What are the treatments for atopic dermatitis (Eczema)?

From the Guidelines

Atopic dermatitis (Eczema) treatments include moisturizers, topical corticosteroids (TCS), topical calcineurin inhibitors (TCI), and phototherapy. The mainstay of treatment for atopic eczema is the use of topical corticosteroids, which can be used safely if certain precautions are taken 1.

First-line treatments

• Moisturizers are front-line therapy for both acute and proactive treatment of atopic dermatitis, and should be applied after bathing 1.
• Topical corticosteroids (TCS) are first-line therapy when nonpharmacologic interventions have failed, but should be used with caution in thinned-skin areas 1.

Second-line treatments

• Topical calcineurin inhibitors (TCI) are effective, steroid-sparing agents used in acute and maintenance therapy of atopic dermatitis, but may have cutaneous side effects 1.
• Phototherapy, specifically narrow-band UVB, is recommended for recalcitrant atopic dermatitis or after failure of first-line treatment with topical agents 1.

Systemic treatments

• Systemic immunosuppressants, such as cyclosporine, azathioprine, and methotrexate, may be considered in patients with severe atopic dermatitis refractory to topical treatments and phototherapy 1.
• Oral Janus kinase inhibitors (JAKi) are highly effective, fast-onset medications used to treat moderate-to-severe atopic dermatitis, but require appropriate patient selection due to potential adverse effects 1.
• Systemic corticosteroids should be avoided due to the risk of atopic flares after discontinuation, unless in cases with acute severe exacerbations and as a bridge therapy to other systemic treatments 1.

From the Research

Treatment Options for Atopic Dermatitis

The treatment for atopic dermatitis (eczema) can be categorized into several options, including:

• Basic therapy: focused on hydrating topical treatment and avoidance of specific and unspecific provocation factors 2
• Anti-inflammatory treatment: based on topical glucocorticosteroids and topical calcineurin inhibitors (TCI) for exacerbation management and proactive therapy in selected cases 3, 4, 2
• Topical corticosteroids: remain the mainstay of therapy, but TCI such as tacrolimus and pimecrolimus are preferred in certain locations 5, 2
• Systemic immune-suppressive treatment: an option for severe refractory cases 5, 2
• Adjuvant therapy: includes UV irradiation, preferably with UVA1 wavelength or UVB 311 nm, and dietary recommendations for diagnosed individual food allergy 2
• Antimicrobial treatment: may be justified in cases of microbial colonization and superinfection 5, 2
• Biologics: such as dupilumab, are effective in treating atopic dermatitis but are currently cost-prohibitive for most patients 5
• Proactive therapy: involves regular intermittent application of low-potency steroids or topical calcineurin inhibitors to prevent new flares 3, 4

Non-Pharmacological Treatments

Non-pharmacological treatments, such as:

• Emollient therapy: improves barrier function and relieves itchiness, and should be used as a basic treatment 4, 6
• Cutaneous hydration: improves barrier function and relieves itchiness, and should be used as a basic treatment 4
• Avoiding aggravating factors: is a basic treatment of atopic dermatitis 4
• Silk clothing, ion-exchange water softeners, and emollient bath additives: have not been shown to benefit eczema patients 6
• 'Eczema school' educational programs: have been proven to be helpful 2

Pharmacological Treatments to be Demoted

Pharmacological treatments that should be demoted, such as:

• Oral antihistamines: do not reduce pruritus and are not recommended 6, 5
• Oral or topical antistaphylococcal treatments: for infected eczema, have limited evidence to support their use 6
• Probiotics: for treating eczema, have limited evidence to support their use 6