Atopic dermatitis and skin diseaseDifferent effects of pimecrolimus and betamethasone on the skin barrier in patients with atopic dermatitis
Section snippets
Patients and treatment regimens
Fifteen patients with mild-to-moderate AD (according to Hanifin and Rajka criteria) and a target lesion score of 3 to 8 (on a scale of 0-12) for both right and left target lesions, and symmetric AD lesions (not differing >1 point between the right and left sides) affecting the upper limbs by at least 10% were treated twice daily for 3 weeks on 1 upper limb with 1% pimecrolimus cream and on the other upper limb with 0.1% betamethasone valerate cream in a double-blind manner. Follow-up
Clinical assessment and stratum corneum hydration
Clinical assessments were performed before the treatment period (day 1), during the treatment period (days 8, 15, and 22), and after a 1-week follow-up period (day 29) to correlate clinical response with possible alterations in skin barrier function. On day 8, considerable clinical improvement was seen after treatment with both betamethasone and pimecrolimus, as assessed by using the pEASI, which includes erythema, infiltration, excoriation, and lichenification. Symptoms of patients treated
Discussion
It has now become clear that defects in the epidermal barrier might be as important as immune dysregulation, which has long been considered the primary cause of AD. It has recently been proposed that inflammation in patients with AD results from inherited and acquired insults to the barrier, and the therapeutic implications of this paradigm have been discussed.36 Repair of the epidermal barrier might become an important objective in the development of new drugs for the treatment of AD. Hence it
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Supported by grants of the Deutsche Forschungsgemeinschaft (SFB415/B2 and SFB617/A7, A21) and Novartis Pharma, Nürnberg (Germany), given to E. Proksch and J.-M. Jensen. T. Schwarz and E. Proksch have acted as consultants to Novartis. M. Bräutigam is employed by Novartis.
Disclosure of potential conflict of interest: J.-M. Jensen has received a travel grant from Novartis. T. Schwarz has received grants from Novartis and Therakos and has served as an advisor for Novartis. The rest of the authors have declared that they have no conflict of interest.