What are the treatment options for atopic dermatitis (eczema), including prescription medications and supportive care?

From the Guidelines

Eczema treatment should prioritize a combination of topical corticosteroids, topical calcineurin inhibitors, and supportive care measures, with systemic therapies like dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib considered for severe cases, as recommended by the most recent guidelines 1.

Treatment Options

For mild to moderate eczema, topical corticosteroids like hydrocortisone 1% for the face and triamcinolone 0.1% or betamethasone 0.05% for the body are effective first-line treatments, applied twice daily for 1-2 weeks during flares 1.

• Topical calcineurin inhibitors (tacrolimus 0.03-0.1% or pimecrolimus 1%) can be used on sensitive areas like the face without the side effects of steroids.
• For widespread or severe eczema, oral medications like prednisone (short course of 5-7 days, starting at 40mg daily and tapering) or immunomodulators like dupilumab (300mg subcutaneous injection every two weeks) may be necessary for chronic cases 1.

Supportive Care

Supportive care is equally important and includes:

• Daily moisturizing with fragrance-free emollients like CeraVe, Eucerin, or Vanicream, applied immediately after bathing to lock in moisture.
• Taking short, lukewarm showers or baths (5-10 minutes), using gentle, fragrance-free cleansers, and patting skin dry rather than rubbing.
• Avoiding known triggers such as harsh soaps, certain fabrics (wool, polyester), stress, and allergens.
• Wearing loose-fitting cotton clothing and maintaining a cool, humid environment. These approaches work by reducing inflammation, repairing the skin barrier, and preventing the itch-scratch cycle that worsens eczema symptoms, as supported by recent guidelines 1 and expert recommendations 1.

Considerations

The decision to initiate systemic therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of eczema, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1.

• Phototherapy may be considered for selected patients, although more randomized controlled trial evidence is needed to better understand its role in the treatment of eczema 1.
• The long-term safety of systemic medications for eczema should be continuously monitored with rigorous pharmacovigilance studies 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 options for atopic dermatitis (eczema) include:

• Second-line therapy: pimecrolimus cream 1% for mild to moderate atopic dermatitis in non-immunocompromised adults and children 2 years of age and older who have failed to respond to other topical prescription treatments 2 Prescription medications may be used for treatment, but the specific options are not fully outlined in the provided information. Supportive care is not mentioned in the provided text.

From the Research

Treatment Options for Atopic Dermatitis

The treatment options for atopic dermatitis (eczema) include various prescription medications and supportive care. The following are some of the treatment options:

• Topical corticosteroids (TCS) are the first-line treatment for atopic dermatitis flare-ups 3
• Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, can be used in conjunction with topical corticosteroids as first-line treatment 3, 4
• 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
• Oral antihistamines are not recommended because they do not reduce pruritus 3
• Newer medications, such as crisaborole and dupilumab, are effective in treating atopic dermatitis but are currently cost prohibitive for most patients 3
• Systemic therapies, such as phototherapy, cyclosporine, mycophenolic acid precursors, azathioprine, and methotrexate, can be used for long-term treatment of atopic dermatitis 5

Prescription Medications

Some of the prescription medications used to treat atopic dermatitis include:

• Potent TCS, such as tacrolimus 0.1% and ruxolitinib 1.5%, which are ranked as the most effective treatments for eczema 6
• Mild TCS, such as roflumilast 0.15% and crisaborole 2%, which are ranked as the least effective treatments for eczema 6
• Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, which are effective in treating atopic dermatitis but may have an increased frequency of application-site reactions 4
• Phosphodiesterase-4 (PDE-4) inhibitors, such as crisaborole, which are effective in treating atopic dermatitis but may be less effective than topical corticosteroids 6, 4

Supportive Care

Supportive care for atopic dermatitis includes:

• Liberal use of emollients and daily bathing with soap-free cleansers to maintain skin moisturization 3
• Avoiding allergens and irritants to prevent flare-ups 3
• Education of patients with atopic dermatitis or their parents on how to manage the condition, which is an efficient approach in the management of this chronic skin disease 7
• Interdisciplinary approaches in patients' education containing also psychological elements, which appear to be an attractive new approach for the treatment of atopic dermatitis 7