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Drug delivery methods like oral inhalation, nasal sprays, transdermal patches, eye drops, intravitreal injection,  and rectal administration provide localized effects with reduced toxicity.
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Topical steroids or emollients: does order matter?

Kripa Ahuja1, Peter A Lio2

  • 1Eastern Virginia Medical School, Kripa Raj Ahuja, 825 Fairfax Avenue, Norfolk, VA, 23507, USA. ahujak@evms.edu.

Archives of Dermatological Research
|March 15, 2024
PubMed
Summary
This summary is machine-generated.

Applying topical treatments for atopic dermatitis (eczema) in the correct order is crucial. This review guides clinicians on best practices for topical medication sequencing in pediatric dermatology.

Keywords:
Atopic dermatitisDrug deliveryEmollientOrder of applicationPharmaceutical vehicleTopical corticosteroids

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Area of Science:

  • Dermatology
  • Pediatric Dermatology
  • Pharmacology

Background:

  • Atopic dermatitis (eczema) treatment involves topical corticosteroids, steroid-sparing agents, and emollients.
  • Current guidelines lack specific recommendations for the order and timing of topical agent application.
  • The sequence of topical application can influence drug absorption, efficacy, and distribution, particularly in patients with compromised skin barriers.

Purpose of the Study:

  • To review the literature on the optimal sequencing of topical treatments for atopic dermatitis.
  • To provide evidence-based guidance for clinicians on topical regimen application order.
  • To address the critical importance of application order in pediatric dermatology due to increased systemic absorption risks.

Main Methods:

  • Systematic literature review of studies on topical treatment sequencing for atopic dermatitis.
  • Analysis of factors affecting topical drug absorption and efficacy based on application order.
  • Focus on pediatric populations with atopic dermatitis and their unique absorption characteristics.

Main Results:

  • The order of application significantly impacts the absorption and effectiveness of topical medications for atopic dermatitis.
  • Patients with atopic dermatitis exhibit a dysfunctional skin barrier, increasing systemic drug absorption.
  • Children with atopic dermatitis have a higher surface area-to-weight ratio, further elevating systemic absorption risks.

Conclusions:

  • Establishing clear guidelines for the order of topical treatment application in atopic dermatitis is essential.
  • Optimizing the sequence of topical corticosteroids, steroid-sparing agents, and emollients can improve treatment outcomes.
  • Evidence-based recommendations are needed to guide clinical practice, especially in pediatric dermatology, to ensure safe and effective topical therapy.