EczemaNet Spotlight Article
Research 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 corticosteroids.

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 treating AD.

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 flare-ups.

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 above.

  • 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 treating AD.

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 medication.

While the benefits are evident, it is important to keep in mind that only 28 children participated in this study. More research is needed.

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.

More Information
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; 53: S186-94.

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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Atopic dermatitis is the most common type of eczema, and many people simply call atopic dermatitis "eczema."







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