Abstract
Purpose of the Review
Atopic dermatitis (AD) is a paradigmatic complex disease. It displays a large spectrum in the clinical spectrum which mirrors a highly complex genetic background and immunological mechanisms. It is therefore an ideal candidate for a precision medicine approach. The implementation of precision medicine for AD is a complex development process involving numerous stakeholders. This review will concentrate on aspects of precision medicine which are of interest for the practicing physicians taking care of patients suffering from AD.
Recent Findings
The aim of precision medicine is to provide a tailored answer for prevention and newly developed treatment to ideally homogeneous subgroups of patients with AD identified on the basis of validated biomarkers. Biomarker discovery is dependent on the availability of high quality data and biobanks linked to systems biological approach. As an example, the selection of newborns with high risk to develop AD based on simple measurements opens new avenues in the prevention of this condition which represents the first step to the so-called atopic march.
Summary
The implementation of precision medicine in AD represents a long and tedious road but will ultimately provide a substantial improvement in its management.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Bieber T. Atopic dermatitis. N Engl J Med. 2008;358(14):1483–94.
• Simpson EL, Bieber T, Eckert L, Wu R, Ardeleanu M, Graham NM, et al. Patient burden of moderate to severe atopic dermatitis (AD): insights from a phase 2b clinical trial of dupilumab in adults. J Am Acad Dermatol. 2016;74(3):491–8. Interesting insight into the complex issue of patient burden in AD
Pickett K, Frampton G, Loveman E. Education to improve quality of life of people with chronic inflammatory skin conditions: a systematic review of the evidence. Br J Dermatol. 2016;174(6):1228–41.
Pustisek N, Situm M, Vurnek Zivkovic M, Ljubojevic Hadzavdic S, Vurnek M, Niseteo T. The significance of structured parental educational intervention on childhood atopic dermatitis: a randomized controlled trial. J Eur Acad Dermatol Venereol. 2015;30(5):806–12.
• Ahrens B, Staab D. Extended implementation of educational programs for atopic dermatitis in childhood. Pediatr Allergy Immunol. 2015;26(3):190–6. Practical aspects and outcome in the implementation of parent’s education
Wollenberg A, Oranje A, Deleuran M, Simon D, Szalai Z, Kunz B, et al. ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients. J Eur Acad Dermatol Venereol. 2016;30(5):729–47.
Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70(2):338–51.
• Bieber T, Straeter B. Off-label prescriptions for atopic dermatitis in Europe. Allergy. 2015;70(1):6–11. What to do in severe forms of AD. A review on the off-label medications with an algorithm for the clinical decision
Bieber T, Akdis C, Lauener R, Traidl-Hoffmann C, Schmid-Grendelmeier P, Schappi G, et al. Global Allergy Forum and 3rd Davos Declaration 2015: Atopic dermatitis/Eczema: challenges and opportunities toward precision medicine. Allergy. 2016;71(5):588–92.
• Galli SJ. Toward precision medicine and health: opportunities and challenges in allergic diseases. J Allergy Clin Immunol. 2016;137(5):1289–300. An excellent review to the subject of precision medicine and its application in allergy
Bieber T. Stratified medicine: a new challenge for academia, industry, regulators and patients. London: Future Medicine; 2013.
Hodson R. Precision medicine. Nature. 2016;537(7619):S49.
Bieber T. Concept and scientific background of personalized medicine. In: Bieber T, Nestle FO, editors. Personalized treatment options in dermatology: Springer; 2015.
Jameson JL, Longo DL. Precision medicine—personalized, problematic, and promising. N Engl J Med. 2015;372(23):2229–34.
Spear BB, Heath-Chiozzi M, Huff J. Clinical application of pharmacogenetics. Trends Mol Med. 2001;7(5):201–4.
Bieber T, Bussmann C. Atopic dermatitis. In: Bolognia JL, Lorizzo JL, Schaffer JV, editors. Dermatology: Mosby; 2012. p. 203–216.
• Bieber T. Personalized management of atopic dermatitis: beyond emollients and topical steroids. In: Bieber T, Nestle FO, editors. Personalized treatment options in dermatology: Springer; 2015. The first contribution addressing the issue of precision medicine in AD.
• Bieber T, D’Erme AM, Akdis C, Traidl-Hoffmann C, Lauener R, Schäppi G, et al. Clinical phenotypes and endophenotypes of atopic dermatitis: where are we and where should we go? J Allergy Clin Immunol. 2017; The state of the art in the definition of clinical phenotypes and biomarker discovery
Ardern-Jones MR, Bieber T. Biomarkers in atopic dermatitis: it is time to stratify. Br J Dermatol. 2014;171(2):207–8.
Thijs J, Krastev T, Weidinger S, Buckens CF, de Bruin-Weller M, Bruijnzeel-Koomen C, et al. Biomarkers for atopic dermatitis: a systematic review and meta-analysis. Curr Opin Allergy Clin Immunol. 2015;15(5):453–60.
Bieber T. How to define atopic dermatitis. Dermatologic Clinics. 2017.
Bieber T. Atopic dermatitis 2.0: from the clinical phenotype to the molecular taxonomy and stratified medicine. Allergy. 2012;67(12):1475–82.
• Noda S, Suarez-Farinas M, Ungar B, Kim SJ, de Guzman SC, Xu H, et al. The Asian atopic dermatitis phenotype combines features of atopic dermatitis and psoriasis with increased TH17 polarization. J Allergy Clin Immunol. 2015;136(5):1254–64. Pioneer work on the immunological mechanisms of AD in different ethnic populations
Simpson EL, Chalmers JR, Hanifin JM, Thomas KS, Cork MJ, McLean WH, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014;134(4):818–23.
Horimukai K, Morita K, Narita M, Kondo M, Kitazawa H, Nozaki M, et al. Application of moisturizer to neonates prevents development of atopic dermatitis. J Allergy Clin Immunol. 2014;134(4):824–30. e826
Kelleher MM, Dunn-Galvin A, Gray C, Murray DM, Kiely M, Kenny L, et al. Skin barrier impairment at birth predicts food allergy at 2 years of age. J Allergy Clin Immunol. 2016;137(4):1111–6. e1118
• Bieber T, Vieths S, Broich K. New opportunities and challenges in the assessment of drugs for atopic diseases. Allergy. 2016;71(12):1662–5. A perspective review on the future challenges in drug development in allergic diseases from a regulatory point of view
Acknowledgments
Thomas Bieber is supported by the Christine Kühne-Center for Allergy Research and Education (CK-CARE).
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This article is part of the Topical Collection on Atopic Dermatitis
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Bieber, T. Atopic Dermatitis 2.0: the Long and Tedious Road to Precision Medicine. Curr Derm Rep 6, 144–148 (2017). https://doi.org/10.1007/s13671-017-0172-y
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DOI: https://doi.org/10.1007/s13671-017-0172-y