Is oral gabapentin (anticonvulsant) a treatment option for pediatric atopic dermatitis?

Oral Gabapentin for Pediatric Atopic Dermatitis

Oral gabapentin is not a recognized or recommended treatment option for pediatric atopic dermatitis and should not be used for this indication.

Evidence from Clinical Guidelines

Gabapentin does not appear in any established treatment guidelines for pediatric atopic dermatitis. The most comprehensive guidelines from the American Academy of Dermatology 1 and the Taiwan Academy of Pediatric Allergy, Asthma and Immunology 1 systematically reviewed all available systemic agents for atopic dermatitis and gabapentin is notably absent from all treatment algorithms and recommendations.

What Guidelines Actually Recommend for Systemic Therapy

The established systemic treatment options for pediatric atopic dermatitis, in order of evidence strength, include:

For pruritus management specifically:

• Oral antihistamines are recommended as adjuvant therapy for reducing pruritus, though evidence shows they work primarily through sedation rather than antipruritic effects 1
• Sedating antihistamines may improve sleep quality in children with atopic dermatitis, but caution is warranted in school-age children due to potential negative effects on school performance 1

For severe/refractory disease:

• Dupilumab is the first-line biologic for severe to very severe atopic dermatitis refractory to topical treatment 1, 2
• Immunomodulators including cyclosporine, azathioprine, and methotrexate may be used in children with very severe disease 1, 3

Why Gabapentin Is Not Appropriate

The absence of gabapentin from comprehensive systematic reviews is telling. The American Academy of Dermatology work group specifically identified "gaps in research" and acknowledged that "much has yet to be learned" about systemic medications for atopic dermatitis 1. Despite this acknowledgment, gabapentin was not even mentioned as a potential agent under investigation or consideration.

Important Safety Consideration

The Taiwan guidelines specifically note that "special caution should be taken in patients with epilepsy" when using antihistamines, with some agents contraindicated or associated with convulsions 1. While this refers to antihistamines, it highlights the importance of neurological safety considerations in pediatric atopic dermatitis patients—a concern that would extend to any anticonvulsant medication used off-label.

What Should Be Used Instead

For pediatric patients with significant pruritus from atopic dermatitis:

1. First-line approach: Optimize topical therapy with appropriate-potency corticosteroids and liberal emollient use 2, 4
2. For persistent pruritus: Add sedating oral antihistamines (e.g., hydroxyzine, diphenhydramine) primarily for nighttime use to improve sleep 1
3. For refractory severe disease: Consider dupilumab (age-appropriate) or systemic immunomodulators under specialist guidance 1, 2, 3

Common Pitfall to Avoid

Do not use gabapentin as an off-label treatment for pediatric atopic dermatitis pruritus. There is no evidence base supporting its efficacy or safety in this population for this indication, and established alternatives with proven benefit exist 1.