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Clinical Insights Into Atopic Dermatitis Pathogenesis

This short video discusses the pathophysiology of atopic dermatitis, illustrating how it is a disease of both barrier dysfunction and Th2-driven inflammation. Among Th2 cytokines, IL-4 and IL-13 have demonstrated a key role in AD pathogenesis, which has led to the development of a human monoclonal antibody against IL-4Rα for the treatment of moderate-to-severe disease.
Suggested Readings

Atopic Dermatitis Overview and Pathogenesis

Atopic dermatitis endotypes and implications for targeted therapeutics.

Czarnowicki T, et al. J Allergy Clin Immunol. 2019;143(1):1-11.

Identification of atopic dermatitis subgroups in children from 2 longitudinal birth cohorts.

Paternoster L, et al. J Allergy Clin Immunol. 2018:141(3):964-971.

Pathogenesis of atopic dermatitis.

Peng W, Novak N. Clin Exp Allergy. 2015;45(3):566-574.

Expression patterns of atopic eczema and respiratory illnesses in a high-risk birth cohort.

Singh AM, et al. J Allergy Clin Immunol. 2010:125(2):491-493.

Patient Burden and Comorbidities

Determinants of disease severity among patients with atopic dermatitis: association with components of the atopic march.

Holm JG, et al. Arch Dermatol Res. 2019;311(3):173-182.

The atopic march and atopic multimorbidity: many trajectories, many pathways.

Paller AS, et al. J Allergy Clin Immunol. 2019;143(1):46-55.

Association between atopic dermatitis and suicidality: a systematic review and meta-analysis

Sandhu JK, et al. JAMA Dermatol. 2019;155(2):178-187.

Association of atopic dermatitis with allergic, autoimmune, and cardiovascular comorbidities in US adults.

Silverberg JI, et al. Ann Allergy Asthma Immunol. 2018;121(5):604-612

Association of inadequately controlled disease and disease severity with patient-reported disease burden in adults with atopic dermatitis.

Simpson EL, et al. JAMA Dermatol. 2018;154(8):903-912.

Management of Atopic Dermatitis

Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial.

Blauvelt A, et al. Lancet. 2017;389(10086):2287-2303.

Atopic dermatitis yardstick: practical recommendations for an evolving therapeutic landscape.

Boguniewicz M, et al. Ann Allergy Asthma Immunol. 2018;120(1):10-22.

Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement.

Drucker AM, et al. Br J Dermatol. 2018;178(3):768-775.

Application of moisturizer to neonates prevents development of atopic dermatitis.

Horimukai K, et al. J Allergy Clin Immunol. 2014;134(4):824-830.

New and emerging therapies for pediatric atopic dermatitis.

Nguyen HL, et al. Pediatric Drugs. 2019;21(4):239-260.

Phase 2B randomized study of nemolizumab in adults with moderate-to-severe atopic dermatitis and severe pruritus.

Silverberg JI. J Allergy Clin Immunol. 2019 Aug 23 pii: S0091-6749(19)31099-1. [Epub ahead of print].

Efficacy and safety of lebrikizumab (an anti-IL-13 monoclonal antibody) in adults with moderate-to-severe atopic dermatitis inadequately controlled by topical corticosteroids: A randomized, placebo-controlled phase II trial (TREBLE).

Simpson EL, et al. J Am Acad Dermatol. 2018;78(5):863-871.

When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council.

Simpson EL, et al. J Am Acad Dermatol. 2017;77(4):623-633.

Two phase 3 trials of dupilumab versus placebo in atopic dermatitis.

Simpson EL, et al. N Engl J Med. 2016;375(24):2335-2348.

Treatment of atopic dermatitis with tralokinumab, an anti-IL-13 mAb.

Wollenberg A, et al. J Allergy Clin Immunol. 2019;143(1):135-141. 

Linked Resources

Guidelines

Guidelines of care for the management of atopic dermatitis: part 1. Diagnosis and assessment of atopic dermatitis.

Eichenfield LF, et al. J Am Acad Dermatol. 2014;70(2):338-351.

Guidelines of care for the management of atopic dermatitis: part 2. Management and treatment of atopic dermatitis with topical therapies.

Eichenfield LF, et al. J Am Acad Dermatol. 2014;71(1):116-132.

Guidelines of care for the management of atopic dermatitis: part 3. Management and treatment with phototherapy and systemic agents.

Sidbury R, et al. J Am Acad Dermatol. 2014;71(2):327-349.

Guidelines of care for the management of atopic dermatitis: part 4. Prevention of disease flares and use of adjunctive therapies and approaches.

Sidbury R, et al. J Am Acad Dermatol. 2014;71(6):1218-1233.

Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I.

Wollenberg A, et al. J Eur Acad Dermatol Venereol. 2018;32(5):657-682.

Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II.

Wollenberg A, et al. J Eur Acad Dermatol Venereol. 2018;32(6):850-878.

Patient Resources

International Eczema Council

Founded in late 2014, the International Eczema Council (IEC) is a global nonprofit organization led by dermatology experts on atopic dermatitis. The IEC is dedicated to increasing the understanding of atopic dermatitis and promoting its optimal management through research, education, and patient/family care.

National Eczema Association

The National Eczema Association is a nonprofit organization founded in 1988 to improve the health and quality of life for individuals with eczema through research, support, and education.

Clinical Assessment Tools

Children’s Dermatology Life Quality Index (CDLQI)

CDLQI is 10-question patient-reported assessment tool designed to measure impact of any skin disease on the lives of children ages 4-16. (Lewis-Jones MS, Finlay AY. Br J Dermatol. 1995;132(6):942-949).

Eczema Area and Severity Index (EASI)

EASI is a clinician assessment tool designed to measure clinical severity of atopic dermatitis. Severity scores can range from 0 (clear) to 72 (very severe). (Hanifin JM, et al. Exp Dermatol. 2001;10(1):11-18).

Investigator Global Assessment (IGA)

The IGA is a clinician assessment strategy designed to provide a snapshot of overall disease severity in dermatologic clinical trials. (Futamura M, et al. J Am Acad Dermatol. 2016;74(2):288-294).

Patient-Oriented Eczema Measure (POEM)

The POEM is a patient-oriented, self-assessed measurement tool for monitoring aspects of atopic dermatitis in routine clinical practice or in the clinical trial setting. (Charman CR, et al. Arch Dermatol. 2004;140(12):1513-1519).

Scoring Atopic Dermatitis (SCORAD)

SCORAD is a clinical tool used to assess the extent and severity of eczema. (Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993;186(1):23-31.)

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Marching Forward in Atopic Dermatitis

Digging Deep on Shared Decision-Making

Faculty: Peter A. Lio, MD; Anne Marie Singh, MD
Release: 01/28/2020
Expiration: 01/28/2021