Expert Perspectives in the Management of Atopic Dermatitis in Skin of Color - Episode 12
Andrew Alexis, MD, MPH, FAAD: We are very fortunate to have other options beyond the traditional systemics, which have potential end-organ toxicities, a requirement for lab monitoring, potential concerns with long-term use and immunosuppression, and many other potential adverse effects.
In this context, it’s been transformative to have biologic therapy for atopic dermatitis in a form of dupilumab. As we all know, dupilumab works by inhibiting IL-4 and IL-5 mechanisms, which are key cytokines in the pathogenesis of atopic dermatitis. We’ve all experienced remarkable improvements in our patients in their clinical manifestations of atopic dermatitis but also in terms of their quality of life: sleep quality improving, itch improving. Another benefit is its effect on 1 of the key comorbidities of atopic dermatitis, asthma. A tremendous number of advantages.
I’m curious to hear your experience using dupilumab in your patients with atopic dermatitis in general but also specifically in skin of color. Why don’t you start, Heather?
Heather Woolery-Lloyd, MD: I work at the university, which is like a referral practice, so I refer my patients with severe atopic dermatitis to the specialist at the university. But I do use systemics in clinical trials. One thing that I don’t want to underestimate for people who have severe atopic dermatitis is that I try to be more aggressive and treat with systemics in that setting because the impact on quality of life is—you know, there are no words for it. These research patients come to mind—they’ve have been on systemics or failed everything and end up at the research center for a clinical trial. And their life is completely transformed. They sleep through the night. They feel comfortable in their skin. That’s the best way to describe it.
I just want to emphasize that I don’t prescribe that much in my own clinical practice. I use systemics more in the research setting. But I will tell you in that setting the impact on quality of life is just—like I said, there are no words. It’s just to feel comfortable in your own skin. I feel comfortable referring out and reassuring patients that you will get better with a more aggressive approach. I find that in some cases, some children but particularly adults with atopic dermatitis, they can feel hopeless, and the use of systemics can restore that hope.
Andrew Alexis, MD, MPH, FAAD: Absolutely. Candrice, you’ve had a lot of experience using dupilumab in patients of color and have even written on the subject. Go ahead and tell us what your experience has been.
Candrice Heath, MD: I agree with Heather on this. It is a breakthrough treatment. Even for pediatric patients, it also is an effective treatment to help control their atopic dermatitis. One of the things I wanted to mention is that the adverse-effect profile for this medication is very reasonable compared with some other treatments that we have access to.
In the pediatric population, we think about it as a needle, so we have to talk to the kids about that. But often I tell the kids—I beg them—to give me 1 chance. Let’s do this once. That itching is under such great control in most patients after that initial treatment, they are OK getting additional treatments. But like with all medications, we often talk about potential adverse effects. Some adverse effects can include pain from the needle inject. Also, conjunctivitis or inflammation of the tissues around the eyes could also be a potential adverse effect.
Because I have a lot of patients who are in the pediatric range, asthma is often a comorbidity. With that comorbidity, they can actually experience some improvement with their asthma. But I tell them they need to continue all asthma medication unless their primary care doctor says to make a change. It’s not often that we have to tell a patient to continue a treatment, because it may get better but we don’t want to stop this. It’s a unique situation. But both adults and children get it; they understand. We get buy-in with them because you can have such a better control over that itching that they hate the
Transcript Edited for Clarity