Atopic dermatitis medical therapy: Difference between revisions
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*** '''Adult''' | *** '''Adult''' | ||
**** Preferred regimen (1): Phototherapy Ultraviolet light therapy (phototherapy) with PUVA (psoralens plus ultraviolet A radiation), 3 times a week | **** Preferred regimen (1): Phototherapy Ultraviolet light therapy (phototherapy) with PUVA (psoralens plus ultraviolet A radiation), 3 times a week | ||
**** Preferred regimen (2): [[drug name|cyclosporine]] PO 3-5 mg/kg o.d. for 6 weeks ('''monitor BP and serum creatinine q2 weeks for three months, f/u q month)''' | **** Preferred regimen (2): [[drug name|cyclosporine]] PO 3-5 mg/kg o.d. for 6 weeks ('''monitor BP and serum creatinine q2 weeks for three months, f/u q month)'''<ref name="pmid107273133">{{cite journal |vauthors=Czech W, Bräutigam M, Weidinger G, Schöpf E |title=A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life |journal=J. Am. Acad. Dermatol. |volume=42 |issue=4 |pages=653–9 |date=April 2000 |pmid=10727313 |doi= |url=}}</ref> | ||
**** Alternative regimen (1) methotrexatePO | **** Alternative regimen (1) methotrexatePO | ||
**** Alternative regimen (2): azathioprine PO | **** Alternative regimen (2): azathioprine PO | ||
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*** '''Pediatric''' | *** '''Pediatric''' | ||
**** Preferred regimen (1): | **** Preferred regimen (1): | ||
**** Preferred regimen (2): [[drug name|cyclosporine]] PO 3 to 5 mg/kg per day o.d. for 6 weeks ('''monitor BP and serum creatinine q2 weeks for three months, f/b q month)''' | **** Preferred regimen (2): [[drug name|cyclosporine]] PO 3 to 5 mg/kg per day o.d. for 6 weeks ('''monitor BP and serum creatinine q2 weeks for three months, f/b q month)'''<ref name="pmid107273134">{{cite journal |vauthors=Czech W, Bräutigam M, Weidinger G, Schöpf E |title=A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life |journal=J. Am. Acad. Dermatol. |volume=42 |issue=4 |pages=653–9 |date=April 2000 |pmid=10727313 |doi= |url=}}</ref> | ||
**** Alternative regimen (1) Phototherapy Ultraviolet light therapy (phototherapy) with PUVA (psoralens plus ultraviolet A radiation), 3 times a week | **** Alternative regimen (1) Phototherapy Ultraviolet light therapy (phototherapy) with PUVA (psoralens plus ultraviolet A radiation), 3 times a week | ||
**** Alternative regimen (2): azathioprine PO | **** Alternative regimen (2): azathioprine PO | ||
| Line 93: | Line 93: | ||
**** Wet wrap therapy: desoximetasone 0.25% top. then occluded with wet wraps q12h | **** Wet wrap therapy: desoximetasone 0.25% top. then occluded with wet wraps q12h | ||
*** Alternative regimen (1) Phototherapy: narrowband ultraviolet B or psoralen plus ultraviolet A two to three times per week | *** Alternative regimen (1) Phototherapy: narrowband ultraviolet B or psoralen plus ultraviolet A two to three times per week | ||
*** Alternative regimen (2): cyclosporine PO 2.5 to 5 mg/kg o.d. ('''C/I -''' '''abnormal renal function, uncontrolled hypertension or infection, and malignancy''') | *** Alternative regimen (2): cyclosporine PO 2.5 to 5 mg/kg o.d. ('''C/I -''' '''abnormal renal function, uncontrolled hypertension or infection, and malignancy''')<ref name="pmid10727313">{{cite journal |vauthors=Czech W, Bräutigam M, Weidinger G, Schöpf E |title=A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life |journal=J. Am. Acad. Dermatol. |volume=42 |issue=4 |pages=653–9 |date=April 2000 |pmid=10727313 |doi= |url=}}</ref> | ||
*** Alternative regimen (3): prednisone 40 to 60 mg o.d. for one week, then taper the dose over the following two to three week | *** Alternative regimen (3): prednisone 40 to 60 mg o.d. for one week, then taper the dose over the following two to three week | ||
*** Alternative regimen (4): methotrexate 7.5 to 25 mg single weekly dose with folic acid 1 mg o.d. | *** Alternative regimen (4): methotrexate 7.5 to 25 mg single weekly dose with folic acid 1 mg o.d. | ||
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**** Wet wrap therapy: desoximetasone 0.05% top. then occluded with wet wraps q12h-q24h for 2 to 14 days | **** Wet wrap therapy: desoximetasone 0.05% top. then occluded with wet wraps q12h-q24h for 2 to 14 days | ||
