemic treatments:
· Dupixent® (Dupilumab) subcutaneous injections, a type of monoclonal antibody;
· Upadacitinib (Rinvoq®) and abrocitinib (Cibinqo®) and two promising new non-steroid JAK-1 inhibitor medicines newly approved by the FDA for management of stubborn Atopic Dermatitis.
In 2017, Dermatologists also began using a new injectable agent called Dupixent® that acts upon the immune system to decrease what is called cytokine signaling between the white blood cells.