At the start of his session, “Atopic Dermatitis [AD],” presented at the 2022 AAD annual meeting, Lawrence F Eichenfield, MD, FAAD, opened with a question, “Topical Therapies: What’s new and what’s coming?”

He proceeded to the next slide which showcased a quiz in which attendees had to identify the correct type of topical.

“Don’t worry, you don’t need to pass this to leave the room,” he stated as attendees laughed.

He continued to introduce topicals starting with ruxolitinib, a JAK-inhibitor that is approved at 1.5% for patients, 12 and up, with mild to moderate atopic dermatitis. He presented various studies that showcased ruxolitinib as well tolerated with minimum site reactions and no adverse effects (AEs) with a lower baseline itch score suggesting a relationship to systemic exposure.

Next, he presented tapinarof, which is a topical aryl hydrocarbon receptor that is currently in development for AD and psoriasis. Dr Eichenfield shared various trials on tapinarof treating psoriasis in order to expand on the topic of systemic exposure to topicals. These trials showed that patients with psoriasis utilizing tapinarof showed no extreme systemic exposure to topicals. Tapinarof also seemed to be tolerable, and Dr Eichenfield stressed that it would be interesting comparing the psoriasis data to the upcoming studies and trials being conducted for AD.

The last topical Dr Eichenfield touched on was roflumilast which is a PDE-4 inhibitor that, across various trials, displayed improvement in dryness, redness, roughness, tightness, moisturization, smoothness and overall skin clearance. It can also be used for seborrheic dermatitis.

Dr Eichenfields final topic addressed counseling assessment in addition to topical care.

He listed the major points that must be noted to play a part in counseling assessment as a whole:

• Is the family living their life around the eczema?
• Is the child’s life wrapped around their eczema?
• How is sleeping for both the child and family?
• Consequences related to infections and activities
• With more severe presentations of the disease “CONSIDER QUANTIFYING DISEASE” utilizing BSA, SCORAD, or similar
• What is the path forward?

When it comes to combining counseling with topical care, Dr Eichenfield stated that there should be a plan to bring it all together. This means creating a care plan centered around bathing, barrier repair, moisturization, and anti-inflammatory medication. He also stressed that physicians should, “KNOW YOUR AUDIENCE,” by understanding the challenges that come with assessing the patient’s perspectives on disease and therapy.

For pediatrics in particular, Dr Eichenfield noted, “It’s smart to ask about family history, which can be personal to parent.”

He went on to share that his messaging has changed over the years and now he believes that effective long-term treatment is the goal reciting, “minimal rash, minimal itch, minimal sleep disturbance”.

The most important take-aways Dr Eichenfield wanted attendees to remember when thinking about counseling with topical care were:

• establish expectations of clear or almost clear;
• discuss steroids and non-steroids including when to worry about quantities; and
• discuss microbiome and bacteria.

In the end, he stated that counseling is a mix of assessing, listening and talking, bonding (sharing the issues and impacts surround the disease), and education.

Dr Eichenfield concluded his session by stating from his presentation, “We are amidst an EVOLUTION and REVOLUTION in therapy!”

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