Clinical Insights About Topical Treatment of Mild-to-Moderate Pediatric and Adult Atopic Dermatitis (original) (raw)
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Journal of the European Academy of Dermatology and Venereology, 2020
Atopic dermatitis (AD) is a highly pruritic, chronic inflammatory skin disease. The diagnosis is made using evaluated clinical criteria. Disease activity and burden are best measured with a composite score, assessing both objective and subjective symptoms, such as SCORing Atopic Dermatitis (SCORAD). AD management must take into account clinical and pathogenic variabilities, the patient's age and also target flare prevention. Basic therapy includes hydrating and barrierstabilizing topical treatment universally applied, as well as avoiding specific and unspecific provocation factors. Visible skin lesions are treated with anti-inflammatory topical agents such as corticosteroids and calcineurin inhibitors (tacrolimus and pimecrolimus), which are preferred in sensitive locations. Topical tacrolimus and some mid-potency corticosteroids are proven agents for proactive therapy, which is defined as the long-term intermittent anti-inflammatory therapy of frequently relapsing skin areas. Systemic anti-inflammatory or immunosuppressive treatment is a rapidly changing † See Appendix section.
Management of Atopic Dermatitis The Role of
Management of Atopic Dermatitis: The Role of Tacrolimus, 2022
Atopic dermatitis (AD) is a long-lasting inflammatory dermatological condition characterized by itchy, eczematous, sparsely tiny blisters that hold a clear watery substance. Additionally, the diseased skin can suppurate, occasionally with weeping with thickening of the affected skin. This is considered one of the top skin disorders involving both children and adult populations globally. The principal therapeutic intervention for AD is long-standing topical glucocorticoids, which have been used for several decades. Corticosteroid therapy brings several adverse drug effects (ADRs), including irreversible skin atrophy. Tacrolimus belongs to the class of calcineurin inhibitors, which is a type of immunomodulator possessing promising efficacy in treating AD. Topical tacrolimus is an effective and safe non-corticosteroid substitute treatment for AD. We reviewed the available literature to compare and institute the safety, efficacy, and effectiveness of tacrolimus when equated to corticosteroid therapy in managing AD.
New Perspectives in the Treatment of Atopic Dermatitis in the Pediatric Population
Pediatric Allergy, Immunology, and Pulmonology, 2016
Treatment of children diagnosed with atopic dermatitis (AD) is an art. Age-dependent barrier function, skin physiology, body surface:weight ratio, the compliance of patient and caregivers, and legal considerations related to the license status of topical and systemic drugs must be considered. Mild to moderate AD can usually be treated sufficiently with a personalized regimen of emollients and topical anti-inflammatory therapy consisting of topical corticosteroids (TCSs) or topical calcineurin inhibitors. Emollients containing bacterial lysates, tailored wet wrap regimen, and proactive therapy with tacrolimus ointment or some TCSs are new developments in the field. Severe AD may need systemic therapy, but all currently available systemic agents for severe AD are either not licensed for children or not advisable on the long term, or both. Therapeutic patient education based on structured, interactive sessions with patients or caregivers and a multidisciplinary team is highly effective. This publication summarizes the current therapeutic options used in the pediatric AD population.
Topical and systemic pharmacological treatment of atopic dermatitis
South African Medical Journal, 2014
Topical corticosteroids (TCSs) continue to be the mainstay of atopic dermatitis (AD) treatment. For more than four decades TCSs have provided effective flare control by means of their anti-inflammatory, antiproliferative, immunosuppressive and vasoconstrictive actions. They suppress the release of inflammatory cytokines and act on a variety of immune cells, including T lymphocytes, monocytes, macrophages, dendritic cells and their precursors. Various strengths and formulations of TCSs are available. The extent to which they induce cutaneous vasoconstriction and inhibit inflammation corresponds to their potency.
