Treatment Of Atopic Dermatitis In Children Research Articles

Role of Calcineurin Inhibitors in the Management of Atopic Dermatitis in Children

Atopic dermatitis (AD) is a widespread chronic inflammatory skin disease that has a significant impact on various aspects of patient's life. This review presents modern view on AD pathophysiology, its correlation with other concomitant diseases, and covers practical aspects of external anti-inflammatory therapy implementation. The analysis of clinical studies has shown the significant role of calcineurin inhibitors in the effective treatment of AD in children from its first manifestations at early age.

Phototherapy for atopic dermatitis: A survey of European practice.

Phototherapy is used to treat atopic dermatitis (AD). Evidence for its efficacy, impact on quality of life, cost-effectiveness and short- and long-term safety with real-life usage is weak. We established a taskforce to examine how phototherapy is currently being used as a treatment for AD across the United Kingdom and Europe to inform our understanding and guide future research into management of patients with AD using UV-based phototherapies. An anonymous electronic multiple-response survey exploring phototherapy prescribing practices and experience of phototherapy modalities was developed by the study authors and sent to members of phototherapy networks from the United Kingdom and Europe. Responses were received between February and July 2021. About 144 respondents from 27 European countries completed the survey. NBUVB was the most widely used [n = 138 (96%)]. Home-based NBUVB was available in 8/27 countries (25/144 respondents, 17%). Oral psoralen-UVA (PUVA) was more widely available than bath PUVA (n = 106, 74% vs. n = 60, 42%) and used mainly in adult patients. 49/144 (34%) of respondents had access to UVA1. Phototherapy would be considered instead of systemic treatment in 96% of adults and 82% of children for NBUVB, versus 40% of adults and 3% of children for PUVA. Starting doses, standard dosing increments, length of treatment courses, lifetime limits for treatments and thresholds for performing annual skin assessments varied between responders. NBUVB was the most widely used phototherapy for AD in adult and paediatric patients, while PUVA and UVA1 were less used. Prescribing practices varied considerably, highlighting the lack of consensus practice in many different aspects of phototherapy for the treatment of AD in children and adults. This indicates that further studies are required to determine optimal phototherapeutic regimens for AD and informs our understanding of parameters that should be included in future high-quality randomized controlled trials (RCT) of phototherapy.

Efficacy of probiotics in pediatric atopic dermatitis: Asystematic review and meta-analysis.

Atopic dermatitis (AD) is a prevailing skin disease in childhood. Several studies have appraised probiotics as a strategy for treating AD. We aimed to assess the validity of probiotics in the treatment of AD in children. We systematically searched the PubMed/MEDLINE, Embase, Scopus, EBSCO, Web of Science and Cochrane library databases for randomized controlled trials (RCTs) that assessed the effect of probiotic treatment on SCORAD value in pediatric patients with AD compared with a placebo group between 1 January 2010 and 1 January 2023. The risk of bias and the certainty of evidence were assessed using Cochrane ROB 2.0. A total of 10 outcomes from 9 RCTs involving 1000 patients were included. Three of these outcomes were analyzed as dichotomous variables in 373 patients. The other seven were analyzed for continuous variables in 627 patients. A meta-analysis of the random-effect model of the dichotomous variables demonstrated no significant difference between the probiotic and control groups [OR=1.75, 95% confidence interval (CI) (0.70, 4.35), p=0.23, I2 =68%]. A meta-analysis of the random-effect model of continuous variables demonstrated significant differences between the probiotic and control groups [MD=-4.24, 95% CI (-7.78, -0.71), p=0.002, I2 =71%]. Subgroup analysis of continuous variables showed that the effects of children's age, treatment duration and probiotic species on the SCORAD value were not statistically significant. Evidence on the improvement effect of probiotics on pediatric patients with AD is limited. This study showed that single-strain probiotic treatment exerts a positive effect on AD. Restricted to the quantity and quality of incorporated studies, these conclusions have yet to be validated by high-quality studies.

