Current Issues in the Management of Atopic Dermatitis in the Pediatric Patient
Highlights of a Clinical Roundtable
A supplement to Pediatric News supported by an unrestricted educational grant from Novartis. This supplement was jointly sponsored by The Elsevier Office of Continuing Medical Education (EOCME), an ACCME accredited provider, and Pediatric News.
The articles in this supplement are based on a clinical roundtable as well as one clinical dialogue.
To view the supplement, click the image above. To take the CME test, download and print out the PDF file, and follow the test instructions on page 16.
Contents
Introduction
Atopic Dermatitis Today: A Brief Overview
Topical Calcineurin Inhibitors: A Critical Analysis of Current Issues
Skin Cancer and Immunosuppression
Lymphomas: Clarifying the Issues
Cutaneous T-Cell Lymphoma versus Atopic Dermatitis
Infections and Topical Calcineurin Inhibitors: The Data in Perspective
Significance of Calcineurin Inhibitor Blood Levels
Childhood Vaccine Responses
Combination Topical Therapy
Treatment of Infants With Atopic Dermatitis
Black Box Warnings in Dermatology
Referral to a Dermatologic Specialist
Faculty
James J. Leyden, MD, Chair
Professor of Dermatology
University of Pennsylvania School of Medicine
Philadelphia Consultant: Novartis Pharmaceuticals Corporation
Lawrence F. Eichenfield, MD
Professor of Pediatrics and Medicine (Dermatology)
Chief, Pediatric and Adolsescent Dermatology
University of California, San Diego/Children's Hospital
San Diego Clinical Grants: Astellas Pharma Inc., Connectics Corporation, Ferndale Laboratories, Hill Laboratories, Inc., GlaxoSmithKline, and Novartis; Consultant/Speaker's Bureau: Astellas, Connectics and Novartis. He has stated that he will reference the unlabeled/unapproved uses of the following drugs: pimecrolimus, tacrolimus, and several topical corticosteroids.
Eva C. Guinan, MD
Associate Director
Center for Clinical and Translational Research
Dana-Farber Cancer Institute
Boston Consultant: Novartis
Stuart R. Lessin, MD
Director of Dermatology
Fox Chase Cancer Center
Philadelphia Consultant: Yaupon Therapeutics, Inc.
Seth J. Orlow, MD, PhD
Professor of Dermatology, Cell Biology, and Pediatrics
Director of Pediatric & Adolescent Dermatology
New York University School of Medicine
New York Consultant/Speaker's Bureau: Astellas and Novartis. He has stated that he will reference the unlabeled/unapproved uses of the following drugs: topical corticosteroids for infants; pimecrolimus and tacrolimus for infants; oral medications for atopic dermatitis (cyclosporine, azathioprine).
Michael D. Tharp, MD
Chair, Department of Dermatology
Rush University Medical Center
Chicago Clinical Grants/Consultant: Astellas and Novartis
Target Audience
This activity has been developed for pediatricians, dermatologists and other health care professionals who are involved in the diagnosis and management of patients with atopic dermatitis and other immune-mediated inflammatory diseases of the skin.
Educational Needs
Atopic dermatitis is a chronic inflammatory skin disease that is extremely common in childhood. The prevalence of this condition had been increasing in recent decades and is now estimated to affect more than 17% of children in the United States. Atopic dermatitis frequently predates development of asthma and allergic rhinitis in later childhood.
Because traditional treatment regimens for atopic dermatitis center on topical corticosteroids, physicians need to understand the role of topical calcineurin inhibitors in treatment. The two corticosteroid-free topical medications, pimecrolimus and tacrolimus, add to the clinician's options for managing this complex and poorly understood disease.
Atopic dermatitis is characterized by itching, flaking, and inflamed skin, and these signs and symptoms often are accompanied by considerable discomfort and social embarrassment. Moreover, atopic dermatitis is associated with the risk for complications, including serious skin infections. This knowledge is particularly important in light of the US Food and Drug Administration's (FDA) recent advisory letter to clinicians regarding the topical calcineurin inhibitors. For these reasons, clinicians need to remain up-to-date on the benefits and risks of all of the available treatments for atopic dermatitis and understand the proper use of these therapies.
Learning Objectives
By reading and studying this supplement, participants should be able to:
• Understand and list the risks and benefits, efficacy, and safety of topical corticosteroids and topical calcineurin inhibitors to treat atopic dermatitis.
• Recognize the clinical distinctions between atopic dermatitis and early stage cutaneous T-cell lymphoma.
• Explain how calcineurin inhibitors fit into the long-term management of atopic dermatitis and the role of other treatments, including topical corticosteroids, further discussion of steroids which cannot be used long term.
• Discuss the major issues in the controversy over the purported risk for cancer resulting from the use of topical calcineurin inhibitors.
• Explain the difference between health risks associated with topical calcineurin inhibitors versus those associated with oral formulations of these agents.
Accreditation
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Elsevier Office of Continuing Medical Education (EOCME) and Pediatric News. The EOCME is accredited by the ACCME to provide continuing medical education for physicians.
The EOCME designates this educational activity for a maximum of 2.0 AMA/PRA category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the educational activity.
