SAN FRANCISCO — Start simple and use a step-wise approach to treat children with atopic dermatitis, Dr. Sheila Fallon Friedlander recommended.
“Atopic dermatitis matters so much because it can become infected, can impair physical and psychologic function, and has a tremendous effect on family quality of life,” Dr. Friedlander said at a seminar on women's and pediatric dermatology sponsored by Skin Disease Education Foundation.
Using a ladder analogy, start at the bottom with repair of the skin barrier. The next rung is an intervention to short circuit inflammation. Then take care of itching, treat infections, address triggers, and educate patients and their family.
Is the family compliant? “This is extremely important. You need to get family to buy in to a treatment plan that is often complicated,” said Dr. Friedlander of the University of California, San Diego.
Consider the age of the child, severity and duration of disease, and how much body surface area is affected.
Bathing can be beneficial to atopic skin if it hydrates the stratum corneum and removes dirt, scales, and bugs, but breaks in the skin can occur during evaporation, so bathing and moisturizers together are better than either alone, Dr. Friedlander said.
She is a fan of ceramide-based creams for atopic dermatitis. “Ceramides can decrease the amount of steroid you use or perhaps you can use [them] instead of steroids and do as well,” she said.
If barrier repair does not work, the next step of the ladder is short circuiting inflammation. With corticosteroids for atopic dermatitis, use the weakest strength to do the job, blast and taper off, or consider weekend pulses of high potency steroids.
Topical calcineurin inhibitors are another therapeutic option. “There are a lot of data out there, so we know a lot about them,” she said.
Dr. Friedlander's relevant disclosures include being a consultant for Astellas, Graceway Pharmaceuticals, and Novartis. She also receives research support from Astellas, Novartis, Promius Pharma, and SkinMedica. SDEF and this news organization are owned by Elsevier.