*** Alternative regimen (1) Phototherapy: narrowband ultraviolet B (UVB) 3 times per week ('''older children > 6 years''') | *** Alternative regimen (1) Phototherapy: narrowband ultraviolet B (UVB) 3 times per week ('''older children > 6 years''') | ||
*** Alternative regimen (2): cyclosporine PO 2.5 to 5 mg/kg o.d. for 2-4 months ('''monitor renal and hepatic function''') | *** Alternative regimen (2): cyclosporine PO 2.5 to 5 mg/kg o.d. for 2-4 months ('''monitor renal and hepatic function''')<ref name="pmid107273132">{{cite journal |vauthors=Czech W, Bräutigam M, Weidinger G, Schöpf E |title=A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life |journal=J. Am. Acad. Dermatol. |volume=42 |issue=4 |pages=653–9 |date=April 2000 |pmid=10727313 |doi= |url=}}</ref> | ||
*** Alternative regimen (3): methotrexate 0.5 mg/kg PO single weekly dose with folic acid 1 mg o.d.('''up to a maximum of 25 mg per week''') | *** Alternative regimen (3): methotrexate 0.5 mg/kg PO single weekly dose with folic acid 1 mg o.d.('''up to a maximum of 25 mg per week''') | ||
*** Alternative regimen (4): methylprednisolone 0.5 mg/kg o.d. for 1-2 weeks tapered over one month | *** Alternative regimen (4): methylprednisolone 0.5 mg/kg o.d. for 1-2 weeks tapered over one month | ||
'''Management of Infection:''' | '''Management of Infection:''' | ||
* '''Bacterial''' '''infections''': (most common bacteria - ''Staphylococcus. aureus'') | * '''Bacterial''' '''infections''': (most common bacteria - ''Staphylococcus. aureus'')<ref name="pmid20670815">{{cite journal |vauthors=Ong PY, Leung DY |title=The infectious aspects of atopic dermatitis |journal=Immunol Allergy Clin North Am |volume=30 |issue=3 |pages=309–21 |date=August 2010 |pmid=20670815 |pmc=2913147 |doi=10.1016/j.iac.2010.05.001 |url=}}</ref> | ||
** Clinically infected skin: | ** Clinically infected skin: | ||
*** Mupirocin 2% top. BID for one to two weeks | *** Mupirocin 2% top. BID for one to two weeks | ||
*** More extensive infection: oral antibiotic therapy with cephalosporins or penicillinase-resistant penicillins X two weeks | *** More extensive infection: oral antibiotic therapy with cephalosporins or penicillinase-resistant penicillins X two weeks | ||
** Clinically uninfected skin: | ** Clinically uninfected skin: | ||
*** liquid chlorine bleach- 0.5 cup or 120 ml of 6% bleach in a full bathtub [40 gallons or 150 L] of lukewarm water | *** liquid chlorine bleach- 0.5 cup or 120 ml of 6% bleach in a full bathtub [40 gallons or 150 L] of lukewarm water<ref name="pmid19403473">{{cite journal |vauthors=Huang JT, Abrams M, Tlougan B, Rademaker A, Paller AS |title=Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity |journal=Pediatrics |volume=123 |issue=5 |pages=e808–14 |date=May 2009 |pmid=19403473 |doi=10.1542/peds.2008-2217 |url=}}</ref> | ||
* '''Viral infections:''' | * '''Viral infections:''' | ||
** Herpes simplex: | ** Herpes simplex: | ||
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*** cryotherapy, curettage, cantharidin, and podophyllotoxin as first-line therapeutic options | *** cryotherapy, curettage, cantharidin, and podophyllotoxin as first-line therapeutic options | ||
* '''Fungal infections:''' | * '''Fungal infections:''' | ||
** Dermatophyte infections'''-''' topical or oral antifungals | ** Dermatophyte infections'''-''' topical or oral antifungals<ref name="pmid11421895">{{cite journal |vauthors=Lintu P, Savolainen J, Kortekangas-Savolainen O, Kalimo K |title=Systemic ketoconazole is an effective treatment of atopic dermatitis with IgE-mediated hypersensitivity to yeasts |journal=Allergy |volume=56 |issue=6 |pages=512–7 |date=June 2001 |pmid=11421895 |doi= |url=}}</ref> | ||
'''Controlling pruritus:''' | '''Controlling pruritus:''' | ||
