The curse of severe eczema may be coming to an end

The curse of severe eczema may be coming to an end
Ordinary case of eczema. It can be much worse.

“Doctors suddenly got way better at treating eczema,” reports The Atlantic:

Up until a few years ago, Heather Sullivan’s 14-year-old son, Sawyer, had struggled with eczema his entire life. When he was just a baby, most of his body would be covered in intensely itchy rashes that bled and oozed when he couldn’t help but scratch…At 15 months, he went on cyclosporine, a powerful immunosuppressant usually given to organ-transplant patients. It cleared him up, but the drug comes with potentially dangerous side effects over time. Doctors, Sullivan recalls, were “just appalled that my child would be on this amount of medicine at this age”—but his eczema came roaring back as soon as he went off it.

When a new eczema drug called Dupixent finally became available to Sawyer a few years ago, his turnaround was fast and dramatic. Within a week, his itchiness and redness started calming down. He felt and looked better. The condition that had dominated their lives began to fade into the background.

Doctors who treat severe eczema now speak of pre- and post-Dupixent eras: “It changed the landscape of having eczema forever,” says Brett King, a dermatologist at Yale. Today, a half dozen novel treatments are available for the skin condition, all of which work by quieting the same biological pathway in eczema; dozens more are in clinical trials. Unlike older drugs, these new ones are precisely targeted and in many cases startlingly effective.

Eczema, also known as atopic dermatitis, is characterized by red, itchy, and inflamed skin. It’s a very common condition, estimated to affect 10 percent of Americans. Of those, a large minority suffer from moderate to severe eczema that seeps into everyday life. “Just imagine scratching endlessly,” King says. “You wake up from sleep scratching. Your sheets are bloody in the morning.” The most basic eczema advice is to moisturize, and moisturize often, to protect the barrier of the skin. But scientists now know that eczema’s cause is not in the skin alone. Many patients also have “an over-reactive or overzealous immune system,” says Dawn Davis, a dermatologist at the Mayo Clinic. Their immune cells release chemicals that irritate nerves, causing itch, and even degrade the skin itself.

Topical steroids, such as over-the-counter hydrocortisone cream, can tamp down the immune reaction that flares in eczema. If these fail, doctors have resorted to more powerful oral steroids, such as prednisone, or other oral immunosuppressants, such as the aforementioned cyclosporine. The drugs can calm eczema, but because they suppress the overall immune system, they also do much more. Prednisone, for example, makes you more prone to infections as well as bone fractures, high blood pressure, and glaucoma when taken in the long term. Of course, for many people, eczema is a chronic condition that requires long-term treatment. “Prednisone is kind of like carpet bombing,” says Peter Lio, a dermatologist at Northwestern University. It blasts eczema away, but at a cost.

In contrast, the newer drugs, Lio says, are more like shotguns that target specific parts of the immune system—with less collateral damage. They fall into two broad classes. Monoclonal antibodies, such as Dupixent, intercept the immune-signaling molecules that trigger itch and skin inflammation. And then JAK inhibitors, which include pills such as Rinvoq and the topical cream Opzelura, scramble the signal after cells have received it. The development of these drugs came after years of research zeroed in on some of the key immune molecules dysregulated in eczema. But serendipity played a role too: The first such drugs were originally developed for other conditions, such as rheumatoid arthritis—only to be repurposed when researchers realized that they targeted the very pathways involved in eczema. The breakthroughs in eczema treatment, in fact, are part of a broader revolution in treating inflammatory disorders; both classes of new drugs are now used to tune the immune system in a whole host of different conditions.

In other good medical news, artificial intelligence “is building highly effective antibodies that humans can’t even imagine,” reports Wired.

A new ultrasound therapy may help treat cancer, Alzheimer’s disease, and Parkinson’s disease.

In Hungary, doctors are using artificial intelligence to detect cases of breast cancer more effectively, enabling them to remove such cancers before they can metastasize and kill women.

Doctors recently did the first robotic liver transplant in America. Robots can fit in small spaces in people’s bodies that a surgeon can’t reach without cutting through living tissue, or doing other collateral damage.

The fact that new technologies are already saving lives in other countries does not mean they can immediately be used to save lives in America. The FDA commonly takes years to approve life-saving drugs and medical devices.The FDA didn’t approve a home test for HIV until 24 years after it first received an application. An FDA advisory committee noted that the test “holds the potential to prevent the transmission of more than 4,000 new HIV infections in its first year of use alone.” That means thousands of people got infected with AIDS as a result of the delay in approving it. As Fortune noted, the FDA’s delay in approving the home HIV test was a “scandal.” Similarly, at least a hundred thousand people died waiting for the FDA to approve beta blockers.

Jake Selliger recently described how he is “dying of squamous cell carcinoma, and the treatments that might save [him] are just out of reach,” due to the FDA, which routinely takes many years to approve life-saving medical treatments. “The FDA is responsible for more deaths on an annual basis than any other government agency. [Selliger is] one of its victims,” notes Paul Matzko of the Cato Institute. Researchers are “curing multiple cancers right now,” yet “the FDA is acting like it’s business as usual” and dragging its feet on approving cures.

LU Staff

LU Staff

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