Living with Eczema
How severe is your Atopic Dermatitis?
What is mild Atopic Dermatitis (AD)?
Patients with mild AD may experience areas of dry skin with infrequent itching and/or redness, and have a small to moderate impact on everyday activities, sleep and psychosocial well-being. [1][2]
Who does it affect?
Atopic dermatitis is most common in infants. It may start as early as age 2 to 6 months. Many people outgrow it by early adulthood.[3] The risk increases with certain factors such as a family history of atopy, filaggrin mutations, urban environment or allergic multimorbidity.[4]
Treatment options
Mild AD can typically be managed with topical ointments/creams prescribed by doctors, moisturising the skin, and taking regular care of one's skin health.[3] If you experience multiple AD symptoms more frequently, your AD may have become moderate or severe based on the Dermatology Life Quality Index.[1]
Topical corticosteroids
Topical corticosteroids serve as a first-line treatment for AD flare-ups.[5][6] They are classified by potency from mild to very potent, and the choice of potency used is based on patient age, treated area and severity of AD. Low- to moderate-potency topical corticosteroids are usually sufficient for treating mild AD.[7]
Steroid-associated risk appears to be low if monitored by a physician according to treatment guidelines.[8]
While steroid-associated risk is low, 21 - 84% of patients may experience a fear of topical steroids known as steroid phobia.[9] A poor understanding of topical treatment plans may lead to a lack of adherence to these plans and failure to manage AD symptoms.[10]
Side effects may include[11]:
- Atrophy
- Acne
- Perioral dermatitis
- Striae, rosacea and purpura
Topical calcineurin
inhibitors (TCI) (Non-steroidal)
TCIs are immunosuppressants that prevent the release of proinflammatory cytokines. TCIs have been approved for short-term or chronic intermittent treatment of AD in patients aged 2 and above where other treatments are ineffective.[12]
In 2006, the US FDA implemented a Boxed Warning for TCIs based on a possible risk of lymphoma (a type of blood cancer). To date, no causal evidence has been demonstrated between TCI use and increased risk of lymphoma, but the US FDA has concluded a link cannot be ruled out. [12]
Side effects may include[12][13]:
- Stinging and skin burning
- Pruritus
Topical PDE4 inhibitors (Non-steroidal)
PDE4 inhibitors are anti- inflammatory agents that target an immune system enzyme called phosphodiesterase 4 (PDE4), which promotes inflammatory cytokine production and responses.[14]
PDE4 inhibitors reduce the release of inflammatory cytokines by increasing intracellular levels of cyclic adenosine monophosphate.[14]
PDE4 inhibitors have been approved by the US FDA and in Singapore for patients aged 3 months and above.[15][16]
Side effects may include[14]:
- Application site reactions (pain, burning, pruritus, stinging, and erythema)
- Infection (including Kaposi varicelliform eruption, yeast infection, and nasopharyngitis)
- Exacerbation of AD
All images are for representation purpose only
References:
1. Finlay, A. Y. and Khan, G. K. 1994. Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use. Clinical and Experimental Dermatology 19 (3), pp.210-216.(10.1111/j.1365-2230.1994.tb01167.x)
2. Medthority. Atopic Dermatitis Overview [Internet]. Tunbridge Wells, UK; 2021 [updated 2021 July 27, cited 2022 September 19]. Available from: https://www.medthority.com/atopic-dermatitis/atopic-dermatitis-overview/
3. Icahn School of Medicine at Mount Sinai. Atopic Dermatitis. [Internet]. New York City, New York, USA, Mount Sinai; 2022 [updated 2022 November 18, retrieved 2023 May 9]. Available from: https://www.mountsinai.org/health-library/diseases-conditions/atopic-dermatitis
4. A.D. Irvine, P. Mina-Osorio. Disease trajectories in childhood atopic dermatitis: an update and practitioner's guide. Hoboken, New Jersey, USA, Wiley Online Library; 2019 [updated 2019 February 13, accessed 2023 May 9]. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.17766
5. Wollenberg A, Barbarot S, Beiber T, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol. 2018;32(5):657-682.
6. Eichenfield L, Wynnis TL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2: management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116–132.
7. Joanne R Chalmers, Emma Axon et al. Different strategies for using topical corticosteroids in people with eczema [Internet]. [Place Unknown], National Library of Medicine; 2019 [updated 2022 Mar 11, retrieved 2023 Feb 21]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6582261/
8. Boguniewicz M, Fonacier L, Guttman-Yassky E, Ong PY, Silverberg J, Farrar JR. Atopic dermatitis yardstick: practical recommendations for an evolving therapeutic landscape. Ann Allergy Asthma Immunol. 2018;120(1):10-22
9. Li AW, Yin ES, Antaya RJ. Topical corticosteroid phobia in atopic dermatitis: a systematic review. JAMA Dermatol. 2017;153(10):1036-1042.
10. Beattie PR, Lewis-Jones MS. Parental knowledge of topical therapies in the treatment of childhood atopic dermatitis. Clin Exp Dermatol. 2003;28(5):549-553.
11. Arijit Coondoo, Meghana Phiske, Shyam Verma, Koushik Lahiri. Side-effects of topical steroids: A long overdue revisit. [Place Unknown], National Library of Medicine; 2014 [retrieved 9 May 2023]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4228634/
12. Warner W. Carr. Topical Calcineurin Inhibitors for Atopic Dermatitis: Review and Treatment Recommendations. Pediatr Drugs (2013) 15:303–310
13. Lawrence F. Eichenfield, MDa [Co-chair], Wynnis L. Tom, MD, et al. GUIDELINES OF CARE FOR THE MANAGEMENT OF ATOPIC DERMATITIS: Part 2: Management and Treatment of Atopic Dermatitis with Topical Therapies. J Am Acad Dermatol. 2014 July ; 71(1): 116–132. doi:10.1016/j.jaad.2014.03.023
14. Huan Yang, MD; Ji Wang, MD; Xin Zhang, MD, PhD; et al. Application of Topical Phosphodiesterase 4 Inhibitors in Mild to Moderate Atopic Dermatitis: A Systematic Review and Meta-analysis. San Francisco, California, USA; 2019 [updated 2019 March 27, retrieved 2023 May 9]. Available from: https://jamanetwork.com/journals/jamadermatology/fullarticle/2729076
15. Elana Kleinman, Jennifer Laborada et al. What’s New in Topicals for Atopic Dermatitis? American Journal of Clinical Dermatology (2022) 23:595–603
16. Crisaborole Local Product Document. Accessed on 24th May 2023. Available from: https://eservice.hsa.gov.sg/prism/common/enquirepublic/SearchDRBProduct.do? action=load&_ga=2.183810082.563179921.1554083187 551332391.1551944793
