From the Guidelines
The treatment for atopic dermatitis should prioritize a multi-faceted approach focusing on skin hydration, inflammation control, and trigger avoidance, with emollients and prescription topical therapies being sufficient for most people, while those with more severe cases may require phototherapy or systemic therapies, as recommended by the American Academy of Dermatology guidelines 1.
Key Components of Treatment
- Daily moisturizing with fragrance-free emollients like CeraVe, Eucerin, or Vanicream, applied immediately after bathing to lock in moisture
- Topical corticosteroids, such as hydrocortisone 1% for the face and triamcinolone 0.1% for the body, for mild flares, applied twice daily for 1-2 weeks
- Non-steroidal alternatives, including tacrolimus (Protopic) 0.03-0.1% and pimecrolimus (Elidel) 1%, for sensitive areas like the face
- Phototherapy or systemic therapies, such as dupilumab (Dupixent) injections, for severe or widespread dermatitis
Lifestyle Modifications
- Using lukewarm water for short (5-10 minute) baths or showers
- Gentle fragrance-free soaps
- Avoiding known triggers like certain fabrics or allergens
- Maintaining good sleep hygiene
Decision-Making
The decision to initiate more advanced therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of atopic dermatitis, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1.
Evidence-Based Recommendations
The American Academy of Dermatology guidelines provide evidence-based recommendations for the management of atopic dermatitis in adults with phototherapy and systemic therapies, including strong recommendations for the use of dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib 1.
From the FDA Drug Label
Hydrocortisone Butyrate Ointment, 0.1% is indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. The treatment for atopic dermatitis is hydrocortisone butyrate ointment, 0.1% as it is indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses, which includes atopic dermatitis 2.
- Key points:
- Indication: relief of inflammatory and pruritic manifestations
- Condition: corticosteroid-responsive dermatoses, including atopic dermatitis
- Drug: hydrocortisone butyrate ointment, 0.1%
From the Research
Treatment Options for Atopic Dermatitis
The treatment for atopic dermatitis involves a combination of lifestyle changes, topical medications, and systemic therapies. Some of the key treatment options include:
- Maintenance therapy with liberal use of emollients and daily bathing with soap-free cleansers 3
- Topical corticosteroids as the first-line treatment for atopic dermatitis flare-ups 3, 4
- Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, which can be used in conjunction with topical corticosteroids as first-line treatment 3
- Ultraviolet phototherapy as a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate 3
- Antistaphylococcal antibiotics for treating secondary skin infections 3
- Systemic treatments, such as Janus kinase inhibitors and interleukin inhibitors, which have proven efficacious in atopic dermatitis 5
Medications to Avoid
Some medications are not recommended for the treatment of atopic dermatitis, including:
- Oral antihistamines, which do not reduce pruritus and are not recommended by the American Academy of Dermatology 3, 6
- Integrative medicine, for which there is a lack of evidence to support its use in the treatment of atopic dermatitis 3
Newer Medications
Newer medications, such as crisaborole and dupilumab, have been approved by the U.S. Food and Drug Administration for the treatment of atopic dermatitis, but are currently cost-prohibitive for most patients 3, 5