Proactive versus reactive therapy: due approcci terapeutici a confronto

Conventional treatment for atopic dermatitis (AD) consists in daily application of topical corticosteroids or topical calcineurin inhibitors on visible skin lesions on an "as needed" basis. This traditional reactive approach has been challenged by the proactive treatment concept, which approaches AD treatment on a long term basis. This proactive strategy uses intensive topical anti-inflammatory therapy until all lesions have mostly cleared, followed by long-term, low dose intermittent application of anti-inflammatory agents to previously affected skin areas to prevent disease relapse. A proactive approach to treatment is supported by the evidence that even normal-looking, nonlesional skin of AD is characterized by an impaired barrier function and a sub-clinical eczematous skin reaction. Therefore, proactive therapy is an attempt to control residual disease with minimal use of anti-inflammatory agents. Clinical trial data are available for long term, twice-weekly applications of both to...