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Всем доброго времени суток. Собственно, вопрос.
Те у кого была экзема в СНГ, как вам теперь живётся с этим недугом в Канаде? Есть ли разница? Как ее здесь лечат, как обследуют? В России вот с этим дела, мягко говоря, "не очень" обстоят.

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Зависит от экземы. Некоторые снчала просто кремом питательным говорят мазать. Если не помогает, то выписывают что-то по рецепту. Если и это не помогает, то семейный доктор может дать направление к дерматологу.

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Canadian reference for health care professionals, если интересно;


Skin Disorders: Atopic Dermatitis

Miriam Weinstein, MD, FRCPC

Date of revision: January 2015


Introduction

Atopic dermatitis (AD), also known as eczema, is an inflammatory disorder of the skin with an onset usually in early childhood. Patients typically have flares of dermatitis that present as ill-defined patches of erythema, scale and excoriations. Significant pruritus and generalized dry skin are usually prominent features. Atopic dermatitis may be associated with other atopic conditions such as asthma, allergic rhinoconjunctivitis and food allergies. Although patients with atopic dermatitis are more likely to have food allergies, food ingestion as a causal factor in eczema flares is uncommon.


Goals of Therapy

Atopic dermatitis is a chronic, recurring condition without a cure, so the major focus is control of dermatitis, pruritus and dryness. Goals of therapy are:

Relieve generalized dry skin and pruritus, particularly when they interfere with activities of daily living
Treat patches of dermatitis to reduce inflammation and pruritus and reduce risk of secondary infection
Prevent flare-ups caused by environmental irritants
Promptly treat complications of atopic dermatitis such as secondary bacterial or viral infection


Investigations

Physical exam may show 1 of 3 typical morphologic patterns:
facial and extensor dermatitis in infants
flexural and fold dermatitis in older children
prominence of facial and hand dermatitis in adults


Investigations are rarely required for the work-up of classic atopic dermatitis. Bacterial swabs showing moderate or heavy growth of organisms may suggest secondary bacterial infections in resistant patches of dermatitis. However, many patients with atopic dermatitis are colonized with Staphylococcus aureus, making swabs with minimal growth difficult to interpret.


Therapeutic Choices

An algorithm for the management of atopic dermatitis is presented in Figure 1 - Management of Atopic Dermatitis .


Prevention

Maternal use of probiotics during pregnancy and maternal and/or infant use during breastfeeding may be helpful in reducing the development of atopic dermatitis in the child [Evidence: SORT B].1 , 2 However, there is not enough evidence to support the role of probiotics in the treatment of established atopic dermatitis.3 , 4


Nonpharmacologic Choices

Evidence suggests that disease-specific formal patient education programs, usually provided by a trained nurse, contribute to the success of treatment.5

Reducing environmental irritants is very useful; use nonirritating soaps and avoid perfumed products, wool and synthetic fibres, dry grass and leaves.

Patients with atopic dermatitis have abnormal barrier function, so they cannot maintain adequate hydration. Frequent use of lubricating skin emollients such as petrolatum helps seal in moisture. Emollients are first-line therapy for prevention of flares and treatment of minimal irritation and itch. Even when medication is required, emollients should be used at least twice daily. Remind patients to apply medicated treatments directly to the skin, not over emollients. Emollients should not contain fragrances or irritants (e.g., salicylic acid). Plain petrolatum jelly, while greasy, is highly effective, nonirritating and inexpensive.

Bathing, done properly, can help to hydrate the skin and protect the barrier. Bathing should be brief (5–10 minutes), the water warm (not hot) and the skin patted dry rather than rubbed aggressively. After bathing, apply emollients within 3 minutes of light drying.

Wet wraps (wet bandages applied over emollients or medication) are a useful second-line therapy but should be supervised by a physician experienced in this technique. Multiple different approaches are used and complications can occur. These include hypothermia, tissue maceration, infection and excessive absorption of medication.


