What is the best treatment for atopic dermatitis (eczema)?

From the Guidelines

The most effective treatment for eczema, based on the latest evidence, involves the use of systemic medications such as dupilumab, tralokinumab, or upadacitinib for moderate to severe cases, as recommended by the guidelines of care for the management of atopic dermatitis in adults 1. When considering treatment options for eczema, it's essential to prioritize morbidity, mortality, and quality of life as outcomes. The guidelines of care for the management of atopic dermatitis in adults provide recommendations for the use of phototherapy and systemic therapies, including dupilumab, tralokinumab, and upadacitinib, which have been shown to be effective in reducing inflammation and improving symptoms in adults with moderate to severe atopic dermatitis 1. Some key points to consider when treating eczema include:

• The use of moisturizers and topical medications to reduce inflammation and repair the skin barrier
• Avoiding triggers such as harsh soaps, certain fabrics, stress, and allergens
• Considering phototherapy, such as narrowband UVB, for severe cases
• Using systemic medications, such as dupilumab, tralokinumab, or upadacitinib, for moderate to severe cases The evidence from the guidelines of care for the management of atopic dermatitis in adults suggests that dupilumab, tralokinumab, and upadacitinib are effective treatment options for moderate to severe eczema, with a strong recommendation and moderate certainty of evidence 1. In contrast, the evidence for phototherapy, such as narrowband UVB, is conditional, with low certainty of evidence 1, and the evidence for methotrexate is also conditional, with low certainty of evidence and concerns about toxicity 1. Overall, the best treatment for eczema involves a comprehensive approach that includes moisturizers, topical medications, trigger avoidance, and consideration of phototherapy and systemic medications, with a focus on reducing inflammation and improving quality of life.

From the FDA Drug Label

ELIDEL Cream is a prescription medicine used on the skin (topical) to treat eczema (atopic dermatitis). The best treatment for eczema is ELIDEL Cream, a topical calcineurin inhibitor, for adults and children age 2 years and older who do not have a weakened immune system.

• It should be used only on areas of skin that have eczema.
• It should be used for short periods, and if needed, treatment may be repeated with breaks in between.
• Patients should stop ELIDEL Cream when the signs and symptoms of eczema go away, or as directed by the doctor 2 2.

From the Research

Treatment Options for Eczema

• Topical corticosteroids are a common treatment for eczema, with potent and very potent topical corticosteroids being more effective than mild topical corticosteroids 3, 4, 5
• The effectiveness of topical corticosteroids can be similar between once daily and twice daily (or more) frequent use 3
• Topical corticosteroids can be used to prevent eczema relapse (flare-ups), with weekend (proactive) therapy being more effective than no topical corticosteroids/reactive use 3
• Other topical anti-inflammatory treatments, such as tacrolimus 0.1% and ruxolitinib 1.5%, can also be effective for eczema 4, 5

Safety and Adverse Effects

• Local adverse events, such as abnormal skin thinning, can occur with topical corticosteroid use, especially with higher-potency topical corticosteroids 3, 4, 5
• The risk of adverse effects increases with prolonged use, large area of application, higher potency, occlusion, and application to areas of thinner skin 6
• Skin thinning was not increased with short-term use of any topical steroid potency, but skin thinning was reported in 0.3% of participants treated with longer-term topical steroids 5

Application and Usage

• Correct patient application is critical to successful use of topical corticosteroids, with patients being taught application using the fingertip unit method 6
• Topical corticosteroids can be applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 6
• There is no specified time limit for low-potency topical corticosteroid use 6