Atopic dermatitis in children. A current algorithm for the disease treatment and control

Cover Page

Cite item


The article discusses key aspects of the pathogenesis of atopic dermatitis and issues of the selection of pathogenetically substantiated therapy methods. The authors provide data on the efficient use of basic drugs used to treat dermatosis in children - topical glucocorticosteroids and calcineurin inhibitors. The authors also describe a current algorithm for using topical calcineurin inhibitors during the period of an exacerbation of atopic dermatitis and to prevent relapses.

About the authors

D. V. Proshutinskaya

State Research Center of Dermatovenereology and Cosmetology, Ministry of Healthcare of the Russian Federation

Author for correspondence.
Russian Federation


  1. Zuberbier T., Orlow S.J., Paller A.S. et al. Patient perspectives on the management of atopic dermatitis. J Allergy Clin Immunol 2006; 118: 226-32.
  2. Lewis-Jones S. Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema. Int J Clin Pract 2006; 60: 984-92.
  3. Bieber T. Atopic dermatitis. N Engl J Med 2008; 358: 1483-94.
  4. McKenna S.P., Doward L.C. Quality of life of children with atopic dermatitis and their families. Curr Opin Allergy Clin Immunol 2008; 8 (3): 228-231.
  5. Wadonda-Kabondo N., Sterne J.A., Golding J. et al. ALSPAC Study Team. A prospective study of the prevalence and incidence of atopic dermatitis in children aged 0-42 months. Br J Dermatol 2003; 149 (5): 1023-1028.
  6. Williams H.C. Inflammatory skin diseases I: atopic dermatitis, In: Williams H.C., Strachan D.P., eds. The Challenge of Dermato-epidemiology. Boca Raton, F.L: CRC Press Inc 1997; 131. Литература
  7. Spergel J.M. From atopic dermatitis to asthma: the atopic march. Ann Allergy Asthma Immunol 2010; 105: 99-106.
  8. Linnet J., Jemec G.D. An assessment of anxiety and dermatology life quality in patients with atopic dermatitis. Br J Dermatol 1999; 140: 268-72.
  9. Fivenson D., Goldberg Arnold R.J., Kanieski D.J. et al. The effect of atopic dermatitis on total burden of illness and quality of life on adults and children in a large managed care organization. J Managed Care Pham 2002; 8: 333-42.
  10. Ellis C.N., Mancini A.J., Paller A.S., Simpson E.L., Eichenfield L.F. Understanding and managing atopic dermatitis in adult patients. Semin Cutan Med Surg 2012; 31 (3 Suppl): 18-22.
  11. Guidelines of care for the management of atopic dermatitis. Section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol 2014; 70: 338-51.
  12. Hamid Q., Boguniewicz M., Leung D.Y. Differential in situ cytokine gene expression in acute versus chronic atopic dermatitis. J Clin Invest 1994 Aug; 94 (2): 870-6.
  13. Leung D.Y., Boguniewicz M., Howell M.D. et al. New insights into atopic dermatitis. J Clin Invest 2004 Mar; 113 (5): 651-7.
  14. Sugiura H., Ebise H., Tazawa T. et al. Large-scale DNA microarray analysis of atopic skin lesions shows overexpression of an epidermal differentiation gene cluster in the alternative pathway and lack of protective gene expression in the cornified envelope. Br J Dermatol 2005 Jan; 152 (1): 146-9.
  15. Cork M.J., Robinson D.A., Vasilopoulos Y. et al. New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environment interactions. J Allergy Clin Immunol 2006 Jul; 118 (1): 3-21.
  16. Homey B., Steinhoff M., Ruzicka T., Leung D.Y. Cytokines and chemokines orchestrate atopic skin inflammation. J Allergy Clin Immunol 2006 Jul; 118 (1): 178-89.
