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Don’t Forget to Address Autoimmune Comorbidities of Atopic Dermatitis

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Jonathan Silverberg, MD, PhD, MPH, presented his tips for effectively treating atopic dermatitis without worsening autoimmune comorbidities.

At the 2024 Revolutionizing Alopecia Areata, Vitiligo, and Eczema (RAVE) conference in Chicago, Illinois, Jonathan Silverberg, MD, PhD, MPH, presented “Two for One: Managing Autoimmune Comorbidities of Atopic Dermatitis” during the first evening of the Revolutionizing Atopic Dermatitis (RAD)component of RAVE on June 9th. Silverberg, the conference chair of RAD, and professor of dermatology and director of clinical research and contact dermatitis at the George Washington University School of Medicine and Health Sciences in Washington, DC, addressed some of the high-level concerns regarding autoimmune comorbidities associated with atopic dermatitis.

“The whole spectrum of autoimmune disease shows up at high rates in patients with atopic dermatitis, and that even of itself is pretty thought-provoking for many dermatologists who are often thinking more about the allergic comorbidities, but don’t even address or are not aware of these autoimmune comorbidities,” said Silverberg.

Specifically in his presentation, Silverberg focused on some of the more common and therapeutically relevant comorbidities of atopic dermatitis such as rheumatoid arthritis or inflammatory bowel disease that already have approved therapies of their own.

Another important aspect of Silverberg’s presentation was the discussion of atopic dermatitis therapeutics that may worsen autoimmune comorbidities.

“We have some amazing new treatments for atopic dermatitis and precision medicine approaches. I often say to patients, ‘The strength of these medications is how precise they are, how targeted they are. The weakness of these medications is how targeted they are,’ because when you have a scenario where you're targeting one end of the immune spectrum, it's well documented this concept of either phenotypical shifting or just the idea that we shift to another end of the immune spectrum and paradoxically worsen autoimmune comorbidities. Or, if they have both, you might just be treating one aspect of their immune issues in terms of the atopic dermatitis but not the autoimmune disorders,” said Silverberg.

Silverberg stressed to the audience the importance of paying attention to which therapies can address both atopic dermatitis and autoimmune disorders simultaneously or consider combination therapies to use side-by-side to effectively treat both sides.

“Of course, that gets costly and there are all kinds of treatment nuances about combination therapy, but this becomes a very important consideration in this patient subset,” concluded Silverberg

Reference

Silverberg J. Two for one: managing autoimmune comorbidities of atopic dermatitis. Presented at: 2024 Revolutionizing Alopecia Areata, Vitiligo, and Eczema Conference; June 8-10, 2024; Chicago, IL.

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