Topical Therapy Of Atopic Dermatitis Research Articles

Current and emerging topical therapies for atopic dermatitis

The pathogenesis of atopic dermatitis (AD) involves epidermal barrier dysfunction and T helper cell type 2 (Th2) lymphocyte-driven inflammation. Cytokines, such as interleukin 4 (IL-4) and IL-13, are important in this reaction. They stimulate B cells to produce immunoglobulin E, causing atopic disease. This process has been well characterized, and new therapies for AD, such as phosphodiesterase 4 (PDE-4) inhibitors, Th2-expressed chemoattractant receptor–homologous molecule antagonists, and Janus kinase inhibitors, work by antagonizing this cellular pathway. Recently, there have been many advances in treatment strategies and novel therapies for AD. This review summarizes the clinical evidence supporting the use of current and emerging topical treatments for AD, as well as their safety and efficacy profiles. Crisaborole, a novel PDE-4 inhibitor, is of particular note because phase III clinical trials were recently completed, as summarized here. It is prudent for dermatologists to be current with updates in the field because therapies are constantly changing. In addition to the academic interest, this results in improvement of patient care and advancement of the field.

NEW FORMULATIONS OF HYDROCORTISONE-17-BUTYRATE IN THE ARSENAL OF MEANS FOR TOPICAL TREATMENT OF ATOPIC DERMATITIS IN CHILDREN

Topical therapy of atopic dermatitis in children is a complex and multifactorial problem. Irrational choice of means of treatment may lead to the deterioration of the child, cause complications of dermatosis , promote the development of « atopic march » . Topical treatment’s « Gold standard » is topical corticosteroids. The application of these medicines is not limited to conventional dosage forms such as cream and ointment. The features of the new formulations are presented (emulsions with different lipid concentration), the recommendations on their practical use are stated, the clinical experience of their application in the treatment of children with atopic dermatitis is described.

Pathogenetic substantiation of an integrated approach to topical therapy of atopic dermatitis

The article contains a description of the various groups of drugs for topical treatment of atopic dermatitis with an assessment of their effectiveness, as well as the influence on the mechanisms of the immune response.

Stepwise Approach to Topical Therapy for Atopic Dermatitis

Stepwise Approach to Topical Therapy for Atopic Dermatitis

A systematic review of the safety of topical therapies for atopic dermatitis

The safety of topical therapies for atopic dermatitis (AD), a common and morbid disease, has recently been the focus of increased scrutiny, adding confusion as how best to manage these patients. The objective of these systematic reviews was to determine the safety of topical therapies for AD. Databases searched included: OVID Medline, Medline In-Process and Other Non-Indexed Citations, Embase, and the Cochrane Central Register of Controlled Trials. In addition to the articles identified by this search, investigators were also referred to a list of links (most recently updated 25 September 2005) to recent Food and Drug Administration (FDA) studies, reports and meetings regarding the topical calcineurin inhibitors for further potential references. Only fully published papers available in English and data obtained from FDA sites were included. Furthermore, the criteria for inclusion and exclusion for each systematic review were further evaluated at a meeting of all of the content and evidence-based medicine experts participating in this process and alteration of the inclusion criteria was done at that time when it was felt necessary to avoid inclusion of lower-quality data in the review. Qualitative review of the abstracted data was performed and reviewed at a meeting of all of the content and evidence-based medicine experts. While systemic exposure to these topical agents does occur, physiological changes appear to be uncommon and systemic complications rare and have only been found with use of topical corticosteroids. Based on the data that are available the overall safety of AD therapies appears to be good with the only documented systemic side-effects of therapy those occasionally seen with use of topical corticosteroids.

Topical treatment of atopic dermatitis.

Topical therapy of atopic dermatitis should incorporate an understanding of the underlying immune abnormalities of this complex chronic skin disease. Avoidance of irritants and proven allergens, skin hydration, and use of emollients and anti-inflammatory therapy help maintain a normal skin barrier. Topical calcineurin inhibitors have been added to the topical treatment armamentarium. Although the optimal treatment approach remains to be defined, several studies suggest the use of topical calcineurin inhibitors as early intervention therapy and topical corticosteroids as rescue therapy.

LONG-TERM TREATMENT WITH CETIRIZINE OF INFANTS WITH ATOPIC DERMATITIS: A MULTI-COUNTRY, DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED TRIAL (THE ETAC TRIAL) OVER 18 MONTHS

Diepgen TL and the Early Treatment of the Atopic Child Study Group. Pediatr Allergy Immunol. 2002;13:278–286 To analyze the effects of long-term use of cetirizine on the severity, natural history, and treatment of atopic dermatitis (AD). A total of 795 infants, 12 to 24 months old, with active AD for at least 1 month and 1 parent or sibling with a history of AD, allergic rhinitis, or asthma were enrolled from 12 European countries and Canada. This was a prospective, randomized, double-blind, parallel-group study comparing cetirizine with placebo in infants with AD and a family history of atopy. Systemic corticosteroids, cromoglycate, and oral antihistamines were discontinued; however, topical therapy for AD was continued. After a washout period, participants then received treatment with 0.25 mg/kg of cetirizine or placebo twice daily for 18 months. …

Cost-effectiveness analysis of tacrolimus ointment versus high-potency topical corticosteroids in adults with moderate to severe atopic dermatitis

Background: Few cost-effectiveness analyses have been conducted on topical therapies for atopic dermatitis. Objective: We sought to compare cost-effectiveness of high-potency topical corticosteroids (HPTCs) and tacrolimus ointment for the treatment of moderate to severe atopic dermatitis for patients who are not responsive to or not well controlled with mid-potency topical corticosteroids. Methods: A Markov model represented the cyclic nature of atopic dermatitis. Clinical outcomes were derived from published literature. “Efficacy” was defined as disease-controlled days on which patients experienced a greater than 75% improvement in their disease. Resource use and changes in management were on the basis of opinions of a physician panel; secondary treatment was an oral antibiotic with topical corticosteroids. Sensitivity analyses were conducted for all variables. Results: The model was sensitive to duration of continuous treatment with HPTCs. HPTCs, when limited to 2-week treatment cycles, were associated with the highest total costs ($1682 per year) and the least efficacy (185 disease-controlled days). HPTCs in 4-week treatment intervals and tacrolimus ointment were similar in total costs and efficacy ($1317 vs $1323 for 194 vs 190 disease-controlled days, respectively). Although primary drug costs were higher for patients treated with tacrolimus ointment, patients treated with regimens of HPTCs incurred higher secondary drug costs. Conclusion: In the base case analyses, tacrolimus ointment was more cost-effective than HPTCs administered in 2-week treatment cycles, and similar in cost-effectiveness to 4-week cycles of HPTCs. (J Am Acad Dermatol 2003;48:553-63.)