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Tacrolimus ointment: utilization patterns in children under age 2 years
Tamara Salam Housman1, Amy B Norton, Steven R Feldman
1Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Insights
Atopic dermatitis (AD) affects many children, often appearing in infancy. Current treatments like topical corticosteroids (TCS) carry risks, especially in young children, prompting a need for safer alternatives.
Area of Science:
- Pediatric Dermatology
- Allergen and Immune System
Background:
- Atopic dermatitis (AD) is a prevalent eczematous skin condition affecting 10-17% of children, with onset frequently in the first year of life.
- Standard AD treatment for young children includes conservative measures and low-potency topical corticosteroids (TCS).
- Concerns exist regarding TCS safety in pediatrics due to potential side effects and systemic absorption, leading to hypothalamic-pituitary-adrenal axis suppression and growth retardation.
Purpose of the Study:
- To review the current treatment principles for atopic dermatitis in young children.
- To highlight the limitations and potential complications associated with topical corticosteroid use in this population.
- To underscore the challenges in managing AD in infants and the need for approved therapies.
Main Methods:
- Literature review of existing studies and clinical guidelines on atopic dermatitis management in pediatric populations.
- Analysis of the risks and benefits of conservative measures and topical corticosteroids.
- Examination of systemic absorption risks and potential adverse effects in infants and young children.
Main Results:
- Conservative measures like avoiding irritants and using emollients are foundational but often insufficient.
- Low-potency TCS are standard, but mid- and high-potency are reserved for severe cases due to risks.
- Pediatric patients face higher systemic absorption risks, potentially causing significant adverse effects, and many treatments lack FDA approval for children under two.
Conclusions:
- Conservative management and low-potency TCS are initial approaches for pediatric atopic dermatitis.
- The risk of adverse effects from TCS, including systemic absorption and growth issues, is a significant concern in young children.
- There is a clinical need for effective and safe treatments for atopic dermatitis in children under two years old, as current options are often used off-label.
Abstract:
Atopic dermatitis (AD) is a common eczematous skin condition; as many as 10-17 percent of all children are affected, and 35-60 percent of affected patients manifest symptoms manifest during the first year of life. Treatment principles for AD in young children involve conservative measures such as avoidance of hot water and environmental irritants, combined with liberal use of emollients after bathing. Low potency topical corticosteroids (TCS) are the current standard of therapy for AD in young children, reserving mid- and high-potency TCS for severe disease. However, complications of long-term use of TCS include skin atrophy, stria formation, telangiectasia, hypopigmentation, secondary infections, steroid acne, allergic contact dermatitis, and miliaria. The pediatric population is also at increased risk for systemic absorption because of their high ratio of skin surface to body mass. Systemic absorption may result in hypothalamic-pituitary-adrenal axis suppression and ultimately growth retardation. Although most topical and systemic corticosteroids are not approved by the Food and Drug Administration for use in children less than 2 years of age, conservative treatment often fails in this age group and frequently patients are treated with TCS, antibiotics, and antihistamines.
