What's new in pediatric dermatology?
Eczema treatment
The new immunomodulators, Protopic® (Tacrolimus) and Elidel® (Pimecrolimus) have been found to be safe and effective in treating young children with eczema. One benefit of using this class of topical agents is that, unlike topical corticosteroids (topical steroid creams, lotions and ointments), these newer agents do not thin the skin and can be used without fear of causing telangiectasias (new blood vessels). They are approved for children as young as 2 years of age. Protopic is an ointment and Elidel is a cream. These drugs can be used alone, in combination with the topical steroids (to achieve "steroid sparing," i.e., to decrease the child’s exposure to corticosteroids) or in combination with each other (an ointment at night and cream during the day).
Why do treatments fail?
It is very important that the patient and the family or caregivers understand how to use medications, both systemic (taken by mouth) or topical. Treatment regimens may not be unusually difficult, but they can be complex and require understanding of how and when to administer what medication. Compliance (using the medication as prescribed) and adherence to the regimen are of the utmost importance.
Treatment for Vitiligo (loss of pigment):
This disease can be a very disturbing psychologically, especially in people of color. Depression, loss of self-esteem, embarrassment, and fear of appearing different from peers can all be devastating psychological effects. There are many treatments for this disease, none of which are perfect or without side-effects. Medical therapies for this disease include:
- Topical steroids
- Systemic steroids
- Topical photochemotherapy (PUVA)
- Oral photochemotherapy (PUVA)
- Phototherapy (narrowband UVB or broadband UVB)
- Dovonex® (Calcipotriene)
- Immunomodulators (Tacrolimus [Protopic] and Pimecrolimus [Elidel])
- Tar products
- Chemical depigmentation
- Targeted light therapy
- Cosmetic cover-ups (i.e., Dermablend®)
When choosing a therapy, consider the extent of the disease, the age of the patient, and the stability or progression of the disease. Obtain routine laboratory work to rule out any underlying systemic disease (i.e., thyroid disease), which could be the cause of the vitiligo. Monotherapy and combination therapies have been shown to be effective when the disease is diagnosed early and treated early in the course of the illness. There is no right or wrong therapy, and skin care treatments should be individualized based on the patient's extent of disease and areas to be treated.
The information provided here should not be used not in place of a visit to the dermatologist. For additional information, consult the National Vitiligo Foundation (http://nvfi.org/index.php) and the American Academy of Dermatology (http://www.aad.org/).
