What is the treatment for atopic (atopic) dermatitis?

From the Guidelines

For most people with atopic dermatitis, emollients and prescription topical therapies are sufficient to achieve disease control, but those with more severe or widespread disease may consider phototherapy or systemic therapies to improve disease control and quality of life. When considering treatment options for atopic dermatitis, it is essential to take into account the severity of the disease, its impact on the patient, and the efficacy, safety, and accessibility of available interventions 1. The American Academy of Dermatology guidelines suggest several effective topical treatments available for atopic dermatitis, including emollients and prescription topical therapies, which are often sufficient for disease control 1. However, for individuals with more severe or widespread disease, or those whose disease is refractory to optimized topical therapy, phototherapy or systemic therapies may be considered to improve disease control and quality of life 1. Some key recommendations from the guidelines include:

• The use of ultraviolet B, ultraviolet A1, and psoralen plus ultraviolet A phototherapy
• The use of injectable monoclonal antibodies, such as dupilumab and tralokinumab
• The use of oral Janus kinase inhibitors, such as abrocitinib, baricitinib, and upadacitinib
• Conditional recommendations for the use of azathioprine, cyclosporine, methotrexate, and mycophenolate
• Avoidance of systemic corticosteroids due to potential side effects 1. It is crucial to note that the decision to initiate these more advanced therapies should be made using shared decision-making between patients and clinicians, taking into account individual patient needs and circumstances 1.

From the FDA Drug Label

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 INDICATIONS AND USAGE 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.

• Atopic Dermatitis Treatment: Pimecrolimus cream 1% is indicated for the treatment of mild to moderate atopic dermatitis in patients 2 years and older.
• Key Points:
  • The cream is used as second-line therapy for short-term and non-continuous chronic treatment.
  • It is intended for patients who have failed to respond adequately to other topical prescription treatments or when those treatments are not advisable.
  • The studies support the use of ELIDEL Cream in patients 2 years and older with mild to moderate atopic dermatitis 2.
  • ELIDEL Cream is not indicated for use in children less than 2 years of age 2.

From the Research

Definition and Causes of Atopic Dermatitis

• Atopic dermatitis (atopic eczema) is a chronic relapsing and remitting inflammatory skin disease affecting one in 10 people in their lifetime 3.
• It is caused by a complex interaction of immune dysregulation, epidermal gene mutations, and environmental factors that disrupts the epidermis causing intensely pruritic skin lesions 3.

Diagnosis and Treatment

• The American Academy of Dermatology has created simple diagnostic criteria based on symptoms and physical examination findings 3.
• Maintenance therapy consists of liberal use of emollients and daily bathing with soap-free cleansers 3.
• Use of topical corticosteroids is the first-line treatment for atopic dermatitis flare-ups 3, 4, 5, 6, 7.
• Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, can be used in conjunction with topical corticosteroids as first-line treatment 3, 4, 5, 6, 7.

Treatment Options for Thin and Sensitive Skin Areas

• Topical corticosteroids are effective for the treatment of atopic dermatitis in thin and sensitive skin areas, but their use is limited due to adverse events, such as skin thinning, and the potential for impairing the skin barrier 5, 6.
• Topical calcineurin inhibitors provide effective treatment without impairing the skin barrier or inducing skin thinning, making them a suitable option for thin and sensitive skin areas 5, 6, 7.

Comparison of Topical Corticosteroids and Topical Calcineurin Inhibitors

• Tacrolimus has been shown to have statistically significant improvement in disease severity compared with weak topical corticosteroids 7.
• The data suggest greater treatment efficacy of tacrolimus over weak topical corticosteroids, and inferior efficacy of pimecrolimus compared with both tacrolimus and weak topical corticosteroids 7.