What is moderate to severe Atopic Dermatitis (AD)?

Moderate to severe AD involves flare-ups and symptoms which include itching, rashes, discoloured or thickened skin and small, raised bumps on the skin. For patients with severe AD, they may experience nocturnal scratching that disrupts their sleep and daily activities.[1][2][3]

Patients with severe AD may also have a significantly lower quality of life, due to distress, stigmatisation and social isolation.[3]

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icon-doctor.svgWho does it affect?

Patients with moderate to severe AD include both children and adults. They tend to have weaker skin barriers that may have been triggered by environmental factors and triggers such as contact allergens, or be a result of genetic variations that impair normal skin barrier function. Their condition may fail to improve with first-line conventional therapy such as good skincare practices and topical treatment.[4][5]

icon-medicine-box.svg Treatment options

COMMON TREATMENT

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Topical steroids

Topical steroid creams may be prescribed for moderate AD to reduce irritation, itching and inflammation. [3]
Some of these creams may contain hydrocortisone. [6][7]

Side effects may include:

  • Thinning, peeling, or blistering skin
  • Acne
  • Burning sensation on the skin

TARGETED THERAPIES
Targeted therapies may be prescribed for patients whose AD can no longer be managed with steroid creams or ointments. These include:

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Injections [8][9]

Injectables for AD contain receptor antagonists that bind to proteins in the body which trigger overreactions in the immune system, leading to AD.

Side effects may include:

  • Conjunctivitis
  • Inflammation of the cornea
  • Eye itch or dry eye
  • Swollen or puffy eyelids
  • Reactions on the injection site
  • Oral herpes or other herpes simplex virus infections

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Phototherapy [10]

Phototherapy involves shining ultraviolet (UV) light onto affected skin, typically over 20-minute UVA treatment sessions up to twice a week. The UV light also helps to prevent bacterial infections on the skin which AD patients may be susceptible to, due to their damaged skin.

Side effects may include:

  • Skin cancer
  • Cataracts

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Pills [11][12][13][14]

Oral medication is an option for patients whose AD can no longer be managed with topical therapies. They work by inhibiting the effects of cytokines, or proteins that trigger itching, and are less likely to stimulate immune system responses.

Side effects may include:

  • Nausea
  • Acne
  • Nasal inflammation
  • Headache
  • Inflammatory bowel disease
  • Pancreatitis
  • Herpes

References: 
1. Healthline. What Are the 7 Different Types of Eczema? [Internet]. [Place Unknown], Healthline; 2022 [updated 2022 January 27, cited 2022 July 26]. Available from: https://www.healthline.com/health/types-of-eczema#atopic-dermatitis 
2: Yung-Sen Chang, MD, MPH, PhD; Bor-Luen Chiang, MD, PhD. Sleep disorders and atopic dermatitis: A 2-way street? [Internet]. Wisconsin, USA, Elsevier; 2018 [updated 2018 August 22, cited 2022 September 5]. Available from: https://www.jacionline.org/article/S0091-6749(18)31176-X/fulltext
3. Judith Hong, MD; Joerg Buddenkotte, PhD et al. Management of Itch in Atopic Dermatitis [Internet]. Rhode Island, USA, National Library of Medicine, 2011 [updated 2013 July 8, cited 2022 September 9]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704137/
4. Robert Kantora, Jonathan I. Silverberg. Environmental risk factors and their role in the management of atopic dermatitis [Internet]. Rhode Island, USA, National Library of Medicine, 2016 [updated 2017, cited 2022 September 5]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5216178/
5: Brian B Johnson, Abigail I Franco, et al. Treatment-resistant atopic dermatitis: challenges and solutions [Internet]. [Place Unknown], National Library of Medicine; 2019 [updated 2019 March 21, cited 2022 July 26]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6432884/
6. David Luk, Kam Lun Ellis Hon et al. Practical Recommendations for the Topical Treatment of Atopic Dermatitis in South and East Asia [Internet]. [Place Unknown], National Library of Medicine; 2020 [updated 2021 February, cited 2022 September 5]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859143/
7: RxList. Hydrocortisone Side Effects Center [Internet]. [Place Unknown], [Publisher Unknown]; 2022 [updated 2022 June 23, cited 2022 July 26]. Available from: https://www.rxlist.com/hydrocortisone-side-effects-drug-center.htm
8: RxList. Dupixent Side Effects Center [Internet]. [Place Unknown], RxList; 2022 [updated 2022 June 15, cited 2022 July 26]. Available from: https://www.rxlist.com/dupixent-side-effects-drug-center.htm 
9. National Eczema Association. Dupixent for Atopic Dermatitis FAQ [Internet]. California, USA, National Eczema Association [cited 2022 September 5]. Available from: https://nationaleczema.org/eczema/treatment/injectibles/dupixent-faq/
10: University of Michigan Health. Phototherapy for Atopic Dermatitis [Internet]. Michigan, USA, University of Michigan Health; 2020 [updated 2020 July 2, cited 2022 July 26]. Available from: https://www.uofmhealth.org/health-library/hw215920
11: Thomas Bieber, M.D., PhD., Eric L. Simpson, M.D., et al. Abrocitinib versus Placebo or Dupilumab for Atopic Dermatitis [Internet]. Massachussetts, USA. The New England Journal of Medicine; 2021 [updated 2021 March 25, cited 2022 July 26]. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa2019380
12: Eric L. Simpson, M.D., Rodney Sinclair, et al. Efficacy and safety of abrocitinib in adults and adolescents with moderate-to-severe atopic dermatitis (JADE MONO-1): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial [Internet]. [Place Unknown], National Library of Medicine; 2020 [updated 2020 July 25, cited 2022 July 26]. Available from: https://pubmed.ncbi.nlm.nih.gov/32711801/
13. Vivian Y. Shi, MD; Tina Bhutani, MD et al. Phase 3 efficacy and safety of abrocitinib in adults with moderate-to-severe atopic dermatitis after switching from dupilumab [Internet]. Massachussetts, USA, Journal of the American Academy of Dermatology, 2022 [updated 2022 April 15, cited 2022 September 5]. Available from: https://www.jaad.org/article/S0190-9622(22)00608-9/fulltext
14. Maddalena Napolitano, Gabriella Fabbrocini et al. The Efficacy and Safety of Abrocitinib as a Treatment Option for Atopic Dermatitis: A Short Report of the Clinical Data [Internet]. Rhode Island, USA, National Library of Medicine, 2021 [updated 2021 March 10, cited 2022 September 5]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956861/ 

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