Consensus Recommendations on Adjunctive Topical Management of Atopic Dermatitis

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

formulation (product A) containing a medium of thermal water, proprietary to a spring in the town of La Roche Posay, France, a prebiotic biomass of non-pathogenic bacteria (Vitreoscilla filliformis), a selected carbon source (mannose), and ingredients supporting barrier repair (ie, shea butter, niacinamide, glycerin) applied over 28 days provided greater improvement in signs and symptoms of AD, lack of increase in staphylococci, and increased microbial diversity versus a comparator moisturizer(product B) containing ceramide, glycerin, and shea butter.53 Importantly, these observed differences between formulations were more pronounced with relapse of AD. Other outcomes were a 2-fold higher relapse rate with product B versus product A (60% vs 30%) with use after completion of 15 days of drug treatment, with greater severity of flaring with product B.53 It has also been noted that improvements in AD with treatment are preceded by increased cutaneous bacterial diversity.52These data suggest an additional adjunctive benefit related to skin microbiology that can positively impact on both short term and long term management, especially as AD is a chronic relapsing disorder.This article now concludes with results from the panel of authors who met together on November 3, 2018 in Nashville,Tennessee. Two authors (LK, JH) presented data accumulated from a thorough literature review on the pathogenesis ofAD, current management approaches, and adjunctive topical therapy of AD. Using a modified delphi approach, the panelwere then queried on specific management considerations and provided their answers independently. The results werethen culled together and collectively discussed, with the group outlining consensus recommendations for topical adjunctive AD management along with comments on evidence support (Table 2).

CONCLUSION

AD is a heterogenous inflammatory/eczematous disorder associated with genetic predisposition and a complex pathophysiology.This disorder usually starts in early life, is typified by chronicity with flares and remissions, and can persist into adulthood. Adjunctive topical barrier repair therapy can assist in the long-term management of AD by decreasing clinicalmanifestations and reducing flares. This occurs if well-designed formulations are used regularly to counter some of the recognizedimpairments in epidermal barrier function that are innate to atopic skin and further exacerbated during AD flares. Newer information on the role of cutaneous microbiome shifting associated with AD supports the development of adjunctive formulationsthat promote commensal competition by enhancing a balanced and diverse skin microbiome.

DISCLOSURES

All faculty have received honoraria compensation for providing advisory board services.

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AUTHOR CORRESPONDENCE

James Q. Del Rosso DO jqdelrosso@yahoo.com