During his session at the 2022 AAD annual meeting titled, “Atopic Dermatitis,” Eric Lawrence Simpson, MD, FAAD, opened with studies and trials regarding primary prevention during infancy via emollients. Unfortunately, not only did these trials fail preventing atopic dermatitis (AD), but there’s a possibility they increased skin infection, he said.

“I'm not quite ready to give up yet, however,” Dr Simpson stated. “There's still a couple big studies to come.”

He then transitioned into the topic of secondary prevention.

“So, can we do something as dermatologists to change? Maybe not the onset, but can we do secondary prevention, which is changing the severity of the disease? Or when growing out of the disease can you accelerate that timeframe? Or even the kind of prevention where you're preventing comorbidities,” Dr Simpson asked.

He then showed observational data from a study conducted in Japan where aggressive therapy was proven to reduce incidence of food allergies—a comorbidity of AD—via prevention of flare-ups in children up to 12 months within 4 months. Aggressive therapy is clearing the disease and then using proactive treatment with topical steroids twice weekly, once it's clear. However, Dr Simpson noted that long-term data needs to be obtained before it’s possible to enact this process.

He proceeded to talk about the recognizing eczema in the elderly. He noted there were various changes that come with aging such as changes in the immune system, skin barrier, and dysregulation of innate immunity. He utilized images to look at elderly skin diseases and emphasized that, as dermatologists, there’s an importance in recognizing what’s a rash and what’s not a rash. However, he shared that even after 20 years, he had difficulty with one patient—who was not elderly—in determining if they were presenting a rash or not. Therefore, he noted that sometimes even addressing that question can get a bit challenging.

However, Dr Simpson was very clear to state that pruritus of elderly is NOT a diagnosis.

He emphasized the use of generalized pruritus work up (renal, blood count, etc), and went on to list the five most common disorders with rash:

• eczematous dermatosis;
• lichen simplex/prurigo nodularis;
• subacute prurigo;
• transient acantholytic dermatosis; and
• neuropathic disorder.

He wrapped up his discussion on making the diagnosis with some final thoughts including the importance of questioning rash or no rash, checking medications while considering stopping the use of HCTZ or calcium channel blockers despite how unlikely this would help, and checking products. He also stressed that physicians should consider patch testing, biopsy to r/o CTCL or pemphigold in addition to checking for internal causes of minimal rash. He concluded stating that, when it comes to the diagnosis, it’s best to try treating like AD.

Reference
Simpson E. Atopic Dermatitis. Presented at: AAD Annual Meeting; March 25-28, 2022; Boston, MA.