P93 Dupilumab treatment in children with moderate-to-severe atopic dermatitis increases levels of bone mineralization biomarkers

Abstract Children with atopic dermatitis (AD) are at risk for lower bone mineral density (BMD) and lower alkaline phosphatase (ALP) levels than healthy children. Low BMD and ALP in children could contribute to a higher lifetime prevalence of fractures, osteopenia and osteoporosis. Dupilumab is a fully humanized monoclonal anti-interleukin (IL)-4R antibody approved for the treatment of AD in children. The objective of this analysis is to report the impact of dupilumab treatment on markers of bone mineralization in children aged 6–12 years with moderate-to-severe AD vs. reference intervals (RIs). Analysis was performed retrospectively on sera from participants in LIBERTY AD PEDS, a phase III placebo-controlled trial of 16 weeks (NCT03345914) and LIBERTY AD PED-OLE (NCT02612454), an open-label extension trial in which eligible patients received dupilumab until week 52. Biomarkers, including bone ALP (BALP), procollagen type 1 N-terminal propeptide (P1NP), C-terminal crosslinking telopeptide of β-1 collagen (β-CTX), osteocalcin (OC) and insulin-like growth factor 1 (IGF-1), were analysed at baseline, 8, 12 and 16 weeks; only BALP was measured at 52 weeks. Both dupilumab dosing regimens led to significant increases in geometric mean (SE) levels of BALP at 8, 12 and 16 weeks compared with placebo. For the 100/200-mg Q2W group, at week 8 the BALP level was 72.7 (1.03) μg L−1 vs. 62.0 (1.05) μg L−1 (P < 0.0001), at week 12 it was 74.7 (1.03) μg L−1 vs. 64.3 (1.05) μg L−1 (P < 0.001) and at week 16 it was 78.0 (1.03) μg L−1 vs. 65.0 (1.04) μg L−1 (P < 0.001). For the 300-mg Q4W group, at week 8 the BALP level was 76.7 (1.03) μg L−1 vs. 62.0 (1.05) μg L−1 (P < 0.001), at week 12 it was 73.3 (1.04) μg L−1 vs. 64.3 (1.05) μg L−1 (P = 0.002) and at week 16 it was 77.3 (1.03) μg L−1 vs. 65.0 (1.04) μg L−1 (P < 0.001). At 52 weeks, BALP levels were statistically significantly increased compared with baseline [placebo vs. placebo transitioned to dupilumab: 64.2 (1.04) μg L−1 vs. 82.9 (1.04) μg L−1 (P < 0.001); 100/200 mg Q2W: 62.0 (1.05) μg L−1 vs. 83.8 (1.03) μg L−1 (P < 0.001); 300 mg Q4W: 64.1 (1.04) μg L−1 vs. 78.7 (1.04) μg L−1 (P < 0.001)] and also increased within RIs. From baseline to week 16, OC, P1NP and β-CTX levels improved from below to within the RIs, and levels of IGF-1 increased from the lower limit of the RI. However, data points were limited due to insufficient sera volumes, preventing statistical analyses for these biomarkers. The overall results suggest an increase in bone mineralization biomarkers in paediatric patients with moderate-to-severe AD following dupilumab treatment. Funding sources:research sponsored by Sanofi and Regeneron Pharmaceuticals Inc.

THE ROLE OF ANTIFUNGAL THERAPY IN THE TREATMENT OF ATOPIC DERMATITIS IN CHILDREN

Relevance. Atopic dermatitis (AD) is a common multifactorial disease in which allergens from the yeast Malassezia can worsen the severity of the disease. Local application of antimycotic drugs can reduce the allergen load on the skin and improve its condition.
 Objective: The aim of this study was to evaluate the effectiveness of ketoconazole 2% cream in the treatment of AD in children as an additional therapy, and the effect of sensitization to Malassezia and polymorphism rs7309123 in the Dectin-1 gene on the effectiveness of treatment.
 Materials and methods. 54 patients with atopic dermatitis aged 6-18 years were included in the study. Patients were randomized into two groups: a group receiving ketoconazole cream 2% (n=28) and a control group (n=26). Specific IgE to Malassezia was analyzed in 28 patients of the main group. Genotyping of the rs7309123 polymorphism in the Dectin-1 gene was performed in a group of patients using real-time PCR. Atopic dermatitis disease activity was evaluated before and after treatment using the SCORAD.
 Results. Improvement was observed in both groups of children in 3 weeks after treatment (p<0,001). Children who received ketoconazole in addition to therapy had significantly better dynamics of the severity indicator, compared to the control group (W=465,0, p<0,001). The rs7309123 polymorphism in the Dectin-1 gene affected the effectiveness of treatment: ΔSCORAD in the subgroup of children with the CC and CG genotypes was significantly higher than in the subgroup of children with the pathological GG genotype (20,2±11,5 and 13±6,5, respectively, T=2,12, p=0,044).
 Conclusion. This study demonstrated the effectiveness of ketoconazole in the treatment of atopic dermatitis as an additional therapy.

