Recent advances in treatment strategies for atopic dermatitis.
A wide range of different therapeutic regimens are used for atopic dermatitis. Although many treatment modalities are well established worldwide among clinicians, only the minority of these therapy recommendations are based on results of randomised controlled trials (RCTs). To close the gap between such 'generally' recommended therapies and therapies that are based on data from controlled trials, this review focuses not only on the pharmacological and clinical aspects of the currently proven agents, but also on the advantages and disadvantages of therapies that have not yet been completely tested.A review of the available literature concerning the pharmacological profile and also the level of evidence of therapeutic efficacy of all currently known topical and systemic agents for the treatment of atopic dermatitis reveals a large gap between the knowledge concerning the pharmacological action in vitro and the evidence of clinical efficacy in many cases. We agree with the conclusion of previous reviews that numerous therapies for atopic dermatitis urgently require more independent RCTs and especially comparative trials (e.g. corticosteroids vs calcineurin inhibitors). These are required in order to facilitate the choice of therapeutic strategy for the individual treatment of atopic dermatitis, with its broad spectrum of clinical manifestations and potential complications in adult patients and, particularly, in children.Finally, we also review preclinical trials with several new drugs. Immunomodulators appear to promise a new dimension for the future of therapy for atopic dermatitis, especially for severe and otherwise refractory forms or as alternatives to corticosteroids, that is, to treat facial atopic eczema without the risk of adverse effects.
Roos
Thomas Christian
TC
Reha Klinik Neuharlingersiel, Interdisciplinary Therapy Center for Allergies, Skin- and Lung-Diseases, Neuharlingersiel, Germany. roos@rehaklinik-neuharlingersiel.de
Geuer
Stefan
S
Roos
Sabine
S
Brost
Harald
H
D000287:Administration, Topical; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D065095:Calcineurin Inhibitors; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006634:Histamine H1 Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans
D000305:Adrenal Cortex Hormones; D000890:Anti-Infective Agents; D065095:Calcineurin Inhibitors; D006634:Histamine H1 Antagonists