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A practical algorithm for the treatment of mild-to-moderate atopic dermatitis (AD) in pediatric patients in Europe:
Matthias Augustin1, Thomas Luger2, Carlo Pincelli3
1Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
Insights
This study proposes a new treatment algorithm for infant and child atopic dermatitis (AD) management. It focuses on a topical calcineurin inhibitor strategy to reduce reliance on topical corticosteroids (TCS) for better long-term outcomes.
Area of Science:
- Pediatric Dermatology
- Inflammatory Skin Diseases
- Evidence-Based Medicine
Background:
- Atopic dermatitis (AD) is a prevalent chronic inflammatory skin condition in children.
- Early management in infancy is crucial for long-term outcomes.
- Current treatments require optimization for efficacy and safety.
Purpose of the Study:
- To develop a practical algorithm for managing pediatric atopic dermatitis in a European context.
- To propose a treatment strategy that spares topical corticosteroids (TCS).
- To provide a supplementary tool for physicians treating pediatric AD.
Main Methods:
- Convened an international panel of dermatologists and pediatric specialists.
- Combined a comprehensive literature review with clinical expertise.
- Developed a practical algorithm for AD management in infants and children.
Main Results:
- Topical corticosteroids (TCS) are recommended as first-line for short-term flares.
- Limitations of TCS include lack of long-term utility and potential side effects.
- An alternative strategy using topical calcineurin inhibitors is needed.
Conclusions:
- Proposed algorithm focuses on a TCS-sparing approach.
- Emphasizes topical calcineurin inhibitors for mild-to-moderate AD in infants and children.
- Aims to support current guidelines and aid clinical practice for pediatric AD.
Background:
Atopic dermatitis (AD) is a chronic inflammatory skin condition, considered to be the most common cutaneous-related disease in children; early management in infancy with treatments of acceptable efficacy and safety has been recognized as important for outcomes.
Methods:
An international panel of six European dermatologists and pediatric specialists was formed to discuss and develop a practical algorithm for the management of AD in pediatric patients in a European setting. The discussion combined a comprehensive review of published literature with clinical experience.
Results:
Current guidelines recommend topical corticosteroids (TCS) as a first-line anti-inflammatory treatment for short-term AD flares, with specific recommendations for pediatric populations and sensitive areas of skin; however, due to the lack of long-term utility and associated side effects with TCS, there is a need for alternative treatments.
Conclusion:
In this article, we propose an algorithm for a TCS-sparing treatment strategy, focusing on topical calcineurin inhibitors for the management of mild-to-moderate AD in infants and children, including AD of sensitive skin areas. This algorithm is intended as a supplementary tool to the current international and national evidence-based treatment guidelines, and to aid physicians who see and treat children with AD in their clinical practice.
