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When managing atopic dermatitis-related itch, use a step-wise approach, address barrier repair and educate patients

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Abstract

Itch (pruritus) is a key clinical feature of atopic dermatitis, has a complex pathogenesis and markedly affects health-related quality of life. Treatment differs according to itch severity, but should always include the use of barrier creams and moisturizers/emollients, as well as patient education and lifestyle advice to manage sleep and reduce stress. Depending on itch severity, treatment with topical corticosteroids, systemic immunosuppressants and other pharmacological and nonpharmacological options may be added using a stepwise treatment approach.

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References

  1. Pavlis J, Yosipovitch G. Management of itch in atopic dermatitis. Am J Clin Dermatol. 2018;19(3):319–32.

    Article  PubMed  Google Scholar 

  2. Dawn A, Papoiu AD, Chan YH, et al. Itch characteristics in atopic dermatitis: results of a web-based questionnaire. Br J Dermatol. 2009;160(3):642–4.

    Article  CAS  PubMed  Google Scholar 

  3. van Zuuren EJ, Fedorowicz Z, Arents BWM. Emollients and moisturisers for eczema: abridged Cochrane systematic review including GRADE assessments. Br J Dermatol. 2017;177(5):1256–71.

    Article  CAS  PubMed  Google Scholar 

  4. Szczepanowska J, Reich A, Szepietowski JC. Emollients improve treatment results with topical corticosteroids in childhood atopic dermatitis: a randomized comparative study. Pediatr Allergy Immunol. 2008;19(7):614–8.

    Article  PubMed  Google Scholar 

  5. Lee HG, Grossman SK, Valdes-Rodriguez R, et al. Topical ketamine-amitriptyline-lidocaine for chronic pruritus: a retrospective study assessing efficacy and tolerability. J Am Acad Dermatol. 2017;76(4):760–1.

    Article  PubMed  Google Scholar 

  6. Kaufmann R, Bieber T, Helgesen AL, et al. Onset of pruritus relief with pimecrolimus cream 1% in adult patients with atopic dermatitis: a randomized trial. Allergy. 2006;61(3):375–81.

    Article  CAS  PubMed  Google Scholar 

  7. Langley RG, Eichenfield LF, Lucky AW, et al. Sustained efficacy and safety of pimecrolimus cream 1% when used long-term (up to 26 weeks) to treat children with atopic dermatitis. Pediatr Dermatol. 2008;25(3):301–7.

    Article  PubMed  Google Scholar 

  8. Lynde CW, Andriessen A. A cohort study on a ceramide-containing cleanser and moisturizer used for atopic dermatitis. Cutis. 2014;93(4):207–13.

    PubMed  Google Scholar 

  9. Lisante TA, Nunez C, Zhang P, et al. A 1% colloidal oatmeal cream alone is effective in reducing symptoms of mild to moderate atopic dermatitis: results from two clinical studies. J Drugs Dermatol. 2017;16(7):671–6.

    CAS  PubMed  Google Scholar 

  10. Draelos ZD, Stein Gold LF, Murrell DF, et al. Post hoc analyses of the effect of crisaborole topical ointment, 2% on atopic dermatitis: associated pruritus from phase 1 and 2 clinical studies. J Drugs Dermatol. 2016;15(2):172–6.

    CAS  PubMed  Google Scholar 

  11. Zane LT, Kircik L, Call R, et al. Crisaborole topical ointment, 2% in patients ages 2 to 17 years with atopic dermatitis: a phase 1b, open-label, maximal-use systemic exposure study. Pediatr Dermatol. 2016;33(4):380–7.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wong SM, Ng TG, Baba R. Efficacy and safety of sodium hypochlorite (bleach) baths in patients with moderate to severe atopic dermatitis in Malaysia. J Dermatol. 2013;40(11):874–80.

    Article  CAS  PubMed  Google Scholar 

  13. Simpson EL, Bieber T, Guttman-Yassky E, et al. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med. 2016;375(24):2335–48.

    Article  CAS  PubMed  Google Scholar 

  14. Roekevisch E, Spuls PI, Kuester D, et al. Efficacy and safety of systemic treatments for moderate-to-severe atopic dermatitis: a systematic review. J Allergy Clin Immunol. 2014;133(2):429–38.

    Article  CAS  PubMed  Google Scholar 

  15. Berth-Jones J, Takwale A, Tan E, et al. Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial. Br J Dermatol. 2002;147(2):324–30.

    Article  CAS  PubMed  Google Scholar 

  16. Pacor ML, Di Lorenzo G, Martinelli N, et al. Comparing tacrolimus ointment and oral cyclosporine in adult patients affected by atopic dermatitis: a randomized study. Clin Exp Allergy. 2004;34(4):639–45.

    Article  CAS  PubMed  Google Scholar 

  17. Harper JI, Ahmed I, Barclay G, et al. Cyclosporin for severe childhood atopic dermatitis: short course versus continuous therapy. Br J Dermatol. 2000;142(1):52–8.

    Article  CAS  PubMed  Google Scholar 

  18. Dawn AG, Yosipovitch G. Butorphanol for treatment of intractable pruritus. J Am Acad Dermatol. 2006;54(3):527–31.

    Article  PubMed  Google Scholar 

  19. LeBovidge J, Borok J, Udkoff J, et al. Atopic dermatitis: therapeutic care delivery: therapeutic education, shared decision-making, and access to care. Semin Cutan Med Surg. 2017;36(3):131–6.

    Article  PubMed  Google Scholar 

  20. Staab D, Diepgen TL, Fartasch M, et al. Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial. BMJ. 2006;332(7547):933–8.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Reynolds NJ, Franklin V, Gray JC, et al. Narrow-band ultraviolet B and broad-band ultraviolet a phototherapy in adult atopic eczema: a randomised controlled trial. Lancet. 2001;357(9273):2012–6.

    Article  CAS  PubMed  Google Scholar 

  22. Wallengren J, Sundler F. Phototherapy reduces the number of epidermal and CGRP-positive dermal nerve fibres. Acta Derm Venereol. 2004;84(2):111–5.

    Article  CAS  PubMed  Google Scholar 

  23. Belgrade MJ, Solomon LM, Lichter EA. Effect of acupuncture on experimentally induced itch. Acta Derm Venereol. 1984;64(2):129–33.

    CAS  PubMed  Google Scholar 

  24. Pfab F, Hammes M, Backer M, et al. Preventive effect of acupuncture on histamine-induced itch: a blinded, randomized, placebo-controlled, crossover trial. J Allergy Clin Immunol. 2005;116(6):1386–8.

    Article  CAS  PubMed  Google Scholar 

  25. Pfab F, Huss-Marp J, Gatti A, et al. Influence of acupuncture on type I hypersensitivity itch and the wheal and flare response in adults with atopic eczema: a blinded, randomized, placebo-controlled, crossover trial. Allergy. 2010;65(7):903–10.

    Article  CAS  PubMed  Google Scholar 

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The article was adapted from the American Journal of Clinical Dermatology 2018;19(3):319–32 [1] by employees of Adis/Springer, who are responsible for the article content and declare no conflicts of interest.

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The preparation of this review was not supported by any external funding.

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Adis Medical Writers. When managing atopic dermatitis-related itch, use a step-wise approach, address barrier repair and educate patients. Drugs Ther Perspect 35, 58–63 (2019). https://doi.org/10.1007/s40267-018-0570-7

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  • DOI: https://doi.org/10.1007/s40267-018-0570-7

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