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Research in Review

Eczema: A Field Ripe For Scientific Discovery

July 2017

Throughout his youth, Eric Simpson, MD, had a front row seat watching his dermatologist father care for patients, in a medically underserved area of El Paso, TX.

“He was a great role model for me growing up, as I witnessed him enjoy a challenging and fulfilling career helping others,” said Dr Simpson, who today is a professor of dermatology at Oregon Health & Science University, as well as the director of its clinical trials.

While his father’s career was wholly inspirational, he recalled, it was only partially aspirational. “Of course, I didn’t want to grow up to be exactly like my dad so I had to find my own way to dermatology toward the end of medical school, in Dallas,” he explained.

A widely-recognized eczema and atopic dermatitis (AD) expert, Dr Simpson’s research involves understanding the burden of disease, disease prevention, and novel therapies. In a conversation with The Dermatologist, he discussed other important role models whose work lit the spark that fueled his own research endeavors, as well his thoughts on the biggest misconception of this often misunderstood and underestimated disease.

Q. Who are some of your other professional role models?
A. Clay Cockerell, MD, and Ponciano D. (Chito) Cruz, MD, were important role models within academic dermatology, while I was in medical school. They opened my eyes to the breadth and depth of the field and exposed me to the excitement of academics. In residency, Frances Storrs, MD, and Clifton White, MD, taught me careful and disciplined observation is required for determining the diagnosis. Then, also during my residency, esteemed AD clinician and researcher Jon Hanifin’s, MD, mentorship and enthusiasm for the field of AD spurred my interest in the field. It is a field of many unknowns and mysteries, ripe for scientific discovery, where education and detailed treatment plans can greatly alleviate patient suffering. How could I not study this field?

Figure. Eric Simpson, MD, with his mentor Jon Hanifin, MD.

Q. Where has your interest in eczema and AD taken you with respect to your research?
A. My research has involved understanding the burden of disease, disease prevention, and novel therapies. I was frustrated with current treatment options and the chronicity of the disease, and thought “wouldn’t it be great to stop the first flare of the disease?” Some highlights of my work thus far include studying a novel approach to atopic disease prevention using skin barrier enhancement, as well as contributing to the study of novel systemic agents. My involvement with the dupilumab (Dupixent) program starting from the phase 1b studies has been a major highlight. I have also been very interested in improving the quality of research in AD and my international collaborations and mentorship from Hywel Williams, MD, in this respect has been another major highlight in my career.1-3

Q. What are some areas/therapies that offer patients with eczema/AD the most promise?  
A. There is much promise in modifying early life skin barrier exposures via emollients or microbes to reduce the risk of AD. For established disease, novel nonsteroidal and targeted therapies are emerging. Hopefully the days of systemic steroids for a chronic disease are over.

Q. What are some of the eczema/AD advances that you are excited about and why?
A. Naturally I’m excited about the new systemic treatments, which of course are major breakthroughs for our patients. Our better understanding of the skin barrier and immunological pathophysiological pathways paves the way for more targeted therapy and personalized medicine in the future. This will lead to patients receiving a personalized and targeted approach depending on the immune or barrier defect driving their particular disease. Hopefully, early targeted intervention can reduce future suffering and reduce the risk of AD-related comorbidity.

Story continues on page 2

Q. What is your role in the National Eczema Association (NEA) and why is the organization of value to dermatologists and patients?  
A. I have been fortunate enough to be involved with the NEA for several years now. This organization was started by my mentor and serves a really important purpose for our patients and providers. AD is a very isolating disease that can wreak havoc on a patient’s quality of life and mental health. The NEA is a cornerstone of therapy for the disease by providing education and support, which actually improves disease outcomes. For the last 2 years, along with my cochair Robert Sidbury, MD, we have established a research program focused on better understanding the burden the disease has on the patients and society. We can advocate for patients more effectively, as we work toward understanding the impact of the disease better.

Q. What do you think is the biggest misconception about eczema treatment and/or research?
A. I think many dermatologists know that AD is not “just eczema,” and that it can really impact the quality of life of a patient. However, there are many physicians and decision makers who underestimate the impact of the disease. Sometimes the skin looks mild-moderate to the physician, but it is severe for the patient. After an exploration of the disease impact, treatment plans should be tailored accordingly.

