Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part I): General Management and Topical Treatment
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Background: Since the treatment guidelines for atopic dermatitis (AD) were released by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been several advances in AD management. Objective: We aimed to establish updated evidence- and experience-based treatment guidelines for Korean AD. Methods: We collected a database of references from relevant systematic AD reviews and guidelines regarding general AD management such as bathing and skin care, avoidance of exacerbating factors, education and psychosocial support, and the use of moisturizers and topical anti-inflammatory and antipruritic drugs. Evidence for each statement was graded and the strength of the recommendation for each statement classified. Thirty-nine KADA council members participated in three rounds of voting to establish an expert consensus of recommendations. Results: Basic AD treatment includes proper bathing and skin care, avoidance of exacerbating factors, proper education and psychosocial support, and use of moisturizers. The regular use of moisturizer has a steroid-sparing effect and reduces relapse episodes. The short- and long-term use of topical corticosteroids and calcineurin inhibitors improves AD symptoms and should be encouraged to use in an active and proactive treatment. Wet-wrap therapy can be used for rapid recovery of acute exacerbation. Topical antipruritic drugs cannot be recommended for the treatment of AD. Conclusion: This report provides up-to-date evidence- and experience- based treatment guidelines for AD regarding general management and topical treatment. In addition, the average agreement scores obtained by a panel of experts based on the Korean healthcare system and patient adherence are presented.
Abstract
Background: Since the treatment guidelines for atopic dermatitis (AD) were released by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been several advances in AD management. Objective: We aimed to establish updated evidence- and experience-based treatment guidelines for Korean AD. Methods: We collected a database of references from relevant systematic AD reviews and guidelines regarding general AD management such as bathing and skin care, avoidance of exacerbating factors, education and psychosocial support, and the use of moisturizers and topical anti-inflammatory and antipruritic drugs. Evidence for each statement was graded and the strength of the recommendation for each statement classified. Thirty-nine KADA council members participated in three rounds of voting to establish an expert consensus of recommendations. Results: Basic AD treatment includes proper bathing and skin care, avoidance of exacerbating factors, proper education and psychosocial support, and use of moisturizers. The regular use of moisturizer has a steroid-sparing effect and reduces relapse episodes. The short- and long-term use of topical corticosteroids and calcineurin inhibitors improves AD symptoms and should be encouraged to use in an active and proactive treatment. Wet-wrap therapy can be used for rapid recovery of acute exacerbation. Topical antipruritic drugs cannot be recommended for the treatment of AD. Conclusion: This report provides up-to-date evidence- and experience- based treatment guidelines for AD regarding general management and topical treatment. In addition, the average agreement scores obtained by a panel of experts based on the Korean healthcare system and patient adherence are presented.
참고문헌 (125)
- Elias PM, "Update on the structure and function of the skin barrier: atopic dermatitis as an exemplar of clinical implications", Semin Cutan Med Surg, 32(2 Suppl 2), pp.S21~S24 (2013)
- Eichenfield LF, "Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies", J Am Acad Dermatol, 71, pp.116~132 (2014)
- Sidbury R, "Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches", J Am Acad Dermatol, 71, pp.1218~1233 (2014)