The Role of Probiotics in the Prevention and Treatment of Atopic Dermatitis in Children: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Atopic dermatitis (AD) is a chronic inflammatory skin disease common among infants and children. It is associated with a high risk of allergies, asthma, and mental health problems. Attempts have been made to use probiotics in clinical interventions for AD. Our objective was to perform an updated meta-analysis of recently published studies to evaluate the effect of probiotics in the prevention and treatment of AD in children and to further understand the role of probiotics in AD interventions in the clinic. We searched the PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang databases with prespecified selection criteria from inception of each database to 11 January 2020. No language restrictions were applied. A total of 25 studies were included in our meta-analysis. Of these, 14 were prevention studies (with 3049 children enrolled) and 11 were treatment studies (with 816 children enrolled). One treatment study was excluded after the sensitivity analysis. From the 14 prevention studies included, the pooled relative risk ratio of AD in those treated with probiotics versus placebo was 0.70 [95% confidence interval (CI) 0.57-0.84; P = 0.0002]. Subgroup analyses showed that only mixed strains of probiotics had a significant effect on lowering the incidence of AD. Probiotics administered solely to infants did not prevent the development of AD, but effects were significant when probiotics were administered to both pregnant mothers and their infants or solely to pregnant mothers. In studies with treatment durations > 6months, the incidence of AD decreased significantly; a similar effect was achieved when the treatment duration was < 6months. Meta-analysis of the ten treatment studies showed a significant decrease in the weighted mean difference (WMD) in Scoring Atopic Dermatitis (SCORAD) index values in the probiotics group compared with the control group (WMD, - 7.23; 95% CI - 10.59 to - 3.88; P < 0.0001). Subgroup analyses showed that both single-strain and mixed-strain probiotics had a significant effect on improving SCORAD values. Studies with participants aged < 1year (P = 0.07) reported no significant results. In studies with treatment periods > 8weeks, SCORAD values seemed to decrease more than in studies with treatment periods < 8weeks. However, the subgroup difference was only statistically significant when the analysis was performed according to participant age in prevention studies. Our updated meta-analysis demonstrates that interventions with probiotics potentially lower the incidence of AD and relieve AD symptoms in children, particularly when treating infants and children aged ≥ 1year with AD. Interventions with mixed-strain probiotics tended to have better preventive and curative effects. Probiotics administered solely to infants appeared to produce negative preventive effects. Different intervention durations might also affect clinical outcomes. However, given the insignificant subgroup differences, except for treatment by participant age, and the moderate heterogeneity among the studies, these conclusions should be interpreted with caution, and more powerful randomized controlled trials using standardized measurements should be conducted to assess the long-term effects of probiotics.

Efficacy and safety of 0.1% Tacrolimus ointment versus 0.05% Clobetasone butyrate ointment in childhood atopic dermatitis

Introduction: Atopic dermatitis (AD) is a chronic relapsing skin condition characterized by intense itching, dry skin, redness, in_ammation and exudation with signi_cant morbidity. It often requires long-term use of topical corticosteroids but, patients’ adherence to corticosteroids may be limited by perceived risks and systemic adverse e_ects. Therefore, steroid-sparing topical agent is needed. To compare the e_cacy and safety of 0.1% tacrolimus ointment and 0.05% clobetasone butyrate ointment in patients with childhood AD. Materials and methods: This monocentric prospective open-label comparative study was carried out in the Department of Dermatology and Venereology, Chittagong Medical College Hospital. Two hundred patients of 2–10 years of age with mild to moderate AD involving _ 50% of the total body surface area (BSA) were randomly assigned. The treatment duration was 4 weeks and was followed-up for 12 weeks. The eczema area and severity index (EASI) and the physician’s global evaluation of clinical response were assessed and evaluated. Results: E_ective sample size was 176 as because 24 patients were dropped out during follow up. EASI score was signi_cantly changed from baseline in follow up weeks and there was a statistically signi_cant di_erence in the reduction of EASI of patients in Tacrolimus groups at the end of 2nd week, 4th week, 6th week than the other group (p < 0.05). At the end of 4 weeks treatment, a median improvement of _ 75% in EASI was observed in 86% and 57% of patients in Tacrolimus and Clobetasone Group, respectively. At the end of the 12 week follow-up period, these improvements persist. Both the regimens were well tolerated. Conclusions: The overall therapeutic e_ectiveness was in favour of topical Tacrolimus ointment (0.1%) over topical Clobetasone butyrate ointment (0.05%) for the treatment of AD in children.

