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    Impact of childhood atopic dermatitis

    Caregivers need therapeutic guidance to achieve optimum results

    Lawrence Schachner, M.D.Dr. SchachnerNo family whose child is being treated for atopic dermatitis (AD) should leave the office without an instructional handout, according to Lawrence Schachner, M.D., a professor of dermatology and former chair at the University of Miami School of Medicine.

    “Many times, we are giving patients a topical steroid, a topical calcineurin inhibitor, an emollient, an antihistamine and an antibiotic. No one is able to keep that all straight without printed instructions,” Dr. Schachner tells Dermatology Times.

    Dr. Schachner, who spoke at a symposium on pediatric atopic dermatitis at the annual meeting of Masters of Pediatric Dermatology in Miami Beach, Fla., said afterward that this is a disease that impacts the whole household.

    “While the afflicted child is often itchy and unhappy, the family itself loses one to two hours of sleep on a nightly basis,” he says. “The family also misses many days of work and school time and will spend a small fortune on the topical care and the office visits.”

    In fact, some studies report that a family’s quality of life “is equivalently altered to the quality of life for a child with juvenile diabetes,” Dr. Schachner notes.

    Instructions for care

    Dr. Schachner’s office handout details daily care for the use of emollients, topical steroids and topical calcineurin inhibitors, including how to use them in the most severe areas, the milder areas, or when not to use them on a regular basis.

    “Once the patient is stable and doing well, these agents can be used twice a week for maintenance,” Dr. Schachner says.

    Several studies have shown that topical calcineurin inhibitors used for cleared atopic dermatitis, two or three times a week in areas of predilection of outbreaks, “will greatly attenuate the number of outbreaks,” Dr. Schachner says. “Some studies indicate that such intermittent treatment prevents outbreaks for many months at a time as opposed to placebo. Thus, not only do you have an active therapeutic effect with topical calcineurin inhibitors, but also a prophylactic effect.”

    A similar prophylactic effect can be found by using emollients in newborns, in families that already have atopic children.

    “This seems to decrease the number of patients who go on to become atopics as opposed to those who do not receive emollients,” Dr. Schachner says.

    Besides discussing the various medications dispensed, Dr. Schachner’s office handout includes basic rules on short nails, short baths, hypoallergenic detergents (no bleach or fabric softeners) and keeping the patient’s environment cool.

    Next: Destabilizers

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