The comorbidities associated with atopic dermatitis can be substantial, and the disease can have a significant burden on quality of life, but new biologics and other future treatments may help, said David Pariser, MD, senior physician at Pariser Dermatology Specialists.
The comorbidities associated with atopic dermatitis can be substantial, and the disease can have a significant burden on quality of life, but new biologics and other future treatments may help, said David Pariser, MD, senior physician at Pariser Dermatology Specialists and professor at Eastern Virginia Medical School Department of Dermatology.
What comorbidities are typically associated with atopic dermatitis?
There are a lot of comorbidities associated with atopic dermatitis. Especially, we have known about the asthma, allergic rhinitis, so-called atopic march of a child who first develops atopic dermatitis then may develop food allergies, asthma later in life. And in addition to those commonly called atopic conditions, there have been some other things that have been more recently associated with atopic dermatitis: cardiac disease, obesity, high blood pressure, heart disease. All these have higher incidence in patients with atopic dermatitis. Infections, of course, both skin infections from a dermatosis that is constantly scratched. Infections are an issue.
Another significant factor that we really only started to recognize more recently is ocular conditions, particularly conjunctivitis, which occurs allergic conjunctivitis and atopic conjunctivitis—something more recently recognized. One of the treatments that we have now actually is especially a little higher incidence of that. And then a big part of the comorbidities are neuropsychic. Children are more likely to have attention-deficit/hyperactivity disorder, depression—children and adults—and anxiety as well. So, these are all part of a spectrum of the comorbidities that we can see in atopic dermatitis. Not to mention all of the lifestyle impact that goes along with it.
How does atopic dermatitis affect quality of life for patients, both socially and professionally?
So, if you can imagine a chronic itchy rash, that's present pretty much all the time, and how the maintenance for that, the treatments for that, as well as the impact that it has on daily functioning. This is a real problem for children in school, who may have trouble concentrating. It’s a problem with adults who may have absenteeism from work because of the disease itself because of doctor visits because of the burdensome nature of some treatments.
How has the introduction of a biologic to treat atopic dermatitis impacted patients and their ability to manage their disease?
The first and only biologic that's currently available, dupilumab, it's been around now for about 2 years, and has made a huge difference in the way that people have been able to control their disease and to improve their quality of life and their lifestyle. There'll be another one early next year, tralokinumab, and a third one down the pike, it's a little bit farther behind maybe another year, year and a half later on: lebrikizumab. In addition to those 2 biologics, we’ll have the Janus kinase inhibitors—at least 2 if not 3 of those within the next year, as well.