Therapeutic Approach of Probiotics in Children with Atopic Dermatitis.

Pediatric atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease, affecting 20% of children all over the world especially in developed countries. The global prevalence of AD in children has been increasing over recent years. This chronic inflammatory skin disease causes economic and social burden to the family. The exact cause of AD is not known, however recent studies suggest that the imbalance of microflora present in the gut leads to AD. The current treatment of AD involves the application of moisturizer, topical corticosteroids, antihistamines and antibiotics. This line of treatment of AD in children has many side effects. An alternative novel therapeutic approach has to be explored to combat this chronic skin disease. In recent years, there has been increasing interest in the use of probiotics in the modulation of gut microbiota for the management of AD. Many research studies showed that the administration of probiotics gives positive results in the prevention and treatment of AD in children, however, the results are not consistent and conclusive. In this review, the phenomenon that the dysbiosis of the gut flora contributes to the development of AD is addressed and clinical evidence of probiotics in the prevention and treatment of AD children is also summarised.

儿童特应性皮炎2 620例疾病严重程度相关因素分析

Objective To investigate factors influencing disease severity in children of Han nationality with atopic dermatitis (AD) in China, and to provide scientific evidences for prevention and treatment of AD in children. Methods From November 2005 to May 2015, data were collected from AD children aged 0-12 years in Department of Dermatology, The First Affiliated Hospital of Anhui Medical University and AD sample collection collaboration network in China. Statistical analysis was carried out with SPSS16.0 software by using univariate and multivariate ordinal logistic regression analysis to investigate factors influencing the severity of AD. Results A total of 2 620 children with AD were enrolled into the study, including 230 (8.8%) with mild AD, 1 379 (52.6%) with moderate AD and 1 011 (38.6%) with severe AD. As univariate analysis showed, factors influencing the severity of AD included region, early onset, itching during sweating, xeroderma, ichthyosis, palmar hyperlinearity, lichen pilaris, orbital darkening, scalp dermatitis and infra-auricular fissure (all P 0.05) . Multivariate ordinal logistic regression analysis showed that southern region (OR = 2.10, 95% CI: 1.76 - 2.51) , early onset (OR = 1.32, 95% CI: 1.01 - 1.71) , itching during sweating (OR = 1.70, 95% CI: 1.42 - 2.02) , xeroderma (OR = 2.57, 95% CI: 2.10 - 3.15) , ichthyosis (OR = 1.49, 95% CI: 1.19 - 1.87) , palmar hyperlinearity (OR = 2.03, 95% CI: 1.61 - 2.57) , lichen pilaris (OR = 1.44, 95% CI: 1.17 - 1.78) , orbital darkening (OR = 1.53, 95% CI: 1.24 - 1.89) , scalp dermatitis (OR = 2.38, 95% CI: 2.01 - 2.82) and infra-auricular fissure (OR = 1.55, 95% CI: 1.31 - 1.85) were positively correlated with the severity of AD (all P<0.05) . Conclusion The severity of AD is associated with patients′ region, early onset, itching during sweating, xeroderma, and other concomitant symptoms. Key words: Dermatitis, atopic; Severity of illness index; Children; Logistic models

Assessing the Effect of Clinical Trial Evidence and Anecdote on Caregivers' Willingness to Use Corticosteroids: A Randomized Controlled Trial [Formula: see text

