Topical Therapy of AD: How to Reach Better Results

Abstract

This review summarizes the current state-of-the-art in topical therapy of atopic dermatitis (atopic eczema), a clinically defined, highly variable, pruritic chronic skin disease characterized by age-dependent distribution patterns and lesion morphology. Current emollient treatment should be performed at least once daily, using about 250 g of emollient per week. Commonly used topical anti-inflammatory treatment is based on topical corticosteroids and the topical calcineurin inhibitors tacrolimus and pimecrolimus. Acute intervention for flares works best with topical corticosteroid creams, which may be applied in a wet-wrap technique. Proactive therapy is defined as long-term intermittent, anti-inflammatory therapy of the frequently relapsing problem zones. This new regimen works with mid-potent topical corticosteroid (TCS) and tacrolimus ointment, may prevent flares, improves the quality of life significantly, and is cost-effective. Topical phosphodiesterase 4 inhibitors may become a treatment alternative for mild to moderate forms. All management should consider the above findings and individual course of disease, with special aim of flare prevention.