Atopic dermatitis medical therapy: Difference between revisions

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{{Atopic dermatitis}}
{{Atopic dermatitis}}


__NOTOC__
{{CMG}}; {{AE}}{{S.S}} [[Ogechukwu Hannah Nnabude, MD]]
{{Atopic dermatitis}}
{{CMG}}; {{AE}}{{S.S}}


==Overview==
==Overview==
The mainstay of treatment for atopic dermatitis depends upon the severity of the disease and is treated with a combination of conservative and medical therapy. The goals of treatment include elimination of aggravating factors, skin barrier function repair, maintaining skin hydration and pharmacologic treatment of skin inflammation.
The mainstay of treatment for atopic dermatitis depends upon the severity of the [[disease]]. The treatment  involves a combination of conservative and medical therapy. The goals of treatment include elimination of aggravating factors, skin barrier function repair, maintaining skin hydration and [[Pharmacological|pharmacologic]] treatment of skin [[inflammation]]. Pharmacologic medical therapies for atopic dermatitis can be classified according to several severity scales including [[SCORAD|SCORAD index]], the eczema area and severity index (EASI), and the patient-oriented eczema measure (POEM).
==Conservative Therapy==
==Conservative Therapy==


{| class="wikitable"
{| class="wikitable"
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!'''Elimination of exacerbating factors'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Elimination of exacerbating factors'''
!'''Maintaining skin hydration'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Maintaining skin hydration'''
!'''Controlling pruritus'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Controlling pruritus'''
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* Avoid trigger factors such as low humidity, overheating of skin<ref name="pmid18829806">{{cite journal |vauthors=Krakowski AC, Eichenfield LF, Dohil MA |title=Management of atopic dermatitis in the pediatric population |journal=Pediatrics |volume=122 |issue=4 |pages=812–24 |date=October 2008 |pmid=18829806 |doi=10.1542/peds.2007-2232 |url=}}</ref>
*Avoid [[trigger]]<nowiki/>s such as low [[humidity]], overheating of skin<ref name="pmid18829806">{{cite journal |vauthors=Krakowski AC, Eichenfield LF, Dohil MA |title=Management of atopic dermatitis in the pediatric population |journal=Pediatrics |volume=122 |issue=4 |pages=812–24 |date=October 2008 |pmid=18829806 |doi=10.1542/peds.2007-2232 |url=}}</ref>
* Treating stress and anxiety
*Treat [[stress]] and [[anxiety]]
* Avoid exposure to solvents and detergents
*Avoid exposure to [[solvents]] and [[detergents]]
* Treat skin infections such as ''Staphylococcus aureus'' and herpes simplex  
*Treat skin [[infections]] such as [[Staphylococcus aureus|S''taphylococcus aureus'']] and [[herpes simplex]].
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* '''Emollients and moisturizers'''
*'''Emollients and moisturizers'''
** Thick creams, ointments (eg, petroleum jelly) with low/zero water content<ref name="pmid188298062">{{cite journal |vauthors=Krakowski AC, Eichenfield LF, Dohil MA |title=Management of atopic dermatitis in the pediatric population |journal=Pediatrics |volume=122 |issue=4 |pages=812–24 |date=October 2008 |pmid=18829806 |doi=10.1542/peds.2007-2232 |url=}}</ref>
**Thick creams, [[Ointment|ointments]] (eg, [[petroleum jelly]]) with low/zero water content<ref name="pmid188298062">{{cite journal |vauthors=Krakowski AC, Eichenfield LF, Dohil MA |title=Management of atopic dermatitis in the pediatric population |journal=Pediatrics |volume=122 |issue=4 |pages=812–24 |date=October 2008 |pmid=18829806 |doi=10.1542/peds.2007-2232 |url=}}</ref>
** Immediately after 5-minute, lukewarm baths BID
**Apply [[emollients]] immediately after lukewarm baths twice daily <ref name="StänderRopper2021">{{cite journal|last1=Ständer|first1=Sonja|last2=Ropper|first2=Allan H.|title=Atopic Dermatitis|journal=New England Journal of Medicine|volume=384|issue=12|year=2021|pages=1136–1143|issn=0028-4793|doi=10.1056/NEJMra2023911}}</ref>
* '''Bathing practices'''
*'''Bathing practices'''
** Warm soaking baths or showers using mild or soap-free cleansers  
**Warm soaking baths or showers using mild or soap-free cleansers
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* Tepid baths<ref name="pmid188298063">{{cite journal |vauthors=Krakowski AC, Eichenfield LF, Dohil MA |title=Management of atopic dermatitis in the pediatric population |journal=Pediatrics |volume=122 |issue=4 |pages=812–24 |date=October 2008 |pmid=18829806 |doi=10.1542/peds.2007-2232 |url=}}</ref>
*Tepid baths<ref name="pmid188298063">{{cite journal |vauthors=Krakowski AC, Eichenfield LF, Dohil MA |title=Management of atopic dermatitis in the pediatric population |journal=Pediatrics |volume=122 |issue=4 |pages=812–24 |date=October 2008 |pmid=18829806 |doi=10.1542/peds.2007-2232 |url=}}</ref>
* Wet dressings (wet wraps)
*Wet dressings (wet wraps)
* Moisturizers containing anti-pruritic ingredients such as phenol, menthol, and camphor
*Moisturizers containing [[Antipruritic|anti-pruritic]] ingredients such as [[phenol]], [[menthol]], and [[camphor]]


*
*
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==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapies for atopic dermatitis can be classified according to the several severity scales( (i.e SCORAD index, the eczema area and severity index [EASI], and the patient-oriented eczema measure [POEM]) which includes characteristics of the rash, questions about itch, sleep, impact on daily activities, and persistence of disease.
 
