Are hormonal drugs needed for atopic dermatitis?

There can be many reasons for exacerbation of atopic dermatitis , both allergic and non-allergic in nature. However, in the end we are dealing with skin inflammation, in which special types of cells take part, which secrete substances that provoke skin redness, edema, and itching.

In addition, many microorganisms live on the body of any person, which, with the normal functioning of the protective skin barrier, do not cause any discomfort. However, in the inflamed areas of the skin, the protective barrier is always broken, and therefore the bacteria tend to get to the focus of inflammation, where they begin to actively reproduce, which leads to even greater edema and the addition of a secondary infection.

Thus, at the slightest hint of skin inflammation, anti-inflammatory therapy should be used in order to avoid deterioration of the skin condition and the addition of a secondary infection. If the inflammation is not severe, as a rule, hormonal drugs (glucocorticosteroids) can be dispensed with. However, when you need to act quickly or the case is neglected, you cannot cope without them.

When applied externally, hormonal drugs suppress inflammatory and allergic skin reactions, which leads to a decrease in objective symptoms (erythema, edema, wetness) and subjective sensations (itching, irritation, pain). After the inflammation has been removed, the protective barrier is restored with the help of  emollients.

Is it safe to use hormonal drugs to treat atopic dermatitis in children?

Many parents (and even some doctors) are intimidated by the prospect of using hormonal drugs, since they have a very large list of side effects. Therefore, the question arises: how safe are hormonal creams and ointments?

In the 90s, doctors often prescribed fluorinated corticosteroids, such as  Ftorocort, Sinaflan ,  for the treatment of skin diseases (including atopic dermatitis)  . Moreover, children were smeared, as a rule, abundantly and for a long time. The uncontrolled use of such strong drugs often led to skin atrophy and other side effects. However, at that time there was simply no “easier” replacement for these drugs, as well as data on the required frequency and duration of use.

Compared to previous experience, the arsenal of doctors has expanded significantly – new, safer drugs have appeared. But most importantly, there are clinical studies and proven practice that allow the use of hormonal drugs with maximum benefit, while reducing the risk of side effects to a minimum.

Yet it is not so easy for a baby to find a safe hormonal drug. The skin of children is much thinner and more delicate than the skin of an adult, the epidermis is still very loose, the  permeability of the vascular endothelium is increased,  and small vessels are located so close to the surface of the skin that sometimes they can be seen with the naked eye . Thanks to this feature, hormones are absorbed into the blood of babies faster and in greater concentration, which increases the risk of side effects, and therefore not everything that is safe for an adult can be used to treat the skin of a baby. That is why drugs with greater safety have been developed for children, which has become a kind of revolution in the treatment of atopic dermatitis.

Hormonal drugs approved for use in babies

The number of drugs for use in children is very, very limited. To date, the drugs of choice for the treatment of atopic dermatitis are Advantan, Lokoid, Afloderm, Elokom. Let’s consider them in more detail.

Permitted age:  for the smallest (from 4 months of age) only Advantan is allowed. Starting from 6 months you can use Lokoid, Afloderm. It is recommended to use Elokom only upon reaching 2 years of age.

Active ingredient in 1 g of the preparation:  Advantan – methylprednisolone aceponate 1 mg; Locoid – hydrocortisone 17-butyrate 1 mg; Afloderm –  alclomethasone dipropionate 0.5 mg ; Elokom – mometasone furoate 1 mg.

Release form:   this aspect is very important, since the more release forms a drug has, the more successfully it can be used in various stages of atopic dermatitis. The widest choice was provided by the manufacturers of Advantan: cream, ointment, oily ointment, emulsion. Lokoid has no fatty ointment. Afloderm is presented only in the form of an ointment and cream. Elokom – ointment, cream, lotion.

Pharmacological action:  all of these drugs have anti-inflammatory, anti-allergic, antipruritic action. Their use leads to a decrease in both objective symptoms (edema,  erythema, lichenification) and subjective sensations (irritation,  itching, pain).  

Indications for use:  superficial inflammatory skin diseases in which the use of topical glucocorticosteroids is effective: dermatitis (including atopic, seborrheic, contact), eczema, psoriasis, etc.

Contraindications:  hypersensitivity to drug components; viral skin lesions in the area of ​​application of the drug (including chickenpox, herpes simplex, shingles, etc.); tuberculous and syphilitic skin lesions in the area of ​​application of the drug; post-vaccination skin reactions; perioral dermatitis; rosacea; violations of the integrity of the skin (open wounds, ulcers) in the area of ​​application of the drug, etc.

Method of administration and dosage: 

Advantan  is applied in a  thin layer  1 time / day to the affected skin. For sunburn, the emulsion is applied 1-2 times / day. Continuous daily use of Advantan in the form of an  oily ointment,  ointment or  cream  should not exceed 12 weeks  for adults and 4 weeks for children. The course of treatment with Advantan in the form of an emulsion is usually no more than 2 weeks. 

Locoid  is applied in a  thin layer  to the affected skin 1–3 times / day. When positive dynamics appear, the frequency of application is reduced to 2-3 times a week. The dose of the drug should not exceed 30-60 g per week.

Afloderm  is applied  to the affected skin  2-3 times / day. evenly  thin layer. On areas with denser skin (palms, elbows, feet, etc.), as well as places from which the drug is easily erased, more frequent application is allowed. In children, as well as during the aftercare period, it is possible to use the drug once / day. and less often. The duration of treatment in children should not exceed 3 weeks.

Elokom is applied 1 time / day. evenly with a thin layer on the affected skin.

Side effects:  when used in accordance with the instructions, the drugs are usually well tolerated. Sometimes local reactions are observed: itching, erythema, burning, blistering, less often allergic reactions to the components of the drug, folliculitis, perioral dermatitis,  hypertrichosis and other skin reactions . With prolonged use, as well as application to large surfaces and / or the use of occlusive dressings, side effects characteristic of systemic glucocorticosteroids may occur. 

Overdose:  With excessively prolonged and / or intensive use of glucocorticosteroids in high doses, it is possible to increase the side effects described above, skin atrophy.

Storage conditions:  all drugs should be stored out of the reach of children at room temperature no higher than 25 ° C (some – no higher than 30 ° C).

Thus, for the most effective and safe use of glucocorticosteroids for atopic dermatitis in children, you should choose only drugs intended for use in babies of the corresponding age group, do not exceed the dosage indicated in the instructions, and carry out therapy under the supervision of a doctor.

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