|
Topical |
|
Corticosteroids |
The mainstay of therapy; for reactive and proactive
use. Extensive experience with the Fingertip Unit method (see text). |
With prolonged use: skin atrophy, hypertrichosis, depigmentation, and
telangiectasias. Systemic absorption, particularly in dysmature
infants. |
Calcineurin inhibitors |
Safe, also < 2 years of age
(off-label). |
Initially stinging/burning on the application
sites. |
PDE4 inhibitors |
Not available in Europe. |
Temporary stinging/burning
on the application sites. |
Wet wraps |
Good alternative to systemic medication for crisis
intervention or averting hospitalization. |
Folliculitis. Systemic
absorption/Cushing in prolonged use. Not indicated during puberty
because of side effects of the corticosteroids (striae). |
Antiseptics |
Topical disinfectants (e.g. bleach) may be used but
evidence is conflicting. |
Rarely allergic reactions. |
|
Systemic |
|
Phototherapy |
Not commonly used in early childhood (feasibility). If
used, preference for narrowband ultraviolet B (311nm) or ultraviolet A1. |
Claustrophobia in small children, erythema/burns, premature ageing of
the skin, photocarcinogenity. |
Antibiotics |
Topical antibiotics are not advised; in case of
superinfection systemic antibiotics are warranted. |
Gastrointestinal
problems, allergies / drug reactions (rare). |
Cyclosporine A |
Approved from the age of 16. |
Hypertension,
nephrotoxicity, tremor, hyperlipidemia. |
Methotrexate |
Safe in children but off-label and effect takes longer
than cyclosporine A. Folic acid suppletion recommended. |
Hepatotoxicity, gastrointestinal discomfort. |
Azathioprine |
Off label. |
Superinfection, nausea, hepatic function
abnormality, malignancies. |
Mycophenolate mofetil |
Off label. |
Superinfection, anemia, leukopenia,
diarrhea. |
Dupilumab |
Biologic (injection). Approved from the age of 12. |
Conjunctivitis, injection site reactions. |