Research Breakthroughs from the 2023 American Academy of Dermatology Meeting
Dr. Lisa Beck, Professor of Dermatology at University of Rochester, spoke about advances in our understanding of the skin barrier. The way that the immune system responds when eczema is present (type 2 inflammation) causes changes in the skin barrier that make it more “leaky” and prone to water loss, penetration by allergens and other “insults”, and causes nerve endings to penetrate the skin surface. Such changes likely disrupt normal sweating patterns, too. However, new studies show that when patients take dupilumab (dupixent), which helps normalize the immune response in people with eczema, these changes to the skin barrier are reversed. In the future we may be able to use tests, such as tape strips, to measure changes to the skin barrier in infants in order to identify children at risk for eczema early on.
Dr. Emma Guttman, Professor and System Chair of Dermatology and Immunology at Mount Sinai also made the case that eczema (atopic dermatitis) is an immune system driven, reversible disease. She noted that skin that does not seem to have signs of eczema (non-lesional skin) also shows signs of inflammation and barrier changes found in “lesional” skin. These new findings suggest all of the skin is likely involved in eczema, not just the areas where we can clearly see rash or dryness.
Dr. Tissa Hata, Clinical Professor of Dermatology at University of California San Diego (UCSD) spoke about advances in our understanding of the skin microbiome as it relates to eczema. She shared a study by Dr. Heidi Kong of NIH that showed that within a household that includes a child with eczema, family members tend to share the same composition of strains of bacteria on their skin – typically an over-abundance of Staph aureus bacteria and less diversity in other strains. This may be why efforts to eradicate staph on the skin of children with eczema aren’t always successful (because it lives in the household and comes back). She noted that new therapies such as dupilimab and tralokinumab, which target immune system abnormalities, also improve the microbiome health in patients, suggesting that improving the immune system response and skin barrier lead to improvements in the skin microbiome environment.
Dr. Richard Gallo, Chair of Dermatology at UCSD, presented on our evolving knowledge of the complicated relationship between the skin, the microbes that live on it, and the immune system. He noted that the skin is designed to collect microbes from the environment and to keep them there. Microbes communicate with each other and with the body through the skin/immune system interface. Some microbes are especially important for skin health. One bacteria, Staphylococcus hominis, can curb Staphylococcus aureus (staph aureus) bacteria common on the skin of people with eczema and helps reduce eczema symptoms as reported in a small early stage trial. The use of Staph hominis was safe with no adverse events. The approach is now moving to larger studies.
A paper by Dr. Amy Paller, Chair of the Department of Dermatology at Northwestern and colleagues showed that patients who take the drug dupilimab have 50% fewer skin infections than those in the placebo group who did not receive the drug, suggesting that improvements in the skin barrier and microbiome after treatment with the drug may lead to fewer problematic skin infections, too. Dr. Paller also highlighted a newly published 52-week study of the drug lebrikizumab in adolescents (age 12+) published in the New England Journal of Medicine by Dr. Jonathan Silverberg of George Washington University and colleagues. The drug showed rapid and sustained improvement in eczema symptoms in this age group. While not approved for use yet, this is a new treatment to watch for young people with AD who haven’t seen success with topical therapy.
In short, research continues to shed light on what causes eczema and how we can treat it! These findings are paving the way for better treatment and someday a cure.
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