During a session at the AAD 2022 annual meeting, a leading group of atopic dermatitis (AD) experts came together to discuss recent AD developments.  

For this session, Jonathan I. Silverberg, MD, PhD, MPH, FAAD, Peter Lio, MD, FAAD, and Andrew Blauvelt, MD, FAAD, spoke to the audience about various updates and changes in the AD spectrum.  

Director of the session, Robert Sidbury, MD, MPH, FAAD, kicked off the session introducing Dr Silverberg jokingly saying, “Seven articles a day are posted on atopic dermatitis, and three are always done by Jonathan.”  

As the audience laughed, Dr Silverberg made his way to the stage where he began reviewing AD-related comorbidities.  

Dr Silverberg said, “AD has been described by some as a systemic disease,” with more than 15 comorbidities linked with AD. He stressed that moderate-to-severe patients should always be assessed for comorbidities—although he said ideally all patients would be assessed.  

Next, he explained that according to recent AAD guidelines, the following areas should be considered as a comorbidity of AD:  

• allergic and allergy conditions;
• immune-mediated conditions;
• mental health and substance abuse;
• ADHD and autism spectrum disorders;
• bone health;
• skin infections;
• cardiovascular diseases; and
• metabolic diseases.

According to Dr Silverberg, all the above-mentioned comorbidities are important to keep in mind for dermatologists’ treatment AD. For example, he said that “AD guidelines don’t necessarily cover depression, but there is plenty of depression-related data that helps support more aggressive treatment of the AD to better control the disease in hopes to improve the mental health and depression of patients.”

He also discussed that sometimes comorbidities make AD worse in patients. Dr Silverberg explained that many AD patients develop urticaria and because that is itchy, it ultimately sets off the “itch to scratch regimen of the AD so you want to treat the urticaria first.”  

Dr Silverberg concluded his portion of the presentation by highlighting a “new” comorbidity that has been identified—cognitive dysfunction. He explained that “the more severe the disease, the more likely a patient will experience cognitive dysfunction.”  

Next to the podium was Dr Lio who discussed emerging evidence for the treatment of AD.  

Dr Lio started his session by stating, “I’m happy to say the evidence is growing.”  

While considering the approach to precision and personalized medicine, Dr Lio reviewed various pieces of recent research that supports use of different and nonconventional treatment options. He stressed, “if we don’t treat correctly then we could contribute to increasing comorbidities.”  

Dr Lio highlighted the following treatment alternatives for patients who may have “steroid-phobia” or other hesitations with treatment:

• coconut oil;
• L-histidine;
• hempseed;
• sunflower oil;
• topical B12;
• topical indigo;
• oolong tea;
• black tea compresses; and
• use of CBD products.  

After highlighting these various treatment approaches, he said “my ego is smaller than my desire to help.”  

Finally, Dr Blauvelt took the stage to discuss emerging therapies for AD. He said that he believes there will be four biologics approved for use in the treatment of AD by 2023.  

He highlighted treatments including nemolizumab and abrocitibib—noting there should be more data to come with these two treatments.  

He also highlighted that there are various safety warnings, including boxed warnings, for JAK inhibitors. Although these are listed, he explained, they are extremely rare. He said most of the time with JAK inhibitor use, patients often experience nausea, headache, and acne.  

He highlighted these things because he said he wants everyone in the audience to “have informed discussions with AD patients on JAK inhibitors.” He continued to say that dermatologists will continue to see expanded use of JAK inhibitors for things like alopecia and vitiligo.   

“Progress has been made and there is still more to come,” he said. “Oral JAK inhibitors are a great thing for dermatology.” 

Of important note during this session, Dr Blauvelt said it was announced at the AAD annual meeting that Olumiant (baricitinib) will no longer be studied for the treatment of AD. Instead, there will be a shift in research to alopecia, and he said it is expected it to be approved later in 2022. If approved, this will be the first FDA-approved treatment for alopecia.

Reference
Silverberg J, Lio P, Blauvelt A. Translating evidence into practice: Atopic dermatitis guidelines. Presented at: AAD Annual Meeting; March 25-28, 2022; Boston, MA.