What is the treatment for atopic dermatitis on the inner elbows and around the navel?

From the Guidelines

The treatment for atopic dermatitis on the inner elbows and around the navel involves a combination of moisturizing, topical medications, and trigger avoidance, with a focus on using emollients and prescription topical therapies as the first line of treatment, as suggested by recent guidelines 1.

Key Treatment Strategies

• Daily application of fragrance-free moisturizers like CeraVe, Vanicream, or Eucerin to affected areas, especially after bathing while skin is still damp, to help maintain the skin's barrier function and reduce dryness.
• For flare-ups, use topical corticosteroids such as hydrocortisone 1% for mild cases or triamcinolone 0.1% for moderate cases, applying a thin layer twice daily for 7-14 days, as these areas are particularly prone to flares due to moisture, friction, and skin folding.
• For persistent cases, topical calcineurin inhibitors like tacrolimus (Protopic) or pimecrolimus (Elidel) may be prescribed, especially for sensitive areas like the navel where steroid use should be limited, as per the guidelines 1.

Additional Recommendations

• Take short, lukewarm showers using gentle, fragrance-free cleansers, and wear loose cotton clothing to reduce irritation and prevent further flare-ups.
• Avoid known triggers such as harsh soaps, certain fabrics, and allergens to minimize the risk of exacerbating the condition.
• If itching disrupts sleep, an oral antihistamine like diphenhydramine (Benadryl) at night may help, but it is essential to consult a healthcare provider before starting any new medication.

Importance of Healthcare Provider Consultation

• Consult a healthcare provider if symptoms worsen or don't improve within two weeks of treatment, as they can assess the severity of the condition and recommend more advanced therapies, such as phototherapy or systemic therapies, if necessary, as outlined in the guidelines 1.

From the FDA Drug Label

CLINICAL STUDIES Three randomized, double-blind, vehicle-controlled, multi-center, Phase 3 studies were conducted in 589 pediatric patients ages 3 months-17 years old to evaluate ELIDEL ® (pimecrolimus) Cream 1% for the treatment of mild to moderate atopic dermatitis Two of the three trials support the use of ELIDEL Cream in patients 2 years and older with mild to moderate atopic dermatitis

The treatment for atopic dermatitis on the inner elbows and around the navel is pimecrolimus cream 1%.

• Key points:
  • Apply a thin layer of pimecrolimus cream 1% to the affected skin areas, twice a day, as directed by the physician.
  • Use the smallest amount of pimecrolimus cream 1% needed to control the signs and symptoms of eczema.
  • Stop pimecrolimus cream 1% when the signs and symptoms of eczema go away, or as directed by the physician.
  • Pimecrolimus cream 1% can be used for short periods, and if needed, treatment may be repeated with breaks in between 2. Note that the provided drug label does not explicitly mention the inner elbows and around the navel, but it does discuss the treatment of mild to moderate atopic dermatitis in general.

From the Research

Treatment Options for Atopic Dermatitis

The treatment for atopic dermatitis on the inner elbows and around the navel typically involves a combination of topical therapies and lifestyle changes.

• Maintenance therapy consists of liberal use of emollients and daily bathing with soap-free cleansers 3.
• Topical corticosteroids are the first-line treatment for atopic dermatitis flare-ups, with pimecrolimus and tacrolimus being topical calcineurin inhibitors that can be used in conjunction with topical corticosteroids as first-line treatment 3, 4, 5.
• Ultraviolet phototherapy is a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate 3.
• Antistaphylococcal antibiotics are effective in treating secondary skin infections 3.

Topical Therapies

Topical therapies are the mainstay treatment for patients with atopic dermatitis, and are used not only by mild patients but also by moderate-to-severe patients, in conjunction with systemic treatment 4.

• Topical corticosteroids, such as betamethasone, are effective in reducing disease severity and cutaneous and systemic inflammatory markers 6.
• Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, have similar anti-inflammatory effects to low-to-medium strength topical corticosteroids, reduce pruritus and improve the quality of life of patients 4, 6, 5.
• Pimecrolimus cream is well-accepted and well-tolerated, encouraging patient adherence and leading to its use by many physicians as a preferred therapy for children and sensitive skin areas 5.

Management and Treatment

The management and treatment of atopic dermatitis with topical therapies involves a comprehensive approach, including nonpharmacologic interventions and pharmacologic topical therapies 7.

• Guidelines of care for the management of atopic dermatitis recommend treatment of atopic dermatitis with nonpharmacologic interventions and pharmacologic topical therapies 7.
• The American Academy of Dermatology has created simple diagnostic criteria based on symptoms and physical examination findings, and recommends maintenance therapy and first-line treatment with topical corticosteroids and topical calcineurin inhibitors 3.