Q. Now with so many treatment options, what roadblocks or challenges stand in the way of improved patient use and/or compliance?
A. I hope that we are just at the beginning of a treatment revolution in the field. As new and higher-priced medications emerge in the marketplace, we will need to be able to make strong arguments why these drugs are needed for our patients. I thoroughly enjoy being in a position to mentor and support many young and talented researchers in this field who are shedding light on the AD disease burden.

Q. What would you like your ultimate contribution to the field of dermatology to be and why?
A. I feel I can make the biggest impact on human suffering by doggedly trying to find a way to prevent or cure AD and allergic diseases. If I cannot do that, then at least I can help bring novel treatments to patients, advocate for them, improve the quality of research in our field, and mentor and inspire the next generation.

References
1. Simpson EL, Bieber T, Guttman-Yassky E; SOLO 1 and SOLO 2 Investigators. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med. 2016;375(24):2335-2348.
2. Schmitt J, Apfelbacher C, Spuls PI, et al. The harmonizing outcome measures for eczema (HOME) roadmap: a methodological framework to develop core sets of outcome measurements in dermatology. J Invest Dermatol. 2015;135(1):24-30.
3. Simpson EL, Chalmers JR, Hanifin JM, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014;134(4):818-823.

For more of the latest news and articles on eczema, go to the Atopic Dermatitis Medical Resource center at www.the-dermatologist.com.

Throughout his youth, Eric Simpson, MD, had a front row seat watching his dermatologist father care for patients, in a medically underserved area of El Paso, TX.

“He was a great role model for me growing up, as I witnessed him enjoy a challenging and fulfilling career helping others,” said Dr Simpson, who today is a professor of dermatology at Oregon Health & Science University, as well as the director of its clinical trials.

While his father’s career was wholly inspirational, he recalled, it was only partially aspirational. “Of course, I didn’t want to grow up to be exactly like my dad so I had to find my own way to dermatology toward the end of medical school, in Dallas,” he explained.

A widely-recognized eczema and atopic dermatitis (AD) expert, Dr Simpson’s research involves understanding the burden of disease, disease prevention, and novel therapies. In a conversation with The Dermatologist, he discussed other important role models whose work lit the spark that fueled his own research endeavors, as well his thoughts on the biggest misconception of this often misunderstood and underestimated disease.

Q. Who are some of your other professional role models?
A. Clay Cockerell, MD, and Ponciano D. (Chito) Cruz, MD, were important role models within academic dermatology, while I was in medical school. They opened my eyes to the breadth and depth of the field and exposed me to the excitement of academics. In residency, Frances Storrs, MD, and Clifton White, MD, taught me careful and disciplined observation is required for determining the diagnosis. Then, also during my residency, esteemed AD clinician and researcher Jon Hanifin’s, MD, mentorship and enthusiasm for the field of AD spurred my interest in the field. It is a field of many unknowns and mysteries, ripe for scientific discovery, where education and detailed treatment plans can greatly alleviate patient suffering. How could I not study this field?

Figure. Eric Simpson, MD, with his mentor Jon Hanifin, MD.

Q. Where has your interest in eczema and AD taken you with respect to your research?
A. My research has involved understanding the burden of disease, disease prevention, and novel therapies. I was frustrated with current treatment options and the chronicity of the disease, and thought “wouldn’t it be great to stop the first flare of the disease?” Some highlights of my work thus far include studying a novel approach to atopic disease prevention using skin barrier enhancement, as well as contributing to the study of novel systemic agents. My involvement with the dupilumab (Dupixent) program starting from the phase 1b studies has been a major highlight. I have also been very interested in improving the quality of research in AD and my international collaborations and mentorship from Hywel Williams, MD, in this respect has been another major highlight in my career.1-3

Q. What are some areas/therapies that offer patients with eczema/AD the most promise?  
A. There is much promise in modifying early life skin barrier exposures via emollients or microbes to reduce the risk of AD. For established disease, novel nonsteroidal and targeted therapies are emerging. Hopefully the days of systemic steroids for a chronic disease are over.

