Topical Therapies in Treating Atopic Dermatitis - Prescription, Dosage, and Adverse Effects

Introduction:

Skin becomes extremely itchy in atopic dermatitis. Living with atopic dermatitis can be difficult, depending on the severity and location of the symptoms. The typical clinical signs of teenage atopic dermatitis can be highly distressing and include xerosis (dry skin), pruritus (itching), and plaques (raised red patches with scales) on the surfaces of the wrists, ankles, and neck. Many daily activities teenagers engage in, such as physical activity or sports and other pursuits that result in heat and sweating, can worsen the symptoms. Treatment can help with symptom control. The prevalence of moderate-to-severe atopic dermatitis (AD) in adolescents is significant, and the lack of systemic medications safe for use at this age makes therapy difficult.

How Does Atopic Dermatitis Impact the Body?

Atopic dermatitis frequently appears where the skin bends or flexes, such as behind the knees or inside the elbow (elbow pit). However, it can happen everywhere, including:

• Hands and fingers.

• Feet and toes.

• Arms.

• Legs.

• Eyelids.

• Lips.

How Prevalent Is Atopic Dermatitis?

The condition is quite usual. One in ten infants and young children experience atopic dermatitis symptoms at some point. Nearly two-thirds of affected persons continue to experience flare-ups as they get older.

How Does Atopic Dermatitis Manifest Itself?

From mild to severe, symptoms might differ substantially from person to person. Typical signs of atopic dermatitis include:

• Dry skin.

• Itching can be quite intense.

• Inflammation and swelling.

• Rashes that are red, brown, purple, or gray.

• Tiny, fluid-filled lumps or crusting.

• Rough skin.

How Is It Diagnosed?

The doctor will evaluate the skin and review medical and family histories. To be certain of the diagnosis, they could occasionally do a skin or blood test.

What Are the Topical Therapies Available for Atopic Dermatitis in Adolescents?

The various prescription topical treatment modalities are as follows.

1. Topical Corticosteroids (TCS): Topical corticosteroids have been the cornerstone of atopic dermatitis treatment for over 50 years. They are the first-choice prescription topical medication for acute flares and can contribute to maintenance therapy by reducing the risk of relapse. Topical corticosteroids have anti-inflammatory, immunosuppressive (suppress the immune response), anti-proliferative, and vasoconstrictive (narrowing of blood vessels) effects. Due to these characteristics, TCS can lessen acute and recurring symptoms of atopic dermatitis while reducing itching symptoms. The relative potency of topical corticosteroids determines how they are categorized. TCS is currently divided into seven classes under the American system, with class I being the most potent and class VII being the least potent.

   1. Adverse Effects of Corticosteroids: Skin thinning, bruising, stretch marks, acne, and telangiectasia (spider veins) are a few local side effects. Glaucoma (increased pressure in the eyeball) and cataracts (a dense, cloudy area that forms in the eye's lens) are negative ocular impacts. Systemic effects have also been observed, such as decreased bone density and growth retardation in children. One prevalent worry among clinicians is tachyphylaxis, where using the same topical corticosteroids repeatedly results in a loss of effectiveness.

   2. Dosage of Topical Corticosteroids: No established dosage guidelines exist for topical corticosteroids. To achieve remission, some healthcare professionals choose to pulse mid- to high-potency corticosteroids for a brief time before switching to a lower-potency medication. However, some healthcare professionals will start therapy with lower-potency corticosteroids and use them consistently for longer. Topical corticosteroids are applied once or twice daily. There was no statistically significant difference in the efficacy of once-daily versus twice-daily administrations. Similarly, there is no standard for the exact amount of medication to apply.

1. Topical Calcineurin Inhibitors (TCI): TCI effectively reduces inflammation during acute flares and can stop disease relapse by reducing the production of proinflammatory cytokines and preventing T-cell activation. Tacrolimus and Pimecrolimus are currently available TCIs and have received FDA approval as second-line therapies for treating AD. While Pimecrolimus has been approved for mild-to-moderate illness, Tacrolimus is advised for treatment in moderate to severe AD.

