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Atopic dermatitis is an inflammatory skin disease, starting in childhood with a chronic, intermittent or persistent course. About 10% of people in North America are affected. 80% of cases do not persist after the age of 8. Asthma and allergic conjunctivitis may also frequently be associated with atopic dermatitis.

Advances in the field of atopic dermatitis have been especially exciting this year.

Atopic Dermatitis Associated with other Conditions:

The disease burden of atopic dermatitis includes dermatitis/eczema symptoms (e.g. itching), loss of work productivity, impaired quality of life, and sleep disturbance.

Also of note, infants with severe atopic dermatitis and egg allergy are at a risk for peanut allergy.  These children should be exposed at an earlier age to foods containing peanuts, starting at 4-6 months as appropriate. However, this early addition of peanuts to the diet did not improve the atopic dermatitis.

Multiple studies have cited the association between atopic dermatitis and attention deficit hyperactivity disorder (ADHD). Atopic dermatitis patients may also have an increased risk of cardiovascular disease, as well as an increased risk of autoimmune diseases, certain malignancies and neuropsychiatric disease.

General Measures:

General recommendations include: short baths and cotton clothing, along with gentle laundry detergent. Emollients should be advised to the entire body after every bath, the thicker (e.g. ointments/balms/creams preferred over lotions) the better, but still elegant enough that the patient will use it regularly. Ideally fragrance-free emollients are to be used, and they should start from birth. Also, the early introduction of fish into the diet of pediatric patients is being advised.

Dealing with itch, the new prescription antihistamine Bilastine (Blexten®) is safe and effective, and it does not cause sleepiness. For those having difficulty sleeping, melatonin is a reasonable alternative to sedating antihistamines.

The importance of the human microbiome is receiving much attention of late. Reduction in bacterial diversity is a major contributing factor in the pathogenesis of atopic dermatitis. Dysbiosis – the imbalance of normal flora and pathogenic microorganisms – must be repaired. Prebiotics are the most promising supplements which contain nondigestable ingredients that selectively stimulate growth and/or activity of indigenous bacteria. Additionally, thermal water has gotten a lot of attention due to the selenium within it. Selenium is anti-inflammatory, anti-neoplastic, keratolytic, and help increase safe levels of gram-negative bacteria Xanthomonas, which helps to balance the high levels of gram-positive bacteria present on the skin.

New Treatment Options:

Topical corticosteroids and topical calcineurin inhibitors (e.g. Protopic®, Elidel®) are first line treatments for atopic dermatitis. Often times a topical steroid is used to get the eczema under quick control (“like a firehose”), and then Protopic® or Elidel® are used preventatively on an ongoing basis, often 2-3 times per week, on previously affected areas to prevent recurrence. Protopic® & Elidel® are also great options for sensitive areas of skin such as the face, neck, ears, armpits and groin, and both are frequently used off-label for other conditions such as seborrheic dermatitis, vitiligo, and more.

After many years with few new products available for atopic dermatitis, there has been a recent flurry of activity regarding pharmacologic treatments for atopic dermatitis. Crisaborole (Eucrisa®, Pfizer), a topical phosphodiesterase-4 inhibitor, was approved in December 2016 in the U.S. as a safe and effective topical treatment for pediatric patients as young as 2 years old. The advent of crisaborole provides an alternative steroid-sparing agent. It will likely be available in Canada in early 2019.

Dupilumab (Dupixent®, Sanofi-Genzyme), an IL-4 and IL-13 inhibitor, was approved in the U.S. for adult patients in March 2017 and in Canada in December 2017 as the first biologic to target atopic dermatitis. Phase II trials are currently ongoing for pediatric patients from ages 12 to 17. Younger patients are being actively enrolled at numerous sites and studies will soon be underway for patients 2-12 years old. Both the effectiveness and safety of this medication are excellent, so this has been a major advance in our management of more extensive atopic dermatitis/eczema. Other biologic agents such as Nemlizumab, Tralokinumab, Lebrikizumab & Tezepelumab are on the horizon, so thankfully there are many exciting developments and options to come.

Acne is the most common skin condition in the United States. In fact, according to the American Academy of Dermatology, roughly 40 million to 50 million Americans have acne at any one time.

For many people, blackheads, whiteheads and pimples are a normal part of puberty. But for plenty of others, women in particular, acne can be a stubborn problem that occurs well beyond their teenage years.

