From the Guidelines
Atopic dermatitis treatment should prioritize a combination of moisturizers, topical corticosteroids, and trigger avoidance, with advanced therapies like phototherapy, oral immunosuppressants, or biologics considered for severe or refractory cases. For daily management, applying a thick, fragrance-free moisturizer like CeraVe, Eucerin, or Vanicream at least twice daily is essential, especially after bathing while skin is still damp 1. Key considerations include:
- Using topical corticosteroids such as hydrocortisone 1% for the face and sensitive areas, or triamcinolone 0.1% for the body, applying a thin layer to affected areas twice daily for 7-14 days
- Identifying and avoiding personal triggers such as certain fabrics, detergents, foods, or stress
- Taking short, lukewarm showers using gentle, fragrance-free cleansers
- Considering antihistamines like cetirizine or diphenhydramine to help manage itching
For more severe cases, prescription-strength steroids like fluocinonide 0.05% or clobetasol 0.05%, or non-steroidal alternatives like tacrolimus (Protopic) or pimecrolimus (Elidel) may be necessary 1. The decision to initiate advanced therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of atopic dermatitis, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions. Recent guidelines suggest strong recommendations for the use of biologics such as dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib for severe or refractory cases 1.
From the Research
Treatment Options for Atopic Dermatitis (Eczema)
The treatment options for atopic dermatitis (eczema) include:
- Topical corticosteroids (TCS) 2, 3, 4
- Topical calcineurin inhibitors (TCI), such as tacrolimus 0.03% and 0.1% 2, 3, 4
- Phosphodiesterase-4 (PDE-4) inhibitors, such as crisaborole 2% and roflumilast 0.15% 3, 4
- Janus kinase (JAK) inhibitors, such as ruxolitinib 1.5% and delgocitinib 0.5% and 0.25% 3, 4
- Aryl hydrocarbon receptor activators 3
- Systemic immunosuppressive treatments, such as dupilumab, tralokinumab, and ustekinumab 5
Topical Treatments
Topical treatments are the first line of treatment for atopic dermatitis. The choice of topical treatment depends on the severity of the disease and the patient's response to treatment.
- Potent and very potent TCS are effective in reducing patient-reported symptoms and clinician-reported signs 3, 4
- Tacrolimus 0.1% is effective in reducing patient-reported symptoms and clinician-reported signs 3, 4
- Crisaborole 2% is less effective than potent TCS and tacrolimus 0.1% 3, 4
Systemic Treatments
Systemic treatments are used for moderate to severe atopic dermatitis that does not respond to topical treatments.
- Dupilumab is the most effective biological treatment for eczema, reducing eczema signs and symptoms in the short term for people with moderate to severe atopic eczema 5
- Tralokinumab and ustekinumab may be effective in reducing eczema signs and symptoms, but the evidence is uncertain due to low-certainty evidence 5
Emollients and Topical Corticosteroids
The order of application of emollient and topical corticosteroids does not make a difference in the severity of atopic eczema in children 6