Pharmacologic Choices

Topical corticosteroids affect several inflammatory pathways in the skin and work quickly and effectively. They are available in a wide variety of potencies and vehicles. The actual clinical potency of topical corticosteroids depends on the molecular structure and vehicle as well as the thickness and integrity of the skin. There is no formula to calculate the precise relationship between these factors. Some principles, however, can guide appropriate treatment selection (see Table 1 and Table 2). A systematic review of once-daily versus more frequent use of potent topical corticosteroids in atopic dermatitis found little difference between regimens with respect to clinical outcomes and adverse events.6

When prescribed and monitored by an experienced physician, topical corticosteroids are safe medications. Clinically significant adverse effects are rare and generally due to misuse.7,8 Laboratory detection of adverse effects such as cutaneous atrophy and HPA axis suppression due to systemic absorption may not translate to clinical effects in the patient.9,10,11,12,13,14 Regardless, in the setting of atopic dermatitis “steroid-phobia” is widespread15 and many patients, particularly children, suffer with undertreated eczema due to exaggerated fears about corticosteroid side effects. Many health care providers automatically warn that these products should be used “sparingly”, reinforcing this fear. This can lead to suboptimal therapy and result in the eczema being maintained in a chronic, active state. Inadequately treated eczema can lead to secondary infection and substantial sleep loss, and can significantly decrease quality of life [Evidence: SORT C].16 The negative effects of undertreatment outweigh the risk of adverse effects of corticosteroids. Ensure effective use of corticosteroids by choosing correct potency and vehicle (see Table 1 and Table 2) and using adequate quantities (see Table 3) for appropriate periods of time. Treatment should continue until rash and itch are resolved. This may be a few days or up to several weeks for each flare depending on the patient (see Figure 1 - Management of Atopic Dermatitis ). However, any eruption which does not improve significantly within 2 weeks, should be reassessed.


Table 1: Selection of Topical Corticosteroid by Body Area
Body Area Skin Properties Corticosteroid Potency
Face, intertriginous folds Thin skin, more absorption Low potency
Body and scalp Medium thickness Medium potency
Palms, soles Thick skin
High potency
Table 2: Selection of Topical Therapy by Vehicle
Vehicle Advantages Disadvantages
Cream Cosmetically elegant Less absorption; additives can irritate
Lotion Evaporates well, good for large areas, hairy areas Alcohol base will sting/irritate open areas of eczema
Gel Good for hairy areas, oily skin Alcohol base will sting/irritate open areas of eczema
Ointment Excellent penetration, offers emollient effect, little or no irritation Cosmetically less acceptable, thick, greasy
Table 3: Estimating Amount of Topical Therapy for One Application Using Fingertip Units (FTU)
Body Area to be Treated Fingertip Units (FTUs) Required for One Application (by age group)a , b
3–6 Months 1–2 Years 3–5 Years 6–10 Years Adults
Face and neck 1 1.5 1.5 2 2.5
1 Arm and hand 1 1.5 2 2.5 4
1 Leg and foot 1.5 2 3 4.5 8
Trunk (front) 1 2 3 3.5 7
Trunk (back, including buttocks) 1.5 3 3.5 5 7
Adapted from Patient.co.uk. Fingertip units for topical steroids for eczema. Available from: http://www.patient.co.uk/health/fingert ... l-steroids.


a. The fingertip unit is approximately 0.5 g, estimated to be the amount squeezed from a tube (with a standard 5 mm nozzle) from the fingertip to the first crease of an adult finger. Each 1 FTU should cover approximately 250 cm2 of area (equal to approximately 2 adult hand prints with fingers together).17
b. To calculate quantity to prescribe: (FTU for body area(s) involved × 0.5 g/FTU) × (# applications/day) × (# days of treatment). E.g., to treat a 10-yr-old's trunk (front) once daily for 2 weeks: 3.5 FTU × 0.5 g/FTU × 1 application/day × 14 days = 24.5 g.

Calcineurin inhibitors, also referred to as topical immune modulators, are a newer class of medications designed to specifically block calcineurin. They provide a targeted, specific anti-inflammatory mechanism in contrast to the wide-ranging effects of corticosteroids. Tacrolimus and pimecrolimus are available in Canada. These products work more slowly than corticosteroids18 and generally require twice-daily dosing. Evidence supports the short-term safety of these products.19

