Combined Antibiotic, Steroid, and Moisturizer for Atopic Dermatitis Pediatric Dermatology

TAKE-HOME MESSAGE

• In this survey-based study, patients with atopic dermatitis (n=728) who were treated with a combined topical regimen of compounded antibacterial (mupirocin 2% cream), steroid (betamethasone valerate 0.1% cream), and a commercially available moisturizer (250–500 g) reported their patient-oriented eczema measure (POEM) scores at frequent intervals. Patients were instructed to apply the product 5 to 7 times per day initially, slowly tapering to once daily with improvement. In all age groups (0–1, 2–7, 8–24, and 25+ years), a significant drop in POEM score was seen between initiation and 30 days, followed by no significant difference between scores at 30, 90, and 180 days.

• A combined regimen of a topical antibiotic, a steroid, and an emollient demonstrated significant patient-reported improvement of eczema within the first month of use, followed by maintenance of the reported improvement with continued use.

– Margaret Hammond, MD

Abstract

BACKGROUND

Eczema treatments that target Staphylococcus aureus include topical mixtures of antimicrobial agent and corticosteroid diluted in a moisturizer base, previously described in the literature as compounded antibacterial, steroid, and moisturizer (CASM). There have been no placebo-controlled blinded studies of CASM. Thus, patient-reported outcome data may prove valuable.

OBJECTIVE

To determine the patient-reported clinical course of eczema treatment with CASM.

METHODS

Longitudinal case series between May 2016 and August 2018 of CASM patients/parents. Patients completed surveys including the POEM measure at start of treatment, 1 week, 2 weeks, 1 month, 3 months, 6 months, 9 months, and 12 months thereafter. Response curves were fitted to severity measures over time and compared by patient age group; survival analysis was used to estimate time-to-clear status as a function of patient age and initial severity.

RESULTS

A total of 2153 reports were received from 728 unique respondents with a median patient age of 7 and range of 0-85. Response curves showed significant improvement over time leading to plateaus between 30 and 60 days of treatment. Overall mean improvement between start and day 90 for POEM was 14.3 (from 20.0 [95% CI 11.4-28.8] to 5.7 [95% CI -3.2 to 14.8]). Improvement was seen in each age group.

CONCLUSIONS

Patient-reported outcomes suggest efficacy of CASM. There were large reductions in POEM scores, mostly in the first 30 days of treatment for all age groups.

Pediatric Dermatology

Combined Antibiotic, Steroid, and Moisturizer for Atopic Dermatitis: A Two-Year Case Series Of Patient-Reported Outcomes

Pediatr Dermatol 2020 Dec 12;[EPub Ahead of Print], J Rajkumar, N Jetter, K Samuels, A Schwartz 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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