This document discusses atopic dermatitis (eczema), including its pathophysiology, epidemiology, treatment recommendations, and evidence. Key points: 1. Atopic dermatitis is a chronic, relapsing inflammatory skin disease caused by genetic and immune mechanisms resulting in dry, itchy skin. 2. Treatment recommendations include topical corticosteroids and calcineurin inhibitors based on severity, with more potent topical/oral steroids, phototherapy, immunosuppressants for refractory cases. 3. Evidence suggests ultra-potent topical steroids should not be used continuously for more than 3 weeks to avoid side effects like skin atrophy.

1. ATOPICDERMATITIS
INTEGRANTES:
Castro Vega Francisco
Cerón Andrea
Chávez Rosario Karla
Chango Checa Cristian
Chiluisa Vaca Paulina

2. Chronic, relapsing inflammatory skin
disease immune mechanism

3. prurigo
intense
dry skin erythema exudate
Characterized by lesions

4. • Folds of elbows-knees
• Face
• neck
• Asthma
• Rhinitis
• Food allergic.
Flexural surfaces affects Clinical phenotype

5. EPIDEMIOLOGY

6. EPIDEMIOLOGY

7. Families of patients with atopic dermatitis are also affected
by the disease
3.4% a normal quality of life
23.3% slightly affected
66.4% moderately impaired
6.9% strong impact on their quality of
life.

8. Pathophysiology

10. Genetic predisposition
Genes encoding
elements of the
immune system
• 5q 31-33
• Th2: IL4, IL5,
IL13, GM-CSF
Genes encoding
structural proteins
of the skin
• 1q 21-23 FLG
(filaggrin)
• epidermal
differentiation
genes

11. Skin barrier dysfunction
LOSS OF THE UNION CORNEODESMOSOME

12. LOSS OF LIPID
•LOSS OF WATER
ELASTICITY AND
FLEXIBILITY.
•PENETRATION O
SOLUBLE
SUBSTANCES.

13. DRY SKIN
PRESENTS CRACKS THAT
PERMIT THE ENTRANCE OF
MICROORGANISMS
PRODUCE INFLAMMATION

14. Immunological Alterations
Imbalance in the production of lymphocytes.
Increased production of Th2 lymphocytes
INFLAMMATION
PRURITUS
ERYTHEMA

17. Education and training of
patients and their families:
Recommendations concerning bathing, hydration with
emollients, stress reduction, psychological support, and
avoidance of triggers (irritants, detergents, solvents,
aeroallergens, and certain foods).
The chronic nature of the disease and possible
complications should be explained and patients and
their families should be given any other information
considered helpful.

18. Induction therapy
Topical corticosteroids and
calcineurin inhibitors
(pimecrolimus, tacrolimus).
Maintenance therapy
Used in cases of persistent disease or very severe or frequent
relapses. Intermittent (weekend) regimen of topical corticosteroids
and maintenance therapy with calcineurin inhibitors (twice weekly)

19. Treatment of refractory cases
Very potent topical corticosteroids, oral corticosteroids,
oral ciclosporin, and phototherapy.
In each case, assess
the patient’s age and
the stage and type of
the predominant
lesions (acute,
subacute, chronic
lichenified), the site of
lesions, the extent of
disease, and
response to prior
treatment.
Oral antihistamines to
control pruritus
Treatment of
complications
(bacterial and viral
infections) with topical
and/or systemic
antibiotics or
antivirals if necessary.

20. MILD ATOPIC DERMATITIS:
 1. Basic recommendations and information:
bathing, hydration, avoid triggers, reduce
stress, chronic nature of condition and
possible complications, food, psychological
support, consideration of prebiotic and/or
probiotic treatment, etc.
 2. Topical corticosteroids (1/24 h) until
remission
 3. Topical pimecrolimus or tacrolimus (1/12-24
hours) until remission.

