[What additional measures should be recommended in atopic dermatitis in children?].
The so-called 'adjuvant' measures are an important part of atopic dermatitis (AD) consultations. The practitioner is the 'expert' in the patients' eyes in prescribing, proposing, counselling and replying to the questions concerning moisturizers, thermal spring water cures, the resort to alternative medical, and vaccinations. Moisturizers are aimed at rapidly restoring water in the epidermis, decreasing the sensitivity to irritants and improving the patients' comfort. The available products are usually composed of water, occlusive agents, humidifiers, varyingly combined with tensioactive agents, preservatives and perfumes... Their short term efficacy has been demonstrated, but no study has shown superiority of one product over another. The recommended treatment is 1 to 2 daily applications of a cream or lotion, selected among the products having demonstrated their efficacy, contained the least amount of irritant or sensitizers, the presentation and cost of which is acceptable to the patient. There are no arguments to recommend moisturizers in the absence of xerosis, nor for prolonged periods of clinical remission. Spring water thermal cures. In France there are many cure centres and the spring waters used are distinguished by their clinical or physical features. Although there are no studies that clearly establish their efficacy in AD, the craze and satisfaction of many patients for spring water thermal cures must be taken into consideration, as well as the educational dimension, in the hopes that a consensus will be reached and that regular assessments be made. Alternative medical practices, such as homeopathy or acupuncture, represent a therapeutic alternative chosen by more than one third of patients with AD. However, no study has sufficiently demonstrated the interest of these alternatives and they cannot therefore be integrated in the validated arsenal of treatments. Used in various oriental countries, Chinese herbs have been the subject of controlled studies with encouraging results. But the data available on safety prompt greater care and do not promote the use of such products in children. Vaccination of atopic children is a much debated subject among the medical corps, although currently consensual attitude is possible. In general, there is no reason to limit or delay the French vaccination calendar of an atopic child. Notably vaccination with ROR can be used routinely, even in those allergic to eggs. It is sometimes logical to avoid vaccination during severe flares of eczema. In the case of documented allergy to eggs, the flu and yellow fever vaccinations should be avoided, except in exceptional cases when vaccination is made in hospital settings.
Unité de Dermatologie Pédiatrique, Hôpital Pellegrin-Enfants, Place Amélie-Raba-Léon, F-33076 Bordeaux Cedex. franck.boralevi@chu-bordeaux.fr
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Boralevi
D002648:Child; D000529:Complementary Therapies; D003876:Dermatitis, Atopic / Q000628:therapy*; D004643:Emollients / Q000627:therapeutic use; D006801:Humans; D014611:Vaccination / Q000009:adverse effects
D004643:Emollients