New developments in atopic dermatitis

Las Vegas

- "TIMS (topical immune modulators) are safer than topical steroids if you don’t feed them heavily to monkeys," says Lawrence A. Schachner, M.D., chairman and Harvey Blank Professor of Dermatology, professor of pediatrics, and director, division of pediatric dermatology, Leonard M. Miller School of Medicine, University of Miami, Miami, Fla.

Dr. Schachner’s tongue-in-cheek comment addresses the study of oral pimecrolimus in monkeys. The 39-week study found increased incidences of lymphoma among monkeys with systemic exposure to pimecrolimus at 31 times the dose.

However, overall systemic safety in humans favors the TIMS over topical steroids. Lymphoma inductions data and topical steroid profiles also favor TIMS for treating atopic dermatitis (AD) in children, Dr. Schachner tells Dermatology Times.

Dr. Schachner cautions doctors to avoid treatment pitfalls. Pitfalls include lack of compliance due to fear or lack of understanding, unrealistic expectations and prescribing the wrong steroid, among others. A common pitfall is a lack of patient education. To avoid this pitfall, Dr. Schachner sends a complete, printed regimen home with patients’ parents.

His Treatment Made E.Z. sliding scale includes basic rules such as keeping nails short, limited bath time to less than three minutes, dressing the child in cotton clothing, and keeping the environment cool.

Other instructions include details use of antibiotics, both oral and topical, daily use of TIMS, antihistamines, and proper scalp care with shampoo and topical steroids, if necessary.

Bleach baths are a time-tested treatment for atopic dermatitis. If a patient has a history of staph infections, he should bath in a solution of ¼ cup bleach in a foor of water. Bleach is "an old agent with real contemporary" uses, Dr. Schachner says.

In a study of alternative therapies, Dr. Schachner found that atopic dermatology systems significantly decreased in patients who received massage therapy in addition to prescribed medications (Schachner LA, Field T, Hernandez-Reif M, Duarte A, Krasnegor, J, Pediatric Dermatology, 1998; 15(5); 390-395).

However, all alternative therapies are not alike. Regarding introducing probiatics as treatment for AD, Dr. Schachner says, "I’m not impressed - just not impressed." Probiotics appear to improve AD only in food-sensitized children. DT