Treatment of childhood atopic dermatitis (AD) is hindered by nonadherence, but caregiver reassurance may help overcome this hurdle. To assess caregivers' willingness to treat childhood AD with a corticosteroid when presented with clinical trial evidence, anecdote, or both. A total of 476 caregivers were recruited through a dermatology clinic and online crowdsourcing platform. Subjects were randomized to receive clinical trial evidence, anecdote, or both, using either the term "medication" or "topical steroid." Additional caregivers were queried about their willingness to treat with the doctor's recommendation or without knowledge of its safety information. Responses were recorded on a 10-point Likert scale. Caregivers' willingness to treat was higher in all information assignment groups compared to those not provided with safety information: clinical trial evidence of a "medication" (P = .003; Cohen's d = 0.83) or "topical steroid" (P = .030; d = 0.55), anecdote of a "medication" (P < .0001; d = 1.37) or "topical steroid" (P < .0001; d = 0.85), both clinical trial evidence and anecdote of a "medication" (P < .0001; d = 1.00) or "topical steroid" (P = .000; d = 0.89), and simply the doctor's recommendation (P < .0001; d = 0.92). Significance was corrected for multiple comparisons to 0.0018. There were no differences between caregivers of children with and without AD (P = .36). Providing anecdotal reassurance, even in the setting of reported high willingness to treat with the doctor's recommendation, may be an effective strategy to improve caregivers' perceptions of starting new medications.

CURRENT CONCEPTS OF ATOPIC DERMATITIS IN CHILDREN: PROBLEMS AND PROSPECTS

There are presented modern data describing the current understanding of the pathogenesis of atopic dermatitis (AD): a genetic predisposition to atopy, disruptions of epidermal barrier integrity and a cascade of immune responses, contributing allergic inflammation in the skin. There are both described several mechanisms of acute and chronic phases of AD, the main directions of pathogenetically substantiated treatment of AD in children and indicated the prospects of new preparations specific blockers of proinflammatory cytokines involved in the development of AD - crisaborole, apremilast, dupilumab, lebrikizumab, tralokinumab, tezepelumab. There is especially presented in details external therapy of atopic skin lesions in children with the use of means of modern dermatological cosmetics.

NEW APPROACH TO ASSESSMENT AND CORRECTION OF INTESTINAL MICROBIOME IMBALANCE IN CHILDREN WITH ATOPIC DERMATITIS

Objectives - to study intestinal microbiota species for differentiated approach to treatment of atopic dermatitis (AD) in children. Material and methods. The study included 60 children, 34 girls and 26 boys aged from 3 to 12 years, with AD and concurrent intestinal dysbiosis. The experimental group consisted of 30 children assigned to differentiated correction of intestinal microbiome imbalance in addition to the standard therapy. Correction mode depended on the results of microbiological fecal examination of microbiota species using the mass spectrometry. The control group of 30 children received the standard treatment of atopic dermatitis. Results. Gut microbiome imbalance of different severity was revealed in all children with AD. The study ascertained the increase of the enterobacteria of various types, including true pathogenic ones, in atopic dermatitis. The direct correlation was revealed between the AD severity and the degree of dysbiosis with the coefficient value 0.69. As a result of complex treatment in the experimental group, the ratio of children with severe dysbiosis reduced from 60.0% to 20.0%, the proportion of children with moderate dysbiosis also decreased from 26.6% to 20.0%. The reduced treatment time was one of the study outcomes: 14 days in the experimental group and 21 days in the standard therapy group. Clinical remission was observed in 26.7% of children. Conclusion. The study supported the rationale for the differentiated approach to the treatment of AD in children. The preliminary microbiological study of feces for microbiota species by MALDI-ToF mass spectrometry is necessary. Selection of probiotics depends on the deficit or overbalance of the specific types of microorganisms in a patient. Thus the treatment effectiveness is improved and the remission period is extended.

Effects of Lactobacillus pentosus for the treatment of childhood atopic dermatitis: A randomized, double-blind, placebo-controlled clinical study

Effects of Lactobacillus pentosus for the treatment of childhood atopic dermatitis: A randomized, double-blind, placebo-controlled clinical study

CURRENT CONCEPTS OF ATOPIC DERMATITIS IN CHILDREN: PROBLEMS AND PROSPECTS

Modern data describing the current understanding of the pathogenesis of atopic dermatitis (AD): a genetic predisposition to atopy, disturbances of the intestinal microbiome, disruptions of epidermal barrier integrity and a cascade of immune responses, contributing allergic inflammation in the skin are presented. There are both described several mechanisms of acute and chronic phases of AD, the main directions of pathogenetically substantiated treatment of AD in children and indicated the prospects of new preparations specific blockers of proinflammatory cytokines involved in the development of AD - crisaborole, dupilumab, apremilast et al. External therapy of atopic skin lesions in AD children with modern dermatological cosmetics is presented.

