Update on the management of chronic eczema: new approaches and emerging treatment options

Figures & data

Figure 1 Atopic eczema affecting a young child’s face.

Figure 2 Flexoral eczema on the ankle of a child.

Figure 3 Lichenification from chronic eczema on the posterior neck.

Figure 4 Nummular eczema.

Table 1 Diagnostic features of atopic dermatitis^3,7,13

Major features*

Pruritus Eczematous eruption in a typical age-appropriate distribution (flexoral surfaces, ankles, neck age > 4 years, cheeks, forehead, outer limbs age < 4 years) Chronic and relapsing clinical course Tendency toward xerosis or “sensitive” skin Personal history of asthma or allergic rhinitis (or family history of atopy in patients < age 4 years) Age of onset under 2 years (if over 4 years of age)

Minor or associated features

Ichthyosis Palmar hyperlinearity Follicular findings (keratosis pilaris, perifollicular accentuation) Dennie-Morgan lines (infaorbital folds) Periorbital darkening Pityriasis alba Lichenification, prurigo lesions Environmental influence Intolerance to wool Tendency toward dermatitis at specific body locations (hands, feet, nipples, lips) Elevated serum immunoglobulin E Tendency toward skin infections Abnormal vascular responses (facial pallor, delayed blanch response, white dermatographism) Ocular changes (keratoconus, anterior subcapsular cataract, recurrent conjunctivitis) Food intolerance

Notes:

* Pruritus and at least three other features should be present for diagnosis.

Table 2 Treatment overview of AD

Lifestyle interventions	Emollients, bathing technique, humidification, avoidance of exacerbants
Topical therapy	Topical corticosteroids (first line)
	Topical calcineurin inhibitors (second line)
	tacrolimus, pimecrolimus
	Barrier enhancing creams
Phototherapy	Narrowband UVB (311 nm)
	Broadband UVB (280–315 nm)
	UVA (315–400 nm)
	UVA I (340–400 nm)
	Psoralen UVA
	Extracorporal photochemotherapy
Systemic therapies: Traditional	Corticosteroids
	Cyclosporine
	Azathioprine
	Methotrexate
	Mycophenolate mofetil
Systemic therapies: Biologic	Interferon-γ
	Immunoglobulin E/Interleukin-5
	Inhibitors
	Omalizumab
	Mepalizumab
	Intravenous immunoglobulin
	Tumor necrosis factor-alpha inhibitors
	Infliximab
	Etanercept
	B- and T-cell Inhibitors
	Alefacept
	Rituximab
Ancillary therapies	Antihistamines for control of pruritus
	Antibiotics (oral, topical) for control of secondary infection

KangKPolsterAMNedorostSTStevensSRCooperKDAtopic DermatitisBologniaJJorizzoJRapiniRDermatologyPhiladelphiaMosby2003199214

 Google Scholar

SimpsonELAtopic dermatitis: a review of topical treatment optionsCurr Med Res Opin20102663364020070141

 PubMed Web of Science ®Google Scholar

HanifinJMCooperKDHoVCGuidelines of care for atopic dermatitis, developed in accordance with the American Academy of Dermatology (AAD)/American Academy of Dermatology Association “Administrative Regulations for Evidence-Based Clinical Practice Guidelines”J Am Acad Dermatol20045039140414988682

 PubMed Web of Science ®Google Scholar