From the Guidelines
First-line therapy for atopic dermatitis consists of good skin care practices and topical corticosteroids. Patients should maintain skin hydration with regular use of moisturizers (emollients) applied at least twice daily, especially after bathing while the skin is still damp. Gentle, fragrance-free cleansers should be used instead of soaps. For active flares, topical corticosteroids are the mainstay treatment, with strength selected based on severity and location of the rash. Low-potency steroids like hydrocortisone 1-2.5% are appropriate for the face and intertriginous areas, while medium-potency (triamcinolone 0.1%) or high-potency (fluocinonide 0.05%) preparations may be needed for thicker skin areas or severe flares. Topical steroids should be applied once or twice daily to affected areas until the rash resolves, typically for 1-2 weeks. These medications work by reducing inflammation, itching, and skin reactivity. Patients should be counseled on the "fingertip unit" method for appropriate dosing and advised to avoid prolonged use of high-potency steroids to prevent skin thinning and other side effects. Trigger avoidance is also essential, including minimizing exposure to known allergens, avoiding harsh detergents, and wearing loose cotton clothing. This approach is supported by the most recent guidelines from the American Academy of Dermatology, as outlined in the 2024 guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies 1.
Some key points to consider when managing atopic dermatitis include:
- Maintaining good skin care practices to reduce symptoms and prevent flares
- Using topical corticosteroids as the mainstay treatment for active flares
- Selecting the appropriate strength of topical corticosteroid based on the severity and location of the rash
- Counseling patients on proper dosing and potential side effects of topical corticosteroids
- Encouraging trigger avoidance to reduce symptoms and prevent flares.
It is also important to note that systemic corticosteroids are not recommended as first-line therapy for atopic dermatitis, due to their potential side effects and the availability of more effective and safer alternatives 1. Similarly, diphenhydramine cream and Sarna are not considered first-line therapies for atopic dermatitis, and their use should be individualized based on patient-specific factors and preferences.
From the FDA Drug Label
Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema The answer is c. Topical corticosteroids, as the drug label for hydrocortisone (TOP) mentions it is used to relieve itching associated with eczema, which is another term for atopic dermatitis 2.
- Key points:
- Atopic dermatitis is also known as eczema
- Topical corticosteroids, such as hydrocortisone, are used to relieve itching associated with eczema
- This indicates that topical corticosteroids are considered first-line therapy for atopic dermatitis
From the Research
First-Line Therapy for Atopic Dermatitis
The first-line therapy for atopic dermatitis is a crucial aspect of its management. According to various studies, the following options are considered:
- Topical corticosteroids are widely recognized as the first-line treatment for atopic dermatitis flare-ups 3, 4, 5.
- Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, can be used in conjunction with topical corticosteroids as first-line treatment 3, 6, 7.
Comparison of Options
In contrast to topical corticosteroids, the other options are not considered first-line therapy:
- Systemic corticosteroids are not typically used as first-line treatment for atopic dermatitis due to potential side effects 3.
- Sarna is not mentioned in the provided studies as a first-line treatment for atopic dermatitis.
- Diphenhydramine cream is not recommended as a first-line treatment, as oral antihistamines are not effective in reducing pruritus in atopic dermatitis 3.