Probiotics for the Treatment of Atopic Dermatitis in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objective: Atopic dermatitis (AD) is a prevalent, burdensome, and psychologically important pediatric concern. Probiotics have been suggested as a treatment for AD. Some reports have explored this topic; however, the utility of probiotics for AD remains to be firmly established.Methods: To assess the effects of probiotics on AD in children, the PubMed/Medline, Cochrane Library Scopus, and OVID databases were searched for reports published in the English language.Results: Thirteen studies were identified. Significantly higher SCORAD values favoring probiotics over controls were observed (mean difference [MD], −3.07; 95% confidence interval [CI], −6.12 to −0.03; P < 0.001). The reported efficacy of probiotics in children < 1 year old was −1.03 (95%CI, −7.05 to 4.99) and that in children 1–18 years old was −4.50 (95%CI, −7.45 to −1.54; P < 0.001). Subgroup analyses showed that in Europe, SCORAD revealed no effect of probiotics, whereas significantly lower SCORAD values were reported in Asia (MD, −5.39; 95%CI, −8.91 to −1.87). Lactobacillus rhamnosus GG (MD, 3.29; 95%CI, −0.30 to 6.88; P = 0.07) and Lactobacillus plantarum (MD, −0.70; 95%CI, −2.30 to 0.90; P = 0.39) showed no significant effect on SCORAD values in children with AD. However, Lactobacillus fermentum (MD, −11.42; 95%CI, −13.81 to −9.04), Lactobacillus salivarius (MD, −7.21; 95%CI, −9.63 to −4.78), and a mixture of different strains (MD, −3.52; 95%CI, −5.61 to −1.44) showed significant effects on SCORAD values in children with AD.Conclusions: Our meta-analysis indicated that the research to date has not robustly shown that probiotics are beneficial for children with AD. However, caution is needed when generalizing our results, as the populations evaluated were heterogeneous. Randomized controlled trials with larger samples and greater power are necessary to identify the species, dose, and treatment duration of probiotics that are most efficacious for treating AD in children.

A new topical panthenol-containing emollient for maintenance treatment of childhood atopic dermatitis: results from a multicenter prospective study

Purpose: A study was conducted with a new topical panthenol-containing emollient (NTP-CE) to investigate the efficacy and safety of a 3-month maintenance treatment in infants and children with stabilized mild atopic dermatitis (AD).Methods: After the stabilization phase (up to 2 months) using a corticosteroid-free topical medical device, 108 subjects (aged 2–49 months) with a SCORing AD (SCORAD) on the target area of <5, were randomized to receive NTP-CE (N = 52) or reference emollient (N = 56) twice-daily for ∼3 months. SCORAD scores, occurrence of flares, and tolerability were assessed at regular intervals.Results: In both groups, local SCORAD decreased during the study with a mean change from baseline (=end of stabilization phase) of −1.2 ± 1.3 (NTP-CE) and −1.0 ± 1.9. Kaplan–Meier analysis provided success rates (i.e. proportion of subjects without flares at study end) of 96 and 77% for the NTP-CE and reference group, respectively (p =.083, log-rank test). Mean time to flare-up was 47 days (range: 29–65) in the NTP CE group and 50 days (6–100). Study products were well tolerated.Conclusions: Our results indicate that NTP-CE is efficacious and safe when used for maintenance treatment of mild childhood AD.

Dead Sea ultraviolet climatotherapy for children with atopic dermatitis.