- Ring J, "Guidelines for treatment of atopic eczema (atopic dermatitis) part I", J Eur Acad Dermatol Venereol, 26, pp.1045~1060 (2012)
- Rubel D, "Consensus guidelines for the management of atopic dermatitis: an Asia-Pacific perspective", J Dermatol, 40, pp.160~171 (2013)
- Kim SY, "Guidance for development of clinical practice guidelines", National Evidence-Based Healthcare Collaborating Agency, 607~608 (2011)
- "Oxford Centre for Evidence-based Medicine-Levels of evidence" (2009)[URL]
- Simpson E, "Safety and tolerability of a body wash and moisturizer when applied to infants and toddlers with a history of atopic dermatitis: results from an open-label study", Pediatr Dermatol, 29, pp.590~597 (2012)
- Katayama I, "Japanese Society of Allergology. Japanese guideline for atopic dermatitis", Allergol Int, 60, pp.205~220 (2011)
- Baker M, "NICE guidance points the way to tackling eczema in children", Community Pract, 86, pp.40~ (2013)
- Shaughnessy CN, "Cutaneous delayed-type hypersensitivity in patients with atopic dermatitis:reactivity to surfactants", J Am Acad Dermatol, 70, pp.704~708 (2014)
- Cheong WK, "Gentle cleansing and moisturizing for patients with atopic dermatitis and sensitive skin", Am J Clin Dermatol, 10(Suppl 1), pp.13~17 (2009)
- Shukuwa T, "Disaggregation of corneocytes from surfactant-treated sheets of stratum corneum in hyperkeratosis on psoriasis, ichthyosis vulgaris and atopic dermatitis", J Dermatol, 24, pp.361~369 (1997)
- Bouwstra JA, "Water distribution and related morphology in human stratum corneum at different hydration levels", J Invest Dermatol, 120, pp.750~758 (2003)
- Warner RR, "Hydration disrupts human stratum corneum ultrastructure", J Invest Dermatol, 120, pp.275~284 (2003)
- Fluhr JW, "Effects of prolonged occlusion on stratum corneum barrier function and water holding capacity", Skin Pharmacol Appl Skin Physiol, 12, pp.193~198 (1999)
- Langan SM, "An exploratory prospective observational study of environmental factors exacerbating atopic eczema in children", Br J Dermatol, 154, pp.979~980 (2006)
- 이해진, "Epidermal Permeability Barrier Defects and Barrier Repair Therapy in Atopic Dermatitis", Allergy, Asthma & Immunology Research, 6(4), pp.276~287 (2014), 대한천식알레르기학회
- Sakai T, "Defective maintenance of pH of stratum corneum is correlated with preferential emergence and exacerbation of atopic-dermatitis-like dermatitis in flaky-tail mice", J Dermatol Sci, 74, pp.222~228 (2014)
- Lee HJ, "Topical acidic cream prevents the development of atopic dermatitis- and asthma-like lesions in murine model", Exp Dermatol, 23, pp.736~741 (2014)
- Angelova-Fischer I, "Skin barrier integrity and natural moisturising factor levels after cumulative dermal exposure to alkaline agents in atopic dermatitis", Acta Derm Venereol, 94, pp.640~644 (2014)
- Wong SM, "Efficacy and safety of sodium hypochlorite (bleach) baths in patients with moderate to severe atopic dermatitis in Malaysia", J Dermatol, 40, pp.874~880 (2013)
- Huang JT, "Dilute bleach baths for Staphylococcus aureus colonization in atopic dermatitis to decrease disease severity", Arch Dermatol, 147, pp.246~247 (2011)
- Craig FE, "Bleach baths to reduce severity of atopic dermatitis colonized by Staphylococcus", Arch Dermatol, 146, pp.541~543 (2010)
- Barnes TM, "Use of bleach baths for the treatment of infected atopic eczema", Australas J Dermatol, 54, pp.251~258 (2013)
- Huang JT, "Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity", Pediatrics, 123, pp.e808~e814 (2009)
- Leung TNH, "Clinical guidelines on management of atopic dermatitis in children", HK J Paediatr (new series), 18, pp.96~104 (2013)
- Oosting AJ, "Effect of mattress encasings on atopic dermatitis outcome measures in a double-blind, placebo-controlled study: the Dutch mite avoidance study", J Allergy Clin Immunol, 110, pp.500~506 (2002)
