2015, Number 1
<< Back Next >>
Alerg Asma Inmunol Pediatr 2015; 24 (1)
Updates in the systemic treatment of atopic dermatitis in pediatric patients
Garnica CP, Zúñiga LCG, Huerta LJG
Language: Spanish
References: 64
Page: 18-28
PDF size: 178.66 Kb.
ABSTRACT
Atopic dermatitis is an inflammatory disease that affects the skin; has a topographical distribution specified according to patient age and characterized by erythematous plaques, and appear to be itchy outbreaks; has a physiopathogeny where affected skin barrier so the mainstay of treatment is education, the use of emollients and topical steroids low and medium power; however, there are severe, recalcitrant or poor response to standard treatment in those forms is necessary to use a systemic treatment aiming control disease and improve their quality of life. This literature review is performed with the aim of knowing the drugs used most often in children with severe atopic dermatitis; the information presently known, its safety when administered in pediatric population; the optimal dose is established, the potential adverse effects and the following; however, is at the discretion of the treating physician to individualize each patient for operation and in all cases educate about the disease and the care of your skin.
REFERENCES
Eichenfield LF, Tom WL, Chamlin SL et al. Guidelines of care for the management of atopic dermatitis: Section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014; 70 (2): 338-351.
National Institute for Health and Clinical Excellence (NICE). Atopic eczema in children. Management of atopic eczema in children from birth up to the age of 12 years. NICE. 2007 Dec:CG57 PDF, summary can be found in BMJ 2007; 335 (7632): 1263.
Williams HC. Clinical practice. Atopic dermatitis. N Engl J Med. 2005; 352 (22): 2314-2324.
Elias PM, Steinhoff M. “Outside-to-inside” (and now back to “outside”) pathogenic mechanisms in atopic dermatitis. J Invest Dermatol. 2008; 128: 1067-1070.
Sandilands A, Smith FJ, Irvine AD, McLean WH. Filaggrin’s fuller figure: a glimpse into the genetic architecture of atopic dermatitis. J Invest Dermatol. 2007; 127: 1282-1284.
McGrath JA, Uitto J. The filaggrin story: novel insights into skin-barrier function and disease. Trends Mol Med. 2008; 14: 20-27.
Williams H, Robertson C, Stewart A et al. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol. 1999; 103: 125-138.
Grimalt R, Mengeaud V, Cambazard F, Study Investigators’ Group. The steroid-sparing effect of an emollient therapy in infants with atopic dermatitis: a randomized controlled study. Dermatology. 2007; 214: 61-67.
Cork MJ, Robinson DA, Vasilopoulos Y et al. New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environment interactions. J Allergy Clin Immunol. 2006; 118: 3-21.
Verdier-Sévrain S, Bonté F. Skin hydration: a review on its molecular mechanisms. J Cosmet Dermatol. 2007; 6: 75-82.
Rawlings AV, Harding CR. Moisturization and skin barrier function. Dermatol Ther. 2004; 17 Suppl 1: 43-48.
Flohr C, England K, Radulovic S et al. Filaggrin loss-of-function mutations are associated with early-onset eczema, eczema severity and transepidermal water loss at 3 months of age. Br J Dermatol. 2010; 163: 1333-1336.
Lodén M. The skin barrier and use of moisturizers in atopic dermatitis. Clin Dermatol. 2003; 21: 145-157.
Leung DY. Atopic dermatitis: new insights and opportunities for therapeutic intervention. J Allergy Clin Immunol. 2000; 105: 860-876.
Boguniewicz M. Atopic dermatitis: beyond the itch that rashes. Immunol Allergy Clin North Am. 2005; 25: 333-351.
Elias PM, Schmuth M. Abnormal skin barrier in the etiopathogenesis of atopic dermatitis. Curr Opin Allergy Clin Immunol. 2009; 9: 437-446.
Flohr C, Johansson SG, Wahlgren CF, Williams H. How atopic is atopic dermatitis? J Allergy Clin Immunol. 2004; 114: 150-158.
Langan SM, Williams HC. What causes worsening of eczema? A systematic review. Br J Dermatol. 2006; 155: 504-514.
Langan SM, Bourke JF, Silcocks P, Williams HC. An exploratory prospective observational study of environmental factors exacerbating atopic eczema in children. Br J Dermatol. 2006; 154: 979-980.
