Objective: To investigate the prognosis and topical corticosteroid usage after one year of proactive treatment for children with moderate-to-severe AD.
Methods: A retrospective chart review was conducted for patients under 15 years of age with moderate-to-severe AD (SCORAD >30) hospitalized for the first remission induction at the National Center for Child Health and Development in Tokyo, Japan, between January 2009 and April 2014. The frequency of TCS application one year after admission, together with the level of serum thymus and activation-regulated chemokine (TARC), were assessed.
Results: Seventy-two patients met the inclusion criteria and were analyzed. The median age was 14.5 months old (range: 2 months to 14years) at admission and baseline median SCORAD was 75.5 (IQR: 64.9 -85.85). All patients went into remission within 1-2 months of induction treatment at our hospital. During proactive treatment after remission, most patients used 0.1% hydrocortisone butyrate for the face and 0.1% betamethasone valerate for the body. At the follow-up visit after 12 ±1 months from admission, 49 patients (69.0%) maintained the remission for their face with less than twice-weekly application of TCS (once or less than once-weekly, n=20; emollient only, n=10; topical tacrolimus, n=19). Twenty-nine patients (40.3%) maintained good condition for their body with less than twice-weekly TCS application (once or less than once weekly, n=28; emollient only, n=1). Eleven patients (15.3%) needed TCS three to four times a week due to minor recurrence during proactive treatment. The median level of serum TARC was 5,928 pg/mL (n=72) at admission, which was decreased to 786.5 pg/mL (n=50) after 12±4 months.
Conclusions: Our proactive treatment for moderate-to severe AD resulted in favorable long term-prognosis such as one-year remission with twice-weekly or less application of TCS.