EczemaNet Spotlight Article
Uncovers New Treatment Options for Atopic Dermatitis
As researchers gain a better
understanding of what causes atopic dermatitis (AD), new treatment
options are emerging. These options may offer patients longer
periods without a flare-up and reduced risk of potential side
effects. Here are what the findings from recent studies show:
Product that Heals Skin May be
Nearly as Effective as Topical Corticosteroids
Finding: A topical (applied to the skin) product that
contains essential lipids naturally found in the skin may help
heal the skin and reduce flare-ups.
Research indicates that some
people with AD and other types of eczema have breaks and tears in
their outer layer of skin. The reason seems to be a lack of
essential lipids in the skin. One study suggests that a product
containing essential skin lipids such as ceramides, cholesterol, and
free fatty acids may be almost as effective in treating AD as a
mid-strength topical corticosteroid.
In a recent clinical trial, 113 children aged 6 ½ months to 18 years
of age who had mild to moderate AD received either a lipid-rich
product or a mid-strength corticosteroid. The given product was to
be applied to the AD lesions twice a day for 4 weeks. At the end of
4 weeks, the results were about the same. Those treated with the
lipid-rich product had a 56.4% reduction in lesions. The
mid-strength corticosteroid produced a 68.8% reduction. Both groups
had a similar decrease in itch and loss of sleep.
What the results mean for patients: For children with mild to
moderate AD, twice-daily use of a cream or emollient that contains
essential lipids may help to heal the skin. This could reduce
flare-ups as well as the need for medications such as topical
It is important to know that these lipid-rich creams and emollients,
which also may be called barrier-repair products, are fairly new.
The U.S. Food and Drug Administration (FDA) recently approved
several such products, but additional clinical trials are needed to
learn how safe and effective these products are over time. Cost is
another important consideration. Some products are expensive. As
such, dermatologists are still assessing how to best use these to
treat AD and other types of eczema.
Proactive Treatment May Reduce Flare-ups
Finding: Using intensive treatment until the AD lesions
clear and continuing to treat previously affected skin with a
low dose of medication can prevent flare-ups.
AD can be a long lasting and require
ongoing treatment. For people with mild to moderate AD, ongoing
treatment often involves keeping the skin moist by applying an
emollient at least once a day and treating flare-ups with
medication. Dermatologists call this the “reactive approach” to
Two recent clinical trials seem to indicate that a proactive
approach may more effectively control AD in adults and children with
mild to severe AD. A proactive approach uses intensive treatment to
gain control over the AD and low-dose medication to prevent
One clinical trial conducted in several European cities showed that
the proactive approach can be effective. In this study, adult
patients were divided into 2 groups. One group stopped treating
their skin one the AD was under control. The other group continued
to treat previously affected skin by applying 0.1% tacrolimus
ointment twice a week.
Those who continued to apply the tacrolimus twice a week had much
more time between flare-ups — 142 days vs. 15 days. After 1 year of
treatment, the AD was considered stable in patients who received the
proactive treatment. Those who did not continue to treat twice
weekly had slight worsening of their AD by the end of 1 year.
Similar results were found during a clinical trial that looked at
this treatment approach in children. Aged 2 to 15 years of age, the
children’s AD ranged from mild to severe. Those treated twice weekly
with 0.03% tacrolimus after the AD cleared had fewer flare-ups. In
fact, 50.4% of the children treated proactively did not have a
single flare-up that required treatment during the 1-year study.
What the results mean for patients: The proactive approach
may be especially helpful for people who have persistent AD or
frequent flare-ups. It is important to know that:
The FDA has approved tacrolimus
ointment for short-term use and for long-term intermittent use.
Tacrolimus is not approved for the continuous use described
This is a new treatment approach,
and the long-term effects are not known. While these studies did
not show an increased risk of side effects during the 1-year
period, long-term use warrants careful monitoring.
Sequential Therapy May Offer More
Control, Less Need for Medication
Finding: Using a sequence of medications to gain quick
control over AD may actually lessen the need for long-term use
of corticosteroids and give patients more flexibility in
Sequential therapy involves using
medications in a prescribed sequence to bring quick relief. Research
suggests that using medications in this way also may help reduce the
risk of side effects from all of the medications used.