*Pharmacologic medical therapies for atopic dermatitis can be classified according to several severity scales including [[SCORAD|SCORAD index]], the eczema area and severity index (EASI), and the patient-oriented eczema measure (POEM) which includes characteristics of the [[rash]], questions about [[itch]], [[sleep]], impact on daily activities, and persistence of disease.<ref name="StänderRopper2021">{{cite journal|last1=Ständer|first1=Sonja|last2=Ropper|first2=Allan H.|title=Atopic Dermatitis|journal=New England Journal of Medicine|volume=384|issue=12|year=2021|pages=1136–1143|issn=0028-4793|doi=10.1056/NEJMra2023911}}</ref>
 
===Atopic dermatitis===
===Atopic dermatitis===


* '''MIld atopic dermatitis''':
*'''1. Mild atopic dermatitis''':
** Topical corticosteroids and emollients - mainstay therapy
**'''1.1 [[Topical]] [[corticosteroids]] and [[emollients]] -''' mainstay therapy
*** '''Adult'''
***'''1.1.1 Adult'''
**** Preferred regimen (1): [[drug name|desonide 0.05%]] top. q12h-q24h for 14-28 days  
****Preferred regimen (1): [[Desonide Topical|Desonide]] 0.05% top. q12h-q24h for 14-28 days
**** Preferred regimen (2): [[drug name|hydrocortisone 2.5% top.]] q12h-q24h for 14-28 days  
****Preferred regimen (2): [[Hydrocortisone (ointment)|Hydrocortisone]] 2.5% top. q12h-q24h for 14-28 days<ref name="pmid7547394">{{cite journal |vauthors=Aalto-Korte K, Turpeinen M |title=Pharmacokinetics of topical hydrocortisone at plasma level after applications once or twice daily in patients with widespread dermatitis |journal=Br. J. Dermatol. |volume=133 |issue=2 |pages=259–63 |date=August 1995 |pmid=7547394 |doi= |url=}}</ref>
**** Preferred regimen (3): fluocinolone acetonide [[drug name|0.01% top.]] q12h-q24h for 14-28 days
****Preferred regimen (3): [[Fluocinolone acetonide]] [[drug name|0.01% top.]] q12h-q24h for 14-28 days
**** Alternative regimen (1) tacrolimus 0.1% top. q8h ('''0.03% for adults who do not tolerate the higher dose)'''<ref name="pmid9295241">{{cite journal |vauthors=Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S |title=A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group |journal=N. Engl. J. Med. |volume=337 |issue=12 |pages=816–21 |date=September 1997 |pmid=9295241 |doi=10.1056/NEJM199709183371203 |url=}}</ref>
****Alternative regimen (1): [[Tacrolimus]] 0.1% top. q12h ('''0.03% for adults who do not tolerate the higher dose)'''<ref name="pmid9295241">{{cite journal |vauthors=Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S |title=A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group |journal=N. Engl. J. Med. |volume=337 |issue=12 |pages=816–21 |date=September 1997 |pmid=9295241 |doi=10.1056/NEJM199709183371203 |url=}}</ref>
**** Alternative regimen (2): pimecrolimus 1% top. q8h
****Alternative regimen (2): [[Pimecrolimus]] 1% top. q12h<ref name="pmid92952415">{{cite journal |vauthors=Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S |title=A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group |journal=N. Engl. J. Med. |volume=337 |issue=12 |pages=816–21 |date=September 1997 |pmid=9295241 |doi=10.1056/NEJM199709183371203 |url=}}</ref>
**** Alternative regimen (3) crisaborole 2% top.
****Alternative regimen (3) Crisaborole 2% [[Topical|top.]]<ref name="StänderRopper2021">{{cite journal|last1=Ständer|first1=Sonja|last2=Ropper|first2=Allan H.|title=Atopic Dermatitis|journal=New England Journal of Medicine|volume=384|issue=12|year=2021|pages=1136–1143|issn=0028-4793|doi=10.1056/NEJMra2023911}}</ref>
*** '''Pediatric'''
***'''1.1.2 Pediatric'''
**** Preferred regimen (1): [[drug name|desonide 0.05%]] top. q12h-q24h for 14-28 days
****Preferred regimen (1): [[Desonide]] 0.05% top. q12h-q24h for 14-28 days
**** Preferred regimen (2): [[drug name|hydrocortisone 2.5% top.]] q12h-q24h for 14-28 days
****Preferred regimen (2): [[Hydrocortisone (ointment)|Hydrocortisone]] 2.5% top. q12h-q24h for 14-28 days<ref name="pmid75473942">{{cite journal |vauthors=Aalto-Korte K, Turpeinen M |title=Pharmacokinetics of topical hydrocortisone at plasma level after applications once or twice daily in patients with widespread dermatitis |journal=Br. J. Dermatol. |volume=133 |issue=2 |pages=259–63 |date=August 1995 |pmid=7547394 |doi= |url=}}</ref>
**** Preferred regimen (3):  fluocinolone acetonide [[drug name|0.01% top.]] q12h-q24h for 14-28 days
****Preferred regimen (3): [[Fluocinolone acetonide]] [[drug name|0.01% top.]] q12h-q24h for 14-28 days
**** Alternative regimen (1) tacrolimus 0.03%  top. q8h ('''Children (>2years)'''<ref name="pmid92952412">{{cite journal |vauthors=Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S |title=A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group |journal=N. Engl. J. Med. |volume=337 |issue=12 |pages=816–21 |date=September 1997 |pmid=9295241 |doi=10.1056/NEJM199709183371203 |url=}}</ref>
****Alternative regimen (1): [[Tacrolimus]] 0.03% top. q12h ('''Children (>2years)'''<ref name="pmid92952412">{{cite journal |vauthors=Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S |title=A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group |journal=N. Engl. J. Med. |volume=337 |issue=12 |pages=816–21 |date=September 1997 |pmid=9295241 |doi=10.1056/NEJM199709183371203 |url=}}</ref>
**** Alternative regimen (2): pimecrolimus 1% top. q8h
****Alternative regimen (2): [[Pimecrolimus]] 1% top. q12h<ref name="pmid92952416">{{cite journal |vauthors=Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S |title=A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group |journal=N. Engl. J. Med. |volume=337 |issue=12 |pages=816–21 |date=September 1997 |pmid=9295241 |doi=10.1056/NEJM199709183371203 |url=}}</ref>
**** Alternative regimen (3): crisaborole 2% top.
****Alternative regimen (3): Crisaborole 2% top.
*  '''Moderate atopic dermatitis'''
*'''2 Moderate atopic dermatitis'''
** Topical corticosteroids and emollients are the mainstay of therapy
**'''2.1 Topical [[corticosteroids]] and [[emollients]]''' '''-''' mainstay therapy
*** '''Adult'''
***'''2.1.1 Adult'''
**** Preferred regimen (1): fluocinolone0.025%. q12h-q24h for 14-28 days
****Preferred regimen (1): [[Fluocinolone]] 0.025%. q12h-q24h for 14-28 days
**** Preferred regimen (2): [[drug name|triamcinolone 0.1% top.]] q12h-q24h for 14-28 days
****Preferred regimen (2): [[Triamcinolone (topical)|Triamcinolone]] 0.1% top. q12h-q24h for 14-28 days
**** Preferred regimen (3): fluocinolone acetonide [[drug name|0.025% top.]] q12h-q24h for 14-28 days
****Preferred regimen (3): [[Fluocinolone acetonide]] [[drug name|0.025% top.]] q12h-q24h for 14-28 days
**** Alternative regimen (1) tacrolimus 0.1% top. q8h ('''0.03% for adults who do not tolerate the higher dose)'''<ref name="pmid92952413">{{cite journal |vauthors=Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S |title=A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group |journal=N. Engl. J. Med. |volume=337 |issue=12 |pages=816–21 |date=September 1997 |pmid=9295241 |doi=10.1056/NEJM199709183371203 |url=}}</ref>
****Alternative regimen (1): [[Tacrolimus (topical)|Tacrolimus]] 0.1% top. q12h ('''0.03% for adults who do not tolerate the higher dose)'''<ref name="pmid92952413">{{cite journal |vauthors=Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S |title=A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group |journal=N. Engl. J. Med. |volume=337 |issue=12 |pages=816–21 |date=September 1997 |pmid=9295241 |doi=10.1056/NEJM199709183371203 |url=}}</ref>
**** Alternative regimen (2): pimecrolimus 1% top. q8h
****Alternative regimen (2): [[Pimecrolimus topical|Pimecrolimus]] 1% top. q12h<ref name="pmid92952417">{{cite journal |vauthors=Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S |title=A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group |journal=N. Engl. J. Med. |volume=337 |issue=12 |pages=816–21 |date=September 1997 |pmid=9295241 |doi=10.1056/NEJM199709183371203 |url=}}</ref>
**** Alternative regimen (3) crisaborole 2% top.