Q. What are some of the eczema/AD advances that you are excited about and why?
A. Naturally I’m excited about the new systemic treatments, which of course are major breakthroughs for our patients. Our better understanding of the skin barrier and immunological pathophysiological pathways paves the way for more targeted therapy and personalized medicine in the future. This will lead to patients receiving a personalized and targeted approach depending on the immune or barrier defect driving their particular disease. Hopefully, early targeted intervention can reduce future suffering and reduce the risk of AD-related comorbidity.

Story continues on page 2

Q. What is your role in the National Eczema Association (NEA) and why is the organization of value to dermatologists and patients?  
A. I have been fortunate enough to be involved with the NEA for several years now. This organization was started by my mentor and serves a really important purpose for our patients and providers. AD is a very isolating disease that can wreak havoc on a patient’s quality of life and mental health. The NEA is a cornerstone of therapy for the disease by providing education and support, which actually improves disease outcomes. For the last 2 years, along with my cochair Robert Sidbury, MD, we have established a research program focused on better understanding the burden the disease has on the patients and society. We can advocate for patients more effectively, as we work toward understanding the impact of the disease better.

Q. What do you think is the biggest misconception about eczema treatment and/or research?
A. I think many dermatologists know that AD is not “just eczema,” and that it can really impact the quality of life of a patient. However, there are many physicians and decision makers who underestimate the impact of the disease. Sometimes the skin looks mild-moderate to the physician, but it is severe for the patient. After an exploration of the disease impact, treatment plans should be tailored accordingly.

Q. Now with so many treatment options, what roadblocks or challenges stand in the way of improved patient use and/or compliance?
A. I hope that we are just at the beginning of a treatment revolution in the field. As new and higher-priced medications emerge in the marketplace, we will need to be able to make strong arguments why these drugs are needed for our patients. I thoroughly enjoy being in a position to mentor and support many young and talented researchers in this field who are shedding light on the AD disease burden.

Q. What would you like your ultimate contribution to the field of dermatology to be and why?
A. I feel I can make the biggest impact on human suffering by doggedly trying to find a way to prevent or cure AD and allergic diseases. If I cannot do that, then at least I can help bring novel treatments to patients, advocate for them, improve the quality of research in our field, and mentor and inspire the next generation.

References
1. Simpson EL, Bieber T, Guttman-Yassky E; SOLO 1 and SOLO 2 Investigators. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med. 2016;375(24):2335-2348.
2. Schmitt J, Apfelbacher C, Spuls PI, et al. The harmonizing outcome measures for eczema (HOME) roadmap: a methodological framework to develop core sets of outcome measurements in dermatology. J Invest Dermatol. 2015;135(1):24-30.
3. Simpson EL, Chalmers JR, Hanifin JM, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014;134(4):818-823.

For more of the latest news and articles on eczema, go to the Atopic Dermatitis Medical Resource center at www.the-dermatologist.com.

Throughout his youth, Eric Simpson, MD, had a front row seat watching his dermatologist father care for patients, in a medically underserved area of El Paso, TX.

“He was a great role model for me growing up, as I witnessed him enjoy a challenging and fulfilling career helping others,” said Dr Simpson, who today is a professor of dermatology at Oregon Health & Science University, as well as the director of its clinical trials.

While his father’s career was wholly inspirational, he recalled, it was only partially aspirational. “Of course, I didn’t want to grow up to be exactly like my dad so I had to find my own way to dermatology toward the end of medical school, in Dallas,” he explained.

A widely-recognized eczema and atopic dermatitis (AD) expert, Dr Simpson’s research involves understanding the burden of disease, disease prevention, and novel therapies. In a conversation with The Dermatologist, he discussed other important role models whose work lit the spark that fueled his own research endeavors, as well his thoughts on the biggest misconception of this often misunderstood and underestimated disease.

Q. Who are some of your other professional role models?
A. Clay Cockerell, MD, and Ponciano D. (Chito) Cruz, MD, were important role models within academic dermatology, while I was in medical school. They opened my eyes to the breadth and depth of the field and exposed me to the excitement of academics. In residency, Frances Storrs, MD, and Clifton White, MD, taught me careful and disciplined observation is required for determining the diagnosis. Then, also during my residency, esteemed AD clinician and researcher Jon Hanifin’s, MD, mentorship and enthusiasm for the field of AD spurred my interest in the field. It is a field of many unknowns and mysteries, ripe for scientific discovery, where education and detailed treatment plans can greatly alleviate patient suffering. How could I not study this field?