To find out if this may be a safe and effective treatment option for
children, a small study was recently conducted. This study provided
sequential treatment for 12 weeks to 28 children with mild to severe
AD. In the first two weeks, the children received tacrolimus
ointment in the morning and an appropriate-strength topical
corticosteroid in the evening. During the next two weeks, treatment
with tacrolimus remained the same, but
patients were weaned from the topical corticosteroid. Weaning helps
to prevent a sudden flare-up, which can happen when a topical
corticosteroid is stopped abruptly.
In the final phase of this study, tacrolimus was gradually stopped,
and when the skin was almost clear, the tacrolimus was replaced with
daily use of an emollient. If a flare-up occurred, tacrolimus was
used to treat it.
With the sequential treatment plan described above, 90% of the
children had significantly noticeable improvement by week 6. This
jumped to 96% by week 12. Itching and loss of sleep decreased
steadily throughout the study. Quality of life also improved
significantly by week 12.
What the results mean for patients: A sequential treatment
plan may bring quick relief and keep AD under control in children.
Research suggests that gaining control over AD can greatly improve a
child’s quality of life. Sequential treatment also can limit
long-term exposure to topical corticosteroids, which can reduce the
risk of potential side effects associated with long-term use of this
While the benefits are evident, it is important to keep in mind that
only 28 children participated in this study. More research is
Speak with Your Dermatologist
All of these approaches to treating atopic dermatitis are in the
investigational phase. If you think one or more of these approaches
might be helpful, be sure to discuss the approach with your
dermatologist, who can tell you if this may be appropriate for you
or your child.
Emerging Therapies Could Help Ease the Chronic Symptoms of Atopic
Dermatitis for Adults and Children
Abramovits W. “A clinician's paradigm in the treatment of atopic
dermatitis.” J Am Acad Dermatol 2005; 53: S70-7.
American Academy of Dermatology, “Emerging Therapies Could Help Ease
the Chronic Symptoms of Atopic Dermatitis for Adults and Children.”
News release issued March 5, 2009.
Last accessed March 5, 2009.
Del Rosso J, Friedlander SF. “Corticosteroids: options in the era of
steroid-sparing therapy.” J Am Acad Dermatol 2005; 53: S50-8.
Feldman S, Behnam SM, Behnam SE et al. “Involving the
patient: impact of inflammatory skin disease and patient-focused
care.” J Am Acad Dermatol 2005; 53: S78-85.
Hanifin JM, Paller AS, Eichenfield L et al. “Efficacy and
safety of tacrolimus ointment treatment for up to 4 years in
patients with atopic dermatitis.” J Am Acad Dermatol 2005;
Koo JY, Fleischer AB, Jr., Abramovits W et al. “Tacrolimus
ointment is safe and effective in the treatment of atopic
dermatitis: results in 8000 patients.” J Am Acad Dermatol
2005; 53: S195-205.
Kubota Y, Yoneda K, Nakai K et al. “Effect of sequential
applications of topical tacrolimus and topical corticosteroids in
the treatment of pediatric atopic dermatitis: an open-label pilot
study.” J Am Acad Dermatol 2009; 60: 212-7.
Sugarman JL, Parish LJ. “A topical physiologic, lipid-based barrier
repair formulation is highly effective monotherapy for moderate
pediatric atopic dermatitis.” Presented at: The Fall Clinical
Dermatology Conference: October 16-19, 2008; Las Vegas.
Thaci D, Reitamo S, Gonzalez Ensenat MA et al. “Proactive disease
management with 0.03% tacrolimus ointment for children with atopic
dermatitis: results of a randomized, multicentre, comparative
study.” Br J Dermatol 2008; 159: 1348-56.
Thompson MM, Hanifin JM. “Effective therapy of childhood atopic
dermatitis allays food allergy concerns.” J Am Acad Dermatol
2005; 53: S214-9.
Undre NA, Moloney FJ, Ahmadi S et al. “Skin and systemic
pharmacokinetics of tacrolimus following topical application of
tacrolimus ointment in adults with moderate to severe atopic
dermatitis.” Br J Dermatol 2008 Dec 12. [Epub ahead of print]
Wollenberg A, Reitamo S, Atzori F et al. “Proactive treatment
of atopic dermatitis in adults with 0.1% tacrolimus ointment.”
Allergy 2008 Jun; 63(6): 742-50.
Wollenberg A, Reitamo S, Girolomoni G et al. “Proactive
treatment of atopic dermatitis in adults with 0.1% tacrolimus
ointment.” Allergy 2008 Jul; 63(7): 742-50.
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