<p>Current Perspectives on the Management of Infantile Atopic Dermatitis</p>

Abstract

Atopic dermatitis (AD) is a common disease of childhood, and infantile AD may manifest from birth to 2 years. Guidelines for the management of infantile AD are lacking, and our aim is to provide a comprehensive review of best practices and possible interventions. We will focus on topical therapy, since the use of systemic immunomodulating agents in infantile AD is rarely advised. Topical agents include emollients, topical corticosteroids (TCS), topical calcineurin inhibitors (TCIs), and phosphodiesterase 4 (PDE-4) inhibitors. We will also provide a brief overview of promising emerging therapies currently under investigation in the pediatric population.

Atopic dermatitis in children: when topical steroid treatment “does not work”

“…Patient and caregiver concerns about the side effects of TCS are associated with reduced use of these medications and warrant open discussion 5. Systemic side effects of topical TCS such as glaucoma and adrenal insufficiency and local reactions such as skin atrophy and striae are unlikely to occur with judicious use of TCS 6…”

“…For some children older than 2, topical calcineurin inhibitors (TCI) may be a steroid-sparing topical treatment alternative, especially at sites with thin skin 6. TCI are more costly, may sting on application, and they carry a black box warning for theoretical carcinogenicity 210.…”

Current Perspectives on the Systemic Management of Atopic Dermatitis

“…Since the use of systemic agents in infantile AD is rarely advised, the focus of this review will be on the childhood and adult phases. 15 The infantile phase may manifest from birth to 2 years of age, followed by the childhood phase from 2 years through puberty. The adult phase begins at puberty and may persist throughout adulthood.…”

New Strategies for Improving Budesonide Skin Retention

“…In those cases, the first biologic drug, dupilumab, which is a monoclonal human antibody targeting the IL-4 and IL-13 receptor, was made available in 2017 for long-term treatment in adults and adolescents [3,4]. In all other cases, management is based on topical therapies with topical corticosteroids (TCs); topical calcineurin inhibitors, such as picrolimus and pimecrolimus; or with topical crisaborole, a phosphodiesterase 4 inhibitor [5]. Among these options, the mainstay therapy for AD is still considered treatment with TCs, drugs that have been used for more than 60 years [6] and that have proven to be more effective compared to the other therapeutic options for the treatment of moderate to severe AD [5].…”

“…In all other cases, management is based on topical therapies with topical corticosteroids (TCs); topical calcineurin inhibitors, such as picrolimus and pimecrolimus; or with topical crisaborole, a phosphodiesterase 4 inhibitor [5]. Among these options, the mainstay therapy for AD is still considered treatment with TCs, drugs that have been used for more than 60 years [6] and that have proven to be more effective compared to the other therapeutic options for the treatment of moderate to severe AD [5]. Nevertheless, the prolonged use of TCs may be associated with adverse effects, both local (i.e., skin atrophy, teleangiectases, rosacea) and systemic (i.e., pituitary-adrenal axis suppression, hyperglycemia, glaucoma).…”