Novel therapeutic approach for maintenance treatment with proactive management in childhood atopic dermatitis; mechanistic analysis

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Efficacy of proactive therapy for sensitization to antigens in children with atopic dermatitis (AD) has not been enough described prospectively. To clarify the mechanisms that set off the atopic march, we conducted a randomized, open-label, parallel group study to evaluate the efficacy and safety of proactive management in pediatric patients with moderate to severe AD. Subjects in the proactive treatment group received an intermittent preventive administration of topical corticosteroid for 1 year. The SCORAD index and TARC level significantly decreased in the proactive group. Although ointment use in both groups were not statistically significant, the mean increase in house dust mite-specific IgE level was significantly higher in the reactive treatment group than in the proactive group at the 12 -month study visit. The results of the present study suggest the possibility that maintenance of infantile AD remission by means of intermittent preventive application of topical corticosteroids can effectively prevent subsequent sensitization to aeroallergens and perhaps to the so-called “atopic march.”