American Academy of Dermatology: 15 Million American Kids and Adults Are Itchy, Irritable and Exhausted

The Villain is Eczema--- and It's On the Rise

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Imagine being plagued with inflamed patches on your skin that are uncontrollably itchy. It is estimated that nearly six percent of all Americans are troubled by the red patches and tremendous itchiness of the chronic skin disorder atopic dermatitis, more commonly known as eczema. Sadly, 10 to 20 percent of all infants are sufferers, with a majority of cases diagnosed as early as twelve months of age. The good news is that nearly 40 percent of child sufferers outgrow eczema. The others live with it throughout their lives.

"Eczema is a life-altering disease that must be taken seriously," said Dr. Guy Webster, dermatologist, Jefferson Medical College, Philadelphia, Pa. "While its causes remain unclear, we know that patients have defects in one or more of their genes that makes their skin's immune system overactive. Environmental irritants, allergens and stress provoke skin flares."

Eczema is characterized by inflamed, dry, scaling, itchy skin. In infants and small children, it typically involves the face and scalp, but may be more extensive covering all areas but the diaper area. Adults and teenagers most commonly experience inflammation, dryness and thickening on the hands, neck and chest, inner elbows, back of the knees and the ankles. The itching is so intense that many patients, especially children, scratch or rub themselves until they bleed. This leads to cracked and scaling skin that increases the risk of secondary infection.

Since 1970, the incidence of atopic dermatitis has nearly tripled. Studies point to environmental factors as contributing to the dramatic boost in the number of people with eczema including irritants and allergens that trigger the immune system. Emotional factors like stress and some infections can also influence atopic dermatitis.

"The key to helping patients is to prevent or defend against inflammation," said Dr. Webster. "Treatment plans are based on the patient's age, severity of symptoms and overall health."

Generally, dermatologists will give parents, caregivers and patients information on avoiding common irritants such as perfumed creams and lotions, as well as rough, scratchy or tight clothing and wool. They will also consult on proper bathing and moisturizing techniques and how best to handle uncontrollable factors such as extreme temperature changes.

Prescription treatment options are available. However, there is a therapeutic void since no new topical medications specifically for atopic dermatitis have been introduced in more than forty years. Current treatment options include:

• Topical steroid creams or ointments
• Antihistamines to control itching
• Oral antibiotics if there is a secondary infection
• Oral cyclosporine to suppress the skin's immune system
• Topical tar-based gels
• Ultraviolet light therapy for severe cases

New treatment options are on the horizon. A new class of drugs called topical immunomodulators, or TIMs, show promise. Two TIMs are in development, tacrolimus and ascomycin, and both are steroid-free. Tacrolimus is likely to be the first TIM introduced in the United States for atopic dermatitis.

TIMs work differently than steroids to relieve the itching, redness and pain of eczema in adults and children. Phase III clinical studies showed that tacrolimus ointment improved or completely cleared eczema in over 80 percent of the patients with a lower incidence of side effects possibly seen with topical steroids.

"Physicians, adult patients and parents of young children with eczema are always looking for new treatment options that relieve the devastating discomfort caused by this condition," said Dr. Amy Paller, pediatric dermatologist, Children's Memorial Hospital, Chicago, Ill. "Many sufferers and their families express frustration and sometimes stop medication because of dissatisfaction, so dermatologists are eager for effective new treatments."

Scientists estimate that 65 percent of patients develop symptoms in the first year of life and 90 percent develop symptoms before age five. The long-term impact of the chronic itching and pain, combined with the interruptions in sleep which leads to irritability, presents parents and caregivers with physical and emotional challenges.

"Parenthood is challenging in itself," said Dr. Paller. "Add to it a parent's desire to ease the chronic itching and pain young children and infants experience with eczema and you can expect some pretty frustrated parents."

"Further, teenagers are so self-conscious to begin with, that eczema can really be deflating, which certainly will have an impact later in life. We address the emotional implications of eczema for kids and adults and try to give patients advice on dealing with its upsets."

The American Academy of Dermatology, founded in 1938, is the largest, most influential and most representative of all dermatology associations. With a membership more than 13,000 dermatologists worldwide, the Academy is committed to: advancing the science and art of medicine and surgery related to the skin; advocating high standards in clinical practice, education and research in dermatology; supporting and enhancing patient care; and promoting a lifetime of healthier skin, hair and nails.

CONTACT: For more information, contact the AAD at 1-888-462-DERM or http://www.aad.org .

Feb. 29, 2000