- Koopman LP, "Placebo-controlled trial of house dust mite-impermeable mattress covers: effect on symptoms in early childhood", Am J Respir Crit Care Med, 166, pp.307~313 (2002)
- Gutgesell C, "Double-blind placebo-controlled house dust mite control measures in adult patients with atopic dermatitis", Br J Dermatol, 145, pp.70~74 (2001)
- Ricci G, "Effect of house dust mite avoidance measures in children with atopic dermatitis", Br J Dermatol, 143, pp.379~384 (2000)
- Sanda T, "Effectiveness of house dust-mite allergen avoidance through clean room therapy in patients with atopic dermatitis", J Allergy Clin Immunol, 89, pp.653~657 (1992)
- Yella L, "Population growth and allergen accumulation of Dermatophagoides farinae cultured at 20 and 25oC", Exp Appl Acarol, 60, pp.117~126 (2013)
- Yella L, "Population growth and allergen accumulation of Dermatophagoides pteronyssinus cultured at 20 and 25oC", Exp Appl Acarol, 53, pp.103~119 (2011)
- Wu FF, "Daily vacuuming of mattresses significantly reduces house dust mite allergens, bacterial endotoxin, and fungal β-glucan", J Asthma, 49, pp.139~143 (2012)
- Boyce JA, "Guidelines for the diagnosis and management of food allergy in the United States: summary of the NIAID-sponsored expert panel report", Nutr Res, 31, pp.61~75 (2011)
- Boyce JA, "Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel", J Allergy Clin Immunol, 126(6 Suppl), pp.S1~S58 (2010)
- Katayama I, "Japanese guideline for atopic dermatitis 2014", Allergol Int, 63, pp.377~398 (2014)
- 정경용, "House Dust Mite Allergy in Korea: The Most Important Inhalant Allergen in Current and Future", Allergy, Asthma & Immunology Research, 4(6), pp.313~325 (2012), 대한천식알레르기학회
- 김지현, "The Indoor Level of House Dust Mite Allergen Is Associated with Severity of Atopic Dermatitis in Children", Journal of Korean Medical Science, 28(1), pp.74~79 (2013), 대한의학회
- Arshad SH, "Prevention of allergic disease during childhood by allergen avoidance: the Isle of Wight prevention study", J Allergy Clin Immunol, 119, pp.307~313 (2007)
- Mason R, "Fabrics for atopic dermatitis", J Fam Health Care, 18, pp.63~65 (2008)
- Ricci G, "Silk fabrics in the management of atopic dermatitis", Skin Therapy Lett, 17, pp.5~7 (2012)
- Kurtz EJ, "Use of a silklike bedding fabric in patients with atopic dermatitis", Pediatr Dermatol, 25, pp.439~443 (2008)
- Lopes C, "Functional textiles for atopic dermatitis: a systematic review and meta-analysis", Pediatr Allergy Immunol, 24, pp.603~613 (2013)
- Kiriyama T, "Residual washing detergent in cotton clothes: a factor of winter deterioration of dry skin in atopic dermatitis", J Dermatol, 30, pp.708~712 (2003)
- Thomas KS, "A multicentre randomised controlled trial and economic evaluation of ion-exchange water softeners for the treatment of eczema in children: the Softened Water Eczema Trial (SWET)", Health Technol Assess, 15, pp.v~vi (2011)
- Suárez AL, "Psychoneuroimmunology of psychological stress and atopic dermatitis:pathophysiologic and therapeutic updates", Acta Derm Venereol, 92, pp.7~15 (2012)
- Arndt J, "Stress and atopic dermatitis", Curr Allergy Asthma Rep, 8, pp.312~317 (2008)
- Hashizume H, "Anxiety in allergy and atopic dermatitis", Curr Opin Allergy Clin Immunol, 6, pp.335~339 (2006)
- Chida Y, "The effects of psychological intervention on atopic dermatitis. A systematic review and meta-analysis", Int Arch Allergy Immunol, 144, pp.1~9 (2007)
- Ersser SJ, "Psychological and educational interventions for atopic eczema in children", Cochrane Database Syst Rev, 1, pp.CD004054~ (2014)
- Barbarot S, "Therapeutic patient education in children with atopic dermatitis: position paper on objectives and recommendations", Pediatr Dermatol, 30, pp.199~206 (2013)
- Mancini AJ, "Improving the patient-clinician and parent-clinician partnership in atopic dermatitis management", Semin Cutan Med Surg, 31(3 Suppl), pp.S23~S28 (2012)
- de Bes J, "Patient education in chronic skin diseases: a systematic review", Acta Derm Venereol, 91, pp.12~17 (2011)
