What are the most effective medications for atopic dermatitis (eczema)?

From the Guidelines

The most effective medications for atopic dermatitis (eczema) include biologics such as dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib, as well as topical corticosteroids and non-steroidal options like tacrolimus and pimecrolimus, which have been shown to improve disease control and quality of life in patients with severe or widespread AD 1.

Medication Options

• Topical corticosteroids like hydrocortisone, triamcinolone, or fluocinonide, applied thinly to affected areas 1-2 times daily for 1-2 weeks during flares
• Non-steroidal options such as tacrolimus or pimecrolimus, used twice daily for maintenance without the side effects of long-term steroid use
• Oral antihistamines like cetirizine or diphenhydramine to help control itching
• Biologics such as dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib, which have been shown to be effective in reducing inflammation and immune system overactivity in patients with severe AD 1

Treatment Considerations

• The decision to initiate advanced therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of AD, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1
• Patients with severe or widespread AD, or those whose AD is refractory to optimized topical therapy, may consider the use of phototherapy or systemic therapies to improve disease control and quality of life 1
• The use of systemic corticosteroids is not recommended due to the potential for significant side effects and the availability of safer alternative treatments 1

Additional Recommendations

• Using fragrance-free moisturizers multiple times daily and avoiding triggers like harsh soaps, certain fabrics, and known allergens is essential for effective management of AD
• A multidisciplinary approach to care, including patient education and support, can help improve outcomes and quality of life for patients with AD 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. ELIDEL Cream is a prescription medicine used on the skin (topical) to treat eczema (atopic dermatitis). The most effective medication mentioned for atopic dermatitis (eczema) is pimecrolimus (ELIDEL) Cream 1%, which is used as a second-line therapy for the treatment of mild to moderate atopic dermatitis in non-immunocompromised adults and children 2 years of age and older 2.

• Key points:
  • Used for short-term and non-continuous chronic treatment
  • For patients who have failed to respond adequately to other topical prescription treatments
  • Not indicated for use in children less than 2 years of age 2

From the Research

Effective Medications for Atopic Dermatitis (Eczema)

The following medications have been found to be effective in treating atopic dermatitis (eczema):

• Topical corticosteroids, particularly potent and very potent ones, have been shown to be effective in reducing eczema symptoms 3, 4
• Tacrolimus, a topical calcineurin inhibitor, has been found to be effective in treating moderate to severe eczema, with some studies showing it to be more effective than mild topical corticosteroids 5, 4
• Pimecrolimus, another topical calcineurin inhibitor, has been shown to be effective in treating mild to moderate eczema, although its effectiveness compared to topical corticosteroids is still uncertain 6, 7, 4
• Janus kinase (JAK) inhibitors, such as ruxolitinib and delgocitinib, have been found to be effective in treating eczema, although more research is needed to fully understand their effects 4

Comparison of Medications

Studies have compared the effectiveness of different medications for eczema, including:

• Topical corticosteroids vs. topical calcineurin inhibitors: potent and very potent topical corticosteroids have been found to be more effective than mild topical corticosteroids, while topical calcineurin inhibitors such as tacrolimus and pimecrolimus have been found to be effective in treating moderate to severe eczema 3, 4
• Tacrolimus vs. pimecrolimus: tacrolimus has been found to be more effective than pimecrolimus in some studies, although pimecrolimus has been shown to be effective in treating mild to moderate eczema 6, 5, 7, 4
• Topical corticosteroids vs. JAK inhibitors: JAK inhibitors such as ruxolitinib and delgocitinib have been found to be effective in treating eczema, although more research is needed to fully understand their effects compared to topical corticosteroids 4

Safety and Side Effects

The safety and side effects of medications for eczema have also been studied, including:

• Local adverse effects: topical calcineurin inhibitors such as tacrolimus and pimecrolimus have been found to be more likely to cause local adverse effects such as application-site reactions, while topical corticosteroids have been found to be less likely to cause these effects 4
• Skin thinning: long-term use of topical corticosteroids has been found to increase the risk of skin thinning, although the risk with short-term use is still uncertain 3, 4