New Eczema Drugs To Use or Not to Use



Topical immunomodulators (TIMs), the first new class of drugs in over 40 years to treat eczema, were hailed as revolutionary treatments when they were first marketed a few years ago, offering new hope to the 15 million Americans suffering from this chronic, unsightly skin condition. Today, however, these miracle prescription creams are under assault because of data suggesting they may increase the risk of cancer.

"TIMs are the first drugs that effectively target the diseased skin and not just the symptoms of eczema," says Joshua Fox, MD, a leading dermatologist and founder of Advanced Dermatology and The Center for Laser and Cosmetic Surgery. "They also don't contain corticosteroids, which are the standard treatment for eczema but can suppress the immune system and have other side effects like thinning or lightening of the skin."

Two TIMs have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of eczema: Protopic (tacrolimus) ointment and Elidel (pimecrolimus) cream. The drugs, which were available orally before they were developed as topical treatments, interfere with the immune reaction that leads to eczema.

In large clinical trials conducted all over the world, the drugs have been found to significantly relieve eczema symptoms and improve the appearance of the skin, with fewer side effects than corticosteroid creams. "We were excited about these new therapies until the FDA issued an advisory in March of 2005 warning that animal tests have shown an increase in cancer with use of TIMs," says Dr. Fox. The doses used in those studies were 30 times higher than those typically given to humans, but a small number of skin cancers and lymphomas have also been found in children and adults who used TIMs, but it does not seem to be more than would be statistically expected.

So what's a patient to do This situation might be similar to that faced by arthritis patients using the COX-2 pain relievers Vioxx, Bextra and Celebrex. "These were the only drugs out there that worked for many people, yet they were shown to increase the risk of cardiovascular disease. Although Vioxx and Bextra have been taken off the market, some people are choosing to continue taking Celebrex despite the risks. Each person and his or her doctor have to assess the benefits and risks of a certain drug for that individual. Unlike the above situation TIMs have not been proven to have increased risk-only a suggestion of possible increased risk, " Fox adds.

Until more is known about any real link to cancer 8212;and researchers are actively studying the potential link, although it may take a decade before they know definitively 8212;Dr. Fox advises patients to follow the recommendations of the FDA:

·          Reserve Elidel and Protopic as last-resort treatments.

·          If other drugs fail to control your symptoms or you can't tolerate them, talk to your dermatologist about using Elidel and Protopic for a short period of time and/or intermittently. "We don't advise that you use the drugs continuously or for extended periods of time until we know more about their long-term safety," says Dr. Fox.

·          Use the lowest doses needed to control your symptoms.

·          Don't use TIMs if you have a weakened or compromised immune system or have a history of lymphomia or leukemia. Also, the drugs shouldn't be used by children younger than two years of age because the data aren't clear regarding the effects of TIMs on the developing immune system (almost 500,000 of the nearly 2 million perscriptions for these topical medications between June '03 and May '04 were for children under 2 years of age).

What is eczema

Eczema is a chronic skin condition that inflames the skin, causing pain, itching, dryness, swelling, cracking, weeping and scaling. Skin infections can occur if bacteria invade the skin lesions. Eczema can affect any part of the body, but typically occurs on the face and neck, and the insides of the elbows, knees and ankles in children and adults. The unsightly appearance of eczema scales can lead to depression and a loss of self-esteem.

According to the American Academy of Dermatology, about 15 million Americans suffer from eczema. It affects about one-fifth of school-age children, 60% of whom continue to wrestle with the disease in adulthood.

Bio: Joshua L. Fox, M.D., F.A.A.D.
Joshua L. Fox, M.D. is a leading authority in the field of dermatology with an expertise in skin cancer, cosmetic surgery, and laser procedures. As an official spokesperson for the American Academy of Dermatology and the American Society of Dermatologic Surgery, Dr. Fox has been an expert resource on dermatologic topics for numerous television networks including ABC, CBS, CNN, NBC, Telemundo, talk shows, radio stations, newspapers and magazines. Dr. Fox has served on the board of the National Rosacea Foundation and has done clinical trials in both medical and laser therapy in Rosacea. He has received multiple research and clinical awards including recognition from Top Doctors, Who s Who, Journal of Dermatologic Surgery and Oncology, Community Service Award from the American Society of Dermatologic Surgery, the prestigious Husic Award as well certificates of recognition for service from multiple hospitals, civic, educational and community organizations. Dr. Fox has authored and presented papers of his research on lasers, cosmetic procedures, stretch marks, scars, skin cancer, bug bites, photosensitivity and various rashes.

As founder and director of Advanced Dermatology and The Center for Laser and Cosmetic Surgery, Dr. Fox and associates have expanded the practice to the one of largest in dermatology, laser & cosmetic surgery with more lasers than any hospital or dermatology practice on the eastern coast. Dr. Fox is a graduate of the New York University Medical Center of Skin and Cancer and has been on the advisory board of the Psoriasis Foundation and National Rosacea Foundation among others. He has also been a fellow of many societies including the International Academy of Cosmetic Surgery, International Academy of Cosmetic Dermatology, and the Society for Investigative Dermatology. Dr. Fox is the founder of the AAD Melanoma/Skin Cancer Prevention Program in Queens, New York since 1987. Dr. Fox has been Chief of Dermatology of several major teaching hospitals including Mt. Sinai Hospital of Queens and Jamaica Medical Center and is currently on the staff of ten NY area hospitals. Dr. Fox and Advanced Dermatology the Center for Laser & Cosmetic Surgery have been used as a resource center educating dermatologists, laser surgeons, & cosmetic surgeons and others about lasers, cancer and cosmetic surgery. www.advancedd.com





New Eczema Drugs To Use or Not to Use