Journal of the European Academy of Dermatology and Venereology, 2016
Atopic dermatitis (AD) is a clinically defined, highly pruritic, chronic inflammatory skin disease of children and adults. The diagnosis is made using evaluated clinical criteria. Disease activity is best measured with a composite score assessing both objective signs and subjective symptoms, such as SCORAD. The management of AD must consider the clinical and pathogenic variabilities of the disease and also target flare prevention. Basic therapy includes hydrating topical treatment, as well as avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment of visible skin lesions is based on topical glucocorticosteroids and the topical calcineurin inhibitors tacrolimus and pimecrolimus. Topical calcineurin inhibitors are preferred in sensitive locations. Tacrolimus and mid-potent steroids are proven for proactive therapy, which is long-term intermittent anti-inflammatory therapy of the frequently relapsing skin areas. Systemic anti-inflammatory or immunosuppressive treatment is indicated for severe refractory cases. Biologicals targeting key mechanisms of the atopic immune response are promising emerging treatment options. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Systemic antihistamines (H1R-blockers) may diminish pruritus, but do not have sufficient effect on lesions. Adjuvant therapy includes UV irradiation, preferably UVA1 or narrow-band UVB 311 nm. Dietary recommendations should be patient specific and elimination diets should only be advised in case of proven food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Psychosomatic counselling is recommended to address stress-induced exacerbations. 'Eczema school' educational programmes have been proven to be helpful for children and adults.
Management of Patients with Atopic Dermatitis: The Role of Emollient Therapy
Dermatology Research and Practice, 2012
Atopic dermatitis is a common inflammatory skin disorder that afflicts a growing number of young children. Genetic, immune, and environmental factors interact in a complex fashion to contribute to disease expression. The compromised stratum corneum found in atopic dermatitis leads to skin barrier dysfunction, which results in aggravation of symptoms by aeroallergens, microbes, and other insults. Infants—whose immune system and epidermal barrier are still developing—display a higher frequency of atopic dermatitis. Management of patients with atopic dermatitis includes maintaining optimal skin care, avoiding allergic triggers, and routinely using emollients to maintain a hydrated stratum corneum and to improve barrier function. Flares of atopic dermatitis are often managed with courses of topical corticosteroids or calcineurin inhibitors. This paper discusses the role of emollients in the management of atopic dermatitis, with particular emphasis on infants and young children.
Current Opinion in Immunology, 2011
Atopic dermatitis (AD) is a highly pruritic, chronic, and relapsing inflammatory skin disorder affecting 10-20% of children worldwide. During the past year there have been significant advances in our understanding of the cellular and immunologic mechanisms underlying AD as well as the immunologic triggers involved in its pathogenesis. The introduction of a new class of topical anti-inflammatory medications, topical calcineurin inhibitors, has significantly increased our treatment options and led to the rethinking of potential management approaches in AD. (Chang Gung Med J 2005;28:1-8)
Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement
Australasian Journal of Dermatology, 2015
Atopic eczema is a chronic inflammatory disease affecting about 30% of Australian and New Zealand children. Severe eczema costs over AUD 6000/year per child in direct medical, hospital and treatment costs as well as time off work for care givers and untold distress for the family unit. In addition, it has a negative impact on a child's sleep, education, development and self esteem. The treatment of atopic eczema is complex and multifaceted but a core component of therapy is to manage the inflammation with topical corticosteroids (TCS). Despite this, TCS are often under utilised by many parents due to cortico steroid phobia and unfounded concerns about their adverse effects. This has led to extended and unnecessary exacerbations of eczema for children. Contrary to popular perceptions, TCS use in paediatric eczema does not cause atrophy, hypopigmenta tion, hypertrichosis, osteoporosis, purpura or telangiectasia when used appropriately as per guidelines. In rare cases, prolonged and excessive use of potent TCS has contributed to striae, short-term hypothalamicpituitary-adrenal axis alteration and ophthalmological disease. TCS use can also exacerbate periorificial rosacea.TCS are very effective treatments for eczema. When they are used to treat active eczema and stopped once the active inflammation has resolved, adverse effects are minimal. TCS should be the cornerstone treatment of atopic eczema in children.