When Allergens Come Marching In: A New Study Takes Aim At Halting The Atopic Dermatitis March

For many of us, the term "march" conjures up images of a well-dressed band rallying around the football field at halftime or perhaps toy wooden soldiers, with their knees held high, in the Nutcracker suite. However, dermatologists may have a different association with the word. To them, march signifies the atopic march or the allergic response that starts with dry, itchy skin and often moves to the nose as hay fever and then to the lungs as asthma.

Often, dry itchy skin a.k.a atopic dermatitis or eczema is the first sign that a person is destined to a lifetime of allergies. In fact, up to 80% of children with eczema go on to develop allergic asthma and rhinitis (hay fever).

Not for long.

A recently initiated six-year study led by a prestigious team of researchers at the National Jewish Hospital and Research Center in Denver, CO will look at whether treating eczema early in life can stop the march before it starts.

In this study dubbed SAM (Study of the Atopic March), 1,100 infants with eczema will receive either a steroid-free cream, called Elidel, or a placebo cream at the first sign of eczema. Infants aged 3-18 months are currently being recruited at 20 centers in the US.

After three years, researchers will look to see who got what cream and to what avail. Then all participants will receive Elidel until the 6-year study period is up.

The main goal is to see whether the children receiving Elidel end up developing fewer cases of asthma. If this does not occur, the researchers are hoping that the results will show that this cream is a safe alternative for babies rather than the gold standard of steroid creams.

Other signs of allergic sensitivity such as food allergies, allergic rhinitis, allergic conjunctivitis and levels of the immune antibody IgE (which is found in high levels among 80% of kids with eczema) will also be evaluated.

While still considered the treatment standard for eczema, steroid creams can have side effects such as thinning of the skin, easy bruising and an increased risk of infection. These side effects are even more common when used in high potency formulations for an extended period of time, such as when treating eczema. Additionally, people using steroids can become resistant to them, and as a result, may require larger doses for the same relief.

Currently, two new non-steroid treatments known as topical immunomodulators, Elidel and Protopic, work by producing anti-inflammatory effects on the skin presumably without interfering with the immune system.

Elidel's safety in infants less than two years of age has yet to be determined. There are some concerns because, in theory, suppressing the immune system in any fashion could potentially leave infants more vulnerable to such infections as chicken pox.

There's no need to sit idly by while this study is being conducted, there are a lot of things that parents can do to soothe their child's eczema NOW:

Avoid hot showers, which dry out the skin. Opt for luke-warm water instead.

Avoid bubble baths and anti-bacterial soaps, because they can dry out skin even further. Choose gentle, moisturizing, fragrance-free soap such as Cetaphil Gentle Skin Cleanser or Vanicream Cleansing Bar.

Moisturize within three minutes of bathing or showering using only fragrance-free moisturizing creams or ointments such as Vanicream Moisturizing Skin Cream, 4 oz, PRIORI Advanced AHA Barrier Repair Complex, or Moisturel Therapeutic Cream.

Avoid extra ingredients in skin care products even if they are billed as "all-natural." Avoid fragrance and dyes. Read labels to make certain they are labeled as such. Additionally, labels should state they have been allergy and dermatologist tested and approved. The phrase "hypoallergenic" is unregulated and medically meaningless.

Avoid wool and choose much less irritating 100% cotton clothing.

Denise Mann
DERMAdoctor Staff Writer

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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