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S.J. Brown, What progress have we made in the treatment of atopic eczema? Putting the new biological therapies into a wider context, British Journal of Dermatology, Volume 177, Issue 1, 1 July 2017, Pages 4–6, https://doi.org/10.1111/bjd.15646
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Atopic eczema, also known as atopic dermatitis or eczema,1 is a common chronic inflammatory skin disease that has a significant impact on the quality of life of affected patients, as well as their close family members. Despite this considerable burden of disease, treatment options are limited, and many patients and healthcare practitioners have expressed uncertainty in the appropriate use of established forms of therapy.2
Atopic eczema is a complex trait arising from the interaction of multiple genetic and environmental effects. Genetic studies have identified mechanisms contributing to the pathogenesis of eczema, including both immune factors and skin barrier dysfunction.3 4 In light of these findings from basic research, it seems likely that treatment strategies will require a dual approach, to reduce inflammation and to repair the skin barrier.
Eczema can often be managed effectively using a combination of allergen and irritant avoidance, regular use of emollients, and topical anti‐inflammatory treatments. However, there remains a substantial minority of adult and paediatric patients for whom phototherapy or systemic treatments are required.5 Narrow‐band UVB and UVA1 are the most effective forms of phototherapy for atopic eczema and may be used in adults or older children.6 7 Ciclosporin is currently the only systemic immunosuppressant approved for the treatment of atopic eczema by the European Medicines Agency, but only for adult patients and for only up to 8 weeks’ duration because of the risk of irreversible renal toxicity.8 The efficacy of methotrexate and azathioprine in moderate‐to‐severe atopic eczema has been demonstrated in randomized controlled trials;9 10 these systemic immunomodulatory therapies are widely used by dermatologists in Europe11 12 and North America.13 Methotrexate, azathioprine and ciclosporin appear to have roughly comparable efficacy,9 14 although no studies have been specifically designed, or adequately powered, to demonstrate equivalence in efficacy between these three drugs.
