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Topical Corticosteroids (TCS)

• Use a high-potency topical corticosteroid on the body and a moderate-potency one on the face, in infants, children, and adults, during an atopic dermatitis flare-up. Apply once daily until lesions disappear, without progressive tapering.

On the eyelids, the use of moderate TCS is possible during the acute phase, but a switch to a topical calcineurin inhibitor should be considered for chronic forms.

• No maximum quantity for acute treatment
• A long-term quantity > 4 tubes (30 grams each) of high-potency TCS per month in adults requires a specialist opinion

• Apply topical corticosteroids according to the Finger Tip Unit rule (corresponding to the amount of cream squeezed onto the entire length of the last phalanx of an adult's index finger, allowing for the treatment of an area equivalent to their two palms).
• Same application methods for both children and adults, as first-line treatment for flare-ups and as proactive treatment.

Adverse events (AEs) of TCS are exceptional if used according to recommendations and depend mainly on the potency, duration of use, and application sites (described AEs: skin atrophy, stretch marks, hypertrichosis, facial erythrosis, contact allergies, and risk of depigmentation on dark skin.)

Finally, it is important to screen for corticosteroid phobia (corticophobia), especially when there appears to be a lack of efficacy with TCS.

Topical Calcineurin Inhibitor (TCI)

There are currently two TCIs: tacrolimus ointment and pimecrolimus cream:

• Only topical tacrolimus is marketed in France.
• Prescription on an "exception prescription" form by a pediatrician or dermatologist.
• Currently, only tacrolimus 0.1% ointment is reimbursed for the treatment of severe AD flare-ups in adults.

The Finger Tip Unit (FTU) and the reactive and proactive treatment modalities also apply to TCIs.

• During an acute atopic dermatitis flare-up, initiate treatment with a topical corticosteroid before starting a topical calcineurin inhibitor to improve its tolerance.
• Use topical calcineurin inhibitors in adults and children, particularly in cases of repeated use and in skin areas at risk of atrophy from topical corticosteroids (face including eyelids, skin folds, anogenital region).

Wet Wraps

• In patients presenting with acute erosive and/or oozing lesions or lichenified lesions, "wet wraps" using high-potency TCS can be proposed for a few days to achieve rapid improvement. Treatment initiation is ideally performed in a hospital setting or at home under the guidance of appropriate therapeutic education. Educational videos are available online.

NB.

See the Toolbox: Finger Tip Unit and wet wrapping example.

➜ Tool box ➜ Traitement proactif en cas de récidives fréquentes

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