Reconsidering the procedures for appropriate topical corticosteroid treatment

-Which medicament? What amount? To where? How long?-

Abstract

Although atopic dermatitis is a chronic skin disease, complete remission is also expected when well controlled status is maintained. Therefore treatment goal is to keep no or minimal skin lesion with little medication. To achieve the goal, it is important to control cutaneous inflammation appropriately by reliable treatment for which topical corticosteroids play the major role. In Japan, disease activity of atopic dermatitis has been able to be measured by serum TARC that is a highly sensitive biomarker under health insurance support since 2008. After reviewing the previous topical corticosteroid application methods of severe intractable cases with their serum TARC, it is identified that considerable numbers of patients have been suffered with severe prolonged inflammation as a result of insufficient application of topical corticosteroid. Conventionally topical corticosteroid application method has depended on the art or the sense of individual dermatologist, however it should be reconsider precisely and scientifically.
Several clinical evidences and practical benefit reveal that the concept of treatment strategy should be “tight control” which achieved early complete remission and long-term maintenance of no inflammation even subclinically. Advantage of proactive treatment, prolonged high serum TARC level which suggest persistent enhancement of inflammation by positive feedback, difference value of serum IgE elevation with eczema controlled status in severe atopic dermatitis infants, easily understandable finish line for both patients and physicians, best quality of life without any symptoms for patients, these are the reasons.
Additionally practical procedures of adequate topical corticosteroid application to accomplish the treatment goal were proposed precisely about following questions. Which medicament? What amount? To where? How long?Skin Research, Suppl. 18: 2-8, 2012