From the Guidelines
The treatment of dermatitis, particularly atopic dermatitis, should prioritize emollients and prescription topical therapies for most patients, with consideration of phototherapy or systemic therapies for those with severe or widespread disease, substantially impaired quality of life, or refractory to optimized topical therapy, as recommended by the recent American Academy of Dermatology guidelines 1.
Treatment Approach
The approach to treating dermatitis involves a stepwise strategy, starting with the least invasive and most effective treatments. For mild cases, topical treatments are usually sufficient. However, for more severe cases or those that do not respond to topical therapies, phototherapy or systemic therapies may be considered. The decision to escalate treatment should be made through shared decision-making between the patient and clinician, taking into account the severity of the disease, its impact on the patient's quality of life, and the efficacy, safety, and accessibility of the available interventions.
Topical Therapies
Topical therapies are the mainstay of treatment for dermatitis. These include:
- Emollients to moisturize and protect the skin
- Topical corticosteroids for their anti-inflammatory effects
- Calcineurin inhibitors as non-steroidal alternatives, especially for sensitive areas
Phototherapy and Systemic Therapies
For patients with severe or widespread dermatitis, phototherapy (such as ultraviolet B, ultraviolet A1, or psoralen plus ultraviolet A) or systemic therapies (including injectable monoclonal antibodies, oral Janus kinase inhibitors, or older oral immunomodulators) may be recommended. The choice of therapy depends on the patient's specific condition, the presence of any contraindications, and the potential side effects of the treatments. Strong recommendations are made for the use of dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib, based on the latest evidence 1.
Lifestyle Modifications
In addition to medical treatments, lifestyle modifications play a crucial role in managing dermatitis. These include:
- Avoiding known irritants and allergens
- Using mild soaps and fragrance-free moisturizers
- Taking short, lukewarm showers
- Wearing loose, cotton clothing
- Applying moisturizers immediately after bathing to lock in moisture
Monitoring and Follow-Up
Given the potential for side effects with some treatments, particularly systemic therapies, continuous monitoring and follow-up are essential. This includes regular assessments of the disease's severity, the patient's quality of life, and the occurrence of any adverse effects. The long-term safety of systemic medications for dermatitis should be continuously monitored with rigorous pharmacovigilance studies, as highlighted in the recent guidelines 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 of dermatitis, specifically atopic dermatitis, is ELIDEL (pimecrolimus) Cream 1%, which can be used as a second-line therapy for mild to moderate cases in adults and children 2 years of age and older 2.
- Key points:
- Indicated for non-immunocompromised adults and children
- For short-term and non-continuous chronic treatment
- Used when other topical prescription treatments have failed or are not advisable
- Not indicated for children less than 2 years of age
- Pimecrolimus has been shown to improve symptoms of atopic dermatitis, including erythema and pruritus, in clinical studies 2
From the Research
Treatment Options for Dermatitis
- Maintenance therapy for dermatitis consists of liberal use of emollients and daily bathing with soap-free cleansers 3
- Topical corticosteroids are the first-line treatment for atopic dermatitis flare-ups 3, 4
- Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, can be used in conjunction with topical corticosteroids as first-line treatment 3, 4
- Ultraviolet phototherapy is a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate 3
- Antistaphylococcal antibiotics are effective in treating secondary skin infections 3
- Newer medications, such as crisaborole and dupilumab, are effective in treating atopic dermatitis but are currently cost-prohibitive for most patients 3, 5
Pharmacologic and Non-Pharmacologic Interventions
- Good skin care and trigger avoidance are fundamental to dermatitis management 4, 6
- Topical therapies comprise the foundation of dermatitis treatment 4
- Systemic corticosteroids should generally be avoided but can be used rarely for severe dermatitis under certain circumstances 7
- Phototherapy and systemic medications, including biologics, are also therapeutic options for dermatitis 5