July 29, 2004 -- The future looks brighter than ever for the millions of Americans with eczema and psoriasis thanks to effective and safe new treatments, researchers said Thursday at the annual meeting of the American Academy of Dermatology in New York City.
Nearly 15 million Americans have eczema, a chronic skin condition marked by itchy, red patches of inflamed skin. Until recently, steroid creams applied to the skin were the only available treatment. They reduce inflammation but do so by interfering with the body's immune system.
While still considered the treatment standard for eczema, these creams can cause side effects. They can cause thinning of the skin, stretch marks, easy bruising, and an increased risk of infection. These side effects are even more common when used for an extended period of time, such as when treating eczema.
Soothing the eczema beast has never been easier due to the advent of two new nonsteroid treatments known as topical immunomodulators. Elidel and Protopic work by producing anti-inflammatory effects on the skin -- without interfering with the body's immune system.
"Eczema is a difficult disease because the redness is obvious to other people and socially and emotionally, it can be very difficult. Often it has severe itching to the point that patients are up all night scratching and they may also have burning and stinging," Nancy J. Anderson, MD, a professor of dermatology at Loma Linda University in Loma Linda Calif., tells WebMD.
"The new generation of immunomodulators have a good safety profile," Anderson says. "They are relatively new, of course, so there is no long-term data, but I am impressed so far," she says.
People using steroids can become resistant to them. Patients using them may require larger doses for the same relief, but that does not seem to be the case with the new immunomodulators, she says.
Oral protopic is not currently FDA approved to treat eczema, but in other countries "it is touted as an excellent alternative treatment for severe eczema," she says.
"This is exciting because we see rosacea a great deal and it's very challenging to treat," she says. In addition, topical immunomodulators may help clear up seborrheic dermatitis on the face and vitiligo, a disease in which patients lose pigment on various skin areas, leaving the skin unevenly pigmented. What's more, these treatments may also clear warts, poison oak, and ivy.
Stopping the parade
A new study will look at whether treating eczema early can stop what researchers dub the atopic march.
Many children with eczema may develop other conditions such as asthma or allergic rhinitis (commonly called hay fever), suggesting that eczema may only be the first sign of a sequence of allergic symptoms including food allergy, allergic rhinitis, or asthma. The new study is looking at 1,100 infants aged 3 months to 18 months, she says.
Et Tu Psoriasis?
The treatment of psoriasis, too, is looking up, says Abby S. Van Voorhees, MD, an assistant professor of dermatology at the University of Pennsylvania in Philadelphia.
Psoriasis affects 6 to 7 million Americans and accounts for 2.4 million annual doctor visits and costs about $3 billion a year, she said at a press briefing. The inflammatory skin condition causes red scaly lesions or plaques that are found on the knees, elbows, trunk, and buttocks.
Older treatments were either not entirely effective or highly toxic, but a new class of treatments known as biologics nip the inflammation cascade of psoriasis in the bud. They do this by blocking the activation of cells of the immune system which kicks off the reaction that eventually results in the formation of psoriatic lesions on the skin.
"We have many more choices now that allow us to individualize treatment and provide options for resistant disease," Van Voorhees says.
"It's a very exciting and I am optimistic," she explains. "The future is really looking very bright."
Some caveats exist with the new biologics, namely the expense.
"They are expensive and price tags range from $8,000 to $20,000 a year for these medications. Currently there are insurers that are paying for them," she says.
"This is a disease that can have a profound effect and I believe that psoriasis patients have every bit as much of a right to expensive medications as patients with other diseases," she adds.