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Pediatric atopic dermatitis: a review of the medical management.

Author(s): Carbone A, Siu A, Patel R

Affiliation(s): Pharmacy Department, Saint Barnabas Health Care System, Kimball Medical Center, Lakewood, NJ, USA. acarbone@sbhcs.com

Publication date & source: 2010-09, Ann Pharmacother., 44(9):1448-58. Epub 2010 Jul 13.

Publication type: Review

OBJECTIVE: To evaluate the available treatment options for pediatric atopic dermatitis. DATA SOURCES: A literature review was performed in MEDLINE (1950-February 2010) using the key word atopic dermatitis. The references identified were evaluated in comparative treatment. The references included in this review were limited to studies conducted in children less than 18 years of age and written in the English language. STUDY SELECTION AND DATA EXTRACTION: All of the literature retrieved that was published within the last 5 years (2005-2010) was included in this review. Other pertinent articles published prior to 2005 were also included. DATA SYNTHESIS: Atopic dermatitis is a chronic inflammatory skin disorder that usually begins during infancy. Potential causes include irritants such as soap and detergents, food allergens, contact allergens, and skin infections. Emollients, moisturizing agents that inhibit water loss and provide a protective coating, are recommended in all patients with atopic dermatitis. Additionally, emollients may reduce the need to use topical corticosteroids. Patients receiving desonide 0.05% plus an emollient achieved significant reductions in severity scores compared to those receiving desonide 0.05% as monotherapy (80% vs 70%; p < 0.01). Topical calcineurin inhibitors are not recommended as first-line therapy in pediatric patients with atopic dermatitis; however, their use in children above 2 years of age who fail to respond to topical corticosteroids may be considered. CONCLUSIONS: Emollients are recommended in pediatric patients with a diagnosis of atopic dermatitis regardless of symptoms. Topical corticosteroids reduce the inflammation and pruritus associated with atopic dermatitis and are available in several formulations and strengths. Calcineurin inhibitors may be an alternative in children older than 2 years of age who do not respond to topical corticosteroids.

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