****Alternative regimen (3): [[Crisaborole]] 2% top.
** '''Pediatric'''
***'''2.1.2 Pediatric'''
*** Preferred regimen (1): fluocinolone0.025%. q12h-q24h for 14 days
****Preferred regimen (1): [[Fluocinolone]] 0.025%. q12h-q24h for 14 days
*** Preferred regimen (2): [[drug name|triamcinolone 0.1% top.]] q12h-q24h for 14 days
****Preferred regimen (2): [[Triamcinolone (topical)|Triamcinolone]] 0.1% top. q12h-q24h for 14 days
*** Preferred regimen (3): fluocinolone acetonide [[drug name|0.025% top.]] q12h-q24h for 14-28 days
****Preferred regimen (3): [[Fluocinolone acetonide]] [[drug name|0.025% top.]] q12h-q24h for 14-28 days
*** Alternative regimen (1) tacrolimus 0.03%  top. q8h ('''Children (>2years)'''<ref name="pmid92952414">{{cite journal |vauthors=Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S |title=A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group |journal=N. Engl. J. Med. |volume=337 |issue=12 |pages=816–21 |date=September 1997 |pmid=9295241 |doi=10.1056/NEJM199709183371203 |url=}}</ref>
****Alternative regimen (1): [[Tacrolimus (topical)|Tacrolimus]] 0.03% top. q12h ('''Children (>2years)'''<ref name="pmid92952414">{{cite journal |vauthors=Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S |title=A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group |journal=N. Engl. J. Med. |volume=337 |issue=12 |pages=816–21 |date=September 1997 |pmid=9295241 |doi=10.1056/NEJM199709183371203 |url=}}</ref>
*** Alternative regimen (2): pimecrolimus 1% top. q8h
****Alternative regimen (2): [[Pimecrolimus topical|Pimecrolimus]] 1% top. q12h<ref name="pmid92952418">{{cite journal |vauthors=Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S |title=A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group |journal=N. Engl. J. Med. |volume=337 |issue=12 |pages=816–21 |date=September 1997 |pmid=9295241 |doi=10.1056/NEJM199709183371203 |url=}}</ref>
*** Alternative regimen (3) crisaborole 2% top.
****Alternative regimen (3): [[Crisaborole]] 2% top.
* '''Severe atopic dermatitis'''
*'''3. Severe atopic dermatitis'''
** Phototherapy or systemic immunosuppressant treatment is the mainstay of therapy
**'''3.1 [[Phototherapy]] or systemic [[immunosuppressant]] treatment''' '''-''' mainstay therapy
*** '''Adult'''
***'''3.1.1 Adult'''
**** Preferred regimen (1): Phototherapy Ultraviolet light therapy (phototherapy) with PUVA (psoralens plus ultraviolet A radiation), 3 times a week
****Preferred regimen (1): [[Phototherapy]] [[Ultraviolet light therapy|(Ultraviolet light therapy]]) with [[PUVA therapy|PUVA]] ([[psoralens]] plus ultraviolet A radiation), 3 times a week
**** Preferred regimen (2): [[drug name|cyclosporine]] PO 3-5 mg/kg o.d. for 6 weeks ('''monitor BP and serum creatinine q2 weeks for three months, f/u q month)''' 
****Preferred regimen (2): [[Cyclosporine]] PO 3-5 mg/kg o.d. for 6 weeks ('''monitor BP and serum creatinine q2 weeks for three months, f/u q month)'''<ref name="pmid107273133">{{cite journal |vauthors=Czech W, Bräutigam M, Weidinger G, Schöpf E |title=A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life |journal=J. Am. Acad. Dermatol. |volume=42 |issue=4 |pages=653–9 |date=April 2000 |pmid=10727313 |doi= |url=}}</ref>
**** Alternative regimen (1) methotrexatePO
****Alternative regimen (1): [[Methotrexate]] PO<ref name="pmid195527163">{{cite journal |vauthors=Lyakhovitsky A, Barzilai A, Heyman R, Baum S, Amichai B, Solomon M, Shpiro D, Trau H |title=Low-dose methotrexate treatment for moderate-to-severe atopic dermatitis in adults |journal=J Eur Acad Dermatol Venereol |volume=24 |issue=1 |pages=43–9 |date=January 2010 |pmid=19552716 |doi=10.1111/j.1468-3083.2009.03351.x |url=}}</ref>
**** Alternative regimen (2): azathioprine PO
****Alternative regimen (2): [[Azathioprine]] PO<ref name="pmid121741063">{{cite journal |vauthors=Berth-Jones J, Takwale A, Tan E, Barclay G, Agarwal S, Ahmed I, Hotchkiss K, Graham-Brown RA |title=Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial |journal=Br. J. Dermatol. |volume=147 |issue=2 |pages=324–30 |date=August 2002 |pmid=12174106 |doi= |url=}}</ref>
**** Alternative regimen (3) mycophenolate mofetil PO
****Alternative regimen (3): Mycophenolate mofetil PO
**** Alternative regimen (3) dupilumab 600 mg SQ once and then 300 mg SQ every 2 weeks thereafter
****Alternative regimen (4): [[Dupilumab]] 600 mg SQ once and then 300 mg SQ every 2 weeks thereafter<ref name="pmid250067193">{{cite journal |vauthors=Beck LA, Thaçi D, Hamilton JD, Graham NM, Bieber T, Rocklin R, Ming JE, Ren H, Kao R, Simpson E, Ardeleanu M, Weinstein SP, Pirozzi G, Guttman-Yassky E, Suárez-Fariñas M, Hager MD, Stahl N, Yancopoulos GD, Radin AR |title=Dupilumab treatment in adults with moderate-to-severe atopic dermatitis |journal=N. Engl. J. Med. |volume=371 |issue=2 |pages=130–9 |date=July 2014 |pmid=25006719 |doi=10.1056/NEJMoa1314768 |url=}}</ref>
*** '''Pediatric'''
***'''3.1.2 Pediatric'''
**** Preferred regimen (1):  
****Preferred regimen (1): [[Phototherapy]] ([[Ultraviolet light]] therapy) with [[PUVA therapy|PUVA]] ( [[psoralens]] plus ultraviolet A radiation), 3 times a week('''older children > 6 years''')
**** Preferred regimen (2): [[drug name|cyclosporine]] PO 3 to 5 mg/kg per day o.d. for 6 weeks ('''monitor BP and serum creatinine q2 weeks for three months, f/b q month)'''
****Alternative regimen (1): [[Cyclosporine (oral)|Cyclosporine]] PO 3 to 5 mg/kg per day o.d. for 6 weeks (monitor '''[[blood pressure]] and [[serum creatinine]]''' every 2 weeks for three months, f/b every month''')'''<ref name="pmid107273134">{{cite journal |vauthors=Czech W, Bräutigam M, Weidinger G, Schöpf E |title=A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life |journal=J. Am. Acad. Dermatol. |volume=42 |issue=4 |pages=653–9 |date=April 2000 |pmid=10727313 |doi= |url=}}</ref><ref name="StänderRopper2021">{{cite journal|last1=Ständer|first1=Sonja|last2=Ropper|first2=Allan H.|title=Atopic Dermatitis|journal=New England Journal of Medicine|volume=384|issue=12|year=2021|pages=1136–1143|issn=0028-4793|doi=10.1056/NEJMra2023911}}</ref>
**** Alternative regimen (1) Phototherapy Ultraviolet light therapy (phototherapy) with PUVA (psoralens plus ultraviolet A radiation), 3 times a week
****Alternative regimen (2): [[Azathioprine]] PO<ref name="pmid121741062">{{cite journal |vauthors=Berth-Jones J, Takwale A, Tan E, Barclay G, Agarwal S, Ahmed I, Hotchkiss K, Graham-Brown RA |title=Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial |journal=Br. J. Dermatol. |volume=147 |issue=2 |pages=324–30 |date=August 2002 |pmid=12174106 |doi= |url=}}</ref>
**** Alternative regimen (2): azathioprine PO
****Alternative regimen (3): Mycophenolate mofetil PO
**** Alternative regimen (3) mycophenolate mofetil PO
****Alternative regimen (4): [[Dupilumab]] 600 mg SQ once and then 300 mg SQ every 2 weeks thereafter<ref name="pmid250067192">{{cite journal |vauthors=Beck LA, Thaçi D, Hamilton JD, Graham NM, Bieber T, Rocklin R, Ming JE, Ren H, Kao R, Simpson E, Ardeleanu M, Weinstein SP, Pirozzi G, Guttman-Yassky E, Suárez-Fariñas M, Hager MD, Stahl N, Yancopoulos GD, Radin AR |title=Dupilumab treatment in adults with moderate-to-severe atopic dermatitis |journal=N. Engl. J. Med. |volume=371 |issue=2 |pages=130–9 |date=July 2014 |pmid=25006719 |doi=10.1056/NEJMoa1314768 |url=}}</ref>
**** Alternative regimen (3) dupilumab 600 mg SQ once and then 300 mg SQ every 2 weeks thereafter
*'''4. Severe refractory atopic dermatitis'''
