Atopic Dermatitis and Dupixent

Cold, dry winter weather can contribute to a host of inflammatory skin conditions, and atopic dermatitis (AD) is one of the most common. It affects between 10-20% of children and 1-3% of adults. AD, also commonly called eczema, is a genetic condition that results in inflammation and rashing of the skin. It commonly occurs in people or families that also suffer from asthma, hay fever, and general allergic tendencies.

Though it classically starts before age five, it may be active during infancy, childhood, adolescence, or adulthood, or in some cases intermittently throughout life. Chronic itching is the hallmark of AD. This itching leads to chronic scratching. The end result is red, thickened, scaly and crusted skin. Chronic scratching can also lead to skin infections. Additionally, most people with AD suffer from sleep disturbance due to itching and also experience an overall lower quality of life.

Though there are no known cures for AD, there are many prescription and over-the-counter treatment options available. Topical treatments for AD reduce inflammation in the skin while protecting the skin from outside irritation and water loss. These include steroid applications, non-steroid anti-inflammatory applications, antibiotic applications, and moisturizing and barrier-repair applications. Oral anti-histamines can help in some cases. Oral steroids and antibiotics are utilized for severe flare-ups. Some people find that occasionally soaking in a bath containing about a half cup of bleach is helpful in reducing flare-ups. Bleach baths work by reducing bacteria on the skin. This leads to less itching and a lower risk of skin infection.

More recently, those who suffer from moderate to severe AD also have a very exciting new treatment option. Almost two years ago, the FDA approved Dupixent (Dupilumab), which is the first and only biologic agent approved for AD. It is given via under-the-skin injection every two weeks. Dupixent follows in the footsteps of several other biologic agents that began to come to market about 20 years ago for autoimmune disease  including psoriasis and arthritis. Biologic agents differ from most other drugs in that they must be administered by injection. They are complex, genetically engineered proteins manufactured in high-tech facilities that target specific components of the immune system in order to decrease chronic inflammation.

Most previously available  medications for AD broadly and non-specifically targeted skin inflammation. The target has previously always been general inflammation of the skin. In contrast, Dupixent specifically blocks overactive immune cells called interleukin-4 that directly contribute to the immune cascade that drive the chronic skin inflammation of AD. Normally, interleukins aid the immune system in fighting off invading viruses and bacteria, but in a person with AD, interleukins needlessly help create inflammation in the skin leading to itching and rashes.

Based on clinical trials, the majority of patients taking Dupixent for four months achieved a reduction of 75% in their itching and rashes. The most common side effects reported were conjunctivitis (pink eye), injection site reactions, and cold sores. Unlike topical and systemic steroids that may be used for AD, Dupixent doesn’t negatively impact the skin or other organ systems. Similar to other drugs taken for chronic conditions, Dupixent is used as maintenance therapy for AD. It should not be mistaken for a cure for AD, and just as with other biologic agents used for other conditions, should Dupixent be discontinued, symptoms are likely to recur. Dupixent is currently only approved for AD in patients 18 and older, though it is approved for asthma in the pediatric population. It will hopefully be approved for pediatric AD in the near future.

If you suffer from atopic dermatitis and your symptoms are well controlled with your current treatment, there may be no reason to alter your regimen. However, if you have moderate to severe AD, and your disease state is not adequately controlled with topical or oral medications, Dupixent may be right for you. If you have an interest in learning more about AD or Dupixent please contact Advanced Dermatology to schedule a medical appointment with one of our providers.