Guidelines on the Management of Atopic Dermatitis ... - Dermatology

27. Kyllonen H , Remitz A, Mandelin JM, et al. Effects of 1 year intermittent treatment with topical
tacrolimus monotherapy on skin collagen synthesis in patients with atopic dermatitis. Br J
Dermatol 2004;150:1174-81
28. Luger TA, Lahfa R, Folster-Holst R, et al. Long term safety and tolerability of pimecrolimus
cream 1% and topical steroids in adults with moderate to severe atopic dermatitis. J
Dermatological Treatm 2004;15:169-78
29. Wahn U, Bos JD, Goodfield M, et al. Efficacy and safety of pimecrolimus cream in the long term
management of atopic dermatitis in children. Pediatrics 2002;110:2
30. US Food and Drug Administration. Safety: Elidel (pimecrolimus), Protopic (tacrolimus)
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FAD (PDF last accessed 21 June 2013)
Use of phototherapy in atopic dermatitis [1+; A]
When topical modalities fail to control atopic dermatitis, phototherapy is the next option.
Narrow band UVB (NB-UVB) is highly effective and has replaced broadband UVB for
treating atopic dermatitis. Acutely inflamed atopic dermatitis patients do not tolerate UV well.
Therefore the initial treatment will include immunomodulaters like ciclosporin or
mycophenylate mofetil or immunosuppressives like azathioprine or methotrexate. Once the
acute inflammation has settled, UVB can be instituted. 1,2,4,5,6,7
If there is significant erythroderma, UVL in very low doses has to be introduced to prevent
nonspecific irritancy and flaring of the atopic dermatitis. The dose escalation is much slower
than in patients with psoriasis. 1,2
In patients with acute flares of atopic dermatitis, UVA-1 can be used. 1,2
In patients in whom NB-UVB fails, photochemotherapy (PUVA) can be effective. 2 This can
be given topically (soak/bath PUVA) or systemically (oral PUVA). 1,2,6 Goeckerman therapy
with tar and UVB in a “day treatment” setting will improve more than 90% of patients with
refractory atopic dermatitis, and prolonged remission can be induced. 1,2,3,4,5
References
1. Friedmann PS, Arden-Jones MR, Holden CA. Atopic Dermatitis. In: Burns T, Breathnach S,
Cox N, Griffiths C, editors. Rook‟s Textbook of Dermatology. 8th ed. West Sussex: Wiley
Blackwell Publishers; 2010.P.24.27-24.28
2. Atopic Eczema and non-infectious Immunodeficiency Disorders. In: James WD, Berger TG and
Elston DM, editors. Andrew‟s Diseases of the Skin. Clinical Dermatology 11th ed. Elsevier
Saunders: 2011.P.69.
3. Krutmann J. Phototherapy for atopic dermatitis. Clin Exp Dermatol 2000;25:552-8
4. Reynolds NJ, Franklin V, Gray JC et al. Narrow-band ultraviolet B and broadband ultraviolet A
phototherapy in adult atopic eczema: A randomised control trial. Lancet 2001;357:2012-6
5. Tzaneva S, Seeber A, Schwaiger M et al. High-dose versus medium-dose UVA1 phototherapy
for patients with severe generalised atopic dermatitis. J Am Acad Dermatol 2001;45:503-7
6. Der-Petrossian M, Seeber A, Honigsmann H, Tanow A. Half-side comparison study on the
efficacy of 8-methoxypsoralen bath-PUVA versus narrow-band ultraviolet B phototherapy in
patients with severe chronic atopic dermatitis. Br J Dermatol 2000;142:39-43