* '''Severe refractory atopic dermatitis'''
**'''4.1 Adult'''
** '''Adult'''
***Preferred regimen (1): Intensive [[Topical application|topical]] therapy
*** Preferred regimen (1): Intensive topical therapy
****Soak and smear: Soak for 15 minutes in a tub of water. Apply [[Desoximetasone Topical|desoximetasone]] 0.25% top. to the whole body, except the [[groin]], [[axillae]], and [[face]].
**** Soak and smear: Soak for 15 minutes in a tub of water. Apply desoximetasone 0.25% top. to the whole body, except the groin, axillae, and face
****Wet wrap therapy: [[Desoximetasone Topical|Desoximetasone]] 0.25% top. then occluded with wet wraps q12h
**** Wet wrap therapy: desoximetasone 0.25% top. then occluded with wet wraps q12h
***Alternative regimen (1): [[Phototherapy]]: narrowband ultraviolet B or [[Psoralen and ultraviolet A|psoralen plus ultraviolet A]]  two to three times per week
*** Alternative regimen (1) Phototherapy: narrowband ultraviolet B or psoralen plus ultraviolet A  two to three times per week
***Alternative regimen (2): [[Cyclosporine]] PO 2.5 to 5 mg/kg o.d. ('''C/I -''' '''[[Renal function impairment|abnormal renal function]], uncontrolled [[hypertension]] or [[infection]], and [[malignancy]]''')<ref name="pmid10727313">{{cite journal |vauthors=Czech W, Bräutigam M, Weidinger G, Schöpf E |title=A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life |journal=J. Am. Acad. Dermatol. |volume=42 |issue=4 |pages=653–9 |date=April 2000 |pmid=10727313 |doi= |url=}}</ref>
*** Alternative regimen (2): cyclosporine PO 2.5 to 5 mg/kg o.d. ('''C/I -''' '''abnormal renal function, uncontrolled hypertension or infection, and malignancy''')
***Alternative regimen (3): [[Prednisone]] 40 to 60 mg o.d. for one week, then taper the dose over the following two to three weeks
*** Alternative regimen (3): prednisone 40 to 60 mg o.d. for one week, then taper the dose over the following two to three week
***Alternative regimen (4): [[Methotrexate]] 7.5 to 25 mg single weekly dose with folic acid 1 mg o.d.<ref name="pmid195527162">{{cite journal |vauthors=Lyakhovitsky A, Barzilai A, Heyman R, Baum S, Amichai B, Solomon M, Shpiro D, Trau H |title=Low-dose methotrexate treatment for moderate-to-severe atopic dermatitis in adults |journal=J Eur Acad Dermatol Venereol |volume=24 |issue=1 |pages=43–9 |date=January 2010 |pmid=19552716 |doi=10.1111/j.1468-3083.2009.03351.x |url=}}</ref>
*** Alternative regimen (4): methotrexate 7.5 to 25 mg single weekly dose with folic acid 1 mg o.d.
***Alternative regimen (5): [[Azathioprine]] 2 to 3 mg/kg<ref name="pmid12174106">{{cite journal |vauthors=Berth-Jones J, Takwale A, Tan E, Barclay G, Agarwal S, Ahmed I, Hotchkiss K, Graham-Brown RA |title=Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial |journal=Br. J. Dermatol. |volume=147 |issue=2 |pages=324–30 |date=August 2002 |pmid=12174106 |doi= |url=}}</ref>
*** Alternative regimen (5): azathioprine 2 to 3 mg/kg
***Alternative regimen (6):  Mycophenolate mofetil 1 to 2 g/day
*** Alternative regimen (6): mycophenolate mofetil 1 to 2 g/day
***Alternative regimen (7):  [[Mycophenolic acid]] 720 to 1440 mg/day
*** Alternative regimen (7): mycophenolic acid 720 to 1440 mg/day
***Alternative regimen (8): [[Dupilumab]] 600 mg SQ once and then 300 mg SQ every 2 weeks thereafter<ref name="pmid25006719">{{cite journal |vauthors=Beck LA, Thaçi D, Hamilton JD, Graham NM, Bieber T, Rocklin R, Ming JE, Ren H, Kao R, Simpson E, Ardeleanu M, Weinstein SP, Pirozzi G, Guttman-Yassky E, Suárez-Fariñas M, Hager MD, Stahl N, Yancopoulos GD, Radin AR |title=Dupilumab treatment in adults with moderate-to-severe atopic dermatitis |journal=N. Engl. J. Med. |volume=371 |issue=2 |pages=130–9 |date=July 2014 |pmid=25006719 |doi=10.1056/NEJMoa1314768 |url=}}</ref>
*** Alternative regimen (8)  dupilumab 600 mg SQ once and then 300 mg SQ every 2 weeks thereafter
**'''4.2 Pediatric'''
** '''Pediatric'''
***Preferred regimen (1): Intensive topical therapy
*** Preferred regimen (1): Intensive topical therapy
****Wet wrap therapy: [[Desoximetasone]] 0.05% top. then occluded with wet wraps q12h-q24h for 2 to 14 days
**** Wet wrap therapy: desoximetasone 0.05% top. then occluded with wet wraps q12h-q24h for 2 to 14 days
***Alternative regimen (1) [[Phototherapy]]: narrowband ultraviolet B ([[UVB]])  3 times per week ('''older children > 6 years''')<ref name="StänderRopper2021">{{cite journal|last1=Ständer|first1=Sonja|last2=Ropper|first2=Allan H.|title=Atopic Dermatitis|journal=New England Journal of Medicine|volume=384|issue=12|year=2021|pages=1136–1143|issn=0028-4793|doi=10.1056/NEJMra2023911}}</ref>
*** Alternative regimen (1) Phototherapy: narrowband ultraviolet B (UVB)  3 times per week ('''older children > 6 years''')
***Alternative regimen (2): [[Cyclosporine]] PO 2.5 to 5 mg/kg o.d. for 2-4 months ('''monitor [[Renal function|renal]] and [[Liver function tests|hepatic function]]''')<ref name="pmid107273132">{{cite journal |vauthors=Czech W, Bräutigam M, Weidinger G, Schöpf E |title=A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life |journal=J. Am. Acad. Dermatol. |volume=42 |issue=4 |pages=653–9 |date=April 2000 |pmid=10727313 |doi= |url=}}</ref>
*** Alternative regimen (2): cyclosporine PO 2.5 to 5 mg/kg o.d. for 2-4 months ('''monitor renal and hepatic function''')
***Alternative regimen (3): [[Methotrexate]] 0.5 mg/kg PO single weekly dose with folic acid 1 mg o.d.('''up to a maximum of 25 mg per week''')<ref name="pmid19552716">{{cite journal |vauthors=Lyakhovitsky A, Barzilai A, Heyman R, Baum S, Amichai B, Solomon M, Shpiro D, Trau H |title=Low-dose methotrexate treatment for moderate-to-severe atopic dermatitis in adults |journal=J Eur Acad Dermatol Venereol |volume=24 |issue=1 |pages=43–9 |date=January 2010 |pmid=19552716 |doi=10.1111/j.1468-3083.2009.03351.x |url=}}</ref>
*** Alternative regimen (3): methotrexate 0.5 mg/kg PO single weekly dose with folic acid 1 mg o.d.('''up to a maximum of 25 mg per week''')
***Alternative regimen (4): [[Methylprednisolone]] 0.5 mg/kg o.d. for 1-2 weeks tapered over one month
*** Alternative regimen (4): methylprednisolone 0.5 mg/kg o.d. for 1-2 weeks tapered over one month
 
