Advertisement

Management: Drug Therapy—Ointment

  • Takahiro SatohEmail author
Chapter

Abstract

Atopic dermatitis (AD) is an allergic inflammatory skin disease etiologically associated with disrupted skin barrier function. Topical treatment is a fundamental approach for the management of AD. This includes various kinds of emollients/moisturizers as skin care and anti-inflammatory drugs, such as corticosteroids and tacrolimus. Improvement of barrier function could lead to reduced risk for the development and/or exacerbation of AD and reduces the chance for epicutaneous sensitization against environmental allergens, which may induce systemic allergy. Anti-inflammatory drugs are used for controlling flare-up of skin inflammation during the course of the disease. Proactive therapy, comprising continuous or periodical use and gradual tapering of anti-inflammatory drugs with emollients/moisturizers even when clinical symptoms improve, has been found to be useful for obtaining long-term remission. Patient adherence to external application is essential for reaching successful treatment outcomes with topical drugs.

Keywords

Barrier function Corticosteroids Proactive therapy Tacrolimus 

References

  1. 1.
    Szczepanowska J, Reich A, Szepietowski JC. Emollients improve treatment results with topical corticosteroids in childhood atopic dermatitis: a randomized comparative study. Pediatr Allergy Immunol. 2008;19(7):614–8. doi: 10.1111/j.1399-3038.2007.00706.x.CrossRefPubMedGoogle Scholar
  2. 2.
    Horimukai K, Morita K, Narita M, Kondo M, Kitazawa H, Nozaki M, et al. Application of moisturizer to neonates prevents development of atopic dermatitis. J Allergy Clin Immunol. 2014;134(4):824–830. e6. doi: 10.1016/j.jaci.2014.07.060.CrossRefPubMedGoogle Scholar
  3. 3.
    Loden M. The increase in skin hydration after application of emollients with different amounts of lipids. Acta Derm Venereol. 1992;72(5):327–30.PubMedGoogle Scholar
  4. 4.
    Grether-Beck S, Felsner I, Brenden H, Kohne Z, Majora M, Marini A, et al. Urea uptake enhances barrier function and antimicrobial defense in humans by regulating epidermal gene expression. J Invest Dermatol. 2012;132(6):1561–72. doi: 10.1038/jid.2012.42.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    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;43:1117–45. doi: 10.1111/1346-8138.13392.CrossRefPubMedGoogle Scholar
  6. 6.
    Fukuie T, Hirakawa S, Narita M, Nomura I, Matsumoto K, Tokura Y, et al. Potential preventive effects of proactive therapy on sensitization in moderate to severe childhood atopic dermatitis: a randomized, investigator-blinded, controlled study. J Dermatol. 2016;43:1283–92. doi: 10.1111/1346-8138.13408.CrossRefPubMedGoogle Scholar
  7. 7.
    Feldmann RJ, Maibach HI. Regional variation in percutaneous penetration of 14C cortisol in man. J Invest Dermatol. 1967;48(2):181–3.CrossRefPubMedGoogle Scholar
  8. 8.
    Long CC, Finlay AY, Averill RW. The rule of hand: 4 hand areas = 2 FTU = 1 g. Arch Dermatol. 1992;128(8):1129–30.CrossRefPubMedGoogle Scholar
  9. 9.
    Danby SG, Chittock J, Brown K, Albenali LH, Cork MJ. The effect of tacrolimus compared with betamethasone valerate on the skin barrier in volunteers with quiescent atopic dermatitis. Br J Dermatol. 2014;170(4):914–21. doi: 10.1111/bjd.12778.CrossRefPubMedGoogle Scholar
  10. 10.
    Antille C, Saurat JH, Lubbe J. Induction of rosaceiform dermatitis during treatment of facial inflammatory dermatoses with tacrolimus ointment. Arch Dermatol. 2004;140(4):457–60. doi: 10.1001/archderm.140.4.457.CrossRefPubMedGoogle Scholar
  11. 11.
    Fujiwara S, Okubo Y, Irisawa R, Tsuboi R. Rosaceiform dermatitis associated with topical tacrolimus treatment. J Am Acad Dermatol. 2010;62(6):1050–2. doi: 10.1016/j.jaad.2009.01.029.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of DermatologyNational Defense Medical CollegeTokorozawaJapan

Personalised recommendations