What is the treatment for atopic dermatitis (eczema)?

From the Guidelines

The treatment for atopic dermatitis (eczema) involves a combination of moisturizing, topical medications, and trigger avoidance, with the most recent guidelines suggesting the use of emollients, prescription topical therapies, and consideration of phototherapy or systemic therapies for more severe cases, as recommended by the 2024 guidelines from the Journal of the American Academy of Dermatology 1. The treatment approach should prioritize reducing inflammation and repairing the skin barrier, which is compromised in eczema. Key considerations include:

• Daily moisturizing using thick creams or ointments like petroleum jelly, Eucerin, or CeraVe, applying immediately after bathing to lock in moisture
• Use of 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
• Topical calcineurin inhibitors (tacrolimus, pimecrolimus) as steroid-free alternatives for sensitive areas
• Prescription options for severe cases, including stronger steroids, oral antihistamines for itch relief (like cetirizine 10mg daily), or systemic immunosuppressants such as dupilumab injections
• Identification and avoidance of personal triggers like certain fabrics, detergents, or foods
• Use of gentle, fragrance-free cleansers and short, lukewarm showers to minimize skin irritation The decision to initiate more advanced therapies, such as phototherapy or systemic therapies, 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, as outlined in the 2024 guidelines 1.

From the FDA Drug Label

5 Allergic States Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment: ... Atopic dermatitis 2

• Atopic dermatitis can be treated with prednisone.
• The treatment is indicated for severe or incapacitating allergic conditions that are intractable to adequate trials of conventional treatment.

From the Research

Treatment Options for Atopic Dermatitis (Eczema)

• Topical corticosteroids, such as hydrocortisone 1% and clobetasone butyrate 0.05%, are commonly used to treat eczema 3
• Topical calcineurin inhibitors, such as tacrolimus 0.1%, have been shown to be effective in treating moderate to severe atopic dermatitis 4, 5, 6
• Janus kinase (JAK) inhibitors, such as ruxolitinib 1.5% and delgocitinib 0.5%, have been found to be effective in treating eczema 4, 5
• Ceramide-containing skin care products, such as multilamellar vesicular emulsion (MVE) ceramide-containing liquid cleanser and moisturizing cream, can enhance the treatment outcome of mild to moderate eczema when used in combination with a high-potency corticosteroid 7

Effectiveness of Treatment Options

• Potent topical steroids, tacrolimus 0.1%, and ruxolitinib 1.5% were ranked among the most effective treatments for improving patient-reported symptoms and clinician-reported signs 4, 5
• Very potent topical steroids, tacrolimus 0.1%, and ruxolitinib 1.5% were ranked among the most effective treatments for investigator global assessment 4, 5
• Mild topical steroids and tapinarof 1% were ranked among the least effective treatments for eczema 4, 5

Safety of Treatment Options

• Local application site reactions were most common with tacrolimus 0.1% and crisaborole 2% 4, 5
• 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 4, 5