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Chapter 053. Eczema and Dermatitis (Part 2)

Figure 53-1 Atopic dermatitis. Hyperpigmentation, lichenification, and scaling in the antecubital fossae are seen in this patient with atopic dermatitis. (Courtesy of Robert Swerlick, MD; with permission.) Atopic Dermatitis: Treatment Therapy of AD should include avoidance of cutaneous irritants, adequate moisturizing through the application of emollients, judicious use of topical antiinflammatory agents, and prompt treatment of secondary infection. Patients should be instructed to bathe no more often than daily using warm or cool water, and to use only mild bath soap. Immediately after bathing while the skin is still moist, a topical anti-inflammatory agent in a cream or ointment base should be. | Chapter 053. Eczema and Dermatitis Part 2 Figure 53-1 Atopic dermatitis. Hyperpigmentation lichénification and scaling in the antecubital fossae are seen in this patient with atopic dermatitis. Courtesy of Robert Swerlick MD with permission. Atopic Dermatitis Treatment Therapy of AD should include avoidance of cutaneous irritants adequate moisturizing through the application of emollients judicious use of topical antiinflammatory agents and prompt treatment of secondary infection. Patients should be instructed to bathe no more often than daily using warm or cool water and to use only mild bath soap. Immediately after bathing while the skin is still moist a topical anti-inflammatory agent in a cream or ointment base should be applied to areas of dermatitis and all other skin areas should be lubricated with a moisturizer. Approximately 30 g of a topical agent is required to cover the entire body surface of an average adult. Low- to midpotency topical glucocorticoids are employed in most treatment regimens for AD. Skin atrophy and the potential for systemic absorption are constant concerns especially with more potent agents. Low-potency topical glucocorticoids or non-glucocorticoid anti-inflammatory agents should be selected for use on the face and intertriginous areas to minimize the risk of skin atrophy. Two non-glucocorticoid anti-inflammatory agents are now available tacrolimus ointment and pimecrolimus cream. These agents are macrolide immunosuppressants that are approved by the U.S. Food and Drug Administration FDA for topical use in AD. Reports of broader effectiveness appear in the literature. These agents do not cause skin atrophy nor do they suppress the hypothalamic-pituitary-adrenal axis. Recently however concerns have emerged regarding the potential for lymphomas in patients treated with these agents. Thus caution should be exercised when considering these agents. Currently they are also more costly than topical glucocorticoids. Secondary infection of .