Clinical Edge

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Treatment Options for Children With Atopic Dermatitis

Children with atopic dermatitis (AD) and signs of early sensitization may benefit more from early tacrolimus than corticosteroid treatment, a new study suggests. The interim analysis included 75 patients (55% female) at 1 year of an ongoing 3-year randomized open-label comparative follow-up study of topical tacrolimus vs corticosteroid treatment. Children aged 1-3 years with moderate-to-severe eczema were enrolled. Researchers found:

  • Efficacy parameters, the Eczema Area and Severity Index (EASI), Investigator’s Global Assessment (IGA), transepidermal water loss (TEWL), eczema area, serum total immunoglobulin E (IgE), and the blood eosinophil count showed improvement in both groups.
  • Patients with signs of early sensitization at baseline had statistically lower TEWL at the eczema site and a smaller eczema area at 12 months in the tacrolimus group.

Citation:

Perala M, et al. Young children with moderate-to-severe atopic dermatitis can be treated safely and effectively with either topical tacrolimus or mild corticosteroids. [Published online ahead of print September 4, 2019]. Acta Paediatr. doi: 10.1111/apa.15001.

Commentary:

This is a small study from Finland that demonstrates that topical therapy alone can make a big impact in young children (aged <4 years) with AD. A group of the children showed better improvement with topical tacrolimus than corticoids, although all improved over time. Other studies have documented in a variety of atopic patients that optimum use of topical therapies is often not achieved. This may be due to either patient or prescriber factors. We should be cognizant that when a young child presents with poorly controlled eczema, more aggressive topical therapy may be a good first choice rather than consideration of systemic therapy. — Joseph Fowler, Jr., MD, Clinical Professor of Dermatology, University of Louisville, KY