2) The landscape for treatment of #Atopic #Dermatitis (#AD) is rapidly changing! In this program I'll provide #physicians #physicianassociates #nurses #nursepractitioners #pharmacists an overview of what modalities exist to the treatment of #eczema!
— @derm_ce (@derm_ce) April 27, 2022
4) This program is supported by educational grants from Pfizer & InCyte. Faculty disclosures at https://t.co/UB9pTq270E and is intended for healthcare providers. Please FOLLOW US and let's build a new #CME/CE network: #physicians #physicianassociates #nurses #pharmacists
— @derm_ce (@derm_ce) April 27, 2022
6) If you answered “Th2,” you’re correct! Psoriasis is the one we think of as a prototypical eruption from the Th17 pathway. This is important because as we move more into AD treatment, Th2 targeting drugs have shown efficacy for AD.
— @derm_ce (@derm_ce) April 27, 2022
8) #AD occurs from a combo of:
👉Skin inflammation (#Th2 pathway)
👉Skin barrier dysfunction
👉Infection/other triggers
Successful treatment can target any of these to break the cycle of AD, but treating multiple arms can be helpful.
(fig from 🔓https://t.co/KkPBxAvraN) pic.twitter.com/Vtvc8wCFV2— @derm_ce (@derm_ce) April 27, 2022
10) AD skin gets superinfected easily. Treatment of superinfection or colonization with antibiotics (topical or even oral prn) can help break a flare/cycle. In some cases, we will also use bleach baths. 🔓https://t.co/dyVhheCUK3
— @derm_ce (@derm_ce) April 27, 2022
12) Non-steroidal topicals include the calcineurin inhibitors (#CNI), such as topical #tacrolimus, and #pimecrolimus. Topical #PDE4 inhibitors (#crisabarole) are also used. Most recently, topical #JAK inhibitors have shown up, namely topical #ruxolitinib. pic.twitter.com/IUQzvy7yCM
— @derm_ce (@derm_ce) April 27, 2022
14) #Phototherapy is generally well tolerated. The main AEs include skin burn, a long term risk of skin cancer, and the theoretical risk of activating a photosensitive condition (eg: #lupus). In normal practice, skin dryness and burning occurs.
— @derm_ce (@derm_ce) April 27, 2022
16) Additionally, the use of #methotrexate is tried and true and is perhaps less immunosuppressive. Methotrexate can look scary when you read about it online, but the doses we use are tiny compared to the chemotherapeutic range. pic.twitter.com/ze1dyLxPU9
— @derm_ce (@derm_ce) April 27, 2022
18) Dupilumab blocks #IL4 and #IL13 (#Th2 pathway), and so there is a theoretical risk of parasitic infections. Herpetic infections and eye irritation have been reported as AEs. Also, injection site reactions can always occur with biologics.
Figure from https://t.co/kueajJvzYa pic.twitter.com/1txolQzSVM— @derm_ce (@derm_ce) April 27, 2022
20) Per https://t.co/rhbMGtZlWQ, topical & systemic Janus kinase (JAK) inhibitors are effective for mild-to-moderate AD with minimal treatment-emergent adverse events. Janus kinases are a family of protein tyrosine kinases that interact with cytokine receptors.
— @derm_ce (@derm_ce) April 27, 2022
22) While JAKi's are the next big step in #AD treatment, a recent paper in @NEJM reported ⬆️CV events & cancer in patients treated w/#tofacinitib (albeit, this was in RA patients). A good reminder that these are NEW medications and we’re still learning!https://t.co/2nI4av5ugW pic.twitter.com/9cihGWr60H
— @derm_ce (@derm_ce) April 27, 2022
24) Before I let you go, one last question for the crowd. Which one of the following factors is NOT considered critical in the pathophysiologic pathway ➡️AD? Please VOTE
— @derm_ce (@derm_ce) April 27, 2022
26) And that's it! You have completed the FIRST EVER #tweetorial from @derm_ce. You can snag your certificate for CE/#CME at https://t.co/dqLMlzCxrU. I am @DrStevenTChen and FOLLOW US for more CE/CME by #tweetorial!
— @derm_ce (@derm_ce) April 27, 2022
27) @RoxanaDaneshjou @MishaRosenbach @HarkerDavid @DrJohnBarbieri @ilanarosman @DrEstherFreeman @SBowersMD @DrShadi_ @DewanAnnie @AshleyWysongMD @ElenaHawryluk @JosephMerolaMD @patchtestyu
— @derm_ce (@derm_ce) April 27, 2022
