Atopic Dermatitis: Systemic Immunosuppressive Therapy
Atopic dermatitis (AD) is a pruritic, relapsing skin disorder that negatively impacts the
quality of life of those affected and that of their families. Treatment options for AD
encompass a variety of emollients, topical corticosteroids, topical immunomodulators,
phototherapy, and systemic agents. Such agents as systemic corticosteroids, cyclosporine,
azathioprine, interferon-, methotrexate, and mycophenolate mofetil have been shown
to be efficacious in the treatment of moderate-to-severe AD but are not officially approved
for this purpose. In this article, we review some of the data supporting efficacy of these
medications and discuss some of the adverse events associated with their use.
Semin Cutan Med Surg 27:151-155 © 2008 Elsevier Inc. All rights reserved.
Pediatric Atopic Dermatitis: The Importance of Food Allergens
Food allergy and atopic dermatitis often occur in the same patients. Food-induced eczema
may be perceived as a controversial topic because the immunologic mechanisms have yet
to be fully elucidated. Nevertheless, published clinical studies have clearly demonstrated
that foods can induce symptoms in a subset of patients with atopic dermatitis. Those at
greatest risk are young children in whom eczematous lesions are severe or recalcitrant to
therapy. Allergy testing can be helpful but must be applied judiciously. A medical history
obtained by a skilled and knowledgeable health care provider is of paramount importance
to interpret test results appropriately. Finally, the implementation of proper dietary avoidance
can improve symptoms and provide safety from potentially fatal anaphylaxis. However,
if inappropriate prescribed, elimination diets can have significant negative nutritional
and social consequences.
Semin Cutan Med Surg 27:156-160 © 2008 Elsevier Inc. All rights reserved.
Topical Therapy in Pediatric Atopic Dermatitis
With a prevalence of 10% to 20% in the first decade of life, atopic dermatitis (AD) is one
of the most common skin disorders in young children. It is a chronic illness with limited
therapeutic options. Topical anti-inflammatory agents remain at the core of medical management;
however, their efficacy must be balanced with safety concerns, especially as they
relate to the pediatric population. This article discusses the principles of topical AD therapy
with a detailed review of the differences between topical corticosteroids and topical
calcineurin inhibitors. It also includes specialized topical treatment strategies for AD, such
as wet wraps and diluted bleach baths, and highlights the most common challenges to
patient compliance in atopic dermatitis.
Semin Cutan Med Surg 27:161-167 © 2008 Elsevier Inc. All rights reserved.