Guidelines for treatment of atopic eczema (atopic dermatitis) Part I

Abstract

The existing evidence for treatment of atopic eczema (atopic dermatitis, AE) is evaluated using the national standard Appraisal of Guidelines Research and Evaluation. The consensus process consisted of a nominal group process and a DELPHI procedure. Management of AE must consider the individual symptomatic variability of the disease. Basic therapy is focused on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti‐inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors (TCI) is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the TCI tacrolimus and pimecrolimus are preferred in certain locations. Systemic immune‐suppressive treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Adjuvant therapy includes UV irradiation preferably with UVA1 wavelength or UVB 311 nm. Dietary recommendations should be specific and given only in diagnosed individual food allergy. Allergen‐specific immunotherapy to aeroallergens may be useful in selected cases. Stress‐induced exacerbations may make psychosomatic counselling recommendable. ‘Eczema school’ educational programs have been proven to be helpful. Pruritus is targeted with the majority of the recommended therapies, but some patients need additional antipruritic therapies.

A new topical panthenol-containing emollient: skin-moisturizing effect following single and prolonged usage in healthy adults, and tolerability in healthy infants

“…In addition, NTP-CE incorporates a lipid lamellar technology resembling naturally occurring skin barrier lipids. To become a useful adjunct in the management of AD and other conditions associated with dry skin, NTP-CE has to provide skin-moisturizing potential (3). Findings of an initial set of two studies in healthy adult subjects suggested that twicedaily application of NTP-CE is well tolerated and associated with significant improvements in skin barrier restoration, skin moisturization, and intercellular lipid layer (ICLL) organization in the stratum corneum (SC).…”

Current Views on the Pathogenesis and Principles of External Treatment of Atopic Dermatitis in Children

“…Глюкокортикостероиды имеют многочисленные эф -фекты при воздействии на кожу [32][33][34]. Молекула сте-роида после поглощения связывается с цитоплазмати-ческим рецептором в кератиноцитах, который затем проникает в ядро, воздействуя на транскрипцию рибо-нуклеиновой кислоты.…”

The role of infection in the pathogenesis of allergodermatoses

“…Плацебо-контролируемыми клиническими иссле-дованиями было показано, что суммарный эффект применения топических ГКС или ингибиторов кальциневрина вносит основной вклад в улучшение состояния больных АтД. Дополнительное введение антибиотиков и/или антимикотиков лишь незначи-тельно улучшало динамику выздоровления [59][60][61][62][63]. С учетом риска развития устойчивости к антибио-тикам современные рекомендации по лечению АтД во всем мире предлагают ограничить использование противоинфекционной терапии.…”

“…Включение антибактериальной терапии целесо-образно при распространенном процессе, явных признаках наличия той или иной инфекции и у больных, не отвечающих на базисную терапию [59][60][61]. В последнем случае применение антибиотиков и антимикотиков будет значимым в снижении реак-тивности иммунной реакции на повреждение кож-ного барьера (см.…”