Concerns have been raised about the long-term safety of calcineurin inhibitors, particularly the risk of malignancy.19 Currently, insufficient data exist to adequately support or refute this claim.19 , 20 These agents can be useful in the treatment of atopic dermatitis but should be used only as indicated: in patients over 2 years of age, as second-line therapy and on an intermittent basis. Calcineurin inhibitors can be used as second-line agents for eczema of the face or folds if there is a concern about the amount or frequency of use of low-potency corticosteroids. These patients may continue to use corticosteroids elsewhere on the body while using calcineurin inhibitors on face or folds. Both pimecrolimus and tacrolimus significantly reduce eczema severity scores compared to placebo.21 Tacrolimus 0.03% has demonstrated better efficacy than a mild corticosteroid,22 and tacrolimus 0.1% has shown no difference compared with a mid-potency corticosteroid.23 Pimecrolimus 1% was not as effective as betamethasone valerate 0.1% in patients with eczema of at least moderate severity, although it is indicated for patients with mild to moderate eczema.24 Pimecrolimus has not been compared with low-potency topical corticosteroids as a treatment for mild eczema. Combining calcineurin inhibitors and topical corticosteroids does not appear to confer benefit over topical corticosteroids alone.25

Barrier repair therapies are new products developed in response to recognition of the contribution of a defective barrier to the etiology of atopic dermatitis.26 Disrupted ceramide content is one aspect of barrier dysfunction, and restoring the correct balance of ceramides is a strategy employed by newer products. One study found that a ceramide-dominant product was equivalent to a mid-potency corticosteroid after 28 days.27 However, another study found no difference in the management of mild-to-moderate eczema when comparing ceramide-dominant barrier repair therapy with another barrier repair therapy or a petrolatum-based moisturizer.28

Topical treatments for atopic dermatitis are addressed in Table 4.

There is no convincing evidence of the benefit of dietary supplements in eczema.3

Consider referral to a dermatologist for patients who fail to achieve good control of their eczema despite nonpharmacologic management (trigger avoidance, generous use of emollients) in combination with first- and second-line therapies such as topical corticosteroids or calcineurin inhibitors.

Other therapies such as systemic agents (e.g., cyclosporine, methotrexate, azathioprine) or ultraviolet (UV) light have been used in patients with extensive dermatitis, patients who have not responded to topical treatment and those who are unable to tolerate topical therapy. Alitretinoin is approved for severe chronic hand eczema in adults; referral to a dermatologist is recommended. Oral corticosteroids should not be routinely used in the treatment of atopic dermatitis, given their many side effects and the tendency for the eczema to rebound on withdrawal of corticosteroids.29


Flare Prevention

Evidence suggests the use of long-term intermittent topical corticosteroids or calcineurin inhibitors may help to keep atopic dermatitis in remission. Different regimens exist and generally involve application 2–3 times weekly. Duration of use has ranged from 16–40 weeks or longer, depending on the specific agent.30 , 31 , 32 , 33 , 34 Use of tacrolimus twice weekly for flare prevention is an approved indication in Canada, while the other regimens remain off-label. A systematic review of proactive treatment suggests that both tacrolimus and topical corticosteroids (several potencies) aid in flare prevention when used twice weekly, and that a potent topical corticosteroid may be more efficacious in flare prevention than tacrolimus.35 There is also evidence to support early intervention with calcineurin inhibitors at the first signs of a flare to prevent progression to a more serious episode.36 , 37 This remains an off-label indication for these medications.


Secondary Infection

Secondary infection is common with atopic dermatitis. Treat obviously infected eczema with topical or oral antibiotics. Questions have arisen about the role of preventive strategies with topical antiseptics or prophylactic antibiotics. Bleach baths are a useful second-line therapy but should be supervised by a physician experienced in this technique. Complications can include irritation ranging from mild to severe if the dilution is incorrect. A systematic review examined 26 randomized controlled trials that used a variety of antistaphylococcal treatments in the management of atopic dermatitis, including oral antibiotics, antibacterial soaps, topical antibiotics or antiseptics, special textiles and combinations of topical corticosteroids with antibacterials. While reduction of S. aureus counts on the skin was reported with some interventions, no trials showed improvement in eczema control. The poor quality of many of the studies and low patient numbers make this evidence difficult to interpret.38


Choices during Pregnancy and Breastfeeding


Atopic Dermatitis and Pregnancy

Atopic dermatitis is the most common skin condition in pregnancy, although overall prevalence during pregnancy is unknown.39 Sixty to 80% of affected pregnant patients develop symptoms for the first time during pregnancy, usually within the first 2 trimesters. One quarter of women with pre-existing atopic dermatitis will improve during pregnancy, but over half will experience worsening of the condition. Untreated atopic dermatitis can be extremely uncomfortable and carries the considerable risk of secondary infection. There is some evidence that maternal use of probiotics during pregnancy or maternal and/or infant use during breastfeeding may be helpful in reducing the development of atopic dermatitis in the child.1 , 2


Pre-pregnancy Management

Ideally, disease activity should be minimized prior to conception. Patients receiving systemic treatment may need to discontinue their medication well before conception; timing depends on the drugs involved. Methotrexate must be stopped at least 3 months prior to conception in women.39 , 40 It is also recommended that men stop methotrexate 3 months prior to conception,39 , 40 however a small cohort study showed no adverse pregnancy outcomes after paternal low-dose methotrexate exposure during time of conception.41 Although no specific time period is recommended, psoralens with ultraviolet-A (UVA) should be stopped before attempting to conceive.