'''Management of Infection:'''
'''Other Drugs for atopic dermatitis''':
* '''Bacterial''' '''infections''': (most common bacteria - ''Staphylococcus. aureus'')
 
** Clinically infected skin:
*I[[Interferon-γ|nterferon-γ]] sub-q o.d. for 12 weeks<ref name="pmid8432915">{{cite journal |vauthors=Hanifin JM, Schneider LC, Leung DY, Ellis CN, Jaffe HS, Izu AE, Bucalo LR, Hirabayashi SE, Tofte SJ, Cantu-Gonzales G |title=Recombinant interferon gamma therapy for atopic dermatitis |journal=J. Am. Acad. Dermatol. |volume=28 |issue=2 Pt 1 |pages=189–97 |date=February 1993 |pmid=8432915 |doi= |url=}}</ref>
*** Mupirocin 2% top. BID for one to two weeks
*Anti-CD20 therapy
*** More extensive infection: oral antibiotic therapy with cephalosporins or penicillinase-resistant penicillins X two weeks
**[[Rituximab]]<ref name="pmid18206507">{{cite journal |vauthors=Simon D, Hösli S, Kostylina G, Yawalkar N, Simon HU |title=Anti-CD20 (rituximab) treatment improves atopic eczema |journal=J. Allergy Clin. Immunol. |volume=121 |issue=1 |pages=122–8 |date=January 2008 |pmid=18206507 |doi=10.1016/j.jaci.2007.11.016 |url=}}</ref>
** Clinically uninfected skin:
*Anti-IgE
*** liquid chlorine bleach-  0.5 cup or 120 ml of 6% bleach in a full bathtub [40 gallons or 150 L] of lukewarm water
**[[Omalizumab]]<ref name="pmid16384758">{{cite journal |vauthors=Lane JE, Cheyney JM, Lane TN, Kent DE, Cohen DJ |title=Treatment of recalcitrant atopic dermatitis with omalizumab |journal=J. Am. Acad. Dermatol. |volume=54 |issue=1 |pages=68–72 |date=January 2006 |pmid=16384758 |doi=10.1016/j.jaad.2005.09.030 |url=}}</ref>
* '''Viral infections:'''
*Anti-TNFα therapy
** Herpes simplex:
**[[Infliximab]]<ref name="pmid15761436">{{cite journal |vauthors=Jacobi A, Antoni C, Manger B, Schuler G, Hertl M |title=Infliximab in the treatment of moderate to severe atopic dermatitis |journal=J. Am. Acad. Dermatol. |volume=52 |issue=3 Pt 1 |pages=522–6 |date=March 2005 |pmid=15761436 |doi=10.1016/j.jaad.2004.11.022 |url=}}</ref>
*** Acyclovir 200 or 400 mg PO five times daily
*Anti-IL-6 receptor therapy
*** Famciclovir 750 mg BID for one day or 1500 mg as a single dose
**[[Tocilizumab]]<ref name="pmid21962991">{{cite journal |vauthors=Navarini AA, French LE, Hofbauer GF |title=Interrupting IL-6-receptor signaling improves atopic dermatitis but associates with bacterial superinfection |journal=J. Allergy Clin. Immunol. |volume=128 |issue=5 |pages=1128–30 |date=November 2011 |pmid=21962991 |doi=10.1016/j.jaci.2011.09.009 |url=}}</ref>
** molluscum contagiosum :
 
