Proactive therapy of atopic eczema--an evidence-based concept with a behavioral background

Atopic eczema is a highly pruritic, chronic inflammatory skin disease with a high socioeconomic burden. Different individually relevant exacerbating factors influence the clinical course of the disease. Current therapeutic paradigms call for maintaining or enhancing the epidermal barrier by continuous emollient therapy, which is combined with anti-inflammatory topical treatment applied to all affected areas as they appear. An alternative approach is proactive therapy, which involves long-term, low-dose intermittent topical anti-inflammatory therapy for previously affected areas with subclinical inflammation. The immunodermatological background to this approach is the ongoing epidermal barrier dysfunction, the residual inflammatory skin infiltrate and the persistent immunological abnormalities which are all present but clinically invisible. This manuscript summarizes the immunodermatological and behavioral background, the study data of controlled clinical trials and our personal experience in a special atopic dermatitis clinic. The clinical advantages of proactive therapy are fewer exacerbations, an improved quality of life and--in severe cases--lower treatment costs.