Management of Atopic Dermatitis during Pregnancy

Maximize nonpharmacologic approaches, such as use of emollients and avoidance of environmental irritants. There is no information available on the safety of barrier repair therapies in pregnancy but the ingredients (skin lipids) are not expected to pose a significant risk. Topical corticosteroids remain the main treatment option throughout pregnancy. Low- and mid-potency corticosteroids are preferred over potent or very potent agents.39 , 42 , 43 If further treatment is needed, second-line choices include ultraviolet-B (UVB) therapy and calcineurin inhibitors (very low bioavailability when applied topically).39 Systemic therapy with cyclosporine or azathioprine is considered only in the most severe cases after careful discussion, and requires close monitoring for both mother and baby in a hospital setting. Methotrexate is contraindicated during pregnancy.


Management of Atopic Dermatitis during Breastfeeding

Emollients and topical corticosteroids remain the main treatment options throughout breastfeeding. Though safety data are lacking for ceramide-based barrier repair therapies, there is no theoretical reason for concern. Risk to the baby via passage of topical corticosteroids into breast milk is unlikely since only extensive use of the most potent corticosteroids causes systemic effects in the mother. The topical corticosteroid with the lowest effective potency should be applied to the smallest area possible for the shortest possible time.39 , 44 , 45 Topical calcineurin inhibitors appear to be poorly absorbed after topical administration and are second-line therapy.39 , 44 , 45 Avoid direct contact of the infant with the mother's treated skin. UVB therapy is considered safe during breastfeeding.39 Avoid methotrexate and cyclosporine during breastfeeding.
Up to 2% of mothers develop atopic dermatitis of the nipple or areola during breastfeeding.39 Emollients and low-potency corticosteroids can be applied to the areola or nipple, and wiped off gently but thoroughly before nursing. To prevent ingestion by the infant, topical calcineurin inhibitors should not be applied to the nipple/areola.


A discussion of general principles on the use of medications in these special populations can be found in Drug Use during Pregnancy and Drug Use during Breastfeeding. Other specialized reference sources are also provided in these appendices.


Therapeutic Tips

Ointments are less irritating and penetrate better than creams or lotions. They are an excellent choice for atopic dermatitis but cosmetic acceptability and patient adherence are lower. Generally, the same corticosteroid molecule will be more potent in an ointment base than in cream or lotion.
Education is a key part of therapy. Patients have to understand they have a chronic, recurring condition that can be controlled, not cured.
Sweating, stress and overheating can all increase itching.
Patches of dermatitis that are resistant to treatment despite good adherence to therapy may require a short course of a more potent corticosteroid.
Pruritus in atopic dermatitis is not histamine-mediated and therefore does not respond well to histamine blockade. Nonsedating antihistamines are of little use in the pruritus of atopic dermatitis but may help associated allergic symptoms (e.g., allergic conjunctivitis). Potent, sedating antihistamines (e.g., diphenhydramine, hydroxyzine) taken 30–60 minutes prior to bedtime may provide some relief, possibly through central sedation.


Algorithm


Figure 1 - Management of Atopic Dermatitis




Drug Table


Table 4: Topical Treatments for Atopic Dermatitisa
Classb Drug Dose Adverse Effects Comments Costc
Antibiotic/ Corticosteroid Combinations betamethasone valerate 0.1%/gentamicin 0.1%
Valisone-G BID–TID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. For use in secondarily infected dermatitis.
Caution: extensive use of gentamicin may lead to increased systemic absorption, especially in children.

