Lawrence Eichenfield, MD: Systemic Treatments for Infants with Atopic Dermatitis

In this HCPLive interview, Lawrence Eichenfield, MD, described his presentation on systemic treatment for atopic dermatitis (AD) in infancy, discussing his inspiration for the presentation as well as the decisions dermatologists make in choosing topical versus systemic treatments.

Eichenfield’s presentation was conducted at the Revolutionizing Atopic Dermatitis (RAD) 2023 Annual Meeting in Washington, DC.

He is known for his work as chief of pediatric and adolescent dermatology at Rady Children's Hospital-San Diego. Eichenfield also serves as both professor of dermatology and pediatrics and as vice-chair of the department of dermatology at UC San Diego School of Medicine.

He first discussed the inspiration for his talk and the importance of focusing on this particular age group and its relationship with eczema.

“It's really quite challenging when we see children with atopic dermatitis, you know, in the first year and a half to 2 years of life,” he explained. “Here's a subset who are rather mild, and in some cases, those are the patients who may truly outgrow their eczema over time. But there's a lot of patients who don't have mild atopic dermatitis.”

Eichenfield added that by mild, he was both referring to extent and persistence due to a subset of individuals who he says appear to always have some degree of inflammation or a lack of prolonged skin clearance.

“They may have persistent atopic dermatitis, and it raises particular issues in terms of (whether there are) overlapping other conditions or is this a gino-dermatosis or an immunodeficiency that's presenting with atopic dermatitis,” he stated. “Most of the time, they just have atopic dermatitis, but some of them will have more severe atopic dermatitis, and it's tied to all these issues of infection in the skin, allergy, and the development of comorbidities over time.”

Eichenfield noted that, overall, the ways in which clinicians treat AD are changing due to newer systemic agents that are becoming available.

“Historically, our systemic treatments for atopic dermatitis were restricted to oral corticosteroids which weren’t advised for use in this age group, but used by allergists now and then for rescue therapy,” he explained. “...The breakthrough was really with dupilumab and the extension down to younger children in what was called the Liberty AD PRESCHOOL trial, which was a study of infants from 6 months to 6 years of age.”

He also explained the steps dermatologists take in determining whether or not to use systemic treatments instead of topical treatments.

“I think the algorithm works well, for infants as well,” Eichenfield stated. “You really want to assess the history of the disease, to assess whether there's been an adequate topical treatment regimen before, particularly in infants, as part of that algorithm. To see if there's infection and that the infection has been well-treated. You want to assess the impact of disease on the quality of life, and then you want to assess other potential diagnoses or compounding diagnoses.”

To find out more about Eichenfield’s RAD conference presentation, view the full HCPLive interview segment above.