Satisfy An Itch

Novel medication eases unbearable eczema symptoms.

Joan Cutoneon the golf course posing with her club on her shoulder

Joan’s dry skin is gone, and she can safely enjoy the Florida sun

Joan Cutone raised four healthy sons. It seemed natural for her to follow that up by caring for other people’s children. She ran a day care and nursery school for 21 years.

“I really enjoyed that,” Joan shares. “Working with children can be delightful, just interacting with them and seeing things through their eyes. In some ways, children are easier to work with than adults.”

Today, Joan is 73, retired and living in North Port, where she enjoys a very active lifestyle. But a skin condition she’s had since her youth complicated her activities.

“I’ve had eczema all my life,” Joan shares. “The older I got, the more pronounced and troublesome it became. There’s not one part of my body that’s not affected by it. My skin was extremely dry and itchy, and the medications I used for the eczema exacerbated it.

“My husband and I take two- to three-mile walks every day. We play golf and I started rowing crew when I was 60 years old. It got to the point that if I wanted to be out in the sun, I had to be covered head to toe. When I golfed, I wore sun protective tights and a baseball hat with shields that covered my face. It can be overwhelming being dressed like that outside in the Florida heat.”

Joan tried multiple creams and ointments to alleviate her eczema because she likes being outdoors, but none ever cleared her skin or eased the dryness and itch. Joan’s eczema also interrupted her sleep, and she broke out in an eczema rash when she ate certain foods.

“I was vigilant about putting cream on my skin before I went to bed, but it didn’t really help,” she elaborates. “My legs would burn during the night, and I’d always be throwing off the covers.

On a recommendation from her sister-in-law, Joan went to Alla Gruman, MD, a board-certified dermatologist at Family Dermatology in Osprey. During an initial examination, Dr. Gruman confirmed Joan was suffering with atopic dermatitis, commonly known as eczema.

“Approximately 70 percent of Joan’s body was affected,” Dr. Gruman reports. “She had some of the dermatitis rash on her face as well. It was itchy, caused sleep disturbances and was having a significant impact on Joan’s function and quality of life.”

Cloned Immune Cells

Atopic dermatitis is an extremely common and chronic inflammatory disease of the skin, Dr. Gruman educates. Some studies report up to 10 percent of adults and up to 20 percent of children in developed countries suffer with it. The cause is unknown, but there are two hypotheses explaining its development.

“The first is called the pathogenic hypothesis, which points to a genetic epidermal barrier defect,” Dr. Gruman details. ”This hypothesis is supported by findings that a certain gene mutation predisposes individuals to developing a defective epidermal barrier.”

The second hypothesis involves abnormal characteristics in the skin’s epidermal layer that are initiated by the increased expression of cytokines, molecules that enable cells to communicate with one another. According to this hypothesis, inflammatory cytokines cause the epidermal abnormalities and resulting skin lesions of atopic dermatitis.

“The effect of atopic dermatitis on the patient is tremendous,” Dr. Gruman explains. “It interferes with sleep and social performance and causes anxiety. Multiple studies show it leads to depression as well, so it has a major impact on quality of life.

“Atopic dermatitis disturbs sleep when patients wake up at night to scratch itchy, dry skin. As a result, they are tired during the day, which can impact job and social performance. Children who don’t sleep at night due to itching disturb their parents, who must perform the following day. It creates a vicious cycle.”

The main factor when treating atopic dermatitis is to support the skin barrier, Dr. Gruman stresses.

“We begin treatment using emollients, skin moisturizers to restore the skin barrier, and over-the-counter medications,” the dermatologist divulges. “In advanced cases, we use topical corticosteroid creams or immunomodulators, a cream that does not contain steroids.”

When the disease does not respond to topical treatments, Dr. Gruman sometimes recommends systemic therapy, which involves medications that affect the entire body.

“Dupixent started to work for me within two weeks… and it’s been life-changing.” – Joan

“Multiple systemic therapies have been available over the years, but a new one was introduced and approved by the Food and Drug Administration in 2017,” Dr. Gruman observes. “It’s an injectable medication called dupilumab, brand name Dupixent®.

“Dupixent is the first monoclonal antibody medication for atopic dermatitis. Its cloned immune cells block the signaling of the pro-inflammatory cytokines that are implicated in atopic dermatitis. Its action is more targeted. It lasers in on the specific defect and attacks the specific cells responsible for the disease.”

Dupixent is injected every two weeks. Initially, the injections are delivered by Dr. Gruman at her office so she can monitor the patient’s reaction to the medication. If the medication is tolerated well, patients can give themselves subsequent injections at home.

“Atopic dermatitis is a chronic condition for which there is no cure,” Dr. Gruman declares. “So as long as the condition is present, the treatment must be maintained. Typically, a lifetime of medication is required once it has been introduced.”

“Life-Changing” Response

Dr. Gruman started Joan on Dupixent about a year ago.

“She would have started it sooner, but when COVID-19 hit she said, Let’s not start the medication with the virus out there,” Joan communicates. “But by April, Dr. Gruman said, This virus isn’t going anywhere; let’s give the medication a try. And it has really covered everything for me.

“The Dupixent started to work within two weeks of my first injection, and it’s been life-changing. The dry skin is gone, and it was at the point where even my ears would peel all the time. They don’t anymore. My back and legs were constantly itchy. and that’s gone.

“My legs don’t burn at night anymore. I can go out in the sun and play golf wearing just a visor. I still wear long sleeves because it’s the smart thing to do, but I can expose my legs to the sun without consequences. I rarely ever have to use a cream or ointment related to my eczema.”

The medication has also allowed Joan to eat foods she was avoiding because they made her break out into an eczema rash.

“My husband enjoys fine wine, and I could never enjoy a glass with him,” she says. “I can do that now with no reaction whatsoever.”

Dr. Gruman made an excellent impression on Joan. She greatly appreciates the dermatologist and her staff.

“My husband and I both see Dr. Gruman and we like her very much,” Joan relates. “She’s very pleasant, efficient and caring. She takes everything a step further than other dermatologists I’ve seen. I give her high marks. Everyone at Family Dermatology is very supportive. I can’t say enough about them.”

© FHCN articles by Patti DiPanfilo. Photo by Jordan Pysz. js
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    • Family Dermatology

      The staff of Family Dermatology have a mission to deliver state-of-the-art medical care in a compassionate and comfortable environment. They are committed to providing patient-centered, individualized care while demonstrating the highest lev... Read More

    • Alla Gruman, MD

      Alla Gruman, MD, is board certified in pediatrics and dermatology. Dr. Gruman completed her undergraduate studies in mathematics and biology at New York University. She earned her medical degree at The Johns Hopkins University School of M... Read More