$$$
Antibiotic/ Corticosteroid Combinations fusidic acid 2%/hydrocortisone 1%
Fucidin H TID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. For use in dermatitis with associated S. aureus. $$$
Barrier Repair Products ceramides/cholesterol/free fatty acids
EpiCeram Skin Barrier Emulsion, others BID
Mild burning or stinging lasting 10–15 min. Do not apply within 4 h prior to radiation therapy. $$
Calcineurin Inhibitors pimecrolimus cream 1%
Elidel BID
Transient burning sensations, skin tingling, pruritus at site of application. For use as a second-line agent until skin clears. Not for use in children <2 years of age or in patients who are immunocompromised. Apply a thin layer and avoid unnecessary UV exposure. Indicated for patients with mild to moderate atopic dermatitis. $$$$
Calcineurin Inhibitors tacrolimus ointment 0.03%, 0.1%
Protopic Pediatric (>2 years): 0.03% ointment BID
Adult (≥16 years): 0.03% or 0.1% ointment BID


Transient burning sensations, skin tingling, pruritus at site of application. For use as a second-line agent until skin clears. Not for use in children <2 years of age or in patients who are immunocompromised. Apply a thin layer and avoid unnecessary UV exposure. Indicated for patients with moderate to severe atopic dermatitis. $$$$
Corticosteroids, low-potency desonide 0.05%
Verdeso, generics BID–TID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for face, intertriginous areas. Safe and effective when used appropriately. $
Corticosteroids, low-potency hydrocortisone 1%,d 2%, 2.5%
Emo-Cort, Prevex HC, Topiderm HC, generics BID–TID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for face, intertriginous areas. Safe and effective when used appropriately. $
Corticosteroids, medium-potency betamethasone valerate 0.05%, 0.1%
Betaderm, Celestoderm V, Celestoderm V/2, Luxiq, Prevex B, generics Daily–BID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for body areas. Safe and effective when used appropriately. $
Corticosteroids, medium-potency clobetasone butyrate 0.05%d
Spectro EczemaCare Medicated Cream BID–TID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for body areas. Safe and effective when used appropriately. $$
Corticosteroids, medium-potency diflucortolone valerate 0.1%
Nerisone Daily–BID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for body areas. Safe and effective when used appropriately. $$
Corticosteroids, medium-potency fluocinolone acetonide 0.01%
Derma-Smoothe/FS BID–TID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for body areas. Safe and effective when used appropriately.
Derma-Smoothe/FS product contains peanut oil but not peanut protein.

$
Corticosteroids, medium-potency hydrocortisone valerate 0.2%
Hydroval BID–TID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for body areas. Safe and effective when used appropriately. $
Corticosteroids, medium-potency prednicarbate 0.1%
Dermatop BID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for body areas. Safe and effective when used appropriately. $$
Corticosteroids, medium-potency triamcinolone acetonide 0.1%, 0.5%
Aristocort Creams and Ointments, generics BID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for body areas. Safe and effective when used appropriately. 0.1%: $
0.5%: $$$


Corticosteroids, high-potency amcinonide 0.1%
Cyclocort, generics BID–TID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for thick, lichenified plaques. Safe and effective when used appropriately. $
Corticosteroids, high-potency betamethasone dipropionate 0.025%, 0.05%
Diprosone, Propaderm, generics BID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for thick, lichenified plaques. Safe and effective when used appropriately.
Glycol-based product is ultra potent. See betamethasone dipropionate glycol.

$$
Corticosteroids, high-potency desoximetasone 0.05%, 0.25%
Topicort Preparations BID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for thick, lichenified plaques. Safe and effective when used appropriately. $$
Corticosteroids, high-potency fluocinonide 0.05%
Lidemol, Lidex, Lyderm, Tiamol, Topactin BID–TID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for thick, lichenified plaques. Safe and effective when used appropriately. $
Corticosteroids, high-potency mometasone furoate 0.1%
Elocom, generics Daily
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for thick, lichenified plaques. Safe and effective when used appropriately. $
Corticosteroids, ultra-potent betamethasone dipropionate glycol 0.05%
Diprolene BID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for palms and soles. Safe and effective when used appropriately. $$
Corticosteroids, ultra-potent clobetasol propionate 0.05%
Clobex Lotion, Dermovate, Olux-E, generics BID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for palms and soles. Safe and effective when used appropriately. $
Corticosteroids, ultra-potent halobetasol propionate 0.05%
Ultravate BID
Striae, telangiectasia, atrophy, purpura. When used around the eye for longer periods of time, ocular side effects may rarely occur. Systemic effects include suppression of HPA axis although clinically relevant features are very rare. Good for palms and soles. Safe and effective when used appropriately. $$$ a. Few of the listed products are Health Canada-approved for use in the pediatric population but are often used in this population in practice.
b. Different potency categories may be used by other authors. Vehicle also impacts potency categorization. These rankings are meant to serve as a guide only.
c. Cost of 30 g or 30 mL for topical products; includes drug cost only.
d. Hydrocortisone 1% and clobetasone butyrate 0.05% are available without a prescription.

