What Are Areas of Future Research?

Research is ongoing in several areas in atopic dermatitis (AD) to improve the understanding of the disease and uncover effective treatment options.

Genetic research

Experts know that AD is caused by a combination of factors: a dysfunction of the skin barrier, environmental factors, genetic predisposition, and a dysfunction in the immune system. One of the active areas of research is studying the genetic components of AD. Many different genes are thought to contribute to the development of AD.

One of the earliest genes to be found to be important in some people with AD is the FLG gene. Through research on twins, who share the same genetic information, and families, scientists have identified more than 40 mutations to the FLG gene, which contains the instructions to create the protein filaggrin. Filaggrin plays a key role in its structure and formation of the skin, and the lack of filaggrin in people with AD leads to a dysfunction in skin barrier and an increased amount of water loss. Many children with AD later develop asthma or hay fever, and this progression of illness has been called the “atopic march.” Researchers are searching to identify which genetic mutations put a person at higher risk for atopic march, as well as which genetic mutations might increase a person’s chance of infection.

While FLG is the first identified and most well-studied gene related to AD, researchers are working to identify additional genes that contribute to the development of the condition. Through the ongoing genetic research in AD, doctors hope that uncovering the genetic causes of the disease will lead to novel approaches to treat AD.^1,2

Understanding the itch

The itch caused by AD is one of the most distressing symptoms of the condition that greatly impacts the individual’s quality of life. The itch provokes scratching, which further aggravates the skin. Scratching increases the chance of infection and can lead to lichenification, thickened skin that is always itchy. Researchers are studying the different factors that cause itch, including cytokines (chemical messengers) that stimulate the nerve and how people with AD may have skin sensitivity that causes other sensations, such as heat or pain, to be perceived as itch. Understanding the processes behind the itch sensation provides opportunities for approaches to interrupt the sensation and relieve the itch.³

New treatment options

Researchers are working to identify and develop new treatment options for AD. Some of the promising therapies include:

• Biologics are drugs that have been genetically engineered to act on specific immunological targets. Because AD is partially caused by a dysfunction in the immune system, biologics may be able to interrupt that dysfunction and improve the symptoms of AD. One biologic treatment that was recently approved by the U.S. Food and Drug Administration (FDA) for the treatment of moderate to severe AD is Dupixent® (dupilumab). Other biologics are currently in clinical trials.^4,5
• Janus kinase inhibitors, or JAK inhibitors, block the action of certain enzymes that are involved in the inflammatory process. JAK inhibitors have shown benefit in treating diseases like rheumatoid arthritis, inflammatory bowel disease, and psoriasis. JAK inhibitors are now been studied for their potential benefit in AD.^4,6

Clinical trials

Clinical trials are a type of research in which new treatments are tested on human patients. Clinical trials are an important part of the scientific process to find and prove the effectiveness and safety of new medications and treatments. The clinical trial process is long and expensive – it takes many years for a product to go through all the necessary phases, and the majority of potential treatments fail to show effectiveness to move to the next phase. In addition, many trials fail because they do not have enough participants. Regulatory agencies like the FDA require large groups of participants in trials to ensure the safety and effectiveness of therapies before they are brought to market.

If you are interested in participating or learning more about clinical trials, the U.S. National Institutes of Health has a database of clinical trials at their website ClinicalTrials.gov. The NIH site lists trials that are being conducted around the world. CenterWatch also provides a list of clinical trials in AD throughout the U.S. at www.centerwatch.com.^7,8