From the Guidelines
The best intervention for itching associated with atopic dermatitis is a multi-faceted approach that includes good skin hydration, topical corticosteroids, and for severe cases, prescription medications like dupilumab, as recommended by the American Academy of Dermatology guidelines 1.
Key Interventions
- Good skin hydration using fragrance-free moisturizers applied at least twice daily, especially after bathing
- Topical corticosteroids such as hydrocortisone 1% for the face and triamcinolone 0.1% for the body for mild to moderate itching
- Non-steroidal alternatives like topical calcineurin inhibitors (tacrolimus 0.03-0.1% or pimecrolimus 1% cream) for sensitive areas
- Oral antihistamines (sedating options like diphenhydramine 25-50mg at bedtime or non-sedating options like cetirizine 10mg daily) for more severe itching
- Trigger avoidance, including mild soaps, short lukewarm showers, cotton clothing, and avoiding known allergens
Prescription Medications for Severe Cases
- Dupilumab, tralokinumab, upadacitinib, abrocitinib, and baricitinib are recommended for adults with moderate to severe atopic dermatitis, as per the guidelines 1
- These medications have shown strong evidence for reducing inflammation and improving quality of life in patients with atopic dermatitis
Important Considerations
- The decision to initiate these advanced 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
- Continuous monitoring of the long-term safety of systemic medications for atopic dermatitis is necessary with rigorous pharmacovigilance studies 1
From the FDA Drug Label
More ELIDEL patients (57%) had mild or no pruritus at 6 weeks compared to vehicle patients (34%) The improvement in pruritus occurred in conjunction with the improvement of the patients’ atopic dermatitis.
- Pimecrolimus (TOP) Cream 1% is effective in reducing itching associated with atopic dermatitis.
- The best intervention for itching associated with atopic dermatitis is applying pimecrolimus (TOP) Cream 1% twice daily to the affected skin, as it has been shown to reduce pruritus in patients with mild to moderate atopic dermatitis 2.
- It is recommended to stop using the cream when signs and symptoms resolve, and to re-examine the patient if symptoms persist beyond 6 weeks 2.
From the Research
Treatment Options for Itching Associated with Atopic Dermatitis
- Topical corticosteroids are considered a first-line treatment for atopic dermatitis flare-ups, including itching associated with the condition 3, 4.
- The use of topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, can be used in conjunction with topical corticosteroids as a first-line treatment for atopic dermatitis, including itching 4, 5.
- Emollients have long been used to maintain the skin barrier function in patients with atopic dermatitis and can help reduce itching 5.
- Newer medications, such as crisaborole and dupilumab, have been approved for the treatment of atopic dermatitis, including itching, but are currently cost-prohibitive for most patients 4.
- Topical hydrocortisone 17-butyrate 21-propionate has been shown to be effective in the treatment of inflammatory skin diseases, including atopic dermatitis, with a favorable benefit/risk ratio 6.
Application and Usage
- 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 3.
- The quantity of corticosteroid prescribed depends on the duration of treatment, the frequency of application, the skin location, and the total surface area treated 3.
- Correct patient application is critical to successful use, and patients may be taught application using the fingertip unit method 3.
Safety and Efficacy
- Topical corticosteroids are generally safe and effective, but the risk of adverse effects increases with prolonged use, large area of application, higher potency, occlusion, and application to areas of thinner skin 3.
- Topical calcineurin inhibitors provide targeted anti-inflammatory activity without the local or systemic side-effects seen with topical corticosteroids 5.
- Novel therapies are currently under investigation, with the hope of shifting the paradigm of atopic dermatitis management from symptom control to disease eradication 7.