From the Guidelines
Current guidelines for atopic dermatitis in adults recommend the use of dupilumab, tralokinumab, upadacitinib, abrocitinib, and baricitinib for moderate to severe cases, as well as phototherapy and oral immunosuppressants like cyclosporine and methotrexate, with the decision to initiate these therapies made using shared decision-making between patients and clinicians, taking into account the severity of AD, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1.
Key Recommendations
- For adults with moderate to severe atopic dermatitis, dupilumab, tralokinumab, upadacitinib, abrocitinib, and baricitinib are recommended, with a strong strength of recommendation and moderate certainty of evidence 1.
- Phototherapy is conditionally recommended for adults with atopic dermatitis, with a low certainty of evidence 1.
- Oral immunosuppressants like cyclosporine and methotrexate are conditionally recommended for adults with moderate to severe atopic dermatitis, with a low certainty of evidence 1.
Treatment Approach
- Daily skin hydration with fragrance-free moisturizers is recommended for all patients with atopic dermatitis 1.
- Topical corticosteroids are recommended for flares, with potency based on severity 1.
- Topical calcineurin inhibitors like tacrolimus and pimecrolimus are recommended for maintenance therapy 1.
- Antihistamines like hydroxyzine may be used for itch relief 1.
Important Considerations
- The decision to initiate systemic therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of AD, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1.
- Patients with atopic dermatitis should be monitored for potential side effects of systemic therapies, and alternative treatments should be considered if necessary 1.
- More research is needed to better understand the role of phototherapy and systemic therapies in the treatment of atopic dermatitis, particularly in terms of long-term safety and efficacy 1.
From the FDA Drug Label
ELIDEL ® (pimecrolimus) Cream 1% is indicated as second-line therapy for the short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis in non-immunocompromised adults and children 2 years of age and older, who have failed to respond adequately to other topical prescription treatments, or when those treatments are not advisable. The current guidelines for atopic dermatitis in adults include the use of pimecrolimus cream 1% as a second-line therapy for the short-term and non-continuous chronic treatment of mild to moderate cases.
- Key points:
- Indication: mild to moderate atopic dermatitis
- Patient population: non-immunocompromised adults
- Treatment duration: short-term and non-continuous chronic
- There is no information provided for contact dermatitis. 2
From the Research
Contact Dermatitis Guidelines
- Contact dermatitis is a common inflammatory skin condition characterized by erythematous and pruritic skin lesions that occur after contact with a foreign substance 3.
- The two forms of contact dermatitis are irritant and allergic, with irritant contact dermatitis caused by non-immune-modulated irritation of the skin and allergic contact dermatitis being a delayed hypersensitivity reaction 3, 4.
- Common substances that cause contact dermatitis include poison ivy, nickel, and fragrances 3.
- Treatment for contact dermatitis typically involves avoidance of the causative substance, use of mid- or high-potency topical steroids, and in severe cases, systemic steroid therapy 3, 4.
Atopic Dermatitis Guidelines
- Atopic dermatitis (AD) patients have increased penetration of allergens, immune dysregulation, and frequent use of emollients and topical medications, which may predispose them to developing allergic contact dermatitis (ACD) 5.
- ACD is a significant clinical problem in both children and adults with AD, and common relevant allergens include lanolin, neomycin, formaldehyde, and fragrances 5.
- Patch testing is indicated in AD patients to diagnose ACD, and the preferred patch-testing series and contraindications should be considered 5.
Treatment Options
- Treatment options for dermatitis include moisturizers, topical corticosteroids, topical calcineurin inhibitors, crisaborole, phototherapy, and systemic medications including biologics 6.
- For contact dermatitis, localized acute allergic contact dermatitis lesions can be treated with mid- or high-potency topical steroids, such as triamcinolone 0.1% or clobetasol 0.05% 3.
- In severe cases of contact dermatitis, oral prednisone may be necessary, and should be tapered over two to three weeks to avoid rebound dermatitis 3.