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Atopic Dermatitis

Treatment

Read time: 60 mins
Last updated:26th Jun 2020
Atopic dermatitis is a common inflammatory skin disease predominantly affecting children (Megna et al., 2017). Learn about the current and upcoming treatment classes available to manage the condition and prevent acute flares. Also, discover the ongoing unmet needs that limit patient outcomes, and how treatment impacts patients.

Treatment burdens

While atopic dermatitis may spontaneously resolve in patients, it is not curable. Many patients will experience chronic disease and so the aims of treatment are limited to2:

  1. Minimise the number of flares
  2. Reduce the duration and degree of any flares

Interestingly, when 3,846 dermatology patients across 13 countries were asked whether they had treatment-related issues, 63.4% of patients with atopic dermatitis said they did – more than any other skin disease assessed3.

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Non-pharmacological management

Identification and avoidance of an individual’s trigger factors allows longer periods of remission or total clearance of symptoms. Numerous non-specific physical, chemical and biological factors can irritate the skin and elicit flares in patients with atopic dermatitis.

Meanwhile, specific allergens can also promote skin lesions in sensitised patients18.

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Topical anti-inflammatory treatment

Topical anti-inflammatory treatments currently consist of topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI). Their effective use requires18:

  1. Sufficient strength/potency
  2. Sufficient dosage
  3. Correct application
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Systemic treatment

A variety of systemic treatments have been used for the treatment of severe atopic dermatitis, many of which are off label. Below we discuss the treatments licensed for this indication.

Oral glucocorticoids

Many European countries continue to use oral glucocorticoids for the management of atopic dermatitis18. However, systemic corticosteroids are not anti-pruritic and their prolonged use in atopic dermatitis is not recommended due to their safety profile22.

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Phototherapy

Patients with atopic dermatitis frequently observe an improvement in their symptoms during summer due to the increased sun exposure. During the course of the summer holidays, 74% of patients with mild-to-moderate atopic dermatitis saw complete resolution in one study. Interestingly, more patients saw complete resolution on seaside holidays (91%) than mountain holidays (11%)48

While UV exposure does not completely explain this difference, it supports the positive effects of UV radiation on atopic dermatitis18.

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Emollients and skin care

Management of dry skin is critical to help maintain barrier function. The effective use of bathing and emollients are frequently recommended as an essential component of atopic dermatitis therapy18.

Cleansing and bathing

Cleansing the skin is essential to carefully remove dead skin and eliminate bacterial contaminants. However, it must be performed gently, and quickly to avoid irritation and epidermal dehydration. The use of bath oils, non-soap-based and acidic-cleansers as well as the addition of antiseptics have all been suggested to help manage atopic dermatitis18,22.

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References

  1. Megna M, Napolitano M, Patruno C, Villani A, Balato A, Monfrecola G, et al. Systemic Treatment of Adult Atopic Dermatitis: A Review. Dermatology and Therapy. 2017;7(1):1–23
  2. Thomsen SF. Atopic Dermatitis: Natural History, Diagnosis, and Treatment. ISRN Allergy. 2014;2014:1–7.

Balieva FN, Finlay AY, Kupfer J, Tomas Aragones L, Lien L, Gieler U, et al. The role of therapy in impairing quality of life in dermatological patients: A multinational study. Acta Derm Venereol. 2018;98(6):563–569.

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