An Expert Nurse Practitioner & Physician Assistant Exchange on the Management of Pediatric Atopic Dermatitis - Episode 8

Evolution of Pediatric Atopic Dermatitis Treatment Landscape

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Lakshi Aldredge, MSN, ANP-BC, DCNP, reviews the evolution of the treatment landscape for pediatric patients with atopic dermatitis; highlighting recent advances.

Melodie Young, NP: As we move into what's happened in 2021 and early 2022, it has been an explosion of atopic dermatitis therapeutic options. In dermatology—it's crazy—It's the most drugs I've seen in my 34-year career; in terms that hit at one time. It's exciting and overwhelming trying to learn all these different pieces, and I can see how people would get frustrated with it. So topically and systemic, and they're also medications that are approved for pediatric. Does anybody know what are the systemic options for pediatric patients? Lakshi, I saw you shaking your head.

Lakshi Aldridge, MSN, ANP-BC, DCNP: We've only just recently had a resurgence of interest in atopic dermatitis, and helping us to understand the immunology and the pathogenesis of the disease. We know that itch is a huge factor of this, we know that IL-31 is one of those cytokines that is involved with the itch, and we know that IL-4 and IL-13 are also heavily involved in the pathogenesis of atopic dermatitis. We went from having this large bull's eye, the outer ends of the target view of atopic dermatitis, which for the severe patients we would hit traditionally with those big immunomodulators such as methotrexate, cyclosporine, and prednisone, and those are nonspecific targeted therapy. Even though we've used it for many years, none of these were FDA approved for even adult patients with atopic dermatitis. About five years ago, we had the first FDA approved systemic agent for atopic dermatitis with dupilumab, which specifically targets IL-4 and IL-13. This was initially approved for moderate to severe atopic dermatitis and adult patients over 18 years of age and older, it is now indicated down to six months and older. This has been revolutionary in our treatment of patients, especially those who have more severe disease where topicals and traditional systemics have not been approved or effective.In the last three years, we have seen this wide growth of topical treatment for targeted atopic dermatitis. This has been revolutionary and requires a lot of time and effort on the part of NPs and PAs to shift our thinking of topical treatments. We have traditionally, along with our patients and their families, thought of topical treatments as being somewhat helpful; we use it to treat flares and that was more with a topical steroid.

Melodie Young, NP: Mostly symptom relief, but not disease treatment.

Lakshi Aldridge, MSN, ANP-BC, DCNP: Correct. We now must shift our understanding of the role of topical treatments in atopic dermatitis, as these elegant and targeted treatments in a topical preparation come forward and are highly effective. They seem to have a safe profile and address several of the pathogenic points in the disease of atopic dermatitis, moisturization, barrier repair, and flare prevention. Our thinking and our understanding of the role of topical treatment must shift because these are highly effective and provide a wonderful new treatment option for our patients, even our younger patients, which will hopefully be approved soon. We'll be able to use topical treatment and perhaps decrease the need for systemic or flare treatment as we are able to control the skin.

Melodie Young, NP: You're speaking to what we had called the atopic march, where they come in, have mild disease, the disease progresses and it’s difficult to keep it under control, and then the disease continues, so trying to intervene early.

Transcript Edited for Clarity