An Expert Nurse Practitioner & Physician Assistant Exchange on the Management of Pediatric Atopic Dermatitis - Episode 12
Experts in dermatology hypothesize about the next round of treatment disruptions and their hopes for the future of atopic dermatitis management.
Melodie Young, NP: What do you think are going to be the big things that we’ll talking about in 2023 about atopic dermatitis? I know there’s talk about looking at earlier intervention, using any special populations, and then some prevention, if we can intervene and prevent some of the comorbidities. What do you think? What does your crystal ball tell you for the next year or two?
Matthew Brunner, PA: I think the dermatology field is going to be getting their hands around the systemic Janus kinase inhibitors. We have upadacitinib approved now down to age 12 for atopic dermatitis. We don’t yet have abrocitinib approved for that age group, but we have some new PDE4 inhibitors topically that are under development. Arcutis [Biotherapeutics, Inc] is working to bring roflumilast to market, and then there’s a Japanese firm that’s working on difamilast. There’s a lot of interest in how we combine these therapies. I think some of us are starting to work with that. To your point, Melodie, not every patient is a dupilumab responder, but is there a safe way to combine these therapies where patients are getting benefit, but maybe are not completely clear? There are many of us out there, and that’s one of the things we do really well in dermatology, we look at how these drugs can be used in combination and how we can achieve synergies for patients by mixing and matching. Obviously, a lot of the labels indicate they haven’t been studied together and they may not be safe to be used in conjunction, but I think some of us out there are looking a little deeper at the science of how they work and understanding that it’s probably safe to combine some of these agents.
Alexa Hetzel, MA, PA-C: I was going to add to Matthew, especially when you have different combinations, if you have dyshidrotic eczema, it doesn’t always respond to anything. If you have somebody who has full body eczema and then dyshidrosis on their hands and feet, that combination therapy can be huge for us to look into because I think that’s itchiest part of it all.
Melodie Young, NP: That’s a good point. Atopic dermatitis is not sometimes the only type they have. They can have atopic and dyshidrotic, or atopic and contact [dermatitis]. That’s one of the things that we must speak to, it’s important. Lakshi, what were you going to say?
Lakshi Aldredge, MSN, ANP-BC, DCNP: If I had a crystal ball and looked at 2023 and 2024, what we’re also going to understand are the comorbidities associated with atopic dermatitis. We have a lot of data and literature about comorbidities in psoriasis, which we originally thought was only a skin condition. I think our understanding of eczema and its potential comorbidities is going to expand. I think that we’re also going to have a lot of differences hopefully in the way we treat patients with some of the existing and newer treatments as far as the frequency of use. My hope is that we’ll have an effective treatment that’s maybe used once or twice or even 3 or 4 times a year only, but can help control flares very effectively. So a decrease in the frequency of use, so that we have lovely long-term remission with very infrequent use. I hope that will also be an important factor.
I also hope that we’ll have some affordability of these treatment options for communities of need, and for those folks who perhaps have ethnic, cultural, or other considerations, with our understanding of what works better for those different skin types, we could do a test potentially that shows which treatments or cytokines would be more effectively targeted in certain individuals. So instead of having them go through multiple treatment therapies, we can identify and say, this is the treatment that’s going to be giving you the best control, less variance in disease, and more focused therapy.
Transcript edited for clarity