Use of topical corticosteroids and topical calcineurin inhibitors for the treatment of atopic dermatitis in thin and sensitive skin areas

Background.-Atopic dermatitis (AD) is a common, chronic skin disorder characterized by itch and dry skin, which can develop into pruritic red plaques that ooze when scratched. AD flares often occur in anatomic areas where the skin is naturally thin (the face, neck, and intertriginous zones). Such regions, especially the face, are also areas of sensitive skin and need special consideration when being treated. Objective: This article will briefly review the concepts of thin and sensitive skin and discuss the treatment of AD in such areas. Methods: The MEDLINE database was searched for English-language articles published that contained the text terms atopic dermatitis, sensitive skin, treatment, topical corticosteroids, or topical calcineurin inhibitors. Articles that pertained to the safety and efficacy of various treatments were selected for further review. Results: Topical corticosteroids (TCSs) are effective for the treatment of AD in thin and sensitive skin areas, but their use is limited due to adverse events, such as skin thinning, and the potential for impairing the skin barrier. Topical calcineurin inhibitors (TCls) also provide effective AD treatment without impairing the skin barrier or inducing skin thinning. Although TCls may be associated with a higher incidence of applicationsite reactions such as pruritus and skin burning, these symptoms are typically transient and mild to moderate in nature. Limitations: This analysis focused primarily on relatively recent key trials evaluating the treatment of AD in sensitive skin; due to the limited number of controlled trials evaluating TCS agents, consensus statements and comprehensive review articles were used for most of the information pertaining to this therapeutic option. Conclusions: Although both TCSs and TCls have a place in a long-term, comprehensive treatment strategy for AD, TCls may have a particular use in thin and sensitive skin areas.