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Dermbits

Do you support dupilumab for all of the AD spectrum conditions if moderate-to-severe and failing?

Atopic Dermatitis

Yes, I think this is a great question, and one of the nice things about our diagnosis and our diagnostic criteria that are often used for atopic dermatitis by George Reich and John Hannifin. These are wonderful criteria because they really only ask three things. It has to be itchy, it has to be chronic or relapsing, and it has to be basically in the pattern and distribution of one of the known forms of eczema. So that gives us a really big way to think about this, and it gives us a lot of leeway. So I would argue that, definitionally, the spectrum of ad really is all part of AD. It's not necessarily just the perfect, I guess, the erythematous scaly patches in the elbow creases. Right. Just those anacubidal or papatel faucet. That is not just ad, it's much bigger than that. But I will freely admit that the spectrum can be bigger than some people are comfortable with, because. Do you include pragonodularis? Most people don't. They think prigonodularis is a separate condition, but of course it can have prigonodules in ad context. I have many patients like that, but some clinicians I've met, even really seasoned ones, say, no, it's the same thing. It's all part of the same. It's ad fascinating. Other ones that can be a little bit different, I think dyshydratic eczema, quite different. Sometimes just localized to the hands, little blisters. Is that part of the spectrum? I think, largely speaking, yes. But again, I can also see why splitters might say we should separate that out. And even things like separate dermatitis are sometimes included under the general subheading of eczema. But we really think of that as quite different. That being said, of the things that really fit into the spectrum and subderm would not fit into my concept of the ad spectrum. I find that dupliumab has worked great for all of these diseases. It's a little bit funny, it's bittersweet, because in the very beginning, I think a number of us were excited about using it as a tool to help figure out which ones are different. Maybe we'd say, well, what if certain subtypes respond beautifully and others don't respond at all? Then we'd say, wow, they're not mediated by Il four and Il 13. They're really different. The latin term for this is diagnosis ex uventibus. You can make a diagnosis by what's helping. So if the dupliumab helped, then we know. Well, it turns out it does really well across the whole spectrum. So I guess they're all pretty related. And now we have it FDA approved for paragonodularis as well. And even other things coming down the line, there's discussion about bullis, penfagoid and even things like chronic rhodicaria, so these may be more connected than we understand.