Robert Sidbury, MD, MPH, Chief, Division of Dermatology, Seattle Children's Hospital, discussed how new guidelines issued by the American Academy of Dermatology (AAD) regarding comorbidity risk in patients with atopic dermatitis will influence the condition's treatment.
As novel nonsteroidal therapeutics changed the treatment landscape of atopic dermatitis (AD) in the past decade, new guidelines issued by the American Academy of Dermatology (AAD) provide therapeutic recommendations that also account for risk of other comorbid conditions linked with AD, said Robert Sidbury, MD, MPH, Chief, Division of Dermatology, Seattle Children's Hospital.
Sidbury recently served as co-author of a study published in the Journal of the American Academy of Dermatology, titled, "AAD Guidelines: awareness of comorbidities associated with atopic dermatitis in adults."
How may new AAD guidelines on comorbidity risk for adults with AD affect therapeutic management?
Yeah, well, one of the really interesting things is, will the new treatments that are available prevent some of these types of comorbidities? So I referenced bone fractures, osteoporosis. I referenced the fact that it may be iatrogenic, it may have something to do with that we've used steroids, both systemic and topical for years.
Well, if now we have these new nonsteroidal agents that are more effective, and nonsteroidal—so certainly take that potential adverse effect off the table—will we in the guidelines in 2030 or 2040, maybe we won't see that signal for bones, because it was iatrogenic after all.
Other sorts of things, similarly, with the depression, if we now have a treatment or treatments that are more helpful, more effective, more hopeful—that's sort of probably the key word here since forever we've been able to manage symptoms reasonably well, not great, but reasonably well. But we've never been able to tell patients that they might have a treatment that could maybe make them symptom free, indefinitely. And that's much more hopeful than what we've been able to say before.
So, possibly that element of hope might impact the potential comorbidities we've talked about with regard to psychosocial sorts of things and depression, anxiety, etc.
With no major guideline updates for AD since 2014, what evidence led the dermatology community to issue these changes?
In 2014, one of the things I talked about was what was the one systemic medication that was US FDA approved for eczema—systemic steroids, prednisone, our least favorite, universally, least favorite treatment for this condition. And it's pretty remarkable that the only FDA approved treatment was one that was just universally abhorred, and felt to be inappropriate for the treatment of this condition.
So, the dermatologic community was waiting for something that was not that and waiting for something that was studied in our patient population that was nonsteroidal, ideally, that was demonstrating a level of safety and efficacy that made us want to sort of revise guidelines and say: hey, here's something that's different, here's something that's a better mousetrap. And it's worth sort of having our body, AAD, sanction that and give us guidance and say where it belongs in the therapeutic armamentarium.