Figure. Eric Simpson, MD, with his mentor Jon Hanifin, MD.

Q. Where has your interest in eczema and AD taken you with respect to your research?
A. My research has involved understanding the burden of disease, disease prevention, and novel therapies. I was frustrated with current treatment options and the chronicity of the disease, and thought “wouldn’t it be great to stop the first flare of the disease?” Some highlights of my work thus far include studying a novel approach to atopic disease prevention using skin barrier enhancement, as well as contributing to the study of novel systemic agents. My involvement with the dupilumab (Dupixent) program starting from the phase 1b studies has been a major highlight. I have also been very interested in improving the quality of research in AD and my international collaborations and mentorship from Hywel Williams, MD, in this respect has been another major highlight in my career.1-3

Q. What are some areas/therapies that offer patients with eczema/AD the most promise?  
A. There is much promise in modifying early life skin barrier exposures via emollients or microbes to reduce the risk of AD. For established disease, novel nonsteroidal and targeted therapies are emerging. Hopefully the days of systemic steroids for a chronic disease are over.

Q. What are some of the eczema/AD advances that you are excited about and why?
A. Naturally I’m excited about the new systemic treatments, which of course are major breakthroughs for our patients. Our better understanding of the skin barrier and immunological pathophysiological pathways paves the way for more targeted therapy and personalized medicine in the future. This will lead to patients receiving a personalized and targeted approach depending on the immune or barrier defect driving their particular disease. Hopefully, early targeted intervention can reduce future suffering and reduce the risk of AD-related comorbidity.

Story continues on page 2

Q. What is your role in the National Eczema Association (NEA) and why is the organization of value to dermatologists and patients?  
A. I have been fortunate enough to be involved with the NEA for several years now. This organization was started by my mentor and serves a really important purpose for our patients and providers. AD is a very isolating disease that can wreak havoc on a patient’s quality of life and mental health. The NEA is a cornerstone of therapy for the disease by providing education and support, which actually improves disease outcomes. For the last 2 years, along with my cochair Robert Sidbury, MD, we have established a research program focused on better understanding the burden the disease has on the patients and society. We can advocate for patients more effectively, as we work toward understanding the impact of the disease better.

Q. What do you think is the biggest misconception about eczema treatment and/or research?
A. I think many dermatologists know that AD is not “just eczema,” and that it can really impact the quality of life of a patient. However, there are many physicians and decision makers who underestimate the impact of the disease. Sometimes the skin looks mild-moderate to the physician, but it is severe for the patient. After an exploration of the disease impact, treatment plans should be tailored accordingly.

Q. Now with so many treatment options, what roadblocks or challenges stand in the way of improved patient use and/or compliance?
A. I hope that we are just at the beginning of a treatment revolution in the field. As new and higher-priced medications emerge in the marketplace, we will need to be able to make strong arguments why these drugs are needed for our patients. I thoroughly enjoy being in a position to mentor and support many young and talented researchers in this field who are shedding light on the AD disease burden.

Q. What would you like your ultimate contribution to the field of dermatology to be and why?
A. I feel I can make the biggest impact on human suffering by doggedly trying to find a way to prevent or cure AD and allergic diseases. If I cannot do that, then at least I can help bring novel treatments to patients, advocate for them, improve the quality of research in our field, and mentor and inspire the next generation.

References
1. Simpson EL, Bieber T, Guttman-Yassky E; SOLO 1 and SOLO 2 Investigators. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med. 2016;375(24):2335-2348.
2. Schmitt J, Apfelbacher C, Spuls PI, et al. The harmonizing outcome measures for eczema (HOME) roadmap: a methodological framework to develop core sets of outcome measurements in dermatology. J Invest Dermatol. 2015;135(1):24-30.
3. Simpson EL, Chalmers JR, Hanifin JM, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014;134(4):818-823.

For more of the latest news and articles on eczema, go to the Atopic Dermatitis Medical Resource center at www.the-dermatologist.com.

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