Treatment of atopic dermatitis

Chain Drug Review, July 23, 2007 by Peter Rubino

This month's featured continuing education program focuses on addressing safety concerns in the treatment of atopic dermatitis (AD).

According to Dr. Jon Hanifin, professor of dermatology at Oregon Health and Science University, AD is a chronic, recurring inflammatory disease, characterized by skin barrier disruption, hyperactivity in response to irritants and allergens, and immune dysfunction. The hallmark symptoms of AD are dry skin and pruritus, which can be so severe that they cause intense, prolonged scratching, leading to a breakdown in skin barrier protection, excoriation and secondary infections, and disruption of sleep and social functioning that ultimately can impact and diminish the patient's quality of life.

The prevalence of AD has increased dramatically over the past 40 years, and recent studies suggest that as many as 15% to 21% of children between the ages of 5 and 9 are affected worldwide. The estimated prevalence in the United States may be as high as 6% in the general population and 20% in infants and young children.

Eighty-five percent of patients are diagnosed by the time they are 5 years old. In fact, AD is often the first manifestation of the so-called atopic march, a progression of atopic diseases that include food allergies, asthma and allergic rhinitis. The typical presentation of childhood AD is manifested by characteristic inflamed eczematous lesions on the abdomen (exclusive of the well-hydrated diaper area) and knees of the patient.

Pharmacologic treatment of atopic dermatitis includes the use of emollients, topical corticosteroids and topical calcineurin inhibitors (TCIs). TCIs are effective agents that do not have the side effects of topical corticosteroids. Although studies have shown that TCIs are safe and efficacious, a recent decision by the Food and Drug Administration has sparked renewed interest in a close examination of the appropriate use of those agents.

This month's CE program--prepared by Hanifin, Dr. Mark Boguniewicz, Dr. Adelaide Hebert and Dr. Jonathan Spergel--presents current clinical data that focuses on safety issues surrounding the use of topical corticosteroids and TCIs in the treatment of AD. Pharmacists completing the program will be able to:

* Describe the epidemiology and pathophysiology of atopic dermatitis.

* Assess the various agents used for the treatment of AD and discuss their risks and benefits for specific age groups.

* Evaluate studies describing the safety and efficacy of TCIs for the treatment of AD.

* Describe the importance of early detection and compliance in the treatment of AD.

* Discuss how to communicate and work closely with parents of children with AD, to ensure appropriate treatment and address safety concerns and medication compliance issues.

To learn more about this offering and other online CE programs for pharmacists and allied health professionals, please log onto RxSchool.com.

ArcMesa Educators, coprovider of this program, is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.

This home-study Web activity has been assigned a maximum of 1.0 contact hours (0.10 CEUs) and assigned an ACPE UPN of 200-999-06-026-H01.

Peter Rubino is director of continuing professional education at RxSchool.com.