*** cryotherapy, curettage, cantharidin, and podophyllotoxin as first-line therapeutic options
'''Adjuvant treatment:'''
* '''Fungal infections:'''
 
** Dermatophyte infections'''-''' topical or oral antifungals
*[[Primrose Oil|Primrose]] oil<ref name="pmid23633319">{{cite journal |vauthors=Bamford JT, Ray S, Musekiwa A, van Gool C, Humphreys R, Ernst E |title=Oral evening primrose oil and borage oil for eczema |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD004416 |date=April 2013 |pmid=23633319 |doi=10.1002/14651858.CD004416.pub2 |url=}}</ref>
*[[Omega-3]]<ref name="pmid18241260">{{cite journal |vauthors=Koch C, Dölle S, Metzger M, Rasche C, Jungclas H, Rühl R, Renz H, Worm M |title=Docosahexaenoic acid (DHA) supplementation in atopic eczema: a randomized, double-blind, controlled trial |journal=Br. J. Dermatol. |volume=158 |issue=4 |pages=786–92 |date=April 2008 |pmid=18241260 |doi=10.1111/j.1365-2133.2007.08430.x |url=}}</ref>
*[[Probiotics]]<ref name="pmid22336810">{{cite journal |vauthors=Bath-Hextall FJ, Jenkinson C, Humphreys R, Williams HC |title=Dietary supplements for established atopic eczema |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD005205 |date=February 2012 |pmid=22336810 |doi=10.1002/14651858.CD005205.pub3 |url=}}</ref>
*Chinese herbal medicines
*[[Vitamin D|Oral vitamin D]]<ref name="pmid21087229">{{cite journal |vauthors=Peroni DG, Piacentini GL, Cametti E, Chinellato I, Boner AL |title=Correlation between serum 25-hydroxyvitamin D levels and severity of atopic dermatitis in children |journal=Br. J. Dermatol. |volume=164 |issue=5 |pages=1078–82 |date=May 2011 |pmid=21087229 |doi=10.1111/j.1365-2133.2010.10147.x |url=}}</ref>
 
'''Management of Infections:'''
 
*'''Bacterial''' '''infections''': (most common bacteria - [[Staphylococcus aureus|S''taphylococcus aureus'']])<ref name="pmid20670815">{{cite journal |vauthors=Ong PY, Leung DY |title=The infectious aspects of atopic dermatitis |journal=Immunol Allergy Clin North Am |volume=30 |issue=3 |pages=309–21 |date=August 2010 |pmid=20670815 |pmc=2913147 |doi=10.1016/j.iac.2010.05.001 |url=}}</ref>
**Clinically infected skin:
***[[Mupirocin]] 2% top. BID for one to two weeks
***More extensive infection: Oral antibiotic therapy with [[cephalosporins]] or penicillinase-resistant penicillins for two weeks.
**Clinically uninfected skin:
***Liquid chlorine bleach-  0.5 cup or 120 ml of 6% bleach in a full bathtub [40 gallons or 150 L] of lukewarm water<ref name="pmid19403473">{{cite journal |vauthors=Huang JT, Abrams M, Tlougan B, Rademaker A, Paller AS |title=Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity |journal=Pediatrics |volume=123 |issue=5 |pages=e808–14 |date=May 2009 |pmid=19403473 |doi=10.1542/peds.2008-2217 |url=}}</ref>
*'''Viral infections:'''
**[[Herpes simplex virus]]:
***[[Acyclovir]] 200 or 400 mg PO five times daily
***[[Famciclovir]] 750 mg BID for one day or 1500 mg as a single dose
**[[Molluscum contagiosum|''Molluscum contagiosum'']] :
***[[Cryotherapy]], curettage, [[cantharidin]], and [[podophyllotoxin]] as first-line therapeutic options.
*'''Fungal infections:'''
**[[Dermatophytes|Dermatophyte]] infections '''-''' [[topical]] or [[oral]] [[antifungals]]<ref name="pmid11421895">{{cite journal |vauthors=Lintu P, Savolainen J, Kortekangas-Savolainen O, Kalimo K |title=Systemic ketoconazole is an effective treatment of atopic dermatitis with IgE-mediated hypersensitivity to yeasts |journal=Allergy |volume=56 |issue=6 |pages=512–7 |date=June 2001 |pmid=11421895 |doi= |url=}}</ref>
 
'''Controlling pruritus:'''
'''Controlling pruritus:'''
* Preferred regimen''':'''
 
** Sedatives: diphenhydramine, hydroxyzine, and cyproheptadine
*Preferred regimen''':'''
** Nonsedatives: fexofenadine, cetirizine or loratadine
**Sedatives: [[Diphenhydramine]], [[hydroxyzine]], and [[cyproheptadine]]
* Alternative regimen:
**Non-sedatives: [[Fexofenadine]], [[cetirizine]] or [[loratadine]]
** Topical doxepin
*Alternative regimen:
** Topical calcineurin inhibitors
**Topical [[doxepin]]
***  Pimecrolimus 1% cream or tacrolimus 0.03% to 0.1%  
**Topical [[calcineurin]] inhibitors
*** [[Pimecrolimus]] 1% cream or [[tacrolimus]] 0.03% to 0.1%<ref name="pmid92952414" /><ref name="pmid92952418" />
 