  17. Kabashima K. New concept of the pathogenesis of atopic dermatitis: interplay among the barrier, allergy, and pruritus as a trinity. J Dermatol Sci 2013 Apr; 70 (1): 3-11.
  18. Spergel J.M., Mizoguchi E., Oettgen H., Bhan A.K., Geha R.S. Roles of TH1 and TH2 cytokines in a murine model of allergic dermatitis. J Clin Invest 1999 Apr; 103 (8): 1103-11.
  19. Chan L.S., Robinson N., Xu L. Expression of interleukin-4 in the epidermis of transgenic mice results in a pruritic inflammatory skin disease: an experimental animal model to study atopic dermatitis. J Invest Dermatol 2001 Oct; 117 (4): 977-83.
  20. Nakazato J., Kishida M., Kuroiwa R., Fujiwara J., Shimoda M., Shinomiya N. Serum levels of Th2 chemokines, CCL17, CCL22, and CCL27, were the important markers of severity in infantile atopic dermatitis. Pediatr Allergy Immunol 2008; 19: 605-13.
  21. Guttman-Yassky E., Nograles K.E., Krueger J.G. Contrasting pathogenesis of atopic dermatitis and psoriasis--part II: immune cell subsets and therapeutic concepts. J Allergy Clin Immunol 2011 Jun; 127 (6): 1420-32.
  22. Ezzat M.H., Hasan Z.E., Shaheen K.Y. Serum measurement of interleukin-31 (IL-31) in paediatric atopic dermatitis: elevated levels correlate with severity scoring. J Eur Acad Dermatol Venereol 2011; 25: 334-9.
  23. Stott B., Lavender P., Lehmann S., Pennino D., Durham S., Schmidt-Weber C.B. Human IL-31 is induced by IL-4 and promotes TH2-driven inflammation. J Allergy Clin Immunol 2013 Aug; 132 (2): 446-54.
  24. Kunz B., Oranje A.P., Labreze L., Stalder J.F., Ring J., Taieb A. Clinical validation and guidelines for the SCORAD index: consensus report of the European Task Force on Atopic Dermatitis. Dermatology 1997; 195: 10-19.
  25. Schmitt J., Langan S., Williams H.C. What are the best outcome measurements for atopic eczema? A systematic review. J Allergy Clin Immunol 2007; 120: 1389-98.
  26. Schram M.E., Spuls P.I., Leeflang M.M., Lindeboom R., Bos J.D., Schmitt J. EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference. Allergy 2012; 67: 99-106.
  27. Akdis C., Akdis M., Bieber T. et al. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/ American Academy of Allergy, Acthma and Immunology/PRACTALL Consensus Report. J Allergy Clin Immunol 2006; 118: 152-169.
  28. Van Der Meer J.B., Glazenburg E.J., Mulder P.G., Eggink H.F., Coenraads P.J. The management of moderate to severe atopic dermatitis in adults with topical fluticasone propionate. The Netherlands Adult Atopic Dermatitis Study Group. Br J Dermatol 1999: 140: 1114-21.
  29. Hanifin J., Gupta A.K., Rajagopalan R. Intermittent dosing of fluticasone propionate cream for reducing the risk of relapse in atopic dermatitis patients. Br J Dermatol 2002: 147: 528-37.
  30. Berth-Jones J., Damstra R.J., Golsch S. et al. Twice weekly fluticasone propionate added to emollient maintenance treatment to reduce risk of relapse in atopic dermatitis: randomised, double blind, parallel group study. BMJ 2003: 326: 1367.
  31. Peserico A., Stadtler G., Sebastian M., Fernandez R.S., Vick K., Bieber T. Reduction of relapses of atopic dermatitis with methylprednisolone aceponate cream twice weekly in addition to maintenance treatment with emollient: a multicentre, randomized, double-blind, controlled study. Br J Dermatol 2008; 158: 801-7.
  32. Glazenburg E.J., Wolkerstorfer A., Gerretsen A.L., Mulder P.G., Oranje A.P. Efficacy and safety of fluticasone propionate 0.005% ointment in the long-term maintenance treatment of children with atopic dermatitis:differences between boys and girls? Pediatr Allergy Immunol 2009: 20: 59-66.
