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Published on: July 11, 2013
Management of severe atopic dermatitis in children
Ainah U Tan1, Mercedes E Gonzalez
1New York University School of Medicine, New York, NY 10016, USA.
Insights
Severe childhood atopic dermatitis, often resistant to topical treatments, can improve with second-line therapies. Systemic immunosuppressants and phototherapy offer safe and effective options for managing this condition.
Area of Science:
- Pediatric Dermatology
- Immunology
Background:
- Severe childhood atopic dermatitis significantly impacts children's quality of life.
- Most cases are managed with topical treatments, but some require advanced therapies.
Purpose of the Study:
- To review management strategies for severe childhood atopic dermatitis.
- To discuss second-line therapies for recalcitrant cases.
Main Methods:
- Review of current literature on atopic dermatitis management.
- Focus on topical treatments, phototherapy, and systemic immunosuppressants.
Main Results:
- Topical treatments are effective for most children.
- Narrowband ultraviolet light therapy and systemic immunosuppressants (cyclosporine, azathioprine, mycophenolate mofetil, methotrexate) are safe and effective for severe cases.
- Biologic therapy has shown variable efficacy in childhood atopic dermatitis.
Conclusions:
- Systemic immunosuppressants and phototherapy are valuable options for severe childhood atopic dermatitis.
- Comprehensive management includes topical, adjunctive, and second-line therapies.
Abstract:
Severe childhood atopic dermatitis refers to the presence of recurrent, widespread, eczematous dermatitis that significantly interferes with the daily activities and/or the quality of life of the affected child and family. The vast majority of children with severe, long-standing atopic dermatitis can be managed with the appropriate use of topical treatments, including long-term maintenance therapy and adjunctive treatments. In the recalcitrant patient, second line therapies such as narrowband ultraviolet light therapy and systemic immunosuppressants such as cyclosporine, azathioprine, mycophenolate moefetil, and methotrexate have been shown to be safe and effective in children with severe atopic dermatitis and can lead to sustained clinical improvement. To date, biologic therapy has not been uniformly effective in childhood atopic dermatitis. Management of severe childhood atopic dermatitis, including topical and adjunctive treatments and second-line therapies including systemic immunosuppressants will be reviewed here.
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