Use of an Emollient As a Steroid‐Sparing Agent in the Treatment of Mild to Moderate Atopic Dermatitis in Children

Lucky, Anne W.; Leach, D B S Alan; Laskarzewski, Peter M.; Wenck, Horst

doi:10.1111/j.1525-1470.1997.tb00968.x

Cited by 148 publications

(90 citation statements)

References 15 publications

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“…The regular use of emollients has been advocated to prevent flares of AD. 21 Although legitimized by long use, this practice has never been evaluated rigorously in large clinical studies. In the control group in this study, emollients (and vehicle) alone were inadequate in preventing AD flaring in approximately two thirds of patients over 1 year.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Pimecrolimus Cream in the Long-Term Management of Atopic Dermatitis in Children

Wahn

Bos

Goodfield³

et al. 2002

Pediatrics

331

348

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ABSTRACT. Objective. Pimecrolimus cream (SDZ ASM 981), a nonsteroid inhibitor of inflammatory cytokines, is effective in atopic dermatitis (AD).We assessed whether early treatment of AD signs/symptoms with pimecrolimus could influence long-term outcome by preventing disease flares.Methods. Early intervention with pimecrolimus was compared with a conventional AD treatment strategy (ie, emollients and topical corticosteroids). In this 1-year, controlled, double-blind study, 713 AD patients (2-17 years) were randomized 2:1 to a pimecrolimus-based or conventional regimen. Both groups used emollients for dry skin. Early AD signs/symptoms were treated with pimecrolimus cream or, in the conventional treatment group, vehicle to prevent progression to flares. If flares occurred, moderately potent topical corticosteroids were mandated. The primary efficacy endpoint was ranked flares at 6 months. Safety was monitored clinically, and a skin recall-antigen test was performed at study completion.Results. Baseline Characteristics of the Patients. The mean age for both groups was approximately 8 years, and the majority of patients had moderate disease at baseline.Patient Follow-up and Exposure to Study Medication. The mean duration of follow-up (؎standard error) was 303.7 (؎5.30) days in the pimecrolimus group and 235.2 (؎9.40) days in the control group. The discontinuation rate was significantly higher in the control group than in the pimecrolimus group (51.5% vs 31.6% at 12 months), and proportionately more patients with severe or very severe disease discontinued in the control group. The main reason for the higher discontinuation rate in the control group was unsatisfactory therapeutic effect (30.4% vs 12.4%). This resulted in a substantially higher mean number of study medication treatment days in the pimecrolimus group compared with the control group: 211.9 (69.8% of study days) versus 156.0 (66.3% of study days). Of those patients who completed 12 months on study, 14.2% and 7.0% of patients in the pimecrolimus and vehicle groups, respectively, used study medication continuously.Efficacy. Patients in the pimecrolimus group experienced significantly fewer AD flares than those in the control group, according to the primary efficacy analysis on ranked flares of AD (Van Elteren test). The proportion of patients who completed 6 or 12 months with no flares was approximately twice as high in the pimecrolimus group compared with control (61.0% vs 34.2% at 6 months; 50.8% vs 28.3% at 12 months). Fewer flares were observed in the pimecrolimus group regardless of baseline disease severity, so even severe patients derived benefit from the treatment. The analysis of time to first flare showed that treatment with pimecrolimus was associated with a significantly longer flare-free period (logrank test). Covariate analysis indicated a statistically significant effect on time to first flare of baseline Eczema Area and Severity Index score, and whether patients had "severe" or "very severe" disease at baseline according to the Investigators'...

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Pimecrolimus Cream in the Long-Term Management of Atopic Dermatitis in Children

Wahn

Bos

Goodfield³

et al. 2002

Pediatrics

331

348

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“…Only 2 studies evaluated the significance of emollients in the corticosteroid spare [19, 20], but they did not quantify the corticosteroid consumption by a standardized method. The study of Lucky et al [19] was a bilateral trial, performed in a small sample of children of various ages.…”

Section: Discussionmentioning

confidence: 99%

“…They are also advised as adjuvant to topical anti-inflammatory treatments such as corticosteroids and calcineurin inhibitors, as they are thought to have steroid-sparing properties [15, 16]. However, the use of emollients as steroid-sparing agents has never been clearly demonstrated, since their effect on topical corticosteroid consumption has been only indirectly evaluated [19, 20]. …”

Section: Introductionmentioning

confidence: 99%

The Steroid-Sparing Effect of an Emollient Therapy in Infants with Atopic Dermatitis: A Randomized Controlled Study

2006

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Background: No study has clearly demonstrated the steroid-sparing effect of emollients in the treatment of atopic dermatitis (AD). Aim: Evaluating the effect of an emollient containing oat extracts on the amount of topical corticosteroids used in infants with moderate to severe AD. Study Design: During 6 weeks, 173 infants under 12 months old treated for inflammatory lesions by moderate- and/or high-potency topical corticosteroids randomly received the emollient or not (control group). Methods: Evaluation of corticosteroid consumption by weighing the tubes, disease severity by the Scoring Atopic Dermatitis Index (SCORAD), and infants’ and parents’ quality of life by Infant’s Dermatitis Quality of Life Index and Dermatitis Family Impact scores at D0, D21 and D42. Results: Compared to the control group, the amount of moderate- and high-potency corticosteroids used in 6 weeks decreased by 7.5% (not significant) and 42% (p < 0.05), respectively, in the emollient group. The SCORAD index, and infants’ and parents’ quality of life significantly improved (p < 0.0001) in both groups. Conclusion: The emollient treatment significantly reduced the high-potency topical corticosteroid consumption in infants with AD.

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“…Nemlendiricilerin düzenli olarak günlük kullanımı her hastaya önerilmelidir. Nemlendiriciler AD'nin tüm formlarında tedaviye yardımcı iken hafif formlarda tek başına tedavi edici ajanlardır 77,78 . Nemlendiriciler derinin hidrasyonunu artırmanın yanı sıra AD'nin kaşıntı, eritem, fissürasyon ve likenifikasyon gibi semptom ve bulgularını da azaltmaktadır [79][80][81] .…”

Section: ) Bariyer Fonksiyonunun Güçlendirilmesiunclassified

The Turkish guideline for the diagnosis and management of atopic dermatitis-2018

Ertam¹,

Küçük²,

Alper³

et al. 2018

TURKDERM

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Use of an Emollient As a Steroid‐Sparing Agent in the Treatment of Mild to Moderate Atopic Dermatitis in Children

Cited by 148 publications

References 15 publications

Efficacy and Safety of Pimecrolimus Cream in the Long-Term Management of Atopic Dermatitis in Children

Efficacy and Safety of Pimecrolimus Cream in the Long-Term Management of Atopic Dermatitis in Children

The Steroid-Sparing Effect of an Emollient Therapy in Infants with Atopic Dermatitis: A Randomized Controlled Study

The Turkish guideline for the diagnosis and management of atopic dermatitis-2018

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