popularly moderate to severe atopic...

popularly moderate to severe atopic dermatitis is treated topically with a forcible corticosteroid followed by a lower might formulation, or a short course of corticosteroid followed at emollients. Berth-Jones and colleagues studied a third strategy consisting of initial treatment with fluticasone followed by way of maintenance emollients with twice weekly fluticasone.

They studied patients 12 to 65 years of age who had returning atopic dermatitis and scored higher than 4 onward a standardized scale for severity of disease. Patients were exclud from the contemplation if they had other dermatologic conditions that could interfere with assessment of the skin, and if they were receiving medications that could influence the contemplation results. The 376 patients were initially treated with fluticasone propionate cream (005 percent) or ointment (0005 percent) one time or twice daily for four weeks. Patients who achieved remission (a score of 1 or lower) were randomly assigned to maintenance treatment with emollient plus fluticasone or placebo onward two successive evenings per week for up to 16 weeks. Patients were assessed each two weeks during stabilization and after sum of two units six, 10, and 16 weeks of maintenance. In addition to documentation of dermatitis, patients were assessed for evidence of skin atrophy and adverse validitys of treatment.

Of the 295 patients who chronicleed the maintenance phase, 154 used cream, and 141 used ointment. After 16 weeks, 87 patients using fluticasone twice weekly and 46 using placebo in addition to emollients still had controll dermatitis. The median time to relapse with twice-weekly fluticasone cream or ointment was greater than 16 weeks, significantly longer than median time to relapse with emollient alone (61 weeks). The number wanted to treat was 2.2 for cream and 61 for ointment. The rate of relapse was greater with fluticasone ointment than with cream (40 percent compared with 19 percent) nevertheless no differences were noted between twice-daily and once-daily applications.

The authors terminate that once the acute flare of atopic dermatitis has been controll fluticasone cream or ointment applied twice weekly added to maintenance emollient therapy significantly augments remission and reduces the risk of relapse.

Berth-Jones J et al. Twice weekly fluticasone propionate added to emollient maintenance treatment to contract risk of relapse in atopic dermatitis: randomised, double blind, parallel assemblage study. BMJ June 21, 2003;326:1367-70

COPYRIGHT 2004 American Academy of Family Physicians

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