What is the treatment for topical dermatitis?

From the Guidelines

Topical corticosteroids are the most commonly utilized FDA-approved therapies and should be used as first-line treatment for mild-to-severe dermatitis in all skin regions. The treatment for topical dermatitis typically involves a combination of avoiding triggers, maintaining good skin care, and using medications to reduce inflammation and itching.

First-line Treatments

• Topical corticosteroids such as hydrocortisone 1% for mild cases, or stronger options like triamcinolone 0.1% or fluocinonide 0.05% for moderate to severe cases, applied twice daily for 1-2 weeks, are recommended as the primary treatment option 1.
• Calcineurin inhibitors like tacrolimus (Protopic) 0.03-0.1% or pimecrolimus (Elidel) 1% are steroid-free alternatives, especially useful for sensitive areas like the face.

Additional Therapies

• Daily moisturizing with fragrance-free emollients helps repair the skin barrier and prevents flares.
• For severe itching, oral antihistamines such as cetirizine 10mg daily or diphenhydramine 25mg every 6 hours may provide relief.
• Wet wrap therapy can be beneficial for acute flares, involving applying medication, moisturizer, then covering with damp bandages for 2-8 hours.

Long-term Management

• Identifying and avoiding triggers such as certain soaps, detergents, fabrics, or allergens is crucial for long-term management.
• These treatments work by reducing inflammation, repairing the skin barrier, and breaking the itch-scratch cycle that worsens dermatitis, as supported by recent guidelines 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 treatment for topical dermatitis (specifically atopic dermatitis) is ELIDEL Cream 1% (pimecrolimus), which can be used as a second-line therapy for short-term and non-continuous chronic treatment in patients who have failed to respond to other treatments 2.

• Key points:
  • Indicated for: mild to moderate atopic dermatitis
  • Patient population: non-immunocompromised adults and children 2 years of age and older
  • Usage: apply a thin layer of ELIDEL Cream only to the affected skin areas, twice a day, as directed by the physician 2

From the Research

Treatment Options for Topical Dermatitis

• Topical corticosteroids are a common treatment for inflammatory skin conditions such as psoriasis and atopic dermatitis 3, 4.
• The use of topical corticosteroids has significantly enhanced the treatment of patients with dermatoses such as psoriasis and eczema 3.
• Topical corticosteroids are classified by strength and the risk of adverse effects such as atrophy, striae, rosacea, telangiectasias, purpura, and other cutaneous and systemic reactions 4.

Application and Dosage

• The quantity of corticosteroid prescribed depends on the duration of treatment, the frequency of application, the skin location, and the total surface area treated 4.
• Correct patient application is critical to successful use, and patients may be taught application using the fingertip unit method 4.
• Topical corticosteroids are applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 4.

Alternative Treatments

• Tacrolimus ointment is a non-steroidal topical therapy that has been shown to be effective in treating moderate to severe atopic dermatitis in children 5, 6.
• A study comparing 0.03% tacrolimus ointment with 1% hydrocortisone acetate found that tacrolimus ointment was more efficacious in treating moderate to severe atopic dermatitis in children 5.
• Another study found that topical tacrolimus was more effective than hydrocortisone in reducing the Eczema Area and Severity Index (EASI) score in pediatric patients with atopic dermatitis 6.

Comparison of Topical and Oral Corticosteroids

• A study found that most topical corticosteroids have the potential to achieve greater effective drug levels in the superficial layers of skin than those achieved with standard doses of oral prednisone 7.
• The apparently greater efficacy of oral corticosteroid therapy may be attributable, in part, to poor patient compliance with topical therapy 7.