* Preferred regimen''':''' | * Preferred regimen''':''' | ||
Revision as of 19:45, 10 October 2018
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Atopic dermatitis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Atopic dermatitis medical therapy On the Web |
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American Roentgen Ray Society Images of Atopic dermatitis medical therapy |
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Risk calculators and risk factors forAtopic dermatitis medical therapy |
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Atopic dermatitis Microchapters |
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Diagnosis |
|---|
|
Treatment |
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Case Studies |
|
Atopic dermatitis medical therapy On the Web |
|
American Roentgen Ray Society Images of Atopic dermatitis medical therapy |
|
Risk calculators and risk factors forAtopic dermatitis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shalinder Singh, M.B.B.S.[2]
Overview
The mainstay of treatment for atopic dermatitis depends upon the severity of the disease and is treated with a combination of conservative and medical therapy. The goals of treatment include elimination of aggravating factors, skin barrier function repair, maintaining skin hydration and pharmacologic treatment of skin inflammation.
Conservative Therapy
| Elimination of exacerbating factors | Maintaining skin hydration | Controlling pruritus |
|---|---|---|
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Medical Therapy
- Pharmacologic medical therapies for atopic dermatitis can be classified according to the several severity scales( (i.e SCORAD index, the eczema area and severity index [EASI], and the patient-oriented eczema measure [POEM]) which includes characteristics of the rash, questions about itch, sleep, impact on daily activities, and persistence of disease.
Atopic dermatitis
- MIld atopic dermatitis:
- Topical corticosteroids and emollients - mainstay therapy
- Adult
- Preferred regimen (1): desonide 0.05% top. q12h-q24h for 14-28 days
- Preferred regimen (2): hydrocortisone 2.5% top. q12h-q24h for 14-28 days[4]
- Preferred regimen (3): fluocinolone acetonide 0.01% top. q12h-q24h for 14-28 days
- Alternative regimen (1) tacrolimus 0.1% top. q12h (0.03% for adults who do not tolerate the higher dose)[5]
- Alternative regimen (2): pimecrolimus 1% top. q12h[6]
- Alternative regimen (3) crisaborole 2% top.
- Pediatric
- Preferred regimen (1): desonide 0.05% top. q12h-q24h for 14-28 days
- Preferred regimen (2): hydrocortisone 2.5% top. q12h-q24h for 14-28 days[7]
- Preferred regimen (3): fluocinolone acetonide 0.01% top. q12h-q24h for 14-28 days
- Alternative regimen (1) tacrolimus 0.03% top. q12h (Children (>2years)[8]
- Alternative regimen (2): pimecrolimus 1% top. q12h[9]
- Alternative regimen (3): crisaborole 2% top.
- Adult
- Topical corticosteroids and emollients - mainstay therapy
- Moderate atopic dermatitis
- Topical corticosteroids and emollients are the mainstay of therapy
- Adult
- Preferred regimen (1): fluocinolone0.025%. q12h-q24h for 14-28 days
- Preferred regimen (2): triamcinolone 0.1% top. q12h-q24h for 14-28 days
- Preferred regimen (3): fluocinolone acetonide 0.025% top. q12h-q24h for 14-28 days
- Alternative regimen (1) tacrolimus 0.1% top. q12h (0.03% for adults who do not tolerate the higher dose)[10]
- Alternative regimen (2): pimecrolimus 1% top. q12h[11]
- Alternative regimen (3) crisaborole 2% top.
- Adult
- Pediatric
- Preferred regimen (1): fluocinolone0.025%. q12h-q24h for 14 days
- Preferred regimen (2): triamcinolone 0.1% top. q12h-q24h for 14 days
- Preferred regimen (3): fluocinolone acetonide 0.025% top. q12h-q24h for 14-28 days
- Alternative regimen (1) tacrolimus 0.03% top. q12h (Children (>2years)[12]
- Alternative regimen (2): pimecrolimus 1% top. q12h[13]
- Alternative regimen (3) crisaborole 2% top.