Darsow U, Laifaoui J, Kerschenlohr K et al. The prevalence of positive reactions in the atopy patch test with aeroallergens and food allergens in subjects with atopic eczema: a European multicenter study. Allergy. 2004; 59: 1318-1325.
Garritsen FM, ter Haar NM, Spuls PI. House dust mite reduction in the management of atopic dermatitis. A critically appraised topic. Br J Dermatol. 2013; 168: 688-691.
Kjaer HF, Eller E, Høst A et al. The prevalence of allergic diseases in an unselected group of 6-year-old children. The DARC birth cohort study. Pediatr Allergy Immunol. 2008; 19: 737-745.
Bath-Hextall F, Delamere FM, Williams HC. Dietary exclusions for established atopic eczema. Cochrane Database Syst Rev. 2008; CD005203.
Lever R, MacDonald C, Waugh P, Aitchison T. Randomised controlled trial of advice on an egg exclusion diet in young children with atopic eczema and sensitivity to eggs. Pediatr Allergy Immunol. 1998; 9: 13-19.
Rawlings AV, Canestrari DA, Dobkowski B. Moisturizer technology versus clinical performance. Dermatol Ther. 2004; 17 Suppl 1: 49-56.
Draelos ZD. An evaluation of prescription device moisturizers. J Cosmet Dermatol. 2009; 8: 40-43.
Nuovo J, Ellsworth AJ, Larson EB. Treatment of atopic dermatitis with antihistamines: lessons from a single-patient, randomized clinical trial. J Am Board Fam Pract. 1992; 5: 137-141.
Klein PA, Clark RA. An evidence-based review of the efficacy of antihistamines in relieving pruritus in atopic dermatitis. Arch Dermatol. 1999; 135: 1522-1525.
HoareC, LiWan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess. 2000; 4: 1-191.
Eichenfield LF, Tom WL, Chamlin SL et al. Guidelines of care for the management of atopic dermatitis: Section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014; 71 (1): 116-132.
Ellison JA, Patel L, Ray DW, David TJ, Clayton PE. Hypothalamic-pituitary-adrenal function and glucocorticoid sensitivity in atopic dermatitis. Pediatrics. 2000; 105: 794-799.
Kristmundsdottir F, David TJ. Growth impairment in children with atopic eczema. J R Soc Med. 1987; 80: 9-12.
Patel L, Clayton PE, Addison GM, Price DA, David TJ. Linear growth in prepubertal children with atopic dermatitis. Arch Dis Child. 1998; 79: 169-172.
Callen J, Chamlin S, Eichenfield LF, Ellis C, Girardi M, Goldfarb M et al. A systematic review of the safety of topical therapies for atopic dermatitis. Br J Dermatol. 2007; 156: 203-221.
Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006; 54: 1-15; quiz 6-8.
Breuer K, Werfel T, Kapp A. Safety and efficacy of topical calcineurin inhibitors in the treatment of childhood atopic dermatitis. Am J Clin Dermatol. 2005; 6: 65-77.
Boguniewicz M, Fiedler VC, Raimer S, Lawrence ID, Leung DY, Hanifin JM. A randomized, vehicle-controlled trial of tacrolimus ointment for treatment of atopic dermatitis in children: pediatric tacrolimus study group. J Allergy Clin Immunol. 1998; 102: 637-644.
Eichenfield LF, Lucky AW, Boguniewicz M, Langley RG, Cherill R, Marshall K et al. Safety and efficacy of pimecrolimus (ASM 981) cream 1% in the treatment of mild and moderate atopic dermatitis in children and adolescents. J Am Acad Dermatol. 2002; 46: 495-504.
Kang S, Lucky AW, Pariser D, Lawrence I, Hanifin JM. Long-term safety and efficacy of tacrolimus ointment for the treatment of atopic dermatitis in children. J Am Acad Dermatol. 2001; 44 (1 Suppl): S58-S64.
Abramovits W, Fleischer AB Jr, Jaracz E, Breneman D. Adult patients with moderate atopic dermatitis: tacrolimus ointment versus pimecrolimus cream. J Drugs Dermatol. 2008; 7: 1153-1158.
El-Batawy MM, Bosseila MA, Mashaly HM, Hafez VS. Topical calcineurin inhibitors in atopic dermatitis: a systematic review and meta-analysis. J Dermatol Sci. 2009; 54: 76-87.
Frankel HC, Qureshi AA. Comparative effectiveness of topical calcineurin inhibitors in adult patients with atopic dermatitis. Am J Clin Dermatol. 2012; 13: 113-123.
