Using the topical moisturizing agent in children whit atopic dermatitis is the cornerstone of the successful preventive treatment

Abstract

Summary.This article describes the management of pediatric atopic dermatitis (AD) of all severities and covers the use of nonpharmacologic approaches (eg, moisturizers, bathing practices, and wet wraps). Atopic dermatitis is a chronic, pruritic, inflammatory dermatitis that affects up to 25% of children. Xerosis is one of the cardinal clinical features of AD and results from a dysfunctional epidermal barrier. Topical moisturizers are used to combat xerosis and transepidermal water loss, with traditional agents containing different amounts of emollient, occlusive, and/or humectant ingredients. Although they often include water as well, this only delivers a transient effect, whereas the other components provide the main benefits.Moisturizers can be the main primary treatment for mild disease and should be a part of the regimen for moderate and severe disease. They are also an important component of maintenance treatment and prevention of flares. Moisturizers are therefore a cornerstone of AD therapy and should be included in to the management plans especially in children.There are a few systematic studies to define an optimal amount or frequency of application of moisturizers. It is generally thought that liberal and frequent reapplication is necessary to reduce xerosis to minimal. Traditional moisturizers are formulated into a variety of delivery systems, including creams, ointments, oils, gels, and lotions. Although most ointments have the advantage of not containing preservatives, which may cause stinging when applied to inflamed skin, they may be too greasy for some patients with AD. Lotions have a higher water content that can evaporate and may be less ideal in those with significant xerosis.Head-to-head trials between specific moisturizing products are few, and the published information has not demonstrated the preference of one emollient to others. Therefore, the choice of moisturizing agent highly depends on the individual preference. In our clinic we also have a long experience of using emollients in children with AD, including young children. Very often in our practice we use Topicrem, Physiogel and Oilatum. Analyzing efficiency of each, we have identified 24 children aged from 6 months to 2 years with a diagnosis of atopic dermatitis in remission and divided them into three equal groups. Observation period lasted 14 days. Evaluation of efficacy was performed using SCORAD index, determined not only objective criteria but also subjective marks sleep disorders and severity of itching. During the study, accurately clinical observation refers to the third level of evidence (C), we were able to demonstrate again the high efficiency of moisturizers. Analyzing the results, first of all, we want to emphasize the good clinical efficacy of all three emollients.To conclude, the choice of moisturizers demands an individual approach. The ideal agent should be safe, effective, inexpensive, and free of additives, fragrances, perfumes, and other potentially sensitizing agents.