Wednesday, 14 October 2015
Hall D1 Foyer (Floor 3) (Coex Convention Center)
Mayako Saito, MD
,
National Center for Child Health and Development, Tokyo, Japan
Masami Narita
,
National Center for Child Health and Development, Tokyo, Japan
Akio Yoshida
,
Division of Allergy, National Center for Child Health and Development, Japan
Tomohisa Ando
,
Division of Allergy, National Center for Child Health and Development, Japan
Miyuki Hashimoto
,
Division of Allergy, National Center for Child Health and Development, Japan
Mai Kondo, MD
,
Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
Aki Gen
,
Division of Allergy, National Center for Child Health and Development, Japan
Yumiko Miyaji
,
Division of Allergy, National Center for Child Health and Development, Japan
Shinichiro Inagaki
,
Division of Allergy, National Center for Child Health and Development, Japan
Osamu Natsume
,
Division of Allergy, National Center for Child Health and Development, Japan
Tetsuo Shoda
,
National Center for Child Health and Development, Tokyo, Japan
Kiwako Yamamoto-Hanada, MD
,
National Center for Child Health and Development, Tokyo, Japan
Tomoko Suda
,
Division of Allergy, National Center for Child Health and Development, Japan
Ichiro Nomura
,
National Center for Child Health and Development, Tokyo, Japan
Yukihiro Ohya
,
National Center for Child Health and Development, Tokyo, Japan
Background: Proactive treatment of atopic dermatitis (AD) with intermittent application of anti-inflammatory agents after induction of remission has been recommended as a maintenance therapy for the long-term management of AD. Most of the previous studies examined the effect of twice-weekly application of topical corticosteroid (TCS). In our hospital, once remission can be achieved with this dosage, we will attempt to reduce the frequency with the aim of ceasing the usage of TCS.
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.
