Skip to main content
SpringerLink
Log in

Systemic Treatment

  • Chapter
  • First Online:
Practical Insights into Atopic Dermatitis

  • 360 Accesses

Abstract

The most basic treatment for atopic dermatitis is the use of topical steroids and topical calcineurin inhibitors. In most patients with atopic dermatitis, topical steroids or topical calcineurin inhibitors improve symptoms, but in some cases, topical treatments are not effective and topical steroids are difficult to use due to “steroid phobia.” Short-term use of systemic steroids can be highly effective for acute exacerbation of severe atopic dermatitis. However, if systemic steroids have been administered for a long-term period, they are known to cause various serious adverse reactions such as diabetes, hypertension, osteoporosis, and the like, including the ones related to the endocrine system. Therefore, it is advised to administer systemic steroids restrictively for acute exacerbation of severe cases. As a result, systemic immunomodulators are used when severe atopic dermatitis patients who do not respond to topical agents continue to relapse and get worse. Several systemic immunomodulators including cyclosporine, azathioprine, methotrexate, and mycophenolate mofetil have been widely used so far. As other alternative treatments, sedative H1 antihistamines for pruritus control, and recently developed second-generation H1 antihistamines with antiallergic effects can be used in atopic dermatitis patients. Furthermore, atopic dermatitis may frequently accompany infections by bacteria, viruses, and fungi. Consequently, it is very important to treat such skin infections that aggravate atopic dermatitis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Esteban NV, Loughlin T, Yergey AL, Zawadzki JK, Booth JD, Winterer JC, et al. Daily cortisol production rate in man determined by stable isotope dilution/mass spectrometry. J Clin Endocrinol Metab. 1991;72(1):39–45.

    Article  CAS  PubMed  Google Scholar 

  2. Bloom E, Matulich DT, Lan NC, Higgins SJ, Simons SS, Baxter JD. Nuclear binding of glucocorticoid receptors: relations between cytosol binding, activation and the biological response. J Steroid Biochem. 1980;12:175–84.

    Article  CAS  PubMed  Google Scholar 

  3. Flower RJ, Rothwell NJ. Lipocortin-1: cellular mechanisms and clinical relevance. Trends Pharmacol Sci. 1994;15(3):71–6.

    Article  CAS  PubMed  Google Scholar 

  4. Adcock IM, Ito K. Molecular mechanisms of corticosteroid actions. Monaldi Arch Chest Dis. 2000;55(3):256–66.

    CAS  PubMed  Google Scholar 

  5. Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids—new mechanisms for old drugs. N Engl J Med. 2005;353(16):1711–23.

    Article  CAS  PubMed  Google Scholar 

  6. Buttgereit F, Saag KG, Cutolo M, da Silva JA, Bijlsma JW. The molecular basis for the effectiveness, toxicity, and resistance to glucocorticoids: focus on the treatment of rheumatoid arthritis. Scand J Rheumatol. 2005;34(1):14–21.

    Article  CAS  PubMed  Google Scholar 

  7. Lu NZ, Cidlowski JA. The origin and functions of multiple human glucocorticoid receptor isoforms. Ann N Y Acad Sci. 2004;1024:102–23.

    Article  CAS  PubMed  Google Scholar 

  8. Buttgereit F, Wehling M, Burmester GR. A new hypothesis of modular glucocorticoid actions: steroid treatment of rheumatic diseases revisited. Arthritis Rheum. 1998;41(5):761–7.

    Article  CAS  PubMed  Google Scholar 

  9. Cupps TR, Fauci AS. Corticosteroid-mediated immunoregulation in man. Immunol Rev. 1982;65:133–55.

    Article  CAS  PubMed  Google Scholar 

  10. Amano Y, Lee SW, Allison AC. Inhibition by glucocorticoids of the formation of interleukin-1 alpha, interleukin-1 beta, and interleukin-6: mediation by decreased mRNA stability. Mol Pharmacol. 1993;43(2):176–82.

    CAS  PubMed  Google Scholar 

  11. Kitajima T, Ariizumi K, Bergstresser PR, Takashima A. A novel mechanism of glucocorticoid-induced immune suppression: the inhibiton of T cell-mediated terminal maturation of a murine dendritic cell line. J Clin Invest. 1996;98(1):142–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Balow JE, Rosenthal AS. Glucocorticoid suppression of macrophage migration inhibitory factor. J Exp Med. 1973;137(4):1031–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Hogan MM, Vogel SN. Inhibition of macrophage tumoricidal activity by glucocorticoids. J Immunol. 1988;140(2):513–9.

    CAS  PubMed  Google Scholar 

  14. Parrillo JE, Fauci AS. Mechanisms of glucocorticoid action on immune processes. Annu Rev Pharmacol Toxicol. 1979;19:179–201.

