What are the treatment options for dermatitis?

From the Guidelines

The most effective treatment for dermatitis involves a combination of topical therapies, phototherapy, and systemic therapies, with the decision to initiate these treatments made using shared decision-making between patients and clinicians, taking into account the severity of dermatitis, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions. For most people with dermatitis, emollients and prescription topical therapies are sufficient to achieve control 1. Some key points to consider in the treatment of dermatitis include:

• Identifying and avoiding triggers
• Maintaining good skin care
• Using medications to reduce inflammation and itching
• Considering phototherapy or systemic therapies for more severe or widespread cases
• Using shared decision-making between patients and clinicians to determine the best course of treatment 1. The American Academy of Dermatology guidelines suggest that there are several effective topical treatments available for dermatitis, including emollients, prescription topical corticosteroids, and non-steroidal alternatives such as topical calcineurin inhibitors 1. For severe or widespread dermatitis, oral corticosteroids, biologics, or Janus kinase inhibitors may be prescribed, with the evidence supporting strong recommendations for the use of dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib 1. It is essential to consider the severity of dermatitis, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions when making treatment decisions 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. CLINICAL STUDIES Three randomized, double-blind, vehicle-controlled, multi-center, Phase 3 studies were conducted in 589 pediatric patients ages 3 months-17 years old to evaluate ELIDEL ® (pimecrolimus) Cream 1% for the treatment of mild to moderate atopic dermatitis The treatment for dermatitis, specifically atopic dermatitis, is pimecrolimus (TOP) Cream 1%. It is used as a 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 2.

• Key points:
  • Indicated for: mild to moderate atopic dermatitis
  • Patient population: non-immunocompromised adults and children 2 years of age and older
  • Usage: second-line therapy for short-term and non-continuous chronic treatment
  • Failed to respond: to other topical prescription treatments, or when those treatments are not advisable 2

From the Research

Treatment Options for Dermatitis

• The first-line treatment for atopic dermatitis flare-ups is the use of topical corticosteroids 3, 4, 5.
• Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, can be used in conjunction with topical corticosteroids as first-line treatment 3.
• 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.
• Oral antihistamines are not recommended because they do not reduce pruritus 3.

Use of Systemic Corticosteroids

• The use of systemic corticosteroids for atopic dermatitis is generally discouraged and should be reserved for special circumstances, such as severe atopic dermatitis or as a bridge to other systemic therapies 6.
• Systemic corticosteroids should be used for a limited time and under certain circumstances, including a lack of other treatment options or during acute flares in need of immediate relief 6.

Strategies for Using Topical Corticosteroids

• Potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids, primarily in moderate or severe eczema 7.
• Effectiveness is similar between once daily and twice daily (or more) frequent use of potent topical corticosteroids to treat eczema flare-ups 7.
• Topical corticosteroids weekend (proactive) therapy is probably better than no topical corticosteroids/reactive use to prevent eczema relapse (flare-ups) 7.
• Adverse events, such as abnormal skin thinning, were not well reported and came largely from low- or very low-certainty, short-term trials 7.