- Topical corticosteroids and emollients are the mainstay of therapy
- Severe atopic dermatitis
- Phototherapy or systemic immunosuppressant treatment is the mainstay of therapy
- Adult
- Preferred regimen (1): Phototherapy Ultraviolet light therapy (phototherapy) with PUVA (psoralens plus ultraviolet A radiation), 3 times a week
- Preferred regimen (2): cyclosporine PO 3-5 mg/kg o.d. for 6 weeks (monitor BP and serum creatinine q2 weeks for three months, f/u q month)[14]
- Alternative regimen (1) methotrexatePO
- Alternative regimen (2): azathioprine PO
- Alternative regimen (3) mycophenolate mofetil PO
- Alternative regimen (3) dupilumab 600 mg SQ once and then 300 mg SQ every 2 weeks thereafter
- Pediatric
- Preferred regimen (1):
- Preferred regimen (2): cyclosporine PO 3 to 5 mg/kg per day o.d. for 6 weeks (monitor BP and serum creatinine q2 weeks for three months, f/b q month)[15]
- Alternative regimen (1) Phototherapy Ultraviolet light therapy (phototherapy) with PUVA (psoralens plus ultraviolet A radiation), 3 times a week
- Alternative regimen (2): azathioprine PO
- Alternative regimen (3) mycophenolate mofetil PO
- Alternative regimen (3) dupilumab 600 mg SQ once and then 300 mg SQ every 2 weeks thereafter
- Adult
- Phototherapy or systemic immunosuppressant treatment is the mainstay of therapy
- Severe refractory atopic dermatitis
- Adult
- Preferred regimen (1): Intensive topical therapy
- Soak and smear: Soak for 15 minutes in a tub of water. Apply desoximetasone 0.25% top. to the whole body, except the groin, axillae, and face
- Wet wrap therapy: desoximetasone 0.25% top. then occluded with wet wraps q12h
- Alternative regimen (1) Phototherapy: narrowband ultraviolet B or psoralen plus ultraviolet A two to three times per week
- Alternative regimen (2): cyclosporine PO 2.5 to 5 mg/kg o.d. (C/I - abnormal renal function, uncontrolled hypertension or infection, and malignancy)[16]
- Alternative regimen (3): prednisone 40 to 60 mg o.d. for one week, then taper the dose over the following two to three week
- Alternative regimen (4): methotrexate 7.5 to 25 mg single weekly dose with folic acid 1 mg o.d.
- Alternative regimen (5): azathioprine 2 to 3 mg/kg
- Alternative regimen (6): mycophenolate mofetil 1 to 2 g/day
- Alternative regimen (7): mycophenolic acid 720 to 1440 mg/day
- Alternative regimen (8) dupilumab 600 mg SQ once and then 300 mg SQ every 2 weeks thereafter
- Preferred regimen (1): Intensive topical therapy
- Pediatric
- Preferred regimen (1): Intensive topical therapy
- Wet wrap therapy: desoximetasone 0.05% top. then occluded with wet wraps q12h-q24h for 2 to 14 days
- Alternative regimen (1) Phototherapy: narrowband ultraviolet B (UVB) 3 times per week (older children > 6 years)
- Alternative regimen (2): cyclosporine PO 2.5 to 5 mg/kg o.d. for 2-4 months (monitor renal and hepatic function)[17]
- Alternative regimen (3): methotrexate 0.5 mg/kg PO single weekly dose with folic acid 1 mg o.d.(up to a maximum of 25 mg per week)
- Alternative regimen (4): methylprednisolone 0.5 mg/kg o.d. for 1-2 weeks tapered over one month
- Preferred regimen (1): Intensive topical therapy
- Adult
Management of Infection:
- Bacterial infections: (most common bacteria - Staphylococcus. aureus)[18]
- Clinically infected skin:
- Mupirocin 2% top. BID for one to two weeks
- More extensive infection: oral antibiotic therapy with cephalosporins or penicillinase-resistant penicillins X two weeks
- Clinically uninfected skin:
- liquid chlorine bleach- 0.5 cup or 120 ml of 6% bleach in a full bathtub [40 gallons or 150 L] of lukewarm water[19]
- Clinically infected skin:
- Viral infections:
- Herpes simplex:
- Acyclovir 200 or 400 mg PO five times daily
- Famciclovir 750 mg BID for one day or 1500 mg as a single dose
- molluscum contagiosum :
- cryotherapy, curettage, cantharidin, and podophyllotoxin as first-line therapeutic options
- Herpes simplex:
- Fungal infections:
- Dermatophyte infections- topical or oral antifungals[20]
Controlling pruritus:
- Preferred regimen:
- Sedatives: diphenhydramine, hydroxyzine, and cyproheptadine
- Nonsedatives: fexofenadine, cetirizine or loratadine
- Alternative regimen:
- Topical doxepin
- Topical calcineurin inhibitors
- Pimecrolimus 1% cream or tacrolimus 0.03% to 0.1%
References
- ↑ Krakowski AC, Eichenfield LF, Dohil MA (October 2008). "Management of atopic dermatitis in the pediatric population". Pediatrics. 122 (4): 812–24. doi:10.1542/peds.2007-2232. PMID 18829806.
