Topical tacrolimus in atopic dermatitis: Effects of ... - Helda - Helsinki.fi

for the acute phase of AD, except for UVA1, but serves as concomitant therapy with
topical treatment or as maintenance therapy (Meduri et al. 2007). The length of the
remission after the treatment period varies greatly and is longer for narrow-band UVB
than for UVA (Meduri et al. 2007). Adverse effects include skin erythema, which is less
with UVB treatment, skin burning, and risk for skin malignancies with cumulative UV
dose (Krutmann & Morita 2002).
Antihistamines
Antihistamines are widely used for patients with atopic dermatitis, especially for
pruritus, and also for co-existent allergic rhinoconjunctivitis and allergic asthma. Firstgeneration
compounds such as hydroxyzine are useful for nocturnal pruritus due to their
sedative effect. Second- and third- generation antihistamines, such as cetirizine,
levocetirizine, loratadine, desloratadine, and ebastine are effective against pruritic
immediate allergic reactions and urticaria. These compounds have effects on many
mediators of inflammation and can be assumed to exert effects in the acute phase of AD
(Hoare et al. 2000). An evidence-based review, however, failed to find sufficient
evidence that they relieve AD itself or the itching caused by AD (Klein & Clark 1999).
The ETAC study (Early Treatment of the Atopic Child) compared cetirizine with
placebo. Cetirizine reduced the need for potent corticosteroids in patients with more
severe AD, but had no effect on AD in general, because the use of topical
corticosteroids and decrease in severity parameters in the cetirizine and placebo groups
were similar (Diepgen et al. 2002).
Systemic glucocorticosteroids
Systemic glucocorticosteroids such as prednisone, prednisolone, and
methylprednisolone often serve as rescue therapy in severe AD exacerbations. They
relieve itch and inflammation quickly, but the risk for AD relapse soon after cessation
of treatment is high. In addition to having the same side-effects as do topical
corticosteroids, they may cause arterial hypertension, electrolyte imbalance, impaired
glucose metabolism, Cushing’s syndrome, and osteoporosis, especially in long-term
treatment (Hoare et al. 2000).
Ciclosporin
Severe AD that does not respond adequately to topical treatment or combined topical
and UV-light treatment often requires the addition of systemic long-term
immunosuppressive treatment. However, these treatments will diminish but not abolish
the need for topical treatments. Ciclosporin (cyclosporin A) is a nonmyelosuppressive
immunosuppressant effective in cell-mediated immune responses and widely used in
organ transplant patients (Granlund et al. 1995). It is also used in a variety of
autoimmune diseases such as rheumatoid diseases, psoriatic arthritis, severe psoriasis,
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