Atopic dermatitis: a review of topical treatment options

Abstract

Background:

Atopic dermatitis (AD) is a chronic, pruritic, inflammatory skin disease with a wide range of severity, and is usually the first manifestation of atopic disease. It is one of the most common skin disorders in developed countries, affecting approximately 20% of children and 1–3% of adults. Symptoms such as eczematous papules, plaques, and itch, and their associated consequences, such as sleep disturbance, can significantly impact the quality of life of the patient and family.

Scope:

This is a broad-based review focusing on clinical practice for primary care physicians treating patients with AD. The PubMed database was searched (to 1 November 2008) for English-language articles containing the keywords atopic dermatitis, atopic eczema, topical calcineurin inhibitor, tacrolimus, pimecrolimus, or corticosteroid. Articles focusing on clinical practice for patients with AD were chosen for further review. A limitation is that this is not a systematic review of the literature.

Findings:

Emollients have long been used to maintain the skin barrier function in patients with AD. Topical corticosteroids have been the pillar of medicated therapy for AD since their introduction nearly 50 years ago. The introduction of topical calcineurin inhibitors more than 8 years ago represented the first new class of medication approved for the treatment of AD since topical corticosteroids. Topical calcineurin inhibitors provide targeted anti-inflammatory activity without the local or systemic side-effects seen with topical corticosteroids. More recently, three new, nonsteroidal, barrier creams (Atopiclair^*, Mimyx^†, and Epiceram^‡) have entered the marketplace for AD treatment. A multi-therapeutic approach that incorporates short-term management of flares and longer-term strategies to prolong the time between flares is needed for the treatment of AD.

Conclusion:

Multiple topical therapies have been successfully used to treat patients with AD. An understanding of the available treatment options will help primary care providers striving to achieve best practice in the management of AD.

Key words::

• Atopic dermatitis
• pimecrolimus cream
• tacrolimus ointment
• topical barrier cream
• topical corticosteroids

Transparency

Declaration of funding

The development of this review manuscript was funded by Astellas Pharma Global Development, Inc.

Declaration of financial/other relationships

E.L.S. has disclosed he has been an investigator for studies involving pimecrolimus (Novartis), tacrolimus (Astellas), MimyX (Stiefel), and Epiceram (Ceragenix).

Peer reviewers may receive honoraria from CMRO for their review work. Peer Reviewer 1 has disclosed that he/she has received research funding from, is an advisor to, and sits on the speakers bureau of Amgen, Abbott, Centocor, Galderma and Stiefel. Peer Reviewer 2 has disclosed that he/she has no relevant financial relationships.

Acknowledgments

Editorial assistance, including initial literature search, writing assistance with outline and draft development, spelling and grammatical editing, was provided by Dr Keni Cheng-Siang Lee. Dr Lee is a medical writer at Envision Pharma and was funded on this project by Astellas Pharma Global Development Inc.

Notes

* Atopiclair is a registered trade name of Sinclair Pharma plc, Godalming, Surrey, UK; pharmaceutical composition is comprised of several ingredients.

† MimyX is a registered trade name of Stiefel Laboratories Inc., Coral Gables, FL, USA; pharmaceutical composition is comprised of several ingredients.

‡ Epiceram is a registered trade name of Ceragenix Pharmaceuticals Inc., Denver, CO, USA; pharmaceutical composition is comprised of several ingredients.