Non-steroidal therapies in atopic dermatitis

Las Vegas

- "There are problems with corticosteroids," says Alan B. Fleischer, Jr., M.D., professor and chair of dermatology, Wake Forest University School of Medicine, Winston-Salem, N.C.

For example, Dr. Fleischer cites a study in which hydrocortisone was used twice daily (continuously) or three times weekly (intermittently) to treat normal skin for three weeks.

For patients who used hydrocortisone continuously, collagen peptides were decreased for type I collagen by 89 percent; for type II collagen, 82 percent. For patients treated intermittently, collagen peptides were decreased for type I collagen by 53 percent; for type II collagen, 50 percent (Nuutinen, British Journal of Dermatology, 2008).

Clearly, alternative therapies are needed, Dr. Fleischer says.

"We do need excellent alternatives for patients that do not clear quickly with topical corticosteroids," Dr.Fleischer tells Dermatology Times.

Calcium inhibitors, such as tacrolimus and pimecrolimus both now have long-term open trials spanning multiple years. Calcium inhibitors are safer that corticosteroids in the long term. However, both tacrolimus and pimecrolimus cause more burning, stinging and itching than some corticosteroids in the short term.

Fortunately, new therapies are on the horizon. Three barrier agents have been approved within the past few years. Mimyx, Atopiclair, and Eletone have been approved for treating atopic dermatitis, and EpiCream is "coming," Dr. Fleischer says.

Since these agents are not drugs, they have not been required to demonstrate drug efficacy for approval. Nevertheless, Dr. Fleischer says, "there is one published RTC suggesting efficacy."

Whatever regimen doctors prescribe, the key is to keep it simple, he says. The most important thing is to prescribe a regimen that the patient will use. DT