- ↑ Krakowski AC, Eichenfield LF, Dohil MA (October 2008). "Management of atopic dermatitis in the pediatric population". Pediatrics. 122 (4): 812–24. doi:10.1542/peds.2007-2232. PMID 18829806.
- ↑ Krakowski AC, Eichenfield LF, Dohil MA (October 2008). "Management of atopic dermatitis in the pediatric population". Pediatrics. 122 (4): 812–24. doi:10.1542/peds.2007-2232. PMID 18829806.
- ↑ Aalto-Korte K, Turpeinen M (August 1995). "Pharmacokinetics of topical hydrocortisone at plasma level after applications once or twice daily in patients with widespread dermatitis". Br. J. Dermatol. 133 (2): 259–63. PMID 7547394.
- ↑ Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
- ↑ Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
- ↑ Aalto-Korte K, Turpeinen M (August 1995). "Pharmacokinetics of topical hydrocortisone at plasma level after applications once or twice daily in patients with widespread dermatitis". Br. J. Dermatol. 133 (2): 259–63. PMID 7547394.
- ↑ Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
- ↑ Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
- ↑ Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
- ↑ Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
- ↑ Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
- ↑ Ruzicka T, Bieber T, Schöpf E, Rubins A, Dobozy A, Bos JD, Jablonska S, Ahmed I, Thestrup-Pedersen K, Daniel F, Finzi A, Reitamo S (September 1997). "A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group". N. Engl. J. Med. 337 (12): 816–21. doi:10.1056/NEJM199709183371203. PMID 9295241.
- ↑ Czech W, Bräutigam M, Weidinger G, Schöpf E (April 2000). "A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life". J. Am. Acad. Dermatol. 42 (4): 653–9. PMID 10727313.
- ↑ Czech W, Bräutigam M, Weidinger G, Schöpf E (April 2000). "A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life". J. Am. Acad. Dermatol. 42 (4): 653–9. PMID 10727313.
- ↑ Czech W, Bräutigam M, Weidinger G, Schöpf E (April 2000). "A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life". J. Am. Acad. Dermatol. 42 (4): 653–9. PMID 10727313.
- ↑ Czech W, Bräutigam M, Weidinger G, Schöpf E (April 2000). "A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life". J. Am. Acad. Dermatol. 42 (4): 653–9. PMID 10727313.
- ↑ Ong PY, Leung DY (August 2010). "The infectious aspects of atopic dermatitis". Immunol Allergy Clin North Am. 30 (3): 309–21. doi:10.1016/j.iac.2010.05.001. PMC 2913147. PMID 20670815.
- ↑ Huang JT, Abrams M, Tlougan B, Rademaker A, Paller AS (May 2009). "Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity". Pediatrics. 123 (5): e808–14. doi:10.1542/peds.2008-2217. PMID 19403473.
- ↑ Lintu P, Savolainen J, Kortekangas-Savolainen O, Kalimo K (June 2001). "Systemic ketoconazole is an effective treatment of atopic dermatitis with IgE-mediated hypersensitivity to yeasts". Allergy. 56 (6): 512–7. PMID 11421895.