New Developments in Managing Atopic dermatitis (AD)/eczema

After a year of hiatus, I finally attended the first media event! Rightly so, to update myself about the latest developments in managing atopic dermatitis. Even though this event was meant for the public, I must say that I have also learnt a lot!

AD affects 20% children and 8% adults. 4 main elements in AD includes irretractable itching, dryness, redness/inflammation which can be complicated by secondary bacterial infection due to ineffective skin barrier function.

AD is more than a skin condition. It also affects productivity due to constant scratching. This can result in poor sleep up to 2.5hours! Furthermore, AD can also cause loss of employment, social and psychological burden, embarrassment from socializing and schooling. AD is also costly to treat.

The first talk of the afternoon was delivered by Dato’ Dr Noor Zalmy Azizan. She is a Consultant dermatologist at HKL/Thompson Medical Center. The talk was entitled Introduction to AD (causes, symptoms and impact on patients).

Eczema can be subdivided into Endogenous (eg atopic dermatitis, seborrheic dermatitis) vs exogenous (contact dermatitis due to specific triggers). AD is a clinical diagnosis and does not need blood/patch test to confirm.

AD is a complex, chronic and recurrent itchy inflammatory skin disorder. Disease can flare up with stress and dry environment. However, certain cases can also be continuous. Prolonged uncontrolled ezcema can cause lichenification/thickening of the skin or nodular prurigo. AD is also associated with asthma, allergic conjunctivitis and allergic rhinitis.

The prevalence of AD in Malaysian children has risen from 9.5% (1994)to 12.5% (2002) based on the ISACC studies. The risk is higher if there’s family history with filaggrin gene mutation, causing a lack of protein in the skin which moisturizes the skin naturally. Oxidative stress can further damage the skin. The real reasons behind AD are not fully understood yet. The vicious cycle of scratching, sweating, hot water and sun damage further causes skin breakdown, mimicking a failing brick and mortar model.

According to the Malaysian Clinical Practice Guideline of management of AD,
Emollients is the mainstay of treatment of all AD stages based on Cochrane systematic review and is able to reduce the need for steroid use.

The second presentation by Dr Leong Kin Fon, a prominent pediatric dermatologist spoke about the Management of AD & Tips for Parents.

AD is a dynamic disease with many faces. The distribution of the rash differs with age. Therefore, it is important to seek treatment from dermatologists as early treatment can prevent complications. AD usually starts after 6 months of life as the fetus was initially protected in amniotic fluid. The newborn skin was also protected with vernix.

In general, the amount of emollient needed is 500g for adults and 300g children in a week. Oil or cream based moisturizers should be used over the limbs and body as this can last over the day. Lightweight, lotion/gel based emollients can be used on the face instead. Look for hypoallergenic and low irritation emollient and cleanser which are effective against all these symptoms: Itchiness, dryness and erythema.

Other tips including:
-Avoid extreme weather
-Avoid prolonged bubble bath
-Bathe less than 15minutes with lukewarm water (test with closed eyes)
-Rebalance antioxidant levels on the skin
- Empower the patient in the management plan

6 principles of AD management are:

1. Fine tune expectation-eczema takes months to years to control, not cured. It’s like running for a marathon.
2. Always listen, demystify and educate patients - it is not possible to pinpoint the exact cause of AD as it is complex and multi factorial.
3. Need to mix and match treatment to 'flatten the curve' ( tackling itchiness, infection, dryness and inflammation)- persist with effective treatment until remission is achieved.
4. Learn how to befriend steroid cream (they are natural!) with 7 potency levels depending on severity and thickness of skin- usually 2 weeks long, need to review use regularly and watch out for skin thinning.
5. AD starts with itch first then red rash lastly weeping rash- start treating when it’s itching.
6. Natural products can be harmful and loaded with high potency steroids
--Scrutinize the research behind the products, if possible backed by Randomised Controlled Trials

Lastly, Dr V Shubashini, Medical Affairs Manager of Menarini launched their latest AD products– Introduction to Relizema™️-Dermarel™️

Relizema cream is a topical emollient used to protect the skin’s barrier function containing antioxidants (furfuryl palmitate and tocopherol). It has a fast onset and offered sustainable relief for itchiness.

Dermarel lotion containing 3 types of ceramides and plant based oils. It is a lightweight emollient.

Dermarel cleanser is made of ceramide and amino acids suitable for dry face and body.

Dermarel spray & go soothes red and burning sensation especially in inflamed and dry private areas without the need to rub in.

These tips really help our family of 4 to deal with AD. Be in control!