Atopic dermatitis topical corticosteroids

The topical immunomodulators tacrolimus (Protopic) and pimecrolimus (Elidel) inhibit calcineurin, which normally initiatives T-cell activation. These agents can be used on all parts of the body for prolonged periods without producing corticosteroid-induced adverse effects. Tacrolimus ointment 0.03% and 0.1% is applied twice daily the lower strength is preferred in children with moderate to severe atopic dermatitis. The most common adverse effect is transient itching and burning at the site of application. Pimecrolimus cream 1% is applied twice daily for mild to moderate atopic dermatitis in adults and children older than age 2. 

T Cells May Contribute to the Defects in Innate Immune Response in Atopic Dermatitis Most patients with atopic dermatitis are colonized with S. aureus and experience exacerbation of their skin disease after infection with this organism [2]. In patients with S. aureus infection, treatment with anti-staphylococcal substances can result in the reduction of skin disease. Binding of S. aureus to the epidermis is enhanced by atopic skin inflammation. This is supported by clinical studies demonstrating that treatment with topical corticosteroids or tacrolimus reduces S. aureus counts in atopic dermatitis. 

Numerous glucocorticosteroids for topical application are available. Essentially they all suppress the symptoms of inflammatory and hypersensitivity reactions and their mechanism of action is similar. Their indications include seborrhoeic and atopic dermatitis, phototoxic reactions, psoriasis, chronic discoid lupus, hypertrophic lichen planus and alopecia areata. However it has to be kept in mind that the use of corticosteroids for these conditions in most cases only gives symptomatic relieve and that the problem tends to recur on cessation of therapy. Traditionally topical corticosteroid formulations are grouped according to approximate relative efficacy. This efficacy is determined by both the potency of the agent and the concentration in which the corticosteroid is used. 

Letawe, C., Pierard-Franchimont, C., and Pierard, G.E. Squamometry in rating the efficacy of topical corticosteroids in atopic dermatitis. Eur. J. Clin. Pharmacol. 51, 253-258 (1996). 

These include atypical or subtle manifestations of dermatologic conditions such as seborrheic dermatitis, rosacea, psoriasis, atopic dermatitis, and ichthyosis. Classic manifestations of such diseases are diagnosed with relative ease. However, diagnostic difficulty arises in the presence of atypical morphology, lesions masked by topical therapy (e.g., corticosteroids), or exacerbations due to other topical agents (e.g., skin care products).2,10... 

Therapy for the patient with atopic dermatitis can be divided into three distinct categories topical therapy for the skin, systemic therapy, and ocular therapy.Therapy for the skin includes the use of fluorinated corticosteroids such as triamcinolone or betamethasone or hydrocortisone... 

Topical corticosteroids and emollients are the mainstay for treatment of atopic dermatitis. 

The traditional mainstays of topical treatment for AD have been the topical corticosteroids. It is interesting to note, however, that steroids are not believed to have any effects on histamine release from human mast cells [116, 117]. A direct comparative study of the mechanism of steroids versus tacrolimus has not been performed. However, in preliminary work done by Fujisawa Laboratories in the United States utilizing sequential punch biopsies from patients with atopic dermatitis treated with either steroids or tacrolimus topically, some differences were noted in the patterns of cytokine expression between the two treatments (M. Kobayashi, personal communication, 2000). Additional studies will need to be performed before clear conclusions can be drawn. 

Tacrolimus ointment is the first topical, nonsteroidal, effective and safe immunomodulatory agent to offer the potency of a corticosteroid without its attendant adverse effects. It truly represents the first therapeutic advance in the treatment of atopic dermatitis since the introduction of topical steroids more than 40 years ago [105, 129]. 

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterised by extreme pruritus and lichenified papules and plaques that may begin in or persist in to adulthood. Topical corticosteroids are first-line prescription therapy for AD they are efficacious and have a well established safety profile. The topical calcineurin inhibitors tacrolimus and pimecrolimus have been approved as second-line topical therapy for AD. The current review evaluates the available studies on the comparative effectiveness, safety, cost, and impact on quality of life of topical corticosteroids and topical calcineurin inhibitors for the treatment of adult AD [17 ]. 

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