Atopic dermatitis medical therapy: Difference between revisions

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*** '''1.1.1 Adult'''
*** '''1.1.1 Adult'''
**** Preferred regimen (1): [[Desonide Topical|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): [[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><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>  
**** 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. 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 (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>
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*** '''3.1.1 Adult'''
*** '''3.1.1 Adult'''
**** 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 (1): [[Phototherapy]] [[Ultraviolet light therapy|(Ultraviolet light therapy]]) with [[PUVA therapy|PUVA]] ([[psoralens]] plus ultraviolet A radiation), 3 times a week  
**** 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><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>   
**** 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): [[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><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): [[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<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 (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 (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>
**** 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>
*** '''3.1.2 Pediatric'''
*** '''3.1.2 Pediatric'''
**** Preferred regimen (1): [[Phototherapy]] ([[Ultraviolet light]] therapy) with [[PUVA therapy|PUVA]] ( [[psoralens]] plus ultraviolet A radiation), 3 times a 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>
**** Preferred regimen (1): [[Phototherapy]] ([[Ultraviolet light]] therapy) with [[PUVA therapy|PUVA]] ( [[psoralens]] plus ultraviolet A radiation), 3 times a week('''older children > 6 years''')
**** 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): [[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 (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<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>
Line 91: Line 91:
**** 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 Topical|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 Topical|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<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 or [[Psoralen and ultraviolet A|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 -''' '''[[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 (3): [[Prednisone]] 40 to 60 mg o.d. for one week, then taper the dose over the following two to three week<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 (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.<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 (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<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>  
Line 104: Line 104:
*** 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''')<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 (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 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 (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><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 (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 (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
'''Other Drugs for atopic dermatitis''':
'''Other Drugs for atopic dermatitis''':

Revision as of 18:35, 22 April 2021

Atopic dermatitis Microchapters

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Atopic dermatitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Atopic dermatitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT Scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Atopic dermatitis medical therapy On the Web

Most recent articles

Most cited articles

Review articles

Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Atopic dermatitis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Atopic dermatitis medical therapy

CDC on Atopic dermatitis medical therapy

Atopic dermatitis medical therapy in the news

Blogs onAtopic dermatitis medical therapy

Directions to Hospitals Treating Atopic dermatitis

Risk calculators and risk factors forAtopic dermatitis medical therapy

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

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. Pharmacologic medical therapies for atopic dermatitis can be classified according to the 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 the 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.

Atopic dermatitis

Other Drugs for atopic dermatitis:

Adjuvant treatment:

Management of Infections:

Controlling pruritus:

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 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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