While there is currently no cure for atopic dermatitis (AD) — commonly called eczema — this prevalent condition can often be well managed through conventional drug therapies. Current AD strategies used by dermatologists include symptom relief, patient/parent education, and the prevention of secondary complications.
The “Gold Standard” for Mild to Moderate Atopic Dermatitis
The most frequently used therapies for mild to moderate AD are a combination of diligent moisturization and occasional topical corticosteroids. Current research has highlighted the importance of early effective moisturization in slowing the disease process.
Topical corticosteroids, which have immunosuppressive and anti-inflammatory properties, are fast and effective for many cases of AD. However, long-term use can lead to skin atrophy, spider veins, stretch marks, and pigmentation abnormalities. Rarely in extreme cases, topical corticosteroid use may cause hypothalamic-pituitary-adrenal suppression, leading to Cushing’s syndrome.
Topical Calcineurin Inhibitors
Topical calcineurin inhibitors (TCIs) are a group of immunosuppressive drugs that inhibit the synthesis of proinflammatory cytokines and include tacrolimus ointment and pimecrolimus cream.
Pimecrolimus is approved for mild to moderate AD when corticosteroids are contraindicated or poorly tolerated. Tacrolimus ointment is approved for:
- Moderate to severe AD with insufficient response (or poor tolerance) to conventional conservative treatments
- Supportive therapy for moderate to severe AD to prevent relapses and extend periods without recurrence in cases where patients have previously experienced frequent exacerbation and who responded to treatment with tacrolimus ointment twice a day for a maximum of six weeks
In 2006, the FDA issued a requirement for all TCIs to carry boxed warnings for possible cancer risk. Interim data from long-term studies evaluating these risks are expected to be published in 2017. Of note, the American Academy of Dermatology does not support the FDA warning.
Managing Atopic Dermatitis and Its Complications
In practice, many dermatologists use TCIs continuously for disease maintenance and reserve corticosteroids for disease exacerbations. Additionally, diluted bleach baths are sometimes used to control Staphylococcus aureus colonization in certain patients.
Unfortunately, treatment options for severe AD have been limited. While an option, systemic oral immunosuppressive drugs, such as cyclosporine, are rarely justified and are often coupled with serious side effects. However, targeted biologic therapies may hold the answer for AD sufferers. To learn more about how this treatment strategy is changing the way we treat AD, be sure to read our white paper,