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Appraisal of Proactive Topical Therapy in Atopic Dermatitis: Pros and Cons

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Abstract

Atopic dermatitis is a common inflammatory skin disease that can affect both children and adults. It is a chronic disease with recurrent, highly pruritic eczematous lesions. Topical treatment with anti-inflammatory agents is the mainstay of treatment for atopic dermatitis, either in a reactive or proactive approach according to severity of the disease and always in combination with daily application of an emollient cream. Several studies have shown that proactive therapy with either topical corticosteroids or topical calcineurin inhibitors is significantly superior at reducing the number of flares and increasing the interval between flares compared with reactive therapy in patients with moderate and severe disease. The risk of side effects is considered low, and there seem to be no extra economic costs related to this treatment approach. Proactive therapy is an advisable treatment option for patients with moderate and severe atopic dermatitis to gain prolonged disease control; however, long-term safety data and data on when to stop do not yet exist.

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  1. Department of Dermatology and Venerology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus, Denmark

    Anne Sofie Frølunde, Mette Deleuran & Christian Vestergaard

  2. Department of Dermatology and Venerology, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark

    Jacob Pontoppidan Thyssen

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A.S. Frølunde performed the literature search, drafted and finished the manuscript. J.P. Thyssen critically revised the work and provided design of figures. M. Deleuran critically revised the manuscript. C. Vestergaard performed the literature search, drafted and revised the manuscript.

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No sources of funding were used to conduct this study or prepare this manuscript.

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AS Frølunde has no conflicts of interest that are directly relevant to the content of this article. Dr. Thyssen has been an advisor, speaker or investigator for AbbVie, Pfizer, LEO Pharma, Regeneron, Sanofi-Genzyme and Eli Lilly and Co. Dr. Deleuran has been an advisor, speaker or investigator for AbbVie, Pfizer, LEO Pharma, Regeneron, Sanofi-Genzyme, Eli Lilly, and Incyte. Dr. Vestergaard has received honoraria for lecturing and participation on advisory boards from Leo Pharma, Novartis, MEDA, AbbVie, Pfizer, Pierre Fabre and Sanofi-Genzyme and has received grants from Pfizer, LEO Pharma and Sanofi-Genzyme.

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Frølunde, A.S., Thyssen, J.P., Deleuran, M. et al. Appraisal of Proactive Topical Therapy in Atopic Dermatitis: Pros and Cons. Am J Clin Dermatol 22, 775–783 (2021). https://doi.org/10.1007/s40257-021-00629-0

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