Treatment of exacerbations of atopic dermatitis

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During exacerbations, itching so much in the lesions. Need for treatment with immunosuppressive drugs.

Dermocorticoid:

It is one of the key factors to prevent dermatitis, is necessary when patients are at exacerbations.

The Dermo corticosteroids have effect anti-inflammatory due to making vasoconstriction, inhibition of leukocyte function and alter the immune response. They also have anti-proliferative effect of limiting the synthesis of collagen and in the long term can lead to side effects such as skin atrophy.

+ Classification: according to the classification of France, divided into 4 groups depending on the strength of the dermocorticoid = very strong (I), strong (II), medium (III) and weak (IV), the international classification reverse order.

In practice, in adults, to use a dermocorticoid group II (according to the classification of France) for lesions in the body. Dermocorticoid group III preferred for lesions on the face and / or extensive lesions. Groups II and III dermocorticoid can also be used for children. Dermocorticoid group I used briefly on on the sensitive skin  to the effects of steroids instant and fast. These preparations contraindicated for infants and children. The main effect dermocorticoid little significance in atopic dermatitis.

+ Must be used with caution dermocorticoid in the eyelids (risk of cataracts or glaucoma).

+ Usually applied once per day until the assistance of about 10 days. It should be applied at night to keep the drug in place longer. Apply twice daily without adding any benefit (other than normally possible with some of eczema lichen) but does increase the risk of side effects. When stopping treatment, diagrams decreasing doses (one or two days a topical once) little sense, except in rare cases treatment lasts two days.

Treatment of exacerbations of atopic dermatitis
Treatment of exacerbations of atopic dermatitis

The drug absorbed through the skin increase in cases of skin lesions. With healthy skin is just as important apply area surpass 70% of the body. In adults, the dose should not exceed 50g per week for dermocorticoid group II. To avoid the risk of drug absorption into the body too much. If applied at the skin surface should not exceed 20g. To minimize the adverse effects on site, maximum dose is 500 g for 6 months.

Side effects can be seen as skin atrophy, vasodilation, stretch, hypertrichosis, hypopigmentation, multiple infections. Systemic effects (fear mainly children) can lead to forms of Cushing’s syndrome leads to growth retardation, even in cases of adrenal insufficiency stopped abruptly after taking strong dermocorticoid large type.

Tacrolimus :

Tacrolimus (Protopic) is a macrolide derivatives selected two routes for children or adults in the severe form dermocorticoid when used properly, but still cannot meet. Tacrolimus is little systemic absorption. It inhibits the synthesis and release of inflammatory cytokines, no effect of causing atrophy (this differs from the dermocorticoid cream), the drug can be applied to the lesions on the face and body (including in the eyelids) during exacerbations.

Do not be applied to mucous membranes, skin infections, or under occlusive dressing. However, after the announcement of some rare cases cell lymphoma, skin cancer and a number of malignancies in patients treated with calcineurin inhibitors apply, including Protopic had the revaluation of safety of the use of Protopic

exacerbations
Learn about atopic dermatitis1

The  Agency of the European Drug Administration has concluded to benefit / harm of Protopic is favorable, but requires a long-term assessment of the risk of malignancy in patients treated. While waiting for the results, it is necessary to follow some recommendations: use short-term or long-term medication, but intermittent, not continuous use long-term. The drug is contraindicated in children under two months of age and people with weakened immune systems. From 2 to 16 years of age, the dose should be used only by 0.03%. Aplied on to the lesion, twice / day in the form of thin layers until the end of eczema and then stopped. Within 2 weeks, if not shown to be effective, it should be stopped immediately. Do not illuminate the potential mechanical damage to the malignant or precancerous lesions to treat exacerbations.

The main side effect is burning or tingling (more than 10% of cases), especially in the first days of treatment, and met in adults than in children. When there are multiple infections must be stopped immediately. All clinical signs of infection in the area to be treated, need to be treated first before applied tacrolimus. The phenomenon of intolerance alcool often quite common (1% of cases) when the drug is manifested by flushing and / or irritation of the skin.

Between the soothing ointment and medicine Protopic to 2 hours apart. Limiting the sun during treatment. Due to the risk of failure of vaccination during treatment Protopic, vaccination should be carried out before starting treatment Protopic or 14 days after applied Protopic final (where the live vaccine reduced motility is about this way is 28 days). And prescriptions and repeat for Protopic only for the physician and pediatric skin. There should be a special watch for a course of treatment of exacerbations.

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