Proactive Therapy and Emollient Therapy in Atopic Dermatitis

Abstract

Atopic dermatitis is a common itching disorder that includes the majority of my work in the university clinic of the KinderHaven, Havenziekenhuis/Erasmus MC, Rotterdam. Treatment was always chosen on the basis of severity established with the scoring system, ‘objective SCORAD’. Follow-up may be monitored with a simplified (Target) scoring system called the Three-items-severity Score (TIS), that was developed into the late 1990s in Holland and in particular in Rotterdam by Glazenburg and Oranje. Recently, the HOME group proposed to accept only the EASI as the scoring system and to no longer to use the others. This is totally in disagreement with the author’s opinion and many others of the European Task Force for Atopic Dermatitis. This recommendation of HOME is based on subjective assessment of a group that just partly representing the scientific community. Proactive topical therapy is preferred above other topical treatment schedules. It is a variation of the step-up/step-down strategy (Van der Meer, Glazenburg, Oranje) that starts with intensive and aggressive topical anti-inflammatory therapy until control is achieved. Proactive treatment is defined as “long-term, low dose intermittent topical anti-inflammatory therapy for previously affected areas with subclinical inflammation and involves a behavioral concept” (Wollenberg A, J Dtsch Dermatol Ges 2009;7:117-21) [1]. Both visible and non-visible eczema is treated with at least twice weekly application. Aggressive active treatment is started again in case of recurrence. Emollients have become increasing important in the treatment of atopic dermatitis. In earlier years, there were simply prepared creams or ointments. However, today there are more sophisticated creams and ointments available in an attempt to repair the skin barrier function in atopic dermatitis. It is better to refer to these as moisturizers. Future emollients or moisturizers are expected to have specific properties to restore the barrier function even more efficiently in atopic dermatitis. This manuscript is based on the expert opinion of the author.