What is a typical plan of care for an atopic dermatitis (eczema) flare-up?

From the Guidelines

A typical plan of care for an eczema flare-up involves a multi-faceted approach to reduce inflammation and restore skin barrier function, starting with avoidance of provoking factors and use of moisturizers as recommended by the British Association of Dermologists and the Research Unit of the Royal College of Physicians of London 1. To manage eczema flare-ups, consider the following steps:

• Identify and avoid triggers such as harsh soaps, certain fabrics, or allergens
• Take lukewarm (not hot) showers limited to 5-10 minutes
• Apply a thick moisturizer like CeraVe, Vanicream, or Eucerin within 3 minutes after bathing to lock in moisture
• For active flares, use a topical corticosteroid such as hydrocortisone 1% for mild cases or triamcinolone 0.1% for moderate cases, applying a thin layer to affected areas twice daily for 7-14 days, as suggested by the guidelines of care for the management of atopic dermatitis 1
• For severe or widespread flares, a stronger prescription steroid like fluocinonide 0.05% or a non-steroidal alternative like tacrolimus (Protopic) or pimecrolimus (Elidel) may be needed
• Take oral antihistamines such as cetirizine 10mg daily or diphenhydramine 25mg at bedtime to reduce itching
• Wet wrap therapy can provide relief by applying medication, covering with damp gauze, then a dry layer for 2-8 hours
• Consider proactive application of topical corticosteroids or topical calcineurin inhibitors to prevent disease flares, as recommended by the guidelines of care for the management of atopic dermatitis 1
• If signs of infection (increased redness, warmth, yellow crusting) develop or if symptoms don't improve within two weeks, consult a healthcare provider promptly, as suggested by the expert panel of the International Eczema Council 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. Use ELIDEL Cream only on areas of your skin that have eczema. Use ELIDEL Cream for short periods, and if needed, treatment may be repeated with breaks in between. Stop ELIDEL Cream when the signs and symptoms of eczema, such as itching, rash, and redness go away, or as directed by your doctor

A typical plan of care for an eczema flare-up may include:

• Applying a thin layer of pimecrolimus cream 1% to the affected skin twice daily
• Using the cream only on areas of the skin that have eczema
• Using the cream for short periods, with treatment repeated as needed with breaks in between
• Stopping the cream when signs and symptoms of eczema resolve, or as directed by a doctor 2
• Following a doctor's advice if symptoms of eczema return after a treatment with pimecrolimus cream 2

From the Research

Typical Plan of Care for an Eczema Flare-Up

A typical plan of care for an eczema flare-up involves the use of topical corticosteroids, as well as other treatments to manage symptoms and prevent future flares. The following are some key points to consider:

• Topical corticosteroids are a first-line treatment for eczema flare-ups, with potent and very potent corticosteroids being more effective than mild corticosteroids for moderate to severe eczema 3
• The frequency of application of topical corticosteroids can vary, but once daily application is probably as effective as twice daily application for treating eczema flare-ups 3
• Proactive therapy with twice weekly use of topical corticosteroids can help prevent future flares 3, 4
• Other treatments that may be used to manage eczema symptoms include topical calcineurin inhibitors, phosphodiesterase-4 inhibitors, and janus kinase inhibitors 5, 6
• Emollients and moisturizers can help restore the skin's natural barrier function and reduce inflammation 7, 4
• Wet wrap therapy, anti-histamines, and vitamin D supplementation may also be used as adjunctive treatments 4
• In cases of infected eczema, systemic antibiotics may be necessary, while local antiseptic measures and topical antimicrobial therapies can be used to reduce bacterial colonization 4

Key Considerations

When developing a plan of care for an eczema flare-up, it's essential to consider the following:

• The severity of the eczema and the individual's response to treatment
• The potential side effects of topical corticosteroids and other treatments
• The importance of proactive therapy to prevent future flares
• The need for adjunctive treatments to manage symptoms and prevent complications
• The individual's overall health and medical history, including any allergies or sensitivities to medications

Treatment Options

The following are some treatment options that may be considered for an eczema flare-up:

• Topical corticosteroids (e.g. hydrocortisone, triamcinolone)
• Topical calcineurin inhibitors (e.g. pimecrolimus, tacrolimus)
• Phosphodiesterase-4 inhibitors (e.g. crisaborole)
• Janus kinase inhibitors (e.g. ruxolitinib)
• Emollients and moisturizers (e.g. ceramide-hyaluronic acid emollient foam)
• Wet wrap therapy
• Anti-histamines
• Vitamin D supplementation
• Systemic antibiotics (for infected eczema)
• Local antiseptic measures and topical antimicrobial therapies (for bacterial colonization) 3, 5, 6, 7, 4