J Korean Med Assoc.  2014 Mar;57(3):226-233. 10.5124/jkma.2014.57.3.226.

Treatment for atopic dermatitis

• Kim HS
• Cho SH

• KMID: 2064879
• DOI: http://doi.org/10.5124/jkma.2014.57.3.226

Abstract

Atopic dermatitis (AD) is the most common chronic skin disease of young children and poses a significant global health problem. More than half of children with AD develop asthma and allergies, typically in the first few years of their life. AD is a paradigmatically complex disease with a number of contributing factors, which include genetics, the environment, infection, and skin barrier dysfunction. The diverse clinical phenotypes of AD reflect the genetic and epigenetic background affecting the innate and adaptive immune system, as well as neuro-immunological and environmental factors including microbiologic signals. The gold standard for the management of AD is efficient, ideally proactive, anti-inflammatory treatment combined with strategies aimed at restoring the epidermal barrier. This includes avoidance of trigger factors, skin barrier repair and maintenance, and the use of anti-inflammatory agents. Basic skin care is also considered an important pillar in the management of AD, with functional emollients beginning to appear on the market. In addition, a number of new candidate molecules for the treatment of AD are currently under investigation in clinical trials. Last but not least, treatment compliance remains a key factor for the successful management of AD. Due to its complex clinical phenotype, the future management of AD should be more individualized, addressing personal clinical and genetic/biologic.

Keyword

Atopic dermatitis; Management; Treatment

MeSH Terms

Anti-Inflammatory Agents
Asthma
Child
Compliance
Dermatitis, Atopic*
Emollients
Epigenomics
Genetics
Humans
Hypersensitivity
Immune System
Phenotype
Skin
Skin Care
Skin Diseases
Anti-Inflammatory Agents
Emollients

Reference

1. Krakowski AC, Eichenfield LF, Dohil MA. Management of atopic dermatitis in the pediatric population. Pediatrics. 2008; 122:812–824.

2. Nicol NH, Boguniewicz M. Successful strategies in atopic dermatitis management. Dermatol Nurs. 2008; Suppl. 3–18.

3. Kim KH, Park CW, Eun HC, Cho SH. Eczema. In : Kye YC, Park YM, Shin WY, Lee JH, Kim MN, Song HJ, editors. Textbook of dermatology. 6th ed. Seoul: Medbook;2014. p. 202–213.

4. Hanifin JM, Paller AS, Eichenfield L, Clark RA, Korman N, Weinstein G, Caro I, Jaracz E, Rico MJ. US Tacrolimus Ointment Study Group. Efficacy and safety of tacrolimus ointment treatment for up to 4 years in patients with atopic dermatitis. J Am Acad Dermatol. 2005; 53:2 Suppl 2. S186–S194.

5. Papp KA, Werfel T, Folster-Holst R, Ortonne JP, Potter PC, de Prost Y, Davidson MJ, Barbier N, Goertz HP, Paul C. Long-term control of atopic dermatitis with pimecrolimus cream 1% in infants and young children: a two-year study. J Am Acad Dermatol. 2005; 52:240–246.

6. Boguniewicz M, Nicol N, Kelsay K, Leung DY. A multidisciplinary approach to evaluation and treatment of atopic dermatitis. Semin Cutan Med Surg. 2008; 27:115–127.

7. Akdis CA, Akdis M, Bieber T, Bindslev-Jensen C, Boguniewicz M, Eigenmann P, Hamid Q, Kapp A, Leung DY, Lipozencic J, Luger TA, Muraro A, Novak N, Platts-Mills TA, Rosenwasser L, Scheynius A, Simons FE, Spergel J, Turjanmaa K, Wahn U, Weidinger S, Werfel T, Zuberbier T. European Academy of Allergology and Clinical Immunology. American Academy of Allergy, Asthma and Immunology. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. J Allergy Clin Immunol. 2006; 118:152–169.

8. Wolverton SE. Optimizing clinical use of azathioprine with newer pharmacogenetic data. Arch Dermatol. 2009; 145:707–710.

9. Devillers AC, Oranje AP. Efficacy and safety of 'wet-wrap' dressings as an intervention treatment in children with severe and/or refractory atopic dermatitis: a critical review of the literature. Br J Dermatol. 2006; 154:579–585.

10. Werfel T, Breuer K, Rueff F, Przybilla B, Worm M, Grewe M, Ruzicka T, Brehler R, Wolf H, Schnitker J, Kapp A. Usefulness of specific immunotherapy in patients with atopic dermatitis and allergic sensitization to house dust mites: a multi-centre, randomized, dose-response study. Allergy. 2006; 61:202–205.

11. Pajno GB, Caminiti L, Vita D, Barberio G, Salzano G, Lombardo F, Canonica GW, Passalacqua G. Sublingual immunotherapy in mite-sensitized children with atopic dermatitis: a randomized, double-blind, placebo-controlled study. J Allergy Clin Immunol. 2007; 120:164–170.

12. Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet. 2001; 357:1076–1079.

13. Kalliomaki M, Salminen S, Poussa T, Arvilommi H, Isolauri E. Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet. 2003; 361:1869–1871.

14. Rosenfeldt V, Benfeldt E, Nielsen SD, Michaelsen KF, Jeppesen DL, Valerius NH, Paerregaard A. Effect of probiotic Lactobacillus strains in children with atopic dermatitis. J Allergy Clin Immunol. 2003; 111:389–395.

15. Sidbury R, Sullivan AF, Thadhani RI, Camargo CA Jr. Random-ized controlled trial of vitamin D supplementation for winter-related atopic dermatitis in Boston: a pilot study. Br J Dermatol. 2008; 159:245–247.

16. Lane JE, Cheyney JM, Lane TN, Kent DE, Cohen DJ. Treatment of recalcitrant atopic dermatitis with omalizumab. J Am Acad Dermatol. 2006; 54:68–72.

17. Takiguchi R, Tofte S, Simpson B, Harper E, Blauvelt A, Hanifin J, Simpson E. Efalizumab for severe atopic dermatitis: a pilot study in adults. J Am Acad Dermatol. 2007; 56:222–227.