New possibilities for the treatment of atopic dermatitis in children and adults

Atopic dermatitis is the most common dermatitis among adults and children. According to recent data, up to 20% of the population is affected by atopic dermatitis. At almost every pediatric appointment, you can see a child with atopic dermatitis. The reasons for this are very diverse, but every doctor must know and be able to identify the disease and give recommendations for its treatment.

Despite the fact that the mechanisms of pathogenesis have already been sufficiently studied, and the role of genetic factors in the development of the disease has been identified, the treatment of dermatitis still requires due attention.

Often, atopic dermatitis occurs precisely at the age of up to 3 years. This is just the period that the child should pass as much as possible without any medications. After all, the immune system is only being formed, and it is not worth interfering with it once again. And if treatment is required, then the doctor should always look for other ways, and not immediately resort to steroid drugs.

Therapy of atopic dermatitis is aimed at reducing the manifestation of symptoms, reducing their severity and achieving stable remission. This is achieved by long-term treatment. The main drugs in the treatment are topical glucocorticosteroids. Many years of experience with their use proves their effectiveness, however, they have a high risk of many side effects that again make a person suffer.

Recent studies in the field of dermatology and allergology have focused on alternative treatment of atopic dermatitis without steroids. With this in mind, a new group of outdoor products – topical calcineurin inhibitors. One of them is the drug Protopic, which significantly expanded the possibilities of treating moderate and severe dermatitis. This group of drugs has an immunoregulatory effect on pathological reactions in the skin by selectively blocking the intracellular protein calcineurin. Differences in the mechanisms of action of calcineurin inhibitors and TGCS make it possible to use drugs of this group for a longer time, even in areas with thin skin, without fear of steroid-like side effects.

Clinical Study

Studies have been conducted to investigate the efficacy and safety of topical tacrolimus 0.03% and 0.1% ointment.

Under clinical supervision there were 32 patients aged from 2 to 64 years. The patients were divided into groups.

The first group consisted of 17 children aged 2 to 15 years (7 girls and 10 boys), the second group consisted of 15 adults aged 18 to 64 years (8 women and 7 men).

On average, the duration of the disease in both groups was 14.7 years with a recurrence rate of at least 4-6 times a year. Among pediatric patients, the erythematous form with lichenification prevailed. All adults have the lichenoid form.

Patients in both groups received topical tacrolimus therapy in the form of Protopic ointment 0.1% for adults and 0.03% for children. In addition, an integrated approach to therapy was carried out by prescribing antihistamines (Fenkarol, Suprastin, Zirtek), hyposensitizing agents (calcium glycerophosphate, calcium chloride), detoxification agents (Lactofiltrum, Enterosgel, sodium thiosulfate).

To assess the severity of clinical manifestations, as well as the effectiveness of the therapy, the SCORAD index was used, the value of which is expressed in points. So, 20-60 - moderate severity, more than 60 - severe.

Study results:

Before the start of treatment in group 1, the index values ​​averaged 63.4 points, in group 2 - 57.1. That is, there were no statistical differences in the index value.

For children, the drug was prescribed 2 times a day for 3 weeks, then - 1 time per day until the rash disappeared. For adults, the drug was used 2 times a day until improvement was achieved. The duration of treatment in the first group averaged 18 days. In the course of treatment, deterioration in the condition was not observed in any patient. Clinical recovery was in 5 (30%), significant improvement in 6 (35%), improvement in 6 (35%).

Of the side effects, some patients had a slight burning sensation and itching when applying the product, which eventually passed without intervention.

Index decrease decreased from 63.4 to 14

Therapy in group 2 lasted an average of 25 days. Clinical recovery in 6 (40%), significant improvement in 3 (20%), improvement in 6 (40%)

Index decrease decreased from 52 to 11.7.

The effectiveness of the new agent has been repeatedly mentioned in the literature of foreign and domestic authors. Indeed, according to the results of the study, a decrease in the severity of clinical manifestations was observed in all patients.

In connection with the possibility of replacing topical glucocorticosteroids, the possibilities of dermatology and allergology in the treatment of atopic dermatitis in children and adults have significantly expanded. But do not forget about preventive measures, the implementation of which will prolong remission in patients. Prevention of atopic dermatitis in children and adults is very important.

A few tips to help delay the next aggravation for a long time

1. Humidification of the air in the room. With low humidity in the room, the skin and mucous membranes dry out, microcracks appear, and these are the entrance gates for infections, skin cells become hypersensitive. It is important to monitor the temperature and humidity of the air.
2. Skin hygiene should not be reusable and aggressive. That is, it is not recommended to use soapy chemicals in the shower more than once a day, as this destroys the protective lipid layer on the surface of the skin, which leads to overdrying of the skin.
3. Maintain water balance. During the day, a person should receive the required amount of liquid at the rate of 30 ml per kilogram. That is, with a child weighing 80 kg, a person should drink up to 2400 ml of liquid. This has a positive effect on the condition of the skin and the whole organism.
4. Don't overeat. When overeating, not all substances in the digestive tract are processed and absorbed. "Superfluous" remain uncorrected clod in the intestines and do not have the opportunity to be excreted. This is one of the causes of atopic dermatitis in children and adults. After all, the skin is an organ of excretion. And when the main excretory organ fails to cope with the task, "superfluous" comes out through the skin. It is worth adjusting and balancing nutrition - and dermatitis will recede for a long time until the next unfavorable situation for him.

Following the modern methods of treatment of atopic dermatitis in children and adults, which are proven in research, you will undoubtedly be one step ahead. This will enable patients suffering from atopic dermatitis to forget about the problem for a while. After all, the result of the treatment of dermatitis is always "on the face".

Recall that earlier the international GfK Disease Atlas identified the main shortcomings in the treatment of atopic dermatitis.