Consensus Recommendations on Adjunctive Topical Management of Atopic Dermatitis openaccess articles

October 2018 | Volume 17 | Issue 10 | Original Article | 1070 | Copyright © 2018

James Q. Del Rosso DO,a Julie Harper MD,b Leon Kircik MD,c Glynis Albon MD,d Diane Berson MD,e Adelaide Hebert MD,f Doris Day MDg

aJDR Dermatology Research/Thomas Dermatology, Las Vegas, NV; Touro University Nevada, Henderson, NV bThe Dermatology and Skin Care Center of Birmingham, Birmingham, AL cIcahn School of Medicine at Mount Sinai NY; Indiana Medical Center, Indianapolis, IN; Physicians Skin Care, PLLC; DermResearch, PLLC, Louisville, KY dUniversity of California, Los Angeles, CA; Albon Skin Institute & Research Center, Manhattan Beach, CA eWeill Medical College of Cornell University, New York, NY; New York-Presbyterian Hospital, New York, NY fMcGovern Medical School, The University of Texas Health Science Center at Houston, TX gDay Dermatology and Aesthetics, New York, NY

Abstract

Atopic dermatitis (AD) is well-recognized as a very common chronic and relapsing pruritic skin disorder affecting both children and adults worldwide. The adverse effects on the quality of life of affected individuals and their families is well-established. The pathophysiology of AD is complex, leading to interindividual variations in clinical presentation and severity. The chronicity of AD, characterized by periods of exacerbation and remission, supports a strong need to develop measures that can effectively and safely prolong remissions between flares of the disease. This article provides an overview of AD including prevalence, severity, and disease course/progression, succinct summaries of pathophysiology and medical management, and discussion of epidermal barrier dysfunction and skin microbiome shifting associated with AD. Additional emphasis is placed on adjunctive topical skin barrier approaches that may prolong disease-free remissions. Results from a panel of dermatologists queried about adjunctive approaches to AD, using a modified-Delphi approach, are also discussed. J Drugs Dermatol. 2018;17(10):1070-1076.

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INTRODUCTION

Psoriasis is a chronic, immune-mediated disease that affects approximately 2% of the population.1-3 The use of topical therapy is a key component in the management of almost all psoriasis patients. Topicals are considered first-line therapy for mild disease and are having an increasing role in moderate-to-severe psoriasis.4The use of topical corticosteroids (TCS) is commonplace, mainly due to their immunosuppressive, anti-inflammatory, and anti-proliferative properties. Treatment guidelines suggest their use as monotherapy in mild-to-moderate psoriasis; or in combination with other topical agents, ultraviolet light, or systemic agents in moderate-to-severe disease.4 However, long-term safety concerns remain, particularly with more potent formulations due to increased risk of local cutaneous adverse events (AEs); including skin atrophy, telangiectasia, and infrequently, hypothalamic–pituitary–adrenal (HPA) axis suppression.4-6 Consequently, super potent TCS such as halobetasol propionate (Ultravate® 0.05%, Ranbaxy Laboratories, Inc., Jacksonville, FL) cream are not recommended for more than two consecutive weeks’ use.Formulation advances may provide comparable efficacy, with reduced concentration of active ingredients and a correspondingly improved safety profile that can extend a product's utility. The

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