Eczema, also called atopic dermatitis, commonly affects children and can have a major impact on their development.

Eczema is characterized by extreme bouts of itching. The itching leads to scratching, which in turn leads to a vicious cycle of skin thickening and infection. Sleep deprivation occurs, impairs focus in school, and may lead to attention deficit/hyperactivity disorder. Eczema is associated with asthma, nasal and ocular allergies, and food allergies — peanut, sometimes milk, egg.

Although about 75 percent of children outgrow eczema, for many it continues into adulthood, where it can have devastating effects not only socially but professionally. In adults, the inability to sleep results in a presenteeism (going to work tired not functioning adequately) as well as an increase in absenteeism. I personally have written out more disability forms for patients with atopic dermatitis than any other skin condition

Physiologically, eczema involves two components. First, skin cells in the upper layer of skin (the epidermis) fail to form a proper seal to lock in moisture due to defects in a protein called filaggrin. Second, the impaired barrier function allows improper penetration of outside substances into the second layer of the skin (the dermis). This activates immune cells to produce molecules that activate nerve endings and leads to the sensation of itch.

For mild eczema, treatment with moisturizer creams and mild topical steroids, and other nonsteroidal immunomodulators is helpful. Despite these, eczema often becomes superinfected with bacteria, usually staphylococcus aureus. While antibiotics may treat individual episodes, recurrence is common. Preventing these infections may require the addition of small amounts of bleach to water for bathing.

Until recently, severe eczema was treated with stronger topical steroid ointments, steroid pills, or shots. Stronger topical steroids have greater risk for adverse skin effects such as thinning of the skin. Frequent use of internal steroids may lead to infections, diabetes, hypertension, stomach ulcers, and premature osteoporosis.

New understanding of the immune system has paved the way for a new breakthrough treatment. This treatment, Dupixent, is administered by subcutaneous injection once every two weeks. Dupixent targets the portions of the immune system that fuel the itch-scratch cycle. Dupixent does not increase the risk for infections or malignancy and requires no laboratory monitoring. Most people feel relief in two to four weeks, and by 16 weeks most people improve by 75 percent.

There are many new therapies in the eczema pipeline that hopefully will bring more relief to this disease whose impact on quality of life is often under-recognized.

Windsor Dermatology, 59 One Mile Road Extension, East Windsor. 609-443-0424. www.windsordermatology.com.

Windsor Dermatology: New Options for Severe Eczema

Eczema, also called atopic dermatitis, commonly affects children and can have a major impact on their development.

Eczema is characterized by extreme bouts of itching. The itching leads to scratching, which in turn leads to a vicious cycle of skin thickening and infection. Sleep deprivation occurs, impairs focus in school, and may lead to attention deficit/hyperactivity disorder. Eczema is associated with asthma, nasal and ocular allergies, and food allergies — peanut, sometimes milk, egg.

Although about 75 percent of children outgrow eczema, for many it continues into adulthood, where it can have devastating effects not only socially but professionally. In adults, the inability to sleep results in a presenteeism (going to work tired not functioning adequately) as well as an increase in absenteeism. I personally have written out more disability forms for patients with atopic dermatitis than any other skin condition

Physiologically, eczema involves two components. First, skin cells in the upper layer of skin (the epidermis) fail to form a proper seal to lock in moisture due to defects in a protein called filaggrin. Second, the impaired barrier function allows improper penetration of outside substances into the second layer of the skin (the dermis). This activates immune cells to produce molecules that activate nerve endings and leads to the sensation of itch.

For mild eczema, treatment with moisturizer creams and mild topical steroids, and other nonsteroidal immunomodulators is helpful. Despite these, eczema often becomes superinfected with bacteria, usually staphylococcus aureus. While antibiotics may treat individual episodes, recurrence is common. Preventing these infections may require the addition of small amounts of bleach to water for bathing.

Until recently, severe eczema was treated with stronger topical steroid ointments, steroid pills, or shots. Stronger topical steroids have greater risk for adverse skin effects such as thinning of the skin. Frequent use of internal steroids may lead to infections, diabetes, hypertension, stomach ulcers, and premature osteoporosis.

New understanding of the immune system has paved the way for a new breakthrough treatment. This treatment, Dupixent, is administered by subcutaneous injection once every two weeks. Dupixent targets the portions of the immune system that fuel the itch-scratch cycle. Dupixent does not increase the risk for infections or malignancy and requires no laboratory monitoring. Most people feel relief in two to four weeks, and by 16 weeks most people improve by 75 percent.

There are many new therapies in the eczema pipeline that hopefully will bring more relief to this disease whose impact on quality of life is often under-recognized.

Windsor Dermatology, 59 One Mile Road Extension, East Windsor. 609-443-0424. www.windsordermatology.com.

Facebook Comments