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Nonsteroidal Approaches for the Treatment of Patients With Atopic Dermatitis
abstract
This abstract is available on the publisher's site.
Access this abstract nowTopical corticosteroids (TCSs) are the most widely used treatment for atopic dermatitis (AD), but they can have adverse effects such as skin atrophy, telangiectasias, and hypopigmentation, especially with prolonged use of higher potency steroids. Many patients also have a fear of using TCSs, known as "corticophobia." With the development of biologics and Janus kinase inhibitors, a nonsteroidal approach to the treatment of AD may be possible and may be preferred by certain patients. Given what is known about these nonsteroidal therapies, we propose a structured treatment ladder and action plan that can guide clinicians and patients on the use of these therapies for the treatment of AD. The ladder divides nonsteroidal medication classes into treatments for exacerbation versus maintenance therapies in an escalating order of increasing potential for adverse effects, both real and perceived. This treatment algorithm proposal paves the way for a potential nonsteroidal approach to managing AD.
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Nonsteroidal Approaches for Atopic Dermatitis: A Clinical Update
Dermatitis 2024 Feb 06;[EPub Ahead of Print], PY Ch'en, PA LioFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This review article offers a timely and comprehensive overview of the expanding landscape of nonsteroidal therapies for atopic dermatitis (AD). The emergence of novel treatments, such as biologics, JAK inhibitors, and topical anti-inflammatory agents, has made a paradigm shift away from the traditional reliance on corticosteroids possible. The authors propose a structured therapeutic ladder and eczema action plan format to guide clinicians and patients in effectively utilizing these nonsteroidal options.
The article discusses the potential adverse effects of prolonged use of topical corticosteroids and explores patient preferences and the phenomenon of "corticophobia," emphasizing the importance of understanding alternative treatment modalities. The review covers data regarding a wide range of nonsteroidal topical and systemic agents, including calcineurin inhibitors, phosphodiesterase-4 inhibitors, JAK inhibitors, systemic immunosuppressants, and biologics as well as phototherapy. By providing this comprehensive update, the article equips clinicians with the knowledge necessary to optimize patient care and navigate the evolving treatment landscape.
However, the article does not address the potential for increased costs to patients and coverage issues associated with newer AD medications.1 Many of these therapies, although highly effective, increasingly require prior authorizations and face limited or lack of coverage from specific insurance plans, including Medicaid. These patients are dually disadvantaged in that they not only cannot get access to these medications but also are the population at risk of corticosteroid abuse and misuse, as they are more likely to obtain the medications from places outside the US without a prescription.
Thus, clinicians should consider these factors when developing treatment plans to ensure long-term compliance and optimal outcomes. Furthermore, although it is a minor point, the article does not explicitly mention dilute bleach baths and allergen immunotherapy as alternative therapies for AD.2,3
Overall, the article presents a concise and focused review that guides readers on implementing the suggested therapeutic ladder and offers relevant resources for further learning. As the therapeutic landscape for AD continues to expand, this article provides a valuable resource for clinicians considering nonsteroidal alternatives for their patients.
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