Elaine Siegfried, MD, professor of pediatrics and dermatology, Saint Louis University Health Sciences Center, addresses the comorbidity profile associated with atopic dermatitis and the utility of disease-modifying drugs to reduce risk of comorbid conditions.
Controlling atopic dermatitis early on with novel drugs that address the primary immune dysfunction of the disease can have a disease-modifying impact in reducing risk of comorbid conditions, said Elaine Siegfried, MD, professor of pediatrics and dermatology, Saint Louis University Health Sciences Center.
Are there any preventive measures you would recommend for patients with atopic dermatitis to reduce risk of comorbidities, particularly for younger individuals?
Well, what we're hoping is that with the renaissance of new medications that have been developed for atopic dermatitis, including medications that we discussed that address the primary immune dysfunction of this disease, we're hoping that some of these medications will, in fact, be disease modifying.
The model of rheumatologic diseases where you have disease-modifying antirheumatic drugs, we may in fact be into a new era of disease-modifying anti-inflammatory medications, and we think that that may be true. So, that would suggest that the earlier you treat atopic dermatitis, the beginnings of the atopic march, or the earlier that you address things like food allergies and keep them well controlled, maybe, just maybe, that will help enhance better immune system development.
One of the things that distinguishes immunity in very young children, infants and very young children, is that they have a tendency toward more of a type 2 immune overdrive—they just have a higher type 2 immune dysfunction. Why is that? Nobody really understands, it may be related to prevention against parasitic diseases, we don't see parasitic diseases anymore, but maybe that's just how we've evolved.
And then with normal immune maturation, immunity shifts from a type 2 immunity to a type 1 immunity, but for children with atopic dermatitis that sort of gets stuck. But we hope that early treatment and aggressive treatment can help immune systems mature more normally into a type 2 immunity—what we really don't know because some children outgrow their atopic dermatitis with no treatment, even children who may have more moderate or even severe disease in early infancy.
It's certainly less likely, it happens in children, but we don't know why in some children, they can outgrow it or their disease can go away and why other children don't, but we certainly hope that early treatment and controlling the disease early on can be disease modifying.