Atopic Dermatitis: Disease Impact and Therapy 4/26/2017 6:38 AM CN-1 Atopic Dermatitis: Disease Impact and Therapy Lawrence F. Eichenfield, MD Professor of Pediatrics and Dermatology University of California, San Diego School of Medicine and Children’s Hospital, San Diego

The Prevalence of Atopic Dermatitis in Oregon Schoolchildren 4/26/2017 6:38 AM CN-2 The Prevalence of Atopic Dermatitis in Oregon Schoolchildren Study: Standardized Questionnaire: AD symptoms 5 to 9 years old; 6 Oregon urban & 2 rural schools SQ and history completed by parents Questionnaire scores validated by clinical findings in children with AD Prevalence = 17.2% CONCLUSION: Indicates a high prevalence of AD in the United States, comparable to recently observed rates in Europe and Japan Laughter D, Istvan JA, Tofte SJ, Hanifin JM J Am Acad Dermatol. 2000;43:649-655.

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AD and the Immune System 4/26/2017 6:38 AM CN-6 AD and the Immune System Disordered immune response Set of inflammatory cells — Ag presenters Disrupted skin barrier function Atopic march: Stimulation of immune system and potential impact

Impact on Individuals and Families CN-7 Impact on Individuals and Families Objective data: Quality of life Sleep disturbance, psychosocial dysfunction Societal cost Lost work time, wages, school, decreased performance Medical care costs ($ in ER visits, etc) Human effect

Therapy With TCIs: IMPACT 4/26/2017 6:38 AM CN-8 Therapy With TCIs: IMPACT Medicine in addition to emollients and topical corticosteroids Allows “mixing and matching” of therapy Reducing risks of steroid exposure Tailoring of treatment to disease severity Asthma parallels: Similar epidemiology, pathogenesis, and treatment evolution Treatment has been markedly improved!

TCIs in Study and Practice 4/26/2017 6:38 AM CN-9 TCIs in Study and Practice Tolerated well Used with “medication sparers” Used intermittently in almost all patients Anti-inflammatory, improves skin barrier function, decreases staphylococcal colonization, infection TCIs: No evidence of systemic immune effects in clinical use or studies

Impact of Under-treatment of Eczema 4/26/2017 6:38 AM CN-10 Impact of Under-treatment of Eczema Skin inflammation, disrupted skin barrier, pruritus Cutaneous infection - Staphylococcal (less so strep) colonization and infection Impact on MRSA Secondary impact Cellulitis, hospitalization Exposure to agents with known toxicity Systemic and topical corticosteroids, phototherapy, cyclosporine, others

4/26/2017 6:38 AM CN-11 Topical Calcineurin Inhibitors: Is there enough worry to warrant warning? What is the risk of lymphoma? No clinical data Coincidence events? Will create TCI phobia, to go along with steroid phobia Will lead to undertreatment of eczema and increase the many faces of inflamed dermatitis

My Thanks… For your time 4/26/2017 6:38 AM CN-12 My Thanks… For your time Commitment to balancing concerns for safety with the needs of patients, families, and physicians to care for atopic dermatitis and minimize its tremendous impact