Consensus Recommendations on Adjunctive Topical Management of Atopic Dermatitis
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
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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GENERAL OVERVIEW OF ATOPIC DERMATITIS
Atopic dermatitis (AD) is a commonly encountered heterogenous eczematous disorder that typically starts in infancy and early childhood, and may persist into adulthood; chronic-recurrent nature, associated pruritus, and genetic predisposition are all hallmarks of AD.1,2Whether or not AD is a single disease entity or a spectrum of diseases with a shared phenotype is not completely understood, however, certain clinical features are highly characteristic. These include usual morphology and anatomic distribution of dermatitis, marked pruritus, relapsing course or seasonal variation, associated xerosis, and a personal or family history of atopy.1-4 With regard to diagnostic criteria for AD, the Hanifin and Rajka criteria have long been the standard used in most textbooks and clinical studies, however, several other criteria have been developed, especially in Europe and Asia.3,4 The emergence of newer diagnostic criteria reflect the desire to encompass variations in AD phenotype among different ethnic populations.4 What appears to be shared among various diagnostic criteria is the presence of a chronically relapsing and highly pruritic eczematous dermatitis that usually starts within the first 2 to 5 years of life, exhibiting a tendency for anatomic sites of predilection especially during the childhood and adolescent years. A positive parental history of AD is a very important factor, as the risk for development of AD is doubled if present in one parent and tripled if both parents are affected.2 Interestingly, the prevalence of AD is higher in urban areas and in more affluent and well-developed countries.2PrevalenceDepending on study methodology, the prevalence of childhood AD is estimated to range from 6% to 12.98%, with data from a United States (US) population-based survey reporting a steady increase from 8% in 1997 to >12% in 2010 and 2011.5 Data from 2012 showed a peak in AD prevalence in early childhood (14%) that persisted throughout childhood (13-14%), followed by a decrease during adolescence (8%) that remained stable throughout adulthood (6-8%).5