Topical Medication Choices for Children with Atopic Dermatitis
Children suffering from atopic dermatitis often require the use of topical medications to alleviate itchiness and improve skin conditions. These topical medications include corticosteroids and non-steroidal immunosuppressants, both of which can ameliorate skin symptoms. Therefore, let us introduce some commonly used topical medications for atopic dermatitis.
Topical Antihistamines
One of the most bothersome symptoms for atopic dermatitis patients is the unbearable itchiness. Topical antihistamine medications can provide relief by inhibiting the release of histamine, the compound that triggers itching sensations. This helps reduce scratching and prevent further exacerbation of symptoms.
These antihistamine ointments have relatively mild side effects. Although some may contain menthol which can cause temporary stinging sensations, especially on open wounds, their overall safety profile is higher compared to other medication types. Many parents worry about the potential side effects of long-term corticosteroid use, making antihistamine topicals a viable alternative that patients can carry for on-the-spot itch relief.
At National Taiwan University Hospital, the most commonly prescribed topical antihistamine is C.B. Strong (Strong Shumi). In addition to alleviating itch caused by atopic dermatitis, it is also effective for urticaria, insect bites, and other pruritic conditions.
Topical Corticosteroids – Most Commonly Used and Effective
Corticosteroids remain the most frequently used and effective topical medication for treating atopic dermatitis currently. However, due to parental concerns regarding safety, it is crucial to reiterate that the dosage of topical corticosteroids differs vastly from systemic (oral or injected) administration, thereby significantly reducing risks.
The main mechanism of topical corticosteroids is to suppress skin inflammation, alleviating symptoms such as edema, erythema, and pruritus. Given the low dosage, the risk of systemic side effects like moon facies, buffalo hump, and growth retardation is minimal.
Nonetheless, long-term excessive use of topical corticosteroids may still cause local adverse reactions, including ocular complications (glaucoma, cataracts), skin atrophy, and telangiectasia. Therefore, despite their higher safety profile compared to systemic corticosteroids, topical use should still follow medical guidance regarding appropriate potency and timing to avoid overuse and subsequent side effects.
Currently, clinical topical corticosteroids are classified into seven potency levels. At NTU Hospital, high-potency topicals used include Dermovate, Esperson, and Topsym; mid-potency options are Rinderon-V and Cutivate; while low-potency is represented by Cort. S. Generally, higher potency correlates with better anti-inflammatory effects but also increased risk of side effects. Physicians will evaluate each patient’s condition to determine the appropriate medication strength.
Topical Immunomodulators – New Non-Steroidal Alternatives
In recent years, some pharmaceutical companies have developed new non-steroidal topical immunomodulators for treating atopic dermatitis, offering patients additional options. Unlike traditional corticosteroids, these new drugs inhibit the activated T cells that play a key role in the pathogenesis of atopic dermatitis.
Currently available topical immunomodulators include tacrolimus (Protopic ointment) and pimecrolimus (Elidel cream). Originally used to prevent organ transplant rejection, research has shown their effectiveness in alleviating skin immune disorders, leading to their topical formulations for atopic dermatitis.
In terms of potency, 0.1% tacrolimus ointment is recommended for moderate to severe atopic dermatitis, while 0.03% tacrolimus ointment can be used for mild cases. Pimecrolimus has slightly lower efficacy than tacrolimus and is suggested for mild to moderate patients. Initial use of tacrolimus may cause temporary redness, which will subside after continued application for several days. Due to its oily texture, some patients may find it uncomfortable to use during summer.
On the other hand, pimecrolimus has a less greasy feel and fewer side effects, making it suitable for alternating use with topical corticosteroids for a complementary effect. Patients need not worry about these topical immunosuppressants affecting systemic immunity, as large-scale studies have shown no increased cancer risk in atopic dermatitis patients using these medications topically.
Topical Antibiotics – For Local Wound Use and Faster Healing
One symptom of atopic dermatitis is the development of open, oozing skin lesions, which are prone to bacterial infection from persistent scratching. Therefore, using topical antibiotic ointments is crucial for preventing further infections and promoting wound healing.
In principle, open lesions in atopic dermatitis should avoid topical corticosteroid application. Corticosteroids can suppress local immunity, potentially worsening bacterial infections. The general practice is first to clean the wound with an antiseptic solution like povidone-iodine, then apply antibiotic ointments or powders to prevent secondary infections. Bandaging may also be necessary to protect the wound from contamination.
Common topical antibiotics used at NTU Hospital include Fucidin. These medications primarily aim to prevent further infection of atopic dermatitis scratches rather than completely eliminating bacterial infection. For more severe infections with extensive oozing or pustules, physicians may prescribe stronger systemic antibiotics.
Additionally, some doctors may recommend adding antimicrobial solutions like chlorhexidine or povidone-iodine to bathwater for atopic dermatitis patients. This practice aims to reduce the bacterial load on the skin and lower infection risks but may also lead to excessive dryness if overused. Patients should follow product instructions carefully.
Keratolytic Ointments – For Lichenification and Hyperkeratosis
If atopic dermatitis is poorly controlled over an extended period, the skin may develop a thickened, lichenified horny layer. As this layer of keratin impedes medication absorption and exacerbates itching, leading to a vicious cycle of scratching, using specialized keratolytic ointments is necessary to improve this condition.
These ointments typically contain urea or salicylic acid, which help dissolve and break down accumulated keratin proteins. Common examples include Sinpharderm (10% urea) and Salic Ointment (2.5% salicylic acid).
Keratolytic ointments are relatively gentle and suitable for long-term use. Not only can they improve post-atopic dermatitis lichenification and skin thickening, but they also enhance the penetration of other skincare products. Physicians often recommend using these ointments before applying potent medications like topical corticosteroids or immunomodulators to facilitate better absorption.
Additional Notes
Some additional reminders regarding topical medication use for atopic dermatitis:
Stop using ointments containing emollients (e.g., urea, glycerin) if open wounds develop to avoid exacerbating irritation. During treatment periods, only use basic, additive-free moisturizers to avoid further skin irritation. Do not mix different topical medication types; use each separately for safety. For growing children, choose topicals with lower risk of side effects to avoid developmental impacts. Seek professional medical guidance; do not adjust or increase dosages without consultation. Regular follow-up appointments are crucial for monitoring treatment efficacy and timely medication adjustments. In conclusion, for this stubborn condition, parents should communicate thoroughly with physicians and fully understand the indications and precautions of various topical medications. Proper utilization based on the patient’s condition is essential for achieving optimal therapeutic outcomes.
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