A Therapeutic Renaissance - Emerging Treatments for Atopic Dermatitis

Abstract

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 patho physiology of atopic dermatitis. Besides type 2 cytokines, certain phenotypes of atopic dermatitis may be driven by additional cytokine pathways. However, data to date at tempting to target specific cytokines outside of the type 2 axis have been largely unsuccessful. Further data using largescale and longterm clinical trials are needed in order to create tailored and personalized treatments for atopic dermatitis.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-todate conference abstracts and presentations.

Astaxanthin Ameliorates Atopic Dermatitis by Inhibiting the Expression of Signal Molecule NF-kB and Inflammatory Genes in Mice

“…Due to its complex pathophysiology, a systematic and continuous treatment for AD is required [32]. Treatment approaches of AD include moisturizing, managing the skin, training to avoid aggravating factors, topical treatment, treatment for symptom relief, and use of immunosuppressants [33].…”

Effect of Astaxanthin on Anti-Inflammatory and Anti-Oxidative Effects of Astaxanthin Treatment for Atopic Dermatitis-induced Mice

“…AD is a chronic skin condition/disease characterized by frequent skin barrier defects and variable T-helper cell infiltration [21]. AD has a highly complex pathophysiological mechanism which has not yet been fully identified, but oxidative stress, gastro-microbiome, and aeroallergens, have recently been reported as important factors [22].…”

New and Upcoming Topical Treatments for Atopic Dermatitis: A Review of the Literature

“…More recently, patients colonized with S.aureus have been described as a unique AD phenotype. Patients in this category have more severe disease, reduced barrier function, increased allergen sensitization and elevated IgE, eosinophils, lactate dehydrogenase and various Th2 biomarkers such as TARC, periostin and CCL26 [ 65 , 66 ].…”