Peter Lio, MD: Itch Tales and Dietary Triggers of Atopic Dermatitis

At the American Academy of Dermatology (AAD) 2023 Annual Meeting, held March 17-21, in New Orleans, Louisiana, Peter Lio, MD, FAAD, is conducting various sessions exploring standard and alternative therapies, in the treatment of atopic dermatitis. He gave Dermatology Times® some pearls he hopes attendees at his sessions walk away with.

Transcript:

Peter Lio, MD, FAAD: My name is Peter Leo, I am a clinical assistant professor of dermatology and pediatrics and also the founding director of the Chicago Integrative Eczema Center in Chicago, Illinois. One of the big hot topics right now is itch; I think we are in a state that I like to call the virtuous cycle of drug development. We are learning more about the underlying disease from new treatments, which then allow us to get better treatments and so on. So we're actually watching this happen in real-time. I think we now understand the role of in particular IL-4 and IL-13, and what's sometimes called the master itch, cytokine, IL 31. All of these are playing an important role in itch. And so there are a number of treatments that are both existing and on the horizon that I think are going to help us better understand and treat itch, because it's just a huge issue for not only atopic dermatitis, that's where I encounter it most, but also in prurigo nodularis. Also, in some metabolic diseases, things like lichen simplex chronicus, there's a whole range where people are really uncomfortable. I also think there is an open door, though, for alternative approaches. And that's part of what we get into is this idea that sometimes the kind of conventional medicines are not going to be the right choice. But for some patients, who are not responding to those conventional therapies, or they're not able to take them for whatever reason, sometimes it can be due to a potential adverse event or even access to some of those new treatments, they're very fancy, but they're also expensive. So we have this balance we have to achieve. Sometimes we can use things that are thinking out of the box. And there are a number of alternative and kind of complementary approaches that we can use everything from hypnosis, which can be a powerful way to help deal with some of the repercussions of itch, and then kind of mental affective itch to acupuncture and acupressure, which I've actually personally studied a little bit. And there are some fascinating things there, too, a variety of different supplements and topical preparations that can be helpful. Now, I don't know if any of these are going to be at the same level as the more powerful biologic drugs that we're talking about and systemic agents, but they can play a role for some people. So we kind of delve into some of those things during the session. One of the most common questions I get asked with respect to atopic dermatitis is about diet. And sometimes this happens at the end of a long visit, I'm perspiring, we've gone over all the different treatment stuff, the risks, and benefits; we've made a shared decision-making approach to picking their therapy. And then at the very end, you know, I'm ready to leave to go to see the next patient and they ask about diet. It's so tough because it really is a complex area. And we know, of course, that food allergies are intimately related to atopic dermatitis, but are not the same thing, right? They're a different pathway of the immune system. And we know that there are certain individuals for whom foods are a trigger. But it's complicated because there are so many different types of reactions that foods can do everything from just causing irritation on the skin. So little kids and toddlers are eating food, they make a mess and they get more food on their skin than in them. And we know that if you're eating something like citrus or tomato, that can irritate your skin. So we wouldn't call that an allergy. We wouldn't say that the food is making your eczema, but it certainly makes it worse, and certainly plays a role. Then we have people with example, celiac disease, right? We know those patients can have a skin manifestation called dermatitis herpetiformis to gluten, that's real, but that's different to that's not a topic DERM those are usually micro blisters, extremely itchy, though, can be confusing. And then we have people that have type one allergy. So these would be the things that are like anaphylaxis, angioedema, urticaria, and those are really important food allergies to the kind of true food allergies but again, that's not atopic dermatitis. Now, maybe they could trigger it if you ate. Let's say you're allergic to peanuts and you eat some and you get hives and you start scratching. Yeah, I suppose that could trigger a flare-up, but that's usually not what patients mean. Then we have this very murky area that I think is fascinating about inflammatory foods. What about just eating things that are pro-inflammatory in the body and this might include things like highly processed foods; foods with a high glycemic index like some dairy products seem to be a little bit pro-inflammatory in some people, and we even have mechanisms whereby this might be working. So that's another aspect. And that also may help us understand why, when people make drastic or dramatic dietary changes, many times they get better. And part of it may be just that they're getting rid of some of these pro-inflammatory foods. So all of that makes it very, very tricky to do as a sort of, "by the way" moment, when you're about to leave the room. It really does take some thoughtful history and really digging in. And the truth of the matter is, I think more than anything else is that for the majority of patients, the diet is generally not going to make or break things, it's going to be a secondary thing that we can rely on. But I often say why don't we do the big things first and see where we're at. And then at the follow-up visit, we can really delve into that, especially if we're not happy.

This transcript has been edited for clarity and length.

Lio is presenting "Itch Tales: Looking Beyond Atopic Dermatitis" on Sunday, March 19 from 1:00 PM - 3:00 PM at New Orleans Theater C, and "Dietary Triggers adn Modificaitons of Common Dermatologic Conditions: An Evidence Based Approach" on Monday, March 20 from 3:30 PM to 5:30 PM in New Orleans Theater A.

Sign up here to receive news and updates from the meeting from Dermatology Times.