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Topical corticosteroids for treatment-resistant atopic dermatitis
Nwanneka Okwundu1, Leah A Cardwell1, Abigail Cline1
1Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Cutis
|October 30, 2018
Summary
Many patients with atopic dermatitis (AD) may not respond to topical corticosteroids due to poor adherence, not drug ineffectiveness. Improving adherence can lead to rapid symptom improvement in treatment-resistant AD.
Area of Science:
- Dermatology
- Pharmacology
Background:
- Topical corticosteroids are a primary treatment for atopic dermatitis (AD).
- Tachyphylaxis, or reduced efficacy over time, is a concern with topical corticosteroids.
- Poor treatment adherence is a potential, underrecognized cause of treatment failure in AD.
Purpose of the Study:
- To investigate if atopic dermatitis patients previously unresponsive to topical corticosteroids would respond to desoximetasone spray 0.25% when adherence is optimized.
- To differentiate between true tachyphylaxis and adherence issues in treatment-resistant AD.
Main Methods:
- A 7-day study involving AD patients with prior unsuccessful topical corticosteroid treatment.
- Randomization into two groups: intervention (daily adherence support calls) and control (no calls).
- Assessment of patient response to desoximetasone spray 0.25%.
Main Results:
- Patients in both groups showed rapid improvement with desoximetasone spray.
- The study suggests that adherence support significantly impacts treatment outcomes.
- Rapid improvement indicates that many cases of presumed treatment resistance are linked to adherence.
Conclusions:
- Treatment-resistant atopic dermatitis is frequently associated with poor adherence rather than diminished drug efficacy.
- Optimizing adherence can restore responsiveness to topical corticosteroids in AD patients.
- Desoximetasone spray 0.25% shows efficacy when adherence is ensured.
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