- Stalder JF, "Therapeutic patient education in atopic dermatitis: worldwide experiences", Pediatr Dermatol, 30, pp.329~334 (2013)
- Nicol NH, "The role of the nurse educator in managing atopic dermatitis", Immunol Allergy Clin North Am, 30, pp.369~383 (2010)
- Breternitz M, "Placebo-controlled, double-blind, randomized, prospective study of a glycerol-based emollient on eczematous skin in atopic dermatitis: biophysical and clinical evaluation", Skin Pharmacol Physiol, 21, pp.39~45 (2008)
- Eberlein B, "Adjuvant treatment of atopic eczema: assessment of an emollient containing N-palmitoylethanolamine (ATOPA study)", J Eur Acad Dermatol Venereol, 22, pp.73~82 (2008)
- Wirén K, "Treatment with a barrier-strengthening moisturizing cream delays relapse of atopic dermatitis: a prospective and randomized controlled clinical trial", J Eur Acad Dermatol Venereol, 23, pp.1267~1272 (2009)
- Boralevi F, "Long-term emollient therapy improves xerosis in children with atopic dermatitis", J Eur Acad Dermatol Venereol, 28, pp.1456~1462 (2014)
- Grimalt R, "The steroid-sparing effect of an emollient therapy in infants with atopic dermatitis: a randomized controlled study", Dermatology, 214, pp.61~67 (2007)
- Lucky AW, "Use of an emollient as a steroid-sparing agent in the treatment of mild to moderate atopic dermatitis in children", Pediatr Dermatol, 14, pp.321~324 (1997)
- Sher LG, "Relieving the pruritus of atopic dermatitis: a meta-analysis", Acta Derm Venereol, 92, pp.455~461 (2012)
- Peltonen JM, "Three randomised phase I", IIa trials of 5%cis-urocanic acid emulsion cream in healthy adult subjects and in patients with atopic dermatitis, 2014, pp.94, 415~420
- Tan WP, "A randomized double-blind controlled trial to compare a triclosan-containing emollient with vehicle for the treatment of atopic dermatitis", Clin Exp Dermatol, 35, pp.e109~e112 (2010)
- Hon KL, "Estimating emollient usage in patients with eczema", Clin Exp Dermatol, 35, pp.22~26 (2010)
- Bieber T, "Atopic dermatitis: a candidate for disease-modifying strategy", Allergy, 67, pp.969~975 (2012)
- Flohr C, "New approaches to the prevention of childhood atopic dermatitis", Allergy, 69, pp.56~61 (2014)
- Wollenberg A, "Viral infections in atopic dermatitis: pathogenic aspects and clinical management", J Allergy Clin Immunol, 112, pp.667~674 (2003)
- Lack G, "Factors associated with the development of peanut allergy in childhood", N Engl J Med, 348, pp.977~985 (2003)
- Miller DW, "An over-the-counter moisturizer is as clinically effective as, and more cost-effective than, prescription barrier creams in the treatment of children with mild-to-moderate atopic dermatitis: a randomized, controlled trial", J Drugs Dermatol, 10, pp.531~537 (2011)
- Berth-Jones J, "Twice weekly fluticasone propionate added to emollient maintenance treatment to reduce risk of relapse in atopic dermatitis: randomised, double blind, parallel group study", BMJ, 326, pp.1367~ (2003)
- Hanifin J, "Intermittent dosing of fluticasone propionate cream for reducing the risk of relapse in atopic dermatitis patients", Br J Dermatol, 147, pp.528~537 (2002)
- Nilsson EJ, "Topical corticosteroids and Staphylococcus aureus in atopic dermatitis", J Am Acad Dermatol, 27, pp.29~34 (1992)
- Ference JD, "Choosing topical corticosteroids", Am Fam Physician, 79, pp.135~140 (2009)
- Bleehen SS, "Fluticasone propionate 0.05% cream in the treatment of atopic eczema: a multicentre study comparing once-daily treatment and once-daily vehicle cream application versus twice-daily treatment", Br J Dermatol, 133, pp.592~597 (1995)
- Dekio I, "The weight of a finger-tip unit of ointment in 5-gram tubes", J Dermatolog Treat, 22, pp.302~303 (2011)
- Callen J, "A systematic review of the safety of topical therapies for atopic dermatitis", Br J Dermatol, 156, pp.203~221 (2007)
- Schmitt J, "Efficacy and tolerability of proactive treatment with topical corticosteroids and calcineurin inhibitors for atopic eczema: systematic review and meta-analysis of randomized controlled trials", Br J Dermatol, 164, pp.415~428 (2011)
