Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease characterized by intense pruritus and eczematous rashes, which significantly impairs the quality of life of patients [2]. Although described in modern medicine in 1933, this condition has historical roots dating back to antiquity, with predecessors such as Hebra's prurigo and Besnier's diathetic prurigo [3]. AD is one of the most common inflammatory skin diseases, frequently beginning in childhood and capable of persisting or arising in adulthood [8].
Because atopic dermatitis affects a heterogeneous population and requires an individualized approach, particularly in pediatrics, understanding modern treatment methods is crucial. In recent years, significant therapeutic breakthroughs have occurred in the field of pediatric dermatology, offering new hope for children suffering from this debilitating disease [1].
Diagnosis and Severity Assessment
Accurate diagnosis of atopic dermatitis is based on the characteristic distribution and morphology of rashes according to age, a chronic relapsing course, and the presence of pruritus [8]. However, it is important to perform differential diagnosis, as numerous other conditions can mimic AD [8].
Standardized tools are used to assess disease severity and treatment efficacy:
- SCORAD Index (SCORing Atopic Dermatitis Index): quantitatively determines disease severity and pruritus intensity [2].
- Dermatology Life Quality Index (DLQI): assesses the impact of the disease on the patient's quality of life [2].
- Atopic Dermatitis Control Tool: evaluates long-term disease control [2].
These assessments help physicians make informed decisions regarding therapy selection, especially for moderate and severe forms of AD [2].
Basic Therapy and First-Line Treatment
Initial approaches to treating atopic dermatitis include comprehensive measures aimed at reducing inflammation and improving skin barrier function. These include:
- Environmental control measures: elimination of triggers and irritants [4].
- Topical emollients (moisturizers): regular application to restore the skin barrier and reduce dryness [4].
- Topical corticosteroids: used for rapid relief of inflammation and pruritus [4, 5].
- Topical calcineurin inhibitors: an alternative to corticosteroids, especially for sensitive areas, helping to control inflammation [4].
These methods are often the first line of intervention and may be sufficient for many patients with mild forms of AD [4].
Modern Approaches to Treating Moderate and Severe Atopic Dermatitis
When standard topical methods prove insufficient or are poorly tolerated, more intensive treatment options are considered [4, 5].
Phototherapy
Phototherapy represents an effective second-line treatment option [4]. It can be used either independently or in combination with systemic drugs, such as corticosteroids, in the most severe cases [4]. Various types of light therapy have been tested for treating AD, with ultraviolet A1 (UVA1) and narrow-band ultraviolet B (NB-UVB) considered the most effective for acute and chronic forms of AD, respectively [4]. However, to date, there are no clear guidelines regarding which form of phototherapy is superior [4, 5].
New Topical Agents
New topical medications have emerged for treating moderate to severe atopic dermatitis, showing promising results:
- Janus kinase inhibitors (JAK inhibitors): block signaling pathways involved in inflammation [2].
- Phosphodiesterase-4 inhibitors (PDE4 inhibitors): reduce inflammation by increasing cyclic AMP levels in cells [2].
These agents can significantly improve the condition of patients with moderate-to-severe AD [2].
Biological Therapy and Small Molecules
Recent years have seen exciting advancements in the use of biological agents and small molecules in pediatric dermatology [1]. These medications are designed to treat immune-mediated, chronic inflammatory skin diseases such as atopic dermatitis [6].
Although healthcare professionals may have concerns regarding the safety and efficacy of these drugs in children, new data support their safety and efficacy in the pediatric population [6]. Practical guidelines for initiating biological therapy are being developed, including baseline screening, monitoring, dosing, and special considerations for children [6]. These methods represent an important step forward in treating severe forms of atopic dermatitis in children [1, 6].
Treat-to-Target (T2T) Strategy
The Treat-to-Target (T2T) strategy is a pragmatic therapeutic approach that is gradually being implemented in dermatology following its successful application in other clinical fields [7]. Atopic dermatitis, as one of the most common inflammatory skin diseases, can also benefit from this structured approach [7].
The essence of T2T lies in establishing specific treatment goals (e.g., achieving a certain level of symptom control or improving quality of life) and subsequently adjusting therapy until these goals are met. The International Eczema Council (IEC) is actively exploring the potential of applying T2T in the management of AD, which highlights its significance for future treatment [7].
Conclusion
The treatment of atopic dermatitis in children is constantly evolving, offering new and more effective methods. From basic therapy using emollients and topical agents to advanced biological drugs and the Treat-to-Target strategy, each approach aims to improve the skin condition and quality of life of young patients [1, 2, 7]. An individualized approach based on thorough diagnosis and severity assessment is the key to successfully managing this chronic disease.
Sources
- Pediatric dermatology: a critical approach to novel therapies. https://pubmed.ncbi.nlm.nih.gov/30537373/
- Expert consensus on the management of moderate-to-severe atopic dermatitis in Qatar. https://pubmed.ncbi.nlm.nih.gov/37700510/
- Atopic dermatitis/atopic eczema. https://pubmed.ncbi.nlm.nih.gov/24925387/
- Safety and efficacy of phototherapy in the treatment of eczema. https://pubmed.ncbi.nlm.nih.gov/29124712/
- Phototherapy in atopic eczema. https://pubmed.ncbi.nlm.nih.gov/34709669/
- Practical guidance on the use of biologics in pediatric dermatology. https://pubmed.ncbi.nlm.nih.gov/38229411/
- Treat-to-target strategy in dermatology: a review and International Eczema Council survey on the approach to atopic dermatitis. https://pubmed.ncbi.nlm.nih.gov/37700595/
- Differential diagnosis of atopic dermatitis. https://pubmed.ncbi.nlm.nih.gov/27886900/
The information presented in the article is for informational purposes only and is not a substitute for professional medical advice. Always consult with a qualified physician for the diagnosis and treatment of any medical conditions.