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Williams, Hywel (2002)
Publisher: BMJ Publishing Group
Languages: English
Types: Article
Atopic dermatitis now affects 15% to 20% of chil­\ud dren in developed countries, and prevalence\ud in cities in developing countries undergoing\ud rapid demographic changes is quickly following suit.1\ud Most cases of atopic dermatitis in a given community\ud are mild, but children with moderate to severe disease\ud can have continuous itching and associated loss of\ud sleep. The social stigma of a visible skin disease can also\ud be soul destroying for both patient and family. A few\ud studies have suggested that some degree of prevention\ud of the disease is possible,2 although these measures\ud have not been taken up widely. In the absence of any\ud treatment that is known to alter the clinical course of\ud the disease, most treatment is aimed at reducing symp­\ud toms and signs. After a relative lull of almost 40 years,\ud new drugs—tacrolimus and pimecrolimus—have\ud appeared that offer different approaches to managing\ud this miserable disease. Do they work? Are they safe?\ud And how do they compare with existing treatments?
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1 Williams H, Robertson C, Stewart A, Ait­Khaled N, Anabwani G, Anderson R, et al. Worldwide variations in the prevalence of symptoms of atopic eczema in the international study of asthma and allergies in childhood. J Allergy Clin Immunol 1999;103:125­38.
    • 2 Mar A, Marks R. Prevention of atopic dermatitis. In: Williams HC, ed. Atopic dermatitis. The epidemiology, causes and prevention of atopic eczema. Cambridge: Cambridge University Press, 2000:205­20.
    • 3 Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess 2000;4:1­191.
    • 4 Nghiem P, Pearson G, Langley RG. Tacrolimus and pimecrolimus: from clever prokaryotes to inhibiting calcineurin and treating atopic dermatitis. J Am Acad Dermatol 2002;46:228­41.
    • 5 Queille­Roussel C, Paul C, Duteil L, Lefebvre MC, Rapatz G, Zagula M, et al. The new topical ascomycin derivative SDZ ASM 981 does not induce skin atrophy when applied to normal skin for 4 weeks: a randomized, double­blind controlled study. Br J Dermatol 2001;144:507­13.
    • 6 FK506 Ointment Study Group. Phase III comparative study of FK506 ointment versus betamethasone valerate ointment in atopic dermatitis (trunk/extremities) [in Japanese]. Nishinihon J Derm 1997;59:870­9.
    • 7 FK506 Ointment Study Group. Phase III comparative study of FK506 ointment versus aclometasone dipropionate ointment in atopic dermatitis (face/neck) [in Japanese]. Hihuka Kiyo [Dermatology Bulletin] 1997;92:277­82.
    • 8 Reitamo S, Rustin M, Ruzicka T, Cambazard F, Kalimo K, Friedmann PS, et al. Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone butyrate ointment in adult patients with atopic dermatitis. J Allergy Clin Immunol 2002;109:547­55.
    • 9 Reitamo S, Van Leent EJ, Ho V, Harper J, Ruzicka T, Kalimo K, et al. Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone acetate ointment in children with atopic dermatitis. J Allergy Clin Immunol 2002;109:539­46.
    • 10 Luger T, Van Leent EJ, Graeber M, Hedgecock S, Thurston M, Kandra A, et al. SDZ ASM 981: an emerging safe and effective treatment for atopic dermatitis. Br J Dermatol 2001;144:788­94.
    • 11 FDA/Center for Drug Evaluation and Research. Elidel (pimecrolimus) cream. www.fda.gov/cder/foi/nda/2001/21­302 _Elidel.htm (accessed 22 Apr 2002)
    • 12 Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomised placebo­controlled trial. Lancet 2001;357:1076­9.
    • 13 Arkwright PD, David TJ. Intradermal administration of a killed Mycobacterium vaccae suspension (SRL 172) is associated with improvement in atopic dermatitis in children with moderate­to­severe disease. J Allergy Clin Immunol 2001;107:531­4.
    • BMJ 2002;324:1534-5
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