Atopic dermatitis (AD) is a common, chronic, and relapsing inflammatory skin disorder. Moderate to severe cases represent an extremely disabling disease, for both children and their parents. Dead Sea climatotherapy (DSC), recognized as a natural treatment for patients with skin diseases, takes advantage of the selectively scattered ultraviolet irradiation (UV) present at the lowest terrestrial site on the earth. To investigate the impact on short-term results of DSC in moderate to severe AD children from the Czech Republic treated 4 weeks at the Deutsches Medizinisches Zentrum (DMZ), Israel, and to correlate their results to the cumulative UVA and UVB irradiation doses received during treatment. Seventy-two patients aged <19 years were divided into three groups and treated in March 2014, October 2014, and March 2015 with gradually increasing sun exposure during 28 consecutive days. Daily and cumulative exposure doses of UVB and UVA were calculated through patients' recorded sun exposure logs. The SCORing Atopic Dermatitis (SCORAD) index was recorded immediately after DSC and 3 months later by the same dermatologist. Good clinical results were observed in all groups, with overall improvement in SCORAD reaching 87.5 ± 13.4% and 71.3 ± 21.3% immediately after DSC and 3 months later, respectively. No side effects were observed during the treatments. Higher cumulative exposure times correlated with better results and enhanced remission. Dead Sea climatotherapy represents a valuable option for the treatment of AD in children. Medically controlled and prescribed sun exposure seems to directly and positively influence the results obtained.

A randomized, controlled trial comparing topical steroid application to wet versus dry skin in children with atopic dermatitis (AD)

Soak and smear (SS), a technique whereby a bath is followed by topical corticosteroid (TCS) application to wet skin, is reported to be a beneficial adjunctive therapy for patients with recalcitrant atopic dermatitis (AD). We evaluated whether SS is of greater benefit than application of TCS to dry skin for the treatment of childhood AD. A randomized, investigator-blinded, controlled study was performed in children with AD. Patients were randomized to apply TCS either via SS (n=22) or to dry skin (n=23) for 14days. Theprimary outcome was an improvement in the Eczema Area and Severity Index score. Secondary outcomes included assessments of disease burden, pruritus, and sleep; morning cortisol levels; and adverse effects. Patients with AD severity who applied TCS via SS or to dry skin improved 84.8% (95% confidence interval 77.5-92.1) and 81.4% (95% confidence interval 70.3-92.4) by Eczema Area and Severity Index score, respectively. There was no statistical difference between the 2 groups (P value=.85). Small sample size limited the power of our study. We did not find that application of TCS to presoaked skin works better than application to dry skin for the treatment of AD in children.

Does Order of Application of Emollient and Topical Corticosteroids Make a Difference in the Severity of Atopic Eczema in Children?

Atopic eczema (AE) is a common chronic inflammatory skin disorder in children, with emollients and topical corticosteroids (TCSs) commonly prescribed as treatment. There is no published guidance on the correct order of application of emollient and TCS in children with AE. The objective of this study was to determine whether the order of application of emollient and TCS makes a difference in the severity of AE in children. Forty-six patients ages 4 months to 5 years with moderate to severe AE were randomized to two groups: group A applied emollient followed by TCS 15 minutes later twice daily, and group B applied TCS followed by emollient 15 minutes later twice daily for 2 weeks. There was no statistically significant difference in the Eczema Area and Severity Index (EASI) score, percentage of body surface area (BSA) affected, or itch score between groups A and B (p > 0.05). Group A had statistically significant improvement in the EASI score, percentage BSA affected, and itch score from baseline to weeks 1 and 2; group B demonstrated statistically significant improvement only in the EASI score from baseline to week 1 and in itch score from baseline to week 2. There was no difference in adverse events between the groups. This study suggests that the order of application of emollient and TCS does not matter in the treatment of AE in children and that parents can apply topical medications in whichever order they prefer.

Corticosteroid Phobia Among Pharmacists Regarding Atopic Dermatitis in Children: A National French Survey.

Fear of corticosteroid use among patients and parents of children with atopic dermatitis (AD) may be increased by professional caregiver's mistrust to corticosteroids and a lack of consistency in information provision. This study used a French national survey to assess mistrust among pharmacists of the use of topical steroids for treatment of AD in children. From all pharmacies in France, a random sample of 500 (approximately 2%) was selected to receive a postal survey comprising a standardized questionnaire of 50 items exploring trust, knowledge, beliefs and practices related to the use of topical steroids for children with AD. The main outcome was self-assessment of pharmacists' confidence in topical steroids on a 0-10 visual analogue scale. The mean confidence was 4.46 (95% confidence interval 4.11-4.82). This study highlights that pharmacists have only moderate confidence in topical steroids. This lack of trust may have a high impact on maintaining fear of corticosteroids in parents and patients.