Atopic Dermatitis:Disease Impact and Therapy

Lawrence F. Eichenfield, MDProfessor of Pediatrics and

Dermatology

University of California, San Diego

School of Medicine and

Children’s Hospital, San Diego

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The Prevalence of Atopic Dermatitis in Oregon Schoolchildren

Study: Standardized Questionnaire: AD symptoms• 5 to 9 years old; 6 Oregon urban & 2 rural schools • SQ and history completed by parents • Questionnaire scores validated by clinical findings in

children with ADPrevalence = 17.2%

CONCLUSION: Indicates a high prevalence of AD in the United States, comparable to recently observed rates in Europe and Japan

Laughter D, Istvan JA, Tofte SJ, Hanifin JMJ Am Acad Dermatol. 2000;43:649-655.

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AD and the Immune System

• Disordered immune response

• Set of inflammatory cells — Ag presenters

• Disrupted skin barrier function

• Atopic march: Stimulation of immune system and potential impact

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Impact on Individualsand Families

• Objective data: Quality of life • Sleep disturbance, psychosocial

dysfunction• Societal cost

– Lost work time, wages, school, decreased performance

– Medical care costs ($ in ER visits, etc)• Human effect

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Therapy With TCIs: IMPACT

• Medicine in addition to emollients and topical corticosteroids

• Allows “mixing and matching” of therapy– Reducing risks of steroid exposure– Tailoring of treatment to disease severity

• Asthma parallels: – Similar epidemiology, pathogenesis, and

treatment evolution• Treatment has been markedly improved!

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TCIs in Study and Practice• Tolerated well• Used with “medication sparers” • Used intermittently in almost all patients• Anti-inflammatory, improves skin barrier

function, decreases staphylococcal colonization, infection

• TCIs: No evidence of systemic immune effects in clinical use or studies

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Impact of Under-treatment of Eczema

• Skin inflammation, disrupted skin barrier, pruritus• Cutaneous infection - Staphylococcal (less so strep)

colonization and infection– Impact on MRSA

• Secondary impact– Cellulitis, hospitalization– Exposure to agents with known toxicity

• Systemic and topical corticosteroids, phototherapy, cyclosporine, others

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Topical Calcineurin Inhibitors: Is there enough worry to warrant warning?

• What is the risk of lymphoma?– No clinical data– Coincidence events?

• Will create TCI phobia, to goalong with steroid phobia

• Will lead to undertreatment of eczema and increase the many faces of inflamed dermatitis

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• For your time

• Commitment to balancing concerns for safety with the needs of patients, families, and physicians to care for atopic dermatitis and minimize its tremendous impact

My Thanks…CN-12CN-12