Management of Type 2 Inflammation in Atopic Dermatitis - Episode 7

Managing Atopic Dermatitis During the COVID-19 Pandemic

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A brief discussion on how the coronavirus 2019 pandemic has impacted the management of patients with atopic dermatitis.

Peter A. Lio, MD:
Everything we’re talking about is picked up a notch with COVID[-19] in the background. That’s something that we didn’t mention, but it really does because we know certainly we don’t want to immunosuppress people more now than ever before.

We never want to [immunosuppress people] ever, but especially now [COVID-19] intensified everything, so I think that’s made our job even more difficult, more interesting.

Not to mention the fact that we’re doing a lot more tele[health]. I know I am. I’m actually 2 days a week telehealth.

But even when I’m live, we’re all masked up and it’s just that much harder. There are more barriers to making these decisions.

Marc Serota, MD: I think COVID[-19] has impacted our patients in a number of ways. I think when it comes to atopic dermatitis, what it’s really done is prevented patients from accessing care as easily as they normally would have.

They might be less likely to go into a doctor’s office, perhaps they’re more likely to seek out telemedicine options.

One thing I think is important to understand when it comes to treating an atopic dermatitis patient in the world of COVID[-19] is to understand that the pathway that we’re blocking for atopic dermatitis is the allergic cell pathway.

What I explain is that your allergic cells are not in your body to make you miserable with eczema or allergies or asthma. They’re there to fight parasites. That’s why that pathway exists.

The immune system is getting it wrong and mistaking something that it should identify as an allergen and leave it alone. It’s mistaking [your allergic cells] for a parasite.

Why that’s important is when you block that pathway, you could potentially affect the body’s ability to fight parasites, but it should not affect your body’s ability to fight a virus or bacteria or mount antibody responses to a vaccine.

[Researchers have] studied that specifically with dupilumab [Dupixent] where they tested patients who got either Tdap [tetanus, diphtheria, and pertussis] or meningococcal polysaccharide vaccines and either got dupilumab or [a] placebo.

What they found was that the antibody responses are the same. There’s no recommendation to avoid non-live vaccines of which COVID[-19] is among them if patients are on dupilumab. I don't recommend that for any of the biologics that we typically use in dermatology for psoriasis, for example, or for dupilumab for atopic dermatitis.

It’s more important that we have patients access care when they have atopic dermatitis and then understand that the pathways we’re blocking are not related to your body’s ability to mount a response to either a viral infection or to the vaccine.

Transcript edited for clarity.