Enter hormonal acne.

With temperatures rising and dropping sharply on a whim and harsh winds that dry us out, countered by steaming hot showers and central heating systems that try to warm us up, our complexion—and our skin—suffer.

There are many factors that influence the appearance and state of our skin; tightness, dryness, flaking, chapping, and itchiness are all various skin conditions encountered most frequently during the winter months, and should be treated separately.

Before treating your skin for anything, it’s imperative to know what it’s trying to tell you. Dry skin and dehydrated skin are very different.

Dry skin is a skin condition; often times, the skin will compensate for its dryness by producing oils, whereas dehydrated skin is caused by a lack of water; the skin feels tight and looks dull.

Staying well-hydrated is the first step to combating problematic skin and maintaining a healthy complexion.

The cold dehydrates the skin, thus making it possible for more irritants and allergens to enter, affecting its natural moisture levels. Dry skin can be caused by harsh soaps or detergents, irritating clothing fabrics, or long and hot showers. With dry skin, lack of moisture (lipid content) can cause the skin to become rough or flaky in texture.

Many with dry skin throughout the year often suffer from eczema, and can experience flare ups due to their environment. Similarly, many individuals living in harsh, cold climates experience dry skin during the colder months, making their skin tight, itchy, and flaky.

The more you scratch, the more histamine (a chemical compound that produces allergic responses such as an itch, runny nose, or sneezing) is released, causing more scratching, as well as even longer-lasting damage.

When bare hands are exposed to the cold, they are likely to become dry and chapped around the knuckles. The lack of moisture in the environment dries out the skin, and when immediately exposed to heat seconds later, can make the effects even worse.

The Toronto Dermatology Centre explained: “Areas of seriously dry skin can lead to inflammation of the skin, called dermatitis. When dermatitis is present, your dermatologist may prescribe a corticosteroid cream or ointment. The corticosteroid cream is applied to the affected areas to treat the problem.”

If your skin is suffering, thick and greasy ointments, such as petroleum jelly, form a stronger barrier than creams and lotions, and should be used as a protective barrier.

Products with ingredients like jojoba or coconut oil are rich, natural ingredients that are beneficial for dry skin. However, facial oils can add an additional level of protection and hydration to the skin when used before moisturizers, and are able to penetrate deep into the skin while still allowing it to breathe. These oils are best recommended for skin care, as opposed to heavy creams.

It is important to moisturize the entire body twice a day, every day. The water used on a daily basis should be lukewarm instead of hot, and little to no soap should be used to avoid aggravating the skin.

A cleanser is ideal—Cetaphil or CeraVe are often the most recommended brands.

While the skin is still moist, it is important to add in hydration with a cream or lotion.

Credit: Jodie Vanderslot, Excalibur

We recently donated prizes to Wellspring – “Wellspring is a network of community-based support centres offering programs and services that meet the emotional, social, practical and restorative needs of people living with cancer and those who care for them.”

Our very own Dr. Benjamin Barankin recently published in the April 2018 issue of The Dermatologist discussing at length the condition and steps for diagnosis and various treatment options for rosacea a common skin disease that causes redness, pimples, and swelling on the face.

Check out the full article:

Tamara O’Brien a Canadian trampoline athlete who was performing at the highest competitive level. She was working hard towards her dream but one day she noticed a lump in her neck and then it was as if her worst nightmare had come true. “I was profoundly dumbfounded. I thought I was dreaming. How could I have cancer? I’m 20, I’m an athlete and I’m healthy,” she said. O’Brien was diagnosed with skin cancer, melanoma, while she was in the midst of preparing for the world championships. Click here to read O’Brien’s story on how she battled skin cancer.

Credit: cbc.ca

Here’s a sobering fact: Since the 1980s, incidences of melanoma, the deadliest form of skin cancer, have doubled. “The statistics are staggering — mortality rates for melanoma are increasing faster than those for all other common cancers after esophageal cancer,” says Elizabeth Hale, a dermatologist in New York City and a senior vice president of the Skin Cancer Foundation. “Skin cancer is such a unique cancer because we know exactly what causes it — the sun’s ultraviolet rays — and we can limit sun exposure,” says Hale. Yet over the last 30 years, more people have had skin cancer than all other cancers combined, a fact as confusing as it is scary.

Click here to find out more.

Credit: allure.com