Topical therapy of atopic dermatitis in children

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in children. In 60-80 % of all cases it manifests during the first year of life. AD pathogenesis is characterized by an interplay between genetic disposition (barrier defect, excessive cutaneous inflammation) and an increased susceptibility to reacting to triggering factors (infections, allergens, "stress"). In every stage of the disease, barrier therapy is crucial. Restoration of the defective barrier prevents transepidermal water loss as well as intrusion of allergens and pathogens from outside that promote cutaneous inflammation. Topical barrier therapy should be adapted to the disease stage, the location of the eczema, the season, and the age of the child. Proactive topical anti-inflammatory therapy is based on "modern" topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI). Among a wide selection of TCS, prednicarbate and methylprednisolone are preferred owing to their favorable safety/efficacy profile. According to recently published studies, the same applies to TCI, which are ideally suited for long-term therapy in order to prevent relapses. A total of 90-95% of cases can be effectively controlled by topical therapy tailored to the disease state and patient age. Therapy aims at disease control and prevention of recurrences.