ATOPIC DERMATITIS

Treatments:

• Moisturizers
• Topical Corticosteroids
• Probiotics
  • In a study in 56 children 6-18mos old with mod-severe atopic dermatitis randomized to suspension of Lactobacillus fermentum vs. placebo BID x 8wks, sx scores at 16wks were sig. more improved in the active-tx group (Arch. Dis. Child. 90:892, 2005--JW)
• Non-steroid immunomodulators
  • As effective as moderate-potency topical steroids in some clinical trials (Med. Lett. 43:33, 2001)
  • Do NOT cause skin atrophy
  • Can cause transient local irritation
  • Animal studies suggest possible increased risk of skin malignancies and lymphoma (Med. Lett. op. cit.)
  • Animal studies have shown sensitization to oncogenic effects of UV radiation; manufacturers recommend proctecting treated areas against direct sunlight
  • Specific agents:
    • Pimecrolimus 1% cream (Elidel) ; use BID; systemic absorption is minimal
    • Tacrolimus 0.03% and 0.1% ointment (Protopic); use BID
      • Tacrolimus had sig. greater efficacy and more rapid onset of action than pimecrolimus in one randomized trial (J. Am. Acad. Dermatol. 52:810, 2005--abst)
• Systemic immunosuppressants (e.g. Cyclosporine)
• Bleach baths for atopic dermatitis complicated byinfection
  • In a study in 31 children 6mos-17yo with moderate-to-severe atopic dermatitis and clinical signs of bacterial infection, all of whom were treated initially with cephalexin PO x 2wks, randomized to (baths in dilute bleach (0.5 cup bleach to 40 gallons bathwater) x 5-10min 2x/wk + mupirocin to nares BID x 5d/mo) vs. (plain water baths and petroleum jelly to nares), improvements in the Eczema Area Severity Index were sig. greater in the active-treatment group (Peds 123:e808, 2009-JW)