# Presentation: 717980

## Vincent S. Beltrani, MD, FAAAAIBoard Certified byAmerican Academy of DermatologyAmerican Academy Allergy, Asthma & Immunology

**Associate Clinical Professor**
**Department of Dermatology           Department of Allergy**
**Columbia University                                               UMDNJ**
**New York, New York                         Newark, New Jersey**

**Notes:**
Have served as Chairman of the Eczema Committees several times in past 15-20 years, for all three major organizations:
American Academy of Dermatology;
American College of Allergy, Asthma & Immunology; and The American Academy of Allergy, Asthma & Immunology.
Have been a peer reviewer for the journals of all three organizations – JAAD; Annals of Allergy, Asthma & Immunology; and JACI – for past 20 years (especially for articles regarding AD, and urticaria).

## Atopic dermatitis is the dermatologic syndrome that frequently heralds theAtopic Diathesis

**Notes:**
This is my preferred definition for AD, since it best defines the unique distinction of AD versus other “eczemas”.

## Atopic dermatitis

**The earlier the onset, the more severe the ****	****dermatitis.**
**70% of patients with severe AD developed ****	****asthma compared with 30% of patients ****	****with mild AD, and approx. 8% in general ****	****population.**
**Therapies that modify the severity of AD in ****	****infants and young children might decrease ****	****the risk of the eventual development of ****	****asthma.**

**Notes:**
Ref. Spergel JM, Paller AS. Atopic dermatitis and the atopic march. JACI 2003;112:S118-27.

## AAD GuidelinesJAAD 2004;50:391-400Topical corticosteroids

**Topical CS remain the standard of care.**
**Recognize complications – striae, ****	****atrophy, ****	****telengectasia, limit use.**
**Limited data re: optimal concentrations, ****	****duration and frequency of Rx, ****	****quantity of application, etc.**
**Effect and absorption by hydration &/or ****	****occlusion.**
**Tachyphylaxis (not documented)**
**Long-term intermittent use – helpful & safe.**

**Notes:**
Reference: Hanifin JM et al. Guidelines of care for atopic dermatitis. JAAD2004;50:391-401.

## Risk factors of Topical Steroids

**“****Steroid phobia”**
**Atrophogenicity (essentially to potent CS) **
**Acne/rosacea-genicity**
**Allergic Contact Dermatitis ****	****(nonhalogenated >>halogenated CS**
**(?)Tachyphylaxis **
**Systemic absorption****	****	****	****	****	****“Immunosuppression”****	****	****	****	****	****Hypoadrenalism**

**Notes:**
Emphasizes that “steroid phobia” is the major “risk factor” deterring health care workers from prescribing the “treatment of choice” for AD.

## Atopic Dermatitis Long-Term Management

**Disease severity**

**Treatment**

**Notes:**
The “Long-Term Management” slide from the “Teaching” set of slides for AD available from the AAAAI.  VSB was Chair of the Work Group (Expert Opinions selected by the AAAAI) in 2002. 

## AAD GuidelinesTopical Calcineuron Inhibitors

**CI’s are safe and effective in reducing the ****	****severity of AD symptoms in children ****	****and adults.**
**CI’s have favorable safety profiles for up ****	****to one year of continued use.              ****	****	****	****     ****(Expert Opinion on Drug Safety 2(5):457, 2003)**** **

## AAAAIDisease Management of AD(Annals Allergy Asthma Immunol 2004;93S2.)

**Short-term, multicenter, blinded, vehicle-****	****controlled studies with pimecrolimus ****	****cream 1% patients with AD have shown ****	****pimecrolimus to be both effective and safe.**
**Pimecrolimus cream 1% has been approved for ****	****short-term and intermittent long-term use ****	****in patients with mild-to-moderate AD who ****	****are 2 years and older.**

## Recommendation of theCollege of Allergy

**From our experience with the “negative ****	****effect” by the existing steroid-phobia, ****	****the addition of a possible “black box” ****	****warning to the label of Elidel, will ****	****result in less aggressive treatment for ****	****some patients with AD, who will then ****	****be denied effective intervention to ****	****control their atopic march.**