Systemic Immunomodulatory Treatments for Atopic Dermatitis

What Are Immunomodulatory Drugs?

Immunomodulator drugs modify or modulate the immune system to help the body respond to a disease or infection. Various immunomodulators can affect distinct parts of the immune system. Several classes act very broadly, while others only target extremely specific pathways. Immunomodulators can be somewhat small molecules, whereas others may take the shape of larger proteins, such as monoclonal antibodies. They can work in either way to stimulate or suppress the immune system.

When an immunomodulator stimulates, it gives the immune system the growth it needs to respond to an illness or disorder. Immunomodulators utilized in cancer treatments can function this way. Immunosuppressants suppress or lower immune system activity. These immunomodulators are used when the immune system is used to treat diseases such as autoimmune disorders.

What Is Atopic Dermatitis?

Atopic dermatitis (eczema) is a skin condition that results in itchy, dry, and inflamed skin. It is typical in young children but can arise at any age. It is long-lasting (chronic) and tends to flare occasionally. Atopic dermatitis can be irritating but not contagious. Its symptoms can appear anywhere on the body and range widely from person to person. They may include:

• Itchiness (pruritus).

• Dry or cracked skin.

• Rash on inflamed skin that varies in color depending on the skin color.

• Oozing and crusting.

• Small and raised bumps on brown or black skin.

• Thickened skin.

• Raw and sensitive skin from scratching.

• Darkening of the skin around the eyes.

Atopic dermatitis generally starts before five years of age and may continue into the teen and adult years. For some, it erupts and then clears up for a time.

How Is Atopic Dermatitis Diagnosed?

Atopic dermatitis can be diagnosed based on the symptoms, skin examination, and a review of the medical history. Various tests must be done to identify allergies and regulate other skin diseases. Sometimes certain food causes a rash in children due to potential food allergies. Patch testing may be recommended by the doctor for the skin. In this test, little quantities of various substances are applied to the skin and then covered. Follow-up visits over the next few days are done to check the skin for signs of a reaction. This type of testing can help diagnose specific types of allergies causing dermatitis.

How to Treat Atopic Dermatitis Using Systemic Immunomodulatory Drugs?

Atopic dermatitis (AD) is a long-lasting and relapsing inflammatory skin condition. When AD is mild, it can be operated effectively with over-the-counter emollients and topical prescription therapies, including corticosteroids.

An estimated seven percent of children and two to eight percent of adults have severe disease. In such cases, topical therapies may not be beneficial or inadequate. Treatment with phototherapy or systemic therapy may be needed. Systemic therapeutic options are restricted to traditional immunosuppressive drugs such as Methotrexate, Cyclosporin, Mycophenolate, Azathioprine, and corticosteroids.

Targeted agents have also been developed, including Dupilumab, the first biological approved for the treatment of moderate-to-severe atopic dermatitis. Numerous other biological and small-molecule therapies are nowadays being tested in clinical trials. Specifying the relative efficacy and safety of the older and newer systemic therapies for atopic dermatitis is challenging.

Systemic immunomodulatory drugs that are used to treat atopic dermatitis include Methotrexate, Azathioprine, Mycophenolate, Cyclosporine, and Dupilumab, with Baricitinib, Abrocitinib, Tralokinumab, and Upadacitinib approved in different jurisdictions. Treatment with Dupilumab in atopic dermatitis may have similar effectiveness to higher-dose Cyclosporine and is also superior to Methotrexate and Azathioprine. The association of systemic immunomodulatory therapies for moderate-to-severe atopic dermatitis has positive outcomes, including patient-reported symptoms, change in clinical signs, skin-specific health-related quality of life, and itch severity.

Other Treatment Modalities:

• Medications to Control Itching- Various drugs are available to control itching and repair the skin. They may be available in various forms, such as creams, gels, and ointments. Overuse of a corticosteroid product used on the skin may cause side effects, such as skin thinning. Creams or ointments with calcineurin inhibitors can be a promising choice for patients above two years of age. Examples include Pimecrolimus and Tacrolimus. It should be applied as directed before moisturizing the skin. Avoid strong sunlight while using these products.

• Medications to Control Inflammation- For more-severe eczema, drugs to control the symptoms may be prescribed by the doctor. The drugs can include Cyclosporine, Methotrexate, Prednisone, Mycophenolate, and Azathioprine. These drugs are effective but cannot be used for the long term because of potential side effects.

• Other Options for Severe Eczema- Monoclonal antibodies (injectable biologics) such as Dupilumab and Tralokinumab can be used to treat people with moderate to severe disease. Studies have confirmed that this use is safe and effective in reducing the symptoms of atopic dermatitis. Dupilumab can be used by patients over age six, whereas Tralokinumab can be used in adults.

• Wet Dressings- Another effective and intensive treatment for severe eczema pertains to applying a corticosteroid ointment. This area is then sealed with the medication with a wrap of wet gauze topped with a layer of dry gauze. Occasionally this is done in a hospital for people with widespread lesions because it is labor-intensive and requires nursing expertise.

• Light Therapy- It is used for people who either don't get satisfactory results with topical treatments or rapidly flare again after treatment. The form of light therapy (phototherapy). This involves exposing the affected area to controlled amounts of natural sunlight. Additional forms use artificial ultraviolet A (UVA) and narrow-band ultraviolet B (UVB) alone. However, long-term light therapy has harmful effects, including premature skin aging, hyperpigmentation, changes in skin color, and an increased risk of skin cancer. Because of these reasons, phototherapy is avoided in young children and infants.

• Counseling- Patients with atopic dermatitis may feel embarrassed or frustrated by their skin condition. They can seek help by talking with a therapist or other counselor.

• Relaxation and Behavior Modification- These strategies may benefit people who scratch out of habit.

Conclusion

Systemic immunomodulatory treatments for atopic dermatitis are drugs that work by modifying the immune system to reduce inflammation. They improve symptoms of atopic dermatitis. These medications are particularly used for severe cases of atopic dermatitis that are not responding to other treatments, such as topical corticosteroids and moisturizers.

Some examples of systemic immunomodulatory drugs that can be used for atopic dermatitis include corticosteroids, immunosuppressants, and monoclonal antibodies. Systemic immunomodulatory treatments can have major side effects, and they should be used with caution. They must be used only under the guidance of a healthcare professional, and the potential benefits and risks should be carefully considered before starting treatment.