Treatment of childhood intractable atopic dermatitis

Abstract

Atopic dermatitis (AD) is a disease that affects approximately 10% of the total population in Japan and is frequently encountered in pediatric daily medical care. Uncontrolled refractory AD is not uncommon, even with basic treatment. From the viewpoint of the clinician, this scenario is thought to be caused by problems that can be attributed to both the patient and the healthcare worker. Problems on the patient's side include poor treatment adherence and severe AD itself. Poor treatment adherence by the subject may occur owing to the transition of the treatment from the caregiver to the patient himself/herself. Steroid phobia is a major issue and may be caused by a caregiver's misunderstanding of the side effects of topical steroids. Such a situation would require the intervention of a medical staff with accurate knowledge to provide care or training. Problems on the healthcare worker's side include differential diagnosis, existence of complications, inappropriate topical therapy, and inadequate patient education. Furthermore, it is possible that topical steroids are not properly selected, which necessitates the reconsideration of the treatment choice and the method. In addition, approaches other than topical therapy may need to be introduced.