Proactive Treatment of Atopic Dermatitis in Adult Patients with Tacrolimus Ointment: Observations of How to Shift from " Reactive" to " Proactive" Treatment

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  • 成人アトピー性皮膚炎患者に対するタクロリムス軟膏を用いたプロアクティブ療法―リアクティブ療法からの移行についての検討―
  • セイジン アトピーセイ ヒフエン カンジャ ニ タイスル タクロリムス ナンコウ オ モチイタ プロアクティブ リョウホウ : リアクティブ リョウホウ カラ ノ イコウ ニ ツイテ ノ ケントウ

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Atopic dermatitis (AD) is a chronic inflammatory skin disorder with periods of flares and remissions. The long-term therapeutic concept for AD was conventionally based on daily application of emollients and symptomatic anti-inflammatory agents on demand, termed as " reactive" treatment, however long-term remission is difficult to achieve. Recently, " proactive" treatment has been suggested as a new therapeutic concept for the long-term maintenance of AD. We herein described adult patients with moderate to severe AD who were shifted from reactive to proactive treatment and compared their characters between successfully changed to proactive treatment and failed to be shifted one. 16 patients who had received reactive treatment applied corticosteroid ointment to eczematous lesions twice daily for 4-8 weeks. After the remission, the patients changed to proactive treatment applying tacrolimus ointment on the previous affected areas twice weekly for 12 weeks. 9 patients (56%) completed proactive treatment without severe relapse and their mean Severity Scoring of Atopic Dermatitis (SCORAD) during proactive treatment was lower than that during reactive treatment (20.2 vs. 14.8; P=0.008). 7 patients (44%) discontinued the treatment because of the relapse or irritation due to tacrolimus ointment. Mean SCORAD for 6 months during reactive treatment in completed group was 20.2, whereas 30.5 in discontinued group (P=0.005). As for the detail of SCORAD during this period, mean affected area and visual analog scale (VAS) of pruritus and sleep loss between continued and discontinued groups showed significant difference; mean affected area was 15.0±4.3% vs. 27.5±11.5 (P=0.028), mean VAS was 3.3±0.9 vs. 5.8±1.9 (P=0.012). These results indicated that proactive treatment with tacrolimus ointment is effective for better disease control and recommended for moderate AD patients who presented as mean SCORAD around 20, less than 20% affected area and less than 5 VAS.

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