Abbreviations: HPA = hypothalamic-pituitary-adrenal; UV = ultraviolet

Legend: $ < $10 $$ $10–25 $$$ $25–50 $$$$ $50–75


Suggested Readings

Arkwright PD, Motala C, Subramanian H et al. Management of difficult-to-treat atopic dermatitis. J Allergy Clin Immonol Pract 2013;1(2):142-51.

Lynde C, Barber K, Claveau J et al. Canadian practical guide for the treatment and management of atopic dermatitis. J Cutan Med Surg 2005;8( Suppl 5):1-9.

National Institute for Health and Clinical Evidence. NHS Evidence—Skin disorders. 2010 annual evidence update on atopic eczema. September 13, 2010.

Ring J, Alomar A, Bieber T et al. Guidelines for treatment of atopic eczema (atopic dermatitis) part I. J Eur Acad Dematol Venereol 2012;26(8):1045-60.

Ring J, Alomar A, Bieber T et al. Guidelines for treatment of atopic eczema (atopic dermatitis) part II. J Eur Acad Dematol Venereol 2012;26(9):1176-93.

Sajic D, Asiniwasis R, Skotnicki-Grant S. A look at epidermal barrier function in atopic dermatitis: physiologic lipid replacement and the role of ceramides. Skin Therapy Lett 2012;17(7):6-9.



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Hong E, Smith S , Fischer G. Evaluation of the atrophogenic potential of topical corticosteroids in pediatric dermatology patients. Pediatr Dermatolo 2011;28(4):393-6.
Tan MH, Meador SL, Singer G et al. An open-label study of the safety and efficacy of limited application of fluticasone propionate ointment, 0.005%, in patients with atopic dermatitis of the face and intertriginous areas. Int J Dermatol 2002;41(11):804-9.
Charman CR, Morris AD, Williams HC. Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol 2000;142(5):931-6.
Hon KL, Pong NH, Poon TC et al. Quality of life and psychosocial issues are important outcome measures in eczema treatment. J Dermatolog Treat 2014 Feb 20. [Epub ahead of print].
Long CC, Mills CM, Finlay AY. A practical guide to topical therapy in children. Br J Dermatol 1998;138(2):293-6.
Luger TA, Lahfa M, Folster-Holst R et al. Long-term safety and tolerability of pimecrolimus cream 1% and topical corticosteroids in adults with moderate to severe atopic dermatitis. J Dermatol Treat 2004;15(3):169-78.
U.S. Food and Drug Administration. Pediatric Advisory Committee. Manthripragada A. Addendum: Update on calcineurin inhibitor pediatric literature review. Tacrolimus (Protopic) and pimecrolimus (Elidel). May 10, 2011. Available from: http://www.fda.gov/downloads/AdvisoryCo ... 255140.pdf. Accessed May 14, 2013.
Carr WW. Topical calcineurin inhibitors for atopic dermatitis: review and treatment recommendations. Paediatr Drugs 2013;15(4):303-10.
Iskedjian M, Piwko C, Shear NH et al. Topical calcineurin inhibitors in the treatment of atopic dermatitis: a meta-analysis of current evidence. Am J Clin Dermatol 2004;5(4):267-79.
Reitamo S, Harper J, Bos JD et al. 0.03% Tacrolimus ointment applied once or twice daily is more efficacious than 1% hydrocortisone acetate in children with moderate to severe atopic dermatitis: results of a randomized double-blind controlled trial. Br J Dermatol 2004;150(3):554-62.
Reitamo S, Rustin M, Ruzicka T 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(3):547-55.
Luger T, Van Leent EJ, Graeber M et al. SDZ ASM 981: an emerging safe and effective treatment for atopic dermatitis. Br J Dermatol 2001;144(4):788-94.
Spergel JM, Boguniewicz M, Paller AS et al. Addition of topical pimecrolimus to once-daily mid-potent steroid confers no short-term therapeutic benefit in the treatment of severe atopic dermatitis; a randomized controlled trial. Br J Dermatol 2007;157(2):378-81.
Danby SG, Cork MJ. A new understanding of atopic dermatitis: the role of epidermal barrier dysfunction and subclinical inflammation. J Clin Dermatol 2010;1(2):33-46. Available from: content.yudu.com/Library/A1p7hp/DermatologyVolumeIIs/resources/39.htm.
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Miller DW, Koch SB, Yentzer BA et al. An over-the-counter moisturizer is as clinically effective as, and more cost-effective than, prescription barrier creams in the treatment of children with mild-to-moderate atopic dermatitis: a randomized controlled trial. J Drugs Dermatol 2011;10(5):531-7.
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Breneman D, Fleischer AB, Abramovits W et al. Intermittent therapy for flare prevention and long-term disease control in stabilized atopic dermatitis: a randomized comparison of 3-times-weekly applications of tacrolimus ointment versus vehicle. J Am Acad Dermatol 2008;58(6):990-9.
Peserico A, Stadtler G, Sebastian M et al. Reduction of relapses of atopic dermatitis with methylprenisolone aceponate cream twice weekly in addition to maintenance treatment with emollient: a multicentre, randomized, double-blind, controlled study. Br J Dermatol 2008;158(4):801-7.
Berth-Jones J, Damstra RJ, 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(7403):1367.
Wollenberg A, Reitamo S, Girolomoni G et al. Proactive treatment of atopic dermatitis in adults with 0.1% tacrolimus ointment. Allergy 2008;63(7):742-50.
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Schmitt J, von Kobyletzki L, Svensson A et al. Efficacy and tolerability of proactive treatment with topical corticosteroids and calcineurin inhibitors for atopic eczema: systematic review and meta-analysis of randomized controlled trials. Br J Dermatol 2011;164(2):415-28.
Zuberbier T, Brautigam M. Long-term management of facial atopic eczema with pimecrolimus cream 1% in paediatric patients with mild to moderate disease. J Eur Acad Dermatol Venereol 2008;22(6):718-21.
Gollnick H, Kaufmann R, Stough D et al. Pimecrolimus cream 1% in the long-term management of adult atopic dermatitis: prevention of flare progression. A randomized controlled trial. Br J Dermatol 2008;158(5):1083-93.
Bath-Hextall FJ, Birnie AJ, Ravenscroft JC et al. Interventions to reduce Staphylococcus aureus in the management of atopic eczema: an updated Cochrane review. Br J Dermatol 2010;163(1):12-26.
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Therapeutic Choices. © Canadian Pharmacists Association, 2015. All rights reserved.

