Duration of topical therapy in the maintenance of atopic dermatitis remission in pediatric age

BACKGROUND: Topical Corticosteroids (TCS) are the first-choice treatment for atopic dermatitis (AD) flares. In literature there are clear advices about the potency, dosage and frequency of application of TCS, but there are no shared indications about duration of the treatment during a flare. The aim of the study is to demonstrate if the use of a steroid cream for less than or 5 days , could be equal or more effective than the application for more than 5 days during a flare episode, in keeping a remission state of DA. METHODS: The study population (n=122) was selected according to the following inclusion criteria: at least one specialist allergological and dermatological examination in the period November 2015 to February 2017, age between 1 and 11 years; mild to moderate atopic dermatitis. All patients were given a standardized telephone questionnaire, which concerns on multiple aspects: parents' self-reported perceptions of the severity of their child's condition; actual use of emollients, moisturizers and steroid creams; number of consecutive days of using of topical steroid cream during an exacerbation of AD; average number of AD exacerbations per month in the last year; total number of AD exacerbations in the last year. RESULTS: Data from 96 patients was examined. We classified three groups of patients from data collected: group 1 (n=40): use of TCS for ≤ 5 consecutive days during an exacerbation event of AD; group 2 (n=12): use of TCS for > 5 consecutive days during an exacerbation event of AD; group 3 (n=44): non use of TCS or use of TCS with a different posology. We found a further subgroup in group 3 (3a, n=27) with patients using only emollient crème in AD management. In group 1, 27 patients (67.5%) didn't show a good AD control; on the contrary, 13 patients (27.5%) reported a good AD control. In group 2, 4 patients (25%) didn't show a good AD control; on the contrary, 8 patients (75%) reported a good AD control. By comparing the data obtained in the presence of good DA control, the difference between the percentages obtained was found to be statistically significant (p = 0.034). CONCLUSIONS: The results obtained show that a therapeutic pattern based on the use of TCS for a duration of more than 5 consecutive days during an episode of DA exacerbation is more efficient than the proposed alternative therapeutic scheme in the maintenance of DA remission.