One in 10. That’s the number of people in the U.S. who have some degree of atopic dermatitis (AD), an astoundingly common inflammatory skin condition commonly known as eczema. And as anyone who happens to be that one in 10 knows: This condition isn’t easy to ignore.
Characterized by scaly, itchy patches that can be pink, red or darker depending on a person’s skin tone, eczema can also cause broken and/or oozing skin that is prone to infection, often caused by relentless scratching. “The itching can be unbearable,” says Emma Guttman-Yassky, M.D., Ph.D., Director of the Center for Excellence in Eczema and the Laboratory of Inflammatory Skin Diseases at the Icahn School of Medicine at Mount Sinai. “Patients say it’s like having poison ivy all over their body.”
Up to a third of people with AD have moderate to severe disease, meaning more than 10% of their skin is affected. And “although some patients may have effective management of their disease, there still remains a need for those with moderate to severe disease who are not reaching remission,” says Lloyd Miller, M.D., Ph.D., Vice President, Translational Science & Medicine, Global Immunology, Johnson & Johnson Innovative Medicine.
For many years, eczema was primarily viewed as a cosmetic disease, but it goes way beyond the skin.
With two recent acquisitions, Johnson & Johnson has made a significant investment in research in this space. “Aligned to our immunology pathway approach, these additions have brought multiple investigational therapies into our research pipeline.”
One reason for the difficulty in managing eczema is that rather than having one specific cause, eczema is thought to have “multiple disease-driving pathways,” says Dr. Miller, meaning that a number of things are going awry in the body at once, which can make it difficult for patients to manage their condition.
“The causes are multifactorial,” he explains, and can include genetic mutations as well as environmental factors. “We know that certain people with atopic dermatitis have genetic mutations that affect the integrity of the barrier of the skin, causing inflammation. That makes it easier for things to get into the skin that normally would not—whether it’s allergens and other irritants from the environment or bacteria that live on the skin’s surface.”
Worse yet, the number of people with eczema is increasing—by as much as two or three times in the last three decades—making the search for additional effective treatment options all the more urgent. “For people with severe disease, there continues to be ongoing research for potential additional treatment options for eczema,” says Dr. Guttman-Yassky.
Keep reading to learn more about this pervasive skin condition—and how Johnson & Johnson is working to help the millions across the globe who are living with it.
1.
“For many years, eczema was primarily viewed as a cosmetic disease, but it goes way beyond the skin,” says Dr. Guttman-Yassky. Multiple studies, including some done in her lab at Mt. Sinai, found that the condition is associated with immunological abnormalities, increased inflammatory markers in the blood, hypertension and a heightened risk of cardiovascular problems. And nearly 30% of people with eczema also have asthma, according to a 2021 report in Asthma Research and Practice.
What’s more, patients frequently feel self-conscious because of broken or oozing skin. “Atopic dermatitis can appear on the face and hands—essentially your calling cards when it comes to socializing with others,” says Dr. Guttman-Yassky. “So appearance really becomes an issue.”
2.
The itching caused by eczema can be so intense that it not only leads to skin pain and bleeding from all the scratching, but it keeps patients up at night—often in agony. “We see sleep disturbances in many of our atopic dermatitis patients,” says Dr. Miller. “That can lead to stress, anxiety, depression and even an increased risk of suicide.”
A study of more than 11,000 children, published in 2021 in JAMA Dermatology, found that those with severe eczema had two times the risk of depression. Just as troubling, another review of research in JAMA Dermatology found a 44% increase in the risk of having suicidal thoughts and a 36% increase in suicide attempts compared with people who didn’t have the skin condition.
3.
As important as moisturizing is for infants with eczema, it’s just as crucial for adults. “Moisturizing should be part of every patient’s skincare routine,” says Dr. Guttman-Yassky.
It’s also crucial for children and adults with eczema to avoid putting potentially irritating or allergy-inducing products on the skin. “That means staying away from products with fragrances, harsh soaps and detergents—the fewer ingredients the better.”
Also important: limiting hot showers and time spent in swimming pools or hot tubs, since a dry environment can exacerbate symptoms—as can anything that is drying to skin. Common allergens such as dust mites and pollen can also make the condition worse.
4.
Eczema is especially common in babies and young children—as many as 25% of children have it and an estimated 60% of people with the condition develop it during their first year of life.
“We used to think kids outgrew it, but now we know that if you have had eczema at some point in your life, it can come back,” says Dr. Guttman-Yassky. “Anything that promotes an inflammatory environment can trigger it, including stress, excessive sweating or a virus like COVID-19.”
But treating infants early on can make a difference; specifically, it’s important to restore the barrier of the skin with regular moisturizing, she adds.
“Some studies have shown that if you start regularly using an emollient on babies who have a family history of the condition, the incidence of developing AD is reduced by almost 30%,” says Dr. Miller. That, in turn, might help prevent other conditions that seem to go along with eczema, including asthma and seasonal and food allergies.
5.
The latest research on what triggers eczema has led to certain immune molecules known as cytokines, which are protein-like substances that create an immune response in the body. But with eczema, specific cytokines—namely, interleukin-4 (IL-4), IL-13 and IL-22—become overactive, leading to inflammation, rash and itch associated with the condition.
“We now have treatments that go after these immune molecules—some are approved, and others are being investigated for potential use,” says Dr. Guttman-Yassky.
Most of these initial advanced therapies are believed to work by blocking IL-4 and IL-13, targeting the type of overactive immune response known as type 2 inflammation. “They reduce the symptoms and the rash and itch,” says Dr. Miller.
Other newer approved therapies include what’s known as Janus kinase inhibitors that also work to reduce inflammation.
The newer investigational therapies in the pipeline at Johnson & Johnson are bispecific antibodies, which are believed to target two distinct immune pathways at the same time. Other therapies in development may also help prevent the incidence of asthma along with eczema, he adds. “In the future, we’ll be leaning into these bispecific approaches that are believed to target more than one driver of the disease in a very precise way.”
Says Dr. Guttman-Yassky: “It’s a very exciting time for those of us in the field—and for patients, too.”
