A Therapeutic Renaissance - Emerging Treatments for Atopic Dermatitis
Chan Ho Na, Wenelia Baghoomian, Eric L. Simpson
Atopic dermatitis (AD) is a chronic, inflammatory cutaneous disease that is characterized by complex immune dysregulation and skin barrier dysfunction with a wide variety of clinical phenotypes. Until recently, conventional therapeutic modalities for AD remained rather non-specific despite AD’s complex etiology. Failing to take into account the underlying inflammatory pathways led to treatments with inadequate efficacy or unacceptable long-term toxicities. We are currently in the midst of a therapeutic renaissance in AD. Recent progress in molecular medicine provides us a better understanding of the AD pathogenesis, suggesting a dominant helper T cell (Th) 2/Th22 response with a varying degree of Th1/Th17 overexpression. Targeted therapeutic agents including biologics and small molecule inhibitors in development hold promises for more effective and safer therapeutic approaches for AD. A better understanding of individual differences amongst AD patients will allow for a more tailored approach in the future. This review aims to cover the most promising emerging therapies in the field of atopic dermatitis utilizing recently published manuscripts and up-to-date conference abstracts and presentations.
Effective treatment of atopic dermatitis is complicated due to its chronic nature, multifaceted pathophysiology, and variable clinical manifestations. The success of dupilumab confirms the importance of type 2 cytokines in the pathophysiology of atopic dermatitis. Besides type 2 cytokines, certain phenotypes of atopic dermatitis may be driven by additional cytokine pathways. However, data to date attempting to target specific cytokines outside of the type 2 axis have been largely unsuccessful. Further data using large-scale and long-term clinical trials are needed in order to create tailored and personalized treatments for atopic dermatitis.