From the Guidelines
Chronic spongiotic dermatitis, also known as atopic dermatitis, should be treated with phototherapy and systemic therapies, including biologic therapies and Janus kinase (JAK) inhibitors, for patients refractory to topical therapies, as recommended by the 2024 guidelines of care for the management of atopic dermatitis in adults 1.
Diagnosis
The diagnosis of chronic spongiotic dermatitis, or atopic dermatitis, involves a comprehensive evaluation of the patient's medical history, physical examination, and laboratory tests to rule out other skin conditions. Key features of the condition include itchy, red, and scaly patches on the skin, which can be exacerbated by various triggers such as harsh soaps, certain fabrics, stress, and environmental allergens.
Treatment
Treatment of chronic spongiotic dermatitis typically involves a multi-faceted approach, including:
- Topical corticosteroids, such as triamcinolone 0.1% or fluocinonide 0.05%, applied twice daily for 2-4 weeks to reduce inflammation and itching
- Maintenance therapy with lower potency steroids like hydrocortisone 1% or non-steroidal alternatives such as tacrolimus 0.1% or pimecrolimus 1% to prevent side effects from long-term steroid use
- Oral antihistamines, like cetirizine 10mg daily or hydroxyzine 25mg at bedtime, to help control itching
- Regular application of moisturizers, preferably fragrance-free products like CeraVe or Vanicream, to maintain skin barrier function
- Identification and avoidance of triggers, including harsh soaps, certain fabrics, stress, and environmental allergens
- Consideration of patch testing to identify specific allergens or phototherapy as a steroid-sparing option for patients with persistent symptoms despite treatment, as recommended by the 2024 guidelines 1.
Management
Effective management of chronic spongiotic dermatitis requires consistent treatment and prevention of flares and complications. This involves:
- Regular follow-up appointments with a healthcare provider to monitor the condition and adjust treatment as needed
- Patient education on proper skin care and trigger avoidance
- Consideration of biologic therapies and JAK inhibitors for patients with severe or refractory disease, as recommended by the 2024 guidelines 1
- A comprehensive approach to addressing the physical, emotional, and social impacts of the condition on the patient's quality of life.
From the FDA Drug Label
CLINICAL STUDIES Three randomized, double-blind, vehicle-controlled, multi-center, Phase 3 studies were conducted in 589 pediatric patients ages 3 months-17 years old to evaluate ELIDEL ® (pimecrolimus) Cream 1% for the treatment of mild to moderate atopic dermatitis Two of the three trials support the use of ELIDEL Cream in patients 2 years and older with mild to moderate atopic dermatitis The improvement in pruritus occurred in conjunction with the improvement of the patients’ atopic dermatitis.
The diagnosis of chronic spongiotic dermatitis, also known as atopic dermatitis, is based on clinical evaluation, including assessment of signs such as erythema, infiltration/papulation, lichenification, and excoriations, as well as symptoms like pruritus. The treatment for mild to moderate atopic dermatitis includes the use of ELIDEL Cream (pimecrolimus) 1%, applied twice daily to affected skin areas, as directed by a physician 2. Key points to consider when using ELIDEL Cream include:
- Using the smallest amount needed to control signs and symptoms of eczema
- Applying a thin layer only to affected skin areas, twice a day
- Avoiding use on malignant or pre-malignant skin conditions, or in patients with Netherton’s Syndrome or other skin diseases with potential for increased systemic absorption
- Minimizing or avoiding natural or artificial sunlight exposure during treatment 2.
From the Research
Diagnosis of Chronic Spongiotic Dermatitis (Atopic Dermatitis)
- Chronic spongiotic dermatitis, also known as atopic dermatitis, is a chronic inflammatory skin disease characterized by extreme pruritis and lichenified papules and plaques 3.
- The diagnosis of atopic dermatitis is based on the presence of chronic itch, which is a major diagnostic symptom of the disease 4.
Treatment of Chronic Spongiotic Dermatitis (Atopic Dermatitis)
- Topical corticosteroids are the usual treatment for atopic dermatitis, but long-term use may lead to local side effects such as skin atrophy and systemic side effects such as induction of hypothalamus-pituitary-adrenal axis suppression 5.
- Topical immunomodulators, such as tacrolimus and pimecrolimus, are alternative treatments that have been shown to be effective in various long- and short-term placebo-controlled studies 5, 3.
- Tacrolimus has been found to be as effective as class III-V topical corticosteroids for atopic dermatitis of the trunk and extremities, and more effective than low-potency class VI or VII corticosteroids for atopic dermatitis of the face or neck 3.
- Pimecrolimus is less effective than both tacrolimus and low-potency topical corticosteroids for moderate to severe atopic dermatitis 3.
- Novel topical therapies, such as phosphodiesterase inhibitors (e.g. crisaborole), Janus kinase inhibitors (e.g. ruxolitinib and delgocitinib), and aryl hydrocarbon modulators (e.g. tapinarof), are currently in development and have shown promising results in clinical trials 6, 7.
- The choice of treatment depends on the severity of the disease, the location of the affected area, and the patient's response to previous treatments 5, 3.