What are the treatment options for managing an atopic dermatitis (eczema) flare?

From the Guidelines

To treat an eczema flare, start with gentle skincare and topical corticosteroids, as recommended by the most recent guidelines 1.

Treatment Approach

• Use a medium-potency steroid cream like triamcinolone 0.1% or fluocinolone 0.025% twice daily for 7-14 days on affected areas, then taper to once daily for another week.
• Pair this with frequent moisturizing using fragrance-free emollients like CeraVe, Eucerin, or Vanicream at least 3-4 times daily, especially after bathing while skin is still damp.
• Take short, lukewarm showers using mild, fragrance-free cleansers and pat skin dry.
• For severe itching, an oral antihistamine like cetirizine 10mg daily or diphenhydramine 25mg at bedtime can help.

Prevention of Future Flares

• Consider proactive application of topical corticosteroids or topical calcineurin inhibitors to previously involved skin on a scheduled, intermittent basis to reduce the risk of flare development 1.
• Daily use of moisturizers can also help to lengthen the time to first flare and improve skin hydration.

Important Considerations

• Avoid known triggers such as harsh soaps, fragrances, certain fabrics, stress, and extreme temperatures.
• If the flare includes signs of infection (yellow crusting, increased pain, warmth) or doesn't improve within two weeks of treatment, seek medical attention.
• Corticosteroids work by reducing inflammation and suppressing the immune response in the skin, while moisturizers repair the skin barrier function that's compromised in eczema, preventing water loss and reducing irritant penetration 1.

From the FDA Drug Label

ELIDEL Cream is a prescription medicine used on the skin (topical) to treat eczema (atopic dermatitis). Use ELIDEL Cream exactly as prescribed. Use ELIDEL Cream only on areas of your skin that have eczema. Use ELIDEL Cream for short periods, and if needed, treatment may be repeated with breaks in between. Stop ELIDEL Cream when the signs and symptoms of eczema, such as itching, rash, and redness go away, or as directed by your doctor

Treating Eczema Flare with Pimecrolimus (TOP)

• Pimecrolimus (TOP) cream is used to treat eczema (atopic dermatitis) in adults and children age 2 years and older.
• Apply a thin layer of ELIDEL Cream only to the affected skin areas, twice a day, as directed by your doctor.
• Use the smallest amount of ELIDEL Cream needed to control the signs and symptoms of eczema.
• Treatment may be repeated with breaks in between if needed.
• Stop ELIDEL Cream when the signs and symptoms of eczema go away, or as directed by your doctor 2, 2, 2.

From the Research

Treating Eczema Flare-Ups

• Topical corticosteroids are a first-line treatment for eczema flare-ups, with potent and moderate topical corticosteroids probably being more effective than mild topical corticosteroids 3
• The effectiveness of topical corticosteroids is similar between once daily and twice daily (or more) frequent use to treat eczema flare-ups 3, 4
• Topical corticosteroids weekend (proactive) therapy is probably better than no topical corticosteroids/reactive use to prevent eczema relapse (flare-ups) 3, 5

Safety of Topical Corticosteroids

• Local adverse events, such as abnormal skin thinning, are not well reported and come largely from low- or very low-certainty, short-term trials 3, 5
• The frequency of abnormal skin thinning is low overall and increases with increasing potency of topical corticosteroids 3, 5
• Biochemical adrenal suppression is a potential risk of topical corticosteroid use, but effects are reversible when treatment ceases 5

Other Treatment Options

• Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, can be used in conjunction with topical corticosteroids as first-line treatment for eczema 6, 4
• Ultraviolet phototherapy is a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate 6
• Newer medications, such as crisaborole and dupilumab, are effective in treating atopic dermatitis but are currently cost prohibitive for most patients 6, 4

Treatment Strategies

• The "get control then keep control" regimen, which involves using topical therapies to achieve control of eczema symptoms and then maintaining control with ongoing treatment, is a recommended approach 4
• Patient education and good skin care practices, such as liberal use of emollients and daily bathing with soap-free cleansers, are important components of eczema management 6, 4