    Article  CAS  PubMed  Google Scholar 

  15. Butler WT, Rossen RD. Effects of corticosteroids on immunity in man. I. Decreased serum IgG concentration caused by 3 or 5 days of high doses of methylprednisolone. J Clin Invest. 1973;52(10):2629–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Levis S, Altman R. Bone densitometry: clinical considerations. Arthritis Rheum. 1998;41(4):577–87.

    Article  CAS  PubMed  Google Scholar 

  17. Saeki H, Nakahara T, Tanaka A, Kabashima K, Sugaya M, Murota H, et al. Clinical practice guidelines for the management of atopic dermatitis 2016. J Dermatol. 2016;43(10):1117–45.

    Article  PubMed  Google Scholar 

  18. Kim JE, Kim HJ, Lew BL, Lee KH, Hong SP, Jang YH, et al. Consensus guidelines for the treatment of atopic dermatitis in Korea (part II): systemic treatment. Ann Dermatol. 2015;27(5):578–92.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sidbury R, Davis DM, Cohen DE, Cordoro KM, Berger TG, Bergman JN, et al. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014;71(2):327–49.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wollenberg A, Oranje A, Deleuran M, Simon D, Szalai Z, Kunz B, et al. ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients. J Eur Acad Dermatol Venereol. 2016;30(5):729–47.

    Article  CAS  PubMed  Google Scholar 

  21. Lukert BP, Raisz LG. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med. 1990;112(5):352–64.

    Article  CAS  PubMed  Google Scholar 

  22. Adachi JD, Bensen WG, Brown J, Hanley D, Hodsman A, Josse R, et al. Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. N Engl J Med. 1997;337(6):382–7.

    Article  CAS  PubMed  Google Scholar 

  23. Luengo M, Picado C, Del Rio L, Guanabens N, Montserrat JM, Setoain J. Vertebral fractures in steroid dependent asthma and involutional osteoporosis: a comparative study. Thorax. 1991;46(11):803–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Reid IR, Heap SW. Determinants of vertebral mineral density in patients receiving long-term glucocorticoid therapy. Arch Intern Med. 1990;150(12):2545–8.

    Article  CAS  PubMed  Google Scholar 

  25. Ton FN, Gunawardene SC, Lee H, Neer RM. Effects of low-dose prednisone on bone metabolism. J Bone Miner Res. 2005;20(3):464–70.

    Article  CAS  PubMed  Google Scholar 

  26. Rizzato G, Montemurro L. Reversibility of exogenous corticosteroid-induced bone loss. Eur Respir J. 1993;6(1):116–9.

    CAS  PubMed  Google Scholar 

  27. Buckley LM, Leib ES, Cartularo KS, Vacek PM, Cooper SM. Effects of low dose methotrexate on the bone mineral density of patients with rheumatoid arthritis. J Rheumatol. 1997;24(8):1489–94.

    CAS  PubMed  Google Scholar 

  28. Solomon L. Idiopathic necrosis of the femoral head: pathogenesis and treatment. Can J Surg. 1981;24(6):573–8.

    CAS  PubMed  Google Scholar 

  29. Zizic TM, Marcoux C, Hungerford DS, Dansereau JV, Stevens MB. Corticosteroid therapy associated with ischemic necrosis of bone in systemic lupus erythematosus. Am J Med. 1985;79(5):596–604.

    Article  CAS  PubMed  Google Scholar 

  30. Glueck CJ, Freiberg R, Tracy T, Stroop D, Wang P. Thrombophilia and hypofibrinolysis: pathophysiologies of osteonecrosis. Clin Orthop Relat Res. 1997;334:43–56.

    Article  Google Scholar 

  31. Mont MA, Fairbank AC, Petri M, Hungerford DS. Core decompression for osteonecrosis of the femoral head in systemic lupus erythematosus. Clin Orthop Relat Res. 1997;334:91–7.

    Google Scholar 

  32. Dixon RB, Christy NP. On the various forms of corticosteroid withdrawal syndrome. Am J Med. 1980;68(2):224–30.

    Article  CAS  PubMed  Google Scholar 

  33. Bußmann C, Bieber T, Novak N. Systemic therapeutic options for severe atopic dermatitis. J Dtsch Dermatol Ges. 2009;7(3):205–19.

    Google Scholar 

  34. Berth-Jones J, Graham-Brown RA, Marks R, Camp RD, English JS, Freeman K, et al. Long term efficacy and safety of cyclosporin in severe atopic dermatitis. Br J Dermatol. 1997;136(1):76–81.

    Article  CAS  PubMed  Google Scholar 

  35. Denby KS, Beck LA. Update on systemic therapies for atopic dermatitis. Curr Opin Allergy Clin Immunol. 2012;12(4):421–6.

    Article  CAS  PubMed  Google Scholar 

  36. Harper JI, Berth-Jones J, Camp RD, Dillon MJ, Finlay AY, Holden CA, et al. Cyclosporin for atopic dermatitis in children. Dermatology. 2001;203(1):3–6.

