|Year : 2017 | Volume
| Issue : 3 | Page : 174-176
Treatment guidelines for atopic dermatitis by ISPD Task Force 2016
Sandipan Dhar1, Deepak Parikh2, Ramkumar Rammoorthy3, Sahana Srinivas4, Rashmi Sarkar5, Arun Inamadar6, Manish Shah7, Raghubir Banerjee8, Amrinder Jit Kanwar9, Vibhu Mendiratta10, Renu George11, Ram Gulati12
1 Department of Pediatric Dermatology, Institute of Child Health, Kolkata, West Bengal, India
2 Department of Pediatric Dermatology, Wadia Children Hospital, Mumbai, Maharashtra, India
3 Consultant Pediatric Dermatologist, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India
4 Consultant Pediatric Dermatologist, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
5 Department of DVL-1, CMC, Vellore, Tamil Nadu, India
6 Department of Dermatology, Sri B M Patil Medical College, BLDE University, Bijapur, Karnataka, India
7 Hon. Pediatric Dermatologist, Wadia Hospital for Children, Mumbai, Maharashtra, India
8 Professor of Dermatology, Vivekananda Institute of Medical Science, Kolkata, West Bengal, India
9 Department of Dermatology, Sharda Hospital, Greater Noida, Uttar Pradesh, India
10 Department of Dermatology, Lady Hardinge Medical College, Delhi, India
11 Department of Dermatology, MAMC and Associated LNGP Hospital, New Delhi, India
12 Consultant, Dermatologist, S D M Hospital, Jaipur, Rajasthan, India
|Date of Web Publication||7-Jun-2017|
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|How to cite this article:|
Dhar S, Parikh D, Rammoorthy R, Srinivas S, Sarkar R, Inamadar A, Shah M, Banerjee R, Kanwar AJ, Mendiratta V, George R, Gulati R. Treatment guidelines for atopic dermatitis by ISPD Task Force 2016. Indian J Paediatr Dermatol 2017;18:174-6
|How to cite this URL:|
Dhar S, Parikh D, Rammoorthy R, Srinivas S, Sarkar R, Inamadar A, Shah M, Banerjee R, Kanwar AJ, Mendiratta V, George R, Gulati R. Treatment guidelines for atopic dermatitis by ISPD Task Force 2016. Indian J Paediatr Dermatol [serial online] 2017 [cited 2017 Jun 23];18:174-6. Available from: http://www.ijpd.in/text.asp?2017/18/3/174/207607
| Part-1: General Care of Skin|| |
These guidelines are prepared by ISPD task force. It reflects the groups' experience, opinion and recommendation on the current treatment of atopic dermatitis in the Indian scenario.
| Disclaimer|| |
Adherence to these guidelines will not ensure successful treatment in every situation. Furthermore, these guidelines should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy should be made by the physician and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the disease. This guideline reflects the best available data at the time the guideline was prepared. The results of future studies may require revisions to the recommendations in this guideline to reflect new data.
This guideline outlines various treatment options. The available evidence was evaluated using a unified system called “The Strength of Recommendation Taxonomy.” Grades are assigned on the basis of quality and consistency of available evidence [Table 1] and [Table 2].
| Epidemiology of Atopic Dermatitis in India|| |
Atopic dermatitis (AD) is a chronic, pruritic inflammatory skin disease that occurs most frequently in children but also affects many adults. It has a relapsing course and is often associated with elevated serum IgE levels and a personal or family history of allergic rhinitis and asthma. AD is one of the most common skin diseases which affects up to 20% of children and 1%–3% of adults in most countries of the world. It is often the first step in the development of other atopic diseases such as rhinitis and/or asthma. There is, however, no documentation of atopic march from India. It is not infrequent to see cases of severe AD having concurrent asthma; at times, pulmonary symptoms are exacerbated when the skin lesions are quiescent. It is possible that effective treatment of AD can prevent atopic march. Since the overall severity of AD in India is not much, this could be the reason for not encountering atopic march. Indeed, severity of AD is also related to the climatic and dietary habits. It tends to be more severe in North than South East or West.
AD onset is most common between 3 and 6 months of age. Approximately 60% of patients develop eruption in the 1st year of life and 90% by 5 years of age. Majority of affected individuals have resolution of disease by adulthood, however in 10%–30% of children AD persist. A smaller percentage first develops symptoms in adults. Population-based studies on the epidemiology of AD in India are very few. Most epidemiological data, which are available, are based on hospital-based studies. The prevalence of AD has been increasing over the past few decades in the developed countries and also in India. In 1972, a study from Bihar reported an incidence of 0.38% of the total number of outpatient attendees. In a recent study again from Bihar in 2012, the prevalence of AD was observed to be 7.21% which showed a significant increase from the previous study. Of the 132 patients seen by Kumar et al., in a tertiary care hospital in Bihar, 57 (43.2%) were boys and 75 (56.8%) were girls, male to female ratio was 1:1.3. Other recent hospital-based studies have also determined a low prevalence both in the Northern and Eastern part of the country; the reported prevalence among dermatology outpatient attendees being 0.42% and 0.55%, respectively. In another study from South India, only 0.01% (3 of 2100) of children had AD.,, This relative disparity was attributed to different dietary habits and climate.
