Early Topical Atopic Dermatitis (AD) Treatment In Children Improves Clinical Outcome (For Professionals)
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:
- pruritus
- flares
- skin infections (bacterial and viral)
- Etiology of AD
- genetic?
- environmental ?
- 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:
- twice weekly prevents flares and prolongs flare free intervals.
- 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:
- chronic evolution: flares keep happening
- corticophobia: patients, as well as healthcare providers are sometimes scared of using steroids
- 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 !
- aim of treatment is to have clinically normal skin (not to stop steroids): this will improve chronic evolution (and therefore compliance).
- ask weight of steroids: the weight will diminish with the reduction of extent of skin lesions: this will reduce corticophobia.
- 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
Category : atopic dermatitis - Modifie le 10.12.2010Category : dermatite atopique - Modifie le 10.12.2010Category : importance du traitement precoce - Modifie le 10.12.2010Category : importance of early treatment - Modifie le 10.12.2010