What is the treatment for atopic dermatitis (eczema)?

From the Guidelines

Atopic dermatitis treatment should prioritize a combination of moisturizing, topical medications, and trigger avoidance, with a focus on using the least potent preparation required to keep the eczema under control, as recommended by the most recent guidelines 1. The treatment approach involves:

• Daily moisturizing using thick creams or ointments like petroleum jelly, CeraVe, or Eucerin, applying immediately after bathing to lock in moisture
• Topical corticosteroids, such as hydrocortisone 1% for the face and skin folds, or stronger options like triamcinolone 0.1% for body areas, applying twice daily for 1-2 weeks
• Calcineurin inhibitors like tacrolimus (Protopic) or pimecrolimus (Elidel) as steroid-free alternatives for sensitive areas
• For severe cases, prescription-strength treatments may include higher-potency steroids, oral antihistamines like cetirizine 10mg daily for itch relief, or in persistent cases, systemic medications such as dupilumab injections or oral immunosuppressants
• Lifestyle modifications, including taking short, lukewarm showers, using gentle fragrance-free soaps, identifying and avoiding triggers like certain fabrics, detergents, or foods, and managing stress which can worsen symptoms These approaches work by reducing inflammation, repairing the skin barrier, and minimizing immune system overreaction that characterizes eczema, as supported by recent guidelines 1.

Key considerations in treatment include:

• Using the least potent preparation required to keep the eczema under control, as recommended by the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London 1
• Shared decision-making between patients and clinicians to determine the best course of treatment, taking into account the severity of AD, its impact on the patient, and the efficacy, safety, and accessibility of available interventions 1
• Considering alternate diagnoses, such as allergic contact dermatitis and cutaneous lymphoma, when AD is refractory to standard treatments, including topical therapy and systemic therapies 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 atopic dermatitis (eczema) is ELIDEL Cream 1% as a second-line therapy for short-term and non-continuous chronic treatment in patients who have failed to respond to other topical prescription treatments.

• It is used for mild to moderate atopic dermatitis.
• It is applied twice daily to affected skin areas.
• Treatment should be stopped when symptoms go away or as directed by the physician. 2

From the Research

Treatment Options for Atopic Dermatitis (Eczema)

The treatment for atopic dermatitis (eczema) typically involves the use of topical anti-inflammatory treatments to control symptoms. According to 3, these treatments include:

• Topical corticosteroids (TCS)
• Topical calcineurin inhibitors (TCI)
• Phosphodiesterase-4 (PDE-4) inhibitors
• Janus kinase (JAK) inhibitors
• Aryl hydrocarbon receptor activators
• Other topical agents

Effectiveness of Treatment Options

The effectiveness of these treatment options varies, with some being more effective than others. For example:

• Potent TCS, tacrolimus 0.1%, and ruxolitinib 1.5% were ranked as the most effective treatments for improving patient-reported symptoms and clinician-reported signs 3, 4
• Pimecrolimus cream 1% was shown to be effective and well-tolerated in pediatric patients with mild to moderate atopic eczema 5
• Topical pimecrolimus was found to be less effective than moderate and potent corticosteroids and 0.1% tacrolimus 6

Safety and Adverse Effects

The safety and adverse effects of these treatment options also vary. For example:

• Local application site reactions were most common with tacrolimus 0.1% and crisaborole 2% 3, 4
• Skin thinning was not increased with short-term use of any topical steroid potency, but was reported in 0.3% of participants treated with longer-term topical steroids 3, 4
• Pimecrolimus was associated with a mild to moderate, transient, warm/burning sensation in approximately 10% of patients 5

Key Findings

Some key findings from the studies include:

• Potent topical steroids, JAK inhibitors, and tacrolimus 0.1% were consistently ranked as among the most effective topical anti-inflammatory treatments for eczema 3, 4
• Pimecrolimus and crisaborole 2% were ranked as the most likely to cause local application site reactions 3, 4
• Topical noncorticosteroid immunomodulators, such as tacrolimus and pimecrolimus, may replace topical corticosteroids as the first-line treatment of atopic dermatitis due to their lack of suppressive effects on connective tissue cells 7