Sarkar et al., in a study of clinical-epidemiological profile and factors affecting the severity of AD in North Indian children highlighted that difference in climatic conditions, dietary habits, prolonged breastfeeding, late weaning, larger families, and low frequency of personal and family history of atopy could be contributing to the milder form of AD in children. In 12 months study of the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in the International Study of Asthma and Allergies in Childhood (ISSAC, phase 1), the prevalence of atopic eczema in 56 countries had been found to vary between 3% and 20.5%. As part of phase 1 of ISSAC study, more than 37,000 children from India were studied at 14 different centers. All centers except Kottayam (Kerala) reported 12 months prevalence between 2.4% and 6% while Kottayam reported a prevalence of >9%.
In ISSAC phase 3, prevalence of atopic diseases in more than a million children from around 100 countries was determined using standard questionnaire-based survey. Comparison of data between ISSAC phase 1 and 3 confirmed that worldwide prevalence of AD is increasing, especially in younger children. As far as the prevalence of AD is concerned in the studied age groups, i.e., 6–7 years and 13–14 years, most of the Indian centers participating in the study fell in the lower prevalence (<5%) regions. In a recent study of 4755 cases registered in the outpatient departments of four hospitals one from each zone of the country, the point prevalence of AD on a particular day in November 2012 was 6.75%. The incidence was low in South India. We do not have any documented data about the comparison of prevalence of AD in rural versus metros. Overall prevalence is on the increase. The severity of AD can be graded as mild, moderate, or severe. SCORAD index is a useful tool to grade AD. This index takes into consideration the morphology of the lesions and the extent of involvement using the rule of 9 and the subjective symptoms which include pruritus and sleep loss.
Among the morphological characters, six items have been chosen. These include erythema, edema/papulation, oozing/crusts, excoriations, lichenification, and dryness. Each item should be graded as 0–3 (0 = absent; 1 = mild; 2 = moderate; 3 = severe). Half scoring is not recommended. The area chosen for grading should be representative (average intensity) for each item in a given patient as determined by the clinician, thus excluding one “target” area or the worst affected site. The same site may, however, be chosen for 2 or more items. Dryness should be appreciated in areas not involved by acute lesions and lichenification. The SCORAD is then calculated as follows: A divided by 5 (A stands for area) + B divided by 2 (B stands for intensity) + C (C stands for subjective symptoms: pruritus and sleep loss graded on a scale of 1–10). A/5 + B/2 + C (15,16,17) y.
Financial Support and Sponsorship
This activity was sponsored by Curatio Health Care (I)Pvt. Ltd. from their unlimited Educational Grant.
Conflicts of Interest
There are no conflicts of interest.
| References|| |
Kanwar AJ, Dhar S. Severity of atopic dermatitis in India. Br J Dermatol 1994;131:733-4.
Kanwar AJ, De D. Epidemiology and clinical features of atopic dermatitis in India. Indian J Dermatol 2011;56:471-5.
] [Full text]
Kanwar AJ, Narang T. Adult onset atopic dermatitis: Under-recognized or under-reported? Indian Dermatol Online J 2013;4:167-71.
] [Full text]
Sinha PK. Clinical profile of infantile atopic eczema in Bihar. Indian J Dermatol Venereol Leprol 1972;38:179-84. [Full text]
Kumar MK, Singh PK, Ali Tahir MM. The clinic epidemiological profile and the risk factors associated with the severity of atopic dermatitis in Eastern Indian children. J Clin Diagn Res 2012;6:1162-6.
Dhar S, Kanwar AJ. Epidemiology and clinical pattern of atopic dermatitis in a North Indian pediatric population. Pediatr Dermatol 1998;15:347-51.
Dhar S, Mandal B, Ghosh A. Epidemiology and clinical pattern of atopic dermatitis in 180 children seen in city hospital. Indian J Dermatol 2002;47:202-4. [Full text]
Karthikeyan K, Thappa DM, Jeevankumar B. Pattern of pediatric dermatoses in a referral center in South India. Indian Pediatr 2004;41:373-7.
Sarkar R, Kanwar AJ. Clinico epidemiology profile and factors affecting severity of atopic dermatitis in North Indian Children. Indian J Dermatol 2004;49:115-20.
Bearley R, Keil V, Mutius EV, Pearce N. Worldwide variation in prevalence of symptoms of asthma, allergic rhino-conjunctivitis and atopic eczema ISSAC. Lancet 1998;100:1225-32.
Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR; International Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study Groups. Is eczema really on the increase worldwide? J Allergy Clin Immunol 2008;121:947-54.e15.
Kumar S, Nayak CS, Padhi T, Rao G, Rao A, Sharma VK, et al.
Epidemiological pattern of psoriasis, vitiligo and atopic dermatitis in India: Hospital-based point prevalence. Indian Dermatol Online J 2014;5 Suppl 1:S6-8.
Dhar S. Atopic dermatitis: Indian scenario. Indian J Dermatol Venereol Leprol 1999;65:253-7.
Stalder JF, Taieb A, Consensus report on the the European Task Force on Atopic Dermatitis (coordinators). Severity scoring of atopic dermatitis: The SCORAD index. Dermatology 1993;186:23-31.
[Table 1], [Table 2]