  33. Ring J., Alomar A., Bieber T. et al. Guidelines for treatment of atopic eczema (atopic dermatitis) part I. J Eur Acad Dermatol Venereol 2012: 26: 1045-60.
  34. Tang T.S., Bieber T., Williams H.C. Are the concepts of induction of remission and treatment of subclinical inflammation in atopic dermatitis clinically useful? J Allergy Clin Immunol 2014; 133: 1615-25.
  35. Charman C.R., Morris A.D., Williams H.C. Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol 2000; 142: 931-6.
  36. Aubert-Wastiaux H., Moret L., Le Rhun A. et al. Topical corticosteroid phobia in atopic dermatitis: a study of its nature, origins and frequency. Br J Dermatol 2011; 165: 808-14.
  37. Gollnick H., Luger T., Freytag S. et al. StabiEL: stabilization of skin condition with Elidel - a patients satisfaction observational study addressing the treatment, with pimecrolimus cream, of atopic dermatitis ptetreated with topical corticosteroid. J Eur Acad Dermatol Venereol 2008; 22: 1319-25.
  38. Nghiem P., Person G., Langley R. Tacrolimus and pimecrolimus: from clever prokaryotes to inhibiting calcineurin and treating atopic dermatitis. Ibid. 2002; 46: 228-241.
  39. Kapp A., Papp K., Bingham A. et al. Longterm management of atopic dermatitis in infants with topical pimecrolimus, a nonsteroid anti-inflammatory drug. J Allergy Clin Immunol 2002; 110: 277-84.
  40. Papp K.A., Werfel T., Folster-Holst R. et al. Long-term control of atopic dermatitis with pimecrolimus cream 1% in infants and young children: a two-year study. J Am Acad Dermatol 2005: 52: 240-6.
  41. Sigurgeirsson B., Boznanski A., Todd G. et al. Safety and efficacy of pimecrolimus in atopic dermatitis: a 5-year randomized trial. Pediatrics 2015; 135: 597-606.
  42. Ho V.C., Gupta A., Kaufmann R. et al. Safety and efficacy of nonsteroid pimecrolimus cream1%in the treatment of atopic dermatitis in infants. J Pediatr 2003; 142: 155-62.
  43. Kaufmann R., Folster-Holst R., Hoger P. et al. Onset of action of pimecrolimus cream 1% in the treatment of atopic eczema in infants. J Allergy Clin Immunol 2004; 114: 1183-8.
  44. Hanifin J.M., Boguniewicz M., Eichenfield L. et al. A long-term study of safety and allergic comorbidity development in a randomized trial of pimecrolimus cream in infants with atopic dermatitis. J Invest Dermatol 2010; 130: Abstract 328.
  45. Proshutinskaya D.V., Butareva M.M., Inoyatova L.A. Novyie vozmozhnosti terapii atopicheskogo dermatita u detey i vzroslyih. Vestn dermatol venerol 2013; 3: 78-82. [Прошутинская Д.В., Бутарева М.М., Иноятова Л.А. Новые возможности терапии атопического дерматита у детей и взрослых. Вестн дерматол венерол 2013; 3: 78-82.]
  46. Steven Kempers, MD, Mark Boguniewicz, MD, Eric Carter, Md, et al. A randomized investigator-blinded study comparing pimecrolimus cream 1% with tacrolimus ointment 0.03% in the treatment of pediatric patients with moderate atopic dermatitis. J Am Acad Dermatol 2004; 51: 515-25.
  47. Luger T., De Raeve L., Gelmetti C. et al. Recommendations for pimecrolimus 1% cream in the treatment of mild-to-moderate atopic dermatitis: from medical needs to a new treatment algorithm. Eur J Dermatol 2013; 23: 758-66.

Copyright (c) 2016 Proshutinskaya D.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 60448 от 30.12.2014.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies