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Topical therapy for atopic dermatitis: A review

Background: Pediatric atopic dermatitis(AD) is very common, but its management is frustrating for the dermatologist, child and parents alike as this chronic inflammatory skin disease is marked with numerous difficult to control flares. Although country specific guidelines for AD exist, there is paucity of data with respect to dedicated topical care regimens for AD management in pediatric population. Purpose: This is a broad based review exploring various topical practices and management options to manage pediatric AD during flares and in remissions. Scope: The PubMed database was searched (to 1 June 2020) for English-language articles containing the keywords atopic dermatitis, atopic eczema, topical calcineurin inhibitor(TCI), topical corticosteroid(TCS), topical phosphodiesterase inhibitors, crisaborole, topical therapy. Articles focusing on topical managment for children with AD were chosen for further review. A limitation is that this is not a systematic review of the literature. We have relied heavily on The Indian Dermatology Expert Board Members 2019 Management Guidelines on AD and the 2014 American Academy of Dermatology (AAD) guidelines, soon to be updated. In our review, we focus on Skin directed therapies to repair and maintain healthy skin barrier, suppress inflammatory response, control flares, control itch and manage infectious triggers. Topicals can be used as first line therapy in mild AD, adjuvant for moderate-severe AD or as maintenance to keep the disease in remission. Topical therapy in AD is not limited to TCS, TCI, Crisaborole or newer molecules but also involves moisturization, emollient care and bathing practices; which have been discussed. Conclusion: Multiple topical therapies and practices have been successfully used to treat children with AD. An understanding of the available treatment options will help dermatologists striving to achieve best practice in the management of pediatric AD.