What are the best alternatives to steroids for treating dermatitis around the eye?

From the Guidelines

For dermatitis around the eyes, tacrolimus ointment is the best alternative to steroids, as it can be applied to the lid margins with minimal risk of getting into the eye. According to the most recent study 1, offering tacrolimus ointment for application to the lid margins to adults and children (> 7 years) with dermatitis around the eye is a recommended approach. This is because tacrolimus ointment has been shown to be effective in managing dermatitis around the eye without the risks associated with steroid use, such as increased intraocular pressure and skin atrophy 1.

Some key points to consider when using tacrolimus ointment for dermatitis around the eye include:

• Apply a thin layer to the affected areas twice daily until symptoms improve, then reduce to once daily for maintenance 1
• Avoid getting the ointment directly into the eye, as this can cause irritation
• Use moisturizers containing ceramides, such as CeraVe or Vanicream, to help repair the skin barrier and reduce inflammation
• Cold compresses for 10-15 minutes can also help reduce inflammation and itching
• Avoid potential irritants, including fragranced products, harsh cleansers, and known allergens

It's also important to note that if symptoms persist beyond 2 weeks of treatment or worsen, consulting a dermatologist is recommended, as prescription-strength options or further evaluation for possible contact allergies or other conditions may be necessary. Additionally, warm compresses and topical antihistamines may also be considered as adjunctive therapies 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Alternatives to Steroids for Dermatitis Around the Eye

• Non-steroidal ant-inflammatory agents, such as topical calcineurin inhibitors (TCIs), are a viable alternative to topical corticosteroids in treating dermatitis of the face, neck, eyelids, and intertriginous areas 2
• Topical pimecrolimus 1% cream is an effective and well-tolerated treatment for atopic dermatitis in infants, children, adolescents, and adults, and does not cause skin atrophy or other steroid-induced side effects 3
• Pimecrolimus is effective at reducing the incidence of disease flares and the need for rescue treatment with topical corticosteroids, and improves the health-related quality of life (HR-QOL) of children and adolescents, and the QOL of parents of children with atopic dermatitis 3

Safety and Efficacy of Pimecrolimus

• Pimecrolimus has a favorable safety profile compared to topical corticosteroids, with no potential side effects such as skin atrophy, steroid-induced rosacea, or perioral dermatitis 4
• The most common side effect of pimecrolimus is burning, and placebo-controlled studies suggest that pimecrolimus is associated with a slightly increased incidence of herpes simplex infections 4
• Pimecrolimus does not increase the overall incidence of skin infections, including recurrent herpes simplex infections, compared to topical corticosteroids 4

Treatment Options for Atopic Dermatitis

• Pimecrolimus cream 1% is indicated for the short-term and intermittent long-term treatment of mild-to-moderate atopic dermatitis in non-immunocompromised patients aged ≥2 years who do not respond well to, or may have adverse effects with, conventional treatments 3
• Pimecrolimus is an effective, steroid-sparing therapy for mild-to-moderate atopic dermatitis, and can be used as a first-line therapy 5
• Pimecrolimus has fewer side effects than topical steroids and a better side-effect profile than tacrolimus, and can be used to improve quality of life for many patients, especially children 5