Topical therapy of dermatoses in children with complex localizations

The skin of children has its own anatomical and physiological characteristics, the epidermis is much thinner than in adults, the layers of the dermis and basement membrane are poorly developed and differentiated, the rate of transepidermal water loss is increased and the level of natural moisturizing factor (NMF) is reduced. Such a structure of the skin predisposes to a violation of its barrier function, contributes to the occurrence of skin diseases, provides an increased resorptive capacity of the skin and requires special attention when prescribing external therapy. The use of high-quality emollients is an important part of the basic treatment of chronic dermatoses and has its own characteristics in childhood. The use of emollients prevents the development of exacerbations and reduces the need for anti-inflammatory topical drugs. With the localization of the inflammatory process on the face, neck, genitals and large folds, it is necessary to give preference to short courses of topical glucocorticosteroids (THCS) with sufficient anti-inflammatory activity, rapid onset of action, minimal side effects. Given the high risk of side effects in children in these areas of the skin, strong fluorinated THCS, high-potency THCS, and the use of THCS under occlusive dressings are not recommended. The Russian experience of using 0.1% methylprednisolone aceponate in children of various age groups in the treatment of allergic dermatoses, including those with localization in sensitive areas, has shown good efficacy, tolerance and the absence of side effects. he article presents own clinical observations of the effectiveness of the use of combination therapy: an emollient agent - a special cream with physiological lipids omega 3-6-9 and cream methylprednisolone aceponate (with ceramides in the base) in the treatment of skin diseases in children with an emphasis on complex localizations, such as face, folds, genital area.

Efficacy and safety of dupilumab in complex treatment of patients with severe atopic dermatitis

The increased level of interleukins IL-4 and IL-13 in the area of skin lesions, which are secreted by type 2 T-helpers, eosinophils and other immunocompetent cells, plays a main role in the pathogenesis of AD according to modern concepts. The genetically engineered drug dupilumab selectively binds to the subunit of IL-4Rα receptor complexes for IL-4 and IL-13 and inhibits the signaling function of these cytokines. The drug is approved for the treatment of patients with moderate to severe AD who have indications for systemic therapy, regardless of the use of topical corticosteroids from 6 years age. The efficacy and safety of dupilumab in the treatment of patients with atopic dermatitis has been confirmed by the results of numerous clinical studies. Material and methods.The study included 11 patients with moderate and severe AD at the age from 18 to 48 years. All patients received systemic treatment with dupilumab, topically used methylprednisolone aceponate (two times a day for the first 4 weeks, then a calcineurin inhibitor two times a day until the end of the observation period), emollients (two times a day). The initial dose of dupilumab was 600 mg (two injections of 300 mg at different injection sites), then 300 mg every 2 weeks. Results. After 6 months of complex therapy 73 % of patients achieved IGA 0/1. The SCORAD index decreased by an average of 71.7 % after 6 months. The mean value of the NRS scale decreased by 63.2 %. There were no adverse events reported that would lead to drug withdrawal. Conjunctivitis was noted in 2 (18.2 %) patients. Conclusion. There was a marked decrease in the intensity of the main clinical symptoms (SCORAD), including pruritus (NRS), a significant decrease in the manifestations of anxiety and depression (PROMIS).

Experience in the treatment of dermatitis in children. Clinical examples

Modern external therapy of dermatoses is aimed at controlling the subjective symptoms, the dynamics of inflammatory manifestations, the achievement and duration of remission. The step-by-step approach to the treatment of dermatoses in children and adults is based on the adequate use of various external forms and means according to the inflammatory manifestations and localization of the inflammatory process. The article describes clinical cases of treatment of atopic dermatitis in patients aged 8 and 11, and contact allergic dermatitis in a 15-year-old adolescent using methylprednisolone aceponate cream with ceramides in its base, tacrolimus ointment and emollients. High efficacy and safety of anti-inflammatory drugs for external use have been shown. Clinical examples have proven that the combined use of topical corticosteroids and emollients contributes to a rapid reduction of skin dryness and itching, as well as the intensity of inflammation. The possibility of combining methylprednisolone aceponate cream with ceramides in the base once a day and emollients with physiological lipids increases the effectiveness of therapy and reduces the risks of side effects when using topical corticosteroids in children.

Effectiveness of Dermatosis Topical Therapy

In the complex treatment of skin diseases, the important place is given to topical therapy, which has high efficiency and minimal side effects. At the same time, the leaders of such therapy are glucocorticosteroids, calcineurin inhibitors and emollients. The article provides examples of effective topical therapy of various dermatoses using methylprednisolone aceponate and calcineurin inhibitors, as well as emollients containing polyunsaturated omega-3-6-9 fatty acids. The latter are important components for basic skin care for patients with dermatoses.

Pediatrician’s view about the treatment of atopic dermatitis with methylprednisolone

The article considers the present-day idea of the etiopathogenesis of atopic dermatitis in children, which forms, from the pediatrician’s point of view, basis for decision making on effective modern therapeutic and preventive measures. Due attention is given to the description of highly effective topical glucocorticosteroids, which allows to gain control over the disease within a short time. Among all the topical corticosteroids of methylprednisolone aceponate 0.1%, local glucocorticosteroid can be used in children aged 4 months and older and has an optimal therapeutic index, safe, which is proved in the randomized trials. The article states the principles of management of sick children with atopic dermatitis, taking into account a wide range of comorbid conditions and diseases.

Rowell syndrome in dermatological practice (a clinical case)

Rowell syndrome is a rare cluster of symptoms characterized by clinical manifestation of lupus erythematosus and erythema multiforme (EM). About 100 cases of the syndrome have been reported in medical publications during the last 100 years. This may be related to misinterpretation of the symptoms and subsequent incorrect diagnosis due to its EM-like manifestations. Important clues for the diagnosis of Rowell syndrome are findings of positive rheumatoid factor, anti-nuclear antibodies and other erythematoid markers, as well as additional investigations, in particular, direct immunofluorescence technique. The paper describes a clinical case of Rowell syndrome in a 16-year old male patient. The diagnosis was challenging due to EM-like skin manifestations and required additional laboratory work-up, as well as the patient's follow-up. The diagnosis of Rowell syndrome was based on the clinical manifestations and on such diagnostic criteria as positive rheumatoid factor and anti-nuclear antibodies, as well as histological and laboratory abnormalities characteristic of the erythematosis. The patient was hospitalized and received the following treatment: prednisolone infusion (2.5 mg/kg/daily for 7 days), chloropyramine (1 mL i.m. twice daily for 5 days), hydroxychloroquine (6.5 mg/kg daily for 5 days), magnesium asparaginate/potassium asparaginate (one tablet (166.3 mg/175 mg) 3 times daily for 7 days), topical methylprednisolone aceponate cream 1% (once daily for 7 days). The treatment resulted in positive changes in the skin lesion and improvement of his general state. This clinical observation gives an example of classic Rowell syndrome proven both by lab and clinical signs, taking into account skin symptoms of lupus erythematosus and EM-like rash.