   1. Adverse Effects of TCI: The most common side effect is pruritus or burning at the application site.

   2. Dosage of TCI: For TCI, there is no established treatment protocol. However, numerous studies recommend tapering the frequency of application to three times weekly to help maintain disease control after using this twice daily until the acute flare is under control.

2. Topical Antimicrobials: A weak physical barrier, poor immunological recognition, and other factors make atopic dermatitis patients more susceptible to superficial skin infections. Atopic dermatitis patients are more prone to bacterial colonization and viral and fungal infection. Thus, topical antimicrobials are used as an adjunct therapy in atopic dermatitis.

3. Phototherapy: Light therapy frequently helps people with significant flare-ups despite receiving conventional therapies. Application of moderate UV light to the skin. Long-term use of this therapy is not advised. It may eventually raise the risk of skin cancer and early aging.

What Are the Over-The-Counter Topical Treatments?

Over-the-counter topical treatments for atopic dermatitis are as follows.

1. Moisturizers and Emollients: All dermatitis require emollients and moisturizers as part of treatment. Even though the skin appears and feels comfortable, it must be continued for a prolonged period in atopic dermatitis. They should be used generously and frequently (two to three times per day is advised). Moisturizer use has been linked to decreased frequency of flare-ups and decreased use of topical corticosteroids. Dry skin (xerosis), a typical characteristic of dermatitis, is extremely sensitive to treatment with moisturizers. Adults with severe atopic dermatitis can require up to 500 g of emollient cream each week.

What Are the Adverse Effects of Moisturizers?

• Paraffin-based moisturizers getting absorbed into garments may provide a fire risk.

• Emollients should be used cautiously in the bath, shower, and when holding infants because moisturizers make the skin slippery.

• A surfactant called sodium lauryl sulfate (SLS) is used in moisturizers to blend the oil and water. When left on for an extended amount of time, it irritates dermatitis.

• SLS should not be included in skin care products; there should be only a few chemicals and, ideally, no other irritants or allergens like scents.

What Are the Emerging Topical Treatments for Atopic Dermatitis?

1. Janus Kinase Inhibitors: In September 2021, the United States Food and Drug Administration (FDA) approved Ruxolitinib for many patients aged 12 and older with mild-to-moderate atopic dermatitis.

2. Phosphodiesterase 4 Inhibitors (PDE 4 Inhibitor): The FDA has approved Crisaborole as the first PDE4 inhibitor for topical use in atopic dermatitis. Its effectiveness in treating patients with mild-to-moderate AD has been shown in clinical trials, leading to a considerable reduction in itching.

What Are the Other Treatment Methods for Atopic Dermatitis?

The other treatment options are as follows.

1. Oral Steroids: Prednisone or other oral corticosteroids may be prescribed by the doctor if the inflammation is severe to help control it. Due to possible adverse effects such as excessive blood sugar, decreased growth in children, and slower wound healing, these medications are only used temporarily.

2. Dupilumab: People who have tried and failed to get relief from various forms of treatment for severe atopic dermatitis now have the option of using the new FDA-approved injectable drug.

Can Atopic Dermatitis Be Prevented?

Atopic dermatitis cannot be completely avoided; taking precautions to lessen the likelihood of flare-ups is possible. Avoiding any potential triggers (peanuts, tree nuts, eggs, soy, cow's milk, wheat, shellfish, and seafood) and maintaining good -hydration is the key to achieving this.

What May People Anticipate From Atopic Dermatitis?

Atopic dermatitis cannot be cured completely. The flare-ups, however, will probably be less severe once patients learn how to manage the symptoms effectively. Depending on how frequently flares ups occur, individuals with atopic dermatitis should visit their doctor to ensure they receive the best therapeutic care possible.

Conclusion:

Although atopic dermatitis is not deadly but can be uncomfortable or irritating and seriously impair comfort and quality of life; fortunately, several medications are available to assist in managing the symptoms. Most people notice a significant change once they find and establish a skincare routine that works for them.