'''Potential systemic therapies (not yet approved):'''<ref name="StänderRopper2021">{{cite journal|last1=Ständer|first1=Sonja|last2=Ropper|first2=Allan H.|title=Atopic Dermatitis|journal=New England Journal of Medicine|volume=384|issue=12|year=2021|pages=1136–1143|issn=0028-4793|doi=10.1056/NEJMra2023911}}</ref>
 
* JAK inhibitors:
** Abrocitinib (JAK1)
** Gusacitinib (pan-JAK, SYK)
** Tofacitinib (JAK1 and JAK3)
** Upadacitinib (JAK1)
* Interleukin-13 receptor antibodies
* nterleukin-22 receptor antibody
* Interleukin-31 receptor A antibody
* Interleukin-33 receptor A antibody
* Phosphodiesterase-4 inhibitor


==References==
==References==
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[[Category:Autoimmune diseases]]
[[Category:Autoimmune diseases]]
[[Category:Dermatology]]
[[Category:Dermatology]]
[[Category:Primary care]]
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Latest revision as of 16:52, 25 November 2021

Atopic dermatitis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shalinder Singh, M.B.B.S.[2] Ogechukwu Hannah Nnabude, MD

Overview

The mainstay of treatment for atopic dermatitis depends upon the severity of the disease. The treatment involves a combination of conservative and medical therapy. The goals of treatment include elimination of aggravating factors, skin barrier function repair, maintaining skin hydration and pharmacologic treatment of skin inflammation. Pharmacologic medical therapies for atopic dermatitis can be classified according to several severity scales including SCORAD index, the eczema area and severity index (EASI), and the patient-oriented eczema measure (POEM).

Conservative Therapy

Elimination of exacerbating factors Maintaining skin hydration Controlling pruritus
  • Emollients and moisturizers
  • Bathing practices
    • Warm soaking baths or showers using mild or soap-free cleansers

Medical Therapy

  • Pharmacologic medical therapies for atopic dermatitis can be classified according to several severity scales including SCORAD index, the eczema area and severity index (EASI), and the patient-oriented eczema measure (POEM) which includes characteristics of the rash, questions about itch, sleep, impact on daily activities, and persistence of disease.[3]

Atopic dermatitis

Other Drugs for atopic dermatitis:

Adjuvant treatment:

Management of Infections:

Controlling pruritus:

Potential systemic therapies (not yet approved):[3]

  • JAK inhibitors:
    • Abrocitinib (JAK1)
    • Gusacitinib (pan-JAK, SYK)
    • Tofacitinib (JAK1 and JAK3)
    • Upadacitinib (JAK1)
  • Interleukin-13 receptor antibodies
  • nterleukin-22 receptor antibody
  • Interleukin-31 receptor A antibody
  • Interleukin-33 receptor A antibody
  • Phosphodiesterase-4 inhibitor

