Download with Tacrolimus Clinical Experience Ointment in Atopic Dermatitis III

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10 The Role of Tacrolimus Ointment in Atopic Dermatitis
Preventive phase
Treatment phase
Emollients
Mainstay therapy: topical
corticosteroids
Behavioural techniques
Adjunctive: sedative
antihistamines
Allergen exclusion
(environmental/lifestyle
measures)
Additional therapies: UV,
systemic corticosteroids,
oral cyclosporin etc.
Weaknesses
Weaknesses
Significant burden for
patients/families
Side effects (e.g. skin atrophy
nephrotoxicity of cyclosporin)
Increased emphasis on
prevention due to
weaknesses of treatment
phase
Poor disease control in
many cases
Excessive reliance on preventive
phase/additional therapies
Figure 10.1. The traditional model of atopic dermatitis management and its weaknesses involves preventive and treatment phases. Treatment-phase management is compromised by the inherent limitations of topical corticosteroids, and this in turn places increased stress on the preventive phase of
management
Preventive measures
ity, avoidance of stress, a key trigger in the development of the disease and therefore
probably one of the most important factors to limit, may help to reduce or prevent
disease relapse and flares.
The second treatment phase of the conventional model depends on prompt
medical intervention to treat inflammatory episodes, primarily with short-term
topical corticosteroids. Other agents such as sedative antihistamines and tar preparations may be used as an alternative to corticosteroids in mild atopic dermatitis
or concomitantly to reduce steroid use. A range of second-line therapies including
systemic immunomodulators and phototherapy may be used in corticosteroid treatment-resistant cases.
Although the preventive phase of this paradigm is important, achieving a high
degree of success may place a significant burden on patients with atopic dermatitis,
and indeed their families, in terms of the lifestyle modifications required. It is likely
that in many cases, preventive measures are not performed adequately. Furthermore,
there may be many instances in which the patient’s atopic state is such that even
if carried out satisfactorily, preventive measures are not sufficient to preclude the
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