What Medications Are Used to Treat Atopic Dermatitis?
Atopic dermatitis (eczema) is a common skin condition that is characterized by periods of worsening symptoms (“flares”) and periods of relief when symptoms are lessened or completely gone (remission). The chronic nature of atopic dermatitis can be frustrating, as it may return even with proper skin care. While incorporating a good skin care routine is critical for healing and preventing recurrences of eczema, there are medications that are available for those whose atopic dermatitis isn’t managed with skin care alone.1
There are several different medications used to treat atopic dermatitis. Topical corticosteroids are the foundation of anti-inflammatory therapy and are a primary treatment for eczema that has not responded to proper bathing, regular use of moisturizer, and avoiding irritants. Topical corticosteroids are available in a range of potency, with milder formulations available for purchase over-the-counter and more potent medications being available only by prescription.
Other topical medications used to treat atopic dermatitis are topical calcineurin inhibitors. Topical calcineurin inhibitors block cytokines (chemical messengers) that trigger the inflammatory response. Once absorbed into the skin, topical calcineurin inhibitors reduce symptoms of eczema-like redness and itchiness.
Topical phosphodiesterase-4 (PDE4) inhibitors are also used to treat atopic dermatitis. PDE4 inhibitors increase the levels of a chemical messenger called cyclic adenosine monophosphate (cAMP). This chemical suppresses the immune response.2-4
In people with atopic dermatitis, there is a dysfunction in the immune system, which results in an overactive, inflammatory state. Because of this dysfunction in the immune system, treatment with immunosuppressants may be appropriate for individuals with severe atopic dermatitis. Immunosuppressants suppress or interfere with the immune system response and may indirectly improve the skin barrier's function.
Biologics and other cytokine therapies
Biologic medications are medications that are targeted to treat diseases at the immune level. For atopic dermatitis, biologic agents target the cells in your body that cause inflammatory reactions by blocking specific proteins in your system called cytokines. The specific cytokines targeted are called known as Interleukin-4 (IL-4) and Interleukin-13 (IL-13).
Cytokines are signaling molecules that assist in cell-to-cell communication in the body’s immune response. Cytokine therapies interfere with the immune system response and may indirectly improve the function of the skin barrier and reduce the symptoms of atopic dermatitis, including itching, redness, and rash.5
Antihistamines are used to treat allergic reactions, such as hives, hay fever, and allergic skin reactions. They may be used in conjunction with the above treatments to treat the itch associated with eczema, however, clinical studies have found that antihistamines have limited effectiveness in relieving symptoms of atopic dermatitis.2,6
Antibiotics are another treatment that may be used in people with atopic dermatitis, as they are at a higher risk of developing infections due to the damage in the skin barrier and the frequent scratching. Antibiotics may be topical or systemic, and are generally only used in those with signs of a bacterial infection.2,6
Systemic medications are used to treat severe atopic dermatitis or those with severe flares that have not responded to topical medication. Systemic medications are treatments that affect the whole body and are generally administered orally or via injection.
While each medication has its uses, each also has potential side effects, some of which resolve when the medication is discontinued. Like systemic corticosteroids, some medications are best when used for short-term therapy to avoid the risk of long-term side effects. Each individual should discuss the risks and benefits of their medications with their doctor.