Ann Dermatol.  2012 Aug;24(3):253-260. 10.5021/ad.2012.24.3.253.

Long Term Treatment Concepts and Proactive Therapy for Atopic Eczema

• Wollenberg A
• Ehmann LM

• KMID: 2265296
• DOI: http://doi.org/10.5021/ad.2012.24.3.253

Abstract

Atopic eczema, also known as atopic dermatitis, is a frequent, highly pruritic, chronic skin disease, which is typically running in flares. The traditional treatment mainly consists of the reactive application of topical anti-inflammatory agents such as topical corticosteroids and topical calcineurin inhibitors. The short term benefit of this approach is well known, but long term remission between flares is difficult to achieve. Therefore, innovative long-term treatment strategies targeting flare prevention and skin barrier stabilization are needed. We and others have shown that normal looking, non-lesional skin of atopic dermatitis patients is immunobiologially not normal but characterized by an invisible inflammation and barrier defect. This has led to the novel concept of proactive therapy, which is defined as long-term, low-dose intermittent application of anti-inflammatory therapy to the previously affected skin, together with an ongoing emollient treatment of unaffected skin. This review article describes the most important long-term treatment options for atopic dermatitis, which includes emollient therapy, the novel concept of proactive treatment, the different ultraviolet light modalities and a selection of systemic immunosuppressive drugs and biologics. Current trial data, licensed indications, off-label use and relevant side effects of the different treatment modalities are summarized.

Keyword

Atopic eczema; Emollients; Flare prevention; Proactive treatment; Topical calcineurin inhibitors; Topical corticosteroids

MeSH Terms

Adrenal Cortex Hormones
Anti-Inflammatory Agents
Biological Agents
Calcineurin
Dermatitis, Atopic
Emollients
Humans
Inflammation
Off-Label Use
Running
Skin
Skin Diseases
Ultraviolet Rays
Adrenal Cortex Hormones
Anti-Inflammatory Agents
Biological Agents
Calcineurin
Emollients

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