Dr Steve Feldman: New Atopic Dermatitis Treatments Effective in Managing Inflammation, Alleviating Itch

In a recent study, Steve Feldman, MD, PhD, a dermatology professor at the Wake Forest University School of Medicine, found that patients with atopic dermatitis (AD) prefer treatments that maximize itch control while minimizing adverse event (AE) risks.

Consequently, he discussed why itch is the most important treatment attribute among patients with AD and listed which treatments are most effective at maximizing itch control.

This transcript has been lightly edited for clarity.

Transcript

In your study, itch control was ranked as the most important treatment attribute among patients. Why do you think that is?

I think itch is the most important treatment attribute identified by patients because they're telling us that the itch really bothers them. It bothers them more than the looks of the lesion, more than the treatments for the disease; the itch is the critical factor.

One of the reasons that it's the critical factor is that it's just annoying to have in the same way that pain is annoying to have, it's bothersome. But, in addition, itch keeps people awake at night. Itch interferes with their concentration. Itch affects their ability to concentrate in school by affecting how well they sleep, itch affects how they perform at work and in school. So, the itch can have long-lasting effects on a person's entire life if it's affecting their schooling or their function at work.

What treatments are most effective at maximizing itch control in patients with moderate to severe AD?

We often think about antihistamines for itch, and antihistamines do little to nothing for the itch of atopic dermatitis. I mean, a little diphenhydramine, Benadryl, may make you sleepy and help you sleep at night, but it's really not affecting the itch.

I think there's 2 ways to improve the itch in atopic dermatitis. One is to treat itch directly as a symptom, and the other is to actually treat the underlying inflammation that's causing the itching. I would say the most effective treatment for the itch is to get rid of the atopic dermatitis; then, you won't be itching. We can do that with topical cortisone medicines, especially for milder disease or for the worst spots in people with extensive disease.

Internal medicines—we used to use methotrexate and cyclosporine, and they turn off the inflammation, but they're toxic medications. We have newer medicines that I think are more effective and safer, like dupilumab. It inhibits one of the key signaling molecules that causes the inflammation of atopic dermatitis. In fact, I think it inhibits 2 of the key signaling molecules that cause the inflammation in atopic dermatitis and thereby improves itch.

But we have other drugs now, the Janus kinase, or, for short, the JAK inhibitors. These drugs not only get rid of the inflammation, but they rapidly get rid of the itch.

Reference

McCormick B. Patients with AD prioritize itch control in treatment preferences. AJMC. Published May 14, 2024. Accessed July 29, 2024. https://www.ajmc.com/view/patients-with-ad-prioritize-itch-control-in-treatment-preferences