Proactive therapy in atopic dermatitis

Atopic dermatitis (AD) is a common pruritic genetically based dermatitis and a part of the Atopic March. Treatment is started based on the severity of AD with a multidisciplinary approach in complicated cases. In the last 15 years, an alternative treatment strategy approach was proposed in which physicians almost never stop with the treatment, but continue with the application of the creams or the ointments twice weekly at sites of treated eczema with a combined application of emollients or bland vehicles. At the end of the 1990s, it was referred to as “step-down” therapy by Glazenburg, van der Meer, and Oranje (1999). Later this was called proactive treatment in 2009 with the major difference that healed spots also were continuously treated at a low frequency. Proactive treatment, emollient supplementation, and bleach baths in cases of overt secondary infection are now the key steps in the modern treatment of AD. Wet wraps with diluted corticosteroids are excellent as a crisis intervention in severe childhood atopic dermatitis. Wet wraps with diluted corticosteroids for severe AD is an effective therapy option for at least a period of 4 weeks. For longer term, proactive approach with wet wrap treatment (WWT) is very useful and safe if supervised by a nurse practitioner.

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