What is the protocol for managing atopic dermatitis (eczema) in Australia?

From the Guidelines

The standard eczema protocol in Australia should prioritize a stepped approach to management, starting with regular use of moisturizers and gentle soap-free cleansers, and progressing to topical corticosteroids, topical calcineurin inhibitors, phototherapy, or systemic medications like biologics or Janus kinase inhibitors for more severe cases, as recommended by recent guidelines 1.

Key Components of Eczema Management

• Regular use of moisturizers (applied at least twice daily) to restore the skin barrier
• Gentle soap-free cleansers to minimize skin irritation
• Topical corticosteroids like hydrocortisone 1% for mild cases or stronger options like mometasone furoate or methylprednisolone aceponate for moderate cases, applied once or twice daily until the flare resolves
• Topical calcineurin inhibitors like pimecrolimus or tacrolimus for severe or persistent eczema
• Referral for phototherapy or systemic medications such as cyclosporine, methotrexate, or biologics like dupilumab for severe cases
• Trigger avoidance, including minimizing exposure to known allergens, using cotton clothing, maintaining optimal humidity, and avoiding excessive bathing with hot water

Considerations for Advanced Therapies

• The decision to initiate advanced therapies like phototherapy or systemic medications should be made using shared decision-making between patients and clinicians, taking into account the severity of eczema, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1
• Recent guidelines support strong recommendations for the use of biologics like dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib, and conditional recommendations for phototherapy, azathioprine, cyclosporine, methotrexate, and mycophenolate 1

Ongoing Management and Monitoring

• Regular follow-up with a healthcare provider to monitor disease severity and adjust treatment as needed
• Patient education on trigger avoidance, medication use, and self-management techniques to enhance treatment adherence and improve quality of life
• Continuous monitoring of the long-term safety of systemic medications for eczema with rigorous pharmacovigilance studies 1

From the FDA Drug Label

The patient or care giver should apply a thin layer of ELIDEL (pimecrolimus) Cream 1% to the affected skin twice daily. The patient or caregiver should stop using when signs and symptoms (e.g., itch, rash and redness) resolve and should be instructed on what actions to take if symptoms recur. If signs and symptoms persist beyond 6 weeks, patients should be re-examined by their health care provider to confirm the diagnosis of atopic dermatitis. Continuous long-term use of ELIDEL Cream should be avoided, and application should be limited to areas of involvement with atopic dermatitis.

The eczema protocol in Australia is not directly mentioned in the provided drug labels. However, based on the dosage and administration instructions for pimecrolimus cream 1% 2, the treatment protocol for atopic dermatitis (eczema) involves:

• Applying a thin layer of cream to the affected skin twice daily
• Stopping use when symptoms resolve
• Re-examining the patient if symptoms persist beyond 6 weeks
• Avoiding continuous long-term use and limiting application to areas of involvement with atopic dermatitis. It is essential to consult a healthcare provider for a personalized treatment plan, as the provided information does not specifically address the eczema protocol in Australia.

From the Research

Eczema Protocol in Australia

• The treatment of eczema in Australia typically involves the use of topical corticosteroids as a first-line treatment 3, 4, 5.
• Topical corticosteroids are classified by strength and the risk of adverse effects, with potent and moderate topical corticosteroids being more effective than mild topical corticosteroids for treating eczema flare-ups 3, 5.
• The application of topical corticosteroids can be once or twice daily, with no significant difference in effectiveness between the two frequencies 3, 5.
• Proactive therapy, which involves applying topical corticosteroids twice weekly to prevent relapse, is also an effective treatment strategy for eczema 3.

Treatment Options

• Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, can be used in conjunction with topical corticosteroids as first-line treatment for eczema 4.
• Ultraviolet phototherapy is a safe and effective treatment for moderate to severe eczema when first-line treatments are not adequate 4.
• Systemic corticosteroids should generally be avoided for atopic dermatitis, but can be used rarely for severe cases under certain circumstances 6.
• Newer medications, such as crisaborole and dupilumab, are effective in treating eczema but are currently cost-prohibitive for most patients 4, 7.

Safety and Efficacy

• The safety and efficacy of topical anti-inflammatory treatments for eczema have been evaluated in a Cochrane systematic review and network meta-analysis, which ranked potent and/or very potent topical steroids, tacrolimus 0.1%, and ruxolitinib 1.5% among the most effective treatments for improving patient-reported symptoms and clinician-reported signs 7.
• Local application site reactions were most common with tacrolimus 0.1% and crisaborole 2%, and least common with topical steroids 7.
• Skin thinning was not increased with short-term use of any topical steroid potency, but was reported in 0.3% of participants treated with longer-term topical steroids 7.