Colorado researchers urge raising the bar for treating severe eczema

The U.S. Federal and Drug Administration (FDA)’s approval of Dupixent (dupilumab) in 2017 transformed the lives of numerous people with atopic dermatitis (AD), and additional biologic medications are on the way.

However, a team of researchers warn that biologics may not be the be-all and end-all in AD treatment.

The investigators, based at the University of Colorado College of Nursing and National Jewish Health, stressed the need for comprehensive guidelines that will provide a solid frame of reference for clinicians.

Without such guidelines, they wrote, clinicians might skip “crucial conventional steps” in treating severe AD, such as regular, appropriate skincare and wet wraps, among other basics.

In their paper, which was published online in January 2018 in the Journal of Allergy and Clinical Immunology: In Practice, they noted several obstacles that have blocked the development of one clear set of guidelines.

AD treatment guidelines vary widely from country to country. Furthermore, the authors noted, available guidelines are often misunderstood or not even used. As a result, some clinicians treat their patients reactively as opposed to proactively during an AD flare. This can lead to inappropriate use of systemic corticosteroids and immunosuppressants that aren’t FDA-approved for treating AD.

The Colorado team reviewed existing guidelines from many countries and culled their most relevant shared recommendations. These treatment steps follow a logical sequence, but in real life, they’re often pursued simultaneously by physicians and patients alike:

• Make a proper diagnosis and define the severity of the disease.
• Identify irritants and allergens.
• Treat infections.
• Treat the psychosocial aspects of AD.
• Develop an action plan.
• Consider wet-wrap therapy during a flare.
• Consider hospitalization.

While Dupixent and other biologics in the pipeline signal a dramatic improvement in AD treatment, the researchers said there are plenty of things that clinicians can and should do before and after prescribing one for their patients with moderate to severe AD.

The guidelines proposed in the new review article should help doctors combine basic skincare techniques with cutting-edge treatments to maximize the well-being of their patients.

https://nationaleczema.org/future-of-eczema-care/