Atopic dermatitis – Perspectives and unmet medical needs

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin disease for which many new insights have been gained in recent years through a better understanding of pathophysiology, concomitant diseases and therapeutics in particular. In this review, new and practice-relevant results from current research are presented. Many studies have been performed on the diagnosis of AD and on different subtypes, yet no diagnostic biomarker or clinical predictor of treatment response has been established. For topical treatment, some agents such as Janus kinase (JAK) inhibitors are in advanced stages of clinical trials or already approved in some countries, which will be available in Europe for the treatment of certain eczema subtypes in the foreseeable future. Current systemic therapies in Europe include two antibodies for inhibition of the interleukin (IL)-4/13 signaling cascades and three oral JAK inhibitors with somewhat different efficacy and safety profiles. Among the antibody therapies for AD already advanced in development, promising new targets include blockade of IL-31, of neurokinin-1 receptor on sensory neurons, and inhibition of the OX40/OX40L axis for cutaneous dendritic cell and T lymphocyte interaction. Primary prevention and modulation of sequential disease progression as well as effects on concomitant diseases by early therapeutic intervention will be important questions in future research on AD.

Epithelial–immune cell interactions in allergic diseases

“…Blocking IL‐33 was not successful in AD [60] but revealed promising results in asthma [61, 62]. Targeting upstream mediators of allergic diseases that trigger immunological cascades of type 2 inflammation following the “atopic march” (atopic dermatitis, allergic rhinitis, asthma, food allergies, esophagitis) may be a broader therapeutic approach with the potential to prevent comorbid diseases [63].…”