- Birnie AJ, "Interventions to reduce Staphylococcus aureus in the management of atopic eczema", Cochrane Database Syst Rev, (3), pp.CD003871~ (2008)
- Kubota Y, "Effect of sequential applications of topical tacrolimus and topical corticosteroids in the treatment of pediatric atopic dermatitis: an open-label pilot study", J Am Acad Dermatol, 60, pp.212~217 (2009)
- Hebert AA, "Desoximetasone 0.25% and tacrolimus 0.1% ointments versus tacrolimus alone in the treatment of atopic dermatitis", Cutis, 78, pp.357~363 (2006)
- Torok HM, "Clocortolone pivalate cream 0.1% used concomitantly with tacrolimus ointment 0.1% in atopic dermatitis", Cutis, 72, pp.161~166 (2003)
- Hengge UR, "Adverse effects of topical glucocorticosteroids", J Am Acad Dermatol, 54, pp.1~15 (2006)
- Chi CC, "Evidence-based (S3) guideline on topical corticosteroids in pregnancy", Br J Dermatol, 165, pp.943~952 (2011)
- Green C, "Topical corticosteroids for atopic eczema: clinical and cost effectiveness of once-daily vs. more frequent use", Br J Dermatol, 152, pp.130~141 (2005)
- Nicol NH, "Wet wrap therapy in children with moderate to severe atopic dermatitis in a multidisciplinary treatment program", J Allergy Clin Immunol Pract, 2, pp.400~406 (2014)
- Janmohamed SR, "The proactive wet-wrap method with diluted corticosteroids versus emollients in children with atopic dermatitis: a prospective, randomized, double-blind, placebo-controlled trial", J Am Acad Dermatol, 70, pp.1076~1082 (2014)
- Albarrán-Planelles C, "Our experience with wet-wrap treatment", Actas Dermosifiliogr, 105, pp.e18~e21 (2014)
- Devillers AC, "Wet-wrap treatment in children with atopic dermatitis: a practical guideline", Pediatr Dermatol, 29, pp.24~27 (2012)
- Lee JH, "The effect of wet-wrap dressing on epidermal barrier in patients with atopic dermatitis", J Eur Acad Dermatol Venereol, 21, pp.1360~1368 (2007)
- Hon KL, "Efficacy and problems associated with using a wet-wrap garment for children with severe atopic dermatitis", J Dermatolog Treat, 18, pp.301~305 (2007)
- Oranje AP, "Treatment of patients with atopic dermatitis using wet-wrap dressings with diluted steroids and", or emollients. An expert panel's opinion and review of the literature, 2006, pp.20, 1277~1286
- Devillers AC, "Efficacy and safety of 'wet-wrap'dressings as an intervention treatment in children with severe and", or refractory atopic dermatitis: a critical review of the literature, 2006, pp.154, 579~585
- Foelster-Holst R, "Efficacy of crisis intervention treatment with topical corticosteroid prednicarbat with and without partial wet-wrap dressing in atopic dermatitis", Dermatology, 212, pp.66~69 (2006)
- Barham KL, "It's a wrap: the use of wet pajamas in wet-wrap dressings for atopic dermatitis", Dermatol Nurs, 17, pp.365~367 (2005)
- Ashcroft DM, "Efficacy and tolerability of topical pimecrolimus and tacrolimus in the treatment of atopic dermatitis: metaanalysis of randomised controlled trials", BMJ, 330, pp.516~ (2005)
- Paller A, "A 12-week study of tacrolimus ointment for the treatment of atopic dermatitis in pediatric patients", J Am Acad Dermatol, 44(1 Suppl), pp.S47~S57 (2001)
- Wollenberg A, "Proactive treatment of atopic dermatitis in adults with 0.1% tacrolimus ointment", Allergy, 63, pp.742~750 (2008), European Tacrolimus Ointment Study Group
- Breneman D, "Intermittent therapy for flare prevention and longterm disease control in stabilized atopic dermatitis: a randomized comparison of 3-times-weekly applications of tacrolimus ointment versus vehicle", J Am Acad Dermatol, 58, pp.990~999 (2008), Tacrolimus Ointment Study Group
- Gollnick H, "Pimecrolimus cream 1% in the long-term management of adult atopic dermatitis: prevention of flare progression. A randomized controlled trial", Br J Dermatol, 158, pp.1083~1093 (2008), Pimecrolimus Cream 1% in (adult)Eczema: Prevention of Progression Multicentre Investigator Study Group