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Всем доброго времени суток. Собственно, вопрос.
Те у кого была экзема в СНГ, как вам теперь живётся с этим недугом в Канаде? Есть ли разница? Как ее здесь лечат, как обследуют? В России вот с этим дела, мягко говоря, "не очень" обстоят.
Как сказал один мой хороший друг, моя печень не видела не чего три года кроме кашки и всего что может быть полезным, результат 0....

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Canadian reference for health care professionals, если интересно;



Что то глючит, запостите еще раз.

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Мне выписывают кортикостероидную мазь. Не очень помагает. Была в дерматолога - точно такую же мазь выписала и больше ничего предложить не могла или не хотела. Экзема началась в Канаде, раньше я и не знала как это выглядит.

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Не захотела. По сути лечение в кортикостероидах и заключается, можно попросить ту же мазь, но в более сильной концентрации.
В идеале надо убрать аллерген, но часто это невозможно.

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В вопросе не шарю но знаю что колега мучался очень сильно от нее. Потом говорит ему какие то уколы прописали и ходит как огурчик.

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Всем доброго времени суток,
Прибыли в Канаду не так давно, у ребенка на коже появились признаки экземы. Хэлф-карту еще не получили, как-то можно ли посетить врача срочно? Может, по карте мужа?
Спасибо.

_________________
Медицина - 12.05.2016
Миссисага - 14.06.2016
Спонсор - 16.08.2016
AOR - 17.08.2016
In Process - 16.08.2016
POVL - 19.04.2017
Landed - 14.05.2017......

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без рецепта можно купить:

Spectro Eczema Care Medicated Cream

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Спасибо Вам большое!!! А то я уже в панике: "что делать"... :(

_________________
Медицина - 12.05.2016
Миссисага - 14.06.2016
Спонсор - 16.08.2016
AOR - 17.08.2016
In Process - 16.08.2016
POVL - 19.04.2017
Landed - 14.05.2017......

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