From the Guidelines
Treatment for atopic dermatitis should prioritize a multi-faceted approach focusing on skin hydration, inflammation control, and trigger avoidance, with the consideration of phototherapy and systemic therapies for severe or widespread cases, as recommended by the most recent guidelines 1. The management of atopic dermatitis involves several key components, including:
- Daily moisturizing with fragrance-free emollients to lock in moisture and support the skin barrier
- Topical corticosteroids, such as hydrocortisone 1% or triamcinolone 0.1%, for mild flares, and prescription-strength options like fluocinonide 0.05% or clobetasol 0.05% for more severe cases
- Non-steroidal alternatives, including tacrolimus (Protopic) 0.03-0.1% or pimecrolimus (Elidel) 1% ointments, for sensitive areas like the face
- Oral antihistamines, such as cetirizine 10mg daily or diphenhydramine 25mg at bedtime, to manage itching
- Systemic treatments, like oral prednisone, cyclosporine, methotrexate, or biologics like dupilumab (Dupixent), for severe or widespread dermatitis, as supported by recent guidelines 1 It is essential to identify and avoid triggers, including harsh soaps, certain fabrics, stress, and allergens, to prevent flares and maintain skin barrier function. The decision to initiate phototherapy or systemic therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of atopic dermatitis, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 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 atopic dermatitis is pimecrolimus (TOP) Cream 1%, which can be 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 2 2.
- Key points:
- Indicated for patients who have failed to respond adequately to other topical prescription treatments
- Not indicated for use in children less than 2 years of age
- Shown to be effective in reducing symptoms of atopic dermatitis, including erythema and infiltration/papulation, in clinical studies 2
From the Research
Treatment Options for Atopic Dermatitis
- Topical corticosteroids are a mainstay in the treatment of atopic dermatitis and have been used for several decades 3, 4, 5
- Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, are a valuable addition to the therapeutic armamentarium and can be used in conjunction with topical corticosteroids as first-line treatment 3, 4, 5
- Emollients and moisturizers are important for maintaining skin barrier function and can be used as part of a long-term management strategy 4, 6, 5
- Phototherapy, such as ultraviolet phototherapy, can be used to treat moderate to severe atopic dermatitis when first-line treatments are not adequate 4, 7
- Systemic therapies, such as cyclosporine, mycophenolic acid precursors, azathioprine, and methotrexate, can be used to treat severe, refractory disease, but their use should be based on efficacy and safety readouts from well-designed, long-term trials 7
- Antistaphylococcal antibiotics can be used to treat secondary skin infections 4
- Newer medications, such as crisaborole and dupilumab, have been approved for the treatment of atopic dermatitis, but their use may be limited by cost 4
Treatment Approach
- A multi-therapeutic approach that incorporates short-term management of flares and longer-term strategies to prolong the time between flares is needed for the treatment of atopic dermatitis 3, 5
- Treatment should be individualized and based on the severity of the disease, as well as the patient's response to therapy 6
- Maintenance therapy consists of liberal use of emollients and daily bathing with soap-free cleansers 4