Can Nanotechnology Deliver on the Promise of Personalized Atopic Dermatitis Treatment?

🔍 Key Finding This review explores current understanding and approaches to atopic dermatitis, highlighting the interplay of genetic predisposition, environmental factors, and immune dysregulation in its pathogenesis. It also discusses recent therapeutic advances, including nanotechnology-based drug delivery systems, and emphasizes the need for personalized treatments and further biomarker research.

🔬 Methodology Overview

• Design: Comprehensive narrative review
• Data Sources: PubMed, Google Scholar, and ScienceDirect databases
• Scope: Atopic dermatitis (AD), encompassing its immunological aspects, pathogenesis, conventional and novel treatments, and the role of nanotechnology in drug delivery.
• Analysis Approach: Qualitative synthesis of current understanding and approaches to AD management. The review integrates information on the skin’s immunological role, genetic and environmental factors influencing AD, and the mechanisms underlying its pathogenesis. It also discusses established and emerging treatments, highlighting the application of nanotechnology in drug delivery.

📊 Results

• AD affects about 20% of children and 1-3% of adults, with a higher prevalence in females.
• AD was ranked 1st in global burden of disease among skin diseases (measured in disability-adjusted life years) from 1990-2017.
• Children have a 40% increased risk of developing AD if one parent has an atopic disease, and a 60-80% risk if both parents have atopic diseases.
• Filaggrin (FLG) gene mutations are a predisposing factor for AD, particularly in Europeans and Asians, but not Africans.
• Topical corticosteroids and calcineurin inhibitors are common treatments, with nanotechnology improving delivery and efficacy.
• Dupilumab, targeting IL-4 and IL-13, is an effective biologic therapy, but conjunctivitis is a common side effect (28%).
• Etrasimod, an oral S1P receptor modulator, showed improvement in some AD symptoms but did not meet the primary outcome of EASI-75.

💡 Clinical Impact Nanotechnology offers promising advancements in atopic dermatitis treatment by enhancing drug delivery and efficacy of topical and systemic therapies, potentially improving patient adherence and outcomes. This may lead to more personalized treatment strategies and improved disease control for individuals with moderate-to-severe atopic dermatitis.

🤔 Limitations

• Limited long-term safety data for JAK inhibitors.
• Many conventional immunosuppressants showed low-certainty evidence.
• Few studies addressed patient-reported outcomes.
• Limited data on serious adverse events in shorter trials.
• Systemic therapies predispose patients to kidney or liver dysfunction.
• First-generation antihistamines have sedative characteristics.
• Topical corticosteroids may cause striae, atrophy, or skin thinning.
• Topical calcineurin inhibitors can cause skin burning and itching.

✨ What It Means For You Doctors should consider a patient’s individual sensitization profile, genetic background (like FLG mutations), and environmental factors when diagnosing and managing atopic dermatitis. Nanotechnology-based drug delivery systems offer promising advancements in topical treatments by improving drug penetration and retention, potentially reducing side effects and enhancing efficacy of corticosteroids and calcineurin inhibitors. Further research into biomarkers and personalized therapies is needed to improve diagnosis, treatment, and potentially prevention of atopic dermatitis.

Reference Afshari M, Kolackova M, Rosecka M, Čelakovská J, Krejsek J. Unraveling the skin; a comprehensive review of atopic dermatitis, current understanding, and approaches. Frontiers in Immunology. 2024;15:1361005. https://doi.org/10.3389/fimmu.2024.1361005