Q: What are the latest developments in the treatment of eczema?
Eczema has essentially been treated the same way for the past 50 years or so: moisturisers to deal with skin dryness and steroid creams to settle down skin inflammation.
Those with severe eczema may also need occasional courses of steroid tablets or other anti-inflammatories. For many patients, eczema can be a roller coaster ride.
People use their treatments, the eczema clears up so they stop their treatment and then their eczema flares up again.
However, in the last four to five years better understanding of the genetic pathways and the inflammatory pathways has led to major breakthroughs in how we will treat patients with eczema in the future.
There first of these new treatments for severe eczema are biologic therapies. Each biologic attacks a different step in the inflammatory pathway.
Biologics are administered by injection in to the upper arm once or twice a month. The first biologic, Dupixent, is already available and additional biologics may also become available within a few months.
Beyond injectable biologics, we have also been researching JAK inhibitor tablets that specifically target eczema. Sinclair Dermatology is the largest dermatology clinical trial centre in the southern hemisphere and we have already had over 100 patients participate in our centre's eczema trials.
At the other end of the eczema spectrum - for the patients with less severe disease - we have also been researching a range of new creams that are not steroid-based.
They have similar anti-inflammatory effectiveness to cortisone, but fewer and different side effects. This provides people who are intolerant of steroid creams or people who aren't getting benefit from steroid creams with other options. We now have innovations at both ends of the spectrum that will benefit our patients.
For people with severe eczema, the cost of the non-prescription creams, moisturizers, dressings and special skin cleansers they need to buy from the pharmacy can be enormous; I have heard of some patients spending $15,000 a year.
When you add this to the time commitment required to apply all these creams, days off work due to illness and lost productivity due to interrupted sleep, then the expense really adds up.
What causes eczema?
Eczema is an inflammatory disease of the skin caused by an inherited skin sensitivity. The genetic basis of that inheritance is a loss-of-function mutation in the filaggrin gene, which is responsible for maintaining skin barrier function. People with eczema still have one functioning filaggrin gene and have a normal skin barrier, but when their skin is irritated and their barrier is damaged they have limited capacity to repair it.
When the skin barrier is disrupted, the two things happen: water leaves the skin and the skin becomes dry, and allergens and irritants enter the skin - activating the immune system which then produces inflammation and the symptoms of eczema.
Furthermore, because an intact skin barrier protects from bacterial and viral infections patients with eczema are more susceptible are to skin infections.
Australia really punches above its weight in terms of medical research, and the good news for Australian patients is that they can get access to these medications through clinical trials five or six years before they become generally available internationally.
If people are interested in participating in the eczema trials they can look at our website www.sinclairdermatology.com.au.
- Today's answer is provided by Melbourne dermatologist Dr Rodney Sinclair from Sinclair Dermatology, through HealthShare: a digital company dedicated to improving the health of regional Australians. Submit questions, and find more answers, at healthshare.com.au.