Efficacy and Safety Considerations in Topical Treatments for Atopic Dermatitis

Noreen Heer Nicol, MS, RN, FNP

Disclosures

Dermatology Nursing. 2010;22(3):2-11. 

In This Article

Abstract and Introduction

Abstract

Objectives
This continuing nursing educational (CNE) activity is designed for nurses and other health care providers who care for and educate patients and their families regarding topical treatment for atopic dermatitis (AD). For those wishing to obtain contact hour credit, an evaluation follows. After studying the information presented in this article, the nurse will be able to:
1. Discuss the clinical features and diagnosis of AD.
2. Identify skin barrier dysfunction in AD.
3. Explain the treatment options for AD.
4. Describe treatment strategies for AD.

Introduction

Atopic dermatitis (AD), often referred to as atopic eczema, is one of the most common chronic inflammatory skin diseases frequently seen in young children. Key characteristics of AD are severe dryness caused by transepidermal water loss, intense itching, and cutaneous inflammation. The clinical course of AD is cyclic, characterized by disease exacerbations, or flares, ranging from mild to severe. There is no cure for AD, which is often chronic and relapsing, thereby presenting salient challenges for the nurse, the nurse practitioner (NP), other health care providers, as well as patients and their families. Broadly stated, the goals of effective management are to reduce the symptoms of the disease and to prolong the time between flares.

Atopic dermatitis is a complex disease involving interaction among genes (Palmer et al., 2006; Weidinger et al., 2008), the external environment (Flohr et al., 2008; Proksch, Fölster-Holst, & Jensen, 2006), and immune dysregulation (McGirt & Beck, 2006; Ong & Leung, 2006). Breakdown of the epidermal skin barrier is recognized as a fundamental step in the pathogenesis of AD; however, it remains controversial whether barrier dysfunction is secondary to the inflammatory response to irritants and allergens ("inside-outside hypothesis") or whether the epidermal damage is responsible for disease ("outside-inside hypothesis") (Nicol & Boguniewicz, 2008). It is also possible skin barrier dysfunction may both contribute to and exacerbate the development of AD (Spergel, 2008).

Atopic dermatitis affects up to 20% of children and 3% of adults (Larsen & Hanifin, 2002). In recent decades, there has been an increase in the global prevalence of the disease, particularly among young children (Williams et al., 1999). Studies indicate AD precedes the development of other atopic diseases, including asthma, allergic rhinitis, and food allergies, a phenomenon known as "the atopic march" (Kapoor et al., 2008; Porsbjerg, von Linstow, Ulrik, Nepper-Christensen, & Backer, 2006; Spergel & Paller, 2003; van der Hulst, Klip, & Brand, 2007). Some potential risk factors associated with the rise in AD include small family size, increased income and education, migration from rural to urban environments, and increased use of antibiotics (von Mutius et al., 2000). While the exact causes of AD are not fully understood, it is clear the disease can exert a significant burden on quality of life, and it has been linked to low self-esteem, sleep deprivation, and decreased productivity, among other debilitating psychosocial effects (Fivenson et al., 2002).The outcome of AD is very difficult to predict in any individual, but fortunately, the disease often progresses to periods of remission as the patient grows older.

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