What are the treatments for atopic dermatitis (eczema)?

From the Guidelines

Atopic dermatitis (eczema) treatments should prioritize the use of emollients and prescription topical therapies, with phototherapy and systemic therapies considered for more severe or widespread cases, as recommended by the most recent guidelines 1.

Treatment Options

The mainstay of treatment for atopic eczema includes:

• Topical corticosteroids, which can be used safely if certain precautions are taken, as they are the most effective treatment for reducing inflammation and preventing flare-ups 1
• Emollients, such as fragrance-free creams or ointments like CeraVe, Eucerin, or Vaseline, applied at least twice daily and especially after bathing
• Topical calcineurin inhibitors, such as tacrolimus (Protopic) or pimecrolimus (Elidel), as non-steroidal alternatives for sensitive areas like the face
• Antihistamines, like diphenhydramine (Benadryl) 25mg at bedtime, to help manage itching

Severe Cases

For severe cases, the following treatments may be considered:

• Oral corticosteroids, like prednisone, or immunosuppressants
• Biologics, such as dupilumab (Dupixent), which have been shown to be effective in reducing inflammation and improving quality of life in patients with severe atopic dermatitis 1
• Phototherapy, including ultraviolet B, ultraviolet A1, and psoralen plus ultraviolet A

Lifestyle Management

Daily lifestyle management is also crucial in managing atopic dermatitis, including:

• Using lukewarm water for short showers
• Gentle fragrance-free soaps
• Patting skin dry
• Avoiding known triggers
• Wearing loose cotton clothing
• Maintaining optimal humidity levels These treatments and lifestyle modifications work by reducing inflammation, repairing the skin barrier, and interrupting the itch-scratch cycle that worsens eczema. The decision to initiate these treatments 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.

From the FDA Drug Label

ELIDEL Cream is a prescription medicine used on the skin (topical) to treat eczema (atopic dermatitis). ELIDEL Cream is in a class of medicines called topical calcineurin inhibitors 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. ELIDEL Cream is for use after other prescription medicines have not worked for you or if your doctor recommends that other prescription medicines should not be used

The treatment for atopic dermatitis (eczema) includes the use of topical calcineurin inhibitors such as ELIDEL Cream (pimecrolimus), which is used for short periods and can be repeated with breaks in between 2, 2, 2.

• Key points:
  • Used for mild to moderate atopic dermatitis
  • For adults and children 2 years and older without a weakened immune system
  • Used after other prescription medicines have not worked or are not advisable
  • Apply a thin layer to affected skin areas, twice a day
  • Moisturizers can be used with ELIDEL Cream, but check with doctor first.

From the Research

Treatments for Atopic Dermatitis (Eczema)

The treatments for atopic dermatitis (eczema) include:

• Topical anti-inflammatory treatments, such as topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI) 3
• Emollients and lubricants to relieve dryness and itching 4, 5, 6
• Proactive therapy of commonly affected areas of skin to prevent relapses 4
• Topical phosphodiester-9A2 (P-9A2) and Janus kinase (JAK) inhibitors, which are being evaluated in clinical trials 4
• Tacrolimus and pimecrolimus, which are effective in controlling skin inflammation and preventing relapses 7
• Ultraviolet phototherapy for moderate to severe atopic dermatitis 5
• Antistaphylococcal antibiotics to treat secondary skin infections 5

Topical Treatments

Topical treatments for atopic dermatitis include:

• Topical corticosteroids (TCS), which are the first-line treatment for atopic dermatitis flare-ups 3, 5, 6
• Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, which can be used as second-line treatment 3, 7, 5, 6
• Crisaborole, which is a topical phosphodiester-2 (P-2) inhibitor 5
• Dupilumab, which is a monoclonal antibody that targets the interleukin-4 (IL-4) and interleukin-13 (IL-13) pathways 5

Maintenance Therapy

Maintenance therapy for atopic dermatitis includes:

• Liberal use of emollients and daily bathing with soap-free cleansers 5, 6
• Use of topical corticosteroids to reduce relapse rates in patients with recurrent moderate to severe atopic dermatitis 6
• Proactive therapy of commonly affected areas of skin to prevent relapses 4