Amélioration clinique quand la dermatite atopique (DA) chez l’enfant est traitée (localement) tôt (Pour les professionnels)

Early Topical Atopic Dermatitis (AD) Treatment In Children Improves Clinical Outcome (For Professionals)

• chronic AD which is lichenified is difficult to treat

• The 3 major problematic factors with AD are:

1. pruritus
2. flares
3. skin infections (bacterial and viral)

• Etiology of AD

1. genetic?
2. environmental ?
3. atopic march ?

• In the absence of a definate cause, symptom management is very important as a cure is yet to be found.
• Steroids and Calcineurin inhibitors* applied at each flare can reduce the severity of the eczema to make the 3 problematic factors of AD disappear. This is effective if preventive and general measures are taken and that emollients (a moisturizer) are applied. *Recommendations then for using tacrolimus on the long term are:

1. twice weekly prevents flares and prolongs flare free intervals.
2. Tacrolimus has also been shown to be effective if applied at the very beginnning of flares.

• The main problem to treat a long term problem is compliance because of:

1. chronic evolution: flares keep happening
2. corticophobia: patients, as well as healthcare providers are sometimes scared of using steroids
3. chronic side effects (SE): skin atrophy among other SE can occur

• Adaptation for effective long term treatment must therefore be found:

Water stops the fire but when water is too early, fire comes back !

1. aim of treatment is to have clinically normal skin (not to stop steroids): this will improve chronic evolution (and therefore compliance).
2. ask weight of steroids: the weight will diminish with the reduction of extent of skin lesions: this will reduce corticophobia.
3. ask the patient to note date of opening of each tube to use not to much or too little steroids: this will also reduce corticophobia.

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

Source of information: Cambazzard F. How to cure atopic dermatitis in children with an early and complete topical treatment. 19th Congress of the European Academy of Dermatology and Venereology (EADV) – Gothenburg (Göteborg), Sweden (Sverige). Presentor has a conflict of interest with Stiefel and Astellas