From the Guidelines
Eczema treatment should prioritize a combination of moisturizing, topical medications, and trigger avoidance, with the most recent guidelines recommending the use of phototherapy and systemic therapies for severe cases, as outlined in the 2024 guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies 1.
Treatment Options
The treatment of atopic dermatitis (eczema) involves a multi-faceted approach, including:
- Daily moisturizing using fragrance-free creams or ointments like Vaseline, CeraVe, or Eucerin, applying immediately after bathing to lock in moisture
- Topical corticosteroids, such as hydrocortisone 1% for the face and intertriginous areas, or stronger options like triamcinolone 0.1% for the body, applying twice daily for 1-2 weeks
- Non-steroidal alternatives, including tacrolimus (Protopic) or pimecrolimus (Elidel) for sensitive areas
- Short, lukewarm showers using gentle, fragrance-free cleansers
- Identification and avoidance of triggers, such as harsh soaps, certain fabrics, stress, and allergens
Severe Cases
For severe cases of eczema, oral antihistamines like cetirizine (10mg daily) can help with itching, while prescription options may include:
- Oral corticosteroids
- Immunosuppressants, such as cyclosporine
- Biologics, such as dupilumab (Dupixent) These treatments work by reducing inflammation and supporting skin barrier function, as eczema results from immune system overactivity and compromised skin barrier that allows moisture loss and irritant penetration, as noted in the guidelines for the management of atopic dermatitis 1.
Recent Guidelines
The most recent guidelines, published in 2024, recommend the use of phototherapy and systemic therapies for severe cases of atopic dermatitis, and emphasize the importance of shared decision-making between patients and clinicians when considering these advanced therapies 1. The decision to initiate phototherapy or systemic therapies should be based on the severity of the disease, its impact on the patient's quality of life, and the efficacy, safety, and accessibility of the available interventions, as outlined in the 2024 guidelines 1.
From the FDA Drug Label
ELIDEL Cream is a prescription medicine used on the skin (topical) to treat eczema (atopic dermatitis). ELIDEL Cream is for adults and children age 2 years and older who do not have a weakened immune system. ELIDEL Cream is used on the skin for short periods, and if needed, treatment may be repeated with breaks in between.
The treatment options for atopic dermatitis (eczema) include:
- Topical calcineurin inhibitors such as pimecrolimus (ELIDEL Cream) for short periods, with breaks in between treatments
- Moisturizers to keep up good skin care practices
- Other prescription medicines that may be recommended by a doctor if pimecrolimus is not effective or suitable for the patient It is essential to follow the doctor's advice and instructions for using ELIDEL Cream, and to monitor for any side effects or worsening of symptoms 2, 2, 2.
From the Research
Treatment Options for Atopic Dermatitis (Eczema)
- Topical corticosteroids (TCS) are commonly used to treat atopic dermatitis, but their long-term use can lead to side effects such as skin thinning and increased risk of infection 3
- Topical calcineurin inhibitors (TCI), such as pimecrolimus and tacrolimus, are alternative treatment options that can be effective in reducing symptoms of atopic dermatitis, especially in patients who are intolerant of or dependent on TCS 4, 5, 6
- Pimecrolimus cream 1% has been shown to be effective in treating mild to moderate atopic dermatitis in children and adults, with significant reductions in eczema symptoms and improvement in quality of life 4, 5
- Tacrolimus ointment 0.03% and 0.1% are approved for moderate to severe atopic dermatitis in patients aged 2-17 years and 18 years and older, respectively, and have been shown to be effective in reducing symptoms of atopic dermatitis 6, 7
- Other treatment options, such as phosphodiesterase-4 (PDE-4) inhibitors, janus kinase (JAK) inhibitors, and aryl hydrocarbon receptor activators, are also being studied for their potential effectiveness in treating atopic dermatitis 3
Comparison of Treatment Options
- A network meta-analysis of 291 studies found that potent TCS, tacrolimus 0.1%, and ruxolitinib 1.5% were among the most effective topical anti-inflammatory treatments for eczema, while mild TCS, roflumilast 0.15%, and crisaborole 2% were among the least effective 3
- The same analysis found that TCI, such as pimecrolimus and tacrolimus, were more likely to cause local application-site reactions, while TCS were least likely to cause such reactions 3
Patient Preference and Treatment Compliance
- A pilot study found that patient preference for pimecrolimus cream or tacrolimus ointment was influenced by factors such as ease of application, texture, and odor, highlighting the importance of considering patient preferences when selecting a treatment option 7