Atopic Dermatitis Knowledge Centre
- Overview
- Signs & symptoms of atopic dermatitis
- Area of the body commonly affected by atopic dermatitis
- Diagnosis
- Assessment
- General Management
- Education
General Management
Pharmacological therapy
In patients with moderate-to-severe disease, a number of pharmacological therapies are available to treat the symptoms of a flare, including topical corticosteroids (e.g. hydrocortisone, betametasone dipropionate, fluticasone propionate, mometasone furoate) and topical calcineurin inhibitors (tacrolimus and pimecrolimus). These agents act on different molecular targets involved in the development of the immune response to reduce inflammation. Topical corticosteroids are the first-line therapy used for the treatment of flares. However, the potential for side effects, including thinning of the skin, acne, cataracts and, rarely but more seriously, adrenal suppression and Cushing's syndrome, limits their use in the long term. It is recommended by some that the lowest potency preparation is utilised which improves the patient’s symptoms.11 While this approach is commonly used, a new idea has been proposed that recommends a ‘step down’ approach; the aim being to suppress inflammation as soon as possible by treating early and treating intensively.12
Topical calcineurin inhibitors have a distinct mechanism of action compared with topical corticosteroids, which means they do not share the same potential for side effects (for more detailed information on the mode of action of topical calcineurin inhibitors, see the pharmacological treatment sub-section of this website).13 Topical calcineurin inhibitors can be used to treat disease flares, but recently, tacrolimus ointment has also been approved as a twice-weekly treatment to control the underlying subclinical inflammation present in non-lesional skin (see ‘Pathophysiology’ under the Understanding Atopic Dermatitis section of this website). Use of twice-weekly tacrolimus ointment to prevent flares and extend flare-free periods is a new and valuable addition to the therapeutic options available to physicians for the treatment of patients with moderate-to-severe atopic dermatitis.14
It is likely that the physician and patient will need to try different treatment approaches, involving a combination of both non-pharmacological and pharmacological therapies, in order to find a strategy that is best suited to their needs. Development of a management strategy for each patient is an ongoing process that should be regularly reviewed and adapted according to the patients’ age, severity of disease and their individual needs.
For more detailed information on the pharmacological therapies available both for the treatment of flares and for long-term disease control to extend flare-free periods, see the treatment section of this website.
References:
11. Correale CE, Walker C, Murphy L, et al. Atopic dermatitis: a review of diagnosis and treatment. Am Fam Physician 1999; 60: 1191-8, 1209-10.
12. Reitamo S, Remitz A, Haahtela T. Hit early and hit hard in atopic dermatitis and not only in asthma. Allergy 2009; 64: 503-4.
13. Novak N, Kwiek B, Bieber T. The mode of topical immunomodulators in the immunological network of atopic dermatitis. Clin Exp Dermatol 2005; 30: 160-4.
14. Astellas P. Protopic - Summary of Product Characteristics, 2009. http:/anti-infectives/Paris-Event/Live-Webcast.cfmemc.medicines.org.uk/medicine/8816/SPC/Protopic+0.1%25+ointment/
© February 2010 Astellas Pharma Europe LTD.
Disclaimer:
The Atopic Dermatitis Knowledge centre contained within www.epgonline.org and available at www.atopicdermatitisinfo.org is intended to be for educational use only and not designed to provide medical advice or professional services.