What is the recommended treatment for skin asthma?

Treatment for Atopic Dermatitis (Skin Asthma)

Topical corticosteroids are the first-line treatment for atopic dermatitis (commonly called "skin asthma"), with medium to high potency corticosteroids recommended for moderate to severe cases and lower potency formulations for sensitive areas or mild cases. 1

First-Line Treatments

Topical Corticosteroids

• Low potency (e.g., hydrocortisone 1-2.5%): For mild cases, facial application, or sensitive areas
• Medium potency (e.g., triamcinolone 0.1%): For moderate cases on the body
• High potency (e.g., fluocinonide 0.05%): For severe or resistant cases
• Apply twice daily during flares, reducing to once daily as improvement occurs
• Use for 2-4 weeks for active flares, then taper to prevent side effects 2

Topical Calcineurin Inhibitors (TCIs)

• Tacrolimus (0.03% for children, 0.1% for adults): Particularly effective for facial and intertriginous areas
• Pimecrolimus (1%): For milder cases
• Especially useful for areas where skin atrophy from corticosteroids is a concern 3

Treatment Algorithm Based on Severity

Mild Atopic Dermatitis

1. Basic skin care with non-soap cleansers and regular moisturizing
2. Low-potency topical corticosteroids for 1-2 weeks during flares
3. Consider tacrolimus or pimecrolimus for facial or intertriginous areas

Moderate Atopic Dermatitis

1. Medium-potency topical corticosteroids for body areas (2-3 weeks)
2. Low-potency corticosteroids or TCIs for face/sensitive areas
3. Wet wrap therapy for enhanced penetration in resistant cases

Severe Atopic Dermatitis

1. High-potency topical corticosteroids for short courses (1-2 weeks)
2. Consider systemic therapy if inadequate response:
   • Oral corticosteroids (short course for severe flares)
   • Immunosuppressants for chronic severe cases

Important Clinical Considerations

Monitoring for Side Effects

• Watch for skin atrophy, striae, telangiectasia with prolonged corticosteroid use
• TCIs may cause initial burning/stinging but lack the atrophogenic effects of corticosteroids
• Approximately 50% of patients may experience some form of cutaneous side effect from topical corticosteroids 2

Addressing Comorbidities

• Treat secondary bacterial infections (often S. aureus) with appropriate antibiotics
• Consider antifungals for suspected fungal superinfection
• Manage allergic triggers through avoidance strategies

Maintenance Therapy

• Daily moisturizing with emollients is essential
• Proactive twice-weekly application of topical anti-inflammatory agents to previously affected areas can prevent flares
• Consider "weekend therapy" with topical corticosteroids for patients with frequent recurrences

Special Considerations

For Children

• Use the lowest effective potency of topical corticosteroids
• Tacrolimus 0.03% is approved for children ≥2 years
• Monitor growth in children requiring frequent or prolonged treatment

For Sensitive Areas

• Face, neck, genitals, and intertriginous areas: Use low-potency corticosteroids or TCIs
• Evidence suggests tacrolimus is more effective than low-potency corticosteroids for facial dermatitis 3

Proper patient education about application techniques, potential side effects, and the importance of adherence to treatment regimens is crucial for successful management of atopic dermatitis.