Abstract Number: 16

What’s new in atopic dermatitis

A.S. Paller

Meeting: 2014 Dermcoll

Session Information

Date: -

Session Title: Paediatric Symposium 2

Session Time: -

Our increased understanding of the underlying mechanism
of atopic dermatitis (AD) will change the landscape of therapy in the next decade. The key role of emollients and
increasing hydration, given barrier insufficiency, has been
emphasized. Emollients containing deficient epidermal
components, such as ceramides, are now available, and wet
wraps have received increasing attention. The possibility of
pro-actively improving the barrier through topical application
in at-risk neonates and infants has also received attention.
Topical steroids remain the mainstay of therapy, with
topical calcineurin inhibitors (TCIs) as steroid-sparing
agents. Concern about the effects of topical steroids on
barrier function and the risk of local burning with TCI
application has led to rotational schemes, with mediumstrength
or potent topical steroids used briefly for acute
flares, followed by TCIs, preferential use of TCIs for the face
and neck, and “pro-active” therapy with application of
either medium-strength topical steroid or TCIs applied two
to three times weekly to prevent flares. Topical PDE4 inhibitors
are promising nonsteroidal anti-inflammatory topical
approach. Given the importance of S. aureus as a trigger of
inflammation, maintenance therapy with dilute sodium
hypochlorite (bleach) baths decreases both the risk of infec-
tion and the severity of the dermatitis; alternative forms are
now available for use in the shower. Systemically administered
IL4R inhibition leads to significant improvement in
moderate to severe disease and reverses the AD biomarker
abnormalities.