Guidelines on the Management of Atopic Dermatitis ... - Dermatology
Guidelines on the Management of Atopic Dermatitis ... - Dermatology
Guidelines on the Management of Atopic Dermatitis ... - Dermatology
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Intranasal mupirocin combined with sodium hypochlorite (bleach) baths showed promise in a<br />
recent RCT in children. 19<br />
Anti-fungals [1+; A]<br />
Malassezia sympodialis sensitisati<strong>on</strong> plays an important role in atopic dermatitis in adults,<br />
especially in patients with head and neck dermatitis. 20 IgE-mediated reacti<strong>on</strong>s to <strong>the</strong> fungus<br />
can be dem<strong>on</strong>strated in such patients and RCTs with systemic itrac<strong>on</strong>azole 21 and<br />
ketoc<strong>on</strong>azole 22 showed significant benefit in such patients. These drugs represent effective<br />
treatment opti<strong>on</strong>s for this group <strong>of</strong> patients.<br />
Intravenous immunoglobulin [1; B]<br />
This modality can be used as a last resort in children with severe, refractory atopic<br />
dermatitis, supported by at least <strong>on</strong>e RCT. 23<br />
Interfer<strong>on</strong>-gamma<br />
This expensive treatment may be a useful modality for moderate to severe atopic dermatitis<br />
in children and adults who have a history <strong>of</strong> recurrent skin infecti<strong>on</strong>s with herpes simplex,<br />
human papilloma virus or molluscum c<strong>on</strong>tagiosum. 24<br />
Biological drugs<br />
Infliximab, efalizumab, tocilizumab and rituximab have been studied in this regard, but no<br />
firm recommendati<strong>on</strong>s can be provided at this stage.<br />
PPAR-gamma antag<strong>on</strong>ists (thiazolidinedi<strong>on</strong>es)<br />
These anti-diabetic drugs are also anti-inflammatory and (rosiglitaz<strong>on</strong>e) have been<br />
retrospectively shown 25 to be beneficial in atopic dermatitis. It also acts by improving skin<br />
barrier functi<strong>on</strong> and thus may be more effective as preventative treatment. 26<br />
References<br />
1. Denby KS, Beck LA. Update <strong>on</strong> systemic <strong>the</strong>rapies for atopic dermatitis. Curr Opin Allergy Clin<br />
Immunol 2012;12(4):421-6<br />
2. V<strong>on</strong> Ruden U, Bunikowski R, Brautigam M, Staab D. Cyclosporin A treatment <strong>of</strong> children with<br />
severe atopic dermatitis improves quality <strong>of</strong> life <strong>of</strong> <strong>the</strong>ir mo<strong>the</strong>rs. Dermatol Psychosom<br />
2002;314-8<br />
3. Harper Dematology 2001 203 3-6<br />
4. Ricci G, D<strong>on</strong>di A, Patrizi A, Masi M. Systemic Therapy <strong>of</strong> <strong>Atopic</strong> <strong>Dermatitis</strong> in Children. Drugs<br />
2009;69(3):297-306<br />
5. Parakkal D, Sifuentes H, Semer R, Ehrenpreis ED. Hepatosplenic T-cell lymphoma in patients<br />
receiving TNF-alpha inhibitor <strong>the</strong>rapy: expanding <strong>the</strong> groups at risk. Eur J Gastroenterol<br />
Hepatol 2011;2:1150–6.<br />
6 Akdis CA, Akdis M, Bieber T, et al. Diagnosis and treatment <strong>of</strong> atopic dermatitis in children and<br />
adults European Academy <strong>of</strong> Allergology and Clinical Immunology/American Academy <strong>of</strong><br />
Allergy, Asthma and Immunology/PRACTALL C<strong>on</strong>sensus Report. Allergy 2006:61:969–87<br />
7. Werfel T, Spergel JM, Kiess W (eds): <strong>Atopic</strong> <strong>Dermatitis</strong> in Childhood and Adolescence. Pediatr