Proactive therapy for atopic dermatitis

Abstract

Proactive therapy in dermatology is defined as a long-term intermittent application of anti-inflammatory topical agents to maintain a stable and long-term remission in chronic recurrent dermatoses. Proactive therapy is prescribed after reactive treatment in atopic dermatitis, chronic dermatoses, and involves emollients, topical corticosteroids, and topical calcineurin inhibitors. Intermittent therapy allows to control the course of the disease and prolong remissions, which has a positive effect on the patients’ quality of life. The duration of therapy is determined on a case-by-case basis, taking into account the severity of dermatosis and relapse rates. Thus, proactive treatment for atopic dermatitis can last from 12–16 weeks (mild level) to 52 weeks and longer in severe cases. The anti-inflammatory effect of pimecrolimus and tacrolimus has been shown to prevent the production and release of pro-inflammatory cytokines (IL2, IL3, IL4, IL8, IFNγ, TNF, GM-CSF) and to inhibit T-lymphocyte proliferation, and topical calcineurin inhibitors prevent the release of inflammatory mediators (histamine, tryptase) from activated mast cells. In addition, the active substance of tacrolimus and pimecrolimus binds to the protein receptor macrophilin-12 (FKBP-12). The review article looks at whether the outcomes of the recent studies show the effectiveness of proactive therapy, increase in relapse rates in children with atopic dermatitis while using pimecrolimus cream, 1% and emollients after the inflammatory process has been stopped. In-house data on the analysis of the relapse rates in 22 patients (9 girls and 13 boys) aged 6 to 14 years with moderate atopic dermatitis, who were under observation from 2020 to 2022, are presented. Analysis of study results and our own observations demonstrated that such complex external treatment with topical calcineurin inhibitors and emollients can reduce the rate of exacerbations of atopic dermatitis and improve the patients’ quality of life.