Atopic dermatitis (AD) is a chronic, recurring, pruritic, inflammatory skin condition which has its onset in early childhood in most cases. A stepped approach to
therapy, starting with
emollients and adding first mild and then more potent topical medications is recommended. For more than 50 years, topical
corticosteroids (TCs) have been the gold standard in AD
therapy. Increasingly potent TCs have tended to come with increasing risk of adverse events, however. Calculating the benefit/risk ratio [or therapeutic index (TIX)] for TCs when treating children and infants is more challenging in this population. Not only does their increased surface area to volume ratio as a result of their small size mean that they are likely to absorb a greater proportion of any active agent applied to their skin, but
drug metabolism is slower than in adults and the systemic effects of
corticosteroids are more pronounced (in particular reduction of serum
cortisol levels through suppression of the hypothalamic-pituitary-adrenal axis). Unlike traditional TCs, topical
calcineurin inhibitors are not associated with the systemic effects and have shown good efficacy in treating AD in children. Parental/Carer concerns about their long-term use can limit their acceptance for treatment in the paediatric population, however. Modifications to the structure of fourth generation
corticosteroids mean that increased potency is not accompanied by increased risk of adverse events and hence they have an improved TIX.
Methylprednisolone aceponate is a potent fourth generation
corticosteroid which has demonstrated efficacy and safety in acute and maintenance programmes in infants and children. It is licenced for once-daily use, and is available in four formulations -
ointment, fatty
ointment, cream and milk, which combine with its improved TIX to meet the needs of young patients and their carers.