    Article  CAS  PubMed  Google Scholar 

  37. Haw S, Shin MK, Haw CR. The efficacy and safety of long-term oral cyclosporine treatment for patients with atopic dermatitis. Ann Dermatol. 2010;22(1):9–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Kim SW, Park YW, Kwon IH, Kim KH. Cyclosporin treatment of atopic dermatitis: is it really associated with infectious diseases? Ann Dermatol. 2010;22(2):170–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Berth-Jones J, Takwale A, Tan E, Barclay G, Agarwal S, Ahmed I, et al. Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial. Br J Dermatol. 2002;147(2):324–30.

    Article  CAS  PubMed  Google Scholar 

  40. Lee H, Shin JU, Lee KH. The clinical efficacy of azathioprine in Korean patients with atopic dermatitis. Ann Dermatol. 2015;27(6):774–5.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Park YW, Yeom KB, Kim KH. Refractory atopic dermatitis in childhood: improvement with methotrexate? Ann Dermatol. 2013;25(1):114–6.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Weatherhead SC, Wahie S, Reynolds NJ, Meggitt SJ. An open-label, dose-ranging study of methotrexate for moderate-to-severe adult atopic eczema. Br J Dermatol. 2007;156(2):346–51.

    Article  CAS  PubMed  Google Scholar 

  43. Lee SW, Park YM, Kim HO, Kim CW. Therapeutic efficacy of mycophenolate mofetil in atopic dermatitis. Korean J Dermatol. 2002;40(8):908–13.

    Google Scholar 

  44. Assmann T, Ruzicka T. New immunosuppressive drugs in dermatology (Mycophenolate mofetil, Tacrolimus): unapproved uses, dosages, or indications. Clin Dermatol. 2002;20(5):505–14.

    Article  PubMed  Google Scholar 

  45. Grundmann-Kollmann M, Podda M, Ochsendorf F, Boehncke WH, Kaufmann R, Zollner TM. Mycophenolate mofetil is effective in the treatment of atopic dermatitis. Arch Dermatol. 2001;137(7):870–3.

    CAS  PubMed  Google Scholar 

  46. Simons FE, Simons KJ. Histamine and H1-antihistamines: celebrating a century of progress. J Allergy Clin Immunol. 2011;128(6):1139–50.

    Article  CAS  PubMed  Google Scholar 

  47. Simons FE. Advances in H1-antihistamines. N Engl J Med. 2004;351(21):2203–17.

    Article  CAS  PubMed  Google Scholar 

  48. Zechnich AD, Hedges JR, Eiselt-Proteau D, Haxby D. Possible interactions with terfenadine or astemizole. West J Med. 1994;160(4):321–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Kim HS, Cho SH. Treatment for atopic dermatitis. J Korean Med Assoc. 2014;57(3):226–33.

    Article  Google Scholar 

  50. Micali G, Lacarrubba F. Eczema herpeticum. N Engl J Med. 2017;377(7):e9.

    Article  PubMed  Google Scholar 

  51. Choi WS, Kim JW, Park HS, Jang SJ, Choi JC. Treatment of molluscum contagiosum in children by topical imiquimod cream therapy. Korean J Dermatol. 2007;45(6):541–4.

    Google Scholar 

  52. Bayrou O, Pecquet C, Flahault A, Artigou C, Abuaf N, Leynadier F. Head and neck atopic dermatitis and malassezia-furfur-specific IgE antibodies. Dermatology. 2005;211(2):107–13.

    Article  CAS  PubMed  Google Scholar 

  53. Kaffenberger BH, Mathis J, Zirwas MJ. A retrospective descriptive study of oral azole antifungal agents in patients with patch test-negative head and neck predominant atopic dermatitis. J Am Acad Dermatol. 2014;71(3):480–3.

    Article  CAS  PubMed  Google Scholar 

  54. Svejgaard E, Larsen PO, Deleuran M, Ternowitz T, Roed-Petersen J, Nilsson J. Treatment of head and neck dermatitis comparing itraconazole 200 mg and 400 mg daily for 1 week with placebo. J Eur Acad Dermatol Venereol. 2004;18(4):445–9.

    Article  CAS  PubMed  Google Scholar 

  55. Darabi K, Hostetler SG, Bechtel MA, Zirwas M. The role of Malassezia in atopic dermatitis affecting the head and neck of adults. J Am Acad Dermatol. 2009;60(1):125–36.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea (Republic of)

    Chang Ook Park

Authors
  1. Chang Ook Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chang Ook Park .

Editor information

Editors and Affiliations

  1. Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea (Republic of)

    Kwang Hoon Lee

  2. Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea (Republic of)

    Eung Ho Choi

  3. Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea (Republic of)

    Chang Ook Park

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Park, C.O. (2021). Systemic Treatment. In: Lee, K.H., Choi, E.H., Park, C.O. (eds) Practical Insights into Atopic Dermatitis. Springer, Singapore. https://doi.org/10.1007/978-981-15-8159-5_15

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-8159-5_15

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-8158-8

  • Online ISBN: 978-981-15-8159-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation