On the biological underpinnings of the atopic march, also called the atopic triad, and what people with eczema need to know.
Published On: Jan 11, 2016
Last Updated On: Jul 15, 2021
Eczema research continues to shed new light on several aspects of this chronic condition. NEA asked Dr. Friedman to help us understand a bit more about a particularly exciting aspect of emerging science.
Biomarkers are reproducible and measurable indicators that can allow one to examine or follow biological activity or function over time. Biomarkers can be categorized in different types depending on their specific characteristics. They can be used to identify the risk of developing a disease, to diagnose a disease, predict disease progression, mark a particular response to an intervention (i.e. lifestyle change such as exercise, moisturizer use, diet), and for monitoring disease activity and clinical response to medication. This has HUGE implications in medicine, as identifying biomarkers can not only help us better understand how diseases develop, but also improve our ability to diagnosis a condition, follow its activity and severity, and monitor whether a medication is working or not working. In sum, biomarkers allow for a personalized approach, or what has become known in some respects as personalized medicine.
Biomarkers can be used for many different purposes, including an objective (rather than observationally subjective) evaluation of disease severity, confirmation of clinical diagnosis, and to predict response to treatment. More importantly, understanding the importance of a biomarker in disease progression and severity could help identify new treatments based on said biomarker, a paradigm shift which has dominated the drug development world in oncology for over a decade.
Eczema even today remains a clinical diagnosis without an objective approach for confirmation. Not all eczema is created equal, and while exceedingly common, for many years it was almost like an orphan disease given the limited advances made in treatment and management. This is all changing and biomarkers are central to this exponentially growing field of study. Identifying biomarkers will no doubt play an important role in research and personalized medical approach given the variation in disease severity from person to person. The use of biomarkers will enhance the success of treatment by creating therapies that target the patient’s specific biological signature as well as help the physician predict and follow response to said medication. Many biomarkers are currently being studied, derived from different sources (blood, saliva, etc.), to develop the best and most accurate way to evaluate any and all sufferers of eczema.
This means don’t give up hope because we entering a new era! The same enthusiasm and drive to better understand and treat psoriasis over the past 20-30 years has overwhelmed the world of eczema. Multi-institutional teams are working together to identify panels of biomarkers which can be used to better characterize unique differences in eczema individuals, age ranges, sexes, you name it. These same biomarkers being studied are being used to select the best and more effective treatments.
As of right now, the use of biomarkers to characterize and monitor eczema is not recommended as the science is still somewhat in its infancy. No question, advancing this science is of the utmost importance for EVERYONE and therefore this is a team effort. Patients can get involved with patient advocacy organizations, such as the National Eczema Association, to increase awareness, fundraise for research grants, participate in research studies, petition both local and federal government to make this work a priority. We are all in this together: patient, physician, scientist, etc.
Adam Friedman, M.D., FAAD is an Associate Professor of Dermatology and serves as Residency Program Director and Director of Translational Research in the Department of Dermatology at The George Washington University School of Medicine & Health Sciences. Dr. Friedman is currently investigating novel nanotechnologies that allow for controlled and sustained delivery of a wide spectrum of physiologically and medicinally relevant molecules, with an emphasis on treating infectious diseases, accelerating wound healing, immune modulation, and correcting vascular dysfunction. He holds several patents derived from these investigations, and has published over 130 papers/chapters and 2 textbooks on both his research as well as a variety of clinical areas in dermatology. Dr. Friedman is also committed to resident and medical education. He currently serves on the AAD Sulzberger Committee on Education as well as the Poster Task Force, and is the Senior Editor of the Dermatology In-Review Online Workshop and Director of the Oakstone Institute Dermatology Board Review. He has received awards from multiple organizations such as the American Dermatologic Association, American Academy of Dermatology, and The American Society for Dermatologic Surgery.