New Advancements in Atopic Eczema Research

Claudia Hülpüsch

Atopic eczema (AE), or atopic dermatitis, is an inflammatory skin disease with genetic, immunological, and environmental factors have concerned patients and medical professionals alike.

Despite this, powerful systemic treatments have emerged in recent years.

In their review, investigators led by Claudia Hülpüsch, Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, wrote of AE and atopic dermatitis, the complications regarding the disease, treatment progression, and prevention of atopic disease.

Risk Factors and Environmental Factors

Though the reason for the increase in allergies and atopic disease has not been fully explored, various intrinsic risk factors (parental atopic history, filaggrin mutations, underlying medical conditions) and extrinsic risk factors (low microbial exposure and diversity, antibiotic exposure, stress, pollutants) are considered have been linked to AE development.

Environmental factors, both physical and psychosocial, have also been considered in recent years.

Though some environmental factors such as pet exposure had contradicting data, others such as preterm birth had been associated with decreased risk for AE development, while certain climate and pollution exposure was linked to an increased risk for AE development, especially among children.

Psychosocial environmental factors such as stress, which were often the result of pressure’s imposed from a person’s physical environment, have been associated with disease symptom severity and exacerbation.

Psychological interventions have shown positive effects on AE severity in previous meta-analyses.

Diagnosis and New Therapies

To better diagnose AE in young children, the American Academy of Dermatology (AAD) developed consensus criteria consisting of 3 sub-categories of features.

Novel biomarkers were used to distinguish between AE and hyper IgEsyndrome (HIES), and AE severity was determined by validated scores like Scoring atopic dermatitis (SCORAD) or Eczema Area and Severity Index (EASI) in clinical trials.

Daily assessment for treatment success was measured through atopic dermatitis score 7 (ADS7), which considered lesions, discomfort, and quality of life of patients.

According to Hülpüsch and fellow authors, therapy for the disease had undergone “a true revolution” in recent years.

Emollient therapy has been beneficial in skin barrier dysfunction, with applicants of emollients (250g a week) at least once a day being considered “necessary” in enhancing the integrity of the epidermal barrier and in the reduction of irritation and inflammation of the skin.

Topic anti-inflammatory treatment has also been considered useful in mild-to-moderates cases.

Previous studies have addressed the efficacy of pre- and probiotics regarding atopic disease, with 1 study having achieved positive results by applying heat-treated Lactobacillus johnsonii NCC 533 on AE skin.

Additionally, a topical microbiome transplant of Roseomonas mucosa from healthy participants to AE participants improved severity in another clinical I/II safety and activity trial.

Other immunosuppressive drugs such as azathioprine and methotrexate had positive responses recorded in off label and/or second line therapy. Several more biologics and small molecules interfering with key mediators are currently in development and may be utilized in future tailored therapeutic approaches.

Prevention

Though the aforementioned emollient therapies and pre- and probiotics have been known to aid in AE management in some studies, conflicting data does exist.

Therefore, the authors recommended that prevention strategies such as proper education on atopic disease and better diet be incorporated in combating conditions such as AE.

Despite this, the authors remained optimistic.

“Many parts of the complex disease mechanisms could be unraveled in the last decades,” the team wrote. “However, much is still unknown and must be addressed by the science community, particularly host-microbe and environmental interaction.”

The review, “A new era of atopic eczema research: Advances and highlights,” was published online in the European Journal of Allergy and Clinical Immunology.