By: Lewis First, MD, MS; Editor-in-Chief
While our first line of treatment for moderate to severe atopic dermatitis in a child usually involves the use of a topical corticosteroid, steroids, especially the more potent ones, may also have some side effects. As a result, some parents of infants may be concerned about using topical steroids, reducing compliance with this mode of therapy. Fortunately, other therapies have entered the treatment market, offering non-steroidal immunomodulatory effects to reduce the degree of inflammation—but how safe and effective are these drugs?
Sigurgeirsson et al. (doi: 10.1542/peds.2014-1990) opted to answer this question by studying one immunomodulatory drug—pimecrolimus—in a 5-year randomized controlled open-label trial comparing this drug to mild to moderate topical corticosteroids, using one or the other until the flare resolved and reusing the same medication when a flare recurred. While short-term topical steroids were also added to pimecrolimus for more severe disease flares in that group, the results are nonetheless very impressive. The infants who received pimecrolimus had substantially less need for topical steroids during flares than the other group who used them exclusively for flares and the number and quality of adverse events in both groups were minimal and nonsubstantial. Most importantly, there was no change in humoral or cellular immunity in either group.
If you are faced with the need for long-term management of an infant or young child with atopic dermatitis, this study may make the use of pimecrolimus a more rash-ional choice than you may have considered and perhaps move it into first-line treatment for mild to moderate atopic dermatitis in our patients. So are you using pimecrolimus as your first line? Share your responses with us either via this blog, an e-letter or our Facebook or Twitter sites.
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