Treatment Options for Atopic Dermatitis

Atopic dermatitis is the most common type of eczema. It causes dry, itchy, and inflamed patches of skin. It is a chronic condition, and there is no cure. Its symptoms may appear and resolve over and over for years. Some people may experience severe eczema flares that last days or weeks.^1,2

Treatment options for eczema depend upon whether your symptoms are mild, moderate, or severe. They also depend on your age. Not all treatments are available to infants and children.¹

Identifying triggers

Some people can manage their eczema by learning, and then avoiding, their triggers. This can reduce their symptoms. Common triggers include:³

• Fabrics such as wool or polyester
• Personal care items such as shampoos, soaps, body wash, facial cleansers, and lotions
• Fragrances
• Household cleaners and disinfectants
• Scented and dyed laundry detergents or fabric softeners
• Exposure to dry air, or hot or cold temperatures
• Environmental allergens such as pollen or dust

Some people are also triggered by exposure to certain common chemicals, including:³

• Formaldehyde – Found in household disinfectants, some vaccine formulas, and glues or adhesives
• Isothiazolinone – An antimicrobial found in some personal care products
• Cocamidopropyl betaine – A thickener in some shampoos and lotions
• Lanolin – Found in some ointment moisturizers

Lifestyle changes

If your eczema is mild, changing certain lifestyle habits may reduce your symptoms. These changes may include:¹

• Using a non-irritating, unscented thick cream moisturizer on the skin after bathing
• Eating healthy foods
• Getting good quality sleep
• Managing stress

Over-the-counter treatments

Even when you avoid your triggers and make lifestyle changes, you may still experience itching. Some people find relief from their itching with over-the-counter (OTC) medicines. These can be bought and used without a prescription. OTC treatments include topical low-strength steroids and antihistamines.²

Topical medicines are applied directly to the skin. They work by relieving itch and calming inflammation.²

Topical hydrocortisone

Topical hydrocortisone is a commonly used OTC medication. It comes in gel, lotion, ointment, and cream forms. It is a steroid, but OTC versions are much lower strength than prescription versions. OTC versions are typically not effective for moderate to severe eczema.²

Higher-dose topical hydrocortisone is intended for short-term use only – typically up to 14 days. Side effects can include burning and stinging, as well as acne when applied to the face. Thinning of the skin can also occur when using high-strength hydrocortisone for long periods of time. Make sure to discuss this with your doctor and follow their instructions for use.²

Antihistamines

Some people with eczema also have other allergic conditions like asthma and/or allergic rhinitis. If this is the case, your doctor may suggest that you take an oral antihistamine. Antihistamines can help relieve itch driven by environmental allergens.^2,4

Antihistamines do not help itch from eczema. But because some antihistamines make you sleepy, they can be helpful if itching is affecting your sleep.^2,4

Pain relievers

Your doctor may also recommend OTC pain relievers. These can help manage burning, stinging, and inflammation.²

Prescription treatments

When OTC medicines do not treat your symptoms, your doctor may give you a prescription. There are many prescription treatments for eczema.^1,2

Topical medicines

Prescription-strength topical treatments for eczema include steroids and drugs that block certain proteins in the body. Each of these drugs targets a different process in the body thought to be involved in eczema.^2,5

• Corticosteroids – These drugs target immune regulation. They come in a range of types and concentrations.
• JAK inhibitors – These drugs target immune pathways that lead to inflammation. The process is called the Janus kinase-signal transducer and activators of transcription (JAK-STAT) pathway.
• PDE4 inhibitors – These drugs target an enzyme called phosphodiesterase 4 (PDE4). PDE4 is involved in the inflammation that causes eczema.
• Calcineurin inhibitors – These drugs prevent the activation of certain immune cells involved in eczema.

Oral medicines

Prescription medicines taken by mouth for eczema include:^2,5

• Immunosuppressants – These drugs calm the immune system to decrease the symptoms of eczema. They are usually used only for moderate to severe eczema.
• JAK inhibitors – Oral JAK inhibitors block the JAK-1 family of proteins involved in immune signaling. This is available as a topical ointment or oral tablet. When taken by mouth, they work throughout the body instead of just at the affected site.
• Other systemic drugs – Drugs approved to manage or treat other conditions are sometimes used to treat eczema. These conditions include transplant organ rejection, immune diseases, and psoriasis. Use of a drug for a non-approved condition is called an “off-label” use.
• Antibiotics – People with eczema have a higher risk of skin infections caused by a bacteria called Staphylococcus aureus. If you develop a skin infection, your doctor will prescribe an antibiotic medicine to treat it.

Injectable medicines (biologics)

Biologics are drugs made from living cells. They can target specific aspects of the immune system. They are taken as injections beneath the skin or into a vein.²

Biologics used for eczema focus on proteins called interleukins (IL). Too many ILs can lead to inflammation. Biologics keep ILs from binding to cells, which limits the immune system response. This leads to reduced inflammation.²

Phototherapy treatments

Some patients have good results from light therapy treatment called phototherapy. This approach uses ultraviolet light to reduce the symptoms of eczema. Either the whole body or just affected body parts may be treated.²

Phototherapy is usually offered only when at least 1 other primary treatment has failed or is poorly tolerated. It is often used along with topical steroids, an immunosuppressant, or a biologic drug.^2,6

Complementary treatments

Some people with eczema have also found relief from complementary treatments. These include:^7-13

• Medical-grade honey
• Oatmeal bath/oatmeal soap
• Natural oils and plants, such as coconut oil and aloe vera
• Bleach baths
• Cryotherapy
• Meditation
• Acupuncture
• Wet wrap therapy

Complementary treatments should be used along with, not instead of, treatments prescribed by your doctor. Talk to your doctor to learn more about the complementary therapies that might work for you.

Other things to know

It may take time to learn what triggers your itching, how to best manage it, and what medicines work for you. Be patient but prepared. Keep lists of your triggers and how you respond to different treatments. Most importantly, find a primary care doctor, allergist, or dermatologist you trust. Then, keep your appointments with them.¹⁴

Before beginning treatment for eczema, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.