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

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.

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.…”

Immunological Reactions in Atopic Dermatitis and Possible Improvement of Probiotics

“…The atopic diseases are chronic inflammatory disorders caused by aberrant T helper 2 (Th2) immune responses against common innocuous environmental antigens in susceptible individuals. The importance of a delicate balance between allergen -specific T-reg cells and allergen-specific Th2 cells in healthy and allergic immune responses to common environmental allergen was demonstrated in study of Atkis et al [8,9].…”

“…Recent studies showed that probiotics can also exert beneficial effects by directly modulating immune system. The treatment with certain probiotics may prevent and improve symptoms of experimental atopic dermatitis, inflammatory bowel disease and asthma by down regulating inflammatory cytokines inducing immune regulatory mechanism [9,11].…”

Compliance Difficulties in Atopic Children, Reflections from an Eczema School in Sweden

“…As a treating physician, often the major obstacle is not finding a suitable treatment but finding a way to reach the patient and parent in order to have a good understanding of the disease and its treatment and good adherence [6][7][8]. It is well known that education [9][10][11][12][13][14][15] as seen in eczema schools and not only for diseases such as eczema [16] but also other educational measures [15,17,18] at least temporarily enhances compliance. How the eczema school works in different countries and cities depend often on the local clinicians, the facilities found and cultural differences [13,[19][20][21].…”