What is the best intervention for atopic dermatitis?

From the Guidelines

The most effective intervention for atopic dermatitis is a multi-faceted approach that includes moisturizing, managing inflammation, and avoiding triggers, with a focus on shared decision-making between patients and clinicians to determine the best course of treatment, as recommended by the American Academy of Dermatology guidelines 1.

Key Components of Treatment

• Daily application of thick moisturizers (emollients) like petroleum jelly, Cetaphil, CeraVe, or Eucerin to lock in moisture
• Topical corticosteroids, such as hydrocortisone 1% for mild flares, or medium-potency options like triamcinolone 0.1% for moderate cases
• Prescription topical calcineurin inhibitors (tacrolimus, pimecrolimus) or PDE4 inhibitors (crisaborole) for moderate to severe cases
• Systemic treatments, such as oral corticosteroids (prednisone 0.5-1mg/kg/day for 1-2 weeks with taper), dupilumab injections, or other immunosuppressants, for severe or widespread disease

Lifestyle Modifications

• Take short, lukewarm showers using gentle, fragrance-free cleansers
• Wear loose cotton clothing
• Identify and avoid personal triggers, such as certain foods, stress, or environmental allergens
• Maintain good sleep hygiene

Decision-Making Process

• Shared decision-making between patients and clinicians to determine the best course of treatment, taking into account the severity of atopic dermatitis, its impact on the patient, and the efficacy, safety, and accessibility of available interventions, as outlined in the guidelines 1
• Consideration of the evidence-based recommendations for the management of atopic dermatitis in adults with phototherapy and systemic therapies, including the use of ultraviolet B, ultraviolet A1, and psoralen plus ultraviolet A phototherapy, injectable monoclonal antibodies (biologics), oral Janus kinase inhibitors, and other systemic therapies 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 In these studies, patients applied either ELIDEL Cream or vehicle cream twice daily to 5% to 96% of their BSA for up to 6 weeks At endpoint, based on the physician’s global evaluation of clinical response, 35% of patients treated with ELIDEL Cream were clear or almost clear of signs of atopic dermatitis compared to only 18% of vehicle-treated patients.

The best intervention for atopic dermatitis, based on the provided information, is the use of ELIDEL Cream (pimecrolimus), applied twice daily for up to 6 weeks. This treatment has been shown to be effective in 35% of patients, resulting in them being clear or almost clear of signs of atopic dermatitis, compared to 18% of vehicle-treated patients 2.

• Key benefits of ELIDEL Cream include:
  • Improvement in pruritus (57% of patients had mild or no pruritus at 6 weeks)
  • Reduction in erythema and infiltration/papulation by day 8
  • Significant treatment effect seen by day 15

From the Research

Treatment Options for Atopic Dermatitis

The treatment for atopic dermatitis can vary depending on the severity of the condition. Some of the common treatment options include:

• Topical corticosteroids, which are considered the first-line treatment for atopic dermatitis flare-ups 3
• Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, which can be used in conjunction with topical corticosteroids as first-line treatment 3, 4
• Ultraviolet phototherapy, which is a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate 3
• Antistaphylococcal antibiotics, which are effective in treating secondary skin infections 3
• Systemic treatments, such as Janus kinase inhibitors, which can be effective for moderate-to-severe atopic dermatitis, but may have adverse effects 5

Comparison of Topical Treatments

A comparison of topical corticosteroids and topical calcineurin inhibitors found that:

• Tacrolimus had statistically significant improvement in disease severity compared with weak topical corticosteroids 4
• Pimecrolimus had inferior efficacy compared with both tacrolimus and weak topical corticosteroids 4
• Topical calcineurin inhibitors can improve disease severity, especially on thin or intertriginous skin regions most vulnerable to adverse events with topical corticosteroid treatment 4

Systemic Treatments

A systematic review and network meta-analysis of randomized trials found that:

• High-dose upadacitinib was among the most effective treatments for moderate-to-severe atopic dermatitis, but also had a high risk of adverse events 5
• Dupilumab, lebrikizumab, and tralokinumab were of intermediate effectiveness and had a favorable safety profile 5
• The efficacy and safety of other systemic treatments, such as azathioprine, oral corticosteroids, and cyclosporine, are less certain 5