References

  1. ↑ Krakowski AC, Eichenfield LF, Dohil MA (October 2008). "Management of atopic dermatitis in the pediatric population". Pediatrics. 122 (4): 812–24. doi:10.1542/peds.2007-2232. PMID 18829806.
  2. ↑ Krakowski AC, Eichenfield LF, Dohil MA (October 2008). "Management of atopic dermatitis in the pediatric population". Pediatrics. 122 (4): 812–24. doi:10.1542/peds.2007-2232. PMID 18829806.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Ständer, Sonja; Ropper, Allan H. (2021). "Atopic Dermatitis". New England Journal of Medicine. 384 (12): 1136–1143. doi:10.1056/NEJMra2023911. ISSN 0028-4793.
  4. ↑ Krakowski AC, Eichenfield LF, Dohil MA (October 2008). "Management of atopic dermatitis in the pediatric population". Pediatrics. 122 (4): 812–24. doi:10.1542/peds.2007-2232. PMID 18829806.
  5. ↑ Aalto-Korte K, Turpeinen M (August 1995). "Pharmacokinetics of topical hydrocortisone at plasma level after applications once or twice daily in patients with widespread dermatitis". Br. J. Dermatol. 133 (2): 259–63. PMID 7547394.
  6. ↑ Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
  7. ↑ Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
  8. ↑ Aalto-Korte K, Turpeinen M (August 1995). "Pharmacokinetics of topical hydrocortisone at plasma level after applications once or twice daily in patients with widespread dermatitis". Br. J. Dermatol. 133 (2): 259–63. PMID 7547394.
  9. ↑ Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
  10. ↑ Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
  11. ↑ Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
  12. ↑ Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
  13. ↑ 13.0 13.1 Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
  14. ↑ 14.0 14.1 Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
  15. ↑ Czech W, Bräutigam M, Weidinger G, Schöpf E (April 2000). "A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life". J. Am. Acad. Dermatol. 42 (4): 653–9. PMID 10727313.
  16. ↑ Lyakhovitsky A, Barzilai A, Heyman R, Baum S, Amichai B, Solomon M, Shpiro D, Trau H (January 2010). "Low-dose methotrexate treatment for moderate-to-severe atopic dermatitis in adults". J Eur Acad Dermatol Venereol. 24 (1): 43–9. doi:10.1111/j.1468-3083.2009.03351.x. PMID 19552716.
  17. ↑ Berth-Jones J, Takwale A, Tan E, Barclay G, Agarwal S, Ahmed I, Hotchkiss K, Graham-Brown RA (August 2002). "Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial". Br. J. Dermatol. 147 (2): 324–30. PMID 12174106.
  18. ↑ Beck LA, Thaçi D, Hamilton JD, Graham NM, Bieber T, Rocklin R, Ming JE, Ren H, Kao R, Simpson E, Ardeleanu M, Weinstein SP, Pirozzi G, Guttman-Yassky E, Suárez-Fariñas M, Hager MD, Stahl N, Yancopoulos GD, Radin AR (July 2014). "Dupilumab treatment in adults with moderate-to-severe atopic dermatitis". N. Engl. J. Med. 371 (2): 130–9. doi:10.1056/NEJMoa1314768. PMID 25006719.
  19. ↑ Czech W, Bräutigam M, Weidinger G, Schöpf E (April 2000). "A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life". J. Am. Acad. Dermatol. 42 (4): 653–9. PMID 10727313.
  20. ↑ Berth-Jones J, Takwale A, Tan E, Barclay G, Agarwal S, Ahmed I, Hotchkiss K, Graham-Brown RA (August 2002). "Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial". Br. J. Dermatol. 147 (2): 324–30. PMID 12174106.
  21. ↑ Beck LA, Thaçi D, Hamilton JD, Graham NM, Bieber T, Rocklin R, Ming JE, Ren H, Kao R, Simpson E, Ardeleanu M, Weinstein SP, Pirozzi G, Guttman-Yassky E, Suárez-Fariñas M, Hager MD, Stahl N, Yancopoulos GD, Radin AR (July 2014). "Dupilumab treatment in adults with moderate-to-severe atopic dermatitis". N. Engl. J. Med. 371 (2): 130–9. doi:10.1056/NEJMoa1314768. PMID 25006719.
  22. ↑ Czech W, Bräutigam M, Weidinger G, Schöpf E (April 2000). "A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life". J. Am. Acad. Dermatol. 42 (4): 653–9. PMID 10727313.
  23. ↑ Lyakhovitsky A, Barzilai A, Heyman R, Baum S, Amichai B, Solomon M, Shpiro D, Trau H (January 2010). "Low-dose methotrexate treatment for moderate-to-severe atopic dermatitis in adults". J Eur Acad Dermatol Venereol. 24 (1): 43–9. doi:10.1111/j.1468-3083.2009.03351.x. PMID 19552716.
  24. ↑ Berth-Jones J, Takwale A, Tan E, Barclay G, Agarwal S, Ahmed I, Hotchkiss K, Graham-Brown RA (August 2002). "Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial". Br. J. Dermatol. 147 (2): 324–30. PMID 12174106.
  25. ↑ Beck LA, Thaçi D, Hamilton JD, Graham NM, Bieber T, Rocklin R, Ming JE, Ren H, Kao R, Simpson E, Ardeleanu M, Weinstein SP, Pirozzi G, Guttman-Yassky E, Suárez-Fariñas M, Hager MD, Stahl N, Yancopoulos GD, Radin AR (July 2014). "Dupilumab treatment in adults with moderate-to-severe atopic dermatitis". N. Engl. J. Med. 371 (2): 130–9. doi:10.1056/NEJMoa1314768. PMID 25006719.
  26. ↑ Czech W, Bräutigam M, Weidinger G, Schöpf E (April 2000). "A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life". J. Am. Acad. Dermatol. 42 (4): 653–9. PMID 10727313.
  27. ↑ Lyakhovitsky A, Barzilai A, Heyman R, Baum S, Amichai B, Solomon M, Shpiro D, Trau H (January 2010). "Low-dose methotrexate treatment for moderate-to-severe atopic dermatitis in adults". J Eur Acad Dermatol Venereol. 24 (1): 43–9. doi:10.1111/j.1468-3083.2009.03351.x. PMID 19552716.
  28. ↑ Hanifin JM, Schneider LC, Leung DY, Ellis CN, Jaffe HS, Izu AE, Bucalo LR, Hirabayashi SE, Tofte SJ, Cantu-Gonzales G (February 1993). "Recombinant interferon gamma therapy for atopic dermatitis". J. Am. Acad. Dermatol. 28 (2 Pt 1): 189–97. PMID 8432915.
  29. ↑ Simon D, Hösli S, Kostylina G, Yawalkar N, Simon HU (January 2008). "Anti-CD20 (rituximab) treatment improves atopic eczema". J. Allergy Clin. Immunol. 121 (1): 122–8. doi:10.1016/j.jaci.2007.11.016. PMID 18206507.
  30. ↑ Lane JE, Cheyney JM, Lane TN, Kent DE, Cohen DJ (January 2006). "Treatment of recalcitrant atopic dermatitis with omalizumab". J. Am. Acad. Dermatol. 54 (1): 68–72. doi:10.1016/j.jaad.2005.09.030. PMID 16384758.
  31. ↑ Jacobi A, Antoni C, Manger B, Schuler G, Hertl M (March 2005). "Infliximab in the treatment of moderate to severe atopic dermatitis". J. Am. Acad. Dermatol. 52 (3 Pt 1): 522–6. doi:10.1016/j.jaad.2004.11.022. PMID 15761436.
  32. ↑ Navarini AA, French LE, Hofbauer GF (November 2011). "Interrupting IL-6-receptor signaling improves atopic dermatitis but associates with bacterial superinfection". J. Allergy Clin. Immunol. 128 (5): 1128–30. doi:10.1016/j.jaci.2011.09.009. PMID 21962991.
  33. ↑ Bamford JT, Ray S, Musekiwa A, van Gool C, Humphreys R, Ernst E (April 2013). "Oral evening primrose oil and borage oil for eczema". Cochrane Database Syst Rev (4): CD004416. doi:10.1002/14651858.CD004416.pub2. PMID 23633319.
  34. ↑ Koch C, Dölle S, Metzger M, Rasche C, Jungclas H, Rühl R, Renz H, Worm M (April 2008). "Docosahexaenoic acid (DHA) supplementation in atopic eczema: a randomized, double-blind, controlled trial". Br. J. Dermatol. 158 (4): 786–92. doi:10.1111/j.1365-2133.2007.08430.x. PMID 18241260.
  35. ↑ Bath-Hextall FJ, Jenkinson C, Humphreys R, Williams HC (February 2012). "Dietary supplements for established atopic eczema". Cochrane Database Syst Rev (2): CD005205. doi:10.1002/14651858.CD005205.pub3. PMID 22336810.
  36. ↑ Peroni DG, Piacentini GL, Cametti E, Chinellato I, Boner AL (May 2011). "Correlation between serum 25-hydroxyvitamin D levels and severity of atopic dermatitis in children". Br. J. Dermatol. 164 (5): 1078–82. doi:10.1111/j.1365-2133.2010.10147.x. PMID 21087229.
  37. ↑ Ong PY, Leung DY (August 2010). "The infectious aspects of atopic dermatitis". Immunol Allergy Clin North Am. 30 (3): 309–21. doi:10.1016/j.iac.2010.05.001. PMC 2913147. PMID 20670815.
  38. ↑ Huang JT, Abrams M, Tlougan B, Rademaker A, Paller AS (May 2009). "Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity". Pediatrics. 123 (5): e808–14. doi:10.1542/peds.2008-2217. PMID 19403473.
  39. ↑ Lintu P, Savolainen J, Kortekangas-Savolainen O, Kalimo K (June 2001). "Systemic ketoconazole is an effective treatment of atopic dermatitis with IgE-mediated hypersensitivity to yeasts". Allergy. 56 (6): 512–7. PMID 11421895.
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