21. MODERATE ATOPIC
DERMATITIS:
 1. Maintenance regimen of topical corticosteroids
(twice weekly, weekend regimen)
 2. Maintenance regimen of topical pimecrolimus or
tacrolimus (twice weekly)
 3. Oral corticosteroids: PREDNISONE (1 mg/kg/24 h)
until flare is controlled, then gradually tapered (1-3 wk)
 4. Emollient–corticosteroid wet-wrap dressings 1/24 h
for 1 week
 5. CICLOSPORIN (3-5-7 mg/kg/24 h) until flare is
controlled (6-12 wk), then gradually tapered.
 6. PHOTOTHERAPY: Medium doses of narrowband
UV-B, UV-B or UV-A.

22. SEVERE ATOPIC
DERMATITIS:
 1. CICLOSPORIN (2.5 mg/kg/24 h) for at least 6 months
 2. AZATHIOPRINE, maintenance regimen (100-200 mg/24 h)
 3. METHOTREXATE, maintenance regimen (10-20 mg/wk)
 4. MYCOPHENOLATE MOFETIL, maintenance regimen (1-2
g/24 h)
 5. Psoralen UV-A
 6. Intravenous immunoglobulins. (1-2 g/kg/mo) for 3-6 mo
 7. Interferon- 50 g/m2/24 h for 12 wk
 8. Hydroxychloroquine (200 mg/24 h)
 9. Omalizumab
 10. Rituximab
 11. Alefacept
 12. TNF- inhibitors

23.  TO CONTROL
PRURITUS
 1. Sedative
antihistamines
 2. Antileukotrienes
 3. Naltrexone
 4. Serotonin modifiers
 5. Ondansetron
 6. Doxepin
 TO CONTROL
INFECTION
 1. Topical or systemic
 antibiotics (against
Staphylococcus
 aureus) when signs of
 superinfection are
present
 until infection resolves
 2. Topical or systemic
 antivirals

24. EVIDENCE

25. Evidence of double infraorbital foldz

26. The objectives are as :
 To assess the best application
strategies of topical corticosteroids
for treating established eczema in
people of all ages

27. The term ’atopic eczema’
should only refer to individuals
who have the physical features
of eczema plus evidence o
specific immunoglobulin E
(IgE) antibodies to common
environ-mental allergens.

28. Types of studies
 All randomised controlled trials (RCTs)
comparing different strategies for administering
topical corticosteroids for treating eczema

29.  When prescribing topical steroids is
important to consider
the diagnostic and the
steroid potency
route of administration
frequency of
administration
duration of
treatment
side effects

30. Recommendations for clinical
practice
CLINICAL RECOMMENDATION Level of Evidence
Ultra highly potent topical steroids should not be used
continuously for more than three weeks
C
Corticosteroids low power to high power should not
be used continuously for more than three months to
avoid side effects.
C
Combinations of topical steroids and antifungal
agents should generally
avoided to reduce the risk of infections
C

31. Power of Topical
Corticosteroids
Power GENERIC
Ultra high ( I) Betamethasone dipropionate 0.05%
Clobetasol propionate 0.05 %
high (II) Amcinonide 0,1%
Desoximetasona
Medium-High ( III ) Propionato fluticasona 0,005%
Acetónido triamcinolona 0,5%

32. Power GENERIC
Medium ( IV and V ) Valerato betametasona
Valerato hidrocortisona 0,2%
Low ( VI) Alclometasona dipropionato 0,05%
Desonida 0,05%
Less potent (VII ) Fluocinolona 0,01%
Butirato hidrocortisona 0,1%
Hidrocortisona 1%, 2,5%

33. Frequency of administration
 Application once or twice a day is
recommended for Most preparations. The
administration's often does not provide better
results.
 Chronic application of topical steroids can
induce
tolerance and tachyphylaxis

34. Side Effects
 The most common side effect of using topical
corticosteroids is skin atrophy .
 more powerful steroids , occlusion , the skin
more thin, and the older the patient increases
the risk .