5. New therapeutic targets in atopic eczema

Abstract

One of the recent developments is to treat the disease very early in its development, exactly as is being done in asthma. The aim is to evaluate whether it is possible to modify the disease with long-term management. Can flare-ups be prevented? Is it possible to prevent the ‘atopic march’? The typical progress of a patient with atopic dermatitis (AD) was documented by Kissling & Wuthrich (1). They documented the development of eczema in 106 patients from the infantile phase, through childhood and adolescence into adulthood. The majority of patients experienced recurrent cycles of flare-ups, each of which was controlled by steroids. This recurrent cycle of events is distressing to parents who are also concerned about the ‘atopic march’ (2). Atopic eczema is in most cases the first manifestation of atopic disposition; eczema in childhood, compounded by food allergy, leading to asthma and long-term rhinitis. The general approach to treating AD is to treat relapses/flare-ups and when controlled to withdraw active treatment and use emollients (until the next flare-up). A recent trial has investigated whether continued application of a steroid can prevent or delay the cycle of relapses and treatment. Berth-Jones et al. (3) conducted a randomized vehicle (emollient) controlled trial in patients aged 12–65 with moderate to severe disease, to determine whether fluticasone propionate (at two strengths of 0.05% and 0.005%) can prevent relapses. There was a 1-month stabilization phase, followed by maintenance treatment of both ‘healed’ skin and new areas. The primary end point of the study was the time to relapse. A significant (pv0.001) prolongation of remission with application of fluticasone propionate 0.05% was seen. Significant benefit was also seen with fluticasone propionate 0.005%, but the benefit and statistical significance was reduced (p50.01). NEW THERAPEUTIC STATEGIES AND TARGETS