- Reitamo S, "Tacrolimus ointment does not affect collagen synthesis: results of a single-center randomized trial", J Invest Dermatol, 111, pp.396~398 (1998)
- Queille-Roussel C, "The new topical ascomycin derivative SDZ ASM 981 does not induce skin atrophy when applied to normal skin for 4 weeks: a randomized, double-blind controlled study", Br J Dermatol, 144, pp.507~513 (2001)
- El-Batawy MM, "Topical calcineurin inhibitors in atopic dermatitis: a systematic review and meta-analysis", J Dermatol Sci, 54, pp.76~87 (2009)
- Wahn U, "Efficacy and safety of pimecrolimus cream in the long-term management of atopic dermatitis in children", Pediatrics, 110, pp.e2~ (2002), Flare Reduction in Eczema with Elidel (Children)Multicenter Investigator Study Group
- Ruzicka T, "A short-term trial of tacrolimus ointment for atopic dermatitis", N Engl J Med, 337, pp.816~821 (1997), European Tacrolimus Multicenter Atopic Dermatitis Study Group
- Chen SL, "Two topical calcineurin inhibitors for the treatment of atopic dermatitis in pediatric patients: a meta-analysis of randomized clinical trials", J Dermatolog Treat, 21, pp.144~156 (2010)
- National Collaborating Centre for Women's and Children's Health, "Atopic Eczema in Children: Management of atopic eczema in children from birth up to the age of 12 years" (2007), RCOG Press National Collaborating Centre for Women's and Children's Health
- Lübbe J, "Eczema herpeticum during treatment of atopic dermatitis with 0.1% tacrolimus ointment", Dermatology, 201, pp.249~251 (2000)
- Wetzel S, "Eczema molluscatum in tacrolimus treated atopic dermatitis", Eur J Dermatol, 14, pp.73~74 (2004)
- Reitamo S, "A multicentre, randomized, double-blind, controlled study of long-term treatment with 0.1% tacrolimus ointment in adults with moderate to severe atopic dermatitis", Br J Dermatol, 152, pp.1282~1289 (2005), European Tacrolimus Ointment Study Group
- Thaçi D, "Malignancy concerns of topical calcineurin inhibitors for atopic dermatitis: facts and controversies", Clin Dermatol, 28, pp.52~56 (2010)
- Van Leent EJ, "Low systemic exposure after repeated topical application of Pimecrolimus (Elidel), SD Z ASM 981) in patients with atopic dermatitis", Dermatology, 204, pp.63~68 (2002)
- Alaiti S, "Tacrolimus (FK506) ointment for atopic dermatitis: a phase I study in adults and children", J Am Acad Dermatol, 38, pp.69~76 (1998)
- Weisshaar E, "Experimentally induced pruritus and cutaneous reactions with topical antihistamine and local analgesics in atopic eczema", Skin Pharmacol, 10, pp.183~190 (1997)
- orak M, "Histamine induced responses are attenuated by a cannabinoid receptor agonist in human skin", Inflamm Res, 52, pp.238~245 (2003)
- Reimann S, "Topical administration of capsaicin in dermatology for treatment of itching and pain", Hautarzt, 51, pp.164~172 (2000)
- Weisshaar E, "Effect of topical capsaicin on the cutaneous reactions and itching to histamine in atopic eczema compared to healthy skin", Arch Dermatol Res, 290, pp.306~311 (1998)
- Drake LA, "Relief of pruritus in patients with atopic dermatitis after treatment with topical doxepin cream", J Am Acad Dermatol, 31, pp.613~616 (1994)
- Czarnetzki BM, "Topical tiacrilast, a potent mast cell degranulation inhibitor, does not improve adult atopic eczema", Dermatology, 187, pp.112~114 (1993)
- Poole RM, "Apremilast: first global approval", Drugs, 74, pp.825~837 (2014)
- Furue M, "Safety and efficacy of topical E6005, a phosphodiesterase 4inhibitor, in Japanese adult patients with atopic dermatitis:results of a randomized, vehicle-controlled, multicenter clinical trial", J Dermatol, 41, pp.577~585 (2014)
- Nazarian R, "AN-2728, a PDE4 inhibitor for the potential topical treatment of psoriasis and atopic dermatitis", Curr Opin Investig Drugs, 10, pp.1236~1242 (2009)
- 김정은, "Disease Awareness and Management Behavior of Patients with Atopic Dermatitis: A Questionnaire Survey of 313 Patients", Annals of Dermatology, 27(1), pp.40~47 (2015), 대한피부과학회
