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Content Update

May 16, 2017

Dupilumab (Dupixent®) Approved for Moderate to Severe Atopic Dermatitis: Dupilumab is a monoclonal antibody that binds to the interleukin-4 (IL-4) receptor alpha subunit (IL-4rα), inhibiting the inflammatory response involved in development of atopic dermatitis (AD). It is approved for treatment of adults with moderate-to-severe AD whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. Three phase 3 clinical trials demonstrated improved AD symptoms when compared to placebo; no comparative trials with other systemic therapies have been conducted. Side effects are generally mild and include injection site reactions, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, and dry eye.

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KEY CONCEPTS

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KEY CONCEPTS

  • Image not available. Atopic dermatitis (AD) is a chronic skin disorder involving inflammation associated with intense pruritus, a hallmark symptom. Management of AD must always include appropriate management of the associated pruritus.

  • Image not available. AD is associated with other atopic diseases such as asthma and allergic rhinitis in the same patient or family. The three conditions are known as the atopic triad.

  • Image not available. The prevalence of AD appears to have increased two- to threefold in many developed and developing countries during the last three decades. Recent data indicate age and country or regional differences, with some countries showing no change or even a decrease. Rural areas appear to have lower prevalence rates.

  • Image not available. There are genetic and environmental factors in the pathogenesis and pathophysiologic manifestations of AD. The inheritance pattern is not straightforward. More than one gene may be involved in the disease, with the filaggrin gene (FLG) being a key player. Other genes coding for specific cytokines are also involved.

  • Image not available. AD usually presents in infants and young children. The clinical presentation differs somewhat depending on the age of the patient.

  • Image not available. Secondary bacterial skin infections are common in patients with AD and must be promptly treated.

  • Image not available. Management of AD must always include appropriate nonpharmacologic management of any controllable environmental factors, such as avoidance of identified triggers. These may include aeroallergens (eg, mold, grass, pollen), foods (eg, peanuts, eggs, tomatoes), chemicals (eg, detergents, soaps), clothing material (eg, wool, polyester), temperature (eg, excessive heat), and humidity (eg, low humidity).

  • Image not available. Nonpharmacologic management of AD entails managing the symptoms associated with pruritus and encouraging appropriate skin care habits such as proper bathing techniques and the copious use of moisturizers, which is a standard of care.

  • Image not available. Topical corticosteroids (TCS) are the drugs of first choice for AD.

  • Image not available. Topical calcineurin inhibitors (tacrolimus and pimecrolimus) are alternate treatment options for adults and children older than 2 years.

  • Image not available. Phototherapy is a second-line treatment when TCS and topical calcineurin inhibitors fail.

  • Image not available. This chronic illness has substantial socioeconomic impact. The cost may be magnified by undertreatment.

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Image not available. Atopic dermatitis (AD) is a chronic, pruritic inflammatory skin disease. It is often referred to as eczema, which is a general term for several types of skin inflammation. AD is the most common type of eczema (Table 98-1...

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