1. Atopic Dermatitis: Disease Impact and Therapy
4/26/2017 6:38 AM
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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

2. The Prevalence of Atopic Dermatitis in Oregon Schoolchildren
4/26/2017 6:38 AM
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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:

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6. AD and the Immune System
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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

7. Impact on Individuals and Families
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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

8. Therapy With TCIs: IMPACT
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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!

9. TCIs in Study and Practice
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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

10. Impact of Under-treatment of Eczema
4/26/2017 6:38 AM
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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

11. 4/26/2017 6:38 AM
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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

12. My Thanks… For your time
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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