Baumer JH. Atopic eczema in children, NICE. Arch Dis Child Educ Pract Ed. 2008; 93: 93-97.
Meduri NB, Vandergriff T, Rasmussen H, Jacobe H. Phototherapy in the management of atopic dermatitis: a systematic review. Photodermatol Photoimmunol Photomed. 2007; 23: 106-112.
Clayton TH, Clark SM, Turner D, Goulden V. The treatment of severe atopic dermatitis in childhood with narrowband ultraviolet B phototherapy. Clin Exp Dermatol. 2007; 32: 28-33.
Grundmann-Kollmann M, Behrens S, Podda M, Peter RU, Kaufmann R, Kerscher M. Phototherapy for atopic eczema with narrow-band UVB. J Am Acad Dermatol. 1999; 40: 995-997.
Reynolds NJ, Franklin V, Gray JC et al. Narrow-band ultraviolet B and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial. Lancet. 2001; 357: 2012-2016.
Sidbury R, Davis D, Cohen D et al. Guidelines of care for the management of atopic dermatitis: Section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014; 71: 327-349.
Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB et al. Guidelines of care for the management of psoriasis and psoriatic arthritis, section 5: guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy. J Am Acad Dermatol. 2010; 62: 114-135.
Rombold S, Lobisch K, Katzer K, Grazziotin TC, Ring J, Eberlein B. Efficacy of UVA1 phototherapy in 230 patients with various skin diseases. Photodermatol Photoimmunol Photomed. 2008; 24: 19-23.
Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess. 2000; 4: 1-191.
Allen B. A multicenter double-blind placebo controlled crossover to assess the efficacy and safety of cyclosporin A in adult patients with severe refractory atopic dermatitis. Athens (Greece): Royal Society of Medicine Services Ltd; 1991.
Harper JI, Ahmed I, Barclay G et al. Cyclosporin for severe childhood atopic dermatitis: short course versus continuous therapy. Br J Dermatol. 2000; 142: 52-58.
Meggitt SJ, Gray JC, Reynolds NJ. Azathioprine dosed by thiopurine methyltransferase activity for moderate-to-severe atopic eczema: a double-blind, randomized controlled trial. Lancet. 2006; 367: 839-846.
Berth-Jones J, Takwale A, Tan E, Barclay G, Agarwal S, Ahmed I et al. Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial. Br J Dermatol. 2002;147: 324-330.
Murphy LA, Atherton D. A retrospective evaluation of azathioprine in severe childhood atopic eczema, using thiopurine methyltransferase levels to exclude patients at high risk of myelosuppression. Br J Dermatol. 2002; 147: 308-315.
Hon KL, Ching GK, Leung TF, Chow CM, Lee KK, Ng PC. Efficacy and tolerability at 3 and 6 months following use of azathioprine for recalcitrant atopic dermatitis in children and young adults. J Dermatolog Treat. 2009; 20: 141-145.
Weatherhead SC, Wahie S, Reynolds NJ, Meggitt SJ. An open-label, dose-ranging study of methotrexate for moderate-to-severe adult atopic eczema. Br J Dermatol. 2007; 156: 346-351.
Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB et al. Guidelines of care for the management of psoriasis and psoriatic arthritis, section 4: guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol. 2009; 61: 451-485.
Schmitt J, Schakel K, Folster-Holst R, Bauer A, Oertel R, Augustin M et al. Prednisolone vs cyclosporin for severe adult eczema: an investigator-initiated double-blind placebo-controlled multicenter trial. Br J Dermatol. 2010; 162: 661-668.
Daley-Yates PT, Richards DH. Relationship between systemic corticosteroid exposure and growth velocity: development and validation of a pharmacokinetic/pharmacodynamics model. Clin Ther. 2004; 26: 1905-1919.
Wollenberg A, Ehmann L. Long term treatment concepts and proactive therapy for atopic eczema. Ann Dermatol. 2012; 24 (3): 253-260.
Ring J et al. Guidelines for treatment of atopic eczema (atopic dermatitis) Part I- II JEADV 2012; 26: 1045-1060.
Heil PM, Maurer D, Klein B, Hultsch T, Stingl G. Omalizumab therapy in atopic dermatitis: depletion of IgE does not improve the clinical coursee a randomized, placebo-controlled and double blind pilot study. J Dtsch Dermatol Ges 2010;8:990-8