Andrew Alexis, MD, MPH: The State of Atopic Dermatitis

Andrew Alexis, MD, MPH, an associate professor of dermatology at the Icahn School of Medicine, and the dermatology chair at Mount Sinai St. Luke’s, sat with MD Magazine to discuss the current state of care for atopic dermatitis, and spoke about how 2017 offered much to look forward to for the field of dermatology.

Alexis, a key opinion leader in the field of skin care and dermatology, was excited about all the therapies that have become available for atopic dermatitis, as well as the state of the pipeline in dermatology, which offers high promise for patients with the condition.

Andrew Alexis, MD, MPH, an associate professor of dermatology at the Icahn School of Medicine, and the dermatology chair at Mount Sinai St. Luke’s:

This turns out to be a very exciting time in the treatment of atopic dermatitis. For the first time in many years, we have new therapies that are non-corticosteroid based that can have a tremendous impact on our patients with atopic dermatitis.

The first of these that I'll talk about is the topical agent that was approved within the past year or so, called crisaborole, and as a non-steroid topical ointment. It's particularly well suited for mild to moderate atopic dermatitis, especially for maintenance therapy with and applying to anatomic areas where we wouldn't be able to safely use topical corticosteroids, such as the eyelids or elsewhere on the face or where the body folds.

The second big advancement is dupilumab, which is an injectable biologic agent for atopic dermatitis. Now this one is approved for moderate to severe atopic dermatitis, that we're talking about, [but] a more severe population than the topical that I mentioned. This blocks—it basically blocks the effects of 2 cytokines that are important in the pathogenesis of atopic dermatitis, you know interleukin-4 and interleukin-13. This has really been transformative for our patients with moderate to severe atopic dermatitis in being able to really relieve, reduce, and improve many of the manifestations of the disease, both clinically and also with respect to sleep disturbance and itching, which really is one of the more difficult aspects for patients but with atopic dermatitis to deal with.

This year—2017—has been a very exciting year for dermatology, and the future looks even more exciting. As we get more and more agents that can block specific targets for various inflammatory diseases in psoriasis, we have and we continue to have recently approved and new agents coming down the pike that can block specific cytokines with fewer side effects than traditional agents. Similarly, for atopic dermatitis, there are new products in development, including janus kinase (JAK) inhibitors, that show a lot of promise for the future of treating atopic dermatitis.

In the world of vitiligo and other pigment area disorders, and pigment area disorders as a whole, is an area that has been historically a little underserved with respect to new development and new innovations. But we're seeing a lot of exciting research that may lead to new breakthrough therapies in the very near future for vitiligo, and even some disorders of hyperpigmentation such as melasma.