Atopic Dermatitis: Disease Impact and Therapy

1
Atopic DermatitisDisease Impact and Therapy
CN-1

• Lawrence F. Eichenfield, MD
• Professor of Pediatrics and Dermatology
• University of California, San Diego
• School of Medicine and
• Childrens Hospital, San Diego

2
The Prevalence of Atopic Dermatitis in Oregon
Schoolchildren
CN-2

• Study Standardized Questionnaire AD symptoms
• 5 to 9 years old 6 Oregon urban 2 rural
  schools
• SQ and history completed by parents
• Questionnaire scores validated by clinical
  findings in children with AD
• Prevalence 17.2
• CONCLUSION Indicates a high prevalence of AD in
  the United States, comparable to recently
  observed rates in Europe and Japan
• Laughter D, Istvan JA, Tofte SJ, Hanifin JMJ Am
  Acad Dermatol. 200043649-655.

3
CN-3
4
CN-4
5
CN-5
6
AD and the Immune System
CN-6

• Disordered immune response
• Set of inflammatory cells Ag presenters
• Disrupted skin barrier function
• Atopic march Stimulation of immune system and
  potential impact

7
Impact on Individualsand Families
CN-7

• Objective data Quality of life
• Sleep disturbance, psychosocial dysfunction
• Societal cost
• Lost work time, wages, school, decreased
  performance
• Medical care costs ( in ER visits, etc)
• Human effect

8
Therapy With TCIs IMPACT
CN-8

• Medicine in addition to emollients and topical
  corticosteroids
• Allows mixing and matching of therapy
• Reducing risks of steroid exposure
• Tailoring of treatment to disease severity
• Asthma parallels
• Similar epidemiology, pathogenesis, and treatment
  evolution
• Treatment has been markedly improved!

9
TCIs in Study and Practice
CN-9

• Tolerated well
• Used with medication sparers
• Used intermittently in almost all patients
• Anti-inflammatory, improves skin barrier
  function, decreases staphylococcal colonization,
  infection
• TCIs No evidence of systemic immune effects in
  clinical use or studies

10
Impact of Under-treatment of Eczema
CN-10

• Skin inflammation, disrupted skin barrier,
  pruritus
• Cutaneous infection - Staphylococcal (less so
  strep) colonization and infection
• Impact on MRSA
• Secondary impact
• Cellulitis, hospitalization
• Exposure to agents with known toxicity
• Systemic and topical corticosteroids,
  phototherapy, cyclosporine, others

11
Topical Calcineurin Inhibitors Is there enough
worry to warrant warning?
CN-11

• What is the risk of lymphoma?
• No clinical data
• Coincidence events?
• Will create TCI phobia, to goalong with steroid
  phobia
• Will lead to undertreatment of eczema and
  increase the many faces of inflamed dermatitis

12
CN-12
My Thanks

• For your time
• Commitment to balancing concerns for safety with
  the needs of patients, families, and physicians
  to care for atopic dermatitis and minimize its
  tremendous impact