What are the treatment options for atopic dermatitis (eczema)?

From the Guidelines

Eczema treatment should prioritize a combination of moisturizing, topical medications, and trigger avoidance, with consideration of phototherapy and systemic therapies for severe or refractory cases, as recommended by the most recent guidelines from the American Academy of Dermatology 1.

Initial Treatment Approach

Start with regular application of fragrance-free moisturizers like CeraVe, Eucerin, or Vanicream immediately after bathing to lock in moisture. For mild flares, use over-the-counter 1% hydrocortisone cream twice daily for up to two weeks. More severe cases may require prescription-strength topical corticosteroids like triamcinolone 0.1% or fluocinonide 0.05%, applied thinly to affected areas twice daily for 1-2 weeks. Non-steroidal alternatives include tacrolimus (Protopic) or pimecrolimus (Elidel) for sensitive areas like the face.

Considerations for Severe or Refractory Cases

For people with more severe or widespread atopic dermatitis, or those whose condition is refractory to optimized topical therapy, phototherapy or systemic therapies may be considered to improve disease control and quality of life, as outlined in the guidelines 1. The decision to initiate these more advanced therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of the condition, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions.

Key Recommendations

• Use emollients and prescription topical therapies as the first line of treatment for most people with atopic dermatitis.
• Consider phototherapy or systemic therapies, including biologics and Janus kinase inhibitors, for severe or refractory cases.
• Make decisions about treatment using shared decision-making between patients and clinicians, considering the severity of the condition, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions.
• Continuously monitor the long-term safety of systemic medications for atopic dermatitis with rigorous pharmacovigilance studies, as highlighted in the guidelines 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 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.

Eczema Treatment with Pimecrolimus (TOP): Pimecrolimus cream 1% is used to treat mild to moderate atopic dermatitis (eczema) in adults and children aged 2 years and older.

• It should be applied only to areas of the skin with eczema, for short periods, and repeated with breaks in between if needed.
• Patients should stop using the cream when symptoms such as itching, rash, and redness go away, or as directed by their doctor.
• The safety of using ELIDEL Cream for a long period of time is not known, and a link to cancer has not been shown, but it is recommended to avoid continuous long-term use 2, 2, 2.

From the Research

Eczema Treatment Options

• Topical corticosteroids are a common treatment for eczema, with different potencies and formulations available 3, 4, 5, 6, 7
• The choice of topical corticosteroid potency and frequency of application depends on the severity of the eczema and the individual patient's response to treatment 4, 6

Topical Corticosteroid Potency

• Potent and very potent topical corticosteroids are probably more effective than mild topical corticosteroids for treating moderate or severe eczema 4, 5
• However, there is uncertain evidence to support any advantage of very potent over potent topical corticosteroids 4
• The risk of adverse effects, such as skin thinning, increases with higher potency topical corticosteroids 3, 7

Frequency of Application

• Once daily application of topical corticosteroids is probably as effective as twice daily or more frequent application for treating eczema flare-ups 4, 6
• Weekend (proactive) therapy with topical corticosteroids is probably better than no topical corticosteroids or reactive use to prevent eczema relapse (flare-ups) 4

Safety of Topical Corticosteroids

• The safety of topical corticosteroids in atopic eczema has been evaluated in several systematic reviews, with most finding no significant increased risk of skin thinning or biochemical adrenal suppression with short-term use 7
• However, long-term safety data are limited, and the risk of adverse effects may increase with prolonged use or higher potency topical corticosteroids 3, 7