Dr Jason Ezra Hawkes on Advances in Clinical Research and Gaps in Knowledge for Atopic Dermatitis

Primary failures vs secondary failures for therapy, differences in pathophysiology across different ethnic groups, and adult-onset disease are 3 key topics that are either being investigated or warrant further study among patients with atopic dermatitis (AD), said Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of dermatology at the University of California Davis in Sacramento.

Transcript

Are there any emerging research you find noteworthy in the management of AD and any gaps in knowledge that warrant further investigation?

In eczema, as well as other dermatologic conditions, we're starting to see better studies where we're looking at 2 things that I think are really important. One is we're starting to pay attention to what we call primary failures and secondary failures. So, with primary failures or nonresponders, these are patients that just never got better, for whatever reason, on a particular therapy, but that's very different from those patients that have done really well for 2 or 3 years and then suddenly stopped responding.

So, I think we've started to appreciate these subtypes within the eczema space, as well as other diseases where we're starting to understand the immune mechanisms that are driving why someone responds to a certain therapy and why people don't or why people lose effectiveness over time and what's driving that. And that's maybe going to ultimately open up this future of predicting response to a particular therapy before starting. So, that would really be a big advance in the treatment of inflammatory conditions.

Another area that I'd like to see more investigation, where we're again starting to have the conversation, is looking at disease in particular subtypes. So, certain ethnic groups' eczema may be a little bit different. So, there's this conversation about eczema in the Western population vs in Asian populations where maybe there's higher levels of IL-17 or other pathways that might be contributing.

I think adult onset vs childhood onset is quite interesting. We learned when I was in medical school and residency that eczema is primarily a disease of childhood. But I'm shocked at how many patients every day that I see who have actually never had disease as children who have true adult-onset disease. We need to understand this phenomenon, why at 50, 60, 70 years of life, they don't have this condition and yet develop it later in life. So, those are areas that I think really warrant further investigation and study so that we can start to tease out these subtypes of a condition we know is heterogeneous in terms of its presentation and also its immunology.