Recent insights into the management of treatment-resistant pediatric atopic dermatitis

Abstract

Atopic dermatitis (AD) is a prevalent protracted inflammatory skin condition that affects approximately 12% of children globally. Topical remedies, such as pharmacologic and nonpharmacologic management, and off-label systemic medicines, have traditionally been used to treat pediatric AD patients. To minimize comorbidities, sleep disturbances, pruritus, and signs of inflammation and improve the patient’s quality of life, it is vital to optimize severe AD management in pediatric patients. Treatment resistance can be caused by a variety of circumstances, including deficient obedience or inappropriate medicine usage, a shortage of adequate pharmaceuticals, hypersensitivity reciprocation to local application of therapeutics, cutaneous infections, and other infuriating ecological provoking factors. If these elements are eliminated, a skin biopsy is required to exclude other AD-like cutaneous disorders. New regimens that target peculiar avenues with improved proficiency and promise minimal adverse events have resulted from recent developments and understanding of the etiology of AD. Although the condition of most patients improves quickly with this treatment, some do not respond well. In this review, the author discusses the management of treatment-resistant atopic dermatitis, with an emphasis on the pediatric population.

Current and Emerging Therapies in Pediatric Atopic Dermatitis

“…Follow-up data also revealed a long period of disease remission even after completion of therapy [20]. Adverse effects of phototherapy may include skin burning, transient erythema, pruritus, herpes simplex virus reactivation, and a potentially increased risk for skin cancer, particularly with psoralen (PUVA) [21,22]. These effects warrant attention in the pediatric population, given their longer life expectancy and potential risk for long-term damage [22].…”

“…These effects warrant attention in the pediatric population, given their longer life expectancy and potential risk for long-term damage [22]. Combined with the challenge of scheduling phototherapy on a weekly basis and ensuring proper protection throughout the treatment course, many authors recommend against use of phototherapy in infants and young children [19,21]. Though long-term data on the safety of phototherapy are still lacking, numerous studies currently support the safety of administering NBUVB to children [21,22].…”

“…Commonly used agents include cyclosporine A, azathioprine, methotrexate, mycophenolate mofetil, and corticosteroids. An overview of these agents is presented in Table 1 [19][20][21][22][23][24][25][26][27]. Though the pediatric patient may achieve adequate control of their AD with systemic therapy, the side effect profile will often limit its long-term use.…”

“…Therefore, frequent usage of moisturizers and emollients is the mainstay of nonprescription therapy for pediatric AD. Guidelines currently recommend liberal and frequent reapplication of moisturizers throughout the day to avoid drying of the skin [21,50]. Application soon after a daily 5-10-min warm-water bath may be useful to retain moisture and remove crust [50].…”

The effect of probiotics in the prevention of atopic dermatitis in children: a systematic review and meta-analysis

“…A previous study reported that children with AD are more likely to have allergies, asthma, and mental health problems ( 5 ). Infants and children with AD are often treated with topical corticosteroids, antihistamines, and even antibiotics ( 6 ). However, these drugs have some side effects, and AD symptoms may recur quickly after the treatment is stopped.…”