Treatment of Eczema: Corticosteroids and Beyond

被引:40
作者
Chong, Melanie [1 ]
Fonacier, Luz [1 ]
机构
[1] Winthrop Univ Hosp, Rheumatol Allergy & Immunol, 120 Mineola Blvd,Suite 410, Mineola, NY 11501 USA
关键词
Atopic dermatitis; Topical calcineurin inhibitors; Topical corticosteroids; Difficult-to-treat atopic dermatitis; Contact dermatitis; SEVERE ATOPIC-DERMATITIS; TOPICAL CALCINEURIN INHIBITORS; ANTI-CD20 RITUXIMAB TREATMENT; PIMECROLIMUS PERMEATES LESS; VITAMIN-D SUPPLEMENTATION; WET-WRAP DRESSINGS; DOUBLE-BLIND; TACROLIMUS OINTMENT; FOOD ALLERGY; DILUTED CORTICOSTEROIDS;
D O I
10.1007/s12016-015-8486-7
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Atopic dermatitis (AD) is a chronic inflammatory skin condition that requires a manifold approach to therapy. The goal of therapy is to restore the function of the epidermal barrier and to reduce skin inflammation. This can be achieved with skin moisturization and topical anti-inflammatory agents, such as topical corticosteroids and calcineurin inhibitors. Furthermore, proactive therapy with twice weekly use of both topical corticosteroids and calcineurin inhibitors in previously affected areas has been found to reduce the time to the next eczematous flare. Adjunctive treatment options include wet wrap therapy, anti-histamines, and vitamin D supplementation. Bacterial colonization, in particular Staphylococcus aureus, can contribute to eczematous flares and overt infection. Use of systemic antibiotics in infected lesions is warranted; however, empiric antibiotics use in uninfected lesions is controversial. Local antiseptic measures (i.e., bleach baths) and topical antimicrobial therapies can be considered in patients with high bacterial colonization. Difficult-to-treat AD is a complex clinical problem that may require re-evaluation of the initial diagnosis of AD, especially if the onset of disease occurs in adulthood. It may also necessitate evaluation for contact, food, and inhaled allergens that may exacerbate the underlying AD. There are a host of systemic therapies that have been successful in patients with difficult-to-treat AD, however, these agents are limited by their side effect profiles. Lastly, with further insight into the pathophysiology of AD, new biological agents have been investigated with promising results.
引用
收藏
页码:249 / 262
页数:14
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