Atopic Dermatitis Essay

Current management of atopic dermatitis and interruption of the atopic march
Mark Boguniewicz, MD,a Lawrence F. Eichenfield, MD,b and Thomas Hultsch, MDc,d Denver, Colo, San Diego, Calif, Mainz, Germany, and East Hanover, NJ

Treatment of atopic dermatitis requires a comprehensive approach that includes evaluation of potential triggers and education of the patient and family regarding proper avoidance measures. Hydration of the skin and maintenance of an intact skin barrier remain integral to proper management. Although topical corticosteroids have been a mainstay of anti-inflammatory therapy, the newer topical calcineurin inhibitors offer advantages for treatment of this chronic, relapsing disease. Studies aimed at defining optimal combination therapy and early intervention might change the treatment paradigm for atopic dermatitis. (J Allergy Clin Immunol 2003;112:S140-50.) Key words: Atopic dermatitis, atopy, asthma, steroids, calcineurin inhibitors

Abbreviations used AD: Atopic dermatitis EASI: Eczema area and severity index FTU: Fingertip unit IGA: Investigator’s global assessment NF-ATp: Nuclear factor of activated T-cell protein PUVA: Psoralen ultraviolet A-range SCORAD: Scoring atopic dermatitis index

As discussed in the article by Spergel and Paller,1 not only is atopic dermatitis (AD) an increasingly prevalent disease that impacts significantly on the lives of patients and their families, but approximately half of the patients will go on to develop asthma. New insights into the immunopathogenesis of AD as discussed in the article by Novak et al2 will likely yield more targeted therapy not only for AD but with potential to alter the atopic march. At present, management of patients with AD includes avoidance of irritants and specific triggers, repair and maintenance of the skin barrier, interruption of the itchscratch cycle, and reduction of inflammation. In this article we review principles of conventional therapy as well as